Introduction
Patient satisfaction can be defined as the degree of congruency between a patient’s expectations of ideal care and his /her perception of the real care (s) he receives.1 It is a multidimensional aspect, represents a vital key marker for the quality of health care delivery and this is an internationally accepted factor which must be studied repeatedly for smooth functioning of the health care systems.
The three principle domains of patient satisfaction are delivery of essential medical care, treatments sought by patients and their families, and the provider activities and behaviors.2, 3, 4 Patient satisfaction survey are important from the view of improvement of quality of services and to attain the maximum satisfaction of the patients. By assessing the patient satisfaction, one can identify the gaps in the existing services and to rectify these to ensure quality care to the patients.5 These findings can help in prioritizing resource allocation, transformation of health-care staff, and better management of health services.6
In a study conducted by Verma et al. in a newly established tertiary care hospital in North India, 77% of the patients were satisfied with the IPD services of the hospital.7 Satisfaction of the patients relies on many clinical and non-clinical factors like housekeeping, hygiene, nursing care, medical care, staff behavior etc. More the problems faced in these aspects, lower is the satisfaction level among the patients. Not many studies have been conducted regarding the evaluation of satisfaction level of patients with the IPD services provided by a tertiary care center in north India.
Therefore the present study was planned to identify the problems faced by patients and their level of satisfaction during their stay in the hospital so that the feedback loop could be completed and appropriate measures could be taken in order to satisfy 100% patients.
Materials and Methods
It was a cross sectional study conducted among the IPD patients of a tertiary care hospital. The study was conducted in the indoor wards of SGRD Hospital (private tertiary care teaching institute) attached to the departments of Medicine, Surgery, Obstetrics and Gynecology, Pediatrics, Oncology and ENT. Study population consisted of conscious and cooperative Indoor patients or primary attendant (in case of Pediatrics patients). A self-structured questionnaire was used to collect the information regarding various aspects of hospital care. It also contained questions regarding Socio-demographic profile of the respondent. Questions regarding twelve potential problems were asked which could have been faced by the respondents during their stay in the hospital like quality of care provided by paramedical staff, quality of communication by attending physician, hygiene of washrooms, quality of food and water available. The questionnaire was administered by the authors themselves after taking verbal consent of the respondent. The questionnaire was translated into vernacular language before administration. After informing the respondent about the objectives of the study, the respondents were interviewed and the questionnaire was filled accordingly. The study was conducted for three months, i.e. November 2023 to January 2024. Convenient sampling method was used to collect data. A total 316 patients were contacted out of which 226, who met the eligibility criteria and gave consent were included in the study. The indoor patients who were too sick to respond, admitted in high dependency units (ICU, CCU, Trauma units) were excluded from the study. Checklist provided in the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) guidelines were adopted and stringently followed. The collected data was coded in MS Excel database and analyzed by using SPSS (IBM) version 21.0 and valid conclusions were drawn. Complete confidentiality of every respondent was maintained. Prior approval of the ethical board was obtained before beginning the survey via reference number SGRD/ IEC/ 2023-270.
Results
A total of 226 respondents were interviewed. Out of them, majority (93.8%) were the patients themselves and the rest (6.2%) were their primary attendants. 52.2% of the respondents were females and the remaining (47.8%) were males. Age wise distribution of the respondents showed that majority (82.7%) of them belonged to the age group of 26 to 70 while only 7.5% and 9.7% belonged to <_25 and >70 respectively (Table 1). The mean age of the study subjects was 48.64±16.41. About 2/3rd (67.3%) of the respondents belonged to rural areas and the remaining 1/3rd (32.7%) were urban residents. On inquiring about the educational status of the respondents, about 1/3rd (32.7%) of respondents were matric pass and above, 42% were below matric whereas about 1/4th (25.2%) of the respondents were illiterate. 47.3% of the respondents were engaged in an income generating activity and rest (52.7%) were not engaged in any kind of income generating activity (Table 1).
As far as health insurance is concerned, 54% of the patients were having health insurance and the rest 46% were not having any health insurance. When asked about the reason for selection for this hospital, almost 40% of the respondents told that the hospital was recommended to them by a friend or relative, 20% of respondents selected the hospital on recommendation of a healthcare provider, 27% Respondents selected based on their personal previous experience and the rest (12.8%) had some other reasons for selection of this hospital (Figure 1). As far as referral to the IPD ward is concerned, 65.5% of the patients were referred from OPD, about 1/4th (27.4%) from emergency and the rest (7.1%) were referred to this hospital by any other hospital (Figure 2). When inquired about the problems faced, 46% of the respondents faced difficulty in accessing the hospital and the rest (54%) of the respondents didn’t face any difficulty in accessing the hospital (Table 2) 12.4% of respondents found admission process to be tedious.
The PMJAY insurance of 1/4th (25.2%) of the patients was not honored in the hospital. Approximately 1/3rd (32.7%) of the patients had to bear out of pocket expenditure, Inspite of being insured. 13.7% of the Respondents faced difficulty in availing the prescribed medicine in the hospital. 45.6% of the respondents felt that the overall cost of treatment in the hospital was higher than expected (Table 2). When asked about the satisfaction regarding various services provided by the hospital, majority (92.9%) of the respondents were satisfied with the quality and quantum of communication by the attending physician and a similar proportion of respondents (92.9%) were satisfied with the quality of care provided by the paramedical staff (Table 3). 91.2% of the respondents found that the condition of the washrooms was hygienic. 96.9% of the respondents didn’t face the problem of frequent disruption of electricity supply. 97.3% of the respondents were satisfied with the quality of linen provided by the hospital and sanitary conditions of the ward (Table 3). It was found that majority of the respondents (94.2%) were ready to recommend this hospital to other people for getting their treatment. Overall satisfaction in this survey was found to be 87.2%. A significant association was found between the overall satisfaction of the respondent with the availability of prescribed medicines (p=.02) and unexpected higher cost of treatment (p=.000).
