Assess the Level of patient Satisfaction on Quality of Out patient Services provided in Outpatient Department at Pondicherry Institute of Medical Sciences, Puducherry

Sivaranjeni. V*

Lecturer, Department of Medical and Surgical Nursing, Bharath College of Nursing,

Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu – 600073.

*Corresponding Author E-mail: sivaranjenia@gmail.com

ABSTRACT:

Patient satisfaction with a health care provision is based on satisfaction with numerous aspects of organization. Satisfaction with quality of health care facility includes a delicate balance between expectation of services and care received by patients. Out Patient Department (OPD) is a very crucial department of any hospital being the first point of contact between the patient and the hospital staff. It reflects the functioning of the hospital as OPD is visited by large section of community. In developed countries, patients are highly satisfied (90-95%) with the basic services provided at OPD, while in developing countries it has been shown that, the range of patients’ satisfaction vary between 95% to <50%. So, it is important to assess the level of patient satisfaction on quality of outpatient services. Objectives: To assess the level of patient satisfaction with quality of outpatient services provided at OPD. To find out the association between the patient satisfaction with the selected demographic variables. Methodology: Non experimental, Descriptive study was conducted among 265 outpatients attending Medicine OPD. Convenience sampling technique was used in this study. The data related to demographic variables and level of patient satisfaction on quality of outpatient services was collected from every participant. 20 minutes was spent for each patient to collect the data. Results: Among 265 Outpatients, Majority of the study participants 178(68%) were fairly satisfied, 57(21%) of them were completely satisfied and 30(11%) of them were dissatisfied with the quality of patient services provided at medicine OPD, PIMS Puducherry. Fisher's Exact Test was used to find out the association between the Level of Patient Satisfaction on Quality of Out Patient Services with their selected demographic variables. The demographic variables such as age, gender, education, occupation, residence and previous visit to medicine OPD for consultation were not associated with the Level of Satisfaction with regard to the quality of services provided at OPD. Conclusion: The findings of the study revealed that the majority of the patients were fairly satisfied with the quality of the services received at OPD. So, there is a need for improvement in the services provided at the services provided at the OPD.

KEYWORDS: Quality of Care, Outpatient Department, Patient Satisfactions, Services Provided at OPD

INTRODUCTION:

Out Patient Department (OPD) is a very crucial department of any hospital. It is the starting points of contact between the health care professionals and the patient.

The outpatient department of the hospital is visited by large number of the people in the community. The staff nurses in the OPD should be helpful, cooperative and efficient to manage the critical situations. Now a day’s quality of health care becomes difficult for the health care professionals.

Patient satisfaction with a health care provision is based on satisfaction with numerous aspects of organization. Satisfaction of patient with quality of health care facility includes a delicate balance between expectation of services and care received by patients. Behaviour of staff nurses, interaction of physician with the patient, issues with the administration in providing health care to the patient, physical environment are the critical dimensions of the health care organization.

The quality of patient care is determined by patient satisfaction towards treatment, health care professionals adhere to the treatment protocol, census of patient both in outpatient and in inpatient department. Decreased in level of patient satisfaction is seen wherever there is a struggle between the patient’s expectations and the service received.

At National level Chennai, A descriptive study was done to assess patient satisfaction in outpatient department of a private hospital. The study was conducted among 50 patients attending OPD by using convenient sampling method. Semi structured satisfaction questionnaires were used to collect the data. Result reveals that 40% of the patients are satisfied, 34% of the patients are dissatisfied, 14% are very satisfied, 6% are very dissatisfied, 4% are extremely satisfied about the waiting time in reception. The study concluded that many patients was satisfied on waiting time in the reception.

At Regional level, A descriptive study was done to assess level of satisfaction on nursing care received by patients admitted in orthopaedic ward at Pondicherry institute of medical sciences, study results showed that 3% had poor satisfaction, 7% had moderate satisfaction and 86% had good satisfaction.

OBJECTIVES:

1. To assess the level of patient satisfaction with quality of Out patient services provided at OPD.

2. To find out the association between the patient satisfaction with the selected demographic variables.

HYPOTHESIS (H1):

There is a significant association between the patient satisfaction with the selected demographical variables.

OPERATIONAL DEFINITIONS:

Level of Patient Satisfaction:

In this study it refers to the subjective responses given by patients with regard to the health care services received by them in the outpatient department. The patient satisfaction level was measured by using patient satisfaction questionnaire (PSQ) and it is categorized as fairly satisfied, completely satisfied and dissatisfied.

