“A study on Satisfaction among Patients’ toward the outpatient and in-patient services provided

by Public Health Hospitals in Sarawak, Malaysia.”

1.0 Introduction

In other industries such as the airlines and the hotels industry, the concept of patients’

satisfaction through excellent customer care is the key assessment for these industries. They have

built their success and reputation on the concept of ‘satisfying their customer needs’. This

philosophy has somehow not fully translated into the healthcare system particularly in Malaysia

public healthcare system. James M.,( 2013) explained the hospital ‘customers’ are different from

than those in any other industry for one important reason – they do not want to be in the

hospitals. Most hospitals made the biggest mistakes by making a conclusion that healthcare

system is a necessity to patient rather than luxury. Therefore they are not entitled to superior

patients’ experience. Hospitals in general give not a very pleasant experience to any individual,

therefore in these recent years there is a paradigm shift on how customer care are being

incorporated in the clinical practice.

1.1 Definition of Satisfaction

There is no definitive definition agreed on what patient satisfaction really meant in many of the

literature. However, many describe patients’ satisfaction as a subjective evaluation of the

healthcare service received against patient expectation. It is evaluated based on most of the

operational aspect of the healthcare system particularly the technical quality, healthcare provider

interpersonal aspects, communication, financial aspects, time spent or ease of contact or

availability. In a nutshell, researchers measures patients’ opinion and feedback based on their

experience that they have gone through being in the hospital (Gansegeran K,2015). Ware et al

(1983) in one of the earlier studies on patients’ satisfaction rate this as a personal evaluation of

health care and service providers. Both papers agree however that patients’ satisfaction is

considered as an essential component of quality care and thought to be a good indicator of

healthcare quality. In the recent study wrote by Carman (2000), she pointed out that perception

of service quality is an attitude, and that the attitude is a reaction towards a combination of

attributes that patient considers being the component of quality. These attributes can either be

functional which includes the ambience of healthcare set up as well as the provider (physicians,

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nurses and other healthcare provider) attentiveness or the technical aspects which covers the

outcome of the service delivered.

In Malaysia, Ministry of Health (MOH) is the country major healthcare provider which accounts

to one national level hospital; Hospital Kuala Lumpur, which serves as the National Referral

Centre. This hospital is the largest in the country with more than 2500 beds. In the other states

within Malaysia, each will be equipped with state hospitals which provide comprehensive range

of secondary care services. Their capacity will be within 800 to 1200 beds. Various districts in

the country will be equipped with basic inpatient care which account to about 30-150 beds in

each district. Overall, the healthcare system is also complimented by the private sector which

constitutes about 35% of overall healthcare services. (Noor Hazilah, 2013)

Public that seek medical treatment in the public healthcare are divided to the outpatient and in-

patient treatment. A nominal fee of RM1 for each outpatient visit is charged in accordance with

the Fees (Medical) Order 1976.1 Government employees and their family members benefit from

these services even after their retirement while the Social Security Organization (SOCSO) and

Employees Provident Fund (EPF) do not finance employees in the private sector during their

retirement. In- patient treatment in the public sectors is also charged at minimal amount which is

more than 80 % less than the private healthcare facilities.

With 2.4 million population and on a 48,050 sq m Sarawak, medical services are provided by

twenty one hospitals that are located in the major town within the states. The state hospital,

Hospital Umum Kuching in located in Kuching and has 754 beds. There are three districts

hospitals which have specialist facilities which is Hospital Sibu, Miri, and Bintulu while the

other fifteen districts hospitals are without specialist services. Sarawak is a state where they are

more than 40 ethnics groups living in their own cultures, languages and lifestyle. The urban or

town area of Sarawak are populated predominantly by the Malays, Chinese, and smaller

population of Ibans and Bidayuhs who have migrated from the villages to seek for employment

in town.

1.2 Research Problem Statement

Public Healthcare system in Sarawak needed much evaluation at present because of the

geographical factor and the diversity population distribution. At present, the bed occupancy rate

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(BOR) in Sarawak hospitals is the highest in Malaysia which is more than 69.5% compared to

other states. When the hospital is crowded, the services rendered could be compromise and affect

the level of patients’ satisfaction.

