Introduction

The quality of service in health means an inexpensive type of service with minimum side effects that can cure or relieve the health problems of the patients (1). Health care has two connotations (a) health care programs and (b) medical care organizations. Medical care organizations are mainly providing curative care. They are attractive and high-tech oriented and they should be cost effective (2). Other industries have been paying attention to consumer satisfaction for years. .Health care is the only industry- service or manufacturing - that for years has left the consumer out of it. This is an absolutely prehistoric thinking. To ignore the input from the patient, to ignore the consumer, to say the consumer’s desires are irrelevant is not living with reality. Health care consumers today, are more sophisticated than in the past and now demand increasingly more accurate and valid evidence of health plan quality (3). In recent years, quality assurance has emerged as an internationally important aspect in the provision of health care services (4). ^{Patient-centered outcomes have taken center stage as the primary means of measuring the effectiveness of health care delivery. It is commonly acknowledged that patients’ reports of their satisfaction with the quality of care and services, are as important as many clinical health measures (5). The health care system depends on availability, affordability, efficiency, feasibility, and other factors (6). Consumer satisfaction is recognized as an important parameter for assessing the quality of patient care services. Patient satisfaction with the healthcare services largely determines their compliance with the treatment and thus contributes to the positive influence on health. Satisfaction regarding the attitude of providers toward these services is expected to affect treatment outcome and prognosis. There is a need to analyze the health care system as often as possible (7).}

Health care organizations are operating in an extremely competitive environment, and patient satisfaction has become a key to gaining and maintaining market share. Consumer satisfaction regarding medical care organizations like tertiary care hospital is important in the provision of services to patients. So, this study was designed to assess consumer satisfaction with regard to clinical care such as the approach of the doctor, examination, education on taking medication, availability of services, waiting time, and cost provided in the outpatient department of a medical college hospital.

Materials And Methods

The study was carried out in the outpatient department of Dhiraj Hospital, affiliated with S.B.K.S. Medical Institute and Research Centre (Private Medical College), Pipariya, Vadodara, Gujarat. Prior approval was taken from the board of trustees to conduct this study in the hospital. A preliminary questionnaire was first developed in English, then translated into Gujarati (local dialect) and retranslated several times until it was user friendly and captured the desired constructs. A 27 item pre-tested and pre-structured questionnaire was given to the patients or their attendants at the end of their outpatient visit. A total of 125 patients were selected at random in a time span of 6 days from January 4, 2008 to January 9, 2008 between 12 and 1 p.m. Verbal informed consent was obtained from the study participants. The items in the questionnaire referred to the particulars of the patient such as age, sex, occupation, the concerned department, service particulars in the registration counter, concerned doctor in the respective department, the lab, and the medical stores. The questionnaire included choices like convenient/inconvenient, satisfactory/unsatisfactory, easy/difficult, good/moderate, adequate/inadequate, and 30 minute time slots of actual time spent in each stage of the visit. Informed consent was obtained from the patient. The patients were told that the purpose of the study was to assess the consumer satisfaction of services provided by the hospital so as to bring about further improvement of services. The patients were also told that the investigator was not part of the treatment team. It was also emphasized that they were free to give their honest responses. Anonymity of the examining doctor and the patient was maintained. The responses were expressed in proportions.

Results

The study population consisted of 125 patients (78 males and 47 females). A total of 62% were in the age group between 15-45 years old [Table 1]. Respondents were patients themselves (90%) and accompanying relatives for pediatric patients younger than 15 years old (10%). The opinions of the patients were grouped into the following 4 groups:

• Availability

• Clinical care

• Waiting time

• Cost

Figure 1

Table 1: Distribution of the respondents according to the age, sex, occupation and the concerned departments

Overall availability of services [Table 2] was very good regarding the seating arrangements in the outpatient department (95%) and the cleanliness of the outpatient department (92%). A total of 90% of the respondents were satisfied with the outpatient department timings, 77% of the respondents were satisfied with the services of the outpatient nursing staff, 86% of the respondents found it easy to locate the concerned specialist department in the outpatient department, and 98% of the respondents found the availability of the doctors in the outpatient department to be adequate. Only 18% of the respondents found it difficult to locate the pharmacy.

