MOH/S/IPK/05. 12(PT)

RESEARCH HIGHLIGHT 01/2012

Who is this for?

Policy Makers

Hospital Directors

Hospital personnel

Purpose of this summary

To inform policy makers, hospital directors and hospital personnel on the level of satisfaction of patients.

Contact Address:

Institute for Health Management, Jalan Rumah Sakit, Off Jalan Bangsar, 59000 Kuala Lumpur. Tel: 03-2296 2800 Fax: 03-2296 2838/2832 www.ihm.moh.gov.my

Patient Satisfaction in MOH Hospitals: Are we improving? Issue

Patient satisfaction is an important component of the healthcare service quality especially in the competitive environment of modern healthcare today. Appraisal of patient satisfaction has been advocated as a reliable and inexpensive way to assess quality of service.

Several studies on patient satisfaction were conducted by the MOH hospitals and the Institute for Health Management (IHM) in the Ministry of Heath hospitals using Service Quality Gap Tool (SERVQUAL) between 2008 and 2010. A patient is considered satisfied when he/she perceived quality meets or exceeds his/her expected quality.1 Other measurements used to gauge patient satisfaction are perception based on single question and perception based on multiple questions.

Key Messages Patient satisfaction based on 3 approaches: 1. Perception by Single Question on overall satisfaction

94.9% (2008) and 95.9% (2010)

Not reliable.2 2. Perception by Multiple Questions on satisfaction

88.6% (2008) and 90.7% (2010)

More reliable than single question 3. Service quality gaps (SERVQUAL: Experienced perceptions- Expectations)

38.5% (2008) and 40.5% (2010)

A close approximation to the true value of a patient’s degree of satisfaction.

More valid and reliable This document compares approach 2 and approach 3.

This summary is based on:

Ang KT, Roslinah A, Roslan J, Noriah B; Nor Filzatun B, Mohd Idris O. Patient Satisfaction in Government Hospitals, 2004, 2008 & 2010. Institute for Health Management, Ministry of Health Malaysia. February 2012. For further information and to provide feedback on this document please contact:

En Mohd Idris Omar Idris74@ipk.moh.gov.my

Datin Dr Ang Kim Teng dr_akt@moh.gov.my

This summary was prepared by: Roslinah A, Ang KT, Mohd Idris O, Noriah B, Nor Filzatun B, Magesiwaran M, Siti Zubaidah

Conflict of interest: There is no conflict of interest.

Acknowledgement: This document has been peer reviewed by Dr Sondi Sararaks, Institute for Health Systems Research, Ministry of Health

This summary should be cited as: Ang KT, Mohd Idris O, Roslinah A, Noriah B, Nor Filzatun B, Magesiwaran M, Siti Zubaidah. Patient Satisfaction in MOH Hospitals: 2004-2010. Institute for Health Management, Ministry of Health Malaysia. February 2012. Keywords: Patient satisfaction, Government hospital, Quality of service, SERVQUAL

Patient Satisfaction in Government Hospitals

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Background

SERVQUAL approach suggests using expectation and perception which measure service quality gap. It is an enduring perception that predicts customer satisfaction with a service provider.1, 2 There is strong correlation between service quality and patient satisfaction.3,4 Perception of satisfaction based on single question was not reliable2 while perception of satisfaction based on multiple questions is much more reliable as there are many questions used to gauge patient satisfaction.

