MAJOR RESARCH PROJECT

ON

“PATIENT SATISFACTION IN THE OUT PATIENT

DEPARTMENT OF A SIXTY BEDDED HOSPITAL IN TIER-II
CITY OF INDIA”

To be submitted

DEPARTMENT OF HOSPITAL ADMINISTRATION,

IBS, Ch. Charan Singh University, Meerut

In partial fulfillment of the

MASTER OF BUSINESS ADMINISTRATION

(HOSPITAL ADMINISTRATION)

2 Years

Session 2017-19

SUBMITTED TO : SUBMITTED BY :

Dr. A.K. JAIN ABHISHEK MITTAL

H.O.D. M.B.A (H.A.) ROLL NO. 171234302001

DHA, I.B.S. , C.C.S. University M.B.A. (H.A.) IVth SEM.

 DECLARATION

I hereby declare that the summer training project report entitled “PATIENT SATISFACTION
TOWARDS THE OPD (OUT PATIENT DEPARTMENT)” embodies the original work done
by me at C.C.S. University, Meerut. This work in part or full has not been submitted to any other
university.

…………………………………….

Abhishek Mittal

M.B.A. ( Hospital administration)

~I~
 APPROVAL OR CERTIFICATION

This is to certify that work embodied in this project report entitled “PATIENT
SATISFACTION TOWARDS THE OPD (OUT PATIENT DEPARTMENT)” has been
carried out by Abhishek Mittal under my supervision and guidance. No part of this project
report has been submitted for any degree. The work included in this report is original and is own
work of the candidate. The candidate has put up the required attendance as per the ordinance of
the Ch.Charan Singh University , Meerut.

Signature of the Guide

Date :

~ II ~
 CERTIFICATE

This is to certify that the project work entitled “PATIENT SATISFACTION TOWARDS
THE OPD (OUT PATIENT DEPARTMENT)” submitted by Abhishek Mittal in partial
fulfillment of the requirements for the award of the degree of Master of Business Administration
with specialization in Hospital Administration of Ch. Charan Singh University, Meerut, Uttar
Pradesh has been thoroughly examined and approved by us.

(Sign. Of Internal Examiner) (Sign.of External Examiner)

Place:

Date:

~ III ~
 Dedicated to

Almighty Lord

& Family Members

For their inspiring wisdom, principles and endless support

And providing the foundation of integrity, hard work and persistence.

My Teachers

For showing me the excitement and joys of the profession

And My friends

Driving me through the right path

~ IV~

ACKNOWLEDGEMENT
This Project Work as presented , could not be possible without the contribution from all those
related in the field. I have sincere gratitude for all of them. My guide Dr. A.K. Jain, H.O.D.
MBA ( Hospital Administration ) of Institute Of Business Studies , C.C.S.U. Campus ,Meerut,
has throughout assisted with timely guidance , suggestions & material necessary for the venture.

I would like to extend my hearty thanks to Mr. M.P. Singh, Dr. Pradeep Kumar , Dr. Madhulika
Singh , Director, Meerut Kidney Hospital, Dr. Saket Arora , Administrative and Quality
Manager, Mr. Sanjay Agarwal , Manager , Meerut Kidney Hospital, Mrs. Bhawna , HR
Manager , Mrs.Shikha Vashishtha , Faculty of IBS , CCSU, Mr. Manu Sharma, Training and
Placement Officer , SCRIET, CCSU, Meerut, for their kind support and guidance.

I would also like to express my thanks to Staff and patients who participated in the process of
data collection in Meerut Kidney Hospital and for giving their valuable time to complete the
process with limited time. I thank them for allowing and helping me to carry out this study
encouraging me during data collection.

My thanks to all other contributors , whose names I have not mentioned, but though they all
deserve my gratitude. I have to specially mention about my family and friends who gave me
cheer & encouragement throughout my study. Last but not the least, my heartfelt and sincere
thanks to all the subjects on whom this study was carried out.