Quality of Outpatient Services:

In this study, it means the services received by the patient from doctors, nurses and hospital. Medical services include explanation about the treatment, privacy given for patient, time spend for treating the patient. Nursing services includes caring patient with respect, clarifying the patient doubts and listening to patient problem and General services includes facilities for toilet, parking, seating and water facilities as measured by using patient satisfaction questionnaire (PSQ).

DELIMITATIONS:

The study is delimited to patients attending Medicine OPD at Pondicherry Institute of Medical Sciences.

METHODOLOGY:

Research Approach and Design:

Quantitative research, Non-experimental- Descriptive research design was used to assess the level of patient satisfaction with quality of Outpatient services provided at OPD.

Study Settings:

This study was conducted in OPD at PIMS, Puducherry. It is a multispecialty hospital with 740 beds. This hospital was selected on the basis of feasibility and availability of the sample.

Population of the Study:

Out patients who are attending the OPD are considered as a Population.

Sample:

In this study the participants were out patients attending OPD at Pondicherry Institute of Medical Sciences.

Sample Size and Sampling Technique:

Convenience sampling technique was adopted and the sample size was 264 out patients from the OPD.

Sampling Criteria:

Inclusion Criteria:

1. Both male and female outpatients from 18 years and above.

2. Both new and old patients attending OPD.

Exclusion Criteria:

1. Out Patients who are not able to understand and speak Tamil or English.

2. Patients who are very sick or not oriented.

Tool for data collection:

Section: I

It consists of demographic variables such as age, gender, educational status, occupational status, residence and number of times visited to OPD.

Section: II

Satisfaction Scale to assess the level of patient satisfaction on quality of Outpatient services provided. Self -prepared satisfaction scale to assess the level of satisfaction on quality of services provided at OPD. The patient’s satisfaction questionnaire (PSQ) consists of dimensions including satisfaction with registration services (3 items), Nursing services (6 items), medical services (4 items), General services (11items) and overall (1 item). The possible answers to the PSQ items were Dissatisfied, fairlysatisfiedandcompletely satisfied which were scored from 0 to 2 respectively.

Scoring Procedure:

The investigator will score 0 for dissatisfied and 1for fairly satisfied and 2 for completely satisfied.

S. No	Patient satisfaction	Score	Percentage
1.	Completely satisfied	34-50	67-100 %
2.	Fairly satisfied	17-33	33-66 %
3.	Dissatisfied	0-16	0-32%

Validity of the Tool:

The tool along with the blueprint of the study was validated by five experts. The suggestions of experts were incorporated and the tool was modified and finalized.

Ethical Considerations:

1. Ethical clearance was obtained from the Institutional Review Board.

2. Permission was obtained from the HOD for OPD Department.

3. The study participants were explained about the nature and purpose of the study and written informed consent was obtained.

4. Confidentiality of the data was maintained throughout the study.

Reliability of the Tool:

The measurement of degree of consistency and accuracy with which an instrument measure actually for what it is designed. The three main attributes of a reliability scale are stability, homogeneity and equivalence. The Reliability of the tool was assessed using inter ratter reliability. The r-value is 0.75 the tool was found to be feasible to carry out the main study.

Data Collection Process:

After approval from Institutional Review Board, formal permission was obtained from the HOD, OPD department. Study participants were selected by using convenience sampling. The purpose and the process of the research were explained to the study participants and written informed consent was obtained from the study participants. The data was collected over a period of 4 to 6 weeks in the month of September and October 2020 in the medicine OPD at Pondicherry Institute of Medical Sciences. Data related to registration and general aspect was collected when the patient was waiting to consult the physician and data related to doctor and nursing services was collected after the consultation. By using interview method, the data was collected from the study participants for demographic variables and patient satisfaction level towards quality of outpatient services.

Data Analysis Plan:

Descriptive and inferential statistics was used to analyze the data. Frequency and percentage were used to analyze the demographic variables and patient satisfaction level towards quality of Outpatient services provided. Fisher exact test was used to find the association between patient satisfaction level with demographic variables.

RESULT:

Section I: Distribution of study participants accordingtodemographicvariables.

Table 1: Frequency and Percentage distribution of Demographic Variables of study participants.

Section II: Distribution of study participants according to the satisfaction of services received at OPD.

Table 2: Frequency and Percentage distribution of satisfaction on quality of services received at OPD.

Section III: Assessment of the level of patient satisfaction on quality of outpatient services provided at OPD.

Figure 1: Level of Patient satisfaction on quality of services provided at Medicine OPD.

