|Year : 2018 | Volume
| Issue : 4 | Page : 326-331
Patient satisfaction at a primary level health-care facility in a district of West Bengal: Are our patients really satisfied?
Abantika Bhattacharya1, Sita Chatterjee2, Abhishek De2, Somak Majumder2, Kanti Bhusan Chowdhury3, Mausumi Basu2
1 Department of Community Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
2 Department of Community Medicine, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
3 Department of Community Medicine, Calcutta National Medical College, Kolkata, West Bengal, India
|Date of Web Publication||2-Aug-2018|
Department of Community Medicine, IPGMER and SSKM Hospital, Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
Introduction: Many recent studies have shown an increased association between patient's satisfaction levels, patient's compliance, and success of treatment. Aim: The aim of this study is to assess the level of satisfaction among patients who have utilized the outpatient department services provided in the primary care level health institution. Materials and Methods: A health center-based observational cross-sectional study was conducted from July 2011 to October 2011 at Guskara Primary health center, Burdwan among 422 patients using a pre-designed pre-tested structured schedule. Results: Overall, mean satisfaction score was 2.97 ± 0.37. Highest satisfaction scores were observed among 18–20 years, males were more satisfied regarding technical quality of care, whereas females reported higher satisfaction regarding interpersonal manner, unmarried/single group reported the highest satisfaction with most of the services, literate group reported higher satisfaction than the illiterate group, affluent patients reported higher satisfaction regarding technical quality of care, financial aspect. Conclusions: Causes of dissatisfaction were long waiting time, the inadequacy of seating arrangement in the waiting area, inadequate cleanliness of surroundings, inadequate toilet facilities, nonavailability of medicines, and behavior of doctor.
Keywords: Causes of dissatisfaction, patient satisfaction, primary care level
|How to cite this article:|
Bhattacharya A, Chatterjee S, De A, Majumder S, Chowdhury KB, Basu M. Patient satisfaction at a primary level health-care facility in a district of West Bengal: Are our patients really satisfied?. Med J DY Patil Vidyapeeth 2018;11:326-31
|How to cite this URL:|
Bhattacharya A, Chatterjee S, De A, Majumder S, Chowdhury KB, Basu M. Patient satisfaction at a primary level health-care facility in a district of West Bengal: Are our patients really satisfied?. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2019 Jul 17];11:326-31. Available from: http://www.mjdrdypv.org/text.asp?2018/11/4/326/238164
| Introduction|| |
The outcome of any disease is influenced by the decisions to seek care, timely arrival at appropriate diagnostic and treatment services and receipt of adequate quality care from service providers. The quality care in health means an inexpensive type of service with minimum side effects that can cure or relieve the health problems of the patients.
“Patient satisfaction” can be defined as “proportion/levels of patient's expectations fulfilled in regard to health-care services.” Recent studies have shown an increased association between quality care, patient's satisfaction levels, patient's compliance, and success of treatment. Therefore, a research on patient satisfaction can be an important tool to improve the quality of services.
Patient satisfaction is not only an important, effective and commonly used indicator for measuring the quality in health care but also measures the success of doctors and hospitals. As patient satisfaction affects clinical outcomes, patient retention, medical malpractice claims, and also affects the timely, efficient, and patient-centered delivery of quality health care.
For a health-care organization to be successful, monitoring customer's perception is a simple but important strategy to assess and improve the organization's performance., The sense of growing gap between what patients want and what practitioners perceive as important results in dissatisfaction of patients with health-care systems. Over a lifetime, patient's expectations of health care may change dramatically. Health-care consumers today, are more sophisticated than in the past and now demand increasingly more accurate and valid evidence of health plan quality.
Some patients may place more emphasis on technical competence whereas others, on fulfilment of personal needs, comfort, dignity, and supportive services.
With this background, this study was conducted to assess the level of satisfaction among patients who have utilized the outpatient department (OPD.) services provided in the primary care level health institution and to determine the relationship between some sociodemographic factors and the level of satisfaction (if any).
| Materials and Methods|| |
This was a health center-based observational study, cross-sectional in design, duration of study being 3 months, from July 2011 to October 2011 done at primary level health-care facility at Guskara primary health center, Guskara, Burdwan was chosen purposively for the study.
Guskara primary health centera
This is a 10-bedded primary health care facility under Block Ausgram I, District Burdwan and caters to a population of around 28,000, has a general OPD, DOTS clinic and immunization clinic. It is well connected by railways, highway and is 32 km from Burdwan town.
New adult patients (18 years and above) of both sex, attending OPD and gave informed written consent constituted our study population.
Seriously ill patients who were unable to participate in the interview, patients who were deaf or mute or both, follow-up patients who worked in the same hospital or their relatives and unwilling patients were excluded from the study.
