Patient satisfaction: Concept analysis in the healthcare context

Most quality improvement (QI) activities in developing countries, established with funds from external donors, are focused on specific diseases or outreach programs, such as family planning or child survival. District hospitals in developing countries serve as the primary entry point for patients with surgical problems in developing countries, yet little is known about the extent to which formal QI activities for surgical services are present in these settings or the perceptions of hospital staff about the barriers to improving quality in this setting. This study aimed to document surgical QI efforts at district hospitals and perceived barriers to improving quality in a developing country—Ghana. It also provides a summary of the existing published scientific literature concerning surgical QI in developing countries. A survey team visited 10 government district hospitals in Ghana, one in each of Ghana’s 10 regions. The number and type of QI activities (surgical and nonsurgical) at these district hospitals and the perspectives of hospital staff regarding the steps required to improve the quality of surgical services in their facility were recorded. Of the 10 hospitals assessed, nine reported having some type of QI activity, ranging from satisfaction surveys to assessing quality of infection prevention. Only one hospital reported having QI activity addressing surgical care. To improve the quality of surgical care, seven hospitals reported the need for trained specialists in surgery, obstetrics, and gynecology. Six cited the need for an appropriately equipped operating theater and recovery ward. The primary barrier to achieving these recommendations, cited by 70 % of the hospitals, was the inability to recruit and retain qualified specialists with surgical skills. For Ghana to improve significantly the quality of surgical care provided in its district hospitals, greater emphasis is needed for continuous, systematic QI monitoring and for solving the problems identified. Increasing the number of appropriately trained surgical care providers is essential to strengthen the quality of surgical services in district hospitals. These findings likely apply to other resource-limited countries as well. Increased attention to improving the quality of surgical services at district hospitals in developing countries is urgently needed.

Quality Improvement Activities for Surgical Services at District Hospitals in Developing Countries and Perceived Barriers to Quality Improvement: Findings From Ghana and the Scientific Literature

Background: Patient satisfaction is a key determinant of the quality of medical care. Moreover, satisfaction can be used as a criterion for examining the adequacy of the care, health, and competency of personnel. Objectives: This study was conducted to determine the satisfaction of patients receiving trauma care in the emergency department of a hospital affiliated with Isfahan University of Medical Sciences. Patients and Methods: This simple clinical trial was performed on 104 patients admitted for traumatic injury to an emergency department in Iran. Given that patients frequently enter an emergency department for care, the sampling of patients in the department was done on days that were randomly assigned to the study group. The experimental group received trauma intervention in four areas from their admission to the emergency department to their discharge from the hospital, and the control group received routine nursing care. The data were collected through a questionnaire that asked for demographic characteristics and then went on to ask about patient satisfaction. The satisfaction questionnaire was completed after the trauma intervention at the end of patients’ stay in the hospital. The data were analyzed using SPSS 22 software and descriptive statistical tests and analytical tests (independent t and Chi-square). Results: The mean score for total satisfaction after trauma intervention in the experimental group (45.6 ± 3.69) was significantly different from that of the control group (32.01 ± 7.78) (P < 0.001). Therefore, the levels of total satisfaction in the experimental and control group were favorable and relatively favorable, respectively. Conclusions: In this study, trauma intervention increased satisfaction in patients admitted to the emergency department. Therefore, managers and personnel of hospitals and healthcare training centers are urged to implement trauma intervention in their hospitals or healthcare training centers.

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The Effect of Trauma Intervention on the Satisfaction of Patients Admitted to the Emergency Department: A Clinical Trial Study.

Rationale, aims and objectives: Devising indicators to measure quality of care is challenging in Emergency Departments (ED). It is difficult to measure aspects of quality which are less amenable to measurement; hence waiting time has often been relied on. This study aimed to determine whether patients’ perceptions of empathy are a measurable indicator of quality of care in comparison to waiting time within the ED. 

Method: A cross sectional survey of patients who attended an ED during a 10 day period was conducted to assess correlation between a measure of empathy (the CARE measure), waiting times and perception of care quality. Data other than waiting times were obtained using a questionnaire completed by patients immediately on completion of treatment. Waiting times were obtained from an existing database. Both waiting times and CARE scores were correlated with responses to a patient satisfaction question using Spearman’s rho.

