Patient perception and satisfaction are prudent for assessment and improvement of hospital services: a cross sectional study among OPD patients at ESIC Medical College and Hospital, Faridabad, Haryana

INTRODUCTION

In recent years, one of the fastest growing industries in the service sector is the health care industry. In the health care industry, all hospitals provide the same type of service, but they do not provide the same quality of service.¹ A Hospital be it large or small, can demonstrate successful performance only when it satisfies the factors of quality and service a patient expects.²

Assessment of quality of services provided by the hospitals in these days has been a serious concern for hospitals and health care organizations owing to excessive demands imposed on them by consumers, government and society at large. In a health care system, patient’s perception about quality is critical to understand the relationship between quality of care and utilization of health services. It is also treated as an outcome of health care delivery.³ Perceived quality dimensions have significant effect on patient’s satisfaction, which determines the patient’s compliance with treatment and follow up.

Outpatient department in any hospital is considered to be a shop window of the hospital.⁴ For health managers now a days patient’s perception are indispensable in assessing and developing strategies for improvement of health care services in any hospital. Therefore the present study was planned and conducted in ESIC Medical College & Hospital, Faridabad to study the patient’s perception and satisfaction regarding hospital services.

METHODS

The present study was a hospital based, cross sectional type of study conducted at ESIC Medical College & Hospital in Faridabad district of Haryana from August to September 2016. This is a 300 bedded tertiary care hospital under the Ministry of Labour catering mainly to clients insured under Employee’s State insurance scheme in and around this region. The subjects included in the study were new OPD attendees (new OPD attendee was classified as the one attending OPD for the first time for the present complaint) after completion of their OPD visit. Patients who were excluded from the study were follow-up patients, hospital employees and those attending emergencies. The study was conducted from August 2016 to September 2016. The data collection was done thrice a week between 10.00 AM to 1.00 PM (peak OPD hours) through exit interviews. To cover each day of the week, the days for data collection were sequentially rotated. Questionnaire developed by Rao KD, et al was used to measure patient’s perception of quality and general overall satisfaction.⁵ It is a 19 item 5 point Likert scale which has been empirically evaluated in the hospital environment and has been shown as a reliable and valid instrument in that setting. This scale contains 16 questions regarding patient’s perception about quality of services rendered at the hospital and 3 questions regarding the overall general patient satisfaction. This part of the questionnaire is further supplemented with two more parts. One capturing data regarding socio-demographic profiles of the study subjects and other capturing their personal reasons for satisfaction/dissatisfaction as well as measures suggested by them for further improvement of hospital services.

Approval from Institutional Ethics Committee was obtained prior to data collection. A written informed consent was taken before the interview and anonymity and confidentiality was assured to each participant.

The data was entered into Microsoft-Excel 2007 spreadsheet, cleaned, analyzed and simple descriptive (proportions) and analytical (using tests of significance like Chi square) tables were formulated.

RESULTS

Present study is a hospital based, cross sectional study conducted at ESIC Medical College and Hospital, Faridabad. A total of 145 OPD attendees of ESIC Hospital were interviewed during the study period through exit interviews to assess patient’s perception regarding quality of OPD services as well as their satisfaction towards these services.

The overall perceived quality score greater than 48 was considered good perceived quality and score of 48 or less as poor service quality. Based on these criteria 129 (88.9%) subjects perceived that services rendered at hospital were good and only 16 (11.1%) subjects perceived the quality as poor. Similarly subjects having a composite score greater than 9 for overall satisfaction were considered satisfied with hospital services and those having score 9 or below were dissatisfied with the same. In the present study, 117 (80.68%) subjects were found to be satisfied and only 28 (19.31%) were dissatisfied (Table 1).

Association between the overall perceived quality and socio-demographic variables of study subjects like age, sex, literacy status and occupation was assessed and the difference was not found to be statistically significant. Although perception of hospital services as good was more among youth (age<40years) (87), females (78), literates (112) and employed subjects (86) as compared to subjects >40 years (58), males (67), illiterates (33) and unemployed/homemakers (59) (Table 2).

