Satisfactions Among Admitted Patient of Tertiary Level Hospital in Dhaka City.

Satisfactions Among Admitted Patient of Tertiary Level Hospital in Dhaka City.

Dissertation Submitted byDr. Saleh Ahmed Hamidi

ID No: 14-98248-308/01/2016

Supervised By:Prof.Dr. Md. Nazrul Islam PhD

MPH ProgramDepartment of Public Health

American International University-Bangladesh (AIUB)

Introduction

• Health is a basic human need and fundamental human right.

• It is the responsibility of government and health care personnel to provide health care to all people in equal measures and to ensure the fulfillment of the health needs of entire population.

• A large segment of the population in developing countries is deprived to access to basic health care.

• The services delivered by the health care providers are not up-to the level of need and perception of the clients.

Introduction Contd…

• According to the statistical figures, Bangladesh has made remarkable progress in some indicators of health such as controlling infant, maternal and under-five mortality.

• It has achieved a credible record of sustaining 90% plus vaccine coverage in routine EPI with NIDS (national immunizations days) since 1995.

• Despite this progress, it is well known that the problem of access to modern health care service and reliable treatment is acute in Bangladesh.

• Satisfaction: Satisfaction is the act of fulfilling a need, desire,

or appetite, or the feeling gained from such fulfillment

• Tertiary Level Hospital : A tertiary referral hospital is a hospital that

provides tertiary care, which is health care from specialists in a large hospital after referral from Primary care and Secondary care

• The IOM (Institute of Medicine) defines patient-centered care as: "Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.

• "The word medicine is derived from Latin medicus, meaning "a physician". Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness

• Traditionally, there were no clear boundaries between patient care and patient cure. With changing patterns of disease, newer therapies and patients’ perceptions, care and cure are now entirely separate concepts.

• Doctor–patient relationship : is central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease.

• The doctor–patient relationship forms one of the foundations of contemporary medical ethics.

• Most universities teach students from the beginning, even before they set foot in hospitals, to maintain a professional rapport with patients, uphold patients’ dignity, and respect their privacy.

Introduction Contd…

• Dissatisfaction and lack of faith in the quality of health care services in Bangladesh have led a huge number of Bangladeshi patients to go to the neighboring countries such as India, Thailand and Singapore.

• The concept of patient satisfaction is not new. Patients are one of the main stake holders among the ever expansive modern world of medicine.

Background Information • patient satisfaction is widely considered as an

integral part of the quality of care.• Furthermore, patient satisfaction is identified as an

important dimension for assessing the quality of health care services.

• Recently developing countries, influenced heavily by findings of developed countries, are increasingly interested in evaluating the quality of health care services

• In Bangladesh, very few studies have tried to measuring patient satisfaction with the quality of hospital services.

Background information contd….

• A patient is the ultimate consumer of the hospital. He expects from hospital comfort, care and cure.

• Patient forms certain expectations prior to visit. Once the patient come to the hospital and experience the facilities, they may become either satisfied or dissatisfied.

• Human satisfaction is a complex concept that is related to a number of factors including lifestyle, past experiences, future expectations and the value of both individual and society.

Background information contd….

• The goal of any service organization is creation of satisfaction among customers.

• The primary goal of the tertiary care hospital as a highest level of health care provision is to provide best possible health care to the patients.

• The modern era where it is the right of every patient to demand best possible care in Government hospitals, it is the duty of every staff member of the hospital to deliver his optimum efforts to the entire satisfaction of the patient.

• Satisfaction is a psychological concept which is defined in different ways. Sometimes satisfaction is considered as a judgment of individuals regarding any object or event after gathering some experience over time.

Justification of the Study• Patient satisfaction is a complex, multi-directional

issue it is a very important aspect of medical care. • satisfaction may not be totally influenced by

– the quality of care,– quality of physician available, – but it reflects how the medical care has been

delivered.• There are many factors that affect patient satisfaction. • We may not be aware of all of them. In modern times

when expectation from healthcare institutions are increasing and level of satisfaction is decreasing

Justification of the study contd………

• The purpose of present study is to carry out evaluation of tertiary hospital services by getting feedback from indoor patients conducted in Dhaka city.

