Determinants of patient satisfaction in public hospitals and their remediabilities

Abstract

Problem Statement – Quality in healthcare consists of two aspects. While Technical quality primarily deals with accuracy of diagnosis and procedures and adherence to clinical protocols, service quality refers to the manner in which the health care services are delivered to patients. Since patients are often unable to accurately assess the technical quality of care, functional/ service quality is usually the primary determinant of patient’s perceptions of the quality. This study tries to crystallize ‘critical to quality’ attributes of services from array of wish list of what should be there. We also explored the possible solutions for these issues that can be implemented in public health facilities. Methodology – To develop questionnaires for Patient Satisfaction Survey, first of all ‘Voice of Customer’ (VOC) has been captured thought filed visits, interviews with patients and service providers, focus group discussions. Attributes distilled though VOC are arranged in an Ishikawa Diagram and further converted into a 10-point questionnaire for Outpatient and 20-point questionnaire for Inpatient services measuring patient perception on a five point ‘Likert’ scale ranging from poor to excellent. Feedback on this questionnaire has been taken on quarterly basis on a sample size calculated on 95% confidence level. Data would be analyzed and lowest two performing indicators would be identified for root-cause analysis and developing action plan. Data would further analyzed on Analytical Hierarchy Process Model by pair wise comparison to drill down Critical to Quality (CTQs). Relative weightage of CTQs would then be analyzed through Pareto analysis. Main Findings - Data analysis of patient satisfaction survey across 9 district hospitals of Bihar shows that patient are most dissatisfied with non-availability of drugs and quantum of consultation time in OPD, while for IPD patients, cleanliness of toilets mattered most. At the same time, non-availability of drugs is still most dissatisfying factor. Further, it is emerges through Pareto analysis that more than enhancement by 60% in patients’ satisfaction could be achieved by addressing top three attributes of dissatisfaction. Finally on Kano mode, non-availability of drugs and perception of not getting enough consultation time are ‘Dissatisfies’ , Cleanliness, ready availability of diagnostic services and prolong waiting times as ‘performers’. Nice and courteous behavior of staff of Public Hospitals are the ‘Delighter’ for the patients. Discussion - Services unlike products are produced and consumed at the same time. This characteristic increases the importance of the care provider –patient relationship as well potential for variation in service quality. With the advent of Right based approach in health, patients are no more treated as targets or beneficiaries. They are customers or right seekers and service providers should try to meet their expectations. Patient satisfaction survey is one such tool to measure, whether hospital services are meeting patients’ expectation or not. Patient satisfaction survey is an integral part of Quality Management System developed by NHSRC for Public Hospitals. These surveys helps in improving the service quality as service providers can focus on those issues, which are critical to patients and plan their services accordingly. Quality Function Deployment is one such tool that can be used for planning and implementing solutions.