Post on 07-Nov-2014
description
Dr. Priyanka SrivastavaDepartment of Hospital Administration
Sanjay Gandhi Post Graduate Institute of Medical SciencesLucknow
Study of Assessment of Satisfaction among the selected population utilizing Out-Patient
Services of The General Hospital of a Tertiary Care Teaching Institute in The State Capital of Uttar Pradesh
INTRODUCTION
“Hospital is an integral part of a social and medical
organization, the function of which is to provide the population
complete healthcare both curative and preventive with outpatient
services reaches out to the family in its own environment and also
to carry out training of health workers/functionaries and the bio
social research” – World Health Organization
The Outpatient Department (OPD) is first point of contact
between the hospital and the patient and patient satisfaction
depend on the standard of the health facility and care they
receive at the OPD.
4
Patient’s satisfaction depends on many factors such as quality of
clinical services provided, availability of medicine, behavior of
doctor and other health staff, cost of services, hospital
infrastructure, physical comfort, emotional support and respect
for patient
Assessment of the patients’ satisfaction is important in order to
identify reasons for dissatisfaction and guide us to eliminate
them.
As an administrator to it is important to identify causes of
dissatisfaction in order to alleviate level of satisfaction among
clients.
.
5
Multi sectorial development have increased level of information about medical facilities and Patients awareness about their rights.
Expectations from health care facilities are ever changing and scaling new heights.
It is important to understand causes of dissatisfaction among patients utilizing OPD services to take corrective measures. This study intends to find: Availability and extend of utilization of outpatient services in general hospital
by internal and external patients. Source of information for external patients. Reasons of satisfaction/dissatisfaction among the internal and external patient at
outpatient services. Waiting time for the internal and external patient at outpatient services in
various process and Recommend corrective measures to enhance the patient satisfaction
RATIONALE
6
REVIEW OF LITERATURE
7
Sonu Goel et al in their study to improve quality of care at public-
health facilities in Chandigarh Measuring patient satisfaction about
outpatient services and found out that among 1200 exit interview with
variable like general satisfaction, technical quality, interpersonal
behavior, communication, financial aspects, time spent with doctor,
accessibility and convenience etc.
Overall patients’ satisfaction on various parameters of quality of care
was 86%. (Sub centre- 95%, Dispensary- 89.5%, Community Health
Centers- 87.7%, General Hospital- 83.8% and Polyclinic-82%).
There was significantly more score of satisfaction in General hospital
as compared to other secondary level health facilities. However, the
difference in satisfaction score was not significant between different age
group.
8
Talluru Sreenivas et al in their study “Patient Satisfaction - A
Comparative Study” conducted in three different selected hospitals in
Hyderabad city based on ownership.
270 respondents were selected out of 300 respondents of Osmania General
Hospital (Omanis), completely owned by Government, similarly 90 respondents
out of 100 respondents from Deccan Hospitals Corporation Limited (Deccan)
which runs under the control of private management and 240 respondents from
Nizam's Institute of Medical Sciences (Nizam's) which runs on corporate lines
under the control of State government were selected .
it is found that the t-value for all types of responses and for all pairs of hospital
under study were significant at 5% level
Journal of the Academy of Hospital AdministrationVol. 15, No. 2 (2003-07 - 2003-12)
9
Study on Evaluation of Service Quality of Hospital OPD Services was conducted at a peripheral service hospital to ascertain any service gap between consumer expectations and perceptions in respect of the hospital service outpatient department.
Service quality gaps were identified to exist across all the five dimensions [expectations and perception, quality gaps, service quality, SERVQUAL(of the survey instrument, with statistically significant gaps across the dimensions of ‘tangibles’ and ‘responsiveness’) The quality gaps were further validated by a total unweighted SERVQUAL score of (-) 1.63.].
Significant service quality gaps existed in the delivery of the hospital OPD services, which need to be addressed by focused improvement efforts by the hospital management.
(Medical Journal Armed Forces India volume 67, Issue 3, Pages 221-224, July 2011)
AIM AND OBJECTIVES
11
AIM- Study of Assessment of Satisfaction among the selected population utilizing Out-Patients Services of General Hospital of a Tertiary Care Teaching Institute in The State Capital Of Uttar Pradesh.