Out of 28 dissatisfied respondents, only 26 gave their reasons for dissatisfaction regarding the services rendered at the hospital. Multiple responses were allowed and data thus obtained revealed that poor availability of medicine(s) (46.15%) was the main reason behind their dissatisfaction followed by poor behavior of doctor (38.46%). Long queues at OPDs and poor staff behavior both were reported by 26.92% of subjects. Other reasons for dissatisfaction among 3.85% of respondents were poor USG services, poor lab investigations, poor staff behavior and time consuming procedures (Figure 1).

Out of 145 subjects who participated in the study only 52 subjects responded to the question related to further improvement in hospital services. Multiple responses were allowed and it was observed that 31% of the subjects cited improvement in the availability of medicine as a potential measure. 17% patients suggested that the doctors should improve their behavior and another there should be increase in patient registration counters. The need for improvement in the cleanliness and staff behavior was suggested by 8% of respondents. 6% clients suggested that the emergency services require to be prioritized. Improvement in queue management, security system and electricity backup was suggested by 4% study subjects. The other important suggestion given by 2% respondents was that ultrasonography services require improvement (Figure 2).

DISCUSSION

The study was conducted to assess the quality of services rendered at ESIC Medical College and Hospital, Faridabad and utilizing this information for the improvement in the quality of services rendered at this hospital. It included 145 respondents out of which 46.2% were males and 53.8% were females. 60.0% of the subjects were below 40 years of age. Majority (77.2%) of the respondents was literate and 59.3% of those who participated in the study were employed.

In the present study the enquiry about perception of quality of health services rendered at outpatient department at ESIC Medical College and Hospital, Faridabad was made along five dimensions. These dimensions were medicine availability, medical information, staff behavior, doctor behavior, and hospital infrastructure. The overall perception of quality of health services was considered as good by 88.9% of the respondents in this study (Table 1). 80.68% respondents were found to be satisfied with the services rendered at ESIC Hospital (Table 1). The result of the present study is quite comparable to study conducted by Farah Ahmad et al in OPD in 2015 where 86.2% subjects were found to be satisfied.⁶ Another studies conducted by Syed Shuja Qadri and Kulkarni et al observed patients satisfaction rate as 89.1% and 75% respectively.^7,8

None of the socio-demographic variables (age, sex, marital status, literacy status and socio-economic status) were found to be significantly associated with the perception of service quality (Tables 4). Hansen et al conducted a cross sectional study in 2004 in Afghanistan and also had similar observations.⁹

The various reasons behind the dissatisfaction of the OPD attendees were investigated by analyzing multiple responses of the respondents (Figure 1). Most patients were dissatisfied due to poor medicine availability (46.15%), poor doctor behavior (38.46%), long queues at OPD registration counter (26.92%) and poor staff behavior (26.92%). A cross sectional study conducted by Farah Ahmed also had similar findings with 63.3% of the patients being satisfied with pharmacy and 73.3% with doctor’s services.⁶ Results of the present study are different from a cross sectional study conducted by Bilkish who observed that 94% patients were satisfied with friendliness and helpfulness of registration staff, 58.22% patients were able to get more than 75% of drugs from pharmacy.¹⁰

For further improvement of service quality rendered at outpatient department(s) of ESIC Medical College and Hospital, Faridabad the respondents were asked to give suggestions (Figure 2). Improvement in medicine availability (31%), improvement in doctor behavior (17%) in the hospital was most common suggestions given by the respondents. Almost similar suggestions were given by patients in the study conducted by Kulkarni et al in a tertiary care hospital in Nagpur.⁸

CONCLUSION

Poor medicine availability and poor doctor behavior were identified as the main reasons for dissatisfaction among patients attending OPD facilities at ESIC Medical College & Hospital, Faridabad. These issues need to be addressed so as to fill the gap between patient’s expectations and hospital services rendered to them.

Recommendations

Longitudinal studies conducted in similar settings shall go a long way in improving the health care delivery system. Such efforts can lead to overall improvement of quality of services rendered at tertiary care hospitals.

ACKNOWLEDGEMENTS

The author would like to acknowledge Indian Council of Medical Research (ICMR) for the support and award of short term studentship to Ms. Neha [Reference ID: 2016-01740] under the guidance of Dr. Pooja Goyal.

Funding: Study funded by ICMR STS Project

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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