INTRODUCTION
Out patient Department in any hospital is considered to be shop window of the hospital [1, 2]. There are various problems faced by the patients in out patient department like over crowding, delay in consultation, lack of proper guidance etc that leads to patient dissatisfaction. Now days, the patients are looking for hassle free and quick services in this fast growing world. This is only possible with optimum utility of the resources through multitasking in a single window system in the OPD for better services [3,4].
The Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) is an Institute of National Importance established by an Act of the Indian Parliament. It is an autonomous Institute under the administrative control of the Department of Science and Technology, Government of India and is situated at Trivandrum, the capital city of state of Kerala. It is a tertiary referral hospital with major specialties like Cardiology, Cardiac surgery, Neurology, Neurosurgery. The hospital is 239-bedded having three operation theater complexes and five ICU complexes. About 12,000 patients get registered per month. The patients are categorized as per the socioeconomic assessment by the trained Medical Social Workers in to five socioeconomic categories and patients are billed accordingly. About 20% of the patients receive free treatment and another 40% of the patients get subsidized treatment. In order to improve the satisfaction level of patients, infrastructure modification as per the suggestions of the patients were taken up. It was felt that there is a need to know the satisfaction level of patients and also get a feedback about the services provided in the outpatient departments. Hence this study was undertaken with objectives to study the awareness of patients about the outpatient department services, to evaluate the performance of the services in the patient’s perspective, and to identify the problems of the patients and suggest measures for improvement.
METHODOLOGY
The study was conducted among 200 patients attending OPD of Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India during the period from 01/10/2004 to 25/11/2004. The patients were selected randomly from various specialities. In order to get the details from patients, a questionnaire was designed to include questions eliciting awareness of patients about the outpatient department services, logistic arrangements in the out patient departments, waiting time, facilities, perception about the performance of staff, appointment system, behavior of the staff, support services and any other suggestions of patients. Review of literature was also collected to study the various developments in outpatient department services.
RESULTS
It was necessary to know from where the patient’s received preliminary information about the hospital. 67.8% of the patients responded that they came to know about the hospital from the referring doctor, 20% came to know from friends and relatives, 6% from Newspapers/ television and 5% came to know about it from other patients.
With regard to the patient’s awareness about services in the hospital, 28.5% of the patients said that they know about the services very well. 37.5% responded that they are aware about details of individual treatment and 29% said that they don’t know much and would like to know more.
About the question on guidance received from the hospital, 60% said that the staff of the hospital always guided them. The guidance was provided to 59% of the patients by the Medico Social Workers and 40% of patients by the security staff.
About the waiting time, 57% said that they need to wait occasionally for long hours and 15% said that they never waited for long hours to see the doctor. With this regard, the responses of patients are projected in Figure 1. From the data it is seen that most of the patients have responded that the waiting time is with in one hour. The waiting time in the enquiry and Medical Records Department (MRD) is less than 30 minutes for more than 70% of the patients. However the waiting time for consultation seems to be delayed; in some cases it extends to more than three hours.
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With regard to the availability of medical records in the out patient department, majority of the patients were happy. When asked about the comfort available in the out patient department, 75% of the patients had a good opinion. With regard to the cleanliness in the hospital, 50% of patients were highly satisfied whereas 15.5% said that the cleanliness can surely be improved. With regard to the staggered appointment system followed at SCTIMST, 94% of the patient was satisfied with the system and the same is the case with the signage boards available in the Out Patient Department. With regard to the time spent by the doctors during consultation 96.5% of the patients were satisfied. With regard to the Doctors behavior 56% said that Doctors were well behaved, compassionate and patient, while 35.5% felt that they were well behaved but would have been better if they were more patient. With regard to the privacy in consultation, 97.5% of the patients were satisfied. To a question “Were you benefited” when compared to the time spent for checkup, 79.4% responded that they were highly benefited while 19.6% said that they were benefited but have to wait for long hours to meet the doctor. To another question about their perception of benefit compared to the money spent, 76% said that they were benefited and 23% said that they were benefited but have to wait for long hours for consultation.
