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“A study on Satisfaction among Patients’ toward the outpatient and in-patient services provided
by Public Health Hospitals in Sarawak, Malaysia.”
1.0 Introduction
In other industries such as the airlines and the hotels industry, the concept of patients’
satisfaction through excellent customer care is the key assessment for these industries. They have
built their success and reputation on the concept of ‘satisfying their customer needs’. This
philosophy has somehow not fully translated into the healthcare system particularly in Malaysia
public healthcare system. James M.,( 2013) explained the hospital ‘customers’ are different from
than those in any other industry for one important reason – they do not want to be in the
hospitals. Most hospitals made the biggest mistakes by making a conclusion that healthcare
system is a necessity to patient rather than luxury. Therefore they are not entitled to superior
patients’ experience. Hospitals in general give not a very pleasant experience to any individual,
therefore in these recent years there is a paradigm shift on how customer care are being
incorporated in the clinical practice.
1.1 Definition of Satisfaction
There is no definitive definition agreed on what patient satisfaction really meant in many of the
literature. However, many describe patients’ satisfaction as a subjective evaluation of the
healthcare service received against patient expectation. It is evaluated based on most of the
operational aspect of the healthcare system particularly the technical quality, healthcare provider
interpersonal aspects, communication, financial aspects, time spent or ease of contact or
availability. In a nutshell, researchers measures patients’ opinion and feedback based on their
experience that they have gone through being in the hospital (Gansegeran K,2015). Ware et al
(1983) in one of the earlier studies on patients’ satisfaction rate this as a personal evaluation of
health care and service providers. Both papers agree however that patients’ satisfaction is
considered as an essential component of quality care and thought to be a good indicator of
healthcare quality. In the recent study wrote by Carman (2000), she pointed out that perception
of service quality is an attitude, and that the attitude is a reaction towards a combination of
attributes that patient considers being the component of quality. These attributes can either be
functional which includes the ambience of healthcare set up as well as the provider (physicians,
1
nurses and other healthcare provider) attentiveness or the technical aspects which covers the
outcome of the service delivered.
In Malaysia, Ministry of Health (MOH) is the country major healthcare provider which accounts
to one national level hospital; Hospital Kuala Lumpur, which serves as the National Referral
Centre. This hospital is the largest in the country with more than 2500 beds. In the other states
within Malaysia, each will be equipped with state hospitals which provide comprehensive range
of secondary care services. Their capacity will be within 800 to 1200 beds. Various districts in
the country will be equipped with basic inpatient care which account to about 30-150 beds in
each district. Overall, the healthcare system is also complimented by the private sector which
constitutes about 35% of overall healthcare services. (Noor Hazilah, 2013)
Public that seek medical treatment in the public healthcare are divided to the outpatient and in-
patient treatment. A nominal fee of RM1 for each outpatient visit is charged in accordance with
the Fees (Medical) Order 1976.1 Government employees and their family members benefit from
these services even after their retirement while the Social Security Organization (SOCSO) and
Employees Provident Fund (EPF) do not finance employees in the private sector during their
retirement. In- patient treatment in the public sectors is also charged at minimal amount which is
more than 80 % less than the private healthcare facilities.
With 2.4 million population and on a 48,050 sq m Sarawak, medical services are provided by
twenty one hospitals that are located in the major town within the states. The state hospital,
Hospital Umum Kuching in located in Kuching and has 754 beds. There are three districts
hospitals which have specialist facilities which is Hospital Sibu, Miri, and Bintulu while the
other fifteen districts hospitals are without specialist services. Sarawak is a state where they are
more than 40 ethnics groups living in their own cultures, languages and lifestyle. The urban or
town area of Sarawak are populated predominantly by the Malays, Chinese, and smaller
population of Ibans and Bidayuhs who have migrated from the villages to seek for employment
in town.
1.2 Research Problem Statement
Public Healthcare system in Sarawak needed much evaluation at present because of the
geographical factor and the diversity population distribution. At present, the bed occupancy rate
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(BOR) in Sarawak hospitals is the highest in Malaysia which is more than 69.5% compared to
other states. When the hospital is crowded, the services rendered could be compromise and affect
the level of patients’ satisfaction.
