15 A STUDY ON THE SATISFACTION OF PATIENTS WITH REFERENCE TO HOSPITAL SERVICES DR D. RAMA MOHAN*; DR. KANAGALURU SAI KUMAR** *Associate Professor & Addl. Med. Supdt, Department of Hospital Administration, Narayana Medical College, Nellore -524004, AP. **Professor, Department of Management, Narayana Engineering College, Nellore 524004, AP. ABSTRACT The study has been designed to analyze the factors that are responsible for influencing the satisfaction of patients with respect to selected hospital related services. A sample of 150 patients at different educational backgrounds have been selected and studied with reference to various factors that influence the satisfaction of patients. The study attempted to identify factors which are the combination of pharmacy, laboratory, radiology, blood bank and laundry & linen services. Based on the importance given by the respondents on various factors, opinion scores are calculated and relative importance for each of the variables is established. The level of patient satisfaction was divided into low, medium and high. The gender analysis of patient satisfaction with respect to various hospital services reveals that both male and female patients are highly satisfied with cleanliness, and least satisfied with behavior of staff and charges for medicines. The study also focused on whether the patient satisfaction varies across gender. The Chi square test has been employed to analyze the data. The study reveals that there is a significant difference between level of satisfaction and gender. KEYWORDS: Behavior of staff, charges for medicines, cleanliness, hospital services, patient satisfaction. INTRODUCTION The success or failure of any hospital is largely depends on the satisfaction met by the patients on various services offered. Patients satisfaction is a combination of psychological, physiological and other health care related factors that make a patient to feel happy. Patient satisfaction has been considered as a state where patients express their feelings, prepares to attend for the same hospital more number of times, accept the services and promote the image and goodwill of the hospital more happily. Satisfaction of patients is an emotion, a feeling and a matter of perception. It arises from the patients appraisal of experience in hospital services; it involves likes and dislikes which are internal and external to the patients. With the various changes and developments that take place in health care related environment, patients place more importance on the quality of services offered than before. In recent days patients emphasize not only the environment in the hospitals, but also various services offered in the hospitals. Therefore understanding patients satisfaction is becoming more important.
16 REVIEW OF LITERATURE Across the United States of America and Europe, consumer satisfaction is playing an increasingly important role in quality of care reforms and health-care delivery more generally. However, consumer satisfaction studies are challenged by the lack of a universally accepted definition or measure (Crow, et al 2002). The absence of a solid conceptual basis and consistent measurement tool for consumer satisfaction has led, over the past few years, to a proliferation of surveys that focus exclusively on patient experience, i.e. aspects of the care experience such as waiting times, the quality of basic amenities, and communication with health-care providers, all of which help identify tangible priorities for quality improvement. The increasing importance of patient experience and the sustained interest in comparing people s satisfaction with the health system across different countries and time periods suggests the need to characterize the factors affecting the satisfaction. Studies of patient satisfaction towards health services, health personnel and resources constitute important elements in the extent to which health services received meet consumers expectations and needs. They can be used as a means to assess the quality of health care provided. They also help providers to better understand consumers views (Doghaither et al 2000). Patient satisfaction studies started to appear in the literature about half a century ago. With the growing awareness of the patient as an evaluator of healthcare, more sophisticated and specialized multidimensional scales for measurement of satisfaction were suggested in the literature. Satisfaction can be defined as the extent of an individual's experience compared with his or her expectations (Pascoe, 1983). Patients' satisfaction is related to the extent to which general health care needs and condition-specific needs are met. Evaluating to what extent patients are satisfied with health services is clinically relevant, as satisfied patients are more likely to comply with treatment (Guldvog, 1999), take an active role in their own care (Donabedian, 1988), to continue using medical care services and stay within a health provider and maintain with a specific