View of ANALYSIS OF PATIENT SATISFACTION WITHIN HEALTH CARE SECTOR: AN EXPLORATORY STUDY

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Vol.04,Special Issue 05, (ICIR-2019) September 2019, Available Online: www.ajeee.co.in/index.php/AJEEE

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ANALYSIS OF PATIENT SATISFACTION WITHIN HEALTH CARE SECTOR: AN EXPLORATORY STUDY

Ms. Vidushi Sharma

(Research scholar), Department of Business Management, Faculty of Commerce &

Management, IGN Tribal University, Amarkantak, Anuppur (M.P.) Prof. Ajay Wagh

(Dean) & (Head), Department of Business Management, Faculty of Commerce &

Management, IGN Tribal University, Amarkantak, Anuppur (M.P.) Abstract -

Purpose of the Study: Aim of this paper is to identify the potential factors which are contributing in determining Patient Satisfaction, which in turn may provide Health Care Sector a way to revamp their Hospital Services and resources for delivering the better service and care to the Patients.

Methodology of the Study: For the present study 301 Indoor patients were taken as respondents. The selected population sample size from Government District Health Care centers from different districts of Madhya Pradesh were drawn and convenient sampling was preferred for this study. Exploratory Statistical methods were utilized to scrutinize the data and reaching to the results.

Findings: This research paper predicts that Health Care centers and their performances significantly impact patient’s insights and perception. Subsequently, these perceptions and insights acts as in determining factors for their intention to reuse health care facilities, whereby leading to Branding of the Hospitals. Exploratory Factor Analysis has been used to find out factors such as Quality of Care, Nutritional Care, Ambient Condition and Physician Attitude explaining a total variance of 66.377% in the Data.

Practical Implication: Co-Creation (With Patients as End Users) of Hospital Infrastructure and Service Delivery Parameters should be the Core Agenda/Strategy and Order of the Health Care Sector for survival, development and branding of the Hospitals for long term results

Originality: Paper emphasizes on beneficiaries perspective to be included in revamping/designing health care facilities and developing Key Result Areas of service rendering positive future outcomes beneficial to both the stakeholders.

Keywords: Patient Satisfaction, Hospitals, Health Care Services, Quality of Care, Nutritional Care, Ambient Condition, Physician Attitude

INTRODUCTION

Patients are the end user of Health Care facilities, with the increasing competitiveness within the health care sector, peopleare becoming more judicious, quality conscious (Lau&

Gregoire, 1998) and health consciousness (Karn& Swain, 2017).Patient’s satisfaction is regarded asa key element for their valuable feedback to the Health Care centers. Patient satisfaction is a significant indicator for evaluation ofquality of health care service which deals with the opportunities for development and improvement of healthcare facilities rendered by health care centers (Batbaatar et al., 2017).

Delivery of quality service to patients is on high priority of health care environment (Edura & Kamaruzaman, 2009; Dabholkar, 2015). Patients can be asset for care centers, by in-depth observation and analysis, hospital administration and health care providers can understand the actual needs of their patients. Earlier it is was assumed that falling professional standards and their audit/assessment are enough sufficient to understand the need of the patients (Bader, 1988), but human desires are not easy to recognize and understand, therefore measuring satisfaction of patients becomes a tough task for administrators and health care providers. Patient Satisfaction is considered as general notion though it is a complex, multidimensional and multifaceted concept embedded with many contributing factors (Batbaatar et al., 2017) such as, patients inclusive positive evaluation (Kessler & Mylod, 2011); evaluation of health care service (Pascoe, 1983),quality as quality assurance using some parameters such as Quality of Care(Vuori, 1987; Cleary &

McNeil, 1988),Patient care, Hospital ambient condition(Harris et. al., 2002; Vieira et. al., 2003;Medina-Mirapeix et. al., 2013),Staff Attitude (Sitzia& Wood, 1997; Taylor & Benger, 2004;Alfredson& Annerstedt, 1994), Facilities(Kumari et. al., 2009; Sodani, 2010),

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etc.Emphasizing quality measure also helps in identifying more service quality factors and further may help to improve existing ones. Patient satisfaction is a rewarding lane by which the staff members, health facilitator as well as administrator gradually move and focus towards higher quality care (Kessler & Mylod, 2011) which lead to the direction of better and effective delivery of quality services (Batbaataret al., 2017).

