Patient Satisfaction A case study of zonal hospital, Mandi (HP) R.K. Sharma Abstract : A study was conducted to find out the level of patient satisfaction at a zonal hospital, Mandi (HP). A sample of 50 out-door patients and 50 indoor patients was taken on random basis. The patient satisfaction is judged in terms of services, amenities and different opinion surveys conducted by the researcher to analyse the working of Hospital and Hospital Administration. It was observed that indoor as well as outdoor patients were dissatisfied with most of amenities, cleanliness and behaviour of the staff. Whereas they were satisfied with behaviour and attention given by doctors to them. It is concluded that frequent patient satisfaction survey is very essential to know the shortcomings of services provided and to make improvements on the basis of the opinions and suggestions given by patients. Then only it is possible to have a healthy society, which will in turn work for development of the nation. Key Words : Patient, Satisfaction, case study, Himachal Pradesh Correspondence at : R.K. Sharma Reader in Public Administration, Department of Correspondence Studies, Panjab University, Chandigarh Hospitals are among the most complex and dynamic institutions of our society. The main function of a hospital is to promote the health of the community it serves. The WHO defines hospital as an integral part of a social and medical organisation, the function of which is to provide for the population, complete health care both curative and preventive and whose out-patient services reach out to the family in its home environment. 1 The main objective of hospital is to provide health services to all people, at all times. The expenditure on government run hospitals is to be regarded as an investment that will pay dividends in the form of reduced 151
invalidity/unemployment, otherwise caused by sickness. Thus, a hospital is a place for the definition and treatment of human illnesses and restoration of health and well being of those temporarily deprived of these 2. A modern hospital has become a highly scientific and complex medical institution from its age old concept of a poor house where people left their incurable and dying relatives. The role of hospitals and hospital administration has been broadened in the modern era as the life expectancy has gone up. People expect that all kinds of diseases to be eased out or controlled by the hospitals. Thus, hospital has become a place of high expectations in the modern times to which everyone looks for help in times of distress. The hospital has a noble purpose expressed in the phrase promotion of health and welfare of the people. 2 Hospital Administration is an activity to secure better output through optimum utilization of inputs. 3 It is said that each hospital has an image of its own, a tempo of work and emotional atmosphere peculiar to its traditions, its community of staff and patients. The nature of staff relationship directly influences the staff-patient relationships. It is for this reason there is different working atmosphere in different hospitals. Some hospitals enjoy a good reputation and others a bad one. The patients and the hospital environment are interested only in the ultimate quality of effective health care, which is an important factor in the inputs of a good health care delivery system. In this way all the efforts are directed to achieve a good health care output thereby, providing good quality health care, which will go a long way in creating excellent patient-hospital relationship. With the growing community consciousness about hospital services, expectations about the hospitals performance are also rising. Hospitals are being reoriented from just being centres for medical care and treatment to be more community oriented. There is now a greater pressure of work, for really over-worked hospital personnel due to steep rise in population and type and serious nature of the diseases. The faith of people in the efficiency of public hospital is declining because of the negligence and indifferent attitude on the part of hospital authorities. Medicine is still not an exact science in spite of the great advances in bio-chemical science. It is imperative for doctors, nurses and paramedical personnel to exhibit utmost precaution, care, judgment and skill in dealing while treating the patients, balancing the relative risk of the disease with the risk involved in the use of drugs, surgery or diagnostic procedures, apart from the cost benefit consideration. Wage increase of the medical and paramedical personnel, is not matched with the rising cost of living, which leads to unionism and has a negative impact on the patient satisfaction, which in turn is declining despite the increase in services, hospital personnel and infrastructure. Dissatisfaction among the patients visiting government hospitals is widely publicized by the mass media; political leaders and community in general and has a feeling 152