This study is much needed because the previous many assessments of patient satisfaction has

brought out the issue of equality in healthcare. Despite the effort by the government to bridge the

socio economic gap, there is still issue related to the equality and accessibility of healthcare

services especially to the indigenous group, hardcore poor and rural population. In the state of

Sarawak, there are about 20% of the population who lives more than 5km to the nearest rural

clinic (Unit Perancang Ekonomi). The downside of this will be the difficulty for the patient to

seek medical treatment and the impact will be on the quality of care for these people.

The infrastructure and accessibility of the services of the public healthcare system is mentioned

in the 11th MP to be extended to the under-deserved communities, especially the poor and low-

income households, Orang Asli in Peninsular Malaysia as well as the people in the rural and

remote areas in Sabah and Sarawak (Bernama, 2015). At present, there are still many living in

remote areas in Sarawak for instance along the Baram river who faced more than 2 hours journey

either by ferry or logging trail to reach their nearest district hospitals.

With the challenges that Sarawak is facing with the healthcare system, it is crucial to seek the

people opinion on how satisfied they are with the current situation and identify area that is

lacking to ensure the best quality of care for people in Sarawak.

1.3 Research Question

1. Will the different demographic distribution in Sarawak influence their satisfaction level?

2. Will the patient satisfied with the healthcare providers’ (eg:doctors and nurses)

communication, explanation and services rendered to them?

3. Will the patient be satisfied with the current nunmber of the hospital in Sarawak and the

accessibility and infrastructure available in Sarawak’s public hospital?

4. Will the waiting time for most public hospitals be an issue to the patients in Sarawak?

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1.4 Research Objectives

1. To study the relationship between the demographic distribution and the patients’

satisfaction in Sarawak.

2. To study the relationship between the physical aspect (accessibility, infrastructure and

hospital environment) and patient satisfaction.

3. To study the relationship between the intangibles aspect (healthcare provider relationship,

clarity of information, reliability & responsiveness) and patients’ satisfaction.

4. To study the relationship between waiting time and patients’ satisfaction.

1.5 Research Hypothesis

1. There is positive and significant relationship between demographic distribution and

patients’ satisfaction.

2. There is a positive and significant relationship between physical aspect of the public

healthcare and patients’ satisfaction.

3. There is a positive and significant relationship between intangibles aspect of the public

healthcare and patients’ satisfaction.

4. There is a positive and significant relationship between waiting time and patients’

satisfaction.

1.6 Significance of study

Most of researches agreed on one predicament; patients’ satisfaction may also predict health-

related behaviors of patient such as adherence to treatment and medical recommendation.

Patients who are more satisfied are willing to comply with their treatment plans and maintain

their relationships with their healthcare providers. This essentially translates to lower

readmission rates, reduced lengths of stay, and increased savings for the hospitals.(Murphy

M.,2014) This supports the definition of health from the World Health Organization (WHO)

which defines health as a state of complete physical, mental and social being and not merely the

absence of disease or infirmity. Therefore, the role of the healthcare providers such as

physicians, nurses, and other health personnel is not merely curing a disease but instead

delivering patient-centered services which meet patient needs, wants and preferences.

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2.0 Literature Review

Patient satisfaction has over the years has become an important measure of the quality of care

provides by healthcare organization. (Noor Hazilah,2014). Looking at the earlier paper on patient

satisfaction in the healthcare services, there are few theories that can be summarized. Fox &

Storm (1981) mention that satisfaction is derivable when there is an alignment between what

patients’ perspective on what constitute in healthcare and providers view. Linder-Pelz (1982)

added that satisfaction comes from patients’ previous expectation, personal beliefs and value

towards the delivery of healthcare. Donabedien (1988) also emphasized on the interpersonal

aspects of care towards patient as the most important element that make a satisfied customers.

All the model of these researches however have one agreement in term defining the model of

study which is in measuring patients’ satisfaction; the measurement instrument must be multi-

dimensional and not uni-dimensional. The components of given services must be broken down in

such a way that patient will be able to express their satisfaction for each and every component. It

is agreeable that the measurement tool should not assess overall satisfaction. It is important to

create a breakdown on the services offered so to ensure that the desired answers are obtained

from the patient and not create confusion. This will then offer an opportunity for more focused

study to be done on the factor that contributes to patient dissatisfaction. For example, Ministry of

Health (MOH) Singapore in their yearly report on patient satisfaction in the healthcare system

found that public general satisfaction has improved but the long waiting time is still a pain for

the public. With the multi-dimensional measurement tool, MOH Singapore managed to further

analyze why the waiting time still an inhibiting factor is in the system. The finding showed that

the long waiting time was the highest when waiting to get the next appointment to see another

physician, followed by to get medicines and to see doctors. (Today, 2015). In Malaysia, waiting

time is also a prolong issue that is faced by the public hospitals. Raja Lexshimi et al (2009)

studied on the waiting time in the Orthopedics outpatient clinic in HUKM, Cheras and noted that

most respondents 61 out 100 respondents in the study has waited more than 90 minutes from the

time they were given a number to before the doctors’ consultation.