Method

Findings reported in published and unpublished studies from the IHM5,6 were used. The studies were conducted in 69 hospitals (2008), and 28 hospitals in 2010. The number of respondents for each hospital was approximately 900, comprising of equal numbers of outpatients and inpatients (450 each). For inpatients, only those who had been admitted to the wards for at least 24 hours were included. Self-administered 13 SERVQUAL questionnaire in the Malay and English language were used to measure patient satisfaction based on Service Quality Gap Tool (SERVQUAL) in five dimensions (Tangible, Reliable, Responsiveness, Assurance, and Empathy). Questionnaires were distributed to patients by staff in the wards just before they were discharged or at the dispensary for outpatients. The questions were in two parts, with the first part focusing on patients’ expectations on five dimensions of service quality, while the second part asked for what they perceived as the quality of service received on the same areas. Quality expectations and perceptions were rated using a 5-point Likert scale from 1 (very unsatisfied) to 5 (very satisfied). Patient satisfaction was defined as having perceived service quality (as experienced) meeting or exceeding expected quality. Satisfaction (SP) was computed by subtracting the score for Perceived Quality (Qp) from the score for Expected Quality (Qe) for each of the thirteen questions answered by each respondent. Satisfaction (SP) was then derived for each of the questions, and computed for the five domain areas using summative average of questions under each domain. The proportion of respondents having SP equal or more than zero was then derived, and this represented those that were satisfied (Figure 1). Limitations of the study include the use of convenient sampling and self-administered questionnaire as well as low participation of hospitals in the study where only 28 out of 131 hospitals in the Ministry of Health participated in the 2010 study. Reference 1. Parasuraman, A., Zeithmal, V.&Berry, L. (1991), “Refinement and reassessment of the

SERVQUAL scale”, Journal of Retailing, Vol.67 No.4,pp.420-50. 2. Babakus, E. and Mangold, W.G. (1992), “Adapting the SERVQUAL scale to hospital

services: an empirical investigation”, Health Services Research, Vol. 26 No.6,pp.767-88. 3. Antreas, D.A. and Opoulos,A.I. (2003), Modeling customer in telecommunication:

assessing the multiple transaction points on perceived overall performance of the provider”, Production and Operation Management, Vol.12 No.2, pp.224-45.

4. Spreng, R.A. and MacKoy, R.D. (1996), “An empirical examination of a model perceived service quality and satisfaction”, Journal of Retailing, Vol.72 No.2, pp.201-14.

5. Roslan J, Tahir A, Nazir AA, Azman AB, M Azahadi O, Evi DO (2009). Patient Satisfaction in Ministry of Health Hospitals in Peninsular Malaysia. Institut Pengurusan Kesihatan, K. Lumpur.

6. Roslinah A, Ang KT , Noriah B, Nor Filzatun B, Roslan J, & Mohd Idris O (2011). Patient Satisfaction in Ministry of Health Hospitals, are we getting better? Institut Pengurusan Kesihatan, Kuala Lumpur.

Other articles are available upon request

Figure 1: Conceptual Illustration of patient satisfaction according to Service Quality Gap Tool (SERVQUAL).

Patient Satisfaction in Government Hospitals

IHM IHM

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Key considerations for policy makers and healthcare providers

Service Quality Gaps have better diagnostic capabilities, while perception only measures service quality.

Hospital management must improve on issues related to dimensions of Tangible, Reliable and Responsiveness.

Hospital management needs to consider the requirement and opinion of patients to effect substantial change and significant improvement in the quality of their healthcare services.

Figure 2: Patient satisfaction based on single question, multiple question and service quality by SERVQUAL approach, 2008 & 2010

Figure 6: Comparison of mean differences between patients’ expectations and perceptions using Service Quality Gap Tool (SERVQUAL) between Malaysia (2010), Singapore (2000) and United Kingdom (1995)

Figure 4: All patient satisfaction based on experienced perception, 2008 & 2010

Summary of key findings

Overall satisfaction for 2008 and 2010 respectively, based on : o single satisfaction question increased from 94.9% to

95.9% and o multiple questions/experienced perceptions increased

from 88.6% to 90.7% o service quality gaps (SERVQUAL: Experienced

perceptions-Expectations) increased from 38.5% and 40.5%.

The three dimensions with highest improvements between 2010 and 2008 based on service quality gaps (SERVQUAL: Experienced perceptions-Expectations) (Fig:3) were:

o Tangible, o Assurance and o Responsiveness.

The three dimensions with lowest satisfaction based on service quality gaps as well as on experienced perceptions only between 2010 and 2008 (Fig:3 & Fig:4) were:

o Tangible o Reliable o Responsiveness

Patient satisfaction in Malaysia (IHM, 2010) is comparable with Singapore and UK (Fig: 6) whereby expectations exceed perceptions, but Malaysia seems to have the smallest mean differences (service quality gaps) for most dimensions. (Limitation: year of comparison)

Figure 5 shows between 2008 to 2010, there were improvements in all corporate culture values based on service quality gaps. The highest proportion of satisfaction was for teamwork.

