IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)

e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 17, Issue 3 Ver.7 March. (2018), PP 31-39
www.iosrjournals.org

A study of patient satisfaction level in Out Patient Department

(OPD) in a tertiary care hospital in Maharashtra.
Dr. Sonali K. Kulkarni 1
Dept. Of Community Medicine, Dr. S.C.G.M.C.NANDED, Maharashatra India

Abstract: Background: Patient satisfaction is one of the important goals of any health system, but it is difficult
to measure the satisfaction and gauze responsiveness of health systems as not only the clinical but also the
nonclinical outcomes of care do influence the customer satisfaction. The health sector in India is characterized
by a public health sector and private sector. The major reason for choosing the public health services is its
inexpensiveness, availability with close proximity. However, effectiveness of health system depends upon quality
of services which is largely neglected. Patients are using public health services but majority are not
satisfied.Patient’s satisfaction depends on many factors such as quality of clinical services provided, availability
of medicine, behavior of doctor and other health staff, cost of services, hospital infrastructure, physical comfort,
emotional support and respect for patient preferences.
Material and Methods: A cross-sectional study was carried out at DR.S.C.G.M.C. NANDED in 100 randomly
selected patients. They were interviewed at the exit point of outpatient department during the period from
01/01/2017 to 31/12/17 after taking informed consent. The data were collected on predesigned and pretested
questionnaire.
Results: Most of the respondents were satisfied with availability of ser-vices, professional care, waiting time,
behavior of consultant, nurses, paramedical staff and other staff. The overall satisfaction level was 73%
excellent to good, 22% average and 94% respondents answered ‘yes’ to the question - ‘would you recommend
this hospital to friends and fam-ily’. Out of total 68% respondents were unsatisfied with toilet facility and 56%
were unsatisfied with drinking water facility.
Conclusion: OPD services in a hospital need to be improved by develop- ing patient feedback system.
Keywords: Patient Satisfaction; Health Care Services; Outpatient De-partment; Professional Care
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Date of Submission: 06-03-2018 Date of acceptance: 19-03-2018
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I. Introduction
The hospitals have evolved from being an isolated sanatorium to a place with five star facilities.
Patients and their relatives coming to the hospital not only expect world class treatment, but also other facilities
to make their stay comfortable in the hospital. This change in expectation has come due to tremendous growth
of media and its exposure, as well as commercialization and improvement in facilities.35
Patient Centered Health Care: Patients are central to healthcare delivery, yet all too often their
perspectives and input have not been considered by providers. This is beginning to change rapidly and is having
a major impact across a range of dimensions. Patients are becoming more engaged in their care and patient-
centered healthcare has emerged as a major domain of quality. It is part of a shift in focus which has drawn
increasing interest in recent years, highlighting the importance of incorporating patients‟ needs and perspectives
into care delivery. The patient‟s engagement with their care is now considered a key of patient centred
healthcare.36
Patient-centred healthcare realizes that patients are individuals, each with different needs. Realizing
those needs and the organization‟s ability to meet them are true quality measures. A patient-centred organization
is committed to affirming patients‟ perceptions as their reality and improving the way patients experience care
in the future.37
In addition, the line between “satisfaction” and “experience of care” is not always clear due to the
advent of newer terms (and new surveys designed to measure them). Among the terms are relationship-centred
care, patient engagement, patient empowerment, patient activation and shared decision-making; some have a
precise definition, others are still in flux. All jostle for attention under the rubric of “patient-centred care” (or,
perhaps, “person centred care” or “person- and family-centred care” or “participatory medicine”).