system( Marquis,1983). Satisfaction is one of the core outcome measures for health care. It is intuitively more appealing than measures of health care effectiveness or efficiency that are more difficult to understand. Satisfaction with health care is a measure with a long history in the social sciences. Most current research is less interested in correlations between patients characteristics and satisfaction and more focused on improving the quality of care and service delivered to patients and health plan members. Research on health system satisfaction, which is largely comparative, has identified ways to improve health, reduce costs and implement reform (Blendon, et al, 2003) Satisfaction of patients appears to be a major device in order to take important decisions by the hospital managements. According to Donabedian (1988), any health care provider must desire its basic goals and objectives by offering various patient support services. Therefore, the managements of the health care centers, as a matter of fact, take satisfaction of patients into account as a main goal of strategies.. Marquis et al (1983) and Salam (1998), in their studies also opined to change the attitude of management towards providing relevant, purposeful and meaningful services for the patients and for the society as a whole. Wilkin et al (1992), in their study opine that the measurement of patients satisfaction is a common component of many evaluations. It is a holly subjective assessment of the quality of health care and, as such, is not a measure of final outcome. Evidence has suggested that care, which is less than satisfactory to the patients, is also less effective, because dissatisfaction is associated with noncompliance with
17 treatment instructions, delay in seeking further care and poor understanding and retention of medical information. The substance of literature is that most of the studies identified factors responsible for patient satisfaction in various health care centers conducted in foreign locations giving least scope for the Indian context. Hence, the present study may be considered as one among many studies, which will help the health care providers in better understanding about the various factors that influence the satisfaction of patients and also helps in framing the strategies for effective management of hospitals. Thus the aim of this study was mainly exploratory in nature; with a view to better understand the factors that were associated with patients satisfaction, OBJECTIVES OF THE STUDY The purpose of this study is to investigate the factors influencing the satisfaction of patients on the availability of various selected hospital services. The following are the research objectives formulated to guide the study. 1. To identify the factors responsible for influencing the satisfaction of patients on various hospital related services. 2. To study the attitude of patients with respect to their level of satisfaction on various hospital related services. HYPOTHESIS Null Hypothesis: The satisfaction between male and female patients will be different. Alternative Hypothesis: The satisfaction will be the same between male and female patients. METHODOLOGY INSTRUMENT DEVELOPMENT The instrument used in this study consists of two parts. The first part deals with the demographic profile of the respondents such as gender, age, occupation and annual income etc. Part two deals with the factors which are considered most important by the patients for getting satisfaction or dissatisfaction. These factors have been based on five attributes, such as pharmacy, laboratory, radiology, blood bank and laundry & linen. Each of these factors is again subdivided into number of sub variables that are necessary to represent each factor more clearly. The satisfaction of patients is measured by a structured questionnaire prepared on the basis of various sub variables. It consists of 25 questions, each of which is measured on four point Likert s scale, in which, 1 indicated highly dissatisfied, 2 indicated dissatisfied,3 indicated satisfied and 4 indicated highly satisfied. DATA COLLECTION Personal interview method was adopted to collect data from the sample respondents. Contents and validity of the statements were established by experts consisting of hospital administration and other higher officials working in various hospitals. Each of the experts on the panel was
