Patient's
Satisfaction: Insight into Access to Service,
Interpersonal Communication and Quality of Care
Issues
Abdulaziz
Al Odhayani (1)
Rajab Ali Khawaja (2)
(1) Dr Abdulaziz Al Odhayani, Assistant
Professor1, SBFM, ABF, MRCGP
Department Of Family Medicine, King Khalid University
Hospital, King Saud University
(2) Dr Rajab Ali Khawaja, FCPS, MRCGP, Consultant
Family Physician
Family & Community Medicine, King Saud Medical
City Riyadh,
Correspondence:
Dr Rajab Ali Khawaja, FCPS, MRCGP
Consultant Family Physician
Family & Community Medicine, King Saud Medical
City Riyadh,
Kingdom Of Saudi Arabia
Mobile No: 00966-502704266
Email: rajab99@hotmail.com;
rajabali999@yahoo.com
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Abstract
Objective: To
assess patient satisfaction and expectations
from the family medicine department at
a newly established public sector hospital
in Riyadh.
Methodology:
A cross sectional study. Pre tested, pre
designed, well structured questionnaire
written in English with Arabic translation
was administered to randomly selected
volunteer patients, who presented to family
medicine clinics of a tertiary care hospital
from February to March 2014. A total of
148 anonymously completed questionnaires
were returned to the investigator. Data
were analyzed using SPSS-21 and the results
expressed as counts and percentages.
Results:
The overall level of patient satisfaction
on a Likert scale from 1 to 5 was indicated
by a mean score of 3.84 ± 1.27
for pre-consultation process and 4.63
± 0.75 for process of consultation
by family physicians. The highest satisfaction
was with family physicians who clearly
explained what is wrong before giving
any treatment (4.72 mean points) and the
lowest for availability of reading material
in the waiting room (2.93 mean points).
Conclusion: Consultation
by family physicians followed by nursing
services were highly satisfactory whereas
the satisfaction score and written comments
of some of the participants reflected
a need to improve some infrastructure
and administrative aspects.
Key words: Patient's
satisfaction, Likert Scale, Family Medicine,
Primary Care
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Patient satisfaction is deemed to be one of the
important factors which determine the success
of a health care facility and has long been considered
as an important component when measuring health
outcomes and quality of care (1-4).
Health care consumers today, are more sophisticated
than in the past and now demand increasingly
more accurate and valid evidence of health plan
quality. Hence, basic to the success of any
practice is to satisfy patients by thoroughly
understanding their needs, which definitely
can make a big impact on the service and improves
the overall quality of care (5-9).
Patient satisfaction survey is an effective
tool to either design a new practice plan or
to improve a practice plan in which stakeholders
are already participating (10).
Studies have shown, that patient satisfaction
is directly related to adherence with the pharmaceutical
and non pharmaceutical advice; it improves trust
and loyalty and decreases the number of lawsuits
(11, 12).
A well established process to measure client
satisfaction is by a survey, which is usually
performed by using a short and easily administered
questionnaire, that provides information and
insight on patients' views of the services they
receive (13).
We conducted this study due to the increasingly
competitive environmental and global trend in
healthcare development towards integrating client
satisfaction into the evaluation of medical
service quality. The Family Medicine Department
at Prince Mohammad Bin Abdulaziz hospital (PMAH)
is considered to act as a gatekeeper of treatment
for patients. Thereby, Family Medicine must
achieve customer satisfaction by providing quality
services. This study was therefore undertaken
with the aim to find out the level of patient
satisfaction related to different parameters
of quality of health.
This cross sectional study
was conducted among patients
of Prince Mohammad Bin
AbdulAziz Hospital (PMAH)
during their visit to
the family medicine clinics.
PMAH is a community based
tertiary care hospital
with 500 beds. This hospital
serves the referral patients
from 21 public primary
health care centers of
Riyadh. The study was
conducted from February
to March, 2014 to assess
the patient's satisfaction
related to the service
being provided at family
medicine clinics at PMAH.
A systematic randomized
sampling technique was
used to select the participants
irrespective of their
gender, nationality, age,
marital status, educational
level or Bio-Psycho-Social
status. A pre tested,
pre designed well structured
questionnaire containing
open-ended and close-ended
questions written in English
with Arabic translation,
was administered to every
5th volunteer patient,
during working hours i.e.
8:00 Am - 4:00 Pm from
Saturday to Wednesday.
The covering letter of
the questionnaire outlined
the title and the purpose
of the study and the identity
of the researcher. Participants
were informed about the
importance of the study
and were encouraged to
participate. The questionnaire
was divided into various
sections with 26 items
to highlight the most
important issues related
to the quality of care,
accessibility to the service
and interpersonal attitude
and etiquette. Closed
question responses requested
for items were in a 5-point
Likert scale, ranging
from 'poor =1' to 'excellent
= 5'. In a section at
the end of the survey
questionnaire, comments/suggestions
were requested from the
participants to improve
the quality of service.
Various steps were taken
to increase the content
validity of the questionnaire.
Firstly, a comprehensive
review of the relevant
literature was carried
out. Secondly, a pilot
survey of 30 participants
was conducted and on the
basis of that a few questions
were reformed, added or
deleted. Lastly, all participants
were informed and assured
about the issue of anonymity
and no identifying information
was included in the questionnaire.
