Assessment of patient satisfaction with inpatient services at secondary level setting

Assessment of patient satisfaction with inpatient services at secondary level setting Saravanakumari A D.1, D. Thamarai Selvi.2, Rajesh Kumar R.3*, Paul S.4 DOI: https://doi.org/10.17511/ijphr.2020.i06.03 1 Saravanakumari Arumugham Dhanaraj, Assistant Professor, Department of Community Medicine, Government Villupuram Medical College, Villupuram, Tamil Nadu, India. 2 D. Thamarai Selvi, Associate Professor, Rajah Muthiah Dental College, Chidambaram, Tamilnadu, India. 3* Ramasamy Rajesh Kumar, Research Scientist, College of Agriculture and Biotechnology, Zhejiang University, Hangzhou, China PR. 4 Sayan Paul, Research Scholar, Department of Biotechnology, Manonmaniam Sundaranar University, Tirunelveli, Tamil Nadu, India.


Introduction
Health care system in the world is moving from a set of purely provider-based systems to receiverbased systems. In this regard, patients' satisfaction is an essential component of quality assessment.  Health professionals are also benefited and guided by the outcome of these surveys. The feedback received is likely to help them in identifying potential areas for service improvement. The ability to satisfy patients is vital for many reasons. It is mainly helpful for hospitals to establish a patientoriented quality health service rather than focusing only on the patient's disease. Improvement in the service quality involuntarily uplifts the reputation gained by the health care institution.
Patient satisfaction is also a valuable competitive tool, to increase staff motivation. Recent research has shown that service satisfaction can significantly enhance patients' quality of life. Further awareness among medical practitioners on the effect of patient characteristics over patient satisfaction will enable the provision of patient-oriented health care, satisfying both the health care provider and the patient. It will help strengthen patients' trust and confidence in the health care professional [5].
There are various methods for assessing patient's satisfaction including using electronic forms, phone calls, and face to face interviews with patients.
Performing the Satisfaction Survey using a questionnaire has the features of posing more questions, reducing the possibility of bias, and also cost-effectiveness.
This study was therefore undertaken to evaluate the level of patient satisfaction related to different parameters of quality health care

Sample size determination
In a pilot study out of 50 patients interviewed, 36 of them were highly satisfied in all facilities available in the hospital.
The required sample size has been 100.
A total of 100 inpatients aged above 18 years who got admitted from February 2015 to April 2015 were the study population. Respondents were assured of confidentiality. All respondents were encouraged to express their opinion freely and fairly. Precautions were also taken to obtain unbiased results. Schedules are explained by the researcher personally in a vernacular language and were filled by her personally. Since the investigator herself carried out the survey, there was no problem of observer variation as far as the study is concerned.

Analysis
The surveyed questionnaires were collected and coded in the MS Excel database and analyzed using SPSS version 20. Descriptive statistics were performed on socio-demographic variables. The satisfaction score was expressed as the mean and standard deviation for overall satisfaction with the health services.

Results
A total of 100 patients from the inpatient department were included in the study. It was observed in the present study, out of 100 in patients distribution among the study subjects were equal.
34% of inpatients belong to the age category of 30-45 years. 33% of respondents were illiterates. 5% were graduates indicating higher educational status.
Majority of the subjects (89%) were married. Regarding occupation, 59% belonged to the unskilled group. 48% of participants belonged to families having monthly income less than 3000.
Recording the place of residence, data shows that the majority (95%) of the patients were from rural areas ( Table-1). 90% of inpatients came to the hospital of their own and 10% of patients were referred into the hospital.   The present study shows 95% of the inpatients were satisfied with doctors to visit and 97% were satisfied with nurse's promptness in answering patients call which is consistent with the study by Sumeet et al. [17] in Punjab tertiary care hospital shows that satisfaction levels regarding the quality of service by nursing and paramedical staff were found to be high as 98 % of the patients started the no. of the nurses as adequate. 83% of patients affirmed that they were provided medication promptly by the nurses and rated communication/behavior of the nurses as good /pleasant and satisfactory in 23 % and 59 % of the cases respectively, but 18% of respondents described their behavior as harsh/ rude [17].
In the present study, 81% of the inpatients were satisfied with the quality and quantity of the hospital diet. 85% were satisfied with the timeliness of serving diet. A study by Sumeet et al. [17] in Punjab tertiary care hospital observed 18% of the patients, all of them were pregnant females in the obstetrics ward and were provided meals under JSSK.
Concerning the infrastructure and basic amenities in the hospital, 71% gave a neutral response and 26% were satisfied with the drinking water facility. 100% of the inpatients gave neutral responses towards the ambulance, blood bank, and suggestion box facilities.48% were satisfied with the parking facility which indicates that inpatients were either not aware of the amenities present or a need to utilize did not arise.
A similar finding was observed in Sumeet et al. [17] study that, 21% of patients reported unavailability of drinking water, 43 % reported unavailability of toilets/handwashing facility in the wards. 62% and 40% were dissatisfied with the cleanliness in the toilets and wards respectively. Around 63% of the respondents were dissatisfied with the convenience of parking [17].
Regarding the overall cleanliness of the hospital present study observed satisfaction level was found to be high with 80% which shows the changing attitude and concern towards patients services by the government hospitals which has to be highly appreciated.
The overall satisfaction level of inpatients was found to be a mean of 3.9 could be probably due to the cleanliness of the environment, nursing care, and health improvement that contributes to the satisfaction of inpatients.

Limitations
The information on the total number of patient satisfaction surveys carried out in Asia is limited.
The health sector occupies an enormously important position in ensuring sustainable overall socioeconomic advancement in developing countries.
Health provider related factors such as type of hospital, technical and physical facilities and quality of health professional-patient relationship can change patients' satisfaction. Their effects on satisfaction may vary from country to country.
Inadequacies in the health sector lead to a vicious cycle of ill-health and poverty. Therefore, it is important to receive regular feedbacks periodically from the patients' point of view to modify the quality of current health service.

Conclusion
The response of the patients depends upon their socio-economic profile and perceptions. The majority of the respondents were from a rural area with a low socio-economic status that contributes to the overall satisfaction. Content analysis revealed that the cause of dissatisfaction was poor utilities like water supply, linen, lights, and fans, etc., and poor maintenance of toilets. Infrastructure and architectural corrections need to be made to enhance the comfort and satisfaction of the patients. Hospital managers and staff need to be encouraged in using the Patient Satisfaction Survey (PSS) result in improving the quality of services in the hospitals (inculcate quality culture among the staff) rather than using it as an audit tool in evaluating the performance of the staff or hospitals.
What does the study add to the existing knowledge?
Patient satisfaction study is a major contribution to knowledge. Only a few studies have been done in secondary care settings that too in government hospitals in the state. The questionnaire, data collection methodology adopted is another contribution to knowledge. The feedback received from the study had made the author identify potential areas for service improvement. Cleanliness of the government hospital premises highly appreciated by patients shows the changing health care system towards patient-oriented quality health services.