OUTCOME OF PATIENT SATISFACTION IN HOSPITAL SERVICES, CHENNAI. S.Sharmila MBA., **Dr.Jayasree Krishnan PhD., ABSTRACT

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1 OUTCOME OF PATIENT SATISFACTION IN HOSPITAL SERVICES, CHENNAI * S.Sharmila MBA., **Dr.Jayasree Krishnan PhD., Research Scholar, Dean and Hod for Dept of Mgt Studies Sathyabama University, Chennai. St.Josephs Engineering College, Chennai. ABSTRACT In today s highly competitive environment, hospitals are increasingly realizing the need to focus on service quality as a measure to improve their competitive position. Customer based determinants and perceptions of service quality, therefore, play an important role when choosing a hospital. In this paper the researcher has presented the service quality satisfaction study undertaken in three private hospitals in Chennai city. The sample of 485 patients from the different hospitals revealed that service quality has great impact on patient satisfaction. Though the patients are satisfied by the doctors some measures should be taken to improve the quality of care by the paramedical staff in order to have patient retention and patient loyalty. Keywords: Patient satisfaction, quality of medical services, hospitals, patient retention and patient loyalty. INTRODUCTION With increasing awareness among consumers about their right, the patients, as consumers of health services, expect quality health-care. In the light of these changes, health-care providers need to have closer look at the perception of their patients and try to provide medical services to meet their expectations. The adoption of the marketing concepts is, thus, becoming necessity for the medical services. The strategy for patient satisfaction with health-care service requires effective marketing plans, policies and practices to genuinely meet the needs of different strata of population(mac Alexander,et al,1993).this concept drew the attention of service providers in the early 1970 s and the health care providers in the early 1970s and the health care providers in the advanced countries became conscious of satisfying the patients (Cooper, et al.1979;kotler and Zaltman, 1970; and Woodside,et al, 1989). The major factors that have necessitated a shift towards the

2 marketing approach are intense competition and increased awareness and purchasing power of patients. Consequently, the measurement of patient satisfaction and service quality has become very important to the health care providers (Parasuram, et al 1988 and Brown and Swartz, 1989). Taylor, et al 1981 felt that consumer opinion yielded valuable information about the functioning of health care system and that should be taken into account while assessing quality of medical services. It was found by them that the performance of the hospital staff, as perceived by the patients, was positively associated with the patient s satisfaction. LITERATURE REVIEW The service sector is expanding at an increasing rate and is becoming intensely `1competitive (Chen, et.al., 1994; Johnson, et.al., 1988). As such, service quality has become a very important issue in marketing and has received much attention since the deregulation, and thus increased competition, of many service industries (e.g.: health care, banking and telecommunications in the 1980 s and utilities in the 1990 s). Service quality has become so important that some businesses, not only need high levels of service quality for success, but in some cases, need it for survival (Buzzel and Gale, 1987; Chen et. al., 1994; Ford Motor Company, 1990; Germano, 1992; Hauser and Clausing, 1988; Howcroft, 1993; Kearns and Nadler, 1992; Kettinger and Lee, 1995; Koska, 1990). Service quality is so important that companies have gone to great efforts to evaluate and keep records of service quality levels (Hauser and Clausing, 1988; Phillips, et.al., 1983; Zeithaml, et.al., 1990). By offering high levels of service quality, the Hospital Corporation of America and Ford Motor Company are another two well know companies that have benefited in terms of higher returns on investment and higher profits (Ford Motor Company, 1990; Koska, 1990). Further rewards can come in the form of increased market share (Buzzel and Gayle, 1987; Phillips, et.al., 1983). Given the importance of service quality to the services sector, Taylor and Baker (1994) encourage further operationalization of service quality. Service quality is defined as how well the service meets or exceeds the customers expectations on a consistent basis (Crosby, 1979; Parasuraman, Zeithaml and Berry, 1985). The difficulty, however, is that service quality, unlike product quality, is more abstract and elusive, because of features unique to services: intangibility, inseparability, heterogeneity (Parasuraman, Zeithaml and Berry, 1985) and perish ability, and is therefore difficult to measure.

3 Still, there is need to find a way to achieve better health care quality that is appropriate. It is important to start with an understanding of the real situation. Some common features of the health care challenges in many developing countries according to Ovretveit (2004) are: A low level of basic primary and hospital care, with few preventative services Lack of transport and resources for supervision The low use of these services by the public, due to poor treatment and high user charges for many items An increasing use of private care: private hospitals and clinics in some cities pharmacies and individual doctors and other practitioners working privately, with no effective regulations Lack of knowledge about the quality ideas, methods and results. Lack of skills in using the methods or in implanting programmes Lack of standards which are credible, agreed and authorized by the ministry and professions and which can be applied flexibly in different situations Many personnel are low paid and de-motivated and see no personal or other advantages to spending extra time working on quality improvements: the benefits for them are not clear A low level of training and professionalism for most health practitioners who are not supervised are low paid and rely on patient fees and other sources of private income. NEED FOR THE STUDY: To assess the patient satisfaction of the overall services provided by the doctors and health care institutions regarding the reasons for choosing a particular doctor or hospital. To assess the performance, skill, knowledge and quality of the doctors, staff nurses and the hospital personnel. To analyze the patients reliability of the tests and procedure. To analyze the quality of the consulting suits, rooms, diagnostic labs, billing and admission procedures.

