Patient (Consumer) satisfaction is one of the established yardsticks to measure success of the services being provided in hospitals.
The study evaluates patient satisfaction as a vital "tool" to measure efficiency of these large hospitals managed by Government, Quasi Government and Corporate Sectors.
One of the hospitals managed by corporate sector was found to be satisfying need of patients commendably.
Keywords : Patient satisfaction, out patient behaviour, consumer satisfaction.
Research in the area of "Hospital Administration in India" is still in its infant stage. Studies relating to patient behaviour and satisfaction were also not that many. To mention a few important research works carried out in India, a reference can be made to Veera Prasad1 who examined why the hospital administrator should take patient-satisfaction seriously as a measurement. He further explained the procedures to evaluate the patient satisfaction, Chaskar R.P.2, tried to examine the satisfaction levels of the patients and to study the complaints with regard to various services and to assess whether such complaints affect the overall image of the hospitals. He made some suggestions for improving the quality of patient care. Thimmappayya, A3 establishes a relationship between hospital status, employee satisfaction and service leading to patient satisfaction. Trakroo4 listed some of the factors which effect the satisfaction level of patients utilising outpatient services. They include unusually long time at Registration, irritable behaviour of registration clerk, lack of facilities for toilet, drinking water, lack of proper space for waiting, too long waiting time for doctors consultation, undesirable behaviour of doctors and communication gap between doctor and patient. Others include BalaramanC.S.5, Jagannadhan T6, Sethuraman7, etc. It is in this context, this study aims at analyzing the out patient behaviour and satisfaction in three different hospitals and suggest some measures for making these hospitals patient centred.
A patient is the main user of a hospital. He is a person in distress. He expects from the hospital
His distress is more if8
The primary function of a hospital is patient care. The patient is the ultimate consumer to the hospital. It is one of the yardstick to measure the success of service that it produces. The effectiveness of the hospital relates to provision of good patient care as intended. The patient satisfaction is the real testimony to the efficiency of hospital administration9. As the hospital serves all the members of the society the expectations of the users differ from one individual to another individual because everyone carries a particular set of thoughts, feelings and needs. Hence determination of patients real feelings is very difficult. It is the responsibility of the administrator. "Put yourself in your patient's shoes," this proverb explains how to proceed with a patient. Though it is difficult one can get it by using some tips such as listening to the patients, asking questions and seeking answers, by doing something extra for each patient and by admitting mistakes gracefully and so on.
Satisfaction is an important element in the evaluation stage. It refers to the consumers' state of being adequately rewarded. Adequacy of satisfaction is a result of matching the actual past experience with the expected reward. Patients form certain expectations prior to the visit. Once patients come to the hospital and experience the facilities, they may then become either satisfied or dissatisfied. Satisfaction or dissatisfaction refers to emotional response to the evaluation of service, consumption, experience. It will have five key elements. They are:
Every human being carries a particular set of thoughts, feelings and needs. The wishing list might be of value for those who want to know the real person within the patient. One must admit that there are a lot of things which could be altered. By getting to know the patients a little more to get their views on the care one ought to come closer to what the patients consider as a good care10.
It can be said that there are five determinants of patient satisfaction, they are
Apart from the above, other factors that influences the patient satisfaction include availability of adequate staff, availability of physical facilities and equipment, design of the ward, cleanliness, environment, availability of clinical services, work load of the staff, behaviour of the doctors, nursing staff, paramedical staff, effectiveness of management functions, the leadership styles of administrators, communication channels, policies and procedures etc.
In order to find out an answer to the question as to how far the high technology hospitals have attained their organisational goals, an empirical study is undertaken.
Sample Hospitals: For the purpose of the study, we have selected three different hospitals in Hyderabad city based on ownership. They include Osmania General Hospital (Osmania), completely owned by Government, Deccan Hospitals Corporation Limited (Deccan) which runs under the control of private management and Nizam's Institute of Medical Sciences (Nizam's) which runs on corporate lines under the control of State government. The three hospitals having similar and almost identical facilities.
Keeping the objectives of the study in mind and to identify the factors which influence the patient satisfaction in three superspeciality hospitals under study, the following methodology has been adopted. Questionnaires were prepared for outpatients. The sample respondents were drawn through stratified random sampling. The outpatients were taken based on the average number of patients per day for each hospital. It is observed that aproximately 3000 patients visit Osmania, 2500 visit Nizam's and 1000 visit Deccan. The schedules were distributed to 300 outpatients in Osmania and 270 respondents were selected for final analysis. In case of Nizam's 240 respondents opinions were taken for final analysis. In Deccan 100 schedules were distributed and 90 found to be good and taken for final analysis. Factors such as age, sex, education, nativity, profession, income, etc. have been considered to derive demographic and social background of the patients.