1.1 Objective of The Study

Patient Satisfaction is a vital aspect on which Health Care Providers and Administrators should focus, although it is multifaceted and multi-dimensional phenomena; and plays crucial part in accomplishing purposes of the Health Care Organizations.Commitment, Loyalty, Views and Satisfaction of Patients (Ho et. al., 1998) are extremely important to improve the performance level of the Hospitals, subsequently it contribute to overall Health Care Sector. Hence this study focuses on exploration of the potential factors contributing in generating Patient Satisfaction.

2 LITERATURE

Patient Satisfaction is defined by Pascoe (1983) as“a health care recipient’s reaction to salient aspects of the context, process, and result of their service experience, which encompasses psychological progressions in the form of cognitive evaluation and affective response”.

Brings a picture of overall satisfaction among patients using hospital care services and reflects upon reuse intention of healthcare services as recommendations to the hospital services (Drachman, 1996; Otani et al., 2003; Abramowitz et al., 1987) which may lead towards improvisation of management practices of organization as well as their culture of health care settings (Giaedi, 2012) on the basis of patient outcomes. Another study conducted by Schneider & Bowen (1993) affirms that perception of patient related quality of care stimulates work culture, organizational support positively, this may lead parallel to reduce daily stressors of work life among healthcare staff (Aiken et al., 2002) pinning for staff satisfaction, (Naidu, 2009; Gray &Boshoff, 2004; Andaleeb, 1998) their performance and organizational performance (Butler et al., 1996; Abramowitz et al., 1987). Tucker (2002) explains some more parameters as contributing factors which affects patient’s experiences in the form of availability and convenience of resources as well as staff members.

Dissatisfaction of patients fuel them for switching Health Care Centers (Ho et al., 1998).

Satisfied Patients reflects their positive gesture towards hospitals.(Elder et al., 2004;

Stroupe et al., 2005) which gradually strengthen hospital image, ultimately benefitting healthcare sector.

3 METHODOLOGIES

Exploratory Factor Analysis is utilized to find out the different affecting and associated factors with Patient Satisfaction. A structured questionnaire was developed with use of available literature for measuring Patient Satisfaction, while construction of scale, 30 items were developed but gradually on the basis of extraction value lower than 0.3, 18 items were removed from initial questionnaire and finally 13 items were retained as a final instrument for collecting data from respondents. Three-sectional questionnaire was administered, introducing the research with an opening paragraph and stating the purpose of the study, with anonymity assurance and complete secrecy of individual responses. Data set in term of survey questionnaire were collected through the use of 5 point scale (1 = strongly disagree;

5 = strongly agree).The second part of questionnaire consists of personal demographic profile of the participants like age, gender, designation, experience, etc.; and Last part of the questionnaire reflects Patient satisfaction dimension measured on a 5 point Likert Scale.

The demographic profile of respondents is shown in Table-2. This patient satisfaction Scale was personally administered to 400 indoor patients’ of various Government district hospitals from Madhya Pradesh. At the time of analyzing the data 301 questionnaires were found suitable for the study, with the response rate of 75.2%.Study designed to find out potential factors causing Patient Satisfaction, and for testing the reliability of scale, Cronbach’s Alpha method was used. Its Alpha coefficient value should be ranging from 0 to 1, where 0.6 or more is considered to be quite good in researches conducted in the area of social sciences (Cronbach, 1990). As per the result shown in Table-1, it is concluded that the Alpha Value is pretty satisfactory i.e. 0.859 for total 13 items.

