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ORIGINAL ARTICLE
Year : 2020  |  Volume : 13  |  Issue : 5  |  Page : 480-485  

Correlation between waiting time and satisfaction among those attending outpatient departments of a tertiary care social security hospital, Faridabad, Haryana


1 Department of Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India
2 Department of Community Medicine, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
3 Department of Community Medicine, Saraswathi Institute of Medical Sciences, Hapur, Uttar Pradesh, India

Date of Submission27-Jun-2019
Date of Decision01-Mar-2020
Date of Acceptance25-Jun-2020
Date of Web Publication7-Sep-2020

Correspondence Address:
Mitasha Singh
ESIC Medical College and Hospital, Faridabad - 121 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_186_19

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  Abstract 


Background: Patient satisfaction has been an area of interest among hospital administrators. One of the reasons of this perception quoted in the literature is waiting time and time spent with the service provider. Objective: The objective of this study is to calculate the self-reported waiting time and time spent for consultation and diagnostic procedure among those attending the outpatient departments (OPDs) at Employees State Insurance Corporation, Medical College and Hospital, Faridabad, and second whether this waiting time is a predictor of patient satisfaction. Methodology: A cross-sectional study was conducted in a tertiary level health center which caters to the insured population under the Employees State Insurance Scheme from June 2018 to August 2018. This study was conducted on 265 patients and attendants (age ≥18 years) attending the OPD from 10 a.m. to 01 p.m. The study population was stratified from three points (OPD, laboratory, and pharmacy). Multiple Linear Regression (MLR) model was run to identify whether waiting time was an independent predictor of satisfaction after accounting for confounders. Results: Median time taken by the study population from registration till visiting doctor was 50 min (interquartile range [IQR]: 60). The median time spent with doctor was 5 min (IQR: 5) at laboratory and pharmacy was 10 and 3 min, respectively. The total score for satisfaction ranged from 38 to 79 with a mean score of 61.256 (±2 standard deviation; 8.293). The MLR analysis revealed that the time taken from the laboratory or OPD to pharmacy for taking drugs and time spent in the laboratory had impact on satisfaction. (ß = 0.273, P = 0.03 and ß = 0.247, P = 0.03, respectively). Higher level of education was associated with lower satisfaction level in the current study. Conclusion: It is needed to focus upon the time spent with the patients by the doctors and the number of staff posted at a point of care who are actually working.

Keywords: Employees State Insurance Scheme, insured person, medical benefits, satisfaction, time spent


How to cite this article:
Singh M, Dixit S, Ranjan R, Sharma R, Singla R, Goyal P. Correlation between waiting time and satisfaction among those attending outpatient departments of a tertiary care social security hospital, Faridabad, Haryana. Med J DY Patil Vidyapeeth 2020;13:480-5

How to cite this URL:
Singh M, Dixit S, Ranjan R, Sharma R, Singla R, Goyal P. Correlation between waiting time and satisfaction among those attending outpatient departments of a tertiary care social security hospital, Faridabad, Haryana. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2020 Sep 29];13:480-5. Available from: http://www.mjdrdypv.org/text.asp?2020/13/5/480/294346




  Introduction Top


A tertiary center is ideally designed to deal with referral from primary and secondary centers. However, in India, patients do not follow a strict hierarchy for accessing health care. People prefer tertiary care center-seeking specialist care for minor ailments also, hence burdening the system which already carries a load of referral.[1]

The apex corporate body Employees State Insurance (ESI) Act, 1948, is called the ESI Corporation (ESIC) caters to insured persons (IP) only. The existing wage limit for coverage under the Act is Rs. 21,000/-per month. Full medical care is provided to an IP and his family members from the day he enters insurable employment. There is no ceiling on expenditure on the treatment of an IP or his family member. Medical care is also provided to retired and permanently disabled IP and their spouses. In various cases, reimbursement is permitted to IPs where the corporation hospitals cannot provide all facilities.[2]

In health-care settings during patient care pathway, flow is the movement of patients, information, or equipment between departments, staff groups, or organizations. It is the movement of patients through multiple stages of care.[3] This flow includes waiting time. The waiting time has been reported by many of the studies as one of the reasons of dissatisfaction.[4],[5],[6],[7],[8],[9] This study was conceived as a continuation of a previous study conducted 2 years back to assess the satisfaction level of patients attending the center.[9] With new equipment and additional services available, we hypothesized that satisfaction level will remain the same or increase. Furthermore, it was aimed to assess the role of waiting time in patient satisfaction.

Objectives

  1. To calculate the self-reported waiting time and time spent for consultation and diagnostic procedure among those attending outpatient departments (OPDs) at ESIC, Medical College and Hospital, Faridabad
  2. To assess whether this waiting time is a predictor of patient satisfaction.