Figure 2

Table 2: Distribution of responses from the respondents according to availability of Services

Regarding clinical care [Table 3], 94% of the respondents found the approach of the doctors satisfactory, 88% of the respondents found the communication by the doctor good, 93% of the respondents were satisfied about the explanation of the disease by the doctor, 91% of the respondents found clinical care satisfactory, and 96% found the doctor efficient. A total of 98% of the respondents gave an opinion that the investigations were conducted necessarily and 86% of the respondents were satisfied with the number of investigations that are necessary. Interpretation of the investigation report by the doctor to the patient was satisfactory in 97% of the respondents. The nature of prescription was either simple and easy or satisfactory in 80 % of the respondents. Instruction regarding medication usage by dispensing pharmacists was satisfactory in 74% of the respondents.

Figure 3

Table 3: Distribution of responses from the respondents regarding clinical care

With regard to waiting time [Table 4], 81% of the patients found that the time required for registration was convenient for them (average time = 13.5 ± 7.86 min.). A total of 90% of the patients found the concerned department conveniently (average time = 12.2 ± 4.59 min.). The time required for consulting the doctor was less than 30 minutes in 18% of the cases, 30 to 60 minutes in 65% of the cases, 60 to 90 minutes 19% of the cases, and 90 to 120 minutes in 10% of the cases (average time = 44.8 ± 18.7 min.). Time taken for the investigations was satisfactory in 75% of the patients (average time = 145.3% ± 228.7 min). Time required to locate the pharmacy was satisfactory in 82% of the cases (average time = 8.9 ± 3.5 min) and the time spent in the pharmacy was satisfactory in only 63% of the patients (average time = 28.4 ± 17.2 min.).

Figure 4

Table 4: Distribution of responses of the respondents regarding waiting time

The cost of registration and consultation [Table 5] was satisfactory for 89% and 80% of the respondents respectively. The cost of investigation was low for 8% of the respondents, moderate for 68% of the respondents, and high for 24% of the respondents. The cost of medicines was satisfactory for 77% of the respondents. This may be dependent on the consumer's purchasing power and different costs of medicines.

Figure 5

Table 5: Distribution of responses from the respondents regarding cost

Discussion

The present study was an attempt to assess the level of satisfaction of the patients with the various aspects of health care in the private medical college hospital of Gujarat state. Very few similar studies have been done and therefore we lack the data for comparison. Yet, the findings of the survey are quite helpful if they are transformed into actions for improving the quality of health care.

In this study, each step of the outpatient services assessment was made by the consumer on factors such as availability of services, clinical care, time, and cost of services. It was found to be satisfactory regarding the availability of services and clinical care. But when the time spent in pharmacy was analyzed, it was considered that it was not significantly satisfactory. The costs of investigation were significantly moderate and high in 97% of the cases as assessed by the respondents. In a study by Acharya and Acharya (7), 82.8% of the respondents showed the approach of the doctor is personal. In their study, 81.6% regarded the explanation of the disease to the patient as satisfactory, 93.2% of the subjects were satisfied with the examination by the doctor, and it was simple and easy to understand in 60% of the cases.

The findings of this study are consistent with the similar study carried out by Prasanna KS et al (8), in which 100% of the respondents were satisfied with the seating arrangement and cleanliness of the outpatient department, 97% of the respondents found the approach of the doctors satisfactory, 79% of the patients found that the time required for registration was convenient for them. However, only 53% of the patients found that the time spent in pharmacy was satisfactory.

Conclusion

According to the consumer's opinion, the study showed good results with respect to availability and clinical care. Recommendations regarding ways to reduce the time spent in the pharmacy and the cost of investigations are required to improve consumer satisfaction.

Acknowledgement