In 2010, The proportions of satisfaction based on perceptions for caring , teamwork and professionalism were 88.6%, 86.9% and 88.9% respectively.

The proportion of patient satisfaction for all dimensions (SERVQUAL) (Fig. 3) was much lower than the proportion based on multiple questions/experienced perceptions (Fig. 4). This is because SERVQUAL measures service quality gaps (Experience perceptions – Expectations) while experienced perceptions only measure service quality.

Figure 3: All patient satisfaction based on SERVQUAL (experienced perception – expectation) 2008 & 2010

Figure 5: All patient perceived corporate culture values, 2008 & 2010 based on service quality gaps

SERVQUAL uses mean differences (Perceived Perceptions – Expectations) to assess quality service gaps and can either be positive or negative.

Figure 6 shows that all the mean differences have negative values indicating that they are all below expectations.

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Better Worst

Meet expectation

Satisfaction based on SERVQUAL

approach

Satisfaction based on multiple

perception questions

Satisfaction based on single perception question

Who is this for?

Policy Makers

Hospital Directors

Health Clinics Officers Incharge

Dental Clinics Officers Incharge

Hospital Personnel

Purpose of this summary:

To inform policy makers, hospital directors, health clinics officer incharge, dental clinics officer incharge and hospital personnel on the level of satisfaction of patients.

Contact Address:

Institute for Health Management, Jalan Rumah Sakit, Off Jalan Bangsar, 59000 Kuala Lumpur. Tel: 03-2296 2800 Fax: 03-2296 2838/2832 www.ihm.moh.gov.my

Patient Satisfaction in MOH Facilities, 2011

Issue

Patient Satisfaction is now deemed an important outcome measure for health services. It is an attitude - a person’s general orientation towards a total experience of health care. Satisfaction comprises both cognitive and emotional facets and relates to previous experiences, expectations and social networks.1 Therefore, service providers need to meaningfully ascertain the experiences and perceptions of patients and the community by conducting research to identify the ways and terms in which those patients perceive and evaluate the service.

For MOH facilities, three tools are being used to measure patient satisfaction in 2011:-

SERVQUAL (Service Quality) for hospitals

Klinik Kawanku questionnaire for health clinics

Dental satisfaction questionnaire for dental clinics

Key Messages 1. Hospital o SERVQUAL measures patient ‘s perceived

satisfaction based on 3 approaches:

Single Question ( overall satisfaction), 95.1%.

Multiple Questions, 92.2%.

Overall service quality (Experience perceptions- Expectations), 49.8%.

2. Health Clinics o Patient satisfaction based on Klinik Kawanku

92.0% of health clinics throughout Malaysia achieved Klinik Kawanku status (80% and above).

3. Dental Clinics o Patient satisfaction based on Dental Survey

Questionnaire

Average score of patient satisfaction is 94.6%.

MOH/S/IPK/06.12(PT) RESEARCH HIGHLIGHT 02/2012

This summary is based on:

Mohd Idris O, Noraini MY, Nor ‘Aishah AB, Zurina AB, Roslinah A, Noriah B, Nor Filzatun B, Ang KT. (2012). Patient Satisfaction in MOH facilities, 2011. Institute for Health Management, Ministry of Health Malaysia. For further information and to provide feedback on this document please contact:

En Mohd Idris Omar Idris74@ipk.moh.gov.my

This summary was prepared by: Mohd Idris O, Noraini MY, Nor ‘Aishah AB, Zurina AB, Roslinah A , Noriah B, Nor Filzatun B, Ang KT

Conflict of interest: There is no conflict of interest.

Acknowledgement: This document has been peer reviewed by Dr Wee Lei Hum, Institute for Health Behavioral Research, Ministry of Health.

This summary should be cited as: Mohd Idris O, Noraini MY, Nor ‘Aishah AB, Zurina AB, Roslinah A , Noriah B, Nor Filzatun B, Ang KT. (2012). Patient Satisfaction in MOH facilities, 2011. Institute for Health Management, Ministry of Health Malaysia. Keywords: Patient satisfaction, MOH facilities, SERVQUAL, Klinik Kawanku, Dental Survey

Patient Satisfaction in MOH facilities

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Method This study used secondary data on patient satisfaction for 2011 obtained from hospitals, health and dental clinics which use different measurement tools.