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In Malaysia, the studies done on patients’ satisfaction are mostly done in the urban areas or main

hospital within the states. Mohammed Azali Hassali et al (2014) studied the general public

satisfaction with the public healthcare services in Kedah, Malaysia. Their samples are volunteers

visiting public areas such as shopping malls, night market, photo shops, schools, car service

centre and restaurants. Another study conducted by Ganasegaran.K (2014), covered the busiest

outpatient medical care in Malaysia which is the Tengku Ampuan Rahimah Hospital (HTAR),

Malaysia. This hospital is situated in Klang, Selangor. There were 350 respondents with majority

aged less than 30 years old with 64.4% employed and have tertiary education with monthly

income of MYR3000 or more. University hospitals are also where study on patients’ satisfaction

are usually carried out. Hizlinda T et al (2012) as well as Suriawati G et al (2009) studied

patients’ satisfaction in Hospital University Kebangsaan Malaysia, HUKM. Similarly to the

other studies, 64.7%, 205/317 of the respondents within 30 years to 60 years of age, and 89.6%

received minimum secondary education and majority of them are employed in the government or

private sectors. These studies concluded that there was no significant association between the

social-demographic characteristic with regard to patients’ satisfaction.

Most of the studies also are done either in the outpatient or the inpatient settings. In the

outpatient, some key areas the study focus on are the satisfaction on the waiting time, doctor

consultation, referral procedure as well as the technical aspect involving the accessibility and

environment of the hospital. Where else, inpatient will pay more focus on nursing care, clinical

treatment given or even explanation from the physician. Nor Hazilah & Phang (2011), did an

empirical analysis by preparing two sets of self administered questions to evaluate both

outpatient and inpatient as well. Their studies received a larger sample size which involved 23

states hospitals and selected districts hospitals. Using the convenient sampling method due to the

lack of patient cooperation, 646 out of 900 questionnaires were analysed for inpatient survey an

570 responses for outpatient survey. Another large scale study which involved outpatient health

clinic was done in the state of Selangor, Malaysia by Sharifa Ezzat et al (2010). Unlike the other

studies, they managed to collect samples from the rural area in Selangor. This study concluded

that there was no significant association between the urban or rural with all the dimension of the

SERVQUAL questionnaires.

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The survey on patients’ satisfaction is done through either pre-developed questionnaires or

questionnaires that is derived based on literature review. A. Parasuraman, Valarie A. Zeithaml

and Leonard L. Berry (1998) created SERVQUAL or Service Quality. SERVQUAL is a multiple

scale measuring consumer perception of service quality. The questionnaires comprise of 22-item

scale that allow respondents to indicate the extent of their agreement/ disagreement from

‘strongly disagree’ to ‘strongly agree’. The first 22 item scale will represent what customer

expectation while the other 22 item scale will represent respondents’ recent experience of the

service. Shariza Ezat et al (2010), in her research explained that respondents will need about

30minutes to 1 hour to complete the questionnaires and there are five dimension that covers

aspect such as tangibles, reliability, responsiveness, assurance and empathy while another four

dimension looking at clinic corperation such as caring, professionalism, team work and outcome.

SERVQUAL was also used to evaluate the level of patient satisfaction in Kulim Kedah.