In this part, authors have tried to elicit the information from outpatients. The important areas covered include reception services, registration procedures, security staff etc. Now let us go into the details of the survey.
|1||Reception Services are Good||Yes||10||27.8||78.9|
|2||Adequate Information is available at Recption Counter||Yes||13.3||25.6||76.7|
|3||Time spent at Reception Counter is satisfatory||Yes||16.7||20.0||80.0|
|4||Present Queue System at Registration Counter is satisfactory||Yes||12.2||26.7||86.7|
|5||Counters Provided at Registration is enough||Yes||13.3||36.7||92.2|
|6||On the whole, Registration Procedure is good||Yes||14.4||23.3||84.4|
|7||There is Need for security Staff at Registration Counter||Yes||76.6||64.4||20.0|
Majority of the respondents in Deccan expressed their satisfaction towards reception services. Considerable number of respondents in Nizam's expressed that they are not receiving adequate information from reception counter. High percentage of respondents in Osmania opined that they spent a lot of time at registration counter. Reasonably good number of respondents in Osmania and Nizam's opined that queue system is to be changed and number of counters increased. In Deccan it is observed that the registration procedure in is totally satisfactory. In Osmania a high percentage of respondents expressed the need for security near registration counters and it is observed that seating arrangements in waiting area are not adequate.
Here it is proposed to take information related to consultation and treatment facilities from outpatients. The important areas covered include procedures adopted before and after consulting the doctor, space and physical facilities etc. Now let us go into the details of the survey.
From the above, it can be said that a majority of the respondents in Deccan are under the impression that the procedure adopted before consulting the doctor is satisfactory and staff at the waiting area are sympathetic towards the patients. Time interval between patient arrival and consulting the doctor is reasonable. In case of Osmania very limited number of respondents expressed their satisfaction towards space and physical facilities. Respondents are not happy with the time given by the doctor to narrate the illness. Reasonably good number of respondents in Nizam's is satisfied with the doctor. They said that doctor is sympathetic towards the problems of the patient. When the researcher tried to elicit the information regarding explanation of the doctor to the patient about the illness, reasonable number of respondents in the three sample hospitals expressed their neutral attitude. Very high percentage of respondents in Deccan and a good number of respondents in Nizam's expressed their satisfaction towards the treatment given by the doctor.
|1||Procedure Adopted before consulting the Doctor is satisfactory||Yes||23.3||30.0||86.6|
|2||Staff at waiting area are sympathetic towards Patients probblems||Yes||21.1||35.6||80.0|
|3||Time interval between patient arrival and consulting the Doctor is reasonable||Yes||16.7||23.3||86.7|
|4||Space and physical facilities at consulting room are satisfactory||Yes||25.6||33.3||86.7|
|5||Doctor has given enough time to narrate the illness||Yes||20.0||38.9||82.2|
|6||Are you satisfied with the Doctor after consultation?||Yes||16.7||28.8||86.7|
|7||Doctor is sympathetic towards the problems of the patient||Yes||27.7||34.4||80.0|
In order to find out the satisfaction level towards investigation procedures, from outpatients, it is proposed to take perceptions on a number of investigations, facilities, tests, equipment used etc. The details of the survey are given below.
|1||Many investigations are done for the ailment||Yes||60.0||53.3||52.2|
|2||Investigations done at the outpatient department are satisfactory||Yes||08.9||22.2||64.4|
|3||Facilities at investigation room are good||Yes||10.0||16.7||71.1|
|4||Laboratory tests were done in time||Yes||14.4||30.0||83.3|
|5||Space and staff at investigation area are enough||Yes||33.3||45.6||71.1|
|6||Required medicines are available on hospital premises||Yes||20.0||48.9||80.0|
From the above table, it is observed that many investigations are done for the ailment and the high percentage of respondents told that the investigations are done satisfactorily. Majority of the respondents in Osmania and Nizam's opined that facilities at investigation room are not good. They claimed that laboratory tests were not done in time and also mentioned that space and staff at investigation area are not enough. It can be said that sophisticated equipment is being used for investigations in Deccan.