This study is much needed because the previous many assessments of patient satisfaction has
brought out the issue of equality in healthcare. Despite the effort by the government to bridge the
socio economic gap, there is still issue related to the equality and accessibility of healthcare
services especially to the indigenous group, hardcore poor and rural population. In the state of
Sarawak, there are about 20% of the population who lives more than 5km to the nearest rural
clinic (Unit Perancang Ekonomi). The downside of this will be the difficulty for the patient to
seek medical treatment and the impact will be on the quality of care for these people.
The infrastructure and accessibility of the services of the public healthcare system is mentioned
in the 11th MP to be extended to the under-deserved communities, especially the poor and low-
income households, Orang Asli in Peninsular Malaysia as well as the people in the rural and
remote areas in Sabah and Sarawak (Bernama, 2015). At present, there are still many living in
remote areas in Sarawak for instance along the Baram river who faced more than 2 hours journey
either by ferry or logging trail to reach their nearest district hospitals.
With the challenges that Sarawak is facing with the healthcare system, it is crucial to seek the
people opinion on how satisfied they are with the current situation and identify area that is
lacking to ensure the best quality of care for people in Sarawak.
1.3 Research Question
1. Will the different demographic distribution in Sarawak influence their satisfaction level?
2. Will the patient satisfied with the healthcare providers’ (eg:doctors and nurses)
communication, explanation and services rendered to them?
3. Will the patient be satisfied with the current nunmber of the hospital in Sarawak and the
accessibility and infrastructure available in Sarawak’s public hospital?
4. Will the waiting time for most public hospitals be an issue to the patients in Sarawak?
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1.4 Research Objectives
1. To study the relationship between the demographic distribution and the patients’
satisfaction in Sarawak.
2. To study the relationship between the physical aspect (accessibility, infrastructure and
hospital environment) and patient satisfaction.
3. To study the relationship between the intangibles aspect (healthcare provider relationship,
clarity of information, reliability & responsiveness) and patients’ satisfaction.
4. To study the relationship between waiting time and patients’ satisfaction.
1.5 Research Hypothesis
1. There is positive and significant relationship between demographic distribution and
patients’ satisfaction.
2. There is a positive and significant relationship between physical aspect of the public
healthcare and patients’ satisfaction.
3. There is a positive and significant relationship between intangibles aspect of the public
healthcare and patients’ satisfaction.
4. There is a positive and significant relationship between waiting time and patients’
satisfaction.
1.6 Significance of study
Most of researches agreed on one predicament; patients’ satisfaction may also predict health-
related behaviors of patient such as adherence to treatment and medical recommendation.
Patients who are more satisfied are willing to comply with their treatment plans and maintain
their relationships with their healthcare providers. This essentially translates to lower
readmission rates, reduced lengths of stay, and increased savings for the hospitals.(Murphy
M.,2014) This supports the definition of health from the World Health Organization (WHO)
which defines health as a state of complete physical, mental and social being and not merely the
absence of disease or infirmity. Therefore, the role of the healthcare providers such as
physicians, nurses, and other health personnel is not merely curing a disease but instead
delivering patient-centered services which meet patient needs, wants and preferences.
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2.0 Literature Review
Patient satisfaction has over the years has become an important measure of the quality of care
provides by healthcare organization. (Noor Hazilah,2014). Looking at the earlier paper on patient
satisfaction in the healthcare services, there are few theories that can be summarized. Fox &
Storm (1981) mention that satisfaction is derivable when there is an alignment between what
patients’ perspective on what constitute in healthcare and providers view. Linder-Pelz (1982)
added that satisfaction comes from patients’ previous expectation, personal beliefs and value
towards the delivery of healthcare. Donabedien (1988) also emphasized on the interpersonal
aspects of care towards patient as the most important element that make a satisfied customers.
All the model of these researches however have one agreement in term defining the model of
study which is in measuring patients’ satisfaction; the measurement instrument must be multi-
dimensional and not uni-dimensional. The components of given services must be broken down in
such a way that patient will be able to express their satisfaction for each and every component. It
is agreeable that the measurement tool should not assess overall satisfaction. It is important to
create a breakdown on the services offered so to ensure that the desired answers are obtained
from the patient and not create confusion. This will then offer an opportunity for more focused
study to be done on the factor that contributes to patient dissatisfaction. For example, Ministry of
Health (MOH) Singapore in their yearly report on patient satisfaction in the healthcare system
found that public general satisfaction has improved but the long waiting time is still a pain for
the public. With the multi-dimensional measurement tool, MOH Singapore managed to further
analyze why the waiting time still an inhibiting factor is in the system. The finding showed that
the long waiting time was the highest when waiting to get the next appointment to see another
physician, followed by to get medicines and to see doctors. (Today, 2015). In Malaysia, waiting
time is also a prolong issue that is faced by the public hospitals. Raja Lexshimi et al (2009)
studied on the waiting time in the Orthopedics outpatient clinic in HUKM, Cheras and noted that
most respondents 61 out 100 respondents in the study has waited more than 90 minutes from the
time they were given a number to before the doctors’ consultation.