Definition: Patient satisfaction, which is viewed as a significant indicator of quality of care, can be defined as
fulfilment or meeting of expectation of a person from a service or product1 and has been receiving greater

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 A study of patient satisfaction level in Out Patient Department (OPD ) in a tertiary care hospital in ..

attention as a result of the rise in pay for performance (P4P) 38.It is a personal evaluation of health care services
and providers 37
A comprehensive literature review identified three purposes for patient satisfaction measurement: (a) to
describe healthcare services from the patient‟s perspective, (b) to identify problem areas in healthcare
organizations and generate ideas for solutions, and (c) to evaluate healthcare. The evaluation of healthcare was
considered the most important reason for measuring the patient‟s perspective of care. “The term „evaluation
„suggests a cognitive process in which specific aspects of care are assessed, while „satisfaction‟ refers to an
emotional response to the whole experience” 37

Measuring Patient Satisfaction: Tools developed to measure patient satisfaction have varied over
time, but they generally take one of two forms: episode-specific or general. Episode-specific questions solicit
information about a patient‟s experience during a specific event such as hospital stay, while general questions
do not. In 2002, CMS and the Agency for Healthcare Research and Quality (AHRQ) initiated development of
the HCAHPS survey. based on specific criteria within the nine domains: Communication with
nurses,Communication with doctors,Responsiveness of hospital staff,Hospital environment, cleanliness, and
noise,Pain,Communication regarding medications,Discharge,Global overall rating,Willingness to recommend. 40
The survey response rate and appropriateness of the response are dependent on several factors, such as
design (length, standardization, validation, reliability, responsiveness, discriminatory power, and structure of
questions) and the characteristics of the desired representative population. Customized, standardized, and
validated surveys can be used in the health-care setting successfully as quality-improvement tools. It is not a
“one size fits all” type of instrument.
Outpatient Department in any hospital is considered to be shop window of the hospital.1,2 Patient
satisfaction is as important as other clinical health measures and is a primary means of measuring the
effectiveness of health care delivery.3 Patient satisfaction denotes the extent to which general health care needs
of the clients are met to their requirements. Patients carry certain expectations before their visit and the resultant
satisfaction or dissatisfaction is the outcome of their actual experience.4,5,6,7 The purpose of health care
services is to improve the health status of the population. There is now broad agreement that health services
should becomprehensive, accessible and acceptable, provide scope for community participation and available at
a cost the community and country can afford.8
Hospitals have expanded in terms of availability of specialties, improved technologies, facilities and
increased competition and the expectations of patients and their relatives have increased manyfold. Consumer
expectation in any medical experience influences whether how soon and how often they seek care from which
medical facility. High expectation from a medical organization is a positive indicator of its reputation the society
and is very important for attracting patients, whereas low expectation deters patients from taking timely medical
help, thus negatively affecting himself as well as the medical care provider. However, a very high and
unrealistic expectation may lead to dissatisfaction despite reasonable good standards of medical practice. The
hospitals (even Govt.) have started charging the patient in the name of user charges. Private hospital care cost
has gone very high. With the advent of Consumer Protection Act (1986), the patient‟s expectation has also gone
very high. Now hospitals have to be very careful about patient dissatisfaction to avoid any unnecessary
litigation.
Hospitals have evolved from being an isolated sanatorium to five star facilities. The patients and their
relatives coming to the hospital not only expect world-class treatment, but also other facilities to make their stay
comfortable in the hospital.

II. Patient As A Consumer

Marketing experts are aware that consumers make their decision about utilization of services on the
basis of their perception of the service rather than the reality and hence marketing and patient satisfaction have
become of paramount importance as mouth-to-mouth publicity and personal referral is the most common and
influential cause of using a particular health facility. Healthcare facility is very difficult to measure; hence, it is a
challenge to a healthcare provider to influence a patient‟s perception of quality of care.

III. Quality
It is defined as an inherent and distinctive attribute of a product or service. Common measures of
quality are still structural measures - The condition of physical structure, floor space per bed, facilities for
emergency power and lighting in operating rooms, inspection and cleaning of air intake sources, facilities for
disposal of infectious waste, fire control and many more. Additional standards for facilities and equipment have
been established by the Joint Commission on Accreditation of the Hospitals and by state licensing boards, etc.
These measures are concerned with personnel staffing pattern, educational background of the personnel, safety
and cleanliness of facilities and equipment.

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 A study of patient satisfaction level in Out Patient Department (OPD ) in a tertiary care hospital in ..

IV. The Measurement Of Quality

Steps involved are:
ÂÂ Specification of attributes to be measured
ÂÂ Choice of an approach to measurement
ÂÂ Choice of phenomenon to be measured
ÂÂ Formulation of criteria and standards
ÂÂ Obtaining information about care.
Patient satisfaction depends primarily on outcome of care; since it is ultimate well-being that results from
acceptable care. But satisfaction or dissatisfaction can also result from patient‟s judgment on certain aspects of
care, calibrating the degree of their acceptability. Satisfaction also contributes to the success of future care.