Section IV: Association between levels of patient satisfaction on quality of outpatient services with their selected demographic variables.

Table 3: Association between the Level of Patient Satisfaction on Quality of Out Patient Services with their selected demographicvariables.

The study result shows that Out of 265 study participants 74(28%) of them were in the age group from 18 to 34 years, 141(54%) were females. 94(36%) had completed diploma/degree course. 134(50%) were unemployed, 139(53%) were staying in urban area and 183(69%) of them had previously visited OPD at PIMS for consultation. Among 265 participants 178(68%) of the study participants were fairly satisfied, 57(21%) completely satisfied and 30(11%) were dissatisfied. (57%) of study participants were fairly satisfied about the information received regarding the consultant area and 78(29%) of study participants were dissatisfied about the Queue system for their registration.

76(29%) of were dissatisfied about nurses explanation regarding procedure and treatment.With regard to the medical services 163(62%) were fairly satisfied with time taken to meet the physician, 34(13%) were dissatisfied with the physician treating the patient with dignity and providing privacy to the patient during treatment and consultation.With regard to the general services 163(62%) were fairly satisfied with the clean environment around the OPD 130(49%) were fairly satisfied regarding the items of “availability of the stretcher”. The demographic variables gender is association with the Level of Satisfaction at P value 0.021

Section I: Distribution of study participants according to demographic variables:

Table 1: Frequency and Percentage distribution of Demographic Variables of study participants n=265

Sl. No	Demographic Variables	Categories	Frequency (f)	Percentage (%)
	Age	18-34years	74	28
		35-44years	60	23
		45-54years	71	27
		≥55 years	60	22
	Gender	Female	124	46
	Gender	Male	141	54
	Educational Qualification	Illiterate	49	18
		Primary	21	8
		Highschool	72	27
		Highersecondary	29	11
		Diploma/Degree	94	36
	Occupation	Employed	131	50
	Occupation	Unemployed	134	50
	Residence	Rural	126	47
	Residence	Urban	139	53
	Previouslyvisited the OPD	Yes	183	69
	Previouslyvisited the OPD	No	82	31

Section II: Distribution of study participants according to the satisfaction of services received at OPD.

Table 2: Frequency and Percentage distribution of satisfaction on quality of services received at OPD. n=265

Sl. No.	Item	Completely satisfied		Fairly satisfied		Dis-satisfied
Sl. No.	Item	n	%	n	%	n	%
I	Registration services
1	Time taken for your registration	66	25	127	48	72	27
2	Queue system	51	20	136	51	78	29
3	Informed about the directionfrom registration counter to OPD area.	52	20	150	57	63	23
II	Nursing services
4	Nurses listen to your problems	67	25	154	58	44	17
5	Nurses are respectful/Nurses manner	85	32	167	63	13	5
6	Nurses are helpful/ accessible whenever there isneed	74	28	149	56	42	16
7	Nurses gave adequate explanation about procedure /treatment and provide patient education.	64	24	125	47	76	29
8	Nurses clarify your doubts	66	25	135	51	64	24
9	OPD is having enough nursing personnel.	79	29	121	46	65	25
III	Medical services
10	Time taken for patient to meet the doctor	81	30	163	62	21	8
11	Thephysicianspentenoughtimewhile examining you	91	34	156	59	18	7
12	Physician treats you with dignity & providesprivacy during consultation.	75	28	156	59	34	13
13	Listentopatientsquestionsandprovides information about disease and treatment.	84	32	155	58	26	10
IV	General services
14	Accessibility to OPD	56	21	143	54	66	25
15	Parking facility	46	17	155	58	64	25
16	Waiting area in OPD	48	19	155	58	62	23

Table 1 Reveals the frequency and percentage distribution of demographic Variables ofstudy participants. Out of 265 participants, 74(28%) participants belong to the age group of 18 to34 years, 141 of them (54%) were females, 94 of them (36%) had completed Diploma/Degreecourse, 134(50%) of them were unemployed, 139(53%) of them were staying in urban area and 183(69%) of the participants previously visited medicine OPD at PIMS for consultation.

Table 2 shows that (57%) of study participants were fairly satisfied about the information received regarding the consultant area and 78(29%) of study participants were dissatisfied about the Queue system for their registration. 76(29%) of were dissatisfied about nurses explanation regarding procedure & treatment.With regard to the medical services 163(62%) were fairly satisfied with time taken to meet the physician, 34(13%) were dissatisfied with the physician treating the patient with dignity and providing privacy to the patient during treatment and consultation.With regard to the general services 163(62%) were fairly satisfied with the clean environment around the OPD 130(49%) were fairly satisfied regarding the items of “availability of the stretcher”.