Abhishek Mittal

~V~

ABSTRACT OR EXECUTIVE SUMMARY

Patient satisfaction survey is one of the important tools for measuring the quality of
management. The main objective of the study is to examine satisfaction level of outpatient in
both medical care and other facilities offered by the hospital and to find out the factors affecting
satisfaction level of patient, and to give suggestions to overcome the barriers in achieving patient
satisfaction in outpatient department. Data was collected from Meerut Kidney Hospital
outpatient department in Meerut, only convenient sampling was collected from 50 patients from
the outpatient department.
In this study, it is found that majority of patients are satisfied with the services provided. They
were satisfied with the guidance, logistic arrangements, support services, nursing care, Doctors
consultation etc. Though few patients were not satisfied with the waiting time in the reception, it
is worthwhile to note that there is scope for improvement of the Out Patient Department
Services. Therefore it can be concluded that the OPD services form an important component of
Hospital services and feedback of patients are vital in quality improvement.
Patient satisfaction is an important means of measuring the effectiveness of health care delivery
and quality of medical care. It denotes the extent to which general health care needs of the
patient are met to their requirements. The most important reason to conduct patient satisfaction
surveys is that they provide the ability to identify and resolve potential problems before they
become serious. This study was designed to assess the patient satisfaction regarding the services
provided in outpatient department.

KEY WORDS: patient satisfaction, outpatient department, waiting time, health services.

~VI~

TABLE OF CONTENTS
Chapter

I) INTRODUCTION
a) Statement of Problem
b) Aim of Study
c) Purpose of Study
d) Scope of Study
e) Period of Study
II) DETAILS OF THE HOSPITAL or ORGANISATION’S PROFILE
III) BODY OF THE PROJECT
IV) EXPERIMENTS
V) RESULTS
VI) CONCLUSION
VII) RECOMMENDATIONS
VIII) REFERENCES
IX) BIBLIOGRAPHY
X) APPENDICES

~VII~

LIST OF FIGURES
Figure 1 : Gender of Patients.

Figure 2 : Age of Patients.

Figure 3 : Convinience of the patient in locating the outpatient building in hospital premises.

Figure 4 : Waiting time in reception area.

~VIII~

LIST OF TABLES
Table 1 ANOVA : Analysis of Gender and Waiting Time at Reception.

Table 2 ANOVA : Analysis of Monthly Income And Medical Bills.

Table 3 ANOVA : Analysis of Educational Qualifications of Patients and Suitable

Magazines/TV/ Newspaper Facility.

Table 4 : Gender of Patients.

Table 5: Age of Patients.

Table 6: Convinience of the patient in locating the outpatient building in Hospital Premises.