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Table 1: Reliability Statistics Cronbach's

Alpha No. of Items

.859 13

Subsequently for validating the appropriateness and adequacy of the data, (KMO) Kaiser Meyer Olkin- Bartlett’s Test of Sphericity is conducted for this data set. Suggested KMO value should be between the range of 0 to 1 the more the value is near to 1, the more the data is supposed to be adequate, significance level of Bartlett’s Test of Sphericity should be (p<0.001). The data shown in Table-3 indicates about data sufficiency and strong for factor analysis as test value is quite significant, i.e., 0.815 (which is more than .6 and near to 1) and 0.000 (which is p<0.001) respectively.

Factor Analysis was performed with the help of use of SPSS 17 version, to pinpoint the factors affecting the Patient Satisfaction, by using principal axis factoring method followed by varimax rotation.

Table 2: Demographic characteristics of the participants

Characteristics % F

Place Anuppur 19.9 60

Indore 19.9 60

Bhopal 20.3 61

Gwalior 19.9 60

Jabalpur 19.9 60

Gender Male 37.2 112

Female 62.8 189

Age 18-25 18.9 57

26-35 25.9 78

36-45 19.6 59

46-59 15.0 45

Above 59 20.6 62

Marital Status Single 32.5 98

Married 67.4 203

Occupation Unemployed 36.2 109

Self-employed 11.0 33

Private 49.5 149

Government 3.3 10

Monthly Income Below 5,000 50.8 153

5,001-10,000 38.2 115

Above 10,000 10.9 33

Education Uneducated 42.2 127

Under Graduate 49.1 148

Graduate 6.6 20

Post-Graduation 2.0 6

Frequency to visit this Hospital as preferred Hospital

First Visit 55.5 167 More than Once 18.3 55 More than twice 12.0 36 More than thrice 6.3 19

More than five

times 8.0 24

Table 3: KMO and Bartlett's Test Kaiser-Meyer-Olkin Measure of Sampling

Adequacy. .815

Bartlett's Test of

Sphericity Approx. Chi-

Square 2293.718

Df 78

Sig. .000

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4 3.1 Data Analysis and Interpretation

As data represented in Table-2 shows that data is collected almost equally from different cities i.e. Anuppur, Indore, Bhopal, Gwalior, Jabalpur followed by 19.9 % (60),19.9 % (60), 20.3 % (61), 19.9 % (60), 19.9 % (60) respectively. The data shows the trend regarding gender, i.e., mostly women with 62.8% (189) are admitted in the hospital as compare to menwith 37.2% (112). Patients of the Hospitals belongs to all age groups, the highest number of patients which is 25.9% (78) represented from 26-35 years of age group followed by 20.6% (62) fromAbove 59 Age Group category, 19.6% (59) were from 36-45 Age Group Category, 18.9% (57) were from 18-25 Age Group Category, 15.0% (45) were from 46-59 years of age group. As far as marital status is concerned most of the patients are married with constituting 67.4% (203) and32.5% (98) respondents were single. Occupation wise most of the respondents with49.5% (149) belongs to private owned organization, shadowed by 36.2% (109) who were unemployed, 11.0% (33) are Self Employed, and only 3.3% (10) werefound associated with government institution. The major portion of respondents’ earn less than Rs.5000 which comes around50.8% (153), while 38.2% (115) respondents were ranging their income between Rs. 5001 to 10000 and only10.9% (33) respondents were earning more than Rs.10000.As per the analyzed data set 42.2% (127) respondents were uneducated whereas 49.1% (148) were under graduate, 6.6% (20) were graduates, and just 2.0% (6) respondents completed their post-graduation. The demographic data related to patients frequency of visit to the Health Care Centers reveals that about 55.5% (167) respondents visited centers for the first time , 18.3% (55) visited more than once, 12.0%

(36) visited more than twice, 8.0% (24) visited more than five times and only 6.3% (19) visited the centers more than three times, showing a decreasing trend.

Factor Analysis is used as data reduction technique in which unobservable variables are replicated as observed variables. According to Tabachnick & Fidell (2001) 300 sample size is good enough for conducting Factor Analysis. Communality refers to proportion of variance each explained by the factors. A variable that shares random variance would have a communality of one while those does not shares variance with other variables have zero communality. Principal axis factor method is used as extraction method, where initial values on the diagonal correlation matrix are defined through squared multiple correlation of the variable with remaining other variables, which shown in Table-4 varies within0.3 to 0.7.