• Previously not much work has been done to compare the patient satisfaction level in public and private sector hospitals.

• This study hopes to generate data that can help doctors and managers to improve the standard of care.

Research Hypothesis

• Satisfactions level are poor among admitted patient of tertiary level hospital in Dhaka city.

Research Objectives

General Objective: • To assess the patient’s satisfaction level on

tertiary level hospital in Dhaka city.

Specific objectives To compare the level of satisfactions in various

patients regarding services provided in tertiary level hospital.

To find out other factors related with satisfactions among patient from tertiary level hospital in Dhaka city.

To relate the socio demographic characteristics with satisfactions among patient from tertiary level hospital in Dhaka city.

List of variables

Independent Variable:

1.Socio-Demographic Characteristics

2.Satisfaction related variable

3.Factors related to hospital facilities

Dependent Variable:

Admitted Patient’s Satisfaction

Conceptual Framework

Satisfaction Related Variables

Socio Demographic characteristic

Factors Related to Hospital Facilities

Health Care Services

Admitted Patient’s Satisfaction

Independent Variable Dependant Variable

Literature Review

• Relevant Literature review of this study is done by reviewing of different journal including national and international.

• Various kind of article, Magazine & from Archive• Internet searching, book ,Library was reviewed• Few studies have been conducted regarding

patients satisfaction. • Previous research from Bangladesh and world

perspectives.

Methods and Material

Methodology

Study Design The research is a cross sectional study.

Study periodThe period is 8 month from commencement of

study from May 2015 to December 2015.

Study LocationHoly Family Red Crescent Medical College Hospital• The Study location was the Holy Family Red Crescent

medical college Hospital• Holy Family Red Crescent Medical College is the tertiary

level hospital. Holy Family Hospital (HFH) was established in 1953.

• It is located at 1, Eskaton Garden Road, Bara Maghbazar, capital city of Dhaka, near the ramna thana.

• It was renamed as Holy Family Red Cross Hospital in 1971. It was again renamed as Holy Family Red Crescent Hospital in 1984.

• Finally in the year 2000 it was named as Holy Family Red Crescent Medical College Hospital (HFRCMCH). It is a modern hospital with 646 beds.

Study Population

• Admitted patient in Medicine department of tertiary level hospital in Dhaka from May 2015 to December 2015.

Inclusion Criteria:

Admitted patient in tertiary level hospital Must be co-operative.Motivated to participate.

Exclusion Criteria:

Other than the Medicine Department Non Co-operativeNot motivated to participate.patient who Severely illMentally unsoundAny objection from familyPatients cannot speak (mute) or listen (deaf).

Sample size:

• Sample size is calculated from study population using the following formula n= z2pq/d2

Wheren = desired sample sizep = 0.5 (The proportion in the target population estimated to have a particular characteristics and desire accuracy at 50%.q = 1 - p = 1- 0.5 = 50%)d = degree of error (absolute precision of the study assumed 0.05.)z = the reliability co efficient at the 95% C.I= 1.96.sample size (n) = z2pq/d2

= (1.96)2 x 0.5 x 0.5 / (0.05)2 = 3.8416 x 0.5 x 0.5 / 0.0025

= 385 Thus, required sample size is 385. I collected 170 data (Feasible sample size)

Sampling Technique: Purposive sampling:• During Data collection I was follow purposive sampling

method. Purposive sampling, also known as judgmental, selective or subjective sampling, is a type of non-probability sampling technique.

• Non-probability sampling focuses on sampling techniques where the units that are investigated are based on the judgment of the researcher.

• Purposive sampling technique is a non- probability sampling technique sampling focuses on sampling techniques where the units that are investigated are based on the judgment of the researcher.