(Mohammed Azmi Hassali et al, 2014). In one of the most comprehensive studies done to assess

the service quality in Malaysian public hospital, the questionnaire used was developed by

Institute of Health Management (IHM), Ministry of Health Malaysia. These questions were felt

to be more suitable for patient by Tomes and Ng (1995) because patients in the hospital are

burdened by physical disabilities, fears and anxiety therefore question used was short, straight-

forward question that are simple to answer ( Noor Hazilah & Phang, 2014)

2.1 Demographic distribution

Sample characteristics are collected by all the researchers. The first part is the demographic data

such as the respondents’ gender, age and marital status. The second part of the data collection

will include socio-economic demographic such as the household income, employment status,

education level, and type of residence, overall health perception and the purpose of visit the

clinic. In two studies which is done in HUKM, the result of the data shown that there was no

significant association between the demographic characteristic and patients’ general satisfaction

(Hizlinda T et al, 2012). However, in a study conducted in the busiest outpatient clinic in

Malaysia which is HTAR, Klang, Selangor, the study concluded in a post hoc test that patients

aged 50 years or more perceived higher service satisfaction as compared to the younger age

group. Patients with lower household income less than RM3000, with high school education

background were also recorded to be more satisfied as compared to the higher income group and

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respondents with tertiary education (Kanagesaran G, 2014). From all these findings, the common

conclusion made was the different expectation and perception of the services in the healthcare

associate contribute to the level of patients’ satisfaction. The general expectation highlights

was the need to of patients to be listen to, the importance of clear information given to them, the

level of compassion of the healthcare providers as well as their professionalism.

Alexandra (2015) mention in her article on The Atlantic that person’s expectation and level of

satisfaction will differ from each individual. She also critically mentioned that some questions

asked in the survey known as HCAHPS (Hospital Consumer Assessment of Healthcare Provider

and Systems) such as a section about nurses on how often did patient get help immediately from

the nurses after they press the call bell. This question is said to be misleading because it does not

specify whether the help was medically necessary. Nevertheless, assessing patients’ satisfaction

has gain a widespread recognition in many public sectors services particularly the hospitals. For

example in France since the 1998, the French government regarded patients’ satisfaction survey

as their mandatory exercises to evaluate the hospital environment, patient amenities and

facilities.

2.2 Physical aspect (accessibility, infrastructure,) of the public hospitals

There are many studies that is done to relate the importance of having a good image and

satisfaction. Gronross (1982) realized the role of image in the conceptualization of service

quality and emphasized it as a contributing factor for quality and satisfaction in addition to the

functional and technical quality. In the country, the government realized the need to constantly

upgrade the hospital facility for instance within the next five years, Ministry of Health aim to

improve the ratio of the hospitals bed to 2.3 beds to 1,000 population. There will also be

extension of services to the people in the remote area of Sabah and Sarawak (Bernama, 2015). At

present extension of services includes increasing flying doctors services, specialist visits, and

periodically rural service health screening for the peoples who lives far from the hospitals.

Many western studies when describing accessibility of the public hospitals often associate the

term accessibility to how the facilities are friendly to handicap patients. Aspects related to this

included the existence of ramp, size of toilet doors, parking space sizes, corridor and toilets

(Phua K.L, 2014). In the context of studying patients’ satisfaction in Sarawak public hospitals,

the term accessibility will cover the distance of the hospitals from where the patients are from.

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Geographical factor and population distribution uniqueness in the state became a major issue

when seeking treatments in hospitals will incur larger distance and higher travel cost. This

element is felt to play an important role towards determine the level of patients’ satisfaction. Due

to this, the distance and distribution of the public hospitals in Sarawak will be the key area in this

study.

2.3 Intangibles Aspect of the public hospitals in Sarawak.

Tomes and Ng (1995) in their study measuring the patients’ satisfaction in the National Health

Service (NHS), they created a measurement scale that measure two dimension in the hospital

which is the intangibles care within the hospitals as well as the tangibles aspect. The intangibles

aspect includes assessment on the healthcare staffs, communication, reliability, responsiveness,

courtesy, food and even hospital environment. The result of the study indicates that patients are

fairly satisfied with the hospital services under NHS but expressed dissatisfaction over the

physical environment of the hospitals. In a study to evaluate patients’ satisfaction in public

hospital in Cyprus, patients reported the least satisfied with the clarity of the information given to

them, time nurses spent with them and participation in care (Anastasous, 2013). Patients are

often someone who have lack of knowledge on what to expect, and anxious about their own

condition and are most likely concern about the information given to them. Looking at similar

situation in Sarawak, there might be a tendency that patients did not receive the clarity of

information given to them and thus affect the quality of care they receive.