Further variances are recalculated from the factors that were extracted before, the values are represented as extraction values displayed in Table-4, which indicate the proportion of variance of every variable and can be described through finally retained factors. The extraction values are ranging from0.3 to 0.8 as shown in Table-4.

Table 4: Communalities

Initial Extraction

Quality of food served to patient is good. .707 .844

The food served here is tasty and hygienic .712 .806

Patient’s meal is as per prescribed diet chart. .383 .395

Physician listens to patients carefully before their treatment. .601 .800

Physicians answer the queries of the patients normally. .561 .677

I am happy with the number and placement of beds in the wards. .531 .693

Patients Wardrobe and bedding are changed daily. .528 .695

Nursing staff of this hospital is enough competent in their work. .553 .515

All the medical equipment’s employed here are up to date, with latest techniques. .318 .308 I would like to recommend this healthcare center to others due its services. .785 .817

I’ll consider this healthcare center again due its services .767 .810

I liked the overall facilities of this health care centers. .605 .601

I liked the services provided by the staff members. .656 .667

Extraction Method: Principal Axis Factoring.

The Principal Axis Factor method with Varimax Rotation and Kaiser Normalization cluster converges thirteen items into four factors. Table-5 shows the extracted four factors on the basis of above mentioned methods and displayed its factor loadings, percentage of variances and cumulative percentages. All the four factors have explained Total variance of 66.377%

(the value has been shown Table-5) in Patient Satisfaction which is good and signifies importance of the factors extracted. The factor extraction is displayed below:

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Table 5: Factor Loadings, Communalities and Explained Total Variance

Factor Item Convergence

Eigen Values

Factor Loadings

Rotation Sums of Squared Loadings

Total % of

Variance Cumulative

% Quality of

care I’ll consider this healthcare center again due

its services 5.215 .865

3.629 27.915 27.915 I would like to recommend this healthcare

center to others due its services .861

I liked the services provided by the staff

members. .781

I liked the overall facilities of this health

care centers. .695

Nursing staff of this hospital is enough

competent in their work. .678

All the medical equipment’s employed here

are up to date, with latest techniques. .512 Nutritional

Care Quality of food served to patient is good. 2.253 .900

2.067 15.898 43.813 The food served here is tasty and hygienic .857

Patient’s meal is as per prescribed diet

chart. .616

Ambient

Condition Patients Wardrobe and bedding are changed

daily. 1.230 .792

1.474 11.338 55.150 I am happy with the number and placement

of beds in the wards. .789

Physician Attitude

Physician listens to patients carefully before

their treatment. 1.121 .825

1.459 11.227 66.377 Physicians answer the queries of the

patients normally. .779

Extraction Method: Principal Axis Factoring

F1 Quality of Care:The Quality of Care is a significant factor for patient satisfaction as it individually explains variance of 27.915% with eigen value 5.215. After a thorough investigationof all the items, the marked items associated with the factor explicitlyare “I’ll consider this healthcare center again due its services; I would like to recommend this healthcare center to others due its services; I liked the services provided by the staff members; I liked the overall facilities of this health care centers; Nursing staff of this hospital is enough competent in their work; and All the medical equipment’s employed here are up to date, with latest techniques”. According to the nature of items, factor has been named as

‘Quality of Care’ as of mention in Table-5.

F2 Nutritional Care: The second factor Nutritional Care is clubbed on the basis of three items “Quality of food served to patient is good; The food served here is tasty and hygienic;

and Patient’s meal is as per prescribed diet chart”. This factor explained total variance 15.898% with eigen value 2.253 which affect Patient Satisfaction as well as their decision, thus it is a significant factor. Keeping the tendency of the statements in the mind

‘Nutritional Care’ suits as their name as factor shown in Table-5.