Results: Of the 81 patients who participated the majority reported care to be good (21%) or very good (75%). Waiting times varied between 11 minutes and 5 hours 17 minutes. CARE scores ranged from 12 to 50 (mean 41.1). Analysis showed a statistically significant relationship (p<0.001) between ratings of patient satisfaction and CARE measure scores with a moderate correlation (Spearman’s rho = 0.55), whereas no correlation was found between satisfaction and waiting time (Spearman’s rho = -0.07, p=0.56). 

Conclusions: Length of time was not associated with patients’ perceptions of care quality and hence would have been of limited value as a current measure of quality in the ED. Conversely, empathy was associated with care quality and thus should be considered as a means for assessing quality from the patients’ perspective in the context of ED departments

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Compassion or speed, which is a more accurate indicator of healthcare quality in the emergency department from the patients’ perspective.

The services provided to the patients of pre-hospital emergency center and their satisfactions indicate the quality of pre-hospital emergency services. The goal of this study is to investigate the satisfaction of patients with Ambulance Service services (115) in Shahrekord in the first half of (2012). In this descriptive and analytic study, 450 patients transferred to the hospital by pre-hospital emergency center were chosen using simple random sampling method and data was collected by using satisfaction evaluation questionnaire. The information obtained under SPSS software version 16 was analyzed by statistical descriptive test, independent t test, variance analysis test and Pierson Correlation test. The findings showed that satisfaction level with pre-hospital emergency services in men, low- educated people, married people, those with the record of using emergency services and those with emergency problems was significantly higher than others. Satisfaction level in all fields was above 50% and was totally 71.12. The highest level of satisfaction was for the efficiency of emergency center (58, 78) and the lowest level of satisfaction in the questions was for the performance of technicians (58, 73). Patients' satisfaction with emergency services and their quality is considered as one of the main concepts in pre-hospital emergency procedures, in the manner that the results of this study showed that patients' satisfaction in different fields were high and satisfactory and the technicians should allocate much more time for interaction with patients in order to improve their satisfaction.

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Patients Perception and Satisfaction of the Ambulance Service (115) at Shahrekord, Iran

Patients' satisfaction with emergency care and priorities for change in a university teaching hospital in Nigeria.

Background: Road traffic crashes are a common cause of preventable injury and death worldwide including in Nigeria. Objective: This study assessed the determinants of road traffic crashes among intercity commercial drivers in Ile-Ife, Nigeria. Methods: This was a descriptive cross-sectional study design. Three hundred and fifty commercial drivers completed an interviewer-administered questionnaire on the occurrence and determinants of road traffic crashes. Data were analysed using descriptive and inferential statistics. Results: The respondents were male, with a mean age of 45.6 (10.6) years, married (88.9%), had secondary education (57.4%) and earned above $5/month (94.3%). Only 28.3% attended driving school, 26.9% started driving <10 years and 65.4% drove more than 8 h daily with morning hours considered the busiest (63.4%). Over one-third (36.7%) of the respondents had experienced road traffic crashes with 86.7% driving when crashes occurred. The identified causes of road traffic crashes include bad roads (37.5%), burst tyre (18.8%), over-speeding (18%) and brake failure (16.4%). Other causes include driving fatigue/sleeping while driving (14.1%), driving at night (14.1%) and environmental factors (13.3%). The outcome of road traffic crashes includes vehicular damage (75%), injury to the passenger (45.3%) and driver (38.3%) with fatal (13.3%). The determinants of road traffic crashes include young age (adjusted odd ratio [AOR] = 8.17; 95% confidence interval [CI] = 4.15–17.7; P = 0.001), using sedatives (AOR = 6.49; 95% CI = 2.91–14.46; P = 0.001), alcohol use (AOR = 17.76; 95% CI = 8.72–36.16; P = 0.001), night driving (AOR = 3.10; 95% CI = 1.41–6.78; P = 0.005) and driving over 8 h per day (AOR = 2.78; 95% CI = 1.40–5.53; P = 0.004). Conclusion: Road traffic crashes were common among young commercial intercity drivers with causes varying from human, mechanical and environmental factors. Strategy to reduce these factors will improve road safety among commercial drivers.

Olakunle A. Olakulehin

Papers

Patients' satisfaction with emergency care and priorities for change in a university teaching hospital in Nigeria.

Determinants of road traffic crashes among intercity commercial drivers in Ile-Ife, Nigeria