that the hospital performance is not matching with the expenditure incurred on creation of infrastructure Objective The main objective of the study is to find out the level of patient satisfaction of both out-patient and in patient in a government hospital i.e. zonal hospital, Mandi (HP). Material and Methods The present study was conducted at zonal hospital, Mandi. The hospital bed capacity is about 298 and there are 34 doctors of different specialisations and 61 nurses including Nursing Superintendent. Hospital is taking care of 2 to 3 Lakh out-door patients and approximately 85,000 indoor patients every year with more than five thousand minor and major operations performed every year (Table 1 and 2). A sample of 50 out-door patients and 50 indoor patients was taken on random basis. The patient satisfaction is judged in terms of services and amenities. Five opinion/interview surveys were conducted by the researcher to test the level of satisfaction among the patients (outdoor and indoor). These five opinion surveys were: a) Level of satisfaction of OPD Patients in zonal hospital, Mandi. b) Level of satisfaction among the patients regarding the behaviour of the hospital staff. c) Quality of cleanliness in the hospital. d) Availability of medicines in the hospital. e) Indoor patients: Quality of amenities provided in the hospital. Table 1 : No. of outdoor patients treated (OPD) year wise ZH-Mandi Year New Old Total Male Female Children Total 1996-97 157390 119245 276635 89696 102142 84797 276635 1997-98 165611 131760 297371 92621 121233 83517 297371 1998-99 166667 157613 324379 97895 136908 89576 324379 1999-00 167582 122450 290032 93226 118456 78350 290032 2000-01 158301 139333 297634 98374 130488 68272 297634 Source: CMO office, Mandi. Table 2 : Year-wise Break up: Indoor Patients of Mandi Hospital Year New Old Total Operations Major Minor 1996-97 13844 72459 86303 2519 3489 1997-98 14616 74131 88747 2714 3145 1998-99 16161 77630 87791 2580 4100 1999-00 16774 67516 84290 3037 3780 2000-01 15235 73124 88359 2750 3497 Source: CMO office, Mandi. 153
Findings The levels of patient satisfaction of OPD patients indicates that about half (54%) of the patients were not satisfied with building arrangements for OPD and the responses of the patients regarding the waiting room facility also reveals that most of them were not satisfied (70%). Similar trend was observed regarding the registration procedure (70%) and other official procedures (62%). However, on the contrary when asked about the attention given by the doctor majority (74%) of the respondents were satisfied with it (Table-3). The patient s satisfaction regarding the diagnostic facilities like ECG, X ray and laboratory services available with the hospital is far from being satisfactory. As the trends indicate 82%, 78%, and 80% of the respondents were not satisfied with the ECG, X ray and laboratory services respectively. Further, the response of the patients towards the behaviour of the staff of the hospital indicates that the patients were least satisfied with the behaviour of the Class IV employees (82%) followed by the para-medical staff (76%) and the Nurses (64%). It is interesting to note here that the patients were satisfied (64%) with the behaviour of the doctors. The responses of the patients regarding the satisfaction of the cleanliness in the OPD indicate that the patients were not at all satisfied with the cleanliness in the hospital. It can be seen that 86% of the respondents were not at all satisfied with the condition of cleanliness of the OPD. As regards the cleanliness of verandah (98%), examination room (88%), bathroom (98%) and surrounding (96%) the patients expressed their displeasure. Availability of the medicines in terms of quality, quantity and timely distribution to patients is very crucial for the patient s recovery. The responses concerning availability of medicines for indoor patients have been highlighted in Table 4. It can be inferred that quality wise more than half (56%) of the patients were satisfied as distinct from the quantity wise with which 72% of patients were dissatisfied and with availability of medicine on time (68%) patients have expressed their dissatisfaction. Further, the responses of the patients regarding the quality of the amenities provided in the hospital have shown that by and large the patients were satisfied with quality of the beds (68%) but not satisfied with the quality of the mattresses/ pillows and blankets. They have shown dissatisfaction with other amenities such as equipment in the Ward like drip stand/bedside cabinet/screen (90%), sufficiency of the Linen (92%), food (84%), drinking water (90%), heater (100%), light (60%), wash basin (96%) and availability of bed-pans (96%). Indoor patients were dissatisfied with amenities for attendants of patients such as Attendants rooms/serai (86%), light/heater (88%), drinking water (60%), toilets/ bathrooms (84%), canteen (94%), STD booths (88%) and medical store (78%). Patients were also dissatisfied with cleanliness of ward (70%), linen/blankets (80%), 154