F3 Ambient Condition:The third factor as Ambient Condition opinions about importance of the surroundings of Health Care Centers. As a factor Ambient Condition embedded withtwo items“Patients Wardrobe and bedding are changed daily; and I am happy with the number and placement of beds in the wards”is a contributing factor revealed through its total variance explained with 11.338% and eigen value 1.230 (Table-5).

F4 Physician Attitude:The last factor carries total explained variance of 11.227% and eigen value 1.121, act as a significant determinant in Patient Satisfaction, explained in Table-5. The factor accommodates two items namely “Physician listens to patients carefully before their treatment; & Physicians answer the queries of the patients normally”, here Physician Attitude suits better as a factor name with these two items.

4 DISCUSSION

After data analysis, four determinants of Health Care services were explored that has significant role in patient satisfaction: Quality of Care, Nutritional Care, Ambient Condition and Physician Attitude.

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6 4.1 Socio-Demographic Characteristics

Patients’ socio-demographic characteristics are least understood variables and often researched and studied in relation to patient and patient satisfaction. Variable like gender, age, income etc. Are mainly collected and their frequent appearance in studies itself explains its significance. However its appearance in studies, definitely not explains its nature, be it dramatic or consistent nature in relation with satisfaction.

Weisman et. al. (2000) opined that men and women experience the same basic healthcare services and facilities differently and evaluate it on different factors according to them. Studies of Sitzia & Wood (1997); Hekkert et. al. (2009); Findik et. al. (2010) found positive correlations between gender and patient satisfaction. The data shows that respondents were mostly women with 62.8% that are admitted in the hospital as compare to men with 37.2%. Patients of the Hospitals studied belongs to all age groups from 18 years old to above 59. Studies shows that age acts as an important and consistent factor and researchers like Sitzia & Wood (1997); Venn & Fone (2005) and Hall & Dornan (1990).

Cohen (1996) shows the effect of patients’ age on their satisfaction. Some studies like Hall &

Dornan (1990) & Cohen (1996) provided strong evidence of age effect on patient satisfaction.

Marital status of patient shows mixed response in literature, studies like Xiao &

Barber (2008) stated that married patients are more satisfied and in this study as far as marital status is concerned most of the respondent were married with 67.4% whereas study like Quintana et. al. (2006) showed light on some aspects like cleanliness and comfort, single patients are more satisfied with health services and in this study 32.5% of respondents were single. According to Mummalaneni & Gopalakrishna (1995) among the socio-economic variables, income had much impact on patient satisfaction. In same line, Footman et. al., (2013) found positively correlation between socio-economic status with patient satisfaction and here in this study major portion of the respondents’ earn less than Rs.5000 which constitutes 50.8%.

Studies of Bjertnaes, et. al., (2012); Rahmqvist & Bara (2010) & Hekkert et. al., (2009) found inverse association of education level with satisfaction level and as per the analyzed data set 42.2% respondents in this study are uneducated whereas 49.1% are under graduate shows contrast view of respondent view.

Patient’s regularity to health care has been a determinant factor of patient satisfaction (Kersnik, 2001). Furthermore, Qatari & Haran (1999) establish that the more often patients visiting a health care center are more satisfied with facilities and services.

The frequency of visit to the Health Care Centers in this study shows that 55.5%

respondents visited center for first time and 44.5%respondents repeated visits.

4.2 Quality of care

Patient satisfaction is the outcome of quality of care in the hospital (Donabedian, 1988).

Patient’s satisfaction or dissatisfaction in regard with the quality of hospital care, in every aspects from the staff interpersonal skills to hospital facilities and services, and sometime regarded as element of health status itself.

Nursing care plays a significant role in bringing overall satisfaction of patient stay with a hospital and use of facilities and services and intent to recommend a hospital.

(Abramowitz, 1987). Patient satisfaction is an indispensable indicator in regard with the assessment of the facilities and quality of services and care in hospitals. Nowadays physicians are evaluated and reimbursed on satisfaction scores of patient. Ferguson &

colleagues (2001) observed that patient satisfaction services can be determined within the dimension of ‘staff presentation skills, interpersonal skills, nutrition supplements, and perceived health benefits’.

