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Journal of the Academy of Hospital Administration

Study of Patient Satisfaction in a Tertiary Referral Hospital

Author(s): Arpita Bhattacharya*, Prema Menon**, Vipin Koushal***, K.L.N. Rao****

Vol. 15, No. 1 (2003-01 - 2003-06)

Key Messages:

  • Patient's expect doctors to fully explain the disease, cost and treatment plan, before hospitalization.
  • Attitude and behavior of nurses and paramedical staff towards attendants needs to improve.
  • For a health care organization to maintain and improve its standards, constant monitoring of perceptions and expectations of the patients and their attendants is essential.


Two hundred fifty two in-patients admitted in the wards and intensive care unit of a teaching department of a public sector tertiary referral hospital were interviewed at the time of discharge. The perceptions and expectations of attendants regarding the quality of medical care, general satisfaction and infrastructure are assessed. Very high levels of satisfaction were expressed on doctors' work. The technical aspects of nursing care were satisfactory to 88% of patients. Moderate levels of satisfaction were recorded regarding the general attitude of nurses and ward servants. Thirty seven percent of patients felt the treatment facilities could be better. The consumers recorded many suggestions.

Keywords: Patient satisfaction, Health services, Service quality, Public hospitals


For a health care organization to be successful, monitoring customer's perceptions is a simple but important strategy to assess and improve their performance1,2. Andaleeb proposed and tested a five-factor model that included communication with patients, competence of the staff, their demeanor, quality of the facilities and perceived costs 3. There are very few studies in India that measure patient satisfaction with the services provided by health care organizations.

Patients and Methods

Patient sample: Patients admitted in the ward, neonatal surgical intensive care unit (NSICU) and private wards managed by the Pediatric Surgery department in the Advanced Pediatric Center (APC) of Post Graduate Institute of Medical Education and Research (PGIMER) were taken up for the study. Attendants of 252 patients discharged between September and December 2001 were included in this study. Patient feedback questionnaire: A patient feedback questionnaire consisting of ten domains with a total of 35 questions was used (Table 1). These were formulated to estimate the perceptions and expectations of attendants regarding technical quality, general satisfaction, communication, interpersonal aspects, accessibility, convenience etc. The data was collected from an interview of the parents ora close relative at the time of discharge of the patient.

Analysis: The collected data was analyzed as a whole and a comparative analysis also done by dividing the patients into subcategories on the basis of admission status (ward vs. NSICU), status of illness as well as affordability and literacy of parents. Frequency distributions were obtained to check the frequency of the assertive and negative responses. Chi-Square test was applied to calculate the significance of differences between the opinions of patient attendants belonging to different sub categories except admission status.

Table 1: Assessment of hospital services by patient's attendant; Summary of questionnaire and Percentage distribution of responses

(1) Doctors:

1. Have explained the disease to me and I have completely understood the diseases and treatment 89.3%
2. Have spent enough time with my child to evaluate the disease 98.8%
3. Attended to problems immediately or at the earliest 98.8%
4. Showed concern to child and family 98.2%
5. Treated my child with love and affection 99.6%
(2) (a) Technical delivery of nursing care  
6. Treated my child with love and affection 98.8%
7. Attended to problems immediately or at the earliest 96.4%
8. Are approachable to my personal problems 91.3%
9. Showed concern to child and family 96.8%
10. Advised to my satisfaction at the time of discharge 90.5%
(2) (b) Nurses general behavior with the attendants
11. Pleasant 54.4%
12. Indifferent 21.4%
13.Rude 24.2%
(3) Ward servants/sweepers  
14. Worked to my satisfaction 54.0%
15. Helpful 23.0%
16. No interaction 23.0%
(4) Available facilities for treatment  
17. Best 62.7%
18. Can be better 37.3%
19. Bad 0.0%
(5) Facilities for patient attendants  
20. No facilities 0.4%
21. Allfacilities 27.8%
22. Minimum facilities 71.8%
(6) Cleanliness of ward and corridors  
23. Very clean 0.4%
24. Clean 98.0%
25. Not clean 1.6%
(7) Food  
26. Very good 0.8%
27. Always good 42.1%
28. Occasionally good 49.2%
29. Worst 0.8%
30. Not applicable 7.1%
(8) Toilets  
31. Clean 12.3%
32. Need more frequent cleaning 86.0%
33. Always dirty 1.7%
34. Number of toilets inadequate 77.8%
(9) OPD Services  
35. Satisfactory 98.0%
(10) Open suggestions, if any.  


Sixty-one percent were paying patients. Fifty-nine percent of the attendants were literate. Overall level of satisfaction with doctors ranged from 89.3% to 99.6%. Very high levels of satisfaction were expressed on technical quality of doctors' work and their approachability. However 10.7% felt that doctors hadn't fully explained the disease and the treatment.

The percentage of satisfied attendants regarding technical aspects of nursing care was above 90%. Literate attendants were more satisfied regarding approachability of nurses to their personal problems compared to illiterate/semiliterate attendants (P<0.01). However, the latter were more satisfied than the literate attendants with the advice given at the time of discharge (P<0.05). The level of satisfaction with behavior and attitude of nurses towards the attendants was poor. 24.2% attendants thought that some of the nurses were rude whereas 21.4 % felt they were indifferent. In the NSICU, satisfaction levels with attitude and mode of talking of nurses was higher with paying, literate attendants.

