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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 31  |  Issue : 2  |  Page : 94-98

Patient's satisfaction with care in a government health facility in North East India: A cross-sectional study


Department of Community Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India

Date of Web Publication20-Apr-2017

Correspondence Address:
Bishwalata Rajkumari
Associate Professor, Department of Community Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal - 795 010, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_81_16

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  Abstract 

Background: The study of patient satisfaction with care received is of paramount importance in the context of providing quality patient care services. Objectives: This study planned to assess the satisfaction and associated factors among in-patients attending a tertiary care government health facility. Materials and Methods: A cross-sectional study was conducted among all eligible in-patients of a government health care facility in North East India during March and April 2015 using a semi-structured questionnaire assessing seven domains related to patient care services. Descriptive statistics such as mean, standard deviation, percentiles, and percentages were generated and Chi-square test was applied to look for association between the level of satisfaction and other variables such as income, gender, age, and department admitted. Ethical approval was obtained from the Institutional Ethics Committee. Results: A total of 751 patients were interviewed with males constituting 275 (36.6%). Almost one-third 244 (32.5%) of the patients were highly satisfied with the overall care received. Patient education domain was unsatisfactory for 185 (24.6%) of the patients. Patients admitted to surgery and allied departments showed a significantly higher satisfaction level (P < 0.001) with care received than those admitted in other departments. Conclusion: Although the satisfaction level of physician and nursing care domains were high management needs to improve on the comfort and cleanliness of the wards and quality of food service to bring an overall improvement in the quality of care provided and to augment patients' loyalty.

Keywords: Doctor patient relationship, patient satisfaction, quality of care


How to cite this article:
Rajkumari B, Nula P. Patient's satisfaction with care in a government health facility in North East India: A cross-sectional study. J Med Soc 2017;31:94-8

How to cite this URL:
Rajkumari B, Nula P. Patient's satisfaction with care in a government health facility in North East India: A cross-sectional study. J Med Soc [serial online] 2017 [cited 2020 Oct 25];31:94-8. Available from: https://www.jmedsoc.org/text.asp?2017/31/2/94/204831


  Introduction Top


The main objective of any health care organization is to provide best possible health care to the patients. The study of the patient satisfaction with care received is of paramount importance in the context providing quality patient care services. It is difficult to measure the satisfaction and gauze responsiveness of the health systems as not only clinical but also nonclinical outcomes of care do influence the patient satisfaction.[1] However, patient satisfaction as an indicator of quality of healthcare has evolved as an outcome measure and patient satisfaction surveys are being increasingly identified to be established yardsticks to measure success of the service delivery system functional at hospitals.[2]

Satisfaction is a psychological concept and patient satisfaction depends upon many factors such as: Quality of clinical services provided, availability of medicine, cleanliness, behavior of doctors and other health staff, cost of the services, hospital infrastructure, physical comfort, emotional support, and respect for patient preferences.[3] In general, patient satisfaction has been defined as an evaluation that reflects the perceived differences between expectations of the patient to what is actually received during the process of care.[4] Disparity between patient expectation and the service received is related to lessened satisfaction. Therefore, assessing patient perspectives gives them a voice, which can make public health services more responsive to people's requirements and expectations. For health care organization to be successful, monitoring of customer's perception is a simple but important strategy to assess and improve their performance.[5],[6],[7],[8]

In the recent past, various studies on patient satisfaction have been carried out worldwide. These studies on patient satisfaction gained popularity and usefulness as it provides the chance to health-care providers and managers to improve the services in the public health facilities.[9],[10],[11] Patient's feedback is necessary to identify problems that need to be resolved in improving the health facilities.

Our institution is a newly established medical college in Manipur, in remote North Eastern part of India which was recently upgraded from a State Government Hospital on August 17, 2010. After its up gradation to a medical college, various infrastructural developments along with improved manpower, logistics, and capacity building have taken place. Recently, in some instances, there has been report of altercations between patients and hospital staffs/doctors.[12],[13],[14],[15] In this perspective, this study planned to assess the satisfaction with care received and its associated factors among the in-patients' attending this medical college hospital.


  Materials and Methods Top


This was a cross-sectional study conducted among in-patients attending a tertiary care center attached to a newly established medical college under the state government which is in the 5th year of inception as a medical college having a total capacity of 600 beds providing inpatients, outpatients, and emergency care services. Our study population comprised all patients attending the hospital during March and April 2015. Patients attending Pediatrics Department, Psychiatry Department, those admitted in the Intensive Care Unit, patients attending emergency services, patients who are seriously ill, patients below 18 years of age, and refusal to participate were excluded from the study.

Sample size and sampling

Sample size was universal coverage of all patients fulfilling the inclusion criteria receiving inpatients service during the study.

Study tool and technique

The study tool was a semi-structured questionnaire consisting of two parts. The first part contained information on the sociodemographic profile of the patients. The second part of the questionnaire consisted of questions related to patient care which were divided into seven different domains, namely the satisfaction associated with admission procedure, physician care, nursing care, comfort and cleanliness, food service, patient education about care and patient loyalty. Patients' loyalty was assessed by asking whether they would return to the hospital for any other treatment if they feel necessary and whether they would recommend this hospital to their friends and family. The questionnaire was translated into local language for consistency and translated back again. Each patient was visited in the ward and after obtaining verbal informed consent, the study team conducted the interviews maintaining strict confidentiality.