OT (44%), recovery room (52%), toilet/ bathrooms (84%) and surroundings (80%). They were also dissatisfied with availability of emergency services such as life saving drugs (84%), life saving equipments (88%), availability of stretcher/wheelchair (54%) and ambulance services (60%). Discussion It was observed that indoor as well as outdoor patients were dissatisfied with most of amenities. While OPD patients were not satisfied with building arrangement of OPD, waiting room facilities, registration and other official procedures, X-ray, ECG and lab facilities. They were also not satisfied with behaviour of nurses, para-medical staff and class-iv employees, but they have shown satisfaction related to behaviour of doctors and attention given by doctors. Indoor patients were not satisfied with availability of medication, linen and the equipment such as drip stand, bedside cabinet, screen, heater, wash basin, bed pan etc. They were not Table 3 : Satisfaction level of outdoor patients N=100 Item / Response Highly Satisfied Undecided Dissatisfied Highly Satisfied Dissatisfied Building arrangement for the OPD 05 (10.00) 15 (30.00) 03 (06.00) 10 (20.00) 17 (34.00) Waiting room facility 00 (0.00) 08 (16.00) 02 (04.00) 13 (26.00) 27 (54.00) Attention given by the doctor 09 (18.00) 28 (56.00) 01 (02.00) 10 (20.00) 02 (04.00) Registration procedure 00 (0.00) 09 (18.00) 06 (12.00) 15 (30.00) 20 (40.00) Other official procedures 02 (04.00) 15 (30.00) 02 (04.00) 18 (36.00) 13 (26.00) Diagnostic facilities ECG01 (02.00) 09 (18.00) 02 (04.00) 13 (26.00) 23 (56.00) X Ray 00 (0.00) 10 (20.00) 01 (02.00) 17 (34.00) 22 (44.00) Laboratory service 04 (08.00) 06 (12.00) 00 (0.00) 18 (36.00) 22 (44.00) Cleanliness OPD 00 (0.00) 05 (10.00) 02 (04.00) 20 (40.00) 23 (46.00) Verandah 00 (0.00) 01 (02.00) 00 ( 0.00) 24 (48.00) 25 (50.00) Examination room 00 (0.00) 05 (10.00) 02 (04.00) 19 (38.00) 25 (50.00) Bathrooms / Toilets 00 (0.00) 01 (02.00) 00 (0.00) 24 (48.00) 25 (50.00) Surroundings 00 (0.00) 02 (04.00) 00 (0.00) 22 (44.00) 26 (52.00) Behaviour of hospital staff Doctors 07 (14.00) 25 (50.00) 02 (04.00) 10 (20.00) 06 (12.00) Nurses 02 (04.00) 10 (20.00) 00 (00.00) 22 (44.00) 10 (20.00) Paramedical staff 00 (00.00) 11(22.00) 01 (02.00) 28 (56.00) 10 (20.00) Class IV 00 (00.00) 06 (12.00) 03 (06.00) 10 (26.00) 28 (56.00) Figures in parentheses are percentages. 155
Table 4: Satisfaction Level of Indoor Patients N=100 Item / Response Highly Satisfied Undecided Dissatisfied Highly Satisfied Dissatisfied Availability of Medication Quality wise 06 (12.00) 22 (44.00) 01 (02.00) 13 (26.00) 08 (16.00) Quantity wise 07 (14.00) 10 (20.00) 01 (02.00) 22 (44.00) 14 (28.00) At time 05 (10.00) 11 (22.00) 00 (00.00) 16 (32.00) 18 (36.00) Amenities in the ward Quality of beds 05 (10.00) 29 (58.00) 01 (02.00) 09 (18.00) 06 (12.00) Quality of the mattresses / pillow / blanket 03 (06.00) 15 (30.00) 02 (04.00) 17 (34.00) 13 (26.00) Equipment in the ward like drip stand/ bedside cabinet / screen 00 (0.00) 04 (08.00) 01 (02.00) 20 (40.00) 25 (50.00 Sufficiency of the linen 00 (0.00) 03 (06.00) 01 (02.00) 19 (38.00) 27 (54.00) Patient food 01 (02.00) 06 (12.00) 01 (02.00) 23 (46.00) 19 (38.00) Drinking water 00 (0.00) 03 (06.00) 02 (04.00) 25 (50.00) 20 (40.00) Heater 00 (0.00) 00 (00.00) 00 (00.00) 03 (06.00) 47 (94.00) Light 01 (02.00) 12 (24.00) 01 (02.00) 17 (34.00) 13 (26.00) Wash basin 00 (0.00) 00 (00.00) 02 (04.00) 28 (56.00) 20 (40.00) Availability of bed-pans 01 (02.00) 01 (02.00) 00 (00.00) 23 (46.00) 25 (50.00) Amenities for attendants of patients Attendants rooms/sera 01 (02.00) 04 (08.00) 02 (04.00) 30 (60.00) 13 (26.00) Light/Heater 00 (0.00) 01 (02.00) 02 (04.00) 31 (62.00) 13 (26.00) Drinking, water 01 (02.00) 17 (34.00) 02 (04.00) 12 (24.00) 18 (36.00) Toilets/Bathrooms 00 (0.00) 06 (12.00) 02 (04.00) 19 (38.00) 23 (46.00) Canteen 00 (0.00) 02 (04.00) 01 (02.00) 27 (54.00) 20 (40.00) STD Booths 01 (02.00) 04 (08.00) 01 (02.00) 26 (52.00) 18 (36.00) Medical store 03 (06.00) 07 (14.00) 01 (02.00) 23 (46.00) 16 (32.00) Cleanliness Cleanliness in the ward 00 (0.00) 10 (20.00) 05 (10.00) 18 (36.00) 17 (34.00) Cleanliness of the Linen / Blanket 00 (0.00) 08 (16.00) 02 (04.00) 21 (42.00) 19 (38.00) Cleanliness in the OT 05 (10.00) 21 (42.00) 02 (04.00) 18 (36.00) 04 (08.00) Cleanliness in the Recovery room 05 (10.00) 18 (36.00) 01 (02.00) 16 (32.00) 10 (20.00) Cleanliness in the toilet / bathroom 00 (0.00) 06 (12.00) 02 (04.00) 09 (38.00) 23 (46.00) Cleanliness of surroundings 02 (04.00) 07 (14.00) 01 (02.00) 23 (46.00) 17 (34.00) Availability of essential emergency services Life Saving drugs 02 (04.00) 05 (10.00) 01 (02.00) 20 (40.00) 22 (44.00) Life Saving equipment 01(02.00) 03 (06.00) 02 (04.00) 24 (48.00) 20 (40.00) Blood Bank facilities 03 (06.00) 06 (12.00) 01 (02.00) 18 (36.00) 22 (44.00) Availability of stretcher / wheelchair 02 (04.00) 07 (14.00) 12 (24.00) 11 (22.00) 16 (32.00) Ambulance services 02 (04.00) 08 (16.00) 10 (20.00) 13 (26.00) 17 (34.00) Figures in parentheses are percentages. 156