2.4 Waiting time

In the national study done to gauge the waiting time in Malaysia public hospital, researchers

concluded that average patients waited for more than two hours from the time they registered to

getting prescription slips. This study was done in the thirteen states hospitals in Malaysia

with13,000 responses were obtained. It was also mentioned that average doctor consultation time

was only 15 minutes (Pillay D et al, 2013). This literature also analyzes the reasons among the

hospitals why the waiting time was so long in the public healthcare hospital. It was concluded

that heavy workload, employee attitude, management issue as well inadequate facilities are

factors contributing to this. In Kuala Lumpur, the doctor patient ratio is 1 doctor to 500 patients

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whereas in East Malaysia one doctor to 4000 patient (Susan Thomas et al, 2011). The ratio has

been reduced over the years and recently in the 11th Malaysia Plan (MP) tabled by the Prime

Minister in May 2015, he mentioned within the next five years, doctor patient ratio will be at one

doctor to 400 patients.

2.5 The current and relevant topics in the field

The studies on patients’ satisfaction remain relevant untill today because our country public

health care system need to remain competitive despite recent turmoil such as slower economy

growth resulting in higher operating cost in the public health care. In the recent budget 2016

setting revision, Prime Minister Datuk Seri Najib Razak has announced RM 250 million budget

cut for the Ministry of Health as a cost cutting measure due to the current country economic

situation. This will need a drastic measure from the Ministry of Health to improve their

efficiency and reduce wastage without compromising on the services rendered to patient.

Ministry of Health as the key player in the policy maker for the health care system in the country

is constantly faced with challenges in every angle in the public health care system. Tax payers

and public in general have their eyes on the hospital environment, available of hospitals in every

districts and town in the city, the ability to have qualified serviced providers, and the quality of

services rendered towards the public in Malaysia. In a report prepared by Ministry of Health in

2008, their challenge in giving the best healthcare to the society heightened when more

Malaysian are now living in urban areas with more than 6.6% of the population will be more

than 60 years old. The life expectancy for Malaysian has also increased to 70.6 years for males

and 76.4 years for female in 2005 (Ministry of Health 2008). With the ongoing increase in aging

population and life expectancy, the public hospitals will have to face an influx with the increase

number of patient who will likely to not choose private healthcare in the country due to the

higher cost. The extra demand on the public hospitals at present pressures the hospitals

employees to deliver quality care.

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2.6 Theoretical Framework

Many theories have been proposed to explain customer satisfaction. Duggirala et al (2008), in

their study on Indian hospitals, revealed that there were seven dimensions of healthcare IService

quality, namely infrastructure, personnel quality, process of clinical care, administrative

processes, safety indicators, overall experience of medical care and social responsibility.

These dimensions were quite similar to Padma et al (2010) study, whereby they developed and

measure eight dimensions, namely infrastructure, personnel quality, process of clinical care,

administrative procedures, safety indicators, hospital image, social responsibility, and

trustworthiness of the hospital to obtain the perspectives of both patients and attendants.

Through the review of many literatures on service quality, the critical dimensions of patient-

perceived healthcare quality dimensions have been identified and used as an instrument in

measuring the patient's viewpoint of health care quality in the current study. The following are

the propose dimensions of variables that might contribute to patient satisfaction in healthcare in

this study

The theoretical framework below represents the coverage of the study. All the dimension and

sub-dimension of the study will be study based on the respond from the patients in the public

hospitals in Sarawak.

i. Intangibles aspect

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Intangibles aspect in this study will include measuring patients’ satisfaction towards the

healthcare providers’ communication, responsive towards their needs, their reliability as well as

clarity of giving information related to their medical condition. In a nutshell, this dimension will

measure the non-clinical aspect that relate to patients’ satisfaction. Respondents in this study will

be given statement related to the above aspects. Communication is the essential part in when

measuring this dimension in this study. Effective communication between healthcare providers

will allow crucial information especially related to patients’ health issue to be convey

accordingly to patient. Additionally, the importance of communication between healthcare

providers such as doctor and nurses has to be taken into consideration because this will

determine the reliability as well as responsiveness of the treatment for patients.