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In Malaysia, the studies done on patients’ satisfaction are mostly done in the urban areas or main
hospital within the states. Mohammed Azali Hassali et al (2014) studied the general public
satisfaction with the public healthcare services in Kedah, Malaysia. Their samples are volunteers
visiting public areas such as shopping malls, night market, photo shops, schools, car service
centre and restaurants. Another study conducted by Ganasegaran.K (2014), covered the busiest
outpatient medical care in Malaysia which is the Tengku Ampuan Rahimah Hospital (HTAR),
Malaysia. This hospital is situated in Klang, Selangor. There were 350 respondents with majority
aged less than 30 years old with 64.4% employed and have tertiary education with monthly
income of MYR3000 or more. University hospitals are also where study on patients’ satisfaction
are usually carried out. Hizlinda T et al (2012) as well as Suriawati G et al (2009) studied
patients’ satisfaction in Hospital University Kebangsaan Malaysia, HUKM. Similarly to the
other studies, 64.7%, 205/317 of the respondents within 30 years to 60 years of age, and 89.6%
received minimum secondary education and majority of them are employed in the government or
private sectors. These studies concluded that there was no significant association between the
social-demographic characteristic with regard to patients’ satisfaction.
Most of the studies also are done either in the outpatient or the inpatient settings. In the
outpatient, some key areas the study focus on are the satisfaction on the waiting time, doctor
consultation, referral procedure as well as the technical aspect involving the accessibility and
environment of the hospital. Where else, inpatient will pay more focus on nursing care, clinical
treatment given or even explanation from the physician. Nor Hazilah & Phang (2011), did an
empirical analysis by preparing two sets of self administered questions to evaluate both
outpatient and inpatient as well. Their studies received a larger sample size which involved 23
states hospitals and selected districts hospitals. Using the convenient sampling method due to the
lack of patient cooperation, 646 out of 900 questionnaires were analysed for inpatient survey an
570 responses for outpatient survey. Another large scale study which involved outpatient health
clinic was done in the state of Selangor, Malaysia by Sharifa Ezzat et al (2010). Unlike the other
studies, they managed to collect samples from the rural area in Selangor. This study concluded
that there was no significant association between the urban or rural with all the dimension of the
SERVQUAL questionnaires.
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The survey on patients’ satisfaction is done through either pre-developed questionnaires or
questionnaires that is derived based on literature review. A. Parasuraman, Valarie A. Zeithaml
and Leonard L. Berry (1998) created SERVQUAL or Service Quality. SERVQUAL is a multiple
scale measuring consumer perception of service quality. The questionnaires comprise of 22-item
scale that allow respondents to indicate the extent of their agreement/ disagreement from
‘strongly disagree’ to ‘strongly agree’. The first 22 item scale will represent what customer
expectation while the other 22 item scale will represent respondents’ recent experience of the
service. Shariza Ezat et al (2010), in her research explained that respondents will need about
30minutes to 1 hour to complete the questionnaires and there are five dimension that covers
aspect such as tangibles, reliability, responsiveness, assurance and empathy while another four
dimension looking at clinic corperation such as caring, professionalism, team work and outcome.
SERVQUAL was also used to evaluate the level of patient satisfaction in Kulim Kedah.
