Understanding Patient Satisfaction: Preferences, Expectations and Patient Rights of Practice in Public Hospital Settings of Amhara Regional State, Ethiopia
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Date
2016-06
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Addis Abeba Universty
Abstract
Background: Patient satisfaction has become an indicator and a standard part of evaluation of
the health care system, despite its complex nature and multiple determinants of patient
satisfaction. Health care now a day is a major service area for the people, thus it should satisfy its
customers. There have been different mechanisms to enhance patient satisfaction. Adhere to
services on patients’ preferences, meeting expectations and health care practice based on
patients’ rights were among others. Making health care service more congruent with patients’
preferences, expectations and patients’ rights practice can be achieved through measurement and
feedback of patients’ satisfaction and interventions that address patient concerns. Even countries
have guaranteed patients' rights to process for resolving dissatisfactions with health care
providers. The implementation of patients’ rights can increase patient satisfaction, as well as
achieve equal distribution of responsibility between the patients, and health service providers.
Thus research is needed to move forward with the structural changes regarding patients’ value
judgments in the health care service. Studies on patients’ preference to use health care, patient
expectation and patient rights practice as an important factor for patient satisfaction care
rendered at health care facilities in the developing country context like Ethiopia are often
neglected in health service researches and rarely subjected to scientific inquiry.
Objectives: The study aimed to examine patients’ preference, expectations, and the lived
experience of patients on patient rights practice as a factor of patient satisfaction at public
hospitals in Amhara Region, northern Ethiopia.
Methods: The study was carried out in nine public hospitals of Amhara Region of Ethiopia. It
was designed as a mixed method study in which both quantitative and qualitative data collection
and analyses were employed. About 1005 participants in the out and in patient departments of
general, medical and surgical departments were involved in the preference study which used
Discrete Choice Experiment method. A stated-preference discrete choice experiment survey was
performed among patients who visited the hospitals. Six attributes namely waiting time,
physician communication, nursing communication, drug availability, continuity of care, and
diagnostic facilities were selected based on a literature review of the most important
characteristics of hospital health care service. These attributes were reviewed and validated with
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inputs from patients and researchers in the field. Data were entered in SPSS Version 17 and
analyzed using STATA version 12. A random-effects probit model was used to perform the
analysis.
Regarding the quantitative Pre-and-Post consultation study of patient expectation, 776
participants were involved in the study. Data were collected on two occasions; about the
expectations before consultation, and how their expectations were met and their satisfaction after
the consultation. Data were entered and analyzed using SPSS Version 17. Means were computed
for the overall and the sub categories of expectation items. Paired t-test and logistic regression
analysis techniques were also employed.
For the qualitative study, data were collected using semi-structured interview from 22 patients
who have had experience of health care service utilization in the hospital setting. The
participants were selected purposively using maximum variation sampling technique based on
criteria like age 18 and above years, both sexes, considering residence, educational status, and
experience in the outpatient and inpatient departments. The interview (data) were tape-recorded,
transcribed, translated, reviewed, and analyzed using an iterative content approach of
phenomenographic researches. Open code software version 4.02 was used for data management.
Main categories and sub categories were described. The outcome space was constructed based on
main categories of patients’ conceptions and ways of understanding the phenomenon of patient
rights practice.
Results: The attributes included in the preference study; waiting time, physician communication,
nursing communication, drug availability in the hospital pharmacy, continuity of care and
diagnostic facilities had significant impact on participants’ decisions in the choice of hospitals.
The waiting time coefficient showed a negative value in the main effects model (β=-0.773,
P=0.026) indicated a higher probability of choosing a hospital with less waiting time for a
consultation. Patients were willing to wait up to 3.3 (MRS, 3.263 95%, CI: 1.387-5.139) hours
and 2.7 (MRS, 2.66 95%, CI: 1.769-3.556) hours to get full drugs in the hospital and good
nursing communication, respectively.
Preferences differ with sex occupation and type of hospitals. Farmers preferred a hospital with
good nursing communication (=0.089, P<0.05), and partial drug availability (=0.101, P<0.05).
