Patient Satisfaction towards services received in various Out-Patient Departments at one of the tertiary care centers in Nepal: A cross-sectional study


Narendra Timalsina.,Nepal Mediciti Hospital, Department of Quality & Patient Safety
Manish Deep Dhakal., Nepal Mediciti Hospital, Department of Quality & Patient Safety
Bimala Joshi., Inpatient Operations
Sujita Senchury., Operation Theatre









ABSTRACT:

Health care facilities are established to provide satisfactory and quality health services to consumers. One of the more prominent measures of health care facility performance is the level of patient satisfaction. A descriptive cross-sectional study was carried out to identify the patient satisfaction index among selected institutions and to suggest measures to improve the efficiency of services. The results suggest that 411 (82.2%) respondents had good satisfaction level regarding the services provided at the OPDs, 73 (14.6%) respondents had an average satisfaction level, and 16 (3.2%) respondents had an excellent satisfaction level regarding the services provided at the Out-Patient Department (OPD). To be concluded, knowledge of users’ satisfaction with the service can serve not only as a performance indicator but also to identify areas of improvement to provide better delivery of care and services to the patients.

Key words: Hospital Services, Patient Satisfaction, Out-Patient Departments



INTRODUCTION:

Satisfaction can be defined as the extent of an individual's experience compared with his or her expectations. The goal of the health care team is to provide the best quality of health care and service to the patient. It is now a worldwide trend in the healthcare system to include subjective user satisfaction into the evaluation of quality of medical service provided.2

Many factors including poor systems and the stress level of caregivers can affect the quality of service as well as the satisfaction of patients. Patient satisfaction denotes the extent to which the general health care needs of the clients are met. Patients carry certain expectations before their visit and the resultant satisfaction or dissatisfaction is the outcome of their actual experience.4

Patient satisfaction surveys are useful in gaining an understanding of the users’ needs and their perception of the services received. Assessing the patient’s perspectives gives users a voice, which if given systematic attention, offers the potential to make the services more responsive to patients’ needs and expectations; important elements of making the health system much more effective and is thus an important indicator in evaluating the quality of patient care in the outpatient department.8

OBJECTIVES OF THE STUDY:

1. To measure the satisfaction of OPD patients and
2. To suggest measures to increase the efficiency of the services at the outpatient department of Nepal Mediciti Hospital, Bhaisepati, Lalitpur, Nepal.

METHODOLOGY:

A descriptive cross-sectional approach was used and a sample of 500 outpatients attending various OPDs of the hospital was selected for the study. Formal permission was obtained from Institutional review committee of Nepal Mediciti Hospital. Informed consent was obtained from the study participants regarding their participation in the study and a pre-designed and pre-tested, structured close-ended questionnaire schedule was used for data collection. The questionnaire consisted of items to assess respondents’ profiles, and patient responses towards various OPD services. A 5-point Likert Scale was used. An open-ended question was included for any suggestions offered by the patients. The data collected was analyzed by using descriptive statistical methods to describe sample characteristics in terms of frequency, mode, and percentage.

RESULTS:

Assessments of the data revealed that, of the total 500 (100%) respondents, 272 (54.4%) were male and 228 (45.6%) were female. The age of 141 (28.2%) respondents was between 21 – 30 years, 121 (24.2%) respondents each were in the age group of 41 – 50 years and above the age of 50 years while 117 (23.4%) were in the age group of 31 – 40 years. The education level of 258 (51.6%) respondents was S.L.C. and below, 137 (27.4%) respondents were diploma holders, 93 (18.6%) were college graduates and only 12 (2.4%) respondents were postgraduates. Most of the respondents, 219 (43.8%) were unemployed/student, 103 (20.6%) respondents were government employees, 101 (20.2%) were private employees and 77 (15.4%) were self- employed. An equal number of respondents (50) were selected from ten respective OPDs i.e., Medicine, Neuromedicine, ENT, Nephrology, Surgery, Ophthalmology, Obstetrics & Gynecology, Orthopedics, Diabetes Centre, Cardiology. (Table 1)