satisfied even with the emergency services, availability of food, drinking water and light. They were also dissatisfied with amenities for attendants of patients, but they were satisfied with quality of medicine and bed. Both Indoor and OPD patients were dissatisfied with cleanliness maintained in the wards and OPD area. Both Indoor and OPD patients were dissatisfied with cleanliness maintained in the wards and OPD area. Similarly, a study conducted in New Delhi reported that OPD appeared very congested. Though sitting arrangement with fans was provided but the facilities of toilets and drinking water were inadequate. Indoor patients in every ward cried about dirty linen and stinking toilets, however quality of treatment received in the wards made them satisfied up to some extent. Further equipments for providing care to patient were inadequate. The material like cotton, gauges etc were in short supply. Equipment like bed pan, urinals for bedridden patients were inadequate. There was no shortage of general medication but patients always purchased special medicine. Linen was other scarce material in the ward. 1 Contrary to this, another study conducted in public hospitals of Athens revealed that patients expressed high satisfaction on meal serving, but low level of satisfaction with variety and temperature of meal served. Patients further reported high satisfaction on cleanliness of room, but low level of satisfaction with noise level and cleanliness of toilets. 2 A state survey of patient satisfaction at California reported that 24% patients scored above average and almost same percentage (25%) scored below average. 3 Another study on logistic and supply management system of drug indicated that only 18.4% of OPD patients got all prescribed medicine where as situation is much better in indoor patients. The main reasons expressed by patients for shortage of drug were due to shortage of funds, poor management of drug and pilferage 4. Studies conducted in Sanjay Gandhi Post Graduate Institute 5 and a public sector tertiary care hospital 6 reported contradictory findings to the present study i.e. 63% patients felt that the linen used in their bedding was clean and sufficient and 83% of the patients were satisfied with supplies of hospital in special wards, respectively. However, the study conforms to the findings of the present study that patients expressed dissatisfaction with investigation procedures 8. A study conducted in the ESI hospital indicates similar findings as of the present study i.e. accommodation, furniture, equipment, drug supply and beds were found inadequate in OPD as compared to the hospital wards, however, furniture and drug supply were found to be short even in hospital wards and 29% of the patients reported dirty and torn linen 7. Conclusion It is impossible to truly pursue total quality management and improvement activities without considering clients suggestions and complaints. Patient 157
satisfaction can be directly related to service choice that affects competition for customer acquisition in the service delivery market. In order to provide best services, factors related to patient satisfaction need to be explored off and on and suggestions can be incorporated accordingly. This will help in maintaining a healthy community, which in turn shall work for development of the nation References 1 WHO. Technical Report Series 1968; 395: 6. 2 Goel SL, Kumar R. Management of Hospital-I 2002. Deep & Deep Publishers, New Delhi: 3. 3 Roy P. Hospital service administration in a metropolitan city-a case study of Safdarjang hospital New Delhi. An unpublished theses of Panjab University Chandigarh 1991. 4 Merkouris A, Papathanassoglous EDE, Lemonidou C. Evaluation of patient satisfaction with nursing care: Quantitative or qualitative approach. International Journal of Nursing Studies 2000;41: 355-367. 5 Benko LB. California healing state survey shows waning patient satisfaction. Modern Health Care 2004; September 20:12-14. 6 Gupta D. A study on logistic and supply management system of drugs in a tertiary care Government hospital in Delhi. An unpublished theses of National Institute of Health and Family Welfare New Delhi 2002. 7 Chandra H et al. Tertiary care hospital and patient satisfaction. Hospital Administration 1998; 35:147-169. 8 Vij A et al. Evaluation of the exit proformas in use at special wards of a public sector tertiary care hospital. Journal of Academy of Hospital Administration 2000; 12: 23-27. 9 Sharma K A. Factors affecting satisfaction among employees, State Insurance Corporation Hospital Service. Health and Population Perspective and Issues 1998; 21:253-258. 158