Measuring The Quality Of Healthcare

Attributes of Quality of Healthcare- Donabedin Avedis has described the key properties of healthcare that
constitute quality as: Effectiveness, efficiency, optimality, acceptability, legitimacy and equity.
Effectiveness- is the degree to which the care proposed or received has achieved or can be expected to achieve,
the greatest improvement in health possible now, given the patient‟s condition and the current state of science
and technology of healthcare.
Efficiency- is expressed as a ratio of actual or expected improvement in health to the cost of care responsible for
these improvements. Thus, efficiency can be enhanced by either improving care, reducing cost or both.
Optimality- is a ratio of the effects of care on health or the financial benefits of these, or of the financial
benefits of these effects to the cost of care.
Acceptability- depends on following factors:
Accessibility The patient-practitioner relationship
Amenities
Patient preference as to the effect of care
Patient preference as to the cost of care.
Legitimacy- means conformity to social preference as expressed in ethical principles, values, norms, laws and
regulations.
Equity- is the principle of fairness or justice in the distribution of care and of its benefit among the
Keeping above points in mind, this study was planned in a tertiary care providing government hospital to know
the various factors which affect patient satisfaction; there by to improve quality of care and patient
satisfaction.The present study made an attempt to focus on various aspects of health care provided by Tertiary
Care centre in relation with patient‟s satisfaction.

AIM & OBJECTIVES:

AIM
This study was designed to assess the patient satisfaction regarding the services provided in outpatient
department.
OBJECTIVES To study the patient satisfaction regarding the various services provided in outpatient
department in a tertiary care hospital.

V. Materials And Methods

Study design: A cross-sectional study was carried out at DR.S.C.G.M.C.NANDED among patients attending
outpatient department of during the period from 1/12/2017 to 30/12/17.
Sample size: The sample size was calculated by using the formula n=Z2pq/d2 (where Z=1.96 at 95%
confidence; p= prevalence of patient satisfactions; q=1-p; d= absolute allowable error. For this study we
presumed maximum variability, therefore p=0.5; q=0.5;
d=20% of p. Sample size thus yielded is 96 which is rounded off to a figure as 100.Simple random sampling
technique was used to select patients attending different specialty department of hospital.
Inclusion criteria: New patients in a hospital OPD.
Exclusion criteria: Patients not willing to participate and follow up patients were excluded from the study. The
patients and accompanying persons either parents or relatives for pediatric age less than 15 years were
interviewed at the exit point of hospital after taking informed consent with the help of predesigned and pretested
questionnaire.
Ethical committee approved methodology and data collection procedure of the study. A patient attending the
OPD was included in the study after taking informed consent
The questions included registration process, seating arrangements, cleanliness, approach to the doctor,
pharmacist and investigation site, services provided by the doctor and other Paramedical staff & their behavior
with patients, depth of relationship with patient, time required for locating the consultant, consults by the doctor,

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 A study of patient satisfaction level in Out Patient Department (OPD ) in a tertiary care hospital in ..

investigations and taking medicines from pharmacist. The respondents could answer in this study as satisfactory/
unsatisfactory, yes/no, excellent/ good/ average/ poor. The patients were told that the purpose of the study was to
assess the patient satisfaction of services provided by hospital so as to bring further improvement in services.
The patients were also told that the investigator was not part of treatment team and they were free to give their
responses.

VI. Results
Out of 100 respondents 52 male,48 female, a majority of patients belonged to age group 15- 45 years
with mean age of 42.9(±19.53). The 94% of respondents were patient themselves and 6% of respondents were
accompanying persons either parents or relatives for pediatric age less than 15 year of age. The participants
were asked about concerned department (Table1). Regarding availability of services (Table 2) it was found that,
most of the respondents were satisfied with sitting arrangement, cleanliness, convenience to reach appropriate
OPD, finding of consultant in OPD, convenience to reach investigation site, appropriate signage, symbol,
arrows in respective departments, consultants chamber, lab and pharmacy counters present in hospital OPD, but
only 50% respondents were satisfied regarding convenience to reach pharmacist. Respondents were mostly
unsatisfied with toilet and drinking water facility in OPD.