18 asked to verify the instrument for clarity, wording, overall appearance and meaning in addition to content and validity. The instrument was pilot tested with a group of patients, not included in the sample. The data were collected systematically from the respondents visiting 1140 bedded tertiary care medical college teaching hospital for treatment during the period between May 2011 and July 2011. A sample of 150 patients was selected for the study. ANALYSIS OF DATA The primary data collected for the study have been sorted, classified and tabulated in a format and analyzed by using statistical package for social sciences (SPSS16.0). Appropriate statistical procedures like ratios and Chi- square test has been used for inference. The Chi square test has been used to test the difference of opinions between the male and female of the patients. RESULTS AND ANALYSIS PROFILE OF THE RESPONDENTS Of those responding to the questionnaire, it was found that 65 percent (97) were male while 35 percent (53) were female (Table 1). Out of which 8 percent (12) of the respondents are below 25 years of age, 31 percent (46) are in the age group of 25 to 35 years, 41 percent (62) are in the age group of 35 to 45 years and 20 percent (30) respondents are with above 45 years of age. With respect to educational background of the respondents, 13.33 percent (20) were with SSC, 18.67 percent (28) were HSC, 28 percent (42) were with graduation, 13.33 percent (20) were post graduates and the remaining 26.67 percent (40) were illiterates. Similarly 21.34 percent (32) were in the income level of less than Rs.15, 000, 43.33 percent (65) were in the income level of Rs.15, 000 to Rs.30, 000, 35.33 percent (53) were in the income level of above Rs.30, 000. An analysis of the respondents in terms of their age, education and income levels reveal that majority of respondents were belongs to 35-45 years age category with graduation and whose income levels are ranging from Rs.15, 000 to Rs.30, 000. TABLE 1 PROFILE OF THE RESPONDENTS 1.Gender No. of Respondents Percentage (a) Male 97 65.00 (b) Female 53 35.00 Total 150 100.00 2.Age (a) Less than 25 Years 12 8.00 (b) 25-35 Years 46 31.00 (c) 35-45 Years 62 41.00
19 (d) Above 45 Years. 30 20.00 3.Education Total 150 100.00 SSC 20 13.33 HSC 28 18.67 Graduation 42 28.00 Post Graduation 20 13.33 Illiterate 40 26.67 4.Salary Total 150 100.00 (a) Less than Rs.15,000 32 21.34 ( b) Rs.15,000 to Rs.30,000 65 43.33 (c ) Above Rs.30,000 53 35.33 Total 150 100.00 PATIENT SATISFACTION WITH REGARD TO HOSPITAL SERVICES To assess the level of satisfaction of sample respondents, some of the important hospital related services in terms of pharmacy, laboratory, radiology, blood bank and laundry & linen have been considered. For quantification of the responses of the sample patients weights have been assigned as +2, +1,-1, and -2 for the responses of highly satisfied, satisfied, dissatisfied and highly dissatisfied respectively. Final score for each feature has been calculated as multiplying the number of responses by the weights assigned to corresponding responses. Similarly the maximum score is calculated by multiplying the total number of respondents in each category with +2 and then the product is with total number of attributes. The final score along with the maximum score calculated for all the factors provided by the male respondents and female respondents is shown in table 1 and table 2.
20 TABLE 2 SATISFACTION OF MALE PATIENTS WITH REGARD TO HOSPITAL SERVICES (N = 97) Attributes Highly Satisfied Satisfied Dissatisfied Highly Dissatisfied Final Scores Pharmacy Services Availability of medicines 30 49 10 8 83 Behavior of the staff 27 42 14 14 54 Clarification for queries 20 54 11 12 59 Process of the billing 22 50 14 11 58 Rates or charges for medicines 19 52 14 12 52 Timely issue of drugs 25 54 6 12 74 Process of returning drugs 29 48 10 10 76 Laboratory Services Behavior of the staff 30 45 10 12 71 Co operation from the staff 28 46 9 14 65 Process of issue of reports 31 43 11 12 70 Clarification of queries 29 43 13 12 64 Timely issue of reports 28 50 8 11 76 Radiology services Behavior of the staff 27 48 12 10 70 Co operation of the staff 29 45 13 10 70 Process of issue of reports 30 47 8 12 75 Clarification of queries 29 47 11 10 74 Timely issue of reports 31 46 10 10 78
21 Blood Bank Services Behavior of the staff 28 48 10 11 72 Co operation from the staff 26 49 10 12 67 Clarification of queries 29 43 12 13 63 Process of motivate donors 30 46 12 9 76 Issue of blood during emergency 31 44 13 9 75 laundry & linen services Cleanliness of the bed sheets and pillow covers 32 47 9 9 84 Process of changing of changing of Linen 29 46 9 12 71 Cleanliness of the wards and rooms 29 48 10 10 76 Total Score 1753 Maximum Score 4850 TABLE 3 SATISFACTION OF FEMALE PATIENTS WITH REGARD TO HOSPITAL SERVICES (N = 53) Attributes Highly Satisfied Satisfied Dissatisfied Highly Dissatisfied Final Scores Pharmacy Services Availability of medicines 12 29 9 3 38 Behavior of the staff 14 26 9 4 37 Clarification for queries 15 28 8 2 46 Process of the billing 16 24 6 7 36 Rates or charges for medicines 12 26 9 6 29
22 Timely issue of drugs 17 19 12 5 31 Process of returning drugs 13 29 8 3 41 Laboratory Services Behavior of the staff 16 20 10 7 28 Co operation from the staff 12 28 7 6 33 Process of issue of reports 20 20 9 4 43 Clarification of queries 11 28 10 4 32 Timely issue of reports 19 19 8 7 35 Radiology services Behavior of the staff 14 24 6 9 28 Co operation of the staff 12 27 8 6 31 Process of issue of reports 13 25 9 6 30 Clarification of queries 19 24 9 1 51 Timely issue of reports 14 25 10 4 35 Blood Bank Services Behavior of the staff 16 24 10 3 40 Co operation from the staff 19 22 9 3 45 Clarification of queries 15 22 10 6 30 Process of motivate donors 15 22 8 8 28 Issue of blood during emergency 18 20 7 8 33 laundry & linen services Cleanliness of the bed sheets and pillow covers 26 19 5 3 60 Process of changing of changing of Linen 18 20 12 3 38
