INTRODUCTION:

“Today hospitals and other health care organizations are concerned with protecting consumer rights and are actively engaged in assessing patient client satisfaction as a strategy to improve quality, enhance market share, and meet regulatory and/or accreditation requirements” (Patricia 2005) . Consumer relationships in health care delivery refer to the multitude of encounters between the consumer (client, patient, and customer) and health care system representatives. Consumers differ culturally, ethnically, socially, physically, and psychologically. They have access to limitless amounts of information about health. However such access may vary to some degree by ethnicity and socio economic status.

Although some information that is available from the internet and other resources might not be valid, health care consumers tend to be better informed now more than they ever have been. A hospital's primary objectives are usually humanitarian, philosophical or regulatory and based on some perceived need. However, a problem may arise when what the patient 'needs' are different from what the patient 'wants'. Market research over the past few years has shown that hospitalized patients want a variety of amenities not associated with their need for reasonable good quality medical care. They want smiling, empathetic nurses and staff, a wide selection of foods for their meals and a quick response to their calls. To stay ahead of the competition, it is essential to keep the customer happy. Health care agencies as service organizations must be sensitive to whether the agency milieu is indeed a healing environment that supports and reinforces the actual quality of clinical care. In developing countries the health sector occupies an enormously important position in ensuring sustainable overall socio-economic advancement. The goal of the health care team is to provide the best quality of health care and service to the patient. Providing satisfying and meaningful service is not easy. Every consumer is different, and every situation is different. How things are done and how needs are met vary in each situation. Patient's satisfaction denotes the extent to which health care needs of the clients are met to their requirements. Patients carry certain expectations before their visit to hospital and the resultant satisfaction or dissatisfaction is the outcome of their actual experience.¹ Increasingly, manufacturing and service organizations are using customer satisfaction as the measure of quality. Increasing awareness of the general public regarding healthcare issues, public expectations from healthcare providers, availability of multiple healthcare resources to some people and increasing costs of treatment all have a definite bearing on the level of patient satisfaction from hospital facilities. The aim of this study was to assess the inpatient satisfaction about different aspects of hospital care. Measurement of patient satisfaction is expected to play an increasingly important role in the growing push toward accountability among health care providers overshadowed by measures of clinical processes and outcomes in the quality of care equation. Evaluation of the quality of health care is a complex and challenging process. Currently, there is an emphasis on the use of outcome indicators as a measurement of the quality of health care. Patient satisfaction is a category that has received attention as a useful indicator of the quality of care in consumer-driven health care systems. Measurement of patient judgments about quality of inpatient care and health outcomes is advancing rapidly worldwide, mainly for two reasons: first of all, patients are in an excellent position to evaluate certain aspects of the process of care. Secondly, learning about what consumers want from their health care system and what quality care means to them offers decision-makers a better understanding of their expectations. Patient satisfaction ratings, along with measurable health care outcomes, are important data used by health care organizations to provide quality care and to maintain a competitive edge. Health care organizations collect patient satisfaction data and want high ratings, so much so that they advertise their ratings in the community. Standard setting organizations such as the Joint commission and the National Quality Forum include patient satisfaction as a quality indicator. The patient’s satisfaction and perception of the quality of care are affected by patient - centered care which focuses on individual needs and preferences.

MATERIALS AND METHODS:

This quantitative, non experimental descriptive survey was conducted in a selected tertiary care hospital of Kerala State. A total number of 210 subjects were selected using convenient sampling, a method of non probability sampling technique. Patients who are admitted during the study period, atleast three days in wards mainly medical, surgical, ENT, orthopedics, neurology, nephrology, and gynecology wards, and willing to participate, in the age group of 20 to 70 years were included in the study. But patients form special rooms and psychiatric ward, who can’t give an adequate response to the questionnaire, who cannot understand English or Malayalam were excluded from the study. A demographic data sheet, a four point rating scale containing 18 items to assess inpatient satisfaction regarding service of doctors (3) service of nurses (5) service of paramedical staff (2), general facilities of hospital (5), payment facilities(3), were developed after thorough review of literature. Validity was established by seeking opinion of 3 experts from the field of medicine and administration. A pilot study was conducted among 21 subjects to establish the feasibility of study. No modifications were made in the tool or study protocol after the pilot study. Permission to conduct the study was obtained from the concerned authorities and informed written consent was obtained from the subjects before data collection. After collecting data using developed tools, a focus group discussion was arranged on inpatient satisfaction among 20 patients after discharge done at the last. Analysis was done using descriptive (mean, SD) and inferential statistics (Chi-square) at .05 level of significance.

FINDINGS:

Findings of the study revealed that majority of subjects belonged to the age group of 20-30 years (35.24%), female (57.14%) married(77.62%), educated till high school (43.81%), were unemployed (50%), family income <2000/month (61.43%),average duration of hospital stay was 4-6 days (31.43).

Patient satisfaction about physician competence to treat their diseases (99.05%), regarding the time duration which the physicians spent with them during rounds (97.62%), physician communications to them about their diseases and treatment (97.14%) and overall 72.86% were highly satisfied, 27.14% satisfied regarding service of doctors.