OBJECTIVES:-
1. To study availability of Out-Patient Services and its extent of utilization by Internal and External Patients.
2. To find out the Source of information about the General Hospital to the External Patients.
3. To evaluate the waiting time and the reasons of dissatisfaction among the Internal and External patient at Out-Patient Services.
4. To recommend corrective measures to enhance the patient satisfaction.
METHODOLOGY
STUDY SETTING - Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow Study Area - General Hospital
STUDY DESIGN - Descriptive Study done Prospectively TIMELINE-
Study Span: November, 2012- June, 2013 Data Acquisition: January, 2013 - March, 2013
STUDY POPULATION – The Patients utilizing Out-Patients Services. SAMPLING TECHNIQUE – Population Proportion Sampling STUDY SAMPLE – Internal and External Patient SAMPLE SIZE -
The sample for observation was taken on the basis
Sample size (N) = (Z 2) * p (1-p)
d2
p = 0.12
q= (1-p) = 0.88
z =1.96 as per table of area under normal curve for confidence level of 95 %
d = allowable error, since estimate should be within 5% of true value=0.05
Sample size (N) = (1.96)2 * 0.05 (1 - 0.05) = 384
(0.05)2
Gen. Medicine27%
Gen. Surgery18%
Pediatrics12%
Gynea. & Obst. 21%
Dermatology21%N= 1,75,284
Internal ; 74.61
External; 25.39
Gen. Medicine
n=48,026
Internal ; 58.75
External; 41.25
Gen. Surgery
n=31,925
Internal 82.83
External; 17.17
Pediatrics
n=20,945Internal 41.15
External 58.85
Gynea. & Obst.
n=37,464Internal ; 61.60
External; 38.40
Dermatology
n=36,924
15
Gen. Medicine In-ternal; 143
Gen. Medicine Ex-ternal; 49
Gen. Surgery In-ternal; 75
Gen. Surgery Ex-ternal; 53Pediatrics Internal; 69
Pediatrics External; 14
Gynea. & Obst. In-ternal; 62
Gynea. & Obst. Ex-ternal; 88
Dermatology In-ternal; 91
Dermatology External; 57
SAMPLE SIZE DISTRIBUTION
Sample size = 701
148
150
84127
192
16
TOOLS AND TECHNIQUES:
Tools:Interview schedule for internal patients & external patients
Sample size calculated
Exit patient interview (It included questions about following categories- The general information such as Staff/non staff, name, age, sex. The profile of the patient as-District, resident either urban/rural Specific information as-Source of information, reason for selection of hospital The questions pertaining to patient satisfaction includes such as-Problems at registration counter and problem with behavior of registration clerk, seating arrangement, general cleanliness, drinking water facility , toilet facility, satisfaction with concern Doctor and sample collection technician
TECHNIQUECollection of Secondary data in the form of documents and records and registers
Question pertaining to waiting time in various process such as-Time in queue and process at registration counter, in doctor consultation, in laboratory, in pharmacy, in payment Entry and exit time in OPD and total time in OPD Suggestion if any)
Data acquisition
Data sorted and analyzed using Microsoft Office Excel and Statistical Package For Social Sciences (SPSS)
And following findings were observed
19
OBSERVATION
20
MALE, 27.96
FE-MALE, 72.03
EXTERNAL PATIENT
MALEFEMALE
MALE, 39.09
FEMALE, 60.9
INETRNAL PATIENT
MALEFEMALE
MALE35%
FEMALE65%
TOTAL
GENDER PROFILE OF THE PATIENTS UTILIZING OUTPATIENT SERVICES OF GENERAL HOSPITAL OF SGPGIMS
21GEN MEDIC
INE
GEN SURGERY
PEDIATRIC
S
GYNAE AND O
BS
DERMATOLOGY
TOTAL
97.92 100.00 98.0094.59
86.02
2.08 0.57
79.52
9.42
20.48
2.005.41 3.99
Age Profile of patients utilizing outpatient services (%)
CHILDHOOD(0-12) ADOLOSCENT(13-18)ADULT(19-60) SENIOR CITIZEN(>60)
22
GEN MEDICINE
20%
GEN SURGERY
20%GYNAE AND OBS20%
DER-MA-
TOLOGY40%
NEPAL
GEN MEDICINE
28%
GEN SURGER
Y18%
PEDIATRICS12%
GYNAE AND OBS21%
DERMA-TOLOGY21%
UPGEN MEDICINE
12%
GEN SURGERY
24%
PEDIATRICS4%GYNAE AND OBS
28%
DERMA-TOLOGY
32%
BIHAR
JHARKHAND -1(Dermatology) MP-1 (Dermatology) UTTRAKHAND-2 (Gen surgery)
NAME OF THE STATAE OF THE PATIENTS UTLIZING OUTPATIENT SERVICES (%)
23
FINDINGS
24
OBJECTIVE 1-
To study availability and extent of utilization of outpatient services in general hospital by staff and non staff patients
Gen.Medicine Gen. Surgery Pediatrics Gynea. & Obst. Dermatology Grand Total0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
12,193 13,1703,596
22,04714,178
72,410INTERNAL PATIENTS
No.