|1||Timings of the outpatient department are satisfactory||Yes||34.4||36.7||93.3|
|2||Do you recommend this hospital to your friends and relatives if necessary?||Yes||23.3||33.3||73.3|
|3||Performance of the outpatient department is satisfatory||Yes||24.4||36.7||76.7|
|4||Do you prefer to come to this hospital again if necessary?||Yes||20.0||31.1||90.0|
|5||Patients are satisfied with the behavior of the staff||Yes||16.7||25.6||87.7|
|6||Doctors are discriminating the patients||Yes||54.4||64.4||10.0|
As a next step, the authors have tried to elicit the information related to outpatient department timings, performance of the outpatient department etc. Results are - From the above table, it can be said that timings of the outpatient department in Osmania and Nizam's are to be changed; at the same time the respondents of Deccan are happy with the prevailing time schedule. Most of the respondents in Deccan told that they are going to recommend the hospital to their friends and relatives, that performance of the outpatient department is satisfactory and that they prefer to come to the same hospital again if necessary. In Osmania a majority of the respondents are not happy with the behaviour of the staff. Reasonably good percentage of respondents in Osmania and Nizam's mentioned that they experienced discrimination in receiving treatment facilities.
From the given data it is proposed to observe whether the three sample hospitals be distinguishable. The null hypothesis is framed for this purpose as:
"The perceptions of the outpatients in the three hospitals under study are indistinguishable with respect to Registration procedures, Consultation and treatment facilities, Investigation procedures and other related items".
The calculated f-ratio for all types of responses ("Yes" "No") reveals the following facts. For "Yes", "No" types of responses, the calculated f-value is more than table value. Hence the null hypothesis is rejected. So, the inference can be drawn as the perceptions of outpatients in three hospitals differ from one another.
|Particulars||Registration||Consultation and||Investigation||Other Related|
Further, in order to rate the three hospitals and to identify the most preferential hospital, the data is subjected to t-test. The null hypothesis is framed as:
"The perceptions of the outpatients in the pairs of three hospitals under study are identical to each other with respect to Registration procedures, Consultation and treatment facilities, Investigation procedures and the other related items when arranged in ascending order on the basis of average count responses".
The t-value for all types and for all pairs of responses reveals that t-values in most of the cases of "Yes", "No" type of responses are significant at 5% level. One pair (Osmania-Nizam's) in "Yes" type of response one pair (Osmania-Nizam's) in "No" type of response Osmania -Nizam's) and (Deccan-Osmania) are showing insignificant relationship. From the above discussion, it can be observed that in case of "Yes", "No" type of responses Osmania and Nizam's can be categorised into one group.
|Particulars||Registration||Consultation and||Investigation||Other Related|
For additional confirmation, it is proposed to pool all the responses and to give statistical treatment. To observe whether the three sample hospitals be distinguishable, the null hypothesis is framed as:
"The perceptions of outpatients of three hospitals under study are indistinguishable with respect to the hospital services".
The calculated F ratio for all types of responses in all hospitals is more than the table value i.e. all three hospitals can be distinguished. In order to rate the hospitals and to isolate the most preferential hospital from others, the data is subjected to t-test. For this purpose the null hypothesis is framed as:
"The perceptions of outpatients in pairs of all three hospitals under study are identical to each other with respect to the hospital services when arranged in ascending order on the basis of the average count responses".
|Source of Variation
|Sum of Squares||Degrees of||Mean sum of||F-Ratio|
The t-value for all types of responses and for all pairs of hospitals are significant at 5% level. From the discussion it can be said that except Osmania and Nizam's in case of "Can't say?" category of responses all others are not identical. Further, to find the most preferential hospital it is proposed to use mean values. From the table it is observed that "Yes" type of response is being preferable in given set of questions. Here the highest mean value can be taken as preferable hospital i.e. Deccan is occupying first place and for "No" type of response also the same conclusion can be drawn through analysis.
The concept of hospital today is different from what it used to be in the past. Earlier importance was given to traditional custodian functions but today it is recognised as a social institution. As we are moving to service economy the customers are more critical and keen towards quality services and high standards. Here the importance is for relations along with physical facilities. Patients, the only reason for a hospital's existence, need services, which are reasonably accessible, and readily available at all times. In this changed environment patient becomes focal point. Hence, the hospitals must strive for maximum patient satisfaction and provide patient oriented service. Satisfaction gives confidence in the patient in facing the diseases. It is difficult to determine the real feelings of a patient. It is the responsibility of the hospital administrators to keep the patient and his attendants in satisfied state. From the above discussion, it may be concluded that out of three sample hospitals Deccan that runs along corporate lines is satisfying the needs of the patients considerably. As a superspeciality hospital, the authorities are succeeded in providing basic facilities to the needy patients. Though it stood first in the analysis, these hospitals are not away from the problems. The change in the doctors and other staff of these hospitals is not real. It is only half hearted. Doctors are unable to come out from their own psychological set up. Paramedical staff is becoming strong and envious of doctors and Institution and unable to come up to the expectations of the top administration. Another problem is cost of medical care. One should not ignore the Indian conditions. Here, more than 25% of the population is below the poverty line. These masses cannot afford to pay. But our corporate hospitals are becoming centres for rich. So there is every need to bring down the costs of the services and should be economical. Moreover, unethical advertisements, Heavy advertisements are to be curbed with heavy hand. Doctors should not forget the Indian code of medical ethics, which will be given to each applicant at the time of their registration and asks the applicants to pledge to dedicate their lives to the service of humanity.