Table 2 shows that, out of 500 respondents, 264 (52.6%) indicated that the physical appearance and layout of the OPD was good, 143(28.6%) identified it as very good, 75 (15%) reported it was average, 17 (3.4%) described it as bad and 1(0.2%) said it was very bad. Most of the respondents, 277 (55.4%) said that the timings of OPD were good, 118 (23.6%) said that it was very good, 91 (18.2%) said it was average, 13 (2.6%) said it was bad and 1 (0.2%) said it was very bad. Regarding the attitude of the staff, 292 (58.4%) respondents said that the attitude of staff was good, 115 (23%) said that it was average, 80 (16%) said that it was very good and 13 (2.6%) said that it was bad. The cleanliness of the waiting area was considered good by 289 (57.8%) respondents, 127 (25.4%) respondents said it was very good, 75 (15%) said it was average and 9 (1.8%) said that it was bad. Most respondents, 349 (69.8%) said that the doctor’s response to queries was good, 75 (15%) said that it was very good, 73 (14.6%) said that was average and 3 (0.6%) said that it was bad.

Table 1: Distribution of Patients According to the Profile n=500

Sl. No. Variables Frequency (f) Percentage (%)
1. Gender
Male 272 54.4%
Female 228 45.6%
2 Age(Years)
21 - 30 141 28.2%
31 - 40 117 23.4%
41 - 50 121 24.2%
Above 50 121 24.2%
3 Education Level
S.L.C. and below 258 51.6%
Diploma 137 27.4%
Graduate 93 18.6%
Postgraduate 12 2.4%
4. Occupation
Government employee 103 20.6%
Private employee 101 20.2%
Self-employed 77 15.4%
Unemployed/Student 219 43.8%
5. OPD visited
Medicine 50 10%
Aeromedicine 50 10%
Aeromedicine 50 10%
ENT 50 10%
Nephrology 50 10%
Surgery 50 10%
Ophthalmology 50 10%
Obstetrics & Gynecology 50 10%
Orthopaedic 50 10%
Diabetes Centre 50 10%
Cardiology 50 10%



Regarding the care and concern of doctors, 354 (70.8%) respondents said that it was good, 73 (14.6%) said it was very good, 65 (15%) said that it was average and only 8 (1.6%) said that it was bad. A major proportion of respondents, 329 (65.8%) said that the care and concern of nurses was good, 108 (21.6%) said it was average, 58 (11.6%) said that it was very good and 5 (1%) said that it was bad. Most respondents, 278 (55.6%) said that seating arrangement of OPD was good, 136 (27.2%) said that it was very good, 69 (13.8%) was average and 17 (3.4%) said it was bad. Of the 500 respondents, 234 (46.8%) respondents said that availability of drinking water was good, 148 (29.6%) said it was very good, 99 (19.8%) said that it was average and 19 (3.8%) said it was bad. Most of the respondents, 232 (46.4%) said that the facility of toilets was good, 123 (24.6%) said that it was very good, 116 (23.6%) said it was average, 26 (5.2%) said it was bad while only 1 (0.2%) said it was very bad.

Of the 500 respondents, 333 (66.6%) respondents said that the clarity of information on cost was good, 107 (21.4%) said that it was average, 46 (9.2%) said that it was very good and 14 (2.8%) said it was bad. A proportion of 316 (63.2%) respondents said that the clarity of signs/directions was good, 125 (25%) said it was average, 43 (8.6%) said that it was very good and 16 (3.2%) said it was bad. Regarding the convenience of registration services, 356 (71.2%) respondents said that the convenience of registration services was good, 95 (19%) said it was average, 41 (8.2%) said it was very good and only 8 (1.6%) said it was bad. Many respondents, 304 (60.8%) responded that the promptness of services was good, 148 (29.6%) said it was average, 38 (7.6%) said it was very good and 10 (2%) said it was bad. The waiting time at the registration counter was considered average by 245 (49%) respondents, 152 (30.4%) said it was good, 50 (10%) said it was very good, 49 (9.8%) said it was bad whereas only 4 (0.8%) said it was very bad.