Moderate level of satisfaction score was noted regarding quality of work of ward servants/sweepers. High rate of dissatisfaction was found regarding their helpfulness. Many of the attendants (23%) didn't interact with them. Chronic and literate attendants were more satisfied with their quality of work, helpfulness, and communication. 62.5% of NSICU attendants answered that the number of toilets were adequate. However in the ward, 85% were dissatisfied on this aspect.

According to 62.7% attendants, the hospital provided best facilities for treatment. None of the respondents categorized treatment facilities as bad but 37.3% thought that it could be better. More than 94.5% of the attendants also responded positively to the general cleanliness and food. Most of the attendants were satisfied regarding OPD services provided.


This paper represents a preliminary study that evaluates the perception of patient attendants regarding the services provided to in-patients by the Department of Pediatric Surgery at this Institute. PGIMER is a premier institute in India, which trains medical teachers, provides patient care as a tertiary referral center and conducts high quality medical research in India. It is a 1500-bed hospital, which includes 300 beds in the APC. The Department of Pediatric Surgery was established in 1968. The department was shifted to the newly constructed, spacious Advanced Pediatric Centre in 1999. During the year 2001-02, 12,420 patients visited the Pediatric surgery OPD, 1,617 children/newborns were admitted and a total of 1835 major operative procedures were performed. This patient satisfaction survey among the in-patients in a teaching department is probably the first of its kind for tertiary referral hospitals in the public sector in India. This survey provides an insight to hospital administration, staff, doctors and researchers who want to improve the quality of service and patient satisfaction levels. It appears that such small and well manageable specialty centers may be an answer to the widespread unsatisfactory conditions prevailing in general in public sector hospitals in India.

Overall level of satisfaction about doctors ranged from 89.29% to 99.6%, contrary to the study by Mahapatra et al (2001) where patient satisfaction regarding technical quality of doctors scores only 63% 4. The percentage of satisfied attendants regarding nursing care was slightly lower. The NSICU is an area with consistently highest bed occupancy rate in the entire Institute (155% to 230% during the period January to October 2002). Inspite of restricted entry of attendants and more critical condition of the patients, the NSICU attendants were more satisfied with total services provided by the department. This reflects the fact that the satisfaction level of attendants was closely dependent on three variables namely cleanliness, orderly environment and discipline of the staff, which were much better maintained in the intensive care unit. Overall interaction level of attendants with hospital paramedical staff was poor in comparison to a similar survey 4.

Traditionally, the medical profession was expected to maintain high quality of standards in the hospitals. In general, the quality was defined by the clinicians in terms of technical delivery of medical care5. However, it appears that infrastructure and attitudes require to be improved significantly in the public sector hospitals to meet the consumer's expectations.

Sixty three percent respondents gave assertive feedback to the item, which proposed that the treatment facilities available to the patient were best. Around 72% of the attendants thought they have been provided with minimum facilities by PGI authority. We found that the overall health care provided by the Pediatric surgery department, PGIMER made patient attendants satisfied except for a few variables.

It is most gratifying that corruption among the staff for getting the due services rendered was not cited even by a single patient. This is in sharp contrast to the published reports in similar situations 4,5. Higher percentage of satisfaction regarding out patients service reveal that the respondents perceived a good quality of staff behavior, atmosphere, information, examination comfort and perceived worth. The attendants made the following suggestions:

  • They should be informed about possible costs and total time required for treatment prior to admission.
  • Doctors should explain the condition of the patient everyday to them.
  • All investigation facilities should be provided under the same roof.
  • Nurses, group-D staffs, ward servants, sweepers, reception personnel should receive some training for improving behaviour and attitude.
  • Bed sheets should be changed on regular basis.
  • Safe, drinking water would be easily available.
  • Toilets and other facilities should be improved.
  • Some arrangements for library and indoor games for sick kids should be arranged. These suggestions clearly point out different areas of health care services provided by tertiary referral hospital in India that needs improvement. It can be concluded that although the unit under study provides satisfactory health care services in terms of technical quality, responsiveness, general cleanliness and food; certain areas need improvement namely communication, toilet facilities, facilities for attendants as well as attitude and behavior of paramedical staff. This improvement can be achieved by repeated monitoring of patient satisfaction.


  1. Repert 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.
  2. Gombeski WR, Jr Miller PJ, Hann JH, Gillete CM, Belinson JL, Bravo LN, Curry PS. Patient call back program: a quality improvement, customer service and marketing tool. J Health Care Mark, 1993; 13:60-65.
  3. Andaleeb SS. Determinants of customer satisfaction with hospitals: A managerial model. International Journal of Health Care Quality Assurance 1998. 11:181-187.
  4. Mahapatra P, Srilatha S, Sridhar P. A Patient Satisfaction survey in public hospitals. Journal of Academy of Hospital Administration 2001;13:11-15.
  5. Andaleeb SS. Service quality perceptions and patient satisfaction: a study of hospitals in a developing country. Social Sciences and Medicine 2001; 52:1359-1370.

* Research Fellow
** Assistant Professor of Pediatric Surgery, PGIMER, Chandigarh
*** Deputy Medical Superintendent, PGIMER, Chandigarh
**** Professor and Head of Department of Pediatric Surgery, PGIMER, Chandigarh

Correspondence to:
Dr. K.L.N. Rao, Professor and Head,
Department of Pediatric Surgery, P.G.I., Chandigarh 160 012,
E-mail: [email protected]

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