Development of Research Instrument:

• Instrument for data collection was structure and semi-structure interview schedule containing structure questionnaire and introduction will be giving at the beginning of the interview.

• First took permission and took signature of patients before conducting interview.

Questionnaire design:• In order to obtain relevant information, the

interview questionnaire was carefully designed keeping in mind the objective of the study. The formal survey of each sample will carried out by using the structured questionnaire.

• And researcher was built two types of questionnaires for the Admitted patient in Medicine Department of tertiary level hospital.

• The questions were asked in Bengali language but written in both English and Bengali language

Data collection technique: • By using structured questionnaires, data was collected by

direct interview of the respondent. The researcher himself was conduct face to face interviews.

• At the very beginning of the interview the researcher was introduce himself with the participants and explained the aim and objectives of the study to them. Data collection is a crucial stage in the planning and implementation of a study.

• If the data collection has been superficial, biased or incomplete, data analysis becomes difficult, and the research report was poor quality. Therefore, I should concentrate all possible efforts on developing appropriate tool.

Data Analysis • After collecting information from primary source.

– Reviewed of collected data and information.– Sorted of revised data and information.– Analyzed for easy explanation.

• Then Data entry into computer was continued along with data collection. Data was analyzed using SPSS for windows version 18.0.

• Necessary tabulations and cross-tabulations, charts and diagrams were drawn for summarizing and easy visual presentation of data. The Data was analyzed by the following steps:1. Frequency2. Percentage3. Chi-square (to determine the relation between variables)

Data presentation and interpretation

A questionnaire was prepared according to the objectives of the study and made simple and easily understandable to the respondents. .

Data was presented by verbal description of data.

Narrative information may be presented in standard writing style, tables, figures, diagrams, maps and charts e.t.c.

Data Quality Management:

Data Quality Management: • During the study data quality was always be

maintained.• At first pre-test was done to analyze the data and

verify data and to avoid fake data. • On the basis of pre-test data collection researcher

was construct a standard questionnaire and was translated the questionnaire in both English and Bengali to make it easy to the respondents.

• It was ensure best quality of data.

Ethical Consideration:• Ethical Approval was obtained from Research Committee of

AIUB

• And Before conducting the study an official approval for data collection was sought from the director of HFRCMCH.

• Respondents was fully informed about the study and will have the rights for non response to the questionnaires.

• Informed written consent was taken prior to all interviews with

the respondents.

• Confidentiality of information was ensured at all levels and will not be disclose without their consent.

Limitation:• Time limitation to take a large sample size.

• Only one hospital was included in this study which does not reflect the situation of whole city or nation.

• only admitted patient of medicine department was considered in this study which may not reflect the service provided by hospital as a whole.

Results and Findings

Distribution of age of admitted patient:Age group (in Years) Frequency Percentage

11-20 7 4.12

21-30 64 37.65

31-40 37 21.76

41-50 28 16.47

51-60 21 12.35

61-70 10 5.88

71-80 2 1.17

81-90 1 0.6

Total 170 100

Mean Age 38.42 (SD±14.316) Years.

Distribution of sex of admitted patient

MaleFemale

52.40%47.60%

Sex of the admitted patient

Distribution of Religion in admitted patient

69%

23%

6% 2%Muslim

Hindu

Christian

Buddist

Distribution of education of admitted patient

Admitted Patient Education

Frequency Percentage

Illiterate 33 19.4

Primary 50 29.4

Secondary 27 15.9

H.S.C. 27 15.9

Graduation &

above

33 19.4

Total 170 100

Distribution of Marital Status of Admitted Patient:

Marital Status Frequency Percentage

Unmarried 16 9.4

Married 151 88.8

Separated 1 0.6

Divorced 2 1.2

Total 170 100

Distribution of Number of Children of Admitted Patient:

Number of Children Frequency Percentage1 26 17.33

2 47 31.333 31 20.67

4 25 16.67

5 13 8.67

6 5 3.33

7 2 1.33

9 1 0.67

Total 150 100

Distribution of occupation of admitted patient

Occupation Frequency PercentageUnemployed 6 3.5Govt. service 14 8.2

Private Service 31 18.2NGO 8 4.7

Housewife 51 30.0Garments Workers 8 4.7

Maid Servant 8 4.7Student 14 8.2

Others (Business, Rtd.)