Figure 1 shows that, an improvement in Laboratory Services was required by 159 (31.8%) respondents, 129 (25.8%) respondents required improvement in Pharmacy, 86 (17.2%) respondents said that they need improvement in Radiology, 69 (13.8%) respondents said that they required improvement in OPD, and 57 (11.4%) respondents said that they required improvement at reception.

Fig 1: Patient responses regarding Departments which require improvement.







Table 2: Patient Responses regarding satisfaction towards services received in various OPDs (n = 500)


Questions ∖ Responses Very Bad n (%) Bad n (%) Average n (%) Good n (%) Very Good n (%) Total n (%)
Physical appearance and layout of the OPD 1 (0.2%) 17 (3.4%) 75 (15%) 264 (52.8%) 143 (28.6%) 500 (100%)
Timings of the OPD 1 (0.2%) 13 (2.6%) 91 (18.2%) 277 (55.4%) 118 (23.6%) 500 (100%)
Attitude of the staff 0 (0%) 13 (2.6%) 115 (23%) 292 (58.4%) 80 (16%) 500 (100%)
Cleanliness of the waiting area 0 (0%) 9 (1.8%) 75 (15%) 289 (57.8%) 127 (25.4%) 500 (100%)
Doctor’s response to queries 0 (0%) 3 (0.6%) 73 (14.6%) 349 (69.8%) 75 (15%) 500 (100%)
Care and concern of the Doctors 0 (0%) 8 (1.6%) 65 (13%) 354 (70.8%) 73 (14.6%) 500 (100%)
Care and concern of the Nurses 0 (0%) 5 (1%) 108 (21.6%) 329 (65.8%) 58 (11.6%) 500 (100%)
Seating arrangement in the OPD 0 (0%) 17 (3.4%) 69 (13.8%) 278 (55.6%) 136 (27.2%) 500 (100%)
Availability of drinking water 0 (0%) 19 (3.8%) 99 (19.8%) 234 (46.8%) 148 (29.6%) 500 (100%)
Facility of Toilets 1 (0.2%) 26 (5.2%) 116 (23.6%) 232 (46.4%) 123 (24.6%) 500 (100%)
Clarity of information on cost 0 (0%) 14 (2.8%) 107 (21.4%) 333 (66.6%) 46 (9.2%) 500 (100%)
Clarity of signs/directions 0 (0%) 16 (3.2%) 125 (25%) 316 (63.2%) 43 (8.6%) 500 (100%)
Convenience of registration services 0 (0%) 8 (1.6%) 95 (19%) 356 (71.2%) 41 (8.2%) 500 (100%)
Promptness of services 0 (0%) 10 (2%) 148 (29.6%) 304 (60.8%) 38 (7.6%) 500 (100%)
Waiting time at the Registration counter and OPD 4 (0.8%) 49 (9.8%) 245 (49%) 152 (30.4%) 50 (10%) 500 (100%)


Upon calculation of the mode of value of different parameters of the OPD services it was found that the parameters which received a lowest mode value i.e. 3 and thereby depicted unsatisfactory responses were ‘Waiting Time’ and ‘Improvement of Laboratory and Pharmacy Services’. Other parameters such as ‘Physical Appearance and Layout of the OPD’, ‘Timings of the OPD’, ‘Attitude of the Staff’, ‘Cleanliness of the Waiting Area’, ‘Doctor’s Response to Queries’, ‘Care and Concern of the Doctors’, ‘Care and Concern of the Nurses’, ‘Seating Arrangement in the OPD’, ‘Availability of Drinking Water’, ‘Facility of Restrooms’, ‘Clarity of Information on Cost’, ‘Clarity of Signs/Directions’, ‘Convenience of Registration Services’ and ‘Promptness of Services’ received a highest mode i.e. 4 and thereby depicted a satisfactory response.

Figure 2 shows that, 411 (82.2%) respondents reported a good satisfaction level regarding the services provided at the OPDs, 73 (14.6%) respondents reported an average satisfaction level, 16 (3.2%) respondents indicated an excellent satisfaction level and none of the respondents reported a poor satisfaction level regarding the services provided at the OPDs.