Section III: Assessment of the level of patient satisfaction on quality of outpatient services provided at OPD

Figure 1: Level of Patient satisfaction on quality of services provided at Medicine OPD

Section IV: Association between levels of patient satisfaction on quality of outpatient services with their selected demographic variables.

Table 3: Association between the Level of Patient Satisfaction on Quality of Out Patient Services with their selected demographic variables. n=265

Sl. No.	Demographic variables		Level of Patient Satisfaction			P- Value
Sl. No.	Demographic variables		Completely Satisfied	Fairly Satisfied	Dis-satisfied	P- Value
1.	Age	18 - 34 years	16	48	10	5.771 NS
		35 - 44 years	12	40	8
		45- 54 years	15	46	10
		≥ 55 years	14	44	2
2.	Gender	Male	26	82	16	*0.021 S**
2.	Gender	Female	31	96	14	*0.021 S**
3.	Educational Qualification	Primary	4	17	0	0.422 NS
		High school	17	46	9
		Highersecondary	10	16	3
		Degree/diploma	19	64	11
4.	Occupation	Employed	19	85	27	0.146 NS
4.	Occupation	Unemployed	11	93	30	0.146 NS
5.	Residence	Rural	18	87	21	0.103 N S
5.	Residence	Urban	12	91	36	0.103 N S
6.	Previously Visited OPD	Yes	22	123	38	0.823 N S
6.	Previously Visited OPD	No	8	55	19	0.823 N S

NS = Statistically Not Significant (>0.05 p value)

S = Statistically Significant (< 0.05 p value)

Figure 1 shows that 178(68%) study participants were fairly satisfied, 57(21%) completely satisfied and 30 (11%) were dissatisfied with the services received in theOPD.

Table 3 Shows that there was a significant association between level of satisfaction on quality of patient service with Gender at P value 0.021.

DISCUSSION AND CONCLUSION:

The first objective was to assess the level of patient satisfaction with quality of Outpatient services provided at OPD.

· Among 265 participants 178(68%) of the study participants were fairly satisfied, 57(21%) completely satisfied and 30(11%) were dissatisfied.

· A descriptive study was done to assess the Patient Satisfaction in Outpatient Clinic of Newly Created Department of Geriatric Medicine at tertiary hospital, Uttar Pradesh. The result reveals that the medium satisfaction level was found in 56% and low and high satisfaction was found in 23% and 21% patients respectively. The study concludes that the there is a need to strengthen the manpower in outdoor clinic with better environment.

The second objective was to find out the association between the patient satisfactions with the selected demographic variables.

· There was a significant association between level of satisfaction on quality of patient service with Gender at P value 0.021.

· This result was supported by a cross sectional study which was conducted in Saudi Arabia on association between waiting time and patient satisfaction in outpatient clinics. The sample consists of 406 Patients. Multistage systematic random sampling technique was used in this study. The result showed that the Patients treated at the family medicine clinic were more likely to be satisfied than those seen in other specialized clinics.

IMPLICATIONS:

Nursing Practice and Nursing Education:

1. Train the nurses to treat the patient with respect

2. Short term in-service programmes about the importance of assessing patient satisfaction and quality of services provided at OPD can be organized among staff nurses and health care professionals.

Nursing Administration:

1. The nurse administrators can mobilize the needed resources for OPD settings and arrange for Triage system at OPD.

2. The nurse administrators can take part in regular inspections and do audit on level of patient satisfaction.

RECOMMENDATIONS:

1. The study can be conducted on larger samples

2. CNE can be arranged for the staff to improve quality of care

3. The study can be conducted in corporate, Government and Private hospital

4. Future studies can include more than one hospital in both private and public sectors.

CONCLUSION:

A study to assess the Level of Patient Satisfaction on Quality of Out -Patient Services Provided at OPD Pondicherry Institute of Medical Sciences, Puducherry. The Patient Satisfaction was observed by using self-prepared structured questionnaire. The study concludes that majority of the patients attending OPD were fairly satisfied with the services received at OPD. So, there is a need for improvement in Patient Satisfaction on Quality of Services Provided at outpatient department.

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Received on 22.01.2024 Modified on 15.03.2024

Int. J. of Advances in Nur. Management. 2024; 12(2):89-95.

DOI: 10.52711/2454-2652.2024.00020