- Sample size: Sample size was determined using the following formula.
N = Z 2 pq/e 2
N = estimated sample size
Z = 1.96 at 95% Confidence Limit
p = Prevalence of patient satisfaction
q = 1 − p
e = absolute allowable error
For this study, maximum variability was assumed,
P = 0.5
q = 0.5
e = 5%
Hence, the sample size was calculated to be 384.
Sampling technique was nonrandomized purposive.
Nearly 10% of the estimated sample size was added for incomplete answers, making the estimated sample size to be 422.
Selection of patient – the patients attending the OPD of that health-care facility were selected for the interview by systematic random sampling. Depending on the previous attendance of the particular health facility, a random number was chosen and every 4th patient was selected for the interview. This process was continued until the required sample size was completed.
While selecting patients, it was observed from previous records that average number of new patients attending the OPD at Guskara PHC was around 100/day. Two months were available for data collection. Two days in a week were utilized for data collection (total 17 days in 2 months), and a total number of patients required to be interviewed at the primary level were 422. Hence, per day 25 patients (in average) were interviewed.
In the OPD, the first patient fulfilling the inclusion criteria was identified, and then, every 4th patient (who fulfilled the inclusion criteria) was selected systematically. The patients were interviewed maintaining privacy and requested not to divulge any information to others. Information was elicited by exit interview of patients and review of records (OPD tickets) and information regarding the following variables were obtained: age, sex, education, occupation, socioeconomic status, type of family, religion, marital status, residence, and caste.
A predesigned and pretested interview schedule was used to record information. The initial part of the schedule (Part A) was used to record information on the various socio-demographic characteristics of the patients. Part B of the schedule recorded information on patient's satisfaction. The questions of the schedule were adopted from the short form patient satisfaction questionnaire 18 and the third part of schedule recorded the areas and causes of patient dissatisfaction.
Some questions were modified after pre-testing and were validated by experts.
Permission to conduct the study was obtained from the Institutional Review Board, Burdwan Medical College and from the Chief Medical Officer of Health District Burdwan.
Informed written consent was obtained from all patients before the interview after telling them the objective of this study, approximate time that would be required for interview and assuring the confidentiality and anonymity of their identity. On the days of data collection, the treating medical officer was kept unaware of the questions in the schedule to avoid bias in his/her behavior with the patient.
Data were entered into Microsoft Excel sheet, checked for accuracy, and analyzed using the software Epi Info version 6 (CDC; Centers for Disease Control;1990 Atlanta, Georgia (US)) and Microsoft excel, proportions, unpaired t-test, mean, standard deviation, and one-way ANOVA was computed using SPSS version 17.0 (SPSS Inc. Released 2008, Chicago).
| Results|| |
Patients belonging to 21–30 years age group were found in highest numbers while the percentage of patients above 60 years of age was the least, male patients were more in number than females, higher percentage of patients were from rural area, the highest percentage of patients among Hindu belonged to the general category and maximum proportion of patients were married, while the least percentage belonged to the widowed/separated/divorced category, homemakers contributed to the highest percentage. According to educational status, illiterates were in highest proportions, patients belonging to Grade IV socioeconomic status were highest in number and highest percentage of patients were from joint family.
Overall, mean satisfaction score at primary health-care facility was calculated to be 2.97 ± 0.37.
The highest mean satisfaction score was found regarding interpersonal manner while least satisfaction was observed regarding financial aspect [Table 1].
|Table 1: Patient satisfaction scores according to subscales of satisfaction at primary level health-care facility (n=422)|
Click here to view
Patient satisfaction and age
The highest satisfaction scores were observed among the age group of 18–20 years as compared to the other age groups [Table 2].
|Table 2: Sub-scales of satisfaction and association with age and gender (n=422)|
Click here to view
Patient satisfaction and sex
Males were more satisfied regarding technical quality of care, financial aspect, and time spent with doctor, whereas females reported higher satisfaction regarding the interpersonal manner, communication and accessibility and convenience [Table 2].
Patient satisfaction and marital status
The unmarried/single group reported the highest satisfaction with most of the services as compared to the others, whereas the widowed group reported lowest satisfaction scores. The married group were most satisfied group as far as time spent with doctor was concerned [Table 3].
|Table 3: Sub-scales of satisfaction and association with various sociodemographic variables (n=422)|
Click here to view
Patient satisfaction and literacy status
The literate group reported higher satisfaction than the illiterate group of patients [Table 3].
Patient satisfaction and socioeconomic status
Affluent patients reported higher satisfaction regarding technical quality of care, financial aspect while the less affluent groups reported higher satisfaction regarding the interpersonal manner, communication and accessibility and convenience [Table 3].