4 STATEMENT OF THE PROBLEM: Now a day s hospital sector has become corporate and the standard of the patients has increased and hence the patient-doctor relationships have been changed into consumer-service provider relationship. Hence it is a big and challenging issue whether quality of services has been provided to the patients. As the definition says satisfaction is largely the result of fulfilled expectations of the patients, which is a major challenge to the hospital industry. METHODOLOGY: A direct structured questionnaire was prepared for the purpose of collecting the necessary data. The survey was conducted through personnel interviews. The sample was taken from three of the private hospitals by using convenience sampling method. The study was conducted in Chennai city of Tamilnadu. In order to make the sample more representatives the patients were selected from five major specialties namely medicine, surgery, gynecology, orthopedics and dermatology. It was decided to select 500 patients from all the five specialties from the three hospitals but only 485 questionnaires were received back from the patients. The sample size is 485 out of which 275 were those getting treatments from the outpatient department and 210 were admitted for the treatment. DATA ANALYSIS: CRITERIA FOR SELECTING THE HOSPITAL The respondents were asked to evaluate the criteria for selecting this particular hospital. The reasons provided were, the physical appearance, popularity of the hospital, convenience of location, popularity of the doctor, previous personal experience. The five major reasons for choosing the hospital is summarized below in Table 1:

5 Table: 1 Selection of the Hospital HOSPITAL Reasons for choosing the Hospital Patients Number Percentage Physical appearance of the Hospital Popularity of the hospital Convenience of location Popularity of the doctor Previous personal experience The major reasons indicated by the respondents for choosing a hospital were different. The top two reasons which emerged are, 1. Popularity of the hospital (27.84%), 2. Convenience of location (24.12%) and the third reason found to be the previous personal experience (21.03%). QUALITY OF HEALTHCARE SERVICES: Patient satisfaction about the quality of services provided by the hospital is measured on a fivepoint Likert scale, ranging from the most satisfactory to the most dissatisfactory, with regard to various indicators of services, including the physical appearance, reception and computerized billing, cleanliness, diagnostic lab facilities, room ambience, friendliness of doctors, courtesy of the staff nurses, Para- medical staffs and reliability of the medical records. Responses were collected and mean scores were found. A score five was given to the most satisfactory and one to the most dissatisfactory. The F-test for analysis of variance was applied among various groups of demographic characteristics including age, sex, education, income in order to determine whether there was a significant difference in their satisfaction with the quality of healthcare services.

6 Table 2: Patients satisfaction with quality of healthcare services Demographic variables Number of respondents Mean X Standard Deviation F-ratio F- probability Age: a) 20-29years b) years c) years d) 50 and above Total Education: a) Schooling b) Graduate c) Post graduate and above d) Others Total Sex: a) Male b) Female Total Income: a) Less than 10,000 b) 10,001 to 40,000 c) 40,001 to 60,000 d) Above 60,001 Total From the above table it is inferred that the satisfaction level did not differ significantly among patients of various age groups. However, as compared to younger patients, Patients above 50 years of age appeared to be more satisfied with the quality of services provided. The patients having various educational levels did not differ significantly, however post graduate patients seemed to be more satisfied compared to others.there were significant differences in the opinion of male and female patients regarding the quality of medical services provided by hospitals. Female patients appeared more satisfied with the services in comparison to male patients.

7 OVERALL SATISFACTION LEVEL WITH DEMOGRAPHIC FACTORS OF PATIENTS From the below table it is inferred that post graduate patients are very much satisfied about the quality of services rather than the other set of patients. Table 3: Overall satisfaction on the basis of education Education Particulars Number of respondents Satisfied % Dissatisfied % a) Schooling b) Graduate c) Post graduate and above d) Others Table 4: Percentage of respondents for scaled items CRITERIA VB B M G VG Opinion about the physical appearance of the hospital Computerized registration and billing facility Easy accessibility of the consultation suits Cleanliness of the consultation suits and other area of the hospital Facilities of the diagnostic labs Room ambience and toilet facilities Skill/knowledge, friendliness/courtesy of the physician towards the patient Attitude,promptness,skill and courtesy of the staff nurses Kindness, caring and courtesy of the hospital staff during your visit Reliability of the patients on the tests and reports from the hospital It is inferred that most of the patients likes the physical appearance of the hospital and it really gives them a good image about the hospital. 67% of the patients are convenient with the