(Mohammed Azmi Hassali et al, 2014). In one of the most comprehensive studies done to assess
the service quality in Malaysian public hospital, the questionnaire used was developed by
Institute of Health Management (IHM), Ministry of Health Malaysia. These questions were felt
to be more suitable for patient by Tomes and Ng (1995) because patients in the hospital are
burdened by physical disabilities, fears and anxiety therefore question used was short, straight-
forward question that are simple to answer ( Noor Hazilah & Phang, 2014)
2.1 Demographic distribution
Sample characteristics are collected by all the researchers. The first part is the demographic data
such as the respondents’ gender, age and marital status. The second part of the data collection
will include socio-economic demographic such as the household income, employment status,
education level, and type of residence, overall health perception and the purpose of visit the
clinic. In two studies which is done in HUKM, the result of the data shown that there was no
significant association between the demographic characteristic and patients’ general satisfaction
(Hizlinda T et al, 2012). However, in a study conducted in the busiest outpatient clinic in
Malaysia which is HTAR, Klang, Selangor, the study concluded in a post hoc test that patients
aged 50 years or more perceived higher service satisfaction as compared to the younger age
group. Patients with lower household income less than RM3000, with high school education
background were also recorded to be more satisfied as compared to the higher income group and
7
respondents with tertiary education (Kanagesaran G, 2014). From all these findings, the common
conclusion made was the different expectation and perception of the services in the healthcare
associate contribute to the level of patients’ satisfaction. The general expectation highlights
was the need to of patients to be listen to, the importance of clear information given to them, the
level of compassion of the healthcare providers as well as their professionalism.
Alexandra (2015) mention in her article on The Atlantic that person’s expectation and level of
satisfaction will differ from each individual. She also critically mentioned that some questions
asked in the survey known as HCAHPS (Hospital Consumer Assessment of Healthcare Provider
and Systems) such as a section about nurses on how often did patient get help immediately from
the nurses after they press the call bell. This question is said to be misleading because it does not
specify whether the help was medically necessary. Nevertheless, assessing patients’ satisfaction
has gain a widespread recognition in many public sectors services particularly the hospitals. For
example in France since the 1998, the French government regarded patients’ satisfaction survey
as their mandatory exercises to evaluate the hospital environment, patient amenities and
facilities.
2.2 Physical aspect (accessibility, infrastructure,) of the public hospitals
There are many studies that is done to relate the importance of having a good image and
satisfaction. Gronross (1982) realized the role of image in the conceptualization of service
quality and emphasized it as a contributing factor for quality and satisfaction in addition to the
functional and technical quality. In the country, the government realized the need to constantly
upgrade the hospital facility for instance within the next five years, Ministry of Health aim to
improve the ratio of the hospitals bed to 2.3 beds to 1,000 population. There will also be
extension of services to the people in the remote area of Sabah and Sarawak (Bernama, 2015). At
present extension of services includes increasing flying doctors services, specialist visits, and
periodically rural service health screening for the peoples who lives far from the hospitals.
Many western studies when describing accessibility of the public hospitals often associate the
term accessibility to how the facilities are friendly to handicap patients. Aspects related to this
included the existence of ramp, size of toilet doors, parking space sizes, corridor and toilets
(Phua K.L, 2014). In the context of studying patients’ satisfaction in Sarawak public hospitals,
the term accessibility will cover the distance of the hospitals from where the patients are from.
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Geographical factor and population distribution uniqueness in the state became a major issue
when seeking treatments in hospitals will incur larger distance and higher travel cost. This
element is felt to play an important role towards determine the level of patients’ satisfaction. Due
to this, the distance and distribution of the public hospitals in Sarawak will be the key area in this
study.
2.3 Intangibles Aspect of the public hospitals in Sarawak.
Tomes and Ng (1995) in their study measuring the patients’ satisfaction in the National Health
Service (NHS), they created a measurement scale that measure two dimension in the hospital
which is the intangibles care within the hospitals as well as the tangibles aspect. The intangibles
aspect includes assessment on the healthcare staffs, communication, reliability, responsiveness,
courtesy, food and even hospital environment. The result of the study indicates that patients are
fairly satisfied with the hospital services under NHS but expressed dissatisfaction over the
physical environment of the hospitals. In a study to evaluate patients’ satisfaction in public
hospital in Cyprus, patients reported the least satisfied with the clarity of the information given to
them, time nurses spent with them and participation in care (Anastasous, 2013). Patients are
often someone who have lack of knowledge on what to expect, and anxious about their own
condition and are most likely concern about the information given to them. Looking at similar
situation in Sarawak, there might be a tendency that patients did not receive the clarity of
information given to them and thus affect the quality of care they receive.