Fig 2: Satisfaction level of patients regarding services received at various OPDs.






DISCUSSION:

The results suggest that 411 (82.2%) respondents had good satisfaction level regarding the services provided at the OPDs, 73 (14.6%) respondents had an average satisfaction level, and 16 (3.2%) respondents had an excellent satisfaction level regarding the services provided at the OPDs.

The results were supported by the study conducted by Patavegar Bilkish et al. in which 91% patients said that OPD timings were convenient.4 The results of a study conducted by Prasanna K.S. et al. showed that 81% of the respondents found the communication by the doctor good, 97% of the respondents were satisfied about the explanation of the disease by the doctor. 6 Findings of Md. Ziaul Islam showed that, majority of the patients (81.14%) expressed satisfaction (ranging from fair to good) with respect to adequacy of space, sitting arrangement and cleanliness of the waiting rooms.5

Two parameters of OPD services viz. ‘Waiting Time’ and ‘Improvement of Laboratory Services’ were recognized with a low mode value (mode = 3) which indicated unfavorable responses and thus identified that these aspects of OPD services as requiring improvement. The results are 0 100 200 300 400 500 Poor Average Good Excellent 0 (0%) 73 (14.6%) 411 (82.2%) 16 (3.2%) Frequency Patient responses SATISFACTION LEVEL OF PATIENTS REGARDING SERVICES RECEIVED AT VARIOUS OPDS supported by a study conducted by Girme Adane wherein 44.2 % of the respondents were dissatisfied with the overall waiting time to get the hospital services.27 Similar were the findings of the study by S. B. Jadhav et al. according to which 38.95% of total respondents were unsatisfied with time required for investigations while 48.7% were unsatisfied with time spent in pharmacy.7

Based on the findings, the following administrative measures are suggested to improve patient satisfaction.

√ The overall recommendation is that the OPDs should strive to maintain the highest standards to keep patients satisfied with the services they receive.

√ A need exists to encourage the staff to treat patients with courtesy and respect in line with the Health Sector Reforms and patient centered quality assurance.

√ Review the working arrangements and procedures at the different service delivery stations.

√ To reduce waiting time, a few more counters should be made available at registration and dispensary counters, at least during peak hours.

√ Improve turn- around time for OPD services to give better care to the patients.

√ Patient satisfaction assessment should be conducted regularly every 6 months.

√ Encourage the training programs for the less experience health providers, provide continuing education for the experienced health provider to keep up work updated knowledge and technology, and conduct some workshops to improve their professionalism in customer care.

√ Departments of hospitals should develop a mechanism to communicate with patients and survey after their service is completed.

√ Develop policies and standard operating procedures with regards to OPD Services in the Hospital.

√ Complaint and suggestion boxes should be kept in the OPDs so that patients can freely put their complaints and suggestions for improvement in services provided in this hospital.

√ Drug policies should be revised quarterly and the most commonly prescribed drugs in OPDs should be made available.

√ Waiting time for obtaining prescriptions can be reduced by introducing a token system at the pharmacy counter.

√ Improve the quality of infrastructure and accessibility such as the waiting area; place sign boards to direct the patients to the different stations of the OPD patients flow; provide better cleaning and maintenance of restrooms; and a separate waiting room for children.

√ The assignment of the appropriate staff in the right places for the provision of relevant information.

√ Reduce waiting time at the laboratory through proper staffing while keeping in mind the patient flow in OPDs.

CONCLUSION:

This study concluded that improving medical care requires attention to service features that are regularly rated by patients, including doctors, nurses, tangibles, process features, etc. Given that these are quite essential services provided within the OPD, they can act as a shopwindow of hospitals for patients.

LIMITATIONS:

The interpretation of the research results is subject to the following limitations of the study:

1. Patients working with the health care facility were excluded.

2. Patients with serious physical or mental pathologies, such as terminal disease and psychosis were excluded from the study.

3. Patients were selected only from ten different OPD’s.

4. Patients under the age of 18 years were excluded from the study.

5. Patients who were not willing to participate in the study were excluded.












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