  Methodology Top


Study design and study area

A cross-sectional study was conducted in a tertiary level health center (ESIC Medical College and Hospital, Faridabad) which caters to the insured population under the ESI scheme from June 2017 to August 2017.

Study population

The present study was conducted on people attending the OPD of the study area. The average OPD attendance is 1116/day.

The following study population was included in the study:

  1. Either attendant or patient
  2. Either patient or attendant was of age ≥18
  3. For the patients of the pediatrics age group, attendants were included (≥18 years age).


The exclusion criteria for the study were as follows:

  1. Those who do not consent to participate
  2. Attendants or patients of the inpatient department
  3. Emergency patients.


Sample size

The minimum sample size using the prevalence of dissatisfaction from a previous study in the same setting (19.3%),[9] at 5% absolute precision and 95% confidence interval was calculated to be 239 using the following formula:



P = 0.193, e = 0.05

Taking nonresponse rate of 10%, the sample size was increased to 264 and approximated to 265.

Sampling strategy

Stratified random sampling was used to achieve the calculated sample size. Stratification based on the three points of care. The three points were as follows:

  1. OPD including medicine, OBG, surgery, pediatrics, orthopedics, chest, and tuberculosis
  2. Laboratory
  3. Pharmacy.


The population was stratified in a ratio of 2:1:1 at the three points.

Study tool

The satisfaction scale used in the study was a standardized tool developed by Rao et al.[10] It is a 16-item five-point Likert scale which has been empirically evaluated in the hospital environment and has been shown as a reliable and valid instrument in that setting. This scale contains questions regarding patient's perception about the quality of services rendered at the hospitals and regarding patient satisfaction. The level of satisfaction increased as the score increased. Waiting time was self-reported by study population at different points as well as between points.

Data collection

The data were collected by the medical students during their research methodology classes in the department of community medicine. The students were trained in interviewing and collecting data after taking informed consent. The data collection was done thrice a week between 10.00 a.m. and 1.00 p.m. (peak OPD hours) through interviews. To cover each day of the week, the days for data collection were sequentially rotated. The data were collected in 2 weeks.

Data and statistical analysis

The data were entered into Microsoft-Excel 2007 spreadsheet, cleaned, analyzed, and simple descriptive (proportion, mean, and median) tables were formulated. The satisfaction level was calculated by adding up all the scores for each participant and was considered as a continuous variable (dependent variable). Multiple Linear Regression (MLR) model was run to identify whether waiting time was an independent predictor of satisfaction after accounting for confounders. There was no outlier and autocorrelation in our regression data and the assumption for normality and homoscedasticity were met. Statistical analysis was done using IBM-SPSS version 21

(IBM Corp., Armonk, NY, US).

Ethical justification

This study was carried out in accordance with the declaration of Helsinki. Approval from the Institutional Ethics Committee was obtained before data collection (IEC no.: 134/A/11/16/Academic/MC/2016/131 dated 19.5.2017).


  Results Top


Attendants (81.5%) and males (57.4%) were interviewed in majority. More than one-third of the population was in the age group of 18–30 years (35.5%) and had attained education between the 9th and 12th standard (39.2%). Unskilled (29.1%) and semi-skilled (25.7%) workers attended the hospital in majority among the interviewed [Table 1].
Table 1: Sociodemographic profile of study population

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Among the study participants, 26.8% have visited the hospital several times a year. More than one third study population (67.9%) was interviewed on weekdays. Median time taken by study population from the registration till visiting doctor was 50 min (interquartile range [IQR], 60). Median time spent with doctor was 5 min (IQR, 5), at laboratory and pharmacy was 10 and 3 min, respectively [Table 2].
Table 2: Time spent at different points

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The total score for satisfaction ranged from 38 to 79, with a mean score 61.256 (±2 standard deviation; 8.293). All the variables were subjected to MLR, and it was found that only education, number of service providers at the visited points, time taken from laboratory or OPD to pharmacy for taking drugs, and time spent in lab emerged as the significant predictors of satisfaction (dependent variable). Education had a higher impact on satisfaction level as compared to the number of service providers at the visited points, by comparing standardized coefficient (beta) (−0.396 for education and − 0.360 for number of service providers). The time taken from lab or OPD to pharmacy for taking drugs and time spent in lab were next in line which had impact on satisfaction. (0.273 and 0.247, respectively) [Table 3]. R2 for the above model was 37.5%.
Table 3: Linear regression analysis identifying the predictors of satisfaction among study subjects

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  Discussion Top


The overall satisfaction score in the current study has increased from reported satisfaction prevalence 2 years back in the same institute. Long queues and waiting were quoted in this study as one of the factors for dissatisfaction among around one-fourth of the unsatisfied participants.[9] In continuation of previous study, the current study was focused on studying the role of waiting time in patient satisfaction. Another similar study from a private tertiary hospital reported 32.7% were unsatisfied due to time-consuming processes in the hospital.[11]