Table 1: Distribution of respondents according to socio-demographic variables and concerned

departments
Variables Respondent (n=100)
Age
<15 year 6
15-45 year 58
46-60 year 16
>60 year 20
Sex
Male 52
Female 48
Education
Illiterate 14
Primary school 26
Middle school 18
Higher secondary 20
Graduate and above 22
Occupation
Service 8
Business 28
Laborer 26
House wife 26
Student 12
Department
Medicine 41
Surgery 10
Obstetrics and gynecology 11
Pediatric 6
Orthopedic 15
Dermatology 4
ENT 6
Ophthalmology 7

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

Availability of service Respondent (n=100)

Seating arrangement in OPD

Satisfactory 82
Unsatisfactory 18
Cleanliness in OPD
Satisfactory 70

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 A study of patient satisfaction level in Out Patient Department (OPD ) in a tertiary care hospital in ..

Unsatisfactory 30
Toilet facility
Satisfactory 32
Unsatisfactory 68
Drinking water facility in OPD
Satisfactory 44
Unsatisfactory 56
Convenience to reach appropriate OPD
Satisfactory 72
Unsatisfactory 28
Finding of consultant in OPD
Satisfactory 80
Unsatisfactory 20
Convenience to reach investigation site
Satisfactory 56
Unsatisfactory 44
Convenience to reach pharmacist
Satisfactory 50
Unsatisfactory 50
Appropriate signage, symbol, arrows in OPD
Present 64
Not present 36

Table 3: Distribution of responses from the respondents according to Professional care and depth of
relationship

Professional care and depth of relationship Respondent (n=100)

Examination by doctors
Satisfactory 68
Unsatisfactory 32
Doctor’s explanation about treatment
Satisfactory 62
Unsatisfactory 38
Following doctor’s advise
Satisfactory 74
Unsatisfactory 26
Understanding illness after consultation with doctor
Satisfactory 50
Unsatisfactory 50
Doctor tried to know everything about patient
Yes 62
No 39
Difficulty in telling doctor about private thing
Yes 68
No 32
Doctor really knew what patient was thinking about
Yes 64
No 36

Table 4: Distribution of responses from the respondents according to waiting time

Waiting time Respondent (n=100)
Time taken for OPD slip
Satisfactory 92
Unsatisfactory 8
Time taken to reach consultant in OPD
Satisfactory 80
Unsatisfactory 20
Time taken for examination

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 A study of patient satisfaction level in Out Patient Department (OPD ) in a tertiary care hospital in ..

Less than 5 min 56

5-15 min 34
15-30 min 4
More than30 min 6
Time taken in getting medicine from pharmacy
Satisfactory 52
Unsatisfactory 48
Time taken in getting investigation slip from OPD
Satisfactory 56
Unsatisfactory 44

Table 5: Distribution of responses from the respondents according to general satisfaction

General satisfaction Respondent(n=100)
Satisfaction regarding consultant‟s behavior
Satisfactory 78
Average 18
Poor 4
Satisfaction regarding behavior of Nurse‟s
and paramedical staff‟s
Satisfactory 64
Average 35
Poor 1
Satisfaction regarding behavior of class 3
and class 4 worker
Satisfactory 84
Average 12
Poor 4
General remark over experience in hospital
Excellent 26
Good 47
Average 22
Poor 5
Recommendation of this hospital to your
friends & family.
Yes 94
No 6