30 17.6

Total 170 100

Distribution of monthly family income of admitted patient:

Income (in BDT) Frequency Percentage1000 -10000 62 36.4711000 -20000 50 29.4021000 -30000 30 17.6431000 -40000 9 5.2941000 -50000 8 4.751000 -60000 4 2.3561000 -70000 1 0.671000 -80000 4 2.3581000 -90000 0 0

91000 -100000 2 1.2Total 170 100

Mean income 21052.94 (SD±18841.369) .

Distribution Of Household Condition Of admitted patient

pacca32%

Semi Pacca28%Tin made

kaccha40%

Distribution of source of Drinking water of admitted patient

Source of Drinking Water


Pond water 4 2.4

Tube Wall water 83 48.8

Supply Water 30 17.6

Boiled Water 53 31.2

Total 170 100.0

Distribution of area of admitted patient where they come in

Area of Admitted Patient Where They Come


Rural 91 53.5

Urban 41 24.1

Slam 38 22.4

Total 170 100.0

Distribution Of Sanitation System Of admitted patient

HygienicUnhygienic

79.40%

20.60%

Sanitation system of respondent

Distribution of cause of admission in hospital.

Fever

Neurologica

l Diso

rder

Cardiac

Diso

rder

Respira

tory Diso

rder

GIT D

isorder

Cance

r

Kidney D

isease

s

Skin Dise

ases

Fever,

Neu

rological D

isorder

Fever,

Card

iac D

isorder

Fever,

Resp

iratory D

isorder

Fever,

GIT

Diso

rder

Fever,

Kidney

Dise

ase

Fever,

Skin

Neurologica

l Diso

rder Card

iac D

isorder,

Neurologica

l Diso

rder, K

idney D

isease

Neurologica

l Diso

rder ,Skin

Cardiac

Diso

rder ,R

TI

Cardiac

Diso

rder &G.I.T

Diso

rder

Cardiac

Diso

rder, C

ance

r

Cardiac

Diso

rder ,K

idney D

isease

s

Cardiac

Diso

rder, Skin

Respira

tory Diso

rder & G

IT D

isorder

Respira

tory Diso

rder & Skin D

isorder

G.I.T C

ance

r

GIT &

Skin Infec

tion

Kidney &

Skin Dise

ases

Fever

With

Skin With

C.N

.S Problem

Fever

With

G.I.T

With

Resp

iratory Trac

t Problem

0

5

10

15

20

25

Reason For Your Hospital Visit

Axis Title

Distribution of the Admitted Patients’ Satisfaction about Reception

Satisfaction about Reception


Highly Dissatisfied 5 2.9

Dissatisfied 16 9.4

Neutral 31 18.2

Satisfied 108 63.5

Highly Satisfied 10 5.9

Total 170 100

Distribution of the admitted patient’s satisfaction about cordial service

Satisfaction about cordial service



Dissatisfied 38 22.4

Neutral 38 22.4

Satisfied 75 44.1


Total 170 100.0

Satisfaction about Quick Response of Nurse

34.70%

65.30%

Late Response Quick response50

Distribution of the admitted patients according to their satisfaction of Understanding about illness