Waiting time and satisfaction

Our findings regarding the relationship between self-reported waiting time and satisfaction showed that those who waited long to visit the doctor were less satisfied. Although a very peculiar finding of positive relation between wait times spent from OPD to next service (lab/pharmacy) and satisfaction was observed. The median wait time or time spent from registration till visiting the doctor was much higher (50 min) as compared to the median actual time spent with the doctor (5 min). Taking other factors in account, these two variables had an inverse nonsignificant relation to satisfaction. Xie and Or, in their study at Hong Kong Hospital, also reported similar findings that patients who spent more time with health-care professionals tended to be less satisfied.[12] Average consultation length is also a quality indicator used by the WHO and the International Network for the Rational Use of Drugs to promote the safe and cost-effective use of drugs worldwide.[13] However, a Cochrane systematic review of clinical trials reported that there is insufficient evidence to say whether increasing consultation length provides patient benefit.[14] Irving et al., in their systematic review of 67 countries on consultation time reported that mean consultation time from four studies of India ranged from 1.5 to 2.3 min. The review also discussed that an average of 5 min may be kept as a limit of consultation; below this, the consultation amounts only to the issues of prescription.[13]

The waiting time was least in pharmacy and while taking drugs, and it was positively correlated with satisfaction. This higher time spent by a pharmacist to explain the dosage and frequency of prescribed drugs increased the level of satisfaction of the patient or attendant.

Education of patient or attendant and satisfaction

A higher level of education was associated with lower satisfaction level in the current study. Jafari Kelarijani et al., in their study in social security hospital of Iran and Quintana et al. from the Basque health center, Spain, also reported a similar finding that patients with a higher levels of education are less satisfied.[15],[16] Probable reason could be that education makes them empowered and hence increases their level of satisfaction.

Gender and age of patient or attendant and satisfaction

Male gender and older age group were associated with lower level of satisfaction in our analysis. This was supported by the findings from previous work from same area.[9],[11] However, gender was not associated with satisfaction in studies by Jafari Kelarijani et al. and Khamse et al.[15],[17] Also a contradictory finding of older people being more satisfied was reported from a study from Spain and Iowa, US.[16],[18] The differences in findings can be attributed to the cultural setting of Western and Asian countries. The studies from Western settings have reported theories for older age and satisfaction. They have argued that according to fulfillment theory satisfaction is perceived as the simple difference between what individual desires and that which is actually delivered. The maturational explanation suggests that older individuals are more satisfied with care because they have greater familiarity with the processes of care and greater familiarity with potential shortcomings in the health-care delivery system.[18] The current setting caters to the population of lower-middle socioeconomic status or industrial laborers and their family members. The social security scheme under which they are catered takes a fixed amount from their annual income on behalf of which they are entitled to receive medical benefits. Hence, the level of satisfaction and old age association are affected by the social status and the expectation to receive more as they are paying for the same.

Service providers and satisfaction

A significant inverse relation was observed between the number of service providers and level of satisfaction. This was a peculiar finding which was observed after adjusting for other factors and has not been discussed in the previous literature. We ran a bivariate correlation between the number of service providers and total waiting time and found a significant positive correlation. Hence, the higher number of service providers associated with a lower level of satisfaction is due to the higher wait time. The probable reason could be the absence of some staff or service providers from their chamber and hence leading to increase in wait time.

Frequency of visits to hospital and satisfaction

Higher number of visits to the hospital in last 1 year served as a proxy for patients-seeking care for chronic conditions. The higher the number of visits, higher was the satisfaction level denoting that frequent visitors were more acquainted with hospital setting and staff. Quintana et al. from Spain reported a contradictory finding in the sense that the increasing number of previous visits was associated with a lower level of satisfaction as they were more demanding and critical.[16]

This setting is part of India's social security organization, which is bound to provide medical care and other benefits to its beneficiary. It is different from the public health-care system of the country in sense that here the beneficiaries contribute for these services. Hence, the expectation of beneficiaries is higher here as compared to any other government health center. This study provides evidence for improvement at various points of contact.

Limitations

As the patients knew that they were being studied, some patients might have exaggerated their dissatisfaction or satisfaction with the waiting time. However, the issue may not be easily addressed in direct field observations and questionnaire study. The R2 values were low for the model, indicating that there is scope for improving the predictors of patient satisfaction with other variables not included here. The study catered only OPD patients that too from a hospital that caters to a population enrolled under social security scheme, hence not generalizable. Furthermore, the high level of satisfaction can be biased due to a sense of financial security due to no out-of-pocket expenditure by these patients in terms of hospital services.


  Conclusion Top


Wait time was the highest from registration to visiting a doctor. The time spent with the patients by the doctors was low and the number of staff posted at a point of care, although it was high, but due to their absence from duty was associated with dissatisfaction. This indirectly indicates that if the staff is satisfied with their job they can serve better, and in turn, patient/attendant perception of satisfaction increases.