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Participants with no jobs preferred a hospital with partial drug availability (=0.150, P<0.05)
and those patients who were from referral hospitals preferred a hospital that has continuity of
care (=0.081, P<0.05).
Patients expressed preferences in a decreasing order of all the significant attribute levels: a lot of
diagnostic facilities, full drug availability, presence of continuity of care, good nursing
communication, partial drug availability, good physician communication, and shorter waiting
time for the consultation. A hospital with lots of diagnostic facilities was ranked at the top, which
accounted for 65.9% of the log-likelihood. This was followed by full drug availability in the
hospital, continuity of care, and good nursing communication collectively accounting for 23.5%.
According to Degner Scale to measure the preference in making decisions about medical care,
412(53.1% of participants expressed a desire for sharing responsibility for which treatment is
best for them. This indicates patients prefer collaboration on medical decision. Of the 776
patients included in the study, 594 (76.5%) were satisfied with the global measure of patient
satisfaction. Significant mean difference was reported in overall expectation between preconsultation
and post-consultation ( x 1 =39.62±10.27) to ( x 2= 47.34±14.45) with (t = -12.95,
P<0.001).
The Multivariable logistic regression analysis showed that the probability of patient satisfaction
is contingent on post consultation expectation score level. Higher score of post consultation met
expectation scores, less likely satisfied. Participants with excellent to good self-perceived health
status groups were 3.5 times (OR, 3.53, 95% CI; 2.27-5.49) more likely satisfied than fair to very
poor self-perceived health status groups. Similarly, the odds of satisfaction were higher among
participants who had a lot of perceived control on health compared with their counter parts. The
odds of satisfaction were significantly lower among patients who were disappointed with the
consultation (OR, 0.32, 95% CI; 0.22-0.47) compared to patients who were not disappointed.
Similarly, the odds of satisfaction were lower among participants who had previous experience
in health care service compared with their counter parts. Compared with patients that felt a lot of
influence on the consultation, the odds of satisfaction was significantly lower (OR, 0.58, 95% CI;
0.37-0.91) to patients who do not felt a lot of influence on the consultation. The association with
pre consultation expectation scores and age were not significant in the multivariable regression
analysis.
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The qualitative findings indicated patients described four qualitatively different main categories
of patient rights practice. The main categories of description include: patient centered practice,
being secured, respecting dignity and getting referral. Patient rights practice was understood
from comprehensive to the lowest level hierarchically in the following order: patient centered
practice, getting referral, respect dignity, and being secured.
Conclusion: Patient satisfaction can be understood from the perspective of patient preference,
expectations and patient rights of practice. Changes to the diagnostic facilities of a hospital are
likely to have the greatest impact on patients’ preferences for hospital health care. Patient
satisfaction had no relationship with pre-consultation expectations. But, it had relationship with
post consultation met expectations. Based on the qualitative study, patient centered practice was
a comprehensive way of illustrating patient rights practice in the hospital setting.
Recommendations: Health service providers and managers should focus on patient experience
and work on their preferences to enhance patient satisfaction. Providers should also acknowledge
patient rights practice in the health care continuum. Policy makers should draft a frame work
which incorporates patients have the right to choose to consult a health service, and which one to
consult. The health care should incorporate patient centered care in health care based on the values
and standards established by the patient and the health profession. Health care ethics training both
in the pre-service and in-service as well as ethical reasons in daily activities should get due
attention. Furthermore, health care providers should also take part to identify situations that
violates patients’ rights and focused on to practice with their best effort. Future research on the
preferences for health care in a specific hospital’s department/ward may be important to elicit
disease-specific preferences for hospital health care. Other studies which incorporate health
service providers should be conducted to address the complete picture of patient satisfaction and
the match in expectation and patient rights practice between patients and health service
providers.
Key words: Patient preference, expectations, patient rights practice, hospital health care, patient
satisfaction, Discrete Choice Experiment, Phenomenography
Description
Keywords
Patient preference, expectations, patient rights practice, hospital health care, patient satisfaction, Discrete Choice Experiment, Phenomenography