Patient satisfaction about the reception of ward staff during admission (98.57%), related to bed and bed linen provided for them during admission (91.43%), nurses communication in meeting their needs and problems (96.66%) care of nursing staff (99.52%) behavior and courtesy towards clients (98.57%) and overall 70.95%were highly satisfied,29.05% were satisfied regarding the care of nurses. In patient satisfaction about the ward assistant ‘s service (94.76%),behavior and courtesy of other departmental staff(lab, X-ray, scan, pharmacy)(90%) ,and overall 53.33% were highly satisfied,41.43% were satisfied and 5.24% were dissatisfied regarding the service of paramedical staff. Satisfaction was found to be 81.43% in canteen facilities, cleanliness 90.95% toilet and bathroom 86.66%, visiting hours followed in the hospital 90.47% and overall satisfaction regarding general facilities was found to be 95.72% dissatisfaction 3.8%, highly dissatisfaction (48%).

Inpatient satisfaction about the time duration which they spent to get their discharge bill 74.28%, 19.52% was dissatisfied and 6.2% were highly dissatisfied. About the amount they have to pay for their hospital stay 87.14% were satisfied, 10.48% were dissatisfied and 2.38% were highly dissatisfied. Related to hospital charges for various procedures and diagnostic tests, 84.76% are found to satisfied, 12.38% are dissatisfied and 2.86% were highly dissatisfied and overall satisfaction regarding the payment facilities highly satisfied (42.85%), satisfied (48.1%), dissatisfied (9.05%).

Table 1 shows the department wise level of satisfaction. It was found that none were dissatisfied and highly dissatisfied.

Table 1: Level of satisfaction in various departments N=210

Sl No	Department	Level of satisfaction
Sl No	Department	Highly satisfied (%)	Satisfied (%)
1.	Gynecology	63.33	36.67
2.	Neurology	56.67	43.33
3.	Orthopedics	76.67	23.33
4.	Nephrology	86.67	13.33
5.	ENT	76.67	23.33
6.	Surgical	73.33	26.67
7.	Medical	86.67	13.33
8.	overall	74.29	25.71

Table 2: Presentation of focus group discussion N=20

Sl.No	Patients Response	Frequency	Percentage
1.	Good communication by doctors	17	85
2.	Impressive behavior of nurses	18	90
3.	Long duration to get discharge bill	19	95
4.	Overcrowded pharmacy counters	18	90
5.	Clean and tidy toilets aand bathrooms	15	75
6.	Provision of drinking water in all wards	18	90

Table 2 shows the areas of concern by patients which was evolved during focus group discussion.It was also revealed that the level of satisfaction was not associated with educational status (p<0.03) and not age, gender, marital status, education, occupation, monthly income, no of days of hospital admission.

DISCUSSION:

Impact of quality consciousness in all sectors of life has augmented the need for health care facilities and institutions to keep themselves aware of the needs and expectations of their customers and end users. Inpatient satisfaction related to doctor’s service was 72.86% were highly satisfied and 27.14% were satisfied regarding the service of doctors while nobody was dissatisfied and highly dissatisfied. A similar study done by Arpitha et al in a tertiary care hospital had similar results where patient satisfaction ranged from 89.29% to 99.6% regarding the technical quality of doctors². Jawahar SK et al³ studied out patient satisfaction at a super specialty hospital in India shows relatively high level of satisfaction about the outpatient department services, logistic arrangement in the outpatient departments, waiting time, facilities, perception about the performance of staff, appointment system, behavior of staff, support service and any other suggestions of patients. Since the facilities provided by the hospital plays an important role in the satisfaction of the clients and for the speedy recovery. Above 70 percent of the patients were satisfied with the facilities, doctors, nurses, services and care, except on the few items like information support by doctor or nurses and the facilities for attendants etc. in a study conducted at a tertiary care hospital.⁴

CONCLUSION:

It was found that patients were satisfied with doctors and nursing services and their explanations, and good communication exist between the patients and the health care providers.

REFERENCES:

1. Brennan TA. Incidence of adverse events and negligence in hospitalized patients. Results from the Harvard Medical Practice Society, N Engl J M 1991; 324:370

2. Arpita Bhattacharya, Prema Menon, Vipin Koushal, K.L.N. Rao. (2003). Study of Patient Satisfaction in a Tertiary Referral Hospital, Journal of the Academy of Hospital Administration; Vol. 15, No. 1 (2003-01 - 2003-06)

3. Jawahar SK. A Study on Out Patient Satisfaction at a Super Specialty Hospital in India. Internet Journal of Medical Update 2007 Jul-Dec; 2(2):13-7.

4. L Lam Khan Piang, VK Tiwari, KS Nair, Sherin Raj, Harneet Kaur, Ramesh Gandotra. Indian J. Prev. Soc. Med. Vol. 43 No.4, 2012

Received on 25.03.2015 Modified on 05.04.2015

Int. J. Adv. Nur. Management 3(2): April- June, 2015; Page 124-126