23 Cleanliness of the wards and rooms 15 19 11 8 35 Total Score 913 Maximum Score 2650 It is clear from the above tables that both male and female consumers were positively satisfied with various attributes of hospital services on a modern scale. An analysis of the level of satisfaction of the sample respondents reveal that, male respondents are with total score of 1753 against the maximum score of 4850, while it was 913 against 2650 for the female respondents. Thus it is clear that the level of satisfaction among the female respondents is less than the male respondents. This indicates that the satisfaction is different for male and female patients. To test the result, individual satisfaction levels of the patients have been calculated and divided them into three categories as low, medium and high, based on the individual scores of satisfaction. Those who scored less than zero were identified as having low satisfaction, between zero and 25 were identified as having normal satisfaction and between 25 and 50 were identified as having satisfaction at high level. TESTING OF HYPOTHESIS Null Hypothesis: The satisfaction will not be the same between male and female patients. Alternative Hypothesis: The satisfaction will be the same between male and female patients. TABLE 4 GENDER AND LEVEL OF SATISFACTION OF PATIENTS WITH REGARD TO HOSPITAL SERVICES Gender Level of Satisfaction Male Female Total Low 8 5 13 Medium 56 37 93 High 33 11 44 Total 97 53 150 INTERPRETATION: For 2 degrees of freedom, the Chi-square value at 5% level of significance is 5.9915. The calculated value of Chi-square is 3.688, which is less than the table value of Chi-square at 5% level of significance. Therefore, the relation between the level of satisfaction and the male and female patients is not significant. Thus the null hypothesis is accepted.
24 CONCLUSION The gender analysis of patient satisfaction with respect to various hospital related services reveals that male patients were more satisfied in comparison with female patients. The gender analysis of patients satisfaction with respect to various hospital related services also reveals that, the male patients are more satisfied with cleanliness of the bed sheets and pillow covers followed by availability of medicines and timely issue of reports, while they are least satisfied with rates or charges for medicines, behavior of the staff and the Process of the billing. The gender analysis of patient satisfaction with respect to various hospital services also reveals that female patients are highly satisfied with cleanliness of the bed sheets and pillow covers followed by clarification of quarries both at radiology and pharmacy while they are least satisfied with behavior of staff at laboratory and radiology services as well as rates or charges for medicines. The analysis indicates that both male and female patients are giving first preference to cleanliness of the bed sheets and pillow covers. Similarly, the factors like behavior of staff and high charges for medicines are giving least satisfaction to both male and female patients. Hence, the administrators of the hospitals must consider these factors in view by taking effective steps in molding the behavior of staff towards more satisfaction to the patients and to retain them. REFERENCES 1. Aaker J L, Benet Martfnez V and Garolera J (2001), Consumption Symbols as Carriers and Culture; A Study of Japanese and Spanish Brand Personality Constructs. Journal of Personality and Social Psychology, Vol-81, No 3, pp 492-508. 2. Alias Radam, Mimi Liana Abu and Rosli Yacob. (2010), Consumers Perceptions and Attitudes towards Safety Beef Consumption The IUP Journal of Marketing Research, Vol-9, No.4, pp29-50. 3. Blendon16. RJ, Schoen C, DesRoches C, Osborn R, Zapert K. Common concerns amid diverse systems: health care experiences in five countries. Health Aff (Millwood) 2003;22:106-21. PMID:12757276 doi:10.1377/hlthaff.22.3.106 4. Crow.R, Gage H, Hampson S, Hart J, Kimber A, Storey L,(2002) et al. The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature. Health Technol Assess;6:1-244. PMID:12925269 5. Donabedian A: The quality of care. How can it be assessed? JAMA 260,1743-1748 (1988) 6. Doghaither AH, Abdelrhman BM, Saeed AA.(2000), Patients satisfaction with physicians services in primary healthcare centers in Kuwait City, Kuwait. J R Soc Health; 120:170-174. 7. Gadallah M, Zaki B, Rady M, Anwer W, Sallam I(2003),. Patient satisfaction with primary health care services in two districts in Lower and Upper Egypt. East Mediterr Health Journal; 9:422-430
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