of
pts.
GEN MEDICINE GEN SURGERY PEDIATRICS GYNAE N OBS DERMATOLOGY GRAND TOTAL0
20,000
40,000
60,000
80,000
100,000
120,000
35,833
18,755 17,349 15,417 22,746
110,100
No.
of
pts.
EXTERNAL PATIENTS
Extent of Utilization of Outpatient Services of General Hospital, SGPGIMS (2008-2012)
26
2008 2009 2010 2011 20120
20
40
60
80
100
120
140
TREND OF OUPATIENT SERVICES UTILIZED BY IN-TERNAL AND EXTERNAL PATIENTS (2008-2012)
Gen.Medicine Internal Gen.Medicine External Gen. Surgery Internal
Gen. Surgery External Pediatrics Internal Pediatrics External
Gynea. & Obst. Internal Gynea. & Obst. External Dermatology Internal
Dermatology External
No.
of
Pat
ien
ts in
,00
27
OBJECTIVE-To Explore The Source Of Information For External Patients Utilizing OPD
Services at General Hospital Of SGPGIMS
EMPLOYEE OF SGPGI
OLD PATIENT REFERRAL NEWS PAPER HEALTH PERSONAL
OTHERs0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
5.0
20.3
62.8
1.9 2.3
7.7
external patient
external patient
IN P
ER
CE
NT
AG
E
29
OBJECTIVE-To evaluate the waiting time and the reasons of dissatisfaction among the Internal
and External patient at Out-Patient Services
Response of the patients about the behavior of registration clerk
STAFF NON STAFF
STAFF NON STAFF
STAFF NON STAFF
STAFF NON STAFF
STAFF NON STAFF
GEN MED GEN SURGERY PEDIATRICS GYNAE N OBS DERMATOLOGY
0
20
40
60
80
100
120
140
4 1 2 0 4 1 1 5 2 1
139
48
73
53
65
13
61
8389
56
PROBLEM REGISTRATION CLERK YES PROBLEM REGISTRATION CLERK NO
Nu
mb
er o
f p
ts.
Reason – Rude / Partial behavior
INTERNAL PATIENT
EXTERNAL PATIENT
INTERNAL PATIENT
EXTERNAL PATIENT
INTERNAL PATIENT
EXTERNAL PATIENT
INTERNAL PATIENT
EXTERNAL PATIENT
INTERNAL PATIENT
EXTERNAL PATIENT
GEN MED GEN SURGERY PEDIATRICS GYNAE N OBS DERMATOLOGY
0
20
40
60
80
100
120
140138
49
75
53
68
14
62
8690
57
50 0 0 1 0 0 2 1 0
YES NO
Nu
mb
er o
f p
ts.
RESPONSE OF THE PATIENTS ABOUT THE SEATING ARRANGEMENT
Reason –Less / Dirty chairs
INTERNAL PATIENT
EXTERNAL PATIENT
INTERNAL PATIENT
EXTERNAL PATIENT
INTERNAL PATIENT
EXTERNAL PATIENT
INTERNAL PATIENT
EXTERNAL PATIENT
INTERNAL PATIENT
EXTERNAL PATIENT
GEN MED GEN SURGERY PEDIATRICS GYNAE N OBS DERMATOLOGY
0
20
40
60
80
100
120
140138
49
75
53
68
14
62
8690
57
50 0 0 1 0 0 2 1 0
SATISFIED WITH GENERAL CLEANLINESS YES SATISFIED WITH GENERAL CLEANLINESS NO
Nu
mb
er o
f p
ts.