Satisfaction Of

Understanding About Illness


Highly dissatisfied 7 4.1


Neutral 33 19.4

Satisfied 59 34.7

Highly satisfied 23 13.5

Total 170 100.0

Distribution of the admitted patients’ satisfaction about doctors’ skills

Satisfaction about doctors skill


Highly dissatisfied 3 1.8Dissatisfied 11 6.5

Neutral 17 10.0Satisfied 81 47.6

Highly satisfied 58 34.1Total 170 100.0

Admitted Patients Satisfaction about Attitude of Nurse

Bad26%

Good74%

Nurses Attitude

Distribution of the admitted patients’ satisfaction about nurses’ skill

Nurses’ Skill Frequency Percentage


Dissatisfied 14 8.2

Neutral 37 21.8

Satisfied 87 51.2


Total 170 100.0

Satisfaction about Nurses Sympathy

4.710

17.6

50

17.6

Distribution of the admitted patients’satisfaction about confidentiality of their illness

Confidentiality of Their Illness


Highly dissatisfied 4 2.4


Neutral 27 15.9

Satisfied 45 26.5

Highly satisfied 73 42.9

Total 170 100.0

Distribution of the Admitted Patients Satisfaction about cleanliness of hospital

Cleanliness of Hospital




Neutral 19 11.2

Satisfied 55 32.4


Total 170 100.0

Distribution of the Admitted Patients satisfaction about Sanitation system of this Hospital

sanitation of Hospital Frequency Percentage



Neutral 28 16.5

Satisfied 22 12.9

Total 170 100.0

Distribution of the Admitted Patients Satisfaction about Food of Hospital

Food Hospital Frequency Percentage

Highly

Dissatisfied10 5.9


Neutral 42 24.7

Satisfied 61 35.9


Total 170 100.0

Admitted Patients Satisfaction about Investigation Risk information

Highly Dissatis-fied

Dissatisfied Neutral Satisfied Highly Satisfied

21.2

40.6

17.1 16.5

4.7

Admitted Patients Satisfaction about reaching investigation reports in time

Investigation reports Frequency Percentage


Dissatisfied 67 39.4Neutral 14 8.2

Satisfied 59 34.7


Total 170 100.0

Distribution of the Admitted Patients Satisfaction about giving Discharge Certificate

Discharge certificate Frequency Percentage



Neutral 62 36.5

Satisfied 43 25.3


Total170 100.0

Distribution of the Admitted Patients Satisfaction about availability of drug

highly dissatiesfied Dissatiesfied Neutral Satisfied Highly Satiesfied

5.9

37.6

28.225.9

7.6

Distribution of the Admitted Patients Satisfaction about distribution of drug

Distribution of drug Frequency Percentage



Neutral 52 30.6

Satisfied 44 25.9


Total 170 100.0

Patients Satisfaction about overall service of hospital

Service of Hospital Frequency Percentage



Neutral 48 28.2

Satisfied 73 42.9


Total 170 100.0

Satisfaction about Quick Response of Doctor

21.8%

78.2%

Admitted Patients Satisfaction about Attitude of doctor

92%

8%

GOOD BAD

Patients Satisfaction about Parking Facility ofHospital

Parking Facility of Hospital


Good Parking Facility 112 65.9

Bad Parking Facility 17 10.0

Total 129 75.9

No need of Parking Facility

41 24.1

Admitted Patients Satisfaction about Reliability of Service

14.7%

85.3%

Non reliable Reliable

Satisfaction about gives Extra Payment forGood Service in Hospital

YES NO

42.40% 57.60%

EXTRA PAYMENT FOR GOOD SERVICE

Satisfaction about further Recommendation of others for Admitted in these hospitals

Recommendation of others for Admitted in

these hospital


Yes 122 71.8

No 48 28.2

Total 170 100.0

Education

Satisfaction

Total X2 P-

ValueDissatisfied Satisfied

Freq Per. Freq. Per. Frequency Percentage

2.569a .115Illiterate 52 37.1 86 62.3 138 100

Literate 17 53.1 15 46.9 32 100**Continuity Correction with 2 tailed significant

Association between the Educations of admitted patient with satisfaction with their treatment in hospital

Association Between the occupations of admitted patient with satisfaction with their treatment in hospital