2.4 Waiting time
In the national study done to gauge the waiting time in Malaysia public hospital, researchers
concluded that average patients waited for more than two hours from the time they registered to
getting prescription slips. This study was done in the thirteen states hospitals in Malaysia
with13,000 responses were obtained. It was also mentioned that average doctor consultation time
was only 15 minutes (Pillay D et al, 2013). This literature also analyzes the reasons among the
hospitals why the waiting time was so long in the public healthcare hospital. It was concluded
that heavy workload, employee attitude, management issue as well inadequate facilities are
factors contributing to this. In Kuala Lumpur, the doctor patient ratio is 1 doctor to 500 patients
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whereas in East Malaysia one doctor to 4000 patient (Susan Thomas et al, 2011). The ratio has
been reduced over the years and recently in the 11th Malaysia Plan (MP) tabled by the Prime
Minister in May 2015, he mentioned within the next five years, doctor patient ratio will be at one
doctor to 400 patients.
2.5 The current and relevant topics in the field
The studies on patients’ satisfaction remain relevant untill today because our country public
health care system need to remain competitive despite recent turmoil such as slower economy
growth resulting in higher operating cost in the public health care. In the recent budget 2016
setting revision, Prime Minister Datuk Seri Najib Razak has announced RM 250 million budget
cut for the Ministry of Health as a cost cutting measure due to the current country economic
situation. This will need a drastic measure from the Ministry of Health to improve their
efficiency and reduce wastage without compromising on the services rendered to patient.
Ministry of Health as the key player in the policy maker for the health care system in the country
is constantly faced with challenges in every angle in the public health care system. Tax payers
and public in general have their eyes on the hospital environment, available of hospitals in every
districts and town in the city, the ability to have qualified serviced providers, and the quality of
services rendered towards the public in Malaysia. In a report prepared by Ministry of Health in
2008, their challenge in giving the best healthcare to the society heightened when more
Malaysian are now living in urban areas with more than 6.6% of the population will be more
than 60 years old. The life expectancy for Malaysian has also increased to 70.6 years for males
and 76.4 years for female in 2005 (Ministry of Health 2008). With the ongoing increase in aging
population and life expectancy, the public hospitals will have to face an influx with the increase
number of patient who will likely to not choose private healthcare in the country due to the
higher cost. The extra demand on the public hospitals at present pressures the hospitals
employees to deliver quality care.
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2.6 Theoretical Framework
Many theories have been proposed to explain customer satisfaction. Duggirala et al (2008), in
their study on Indian hospitals, revealed that there were seven dimensions of healthcare IService
quality, namely infrastructure, personnel quality, process of clinical care, administrative
processes, safety indicators, overall experience of medical care and social responsibility.
These dimensions were quite similar to Padma et al (2010) study, whereby they developed and
measure eight dimensions, namely infrastructure, personnel quality, process of clinical care,
administrative procedures, safety indicators, hospital image, social responsibility, and
trustworthiness of the hospital to obtain the perspectives of both patients and attendants.
Through the review of many literatures on service quality, the critical dimensions of patient-
perceived healthcare quality dimensions have been identified and used as an instrument in
measuring the patient's viewpoint of health care quality in the current study. The following are
the propose dimensions of variables that might contribute to patient satisfaction in healthcare in
this study
The theoretical framework below represents the coverage of the study. All the dimension and
sub-dimension of the study will be study based on the respond from the patients in the public
hospitals in Sarawak.
i. Intangibles aspect
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Intangibles aspect in this study will include measuring patients’ satisfaction towards the
healthcare providers’ communication, responsive towards their needs, their reliability as well as
clarity of giving information related to their medical condition. In a nutshell, this dimension will
measure the non-clinical aspect that relate to patients’ satisfaction. Respondents in this study will
be given statement related to the above aspects. Communication is the essential part in when
measuring this dimension in this study. Effective communication between healthcare providers
will allow crucial information especially related to patients’ health issue to be convey
accordingly to patient. Additionally, the importance of communication between healthcare
providers such as doctor and nurses has to be taken into consideration because this will
determine the reliability as well as responsiveness of the treatment for patients.