Hospitals – Data from 25 of the 72 hospitals using SERVQUAL and fulfilled the study criteria were analysed. Sample size for each hospital is 450 inpatients and 450 outpatients. SERVQUAL KKM measures 8 dimensions (tangible, reliable, responsive, assurance, empathy, caring, teamwork and professionalism). Patients score their level of perceived or expected qualities based on a 5-point Likert scale.

Health Clinics – based on analysed Klinik Kawanku data from 762 out of 813 health clinics in the country, compiled by Family Health Development Division. This survey used self-administered questionnaire with a minimum of 100 respondents from each clinic. The standard for Klinik Kawanku status is having a score of 80% and above.

Dental Clinics – based on analysed data compiled by the Oral Health Services Division. The data was based on survey reports of dental clinics throughout the country using a self-administered questionnaire that measures patient’s perceptions on satisfaction. The minimum sample size of a clinic is 100. A total of 24,235 respondents participated in this survey.

Limitations

Data extracted were already analysed and aggregated. Thus, further analysis could not be carried out.

Data received from states are not standardised. Reference

1. Keegan O, Mc Darby V, Tansey A, and Mc Gee H. (2003). Community involvement in A/E satisfaction survey.

2. Family Health Development Division, Ministry of Health, Malaysia.

3. Oral Health Division, Ministry of Health, Malaysia. 4. Mohd Idris O, Noraini MY, Nor ‘Aishah AB, Zurina AB,

Roslinah A, Noriah B, Nor Filzatun B, Ang KT. (2012). Patient Satisfaction in MOH facilities, 2011. Institute for Health Management, Ministry of Health Malaysia.

Other articles are available upon request.

Patient Satisfaction in MOH facilities

IHM IHM

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Key considerations for policy makers and healthcare providers

SERVQUAL measures Service Quality Gaps which have better diagnostic capabilities. Therefore, appropriate measures can be taken to reduce service quality gap in a particular dimension.

The other two measurement tools are based on patient perception only.

Healthcare provider must continuously improve the services by considering the requirement and opinion of patients.

Measurement tools must be reviewed from time to time to ensure their sensitivity and reliability.

Figure 1: Achievement of the health clinics throughout Malaysia on patient satisfaction (N=762)

Figure 2: Patient satisfaction based on single question, multiple question and service quality by SERVQUAL approach, 2008, 2010 & 2011

Summary of key findings

SERVQUAL (Hospitals) Overall satisfaction for hospitals based on:-

Single question - 95.1%.

Multiple questions - 92.2%.

Service quality (SERVQUAL) - 49.8%. Klinik Kawanku (Health Clinics)

Achieved Klinik Kawanku status (satisfaction score more than 80%) – 92.0%.

Dental Survey (Dental Clinics)

Average satisfaction score - 94.6%.

The proportion of patient satisfaction based on single question showed 95.1%, multiple questions 92.2% and overall SERVQUAL 49.8%. There is marked improvement in the proportion of service quality in 2011 (Figure 2). Caring had the lowest score as compared to other SERVQUAL KKM dimensions. The highest score was Assurance (63.2%), followed by Teamwork (62.9%) and Empathy (62.8%). However, it is interesting to note that there is improvement in all dimensions in 2011 (Figure 3).

Figure 4: Achievement of the dental clinics on patient satisfaction by states

Figure 3: Patient satisfaction based on SERVQUAL KKM dimensions, 2008, 2010 & 2011

Data from the Family Health Development Division indicated that 92.0% health clinics (701 out of 762) throughout Malaysia achieved Klinik Kawanku status that is 80% and above (Figure 1).

Data obtained from Oral Health Division showed dental clinics in Negeri Sembilan scored the highest proportion of patient satisfaction (99.2%), followed by Sarawak (99.1%) and Melaka (98.7%) (Figure 4).

Patient Satisfaction in MOH facilities

Patient Satisfaction in MOH facilities

A. HEALTH CLINIC

B. HOSPITAL C. DENTAL CLINIC