The pilot survey questionnaires
were not included in the
main survey. The data
for this study were collected
by staff nurses working
in the primary care clinics
of PMAH.
Statistical Analysis
The Likert scale was used
in this survey research.
It is often used to measure
respondents' attitudes
by asking the extent to
which they agree or disagree
with a particular question
or statement. A typical
scale of "poor, fair,
good, very good and excellent"
was used. Data was entered
into a spread sheet and
processed on Statistical
Package for Social Sciences-21
(SPSS-21). Demographic
data and answers to the
questions in the questionnaire
were analyzed in a descriptive
fashion. Results were
expressed as counts and
percentages. When necessary,
data were also presented
in Mean ± SD.
Out of 200 administered
questionnaires, one
hundred and forty eight
(74%) anonymously completed
questionnaires were
returned to the investigator.
Fifty seven respondents
were men and 91 women.
The mean age of respondents
was 37.40 ± 14.87
years.
Table 1: Demographic
Details Of Participants
The majority of the
respondents refused
to answer their educational
and job status. Participants,
who responded were university
level education (31.8%)
and were professionals
(20.9%).
The questionnaire was
divided into two main
parts:
A). PRE-CONSULTATION
PROCESS AND AVAILABLE
FACILITIES,
B). CONSULTATION PROCESS.
When items of Likert
scale for areas of satisfaction
were recorded, the mean
and standard deviation
for overall level of
satisfaction was 3.84
± 1.27 for pre-consultation
process and 4.63 ±
0.75 for process of
consultation by family
physicians.
The respondents reported
their highest level
of satisfaction with
the quality of the services
provided by doctors
followed by registered
nurses. The lowest level
of satisfaction was
for access to medical
care, waiting time,
appointment time and
comfort of waiting room.
Table 2A presents the
results of the pre consultation
process and available
facilities. The main
area of less satisfaction
were enough reading
material in waiting
room, waiting time,
pleasant environment
of waiting room and
to get an appointment
at a convenient time.
Most of the patients
were satisfied with
the nurses who listened
to them carefully and
addressed their concerns
carefully. Their response
also showed that nurses
were very reassuring.
Click here for Table
2A: Patient's Satisfaction
with Family Medicine
Department, PMAH
Table 2B presents data
for consultation process.
Patients were satisfied
with all the attributes
of consultants. Mean
response was greater
than 4.5 out of 5 for
all the questions.
Click here for Table
2B: Patient's Satisfaction
with Family Medicine
Department, PMAH
Consumer's satisfaction
is generally considered
as the extent to which
the consumers feel that
their needs and expectations
are being met by the
services provided. Patients
usually express their
views through complaints
procedures (12), changing
doctors (14) and by
expressing their opinion
on the quality of services
received (15).
In our study, the overall
level of patient satisfaction
with the services before
consultation, on an
ascending scale from
1 to 5, was indicated
by a mean score of 3.84
implying that, in general,
they perceived that
the quality of the healthcare
services before consultation
were relatively moderate.
They were not entirely
dissatisfied with the
quality of the services,
but they were not entirely
satisfied. On the other
hand, patients were
highly satisfied with
all the attributes of
consultation by family
physicians (mean score
4.63). The findings
of this study related
to patient satisfaction
are comparable to a
similar study from Kuwait
(16), Egypt (17) and
Nigeria (18). Patients
are more satisfied in
our study compared with
the studies from Hail
and Jeddah cities, where
the mean score was 3.60
and 3.76 (7, 19).
Physician's good communication
skill is a well recognized
key component of patient
satisfaction (20-22).
Based on the results
of this study, almost
all patients reported
a high level of satisfaction
with various aspects
of family physician's
consultation. The most
likely explanation for
this positive finding
could be the excellent
communication skills
of the family physician.
Respondents in the current
survey also reported
the highest level of
satisfaction for the
friendliness, courtesy,
personal interest, reassurance,
respect, support and
time offered to the
patients by the physicians.
Waiting time and waiting
room facilities directly
influence the satisfaction
of patients (10). In
our study, patients
were least satisfied
with waiting time and
availability of facilities
in the waiting room.
Findings of this study
are comparable with
the study from United
States in which longer
waiting times were associated
with lower patient satisfaction
(p < 0.05) (23).
In another study, availability
of a video in waiting
room significantly increased
the satisfaction score
(24).
Some limitations should
be considered when evaluating
this study. Relatively
small sample size, not
interviewing patients
directly and limiting
the study to one institute
may influence negatively
towards the generalizability
of the results. Patient's
satisfaction alone,
is not an appropriate
indicator to make favorable
comments on quality
of primary health care
services. Therefore,
there is a need to assess
and evaluate other indicators
of quality in depth,
like error rate, patient's
complaints, lawsuits,
physician's documentation,
etc. However, the significantly
high level of patient's
satisfaction, related
to various areas which
were assessed, justifies
a degree of generalizability.
Patient satisfaction is
an increasingly important
issue, both in evaluation
and the shaping of health
care. The findings from
this study showed that
the overall satisfaction
with services at the family
medicine clinics of a
tertiary care hospital
(PMAH) was above average,
however, we observed varying
degrees of dissatisfaction
with some services.
The results of this study
will support policy and
decision makers to make
better plans to address
the attributes falling
under satisfaction.
ACKNOWLEDGMENTS:
We wish to thank Mr. Munir
Chaudri (Bio-Statistician)
for contribution in data
analysis.
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