Studies conducted during the past three decades show that the clinician’s ability to explain,
listen and empathize can have a profound effect on the wellness, compliance of patient and their
participation in their health management. Therefore, in this study the aim is to evaluate if patient
satisfaction will increased when members of the healthcare team took patients’ problem
seriously, explained information clearly, and tried to understand the patients’ experience, and
provided them with viable options.
ii. Physical aspect of the hospital
Although Sarawak has increasingly became a urban state, the rural population that remains are
seen to be cut off from the rest of the facilities in the urban area due to economic and
geographical factor. There had been several efforts by the government policy to close this rural-
urban gap in care such as setting up 1Malaysia Clinic, rural flying doctors, and also improving
patient-doctor ratio. The question now, is the people content with all these implementation and
how effective are these towards meeting their need in the healthcare system. This study will
12
Patients’ SatisfactionResponsiveness, Reliability and clarity of information
(Non- clinical aspect)
Effective communication
evaluate the relevant feedback from the respondents on their satisfaction level of the accessibility
as well as facility in the public healthcare hospitals in Sarawak. Statement related to the
accessibility of the hospitals, the facilities such as waiting area, hospital beds, and cleanliness
will also be the area study on. Typically, this study will also seek opinion on area related to the
infrastructure of public hospitals that needed most improvement such as equipment’s, number of
nurses and doctors, as well as transportation system to reach the public hospital.
This study assumption will relate on how federal government funding is crucial towards
improving the healthcare system in Sarawak. Areas of improvement infrastructure and
accessibility will only possible with funding for the public hospitals. Evaluation will also be
done on whether funds to have another second state hospital in Sarawak to supplement Sarawak
General Hospital, Kuching
(SGH) as well as reaching the rural areas with more healthcare workforce will contribute to
better level of patients’ satisfaction.
iii. Waiting time
Waiting time is the long standing problem in many public hospitals throughout the world and
also a benchmark for many hospitals in measuring the hospitals key performance index. In the
Sarawak public hospitals, key areas related to the waiting time such as duration of registration to
collection of medications, duration for doctor consultation for outpatients, nurses ward round for
inpatient, waiting time for other healthcare procedure such as labs and x-ray will be evaluate.
Sarawak at present is struggling with a disproportionate patient to doctor ratio, shortage of
specialist for example there is only one cardiologist to serve the entire state in the Sarawak Heart
Centre, Kuching.
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Patients’ Satisfaction Better Hospitals Infrastructure and Improved
Accessibility
Government Funding
However, the public healthcare hospitals in Sarawak is also struggling with high turnover of
medical professionals such as nurses where they are easily lure by the private sectors within
Malaysia or abroad such as Saudi Arabia. Doctors and specialist are also seeking lucrative
employment in the private healthcare sector which obviously offered better salaries. It is also
known that surgeons who served the public’s hospitals in Malaysia are seen to set up their clinics
privately. Therefore, this intrinsic factor of high staffs turnover, possible conflict of interest
between the public and private healthcare hospitals could relate to the long waiting time that is
experienced by many patients.
Efficient clinical management is also a crucial aspect to ensure the workflow in the public
hospitals remain smooth. The clinical management will include effort to ensure adequate
staffing, predicting increase or decrease workforce on certain seasons, classified patients based
on their severity and urgency of their medical treatment and accurate referral to particular
medical specialities. The ability to manage the clinics well will significantly reduce the waiting
time for patients.
iv. Demographic distribution
Study on patients’ satisfaction shall include the respondents’ age, salary range, place of stay,
gender and their occupation and education level. In order to get the relevant association of the
above criteria toward patients’ satisfaction, the diversity of the respondents are crucial.
Respondents will includes patients of various ages’ ranges from more than 18 years of age, and
will be divided to few ages group based on the literature reviews. Similarly, the salary range and
education level that indicate the socio-economic class will be classified to various categories to
enable association against patients’ satisfaction to be done.
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Patients’ Satisfaction Improved waiting time
Effective clinical management
Adequate Staffing
Studying the association between demographic data and patients’ satisfaction will very much
linked to a person perception on how they perceive the service in the public hospitals.
Expectations, with reference to healthcare, refer to the anticipation or the belief about what is to
be encountered in in the healthcare system. It is the mental picture that patients. Every patient
who comes for consultation has expectations based on his understanding of the illness, cultural
background, health beliefs, attitudes, and level of understanding. Patients’ demographics and
visit characteristics also contribute toward this. Women are mentioned in many literatures to be
more critical in their expectation towards services rendered to them. Therefore, when what ones’
perceived or expect does not meet the services rendered to them, dissatisfaction will occur.
15
Patient Satisfaction Demographic distribution
Expectation & Perception
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