Table 1
Socio-demographic profile of the respondents
Table 2
Association between level of satisfaction and problems faced by the respondents
Table 3
Satisfaction of the respondents with various services provided in the hospital
Discussion
The present study was conducted in a tertiary care institute in Punjab. In this study 52.2% of the respondents were females and 47.8% respondents were male. A similar study conducted in a tertiary care institute in north India, also found that 42.9% of the respondents were males and 57.1% were females.7 82.7% of the respondents in this study belonged to the age group 26 to 70 years which is in line with the study conducted by Qadri et al. in Rural Haryana8 in which over 87% of the respondents were over 30 years of age. Mean age of respondents was 48.64±16.41 which is similar to the mean age of respondents (56 ± 11.8) in a study conducted by Rajagopal et al.9 In the present study, 67.3% of the respondents were residents of rural area and 32.7% of the respondents were urban area residents which is in contrast to the study by Verma et al. in which 68.7% of respondents belonged to urban area and 31.3% of respondents were rural area residents.7 The difference could be because of study settings. The present study was conducted in a tertiary care institute that caters to rural population. 32.7% of the respondents in this study were matric pass and above in education, 42% were below and 25.2% were illiterate which is in contrast to study by Qadri et al. in which 44% of respondents were illiterate.8
In this study, 47.3% of the respondents were engaged in an income generating activity whereas 52.7% of respondents were not engaged in any kind of income generating activity. In our study, 54% of the Respondents were having health insurance rest (46%) were not having health insurance which in contrast to study by Verma et al.7 in which only 2.8% of respondents had health insurance. In the present study, Almost 40% of the respondents told that the hospital was recommended to them by a friend or relative, 20% of respondents selected the hospital on recommendation of a healthcare provider, 27% respondents selected based on their personal previous experience and 12.8% had some other reasons for selection of this hospital.
As far as referral to the IPD ward is concerned, 65.5% of the patients were referred from OPD, about 27.4% from emergency and 7.1% were referred to this hospital by any other hospital. In this study, 46% of the respondents faced difficulty in Accessing the hospital whereas in a study by Qadri et al.,8 84% of respondents faced difficulty in accessing the hospital. 12.4% of the respondents in our study faced problem in admission process and found it tedious whereas in a similar study in Ethiopia,10 6.8% and 27.1% of the participants were very dissatisfied and dissatisfied respectively with the admission process of the hospital. PMJAY insurance of 25.2% of the patients, in the present study, was not being honored. 32.7% of the patients in this study had to bear out of pocket expenditure Inspite of being insured. In the present study, 13.7% of respondents faced difficulty in availing the prescribed medicine in the hospital which is similar to the findings of Asamrew et al.10 in which 2.5% and 16.8% of participants were very dissatisfied and dissatisfied respectively with availability of drug and supply in the hospital.
In the present study, 45.6% of the Respondents felt the overall cost of treatment to be higher than expected. This is in concordance with a study conducted by Singh et al. in which 73.4% of the patients were satisfied with the cost of treatment received.11 92.9% of the respondents of this study were satisfied with quality and quantum of communication by the attending physician which is in line with the findings of Garg et al.6 who found that 95% of the respondents labeled the care given by doctors as excellent/ good and 85% labeled that doctors were respectful. Kumari et al.12 found that 62.3% of the doctors explained the patients about their disease and 70.9% of patients were explained their treatment. In the present study, 92.9% of the respondents were satisfied with the quality of care provided by the paramedical staff which is in line with the findings of a study conducted by Pande et al. in which overall satisfaction level given by patients to behavior and work of clinical staff (Doctors, Nurses & Paramedical staff) was 96.22%.13
In the present study, 91.2% of the respondents found the condition of the washrooms hygienic and were satisfied which is much higher than reported by Aleena et al.14 96.9% of the respondents of this study didn’t face the problem of frequent disruption of electricity supply. 97.3% of the respondents of this study were satisfied with the quality of linen provided by the hospital and sanitary conditions of the ward which is much higher than as reported by Raju et al.15 in a similar study where, in regard to cleanliness of the hospital environment, 33% and 46% of respondents chose excellent and good respectively. In the present study, 94.4% of respondents were ready to recommend this hospital to other people for getting their treatment which is similar to the findings of Singh et al.11 where 80.5% of the patients agreed to motivate their friends/ relatives to visit the respective hospital.
In the present study overall satisfaction of the patients with the services received from the hospital came out to be 87.2% which is similar to the figures reported by Kumari et al.12 in Lucknow (81.6%), higher than as reported by Verma et al. (77%)7 and Qadri et al. (79.3%)8 but lower than as reported by SK Jawhar et al.16 (90-95%). In our study overall satisfaction of the respondents was found to be significantly associated with the availability of prescribed medicines (p=.02) and cost of treatment (p=.000).
Conclusion
The study suggests that majority of in patients are highly satisfied with the IPD services provided by the hospital which is highly motivating but every attempt must be made to form the new policies and reform the existing ones to achieve 100% satisfaction of patients. A number of potential barriers have been discovered in this study which may influence patient satisfaction like accessibility, which could be improved by running buses on payment basis etc. Moreover, periodic patient satisfaction survey must be institutionalized so as to continuously improve hospital services. To further improve the patient satisfaction, patient counselling and health education cells could be open, where patients and their relatives could solve their queries, if any.
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