Table 7: Waiting time in reception area

INTRODUCTION
 a) Statement of the problem

Patient satisfaction survey is one of the important tools for measuring the quality
of management. It's valuable to get a view of what patients really think about the care and
treatment they receive .These simple insights will lead to smart decisions on how to improve
healthcare, patient happiness and the job satisfaction of doctors and nurses. Measuring the
quality of intangible service products has become a great challenge for managers and
administrators in the health services industry. Patient satisfaction or dissatisfaction is a
complicated phenomenon that is linked to patient expectations, health status, personal
characteristics, as well as health system characteristics. Nevertheless, patient satisfaction as an
index of quality of healthcare has developed as an effect measure and patient satisfaction surveys
are being increasingly identified to be instituted to measure success of the service delivery
system functional at hospitals. In general, patient satisfaction has been defined as an evaluation
that reflects the perceived differences between expectations of the patient to what is actually
received during the process of care.
Outpatient Department (OPD) is the first point of contact of the hospital with patients
and assists as the shop window to whatever health maintenance service provided to the
residential area. There are various problems faced by the patients in outpatient department like
overcrowding, delay in consultation, lack of proper guidance etc. that leads to patient
dissatisfaction. To overcome this type of problem survey is one the best method to find out how
far patients are satisfied with the service and what action could take to avoid dissatisfaction of
the patient. Patient satisfaction in health care is gaining widespread recognition as a step of
determining how well health services are being delivered. Moreover, individuals with higher
patient satisfaction had lower chances of emergency visits to health care systems and higher
chances of inpatient admission. Satisfaction also pays a role in performance of expectations.
Thus the hospitals must improve their quality and patients’ satisfaction and have their strong
motivation to meet the patients’ needs so that the patients would choose them and the hospitals
can survive and develop.
 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 be
comprehensive, accessible and acceptable, provide scope for community participation and
available at a cost the community and country can afford. The data gathered by measuring
patient satisfaction reflects care delivered by staff and physicians and can serve as a tool in
decision-making. Patient satisfaction surveys can be tools for learning. They can also serve as a
means of holding physicians accountable. Patient satisfaction data can also be used to document
health care quality to accrediting organizations and consumer groups and can provide leverage in
negotiating contracts. Probably the most important reason to conduct patient satisfaction surveys
is that they provide the ability to identify and resolve potential problems before they become
serious. They can also be used to assess and measure specific initiatives or changes in service
delivery. Most importantly, they can increase patient loyalty by demonstrating you care about
their perceptions and are looking for ways to improve. 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.
A hospital is an institution that provides a broad range of medical services to sick,
injured, or pregnant patients. It employs medical, nursing, and support staff to provide inpatient
care to people who require close medical monitoring and an outpatient care to people who need
ambulatory care. Hospitals provide diagnosis and medical treatment of physical and mental
health problems, surgery, rehabilitation, health education programs, and nursing and physician
training. Many hospitals also serve as centres for innovative research and medical training.
However there is a current trend in hospital management to decrease in patient service and to
increase outpatient ambulatory care. Out Patient Department in any hospital is considered to be a
shop window of the hospital (Kunders, 1998) referred to the hospital unit that a patient attended
for treatment or consultation and did not stay overnight in the hospital.
 Out Patient Department is one of the departments of the hospital which cares for the
ambulatory patient who comes for the diagnosis. Now a days, patients are looking for hassle free
and quick services. This demand is only possible with optimum utility of the resources through
multitasking in a single window system of the OPD (Srinivasan, 2000). In the United States, it
wasn’t long ago that hospitalization was routine for most patients. But lengthy hospital stays are
largely now a thing of the past. Today, many patients receive much of their health care as
outpatients—a trend that many see as benefiting the health system. Much of the move toward
outpatient care in the US has been driven by third-party payers in an effort to control expenses.
But this change has been perhaps one of the benefits of managed care, in that it has challenged
healthcare providers to find safe and effective ways to deliver care on an outpatient basis, which
is clearly to the benefit of o patients (Onco Log 2004) For every hospital, patients are the main
users.
The primary function of the hospital is patient care. It is one of the yardsticks to
measure the success of services that it produces. Effectiveness of the hospital relates to provision
of good patient care as intended. According to Swamy (1975) patient satisfaction is the real
testimony to the efficiency of hospital administration. As the hospital serves all the members of
the society, the expectations of the users differ from one individual to another individual because
everyone carries a particular set of thoughts, feelings and needs. Hence determination of
patient’s real feelings is very difficult. It is the responsibility of the administrator team. "Put
yourself in your patient's shoes," was a proverb that explains how to proceed with a patient.
Living in the world of information and technology, nowadays patients are aware of their needs
and rights. They know that health care facilities are established to provide satisfactory and
quality health services to them. If the health care facilities fail to do so, they are considered
unsuccessful in implementing their assigned tasks.
Health care facility performance can be best assessed by measuring the level of Patient
satisfaction. A completely satisfied patient believes that the organization has potential in
understanding patient needs and demands related to health care. The World Health Organization
conference, supporting health for all, held in 1990 defined future development in health to be
human centred. A lot of stress has been made on investment in health, patient care and patient’s
right to delivery of quality health care leading to patient satisfaction. Patient satisfaction is
essential due to multiple reasons. Any unsatisfied patient will not come back to the hospital, and
it will lead to loss of money of patient, as well as wastage of government resources. High
satisfaction level will indicate that hospital is working efficiently. On the other hand, poor
satisfaction level helps the management of a hospital to improve on the health services.
Satisfaction is linked to quality of information, advice and general communication sensitivity,
perceived effectiveness, competence or professionalism, attitude of staff, including concern for
privacy, ease of access, waiting time, continuity of care, involvement in decision making and
benefit from the treatment or intervention.
There are multiple reasons to study the concept of patient satisfaction. It is considered
as an important outcome of the quality of healthcare. Getting views of the patients on the care
services is a much realistic tool to evaluate and improve the health care services since it is based
on direct experiences of the users. The rising strength of consumerism and quality consciousness
in the society with a shift from doctor-to-patient relationship to modern provider-client attitude
has highlighted the importance of recording patient views on healthcare delivery. It is also the
largest revenue generating department in the Hospital. Patient satisfaction results in enhanced
compliance of the patients to the medical regimens, appropriate use of medical resources and
quick recovery from illness besides, evaluation by the patients makes medical staff aware about
their shortcomings. The employees understand that they will be held accountable to the patients
as well as administration. As a result care providers tend to acknowledge patient rights and
involve them in treatment decisions. Patients’ suggestions also help policy makers and planners
to identify bottlenecks in the system, thereby introducing customized improvements in the
service.
Physical facilities are tangible facilities and preparation such as ease of location,
department’s cleanliness and tidiness, bed, ventilation and lighting system, waiting chair,
sanitary rest room, ventilation, light, noise, sitting facilities, clean toilets and sufficient
examination room adequate area space availability. Doctor’s service is referred to the physicians’
communication and consultation skills such as self-introduction, effective consultation
techniques, attentiveness, time management, physicians’ punctuation courtesy, respect of a
doctor for a patient and time spent by the doctor in physical examination. Nurse’s service is
referred to the nurses’ communication and assistance skills such as polite and respectful manner
towards the patients, feedback to patients ‘questions, patient- referring process, and nurses’
punctuation Pharmacy service is referred to the respect and attention shown by pharmacy staff,
drug preparation and explanation, adequate amount of drugs, and pharmacy staff’s punctuation.
Registration staff services include the courtesy paid by the registration staff and his/her good
communication skills.
Working schedule is the effective working shifts designated to respond to patients’
need. Service procedure is the effective service process in terms of time and good coordination
between relevant departments. Accessibility to health care Services is comfort ability to access
the health care services in terms of distance from hospital, waiting time, and information
received. Distance from hospital included home distance from hospital, availability of public
transport, travelling time to reach hospital and money spent on travelling. Waiting time included
waiting time for doctor and total time spent in the OPD. Information received included adequacy
of OPD timing, general information about the hospital and main source of introduction about the
hospital. Experience (perception) to health care services was an important variable because it
made the expectation of patient which in turn were dependant on perceptive image. A common
definition of perceived image is to become aware of something through ones senses - touch,
taste, smell, hearing or sight. It is understood to be the common general knowledge, or
knowledge acquired by self experience or other’s experience of utilization of health care
services.
Experience to health care services was assessed with reference to convenience of care,
quality of care and expenses afforded for Medical care. Convenience is referred to availability of
care when needed such as convenient hospital hours and availability of health care in need. In
this research it included waiting time for physical examination, waiting time for receiving
medicines, convenience of medicine receiving place, adequacy of treatment receiving place,
adequacy of OPD timing, and receiving medical services from one department to another
department in OPD. Quality of care is referred to the provider’s skill and ability in treatment and
sufficiency of health facilities. In this study, it included treatment received from doctor,
availability of prescribed medicines from hospital, skill of the nurse in using medical equipment,
opportunity provided by the doctor for asking about the illness, and attention paid by the hospital
officer in case of any problem.