Out of 100 respondents 52 male,48 female, a majority of patients belonged to age group 15- 45 years
with mean age of 42.9(±19.53). The 94% of respondents were patient themselves and 6% of respondents were
accompanying persons either parents or relatives for pediatric age less than 15 year of age. The participants
were asked about concerned department (Table1). Regarding availability of services (Table 2) it was found that,
most of the respondents were satisfied with sitting arrangement, cleanliness, convenience to reach appropriate
OPD, finding of consultant in OPD, convenience to reach investigation site, appropriate signage, symbol,
arrows in respective departments, consultants chamber, lab and pharmacy counters present in hospital OPD, but
only 50% respondents were satisfied regarding convenience to reach pharmacist. Respondents were mostly
unsatisfied with toilet and drinking water facility in OPD.
Regarding professional care and depth of relationship (Table 3) it was observed that, most of
respondents were satisfied with examination by doctors, doctor‟s explanation about treatment, following
doctor‟s advice, doctor tried to know everything about patient and doctor really knew what patient was thinking
about. Regarding difficulty to telling doctor about some private thing 68% patient felt it was difficult and 50%
satisfied with understanding illness after consultation with doctor. With regard to waiting time (Table 4)most of
the respondents were satisfied with time taken to get OPD slip, time to reached consultation room. Only 52%
respondents were satisfied with the time taken in getting medicine from pharmacy and 56% were satisfied with
time taken in getting investigation slip from OPD. Respondents told that 56% of consultants take less than 5
min. for examination and 34% take 5- 15 min.

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 A study of patient satisfaction level in Out Patient Department (OPD ) in a tertiary care hospital in ..

Regarding general satisfaction (Table 5) most of the respondents were satisfied with behavior of
consultant, nurses and paramedical staff, and behavior of clerical and other staff. In present study 94%
respondents answered „yes‟ to the question -„would you recommend this hospital to friends and family‟. The
overall satisfaction level was excellent to good in 73% respondents, average in 22% and poor in only 5%.

VII. Discussion
The health care system is basically a service based industry and customer experiences and satisfaction
is of the utmost importance just as in other services-oriented systems.It becomes an important indirect marketing
tool as it has direct impact on improving the quality of the „product‟ i.e. health service.
A study conducted by Jadhav SB et al in Out-patient department of Government Medical College,
Miraj, Dist. Sangli reported that 70.57%seating arrangement in OPD & 78.22%cleanliness of OPD found to be
good, which was almost similar to our study.9Jawaharsk, out patient satisfaction at a super specialty hospital in
India, had reported that, 50% of the patients were satisfied with regard to the cleanliness of the hospital.
10Prasanna K S. et al, had reported in study consumer satisfaction about hospital services: a study from the
outpatient department of a private medical college hospital at Mangalore, that patients were fully satisfied in
respect to seating arrangement, cleanliness in the OPD, which was almost similar to our
study.11PatavegarBilkishet al reported , 55.55% patients replied that they were satisfied with cleanliness of
waiting area.12 In another study done by Pralhad Rai et al also found 65% satisfied patients with respect to
cleanliness.13Jadhavsb et al had reported 68.41% respondents satisfied with drinking water facility, 83.71%
respondents could easily find the concerned department while 77.71 % could find easily pharmacy or laboratory
while 46.54% of total participants werenot satisfied with available toilet facility in the hospital. 9 In our study
72% respondents were satisfied with convenient to reach appropriate OPD, 80% of respondents said that finding
of consultant easy and were satisfied, 56% satisfied with convenient to reach investigationsite, while 68%
respondent unsatisfied with
toilet facility in hospital, 56% respondent unsatisfied with drinking water facility and 50% respondent
said there was inconvenient to reach pharmacist and were unsatisfied.