Studies conducted during the past three decades show that the clinician’s ability to explain,

listen and empathize can have a profound effect on the wellness, compliance of patient and their

participation in their health management. Therefore, in this study the aim is to evaluate if patient

satisfaction will increased when members of the healthcare team took patients’ problem

seriously, explained information clearly, and tried to understand the patients’ experience, and

provided them with viable options.

ii. Physical aspect of the hospital

Although Sarawak has increasingly became a urban state, the rural population that remains are

seen to be cut off from the rest of the facilities in the urban area due to economic and

geographical factor. There had been several efforts by the government policy to close this rural-

urban gap in care such as setting up 1Malaysia Clinic, rural flying doctors, and also improving

patient-doctor ratio. The question now, is the people content with all these implementation and

how effective are these towards meeting their need in the healthcare system. This study will

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Patients’ SatisfactionResponsiveness, Reliability and clarity of information

(Non- clinical aspect)

Effective communication

evaluate the relevant feedback from the respondents on their satisfaction level of the accessibility

as well as facility in the public healthcare hospitals in Sarawak. Statement related to the

accessibility of the hospitals, the facilities such as waiting area, hospital beds, and cleanliness

will also be the area study on. Typically, this study will also seek opinion on area related to the

infrastructure of public hospitals that needed most improvement such as equipment’s, number of

nurses and doctors, as well as transportation system to reach the public hospital.

This study assumption will relate on how federal government funding is crucial towards

improving the healthcare system in Sarawak. Areas of improvement infrastructure and

accessibility will only possible with funding for the public hospitals. Evaluation will also be

done on whether funds to have another second state hospital in Sarawak to supplement Sarawak

General Hospital, Kuching

(SGH) as well as reaching the rural areas with more healthcare workforce will contribute to

better level of patients’ satisfaction.

iii. Waiting time

Waiting time is the long standing problem in many public hospitals throughout the world and

also a benchmark for many hospitals in measuring the hospitals key performance index. In the

Sarawak public hospitals, key areas related to the waiting time such as duration of registration to

collection of medications, duration for doctor consultation for outpatients, nurses ward round for

inpatient, waiting time for other healthcare procedure such as labs and x-ray will be evaluate.

Sarawak at present is struggling with a disproportionate patient to doctor ratio, shortage of

specialist for example there is only one cardiologist to serve the entire state in the Sarawak Heart

Centre, Kuching.

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Patients’ Satisfaction Better Hospitals Infrastructure and Improved

Accessibility

Government Funding

However, the public healthcare hospitals in Sarawak is also struggling with high turnover of

medical professionals such as nurses where they are easily lure by the private sectors within

Malaysia or abroad such as Saudi Arabia. Doctors and specialist are also seeking lucrative

employment in the private healthcare sector which obviously offered better salaries. It is also

known that surgeons who served the public’s hospitals in Malaysia are seen to set up their clinics

privately. Therefore, this intrinsic factor of high staffs turnover, possible conflict of interest

between the public and private healthcare hospitals could relate to the long waiting time that is

experienced by many patients.

Efficient clinical management is also a crucial aspect to ensure the workflow in the public

hospitals remain smooth. The clinical management will include effort to ensure adequate

staffing, predicting increase or decrease workforce on certain seasons, classified patients based

on their severity and urgency of their medical treatment and accurate referral to particular

medical specialities. The ability to manage the clinics well will significantly reduce the waiting

time for patients.

iv. Demographic distribution

Study on patients’ satisfaction shall include the respondents’ age, salary range, place of stay,

gender and their occupation and education level. In order to get the relevant association of the

above criteria toward patients’ satisfaction, the diversity of the respondents are crucial.

Respondents will includes patients of various ages’ ranges from more than 18 years of age, and

will be divided to few ages group based on the literature reviews. Similarly, the salary range and

education level that indicate the socio-economic class will be classified to various categories to

enable association against patients’ satisfaction to be done.

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Patients’ Satisfaction Improved waiting time

Effective clinical management

Adequate Staffing

Studying the association between demographic data and patients’ satisfaction will very much

linked to a person perception on how they perceive the service in the public hospitals.

Expectations, with reference to healthcare, refer to the anticipation or the belief about what is to

be encountered in in the healthcare system. It is the mental picture that patients. Every patient

who comes for consultation has expectations based on his understanding of the illness, cultural

background, health beliefs, attitudes, and level of understanding. Patients’ demographics and

visit characteristics also contribute toward this. Women are mentioned in many literatures to be

more critical in their expectation towards services rendered to them. Therefore, when what ones’

perceived or expect does not meet the services rendered to them, dissatisfaction will occur.

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Patient Satisfaction Demographic distribution

Expectation & Perception

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