Causes of dissatisfaction
The primary areas of complain of patients in descending order were as follows: long waiting time (97.6%), lack of adequate drinking water in the waiting area (87.2%), inadequate toilet facilities (82.5%), inadequacy of seating arrangement in the waiting area (79.1%), inadequate privacy (65.7%), nonavailability of medicines and investigations in hospital (53.5%) l, inadequate cleanliness of surroundings (39.8%), inadequate ventilation and fans in the waiting hall (21.8%), behavior of doctor (6.6%), and lack of proper signboards/direction guides (6.2%) [Table 4].
|Table 4: Areas and causes of patient dissatisfaction at primary level of health care facility (n=422)|
Click here to view
| Discussion|| |
The present study was attempted to assess the level of satisfaction of the patients with the various aspects of healthcare at a primary level health-care facility of Burdwan district. Very few similar studies have been done in India and abroad, and therefore, we lack the data for comparison.
The sociodemographic profile showed the importance of hospital, as the majority of the respondents were in the age group of 21–30 years which is economically productive age group for the families belonging to underserved, needy section of the society. Most of them were illiterate, home makers and belonged to Grade IV socioeconomic status. This weaker section is largely dependent on the Government sector hospitals and these needy people do not have large expectations from the hospital besides their medical treatment and provision of basic amenities which is the right of every human being that should be well considered and provided by the Government.
The present study revealed that younger age group were more satisfied than the older age group except regarding financial aspects. These findings were in contrast to findings of Ware et al. where older age were found to be more satisfied. Contrast findings were observed in another study by Matteo et al. where older patients were found to be more satisfied than younger ones.
Few more studies also reported that elder respondents generally record higher satisfaction.,, Age is a well-known determinant of the patient satisfaction index with older patients scoring more highly and being more satisfied than young and middle-aged patients.,
On the contrary, Jenkinson et al. found age was only weakly associated with satisfaction.
In general, it was found that women were more satisfied than males. Evidence about the effects of gender, ethnicity, and socioeconomic status was equivocal due to the small amount of literature available on each.,,,,,,, Some studies have indicated that female report greater satisfaction than male. While other studies have contradicted this finding. Women tended to rate their care more negatively than men in some studies ,,,
The unmarried/singles were more satisfied as compared to the widowed or the married.
Hulka et al. found no relationship between marital status and satisfaction  while Bashur et al. reported that single persons tended to be more satisfied with the technical quality of care.
Two of the four studies that correlated marital status with satisfaction variable found no relationship., Bashur et al. reported that single persons were less satisfied than married persons with a prepaid group practice while another author reported the opposite.,
The literate group was more satisfied regarding all aspects of care as compared to the illiterate group. Similar findings were also observed by two such studies.,
In a study conducted by John Cuevas, the causes of patient dissatisfaction were stated as follows: as for the availability of medicines, laboratory and radiological services, the availability of medicines got a poor satisfaction rating, compared to the availability of laboratory tests and X-ray, ultrasound and computed tomography scans. For accessibility of basic health care, patients or respondents have low satisfaction ratings to access of hospital records and access to the laboratory. As for convenience of the basic health care provided by the OPD, the majority of the respondents gave a low satisfaction rating on the waiting time to get medical records as well as for the procedure to get medical records. The comfort of the X-ray waiting area also garnered low satisfaction.
| Conclusion and Recommendation|| |
Overall mean satisfaction score was 2.97 ± 0.37. Highest satisfaction scores were observed among 18–20 years, males were more satisfied regarding technical quality of care while females reported higher satisfaction regarding interpersonal manner, unmarried/single group reported highest satisfaction with most of the services, literate group reported higher satisfaction than the illiterate group, affluent patients reported higher satisfaction regarding technical quality of care, financial aspect.
Causes of dissatisfaction were long waiting time, inadequacy of seating arrangement in the waiting area, inadequate cleanliness of surroundings, inadequate toilet facilities, nonavailability of medicines, and behavior of doctor.
Improvement of doctor–patient communication and cost effectiveness of the services provided is important to maintain the bond between the doctors and the patient for the achievement of the optimal level of health of the people.
The authors are highly thankful to Dr. Krishnadas Bhattacharyya, Dr. Aditya Prasad Sarkar, Prof. Indranil Saha, and Dr. Amiya Bhattacharya for their support and guidance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kumari R, Idris M, Bhushan V, Khanna A, Agarwal M, Singh S, et al.
Study on patient satisfaction in the government allopathic health facilities of Lucknow district, India. Indian J Community Med 2009;34:35-42.
] [Full text]
Valyasavee A, Jongodomsuk P, Nidtayarumpong S, Porapungkam Y, Laruk N, editors. (Draft) Health Services System Model Appropriate with Thai Society in Next Two Decade. Nonburi: Komonkimtong Foundation; 1999. p. 2.