8 consulting suits for the physicians consulting. 60% of the patients felt that hospital area is clean and that does not make feel bad about the hospital. 57% of the patients felt good about the lab facilities. Most of the patient (70%) felt that the physicians are good in their approach and attitude towards the patients. 60% of the patients state that nurses are good but they have to increase their courtesy.59% of the patients were satisfied about the behavior of the hospital staffs.53% of the patients rely upon the test and procedure results given by the hospital. DISCUSSIONS AND CONCLUSION: This study has focused on the importance of quality of services and patient satisfaction and hence proved the value and importance of improving the service quality in hospitals. By this result the hospitals can improve the quality of services. The study can also be done in depth in administration also to ensure the relationship between the patients and the hospital administrators. In India, hospitals, like many other services firms, lag behind manufacturing firms in their use of marketing. Adoption of marketing concept to the medical services would take the hospitals a long way in giving the best to the patients. From this study it is observed that the patients felt almost good and satisfied in many aspects of the hospitals but there were few suggestions given by the patients that could be implemented to improve the level of satisfaction. They are, Staff could be trained to be polite towards the patients where there exist a miscommunication due to language barriers. Toilets were very few in numbers and it could be increased in order to prevent waste of time in waiting for their turn. The floor near the washing area is slippery so it could be changed or kept dry to prevent any accidents. Procedure rooms and the toilets in that room should also be cleaned periodically; tissues should also be given to the patients. The reports should be dispatched correctly in a single counter in order to avoid misunderstanding. So far, the study has focused on the components of quality and services of the hospital. To complete the triad cost measures and evaluation of the performance of the nurses and staffs can also be researched. The hospitals and medical manager should find out ways and methods to measure the performance of the physicians as well as the costs of effective healthcare.

9 REFERENCES: 1. Mosad Zineldin, Quality of health care and patient satisfaction, international journel of health care quality assurance 200; 19, Andaleeb, s.s 1998 Determinants of customer satisfaction with hospitals; a managerial model, international journal of health care quality assurance vol 11 no Berwick D.M 1989, Continuous improvement as an ideal in healthcare, New England journal of medicine, vol 320 no Bettencourt, L 1997 Customer voluntary performance, customer as partners in services delivery, Journal of retailing, vol 37,no.3 6. Parasuraman, A., Zeithaml, V. A. and Berry, L. L. (1985) A conceptual model of service quality and its implications for future research, Journal of Marketing, 49:4, Parasuraman, A., Zeithaml, V. A. and Berry, L. L. (1988) SERVQUAL: A multiple-item scale for measuring customer perceptions of service quality, Journal of Retailing, 6:41, Phillips, L., Chang, D. and Buzzell, R. (1983) Product quality, cost position and business Performance: A test of some key hypotheses, Journal of Marketing, 47:2, Quinn J. B., Baruch J. J. and Paquette P. C. (1987) Technology in services, Scientific American, 257:6, Reynoso, J., and Moores, B. (1995) Towards the measurement of internal service quality, International Journal of Service Industry Management, 6:3, Rust, R. and Zahorik, A. (1993) Customer satisfaction, customer retention, and market share, Journal of Retailing, 69:2, Saha, U. R. and Bartlema, J. (1998) User free introduction and quality of care: some empirical indicators from Bangladesh and Comilla. Dhaka: Ministry of Health and Family Welfare;Thana Functional Improvement Pilot Project. 13. Scott, D. and Shieff, D. (1993) Service quality components and group criteria in local governments, International Journal of Service Industry Management, 4:4, Steiber, S. R. (1989) Preventing pitfalls in patient surveys, Health Care Strategic Management, May, Steiber, S. R. (1989) Preventing pitfalls in patient surveys, Health Care Strategic Management, May, Taylor S. and Baker, T. (1994) An assessment of the relationship between service quality and customer satisfaction in the formation of consumers purchase intentions, Journal of Retailing, 4:2, John, Joby. (1989) Perceived quality in Health Care Service Consumption: What are the Structural Dimensions?, Developments In Marketing Science, 12, Jon M. Hawes and John Thanopoulos (eds.), Orlando, FL, Academy of Marketing Science, Lanning, J.A. and O Connor, S.J. (1990) The health care quality quagmire: some sign posts, Hospital and Health Services Administration, 35:1, Lewis, B.R. (1991) Customer care in service organizations, Management Decision, 29:1, Lewis, B.R. and Mitchell, W. (1990) Defining and measuring the quality of customer service, Marketing Intelligence Planning, 8:6, Lim, P. and Tang, N. (2000) Study of patients expectations and satisfaction in Singapore hospitals, International Journal of Health Care Quality Assurance, 13:7,

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