In the present study regarding professional care and depth of relationship with doctor, 68% respondents
were satisfied with doctor check everything, 62% said doctor explain everything about treatment and were
satisfied, 50% respond that they understand their illness after consultation with doctor and 74% of respondents
follow doctors advise. Krupal Joshi et al, explanation of the disease by the doctor was satisfactory in about 91%
of patients, 14 which was 81.6% in a study of Acharya & Acharya.15Soleimanpour H. et al, on emergency
department patient satisfaction survey in Imam Reza Hospital, Tabriz, Iran reported that the satisfaction level of
patients in regard to the information given by care provider about medication was very good in 49.4% of
patients.16
In the present study it was also found62% of respondents said that doctor tried to know everything
about illness but 68% also felt difficulty to tell doctor about some private thing. In the present study 92% of
respondents were satisfied with time require to get OPD slip, 80% satisfied with time to reach consultation
room. Jadhav SB et al, 54.8% participants found that the time required for registration was inconvenient for
them, 31.4% participants reported inconvenience in finding concerned department. 9In our study 52%
respondents satisfied with the time getting medicine from pharmacy and 56% with time getting investigation
slip from OPD. Jadhav SB. et al, 38.95% of total respondents were unsatisfied with time required for
investigations while 48.7% were unsatisfied with time spent in pharmacy.9 In the present study respondents tell
that 56% of consultant take time less than 5 min. and 34% take 5- 15 min. Jadhav SB. et al time taken for
consultation & examination by doctor was found to be satisfactory in case of 68.82% participants.9
Regarding general satisfaction in the present study 78% respondents were satisfied with behavior of
consultant, 64% of respondents satisfied with behavior of nurses and paramedical staff, 84% satisfied with
behaviour of clerical and other workers. In a study by Acharya & Acharya, 82.8 % of the respondents showed
that the approach of the doctor is personal, 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.15 Apria Bhattacharya et al reported 98.2%
patients were satisfied with behavior of doctors.17 M V Kulkarni et al, 87.8% patients were satisfied with
behavior of doctors.18PatavegarBilkish et al, a cross-sectional study of patient‟s satisfaction towards services
received at tertiary care hospital on OPD basis reported 94% patients were satisfied with friendliness and
helpfulness of registration staff.12 This finding is in contrast to study conducted by Md. Ziaul Islam and Md.
Abdul Jabbar. They found only 25 % patients were satisfied with friendliness and helpfulness of registration
staff.19 In the present study the over all satisfaction level was in73% respondent excellent to good while in 22%
average. Jadhav SB. et al reported overall rate of availability of services during their visit, it was excellent for
22.15%, good for 29.26%, average for 30%, poor for 8.79% & very Poor for 9.8% respondents.9 The study

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 A study of patient satisfaction level in Out Patient Department (OPD ) in a tertiary care hospital in ..

conducted by Chetwynd S.J. reported total satisfaction was 49%.20 Ranjeeta Kumari et al. in their study total
satisfaction was 73 %.21 Asma brahim et al showed 10% overall satisfaction in their study.22

VIII. Conclusion
Most of the respondents were satisfied with the availability of services, waiting time, professional care
provided by consultant in OPD, behavior of consultant, nurse‟s and paramedical staff‟s. They were unsatisfied
with toilet and drinking water facility present in OPD, approach to pharmacist, understanding illness after
consultation with doctor and difficulty in telling private thing with doctor. So it is recommended that as OPD
services are an important part of health care services in hospital, they need to be improve with special emphasis
on improving toilet facility, drinking water facility and approach to the pharmacist and therefore hospital should
develop patient feedback system which is vital for quality of services.

IX. Recommendations
This study identified some of areas which can be improved in order to improve the patient care and
quality of care. Hospital authority should take action to improve cleanliness in the hospital. Waiting time before
consulting doctor was one of the important factors affecting patient satisfaction. It can be reduced by starting
appointment system at least getting the drugs was one of the important determinant of patient satisfaction. It can
be reduced by introducing token system at the pharmacy counter. Availability of drugs was one of the important
factor determining patient satisfaction. Therefore the drug policy should be revised quarterly in the year and
most prescribed drugs in OPDs should be made available. Patient satisfaction assessment should be conducted
regularly every 6 months. In the OPDs complaint and suggestion box should be kept, so that patients can freely
put their complaints and suggestions for improvement in services provided in this hospital for nonemergency
cases. Waiting time for getting the drugs was one of the important determinant of patient satisfaction. It can be
reduced by introducing token system at the pharmacy counter. Availability of drugs was one of the important
factor determining patient satisfaction. Therefore the drug policy should be revised quarterly in the year and
most prescribed drugs in OPDs should be made available. Patient satisfaction assessment should be conducted
regularly every 6 months. In the OPDs complaint and suggestion box should be kept, so that patients can freely
put their complaints and suggestions for improvement in services provided in this hospital.

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Dr. Sonali K. Kulkarni "A study of patient satisfaction level in Out Patient Department
(OPD) in a tertiary care hospital in Maharashtra.." IOSR Journal of Dental and Medical
Sciences (IOSR-JDMS), vol. 17, no. 3, 2018, pp 31-39

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