RESPONSE OF THE PATIENTS ABOUT THE GENERAL CLEANLINESS
Reason - Unhygienic
INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNALGEN MED GENERAL SURGERY PEDIATRICS GYNEA AND OBST DERMATOLOGY
0
20
40
60
80
100
120
140137
46
66
48
61
14
59
77 78
56
6 39
5 8
03
11 13
1
YES
NO
Nu
mb
er o
f p
ts.
RESPONSE OF THE PATIENTS ABOUT THE TOILET FACILITY
Reason –Unhygienic / Fewer in number
SATISFACTION/DISSATISFACTION WITH CONCERN DOCTOR
INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNALGEN MED GENERAL SURGERY PEDIATRICS GYNEA AND OBST DERMATOLOGY
0
20
40
60
80
100
120
140
160142
48
75
53
68
13
61
87 88
56
1 1 0 0 1 1 1 1 3 1
YES NO
Reason –Unpunctual/Unavailability
Nu
mb
er o
f p
ts.
SATISFACTION/DISSATISFACTION WITH SAMPLE COLLECTIONTECHNICIAN
INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNALGEN MED GENERAL SURGERY PEDIATRICS GYNEA AND OBST DERMATOLOGY
0
20
40
60
80
100
120
140
160 142
48
75
5268
14
62
86 90
57
1 1 0 1 1 0 0 2 1 0
YES NO
Reason – Unpunctual / Unavailability
No
of p
atie
nts
36
OBJECTIVE- TO STUDY WAITING TIME FOR THE EXTERNAL AND INTERNAL PATIENT AT
OUTPATIENT SERVICES
TOTAL TIME SPENT IN OUTPATIENT SERVICES BY INTERNAL AND EXTERNAL PATIENT INCLUDING PHARMACY
INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNALGEN MED GENERAL SURGERY PEDIATRICS GYNEA AND OBST DERMATOLOGY
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
65.0
42.9
26.029.3
76.8
92.9
69.4
29.5
92.3
80.7
29.434.7
12.0 14.5
23.2
7.1
24.2
51.1
7.7
15.8
5.6
22.4
1.0
17.3
6.5
19.3
0.03.5
<=2Hrs >2-4Hrs >4Hrs
%
38
TIME SPENT IN OUTPATIENT SERVICES WITHOUT PHARMACY BY INTERNAL AND EXTERNAL PATIENTS
INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNALGEN MED GENERAL SURGERY PEDIATRICS GYNEA AND OBST DERMATOLOGY
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
77.6
49.0
76.0
43.4
92.8 92.9
79.0
29.5
95.6
80.7
21.7
38.8
21.3
32.1
7.2 7.1
19.4
55.7
4.4
15.8
0.7
12.2
2.7
24.5
1.6
14.8
0.03.5
<=2hrs >2-4 hrs >4hrs
%
39
OBJECTIVE-TO RECOMMEND THE CORRECTIVE MEASURES TO ENHANCE THE PATIENT SATISFACTION
40
OBJECTIVE-TO RECOMMEND THE CORRECTIVE MEASURES TO ENHANCE THE PATIENTSATISFACTION
Enquiry counter and hospital map should be present Transport facility should be provided from main gate to the general hospital USG and X-RAY facility should be provided In the hospital Token system should be present for queue and registration Manpower should be increased PHARMACY COUNTER- Manpower should increased All counter should be open All medicine should be available Worker should behave proper
HOSPITAL INFORMATION SYSTEM(HIS)- Don’t work properly Takes too much time AMBULANCE FACILITY- Not available at time
41
OBJECTIVE-TO RECOMMEND THE CORRECTIVE MEASURES TO ENHANCE THE PATIENTSATISFACTION
TOILET FACILITY- Hygiene should be maintained Number and ladies toilet should be increased Cantene facility should be increased SEATING ARRANGEMENT – Number and space should be increased Behavior and punctuality-
42
Thank you