a) Aim of the Study

To understand the needs of the outpatient and find out reason for dissatisfaction if any and
suggest the hospital to improve their satisfaction level.

b) Purpose of the Study

The purpose of the survey was to examine satisfaction level of outpatient.

To know the overall satisfaction of the patient receiving medical care and other
facilities.
To find out the factors that affects the satisfaction level of patients.

c) Scope of the Study

Assessing various needs of the patients.

Identify and observing various roles of each department in the hospital.

Understanding patient and doctor relationship.

d) Period of the Study

Limited period of time for the project.

Only morning OP samples were collected.
Out patients department is busy with their tasks so researcher couldn't gather
complete information from the staff.
Only convenient sampling taken.

DETAILS OF THE HOSPITAL OR ORGANISATION’S

PROFILE
The main objective of this research is to measure the satisfaction of OPD (Outpatient
Department) patients and identify the strategies to help the hospital to increase their patient
satisfaction scores and sustain patient loyalty on a long-term basis in MEERUT KIDNEY
HOSPITAL in Meerut, Uttar Pradesh in India. Meerut Kidney Hospital, Meerut, is a 60 bed
multispecialty hospital with super specialty in Nephrology and Urology. They commenced
operations way back in 2007 and since then have been a familiar, trusted and comforting
presence, ministering to the healthcare needs of the community.