Acknowledgments

We would like to take the opportunity to thank all the patients and their attendants for patiently devoting their time for this study. Also special thanks to Mr. Rohit Arya, Ms. P Gurubharthi, Ms. Nitika Agarwal and Mr. Nitesh for putting their sincere efforts in data collection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Government of India. Ministry of Health and Family Welfare. Report of task force on Comprehensive Primary Care. National Health Mission. Ministry of Health and Family Welfare. New Delhi. Available from: http://nhsrcindia.org/sites/default/files/Report%20of%20Task%20Force%20on%20Comprehensive%20PHC%20Rollout.pdf. [Last accessed on 2018 Aug 16].  Back to cited text no. 1
    
2.
General Overview. Employees' State Insurance Corporation. Government of India. Ministry of Labour and Employment; 2015. Available from: https://labour.gov.in/general-overview. [Last accessed on 2018 Aug 16].  Back to cited text no. 2
    
3.
Cain C, Haque S. Organizational workflow and its impact on work quality. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Ch. 31. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2638. [Last accessed on 2018 Aug 16].  Back to cited text no. 3
    
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Mendoza Aldana J, Piechulek H, al-Sabir A. Client satisfaction and quality of health care in rural Bangladesh. Bull World Health Organ 2001;79:512-7.  Back to cited text no. 4
    
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Ige OK, Nwachukwu CC. Areas of dissatisfaction with primary health care services in government owned health facilities in a semi urban community in Nigeria. J Rural Trop Public Health 2010;9:19-23.  Back to cited text no. 5
    
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Bar-dayan Y, Leiba A, Weiss Y, Carroll JS, Benedek P. Waiting time is a major predictor of patient satisfaction in a primary military clinic. Mil Med 2002;167:842-5.  Back to cited text no. 6
    
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Feddock CA, Hoellein AR, Griffith CH 3rd, Wilson JF, Bowerman JL, Becker NS, et al. Can physicians improve patient satisfaction with long waiting times? Eval Health Prof 2005;28:40-52.  Back to cited text no. 7
    
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Spaite DW, Bartholomeaux F, Guisto J, Lindberg E, Hull B, Eyherabide A, et al. Rapid process redesign in a university-based emergency department: Decreasing waiting time intervals and improving patient satisfaction. Ann Emerg Med 2002;39:168-77.  Back to cited text no. 8
    
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Goyal P, Singh N, Lukhmana S. Patient perception and satisfaction are prudent for assessment and improvement of hospital services: A cross sectional study among OPD patients at ESIC Medical College and Hospital, Faridabad, Haryana. Int J Community Med Public Health 2017;4:4165-8.  Back to cited text no. 9
    
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Rao KD, Peters DH, Bandeen-Roche K. Towards patient-centered health services in India – A scale to measure patient perceptions of quality. Int J Qual Health Care 2006;18:414-21.  Back to cited text no. 10
    
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Goyal P, Kumar D, Dixit S, Srivastav S, Singh A. Essential criteria for quality OPD services as perceived by patients in a tertiary care hospital in Faridabad City. Int J Res Med Sci 2016;4:441-5.  Back to cited text no. 11
    
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Xie Z, Or C. Associations between waiting times, service times, and patient satisfaction in an endocrinology outpatient department: A time study and questionnaire survey. Inquiry 2017;54:1-10.  Back to cited text no. 12
    
13.
Irving G, Neves AL, Dambha-Miller H, Oishi A, Tagashira H, Verho A, et al. International variations in primary care physician consultation time: A systematic review of 67 countries. BMJ Open 2017;7:e017902.  Back to cited text no. 13
    
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Wilson AD, Childs S. Effects of interventions aimed at changing the length of primary care physicians' consultation. Cochrane Database Syst Rev 2006;2006;1:CD003540.  Back to cited text no. 14
    
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Jafari Kelarijani SE, Jamshidi R, Heidarian AR, Khorshidi M. Evaluation of factors influencing patient satisfaction in social security hospitals in Mazandaran province, North of Iran. Caspian J Intern Med 2014;5:232-4.  Back to cited text no. 15
    
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Quintana JM, González N, Bilbao A, Aizpuru F, Escobar A, Esteban C, et al. Predictors of patient satisfaction with hospital health care. BMC Health Serv Res 2006;6:102.  Back to cited text no. 16
    
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Khamse M, Aqili R, Baradaran HR, Arabi A. Patients' satisfaction with outpatient services at Firoozgar Endocrinology and Metabolism Clinics. Payesh J 2006;1:71-4.  Back to cited text no. 17
    
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Jaipaul CK, Rosenthal GE. Are older patients more satisfied with hospital care than younger patients? J Gen Intern Med 2003;18:23-30.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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