About the services provided by the nursing staff, the patient responded as per Figure 2. It is seen that majority of the patients are satisfied with the care and explanation about the disease and treatment given to them by the nursing staff. However the friendliness component of the nursing service was rated to be only average by 40% of the patients.
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About the Support services in the hospital, patients responded as per Figure 3. It id found that the majority of the patients are satisfied with the support services like Security, Accounts, Attenders and MSW. When asked about recommending this hospital to others, 55.8% said that they would always do so, while 30.2% said that they will do usually and 11.6% said that they will some times recommend this hospital.
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DISCUSSION
Patient satisfaction surveys are useful in gaining an understanding of user’s needs and their perception of the service received. In a survey conducted by Department of Public Health, Ireland the level of satisfaction among the OPD attendees were 94%. Doctors and nurses were perceived as friendly by 61% and 72% and rude by 1% and 1% of patients, respectively. The study highlighted the areas for improvement from the patient’s perspective [5].
Patient satisfaction is an important indicator in evaluating the quality of the patient care in the outpatient department. In a study conducted at Magdeburg, Germany only 3.6% of patients were dissatisfied [6]. It revealed that patient’s participation in their care has a special place with regard to patient satisfaction. While auditing patients experience and satisfaction with Neuro surgical care at the National Hospital, London, it was found that most aspects of the patients care had 70-80% satisfaction [7].
Poor patent patient satisfaction can lead to poor adherence to treatment with consequently poor health outcomes. In another study conducted on a sample of dermatology outpatients, out of 1385 randomly selected patients, 722 patients agreed to participate, 424 fulfilled the inclusion criteria and 396 of these patients (93.4%) completed the study. Overall satisfaction was reported by 60% of patients [8].
From these examples it is evident that the satisfaction of patients attending the OPD is to be assessed periodically. From the present study in a tertiary care hospital in India, it is seen that 90-95% of patients are satisfied with the service offered in the hospital. The waiting time for most of the patients is with in one hour in various departments, except in some occasions where it is prolonged. 96.5% of the patients were satisfied with the time spent by the doctors in consultations. The assessment of the services provided by nurses, security, receptionist, attendees etc also showed that 90-95% of patients were satisfied with the service. The study also revealed that some of the patients waiting time were prolonged and that the friendliness of the nursing staff needs to be improved.
CONCLUSION
Patients attending each hospital are responsible for spreading the good image of the hospital and therefore satisfaction of patients attending the hospital is equally important for hospital management. Various studies about Out Patient Services have elicited problems like overcrowding, delay in consultation, proper behavior of staff etc. In this study, it is found that majority of the patients are satisfied with the services provided. They were satisfied with the guidance, logistic arrangements, support services, nursing care, Doctors consultation etc. wherever there is delay in consultation, it is to be explored to elicit the lacunae. It is worthwhile to note that there is scope for improvement of the Out Patient Department Services. Therefore it can be concluded that the OPD services form an important component of Hospital services and feedback of patients are vital in quality improvement.
REFERENCES
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- Sakharkar BM. Principles of hospital Administration and Planning, Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, 1998:20-35 & 503-4.
- Srinivasan AV. Managing a Modern Hospital, Response Books A Division of Sage Publishers India (P) Ltd., New Delhi, 2000:53-69.
- Llewelyn R. Davies. H.M.C. Macaulay Hospital Planning and Administration, WHO, Geneva, 1996:105-11.
- De Brun C, Howell F, Bedford D, el al. Outpatient experiences in acute hospitals. Ir J Med Sci. 2002 Apr-Jun;171(2):89-93.
- March S, Swart E, Robra B. Patient satisfaction with outpatient/short stay operations in a practice clinic. Gesundheitswesen 2006 Jan;68(6):376-82.
- Thorne L, Ellamushi H, Mtandari S, et al. Auditing patient experience and satisfaction with neurosurgical care: results of a questionnaire survey. Br J Neurosurg. 2002 Jun;16(3):243-55.
- Renzi C, Abeni D, Picardi A, el al. Factors associated with patient statisfaction with care among dermatological out patients. Br J Dermatol. 2001 Oct;145(4):617-23.