OccupationSatisfaction

Total X2 P-Value

Dissatisfied Satisfied

Freq Per. Freq. Per. Frequency percentage

.003a 1.000Unemployed 25 40.3 37 59.7 62 100

Employed 44 40.7 64 59.3 108 100

**Continuity Correction with 2 tailed significant

Association Between the incomes of admitted patient with satisfaction with their treatment in hospital

IncomeSatisfaction

Total X2 P-Value


Freq Per. Freq. Per. Frequency

Percentage

17.767a

.000

<20,000 tk

50 55.6 40 44.4 90 100

>20,000 tk

19 23.8 61 76.2 80 100

**Continuity Correction with 2 tailed significant (p <0.001)

Association Between the area of coming of admitted patient with satisfaction with their treatment in hospital

Areas of coming

Satisfaction Total X2 P-Value



Percentage

7.097a

0.010

Rural 60 46.2 75 53.8 130 100

Urban 9 22.5 31 77.5 40 100

**Continuity Correction with 2 tailed significant (p<0.05)

Association Between the Attitude of doctor to admitted patient with satisfaction of treatment during hospital

Attitudes of doctor




Percentage

.150a

1.000

Good 67 40.4 99 59.6 166 100

Bad 2 50 2 50 4 100

**Continuity Correction with 2 tailed significant

Association Between the Attitude of Nurse with satisfaction of their treatment of admitted patient during hospital

Attitudes of

nurse




Percentage

9.563a

.003

Good 42 33.6 83 66.4 125 100

Bad 27 60 18 40 45 100**Continuity Correction with 2 tailed significant (p<0.05)

Association Between the Reliable services of hospital with satisfaction of admitted patient

Reliable services

of hospital




Percentage

6.662a

.014

Reliable 53 36.6 92 63.4 145 100

Non Reliable

16 64 9 36 25 100**Continuity Correction with 2 tailed significant (p<0.05)

conclusion• Improving the medical care in Bangladesh requires

attention to service features that are regularly rated by patients. These features include doctors, nurses tangibles process features, etc

• Consequences of patient dissatisfaction can include patients not following treatment regimen

• Service orientation of doctors and nurses was found to be the strongest & important factor for influencing patient satisfaction in hospitals

• Foreign hospitals are rated highest on all service dimensions. Unless this awareness is matched by local hospitals, foreign exchange losses can be significant as patients look for care abroad.

Recommendation:According to the study results the following

recommendation should be implemented immediately.

• Necessary action should be taken by tertiary level hospitals’ authority of all public and private sectors to increase their reliable services.

• Media should play an important role and should disseminate proper and correct information about better services and facilities of public hospitals as well as private hospitals.

• Should improve the Sanitation System of the hospital.

Recommendation contd.....• Proper action should taken by hospital

authorities to stop taking bribe or extra money in illegal way and illegal recommendation and other unethical issues.

• Should inform to the patient in short description about investigation for his/her illness.

• Arrange training among doctor,nurses & all other staff to know how to provide quality of care .

• Government should implement a user friendly hospital management policy to satisfy patients and the attendees of the patient at all level hospitals sector.

Acknowledgement• At first I would like to express my praise to almighty Allah most

gracious and most merciful who enabled me to under take and finish this thesis work .

• My Special thanks to Prof. Dr. Md. Nazrul Islam PhD my Professor for well-designed guidance, constructive criticism, intellectual input and opening to me the door of wonderful field of Public Health.

• I am also grateful to Prof. Dr. Ahmed A Neaz, Prof. Dr. Tazul Islam and all other teachers of the Institute for expanding my knowledge in the academic field of Public Health.

• I would like to express my deep sense of gratitude to the patient of (HFRCMCH) for their support

• Thanks to all my classmates, friends and colleagues for creating a nice and friendly research and working Environment

Satisfactions Among Admitted Patient of Tertiary Level Hospital in Dhaka City.

Healthcare

Transcript of Satisfactions Among Admitted Patient of Tertiary Level Hospital in Dhaka City.