Scoring system

A Likert scale score was assigned for each questions related to the different domains with varied scores ranging from 1 to 3 or from 1 to 5, with 1 indicating highly unsatisfied and 5 being highly satisfied. The total probable score ranged from 27 to 88. The summated scores were categorized into 3 groups. Patients scoring above 75th percentile were classified as “satisfied,” those scoring between 25th and 75th percentile as having “average satisfaction” and patients scoring less than 25th percentile as “unsatisfied.”

Statistical analysis

Collected data were entered into Microsoft Excel software and data cleansing was performed. Data were analyzed using SPSS IBM Statistics version 22 (Chicago, IL, USA). Descriptive statistics were generated using mean, standard deviation (SD), percentages, percentiles, and proportions. Analytical statistics like Chi-square test was used to see for correlation. The value of P < 0.05% was considered statistically significant.

Ethical issues

Approval was obtained from the Institutional Ethics Committee. Verbal informed consent was obtained from each patient. All identifiers were removed from collected data and strict confidentiality was maintained.


  Results Top


A total of 751 patients were interviewed during the study out of 832 admissions as 81 patients were excluded and there were no refusals to participate. Females constituted almost two third 476 (63.4%) of the participants. The age of the patients ranged from 18 to 96 years with a mean (SD) age of 38 ± 17.1 years. Quartile points were used to group the patients into four different age categories. Majority of the patients were from medicine and allied departments 289 (38.5%) [Table 1].
Table 1: Distribution of patients by sociodemographic profile of the patients (n=751)

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Majority of the respondents 226 (30.1%) cited “it is a well-known hospital” for choosing the hospital followed by “convenience and nearer to home” being reason given by 156 (20.7%).

More than half, 388 (51.7%) found the waiting time and admission procedures acceptable and almost a third 244 (32.5%) were satisfied with the overall care. Patients' education domain was unsatisfactory for 185 (24.6%) of the patients. Majority of respondents 635 (84.5%) found the courtesy of the staff to be good and almost half 396 (49.1%) were satisfied with the thoroughness of care received from the nursing staff. Majority of the patients' expressed that when they feel anxious or have fear about their treatment they always get enough room for discussion (600, 79.9%). Nearly one-third of the patients, 243 (32.4%) were not satisfied with the cleanliness of the ward. One-fourth of the total respondents, 187 (24.9%) expressed dissatisfaction with the quality of the food served. When asked, around 55.7% (418) of the patients said that they always received medication in a timely manner and 702 (93.5%) said they always have confidence and trust in the doctor treating them [Table 2]. For 279 (37.2%) of the patients, all scheduled investigations were not done in the hospital. When asked about the reason, 45 (16.1%) said that the required investigations were not available, 166 (59.5%) said that the treating physician suggested that the investigation be done outside and 68 (24.3%) expressed that the results from private laboratories were more reliable. Patients admitted to surgery and allied departments showed a significantly higher satisfaction level (P < 0.001) with care received as compared to those admitted in other departments [Table 3].
Table 2: Satisfaction score of the patients by different domains

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Table 3: Comparison of patient satisfaction level by selected variables

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  Discussion Top


The study the first of its kind in this newly established government medical college and hospital in remote North Eastern India is an endeavor to identify the satisfaction and dissatisfaction of the patients it caters to. The average satisfaction level of physician care domain (70.7%) and nursing care domain (81.5%) were relatively high as compared to similar studies.[11],[16] Female patients showed significantly higher satisfaction level than males patients, which was in agreement to a study done by Al-Doghaither.[17] Majority of the patients (80.2%) were satisfied with the admission procedure and waiting time at the hospital. This could be because of the new management which focuses on time management of all staffs and efficient service provision. In spite of recent numerous restructuring and remodeling of the wards and new constructions of other infrastructures of the hospital, majority of the patients showed only average satisfaction with comfort and cleanliness of the ward. Other studies reported higher satisfaction level in relation to comfort and cleanliness.[18],[19] Older patients showed a significantly higher level of satisfaction than younger age group, similar results were also reported elsewhere.[20] Patients attending to surgery and allied departments showed a significantly higher satisfaction level than patients attending other departments; this could be due to lengthier duration of stay involving patients requiring surgery which gave them more time for interaction with the nursing staffs and physicians. The lower the educational level of the patients higher is the satisfaction level. This could reflect on their economic status and affordability as this is a public health facility and larger number of patients belonging to lower income and lesser educational level are accessing the services provided here.

Although the study is the first of its kind for this institution, its limitations are that the satisfaction of patients attending outpatients and emergency care services were not assessed. A further study assessing the services of both private and other public health facilities in the state as well as covering both in- and out-patients services may give a clearer representation about client satisfaction level. Since the assessment was performed during the hospital stay itself, another evaluation of the patients' at the time of discharge may give a more conclusive picture. To improve cleanliness of the wards and hospital surroundings management may outsource the services of support staff for cleaning as well as raise awareness of the general public and patients' party to keep the hospital environment clean. Provision of a wider range of quality assured laboratory investigation facilities with ethical practice by consulting physician may help in improving the overall quality of service and satisfaction level of the clients. As long as basic amenities such as clean toilets, safe drinking water, clean sheets, and the wards being kept hygienic and clean may help in improving patients' satisfaction immensely. Supervision of satisfaction of patient care services should be a continuous process to improve the overall quality of care provided.


  Conclusion Top


Although the satisfaction level of physician and nursing care domains were high management needs to improve on the comfort and cleanliness of the wards and quality of food service in order to increase the quality of care provided and to augment patients' loyalty. The study shows that assessing patients' satisfaction can be a simple and cost effective technique for evaluating the services provided by health care institutions and should be conducted regularly to detect indiscretions and bring about overall improvement in the quality of care provided.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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    Tables

  [Table 1], [Table 2], [Table 3]


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