Quality of care is a determinant factors of patient satisfaction for a hospital stay has been noted in past research of Fleming (1981) & Carey (1982). Batbaatar et. al. (2017) that has been reconfirmed in this study with factor named ‘Quality of care’ with variance of 27.915% and Eigen value of 5.215.

4.3 Nutritional Care

Provision of food services made available by healthcare centers for in house patients is an essential aspect of patient care, as it not only improves patient health outcomes but also patient satisfaction. Dube et. al. (1994) observe patient satisfaction with hospital food

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service varies and influenced with food quality (Messina et. al., 2013)., attitude of the food service staff and meal service reliability, is in line with the factor ‘Nutritional care’ found in this study with items related to ‘Quality of food served; taste and hygienic; and Patient’s meal is as per prescribed diet chart’ with total variance of 15.898% and Eigen value is 2.253, Dall’Oglio et. al. (2015) noted that quality of foodservice provided to patient in hospital, is significant factor for health care quality and has been regarded by patients and their close relatives. Furthermore, quality of foodservice also influence their hospital stay.

(Sheehan-Smith, 2006; Demir& Celik, 2002). Askew, Capra & Sardie (1996) observed that it exceeds the expectations of the patient and viewed it as essential for a quality service.

4.4 Ambient Condition

Although most patients are able to adapt or resist unfavourable ambient conditions.

However in case of ICU patient or one who has had a serious operation, it may not be so.

‘Ambient condition’ is significant contributing factor of this study with variance 11.338%

and Eigen value 1.230. The impact of Patients wardrobe on patient satisfaction is less significant however their willingness to pay for lockable wardrobe is significantly high.

(Eckerlund& Nathorstböös, 2000).

4.5 Physician Attitude

Recently, studies done by Hojat et. al. (2010); Menendez et. al. (2015), noted correlation between patient satisfactions with physician empathy. Studies highlighted the significance of physician attitudes towards patient in health care services and in overall patient engagement and satisfaction.

Patient satisfaction is significantly related to overall improved communication.

Comstock et. al., (1982) noted a significant correlation among physicians’ information provision and patient satisfaction. Physician listening to patient and giving opportunity to ask questions is significantly correlated with patient satisfaction(Williams et. al., 1998).

Furthermore, Wasserman et. al., (1984) ascertained that empathic behaviors of physicians is correlated with satisfaction. The level of patient satisfaction is outcomes of physicians care (Helena, 2008; Rahmqvist & Bara, 2010; Otani, Herrmann & Kurz, 2010), communication skills and listening skills (Xiao& Barber, 2008), adequacy of information on illnesses (Birhanu et. al., 2010), treatments (Bjertnaes, Sjetne& Iversen, 2012), and possible information on complications after discharge (Wong et. al., 2011) by physicians are significantly associated with overall patient satisfaction. The factor named ‘Physician Attitude’ accommodated with two items with their variance of 11.227% and Eigen value 1.121, namely “Physician listens to patients carefully before their treatment; & Physicians answer the queries of the patients normally” is in line with past studies.

5 CONLUSION

The quality of services provided by health care center can be measured by patient satisfaction. Quality of services has positive influences on patient satisfaction and can be regarded as Health service quality indicators. The study found quality of care as strongest determinant of patient satisfaction accompanied with nutritional care, ambient condition and physician attitude among the service indicators. There is a need for longitudinal studies on the study area and other area to ascertain how patient satisfaction is affected by behavioral, cultural, and socio-economic differences, so that a standardized questionnaire be available for the future researcher, which is adaptable and robust enough for groups or countries for comparative study. The study enables healthcare administrators, policy makers, planner and researcher to recognize patients’ needs and make strategic plan accordingly for better quality services. Co-Creation of Value deliverables in the Environment of Patient Health Care services shall be the Mantra of the Day, Here it is worth quoting the worthy contributions of C.K. Prahlad who emphasized Power of Co-creation for reaping joint benefits, goes well.

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