Brundtland GH. Improving Health Systems' Performance. OECD; 2001. p. 4.
Prakash B. Patient satisfaction. J Cutan Aesthet Surg 2010;3:151-5.
] [Full text]
Rapert MI, Babakus E. Linking quality and performance. Quality orientation can be a competitive strategy for health care providers. J Health Care Mark 1996;16:39-43.
Gombeski WR Jr. Miller PJ, Hahn JH, Gillette CM, Belinson JL, Bravo LN, et al.
Patient callback program: A quality improvement, customer service, and marketing tool. J Health Care Mark 1993;13:60-5.
Marshall GN, Hays RD. The Patient Satisfaction Questionnaire Short- form (PSQ-18). Santa Monica: RAND; 1994. p. 7865.
Ware JE Jr., Davies-Avery A, Stewart AL. The measurement and meaning of patient satisfaction. Health Med Care Serv Rev 1978;1:1, 3-15.
Matteo D, Larson D, Rootman I. Physicians' role performance and patient satisfaction. Soc Sci Med 1976;10:29-32.
Pope C, Mays N. Opening the black box: An encounter in the corridors of health services research. BMJ 1993;306:315-8.
Calnan M. Towards a conceptual framework of lay evaluation of health care. Soc Sci Med 1988;27:927-33.
Owens DJ, Batchelor C. Patient satisfaction and the elderly. Soc Sci Med 1996;42:1483-91.
Owens D, Lechman E. Correlates of patient satisfaction. J Soc Sci Med 1992;22:383-91.
Cohen G. Age and health status in a patient satisfaction survey. Soc Sci Med 1996;42:1085-93.
Jenkinson C, Coulter A, Bruster S, Richards N, Chandola T. Patients' experiences and satisfaction with health care: Results of a questionnaire study of specific aspects of care. Qual Saf Health Care 2002;11:335-9.
Wall A, Dornan MC. Patient socio-demographic characteristics as predictors of satisfaction with medical care: A meta-analysis. J. Soc Sci Med 1992;30:841-5.
Shortell SM. Continuity of medical care: Conceptualization and measurement. Med Care 1976;14:377-91.
Fan VS, Burman M, McDonell MB, Fihn SD. Continuity of care and other determinants of patient satisfaction with primary care. J Gen Intern Med 2005;20:226-33.
Padberg RM, Padberg LF. Strengthening the effectiveness of patient education: Applying principles of adult education. Oncol Nurs Forum 1990;17:65-9.
Hargraves JL, Wilson IB, Zaslavsky A, James C, Walker JD, Rogers G, et al.
Adjusting for patient characteristics when analyzing reports from patients about hospital care. Med Care 2001;39:635-41.
Kane RL, Maciejewski M, Finch M. The relationship of patient satisfaction with care and clinical outcomes. Med Care 1997;35:714-30.
Arnetz JE, Arnetz BB. The development and application of a patient satisfaction measurement system for hospital-wide quality improvement. Int J Qual Health Care 1996;8:555-66.
McNeill JA, Sherwood GD, Starck PL, Nieto B. Pain management outcomes for hospitalized Hispanic patients. Pain Manag Nurs 2001;2:25-36.
Rogut L, Newman LS, Cleary PD. Variability in patient experiences at 15 New York city hospitals. Bull N
Y Acad Med 1996;73:314-34.
Woodbury D, Tracy D, McKnight E. Does considering severity of illness improve interpretation of patient satisfaction data? J Healthc Qual 1998;20:33-40.
Howard PB, Clark JJ, Rayens MK, Hines-Martin V, Weaver P, Littrell R, et al.
Consumer satisfaction with services in a regional psychiatric hospital: A collaborative research project in Kentucky. Arch Psychiatr Nurs 2001;15:10-23.
Williams SJ, Calnan M. Key determinants of consumer satisfaction with general practice. Fam Pract 1991;8:237-42.
Linn LS. Factors associated with patient evaluation of health care. Milbank Mem Fund Q Health Soc 1975;53:531-48.
Hulka BS, Zyzanski SJ, Cassel JC, Thompson SJ. Scale for the measurement of attitudes toward physicians and primary medical care. Med Care 1970;8:429-36.
Bashshur RL, Metzner CA, Worden C. Consumer satisfaction with group practice, the CHA case. Am J Public Health Nations Health 1967;57:1991-9.
Rojek DG, Clemente F, Summers CF. Community satisfaction: A study of contentment with local services. J Rural Sociol 1975;12:177-92.
Suchman EA. Socio-medical variations among ethnic groups. Am J Sociol 1964;70:319-31.
Cuevas John PT. Patient Satisfaction of the Health Care Services Provided by the Zamboanga City Medical Centre Out Patient Department; April, 2008.
[Table 1], [Table 2], [Table 3], [Table 4]