Osmania General Hospital (Osmania): From the time of its inception to early 1980s, patients flooded the hospital not because of the care taken by the hospital, but due to the non avaiblability of hospitals and costly treatment in the private hospitals. Since 1980s there is tremendous change in the behaviour of the Indian patients. Indian patient of yesterday was illiterate, poor, without knowledge and information and what ever was available, has considered as favour. But today's patient is backed by resources and knowledge with changed mindset, and hence demanding quality of services at reasonable cost. Osmania administrators followed product concept, where the patients were forced to take up whatever was available. Today, these administrators are unable to change their mindset with changed environment and hence majority of the problems in these hospitals are mainly due to this fact. A day is not far of where they have to search for patients. There is only one way for these hospitals to stay in the future environment and that is the follow up of the marketing concept. It means converting a hospital into patient centred one. There is also a need to reposition the products of the hospital in the minds of the general public and probably effective promotion system may be of more help here.
Nizam's institute of Medical Sciences (Nizam's): The founder fathers of this institutions rightly positioned this semi Government medical institution initially. Over the years laxity and indiscipline entered ruining the base systems of the organization. Patient structured hospital was replaced by bureaucratic structure leading to the down fall of prestige of the institution. Regaining of the lost prestige of this great institution is possible by repositioning it as patient centered once again.
Deccan Hospital Corporation Ltd. (Apollo): With the success and reputation of the premier institution, Apollo Hospital, Chennai Deccan was established by the same management. Highly reputed doctors, committed paramedical staff and administrators with modern management skills were able to create distinct identity in the minds of patients and public in general. Unfortunately the hospital was positioned as the institution available to the higher strata of the people with high quality and high price. In the long run, there is no other alternative except repositioning it while considering the affordability of the Indian patient.
Osmania General Hospital (Osmania): It is a premier medical centre rendering yeoman service in the field of medical care in entire Andhra Pradesh running under Government control. It is started with the mission of providing better patient care to needy and poor people free of cost. The institute is having a bed capacity of 1,168 which include 363 super-speciality beds, 160 emergency beds and 685 general beds. The institute is having 250 doctors i.e. 60 professors, 190 civil assistant surgeons and more than 530 nursing staff. There are more than 800 non-gazetted and class-IV employees along with 300 house surgeons and 240 student nurses.
Nizam's institute of Medical Sciences (Nizam's): Initially it was started as orthopaedic centre and afterwards its activities were expanded and it was named as Nizam's Institute of Medical Sciences in 1986. An Act came into force in 1989. Subsequently, University status was given. Nizam's is committed to create a centre of excellence for providing tertiary medical care, educational and research facilities of the highest order in speciality fields of medical sciences. At present, the hospital consists of 26 full fledged departments with 10 superspeciality departments. There are 12 wards with 183 doctors, 76 senior residents, 24 Junior Residents, nearly 600 Nursing Staff and 260 paramedical staff. More than 150 members are working as ministerial staff.
Deccan Hospital Corporation Ltd. (Apollo): Dr.Pratap C.Reddy floated this hospital at Hyderabad. It is the first corporate hospital in the state of Andhra Pradesh. It commenced its operations in 1989. Presently Deccan Hospital Corporation Limited is having production capacity of 350 beds. Out of 350 beds, only 300 beds were installed and only 283 beds are being utilised. It is having bed occupancy rate of 95%. It is started with a mission to bring healthcare of international standards within the reach of individuals. The Group is committed to the achievement and maintenance of excellence in education, research and healthcare for the benefit of humanity. Today Deccan offers the services of 52 self-sufficient departments, each headed by a specialist with years of experience and high professional standing. It is working with 34 full fledged departments including four superspeciality departments. It is having 8 wards with 120 doctors, more than 300 Nursing Staff, 300 paramedical staff, 75 ministerial staff.
* Lecturer, Department of Management Sciences,
R.V.R.andJ.C.College of Engineering, Guntur-19, A.P.
** Professor, Department of Commerce and Business
Administration, Nagarjuna University, Guntur-10, A.P.