It is a NABH accredited hospital in the region. The approach, based on patient

centricity, state-of-the-art emergency response, integrity, teamwork, ownership and innovation,
combines compassionate patient care with clinical excellence, to achieve a single-minded
objective - Saving and enriching lives. The hospital is approved by DGME Lucknow Govt. of
Uttar Pradesh for Kidney Transplantation. Hospital Provides Kidney care for all kidney
problems under one roof with special emphasis on Preventing kidney disease by screening high
risk groups.The super-speciality kidney care hospital is fully functional since 2007. It is a
hospital catering health care needs of patients. It is a multi-storey building with its own parking
lot. Located at Prabhat nagar, L.I.C. Road, Meerut. 250001, thus away from population and
howling noise of city. It’s easy access and comfortable approach makes it a preferable choice for
the patients. It renders its services to the patients coming from nearby or faraway to almost
whole of Meerut, Muzzaffarnagar and Bijnor population and even patients from outside Uttar
Pradesh. The hospital has a full-fledged Kidney station, Dialysis centre, Kidney Transplant Unit ;
3 OT’s , 2 major OT and 1 minor OT , ICU Facility, Private wards providing specialized Renal
Care centre in the form of OPD, IPD and emergency services. Outpatient care is rich with
quality offerings, accrediting agencies, and leadership credentialing to promote excellence.
However, what is needed is investment in stronger oversight, mandatory licensing, leadership
expectation, and standards across states and outpatient service lines.

Vision & Values

"Leading with innovations treating with compassion".

Team
The team of doctors attached to the hospital are leading ones in their fields. Hospital is serving
the kidney patients by the experienced nephrologists, urologists, cardiologists, physicians,
surgeons, ophthalmologist, pathologist, radiologist and dietician.

Facilities Available

With OPD facilities. It has -

» A Haemodialysis Unit with 24 Hrs availability.

» HD,PD and CAPD Unit.
» Three well equipped operation theatres with laminar flow and HEPA Filter.
» Ten Bedded intensive care unit. (ICU) with Ventilator , Cardiac monitor, Defibrillator.
» A separate Kidney transplants ICU.
» Super Deluxe, AC, Non AC Semi private & General ward accommodation for IPD patients.
 Blood Pressure, Diabetes, Chronic Renal Failure, Acute Renal Failure, Snake Bite and
Poisoning treatment available.
 Kidney Biopsy facility.
 All type of Kidney and Stones Operation, PCNL , URSL.
 Prostate Operation with Endoscope.
 Urology Operation with Laparoscopic surgery.
 Pathology, Radiology and Pharmacy.
 Ambulance Service.
 Physiotherapy.

No. of Departments
  Nephrology
 Urology
 Pathology
 Microbiology
 Radiology
 Opthalmology
 Medicine IPD
 Chest IPD
 General Surgery IPD
 Dietetics
 Physiotherapy
 Medical Record Deptt.
 Resident Doctor’s (RMO’s)
 Nursing Deptt.
 Quality Cell
 Housekeeping
 Maintainence
 Security
 Biomedical Engineering
 Reception
 Human Resource
 Staff Clinical/ Non Clinical
 Store
 Office and Accounts
 Manager
 Administrator
 Financial and Executive Director
 Medical Directors
ICU Facility
 Present
No. of Operation Theatres
 Three –
 2 Major O.T.
 1 Minor O.T.

Average Occupancy
 15-20 Beds

Specialization of Hospital
 Nephrology
 Urology
 Dialysis

Major Problem Area

 Housekeeping
 Maintainence

Major Strengths
 Medical Directors
 RMO’s
 Reception
 Nursing Deptt.
 Quality Cell
 Heamo Dialysis Unit
 Office and Accounts
 Store
 Pathology

Major Weakness
  Staff Non Clinical
 HouseKeeping
 Maintainence
 Physiotherapy
 Microbiology

Owner of Hospital
 Mr. Mahipal Singh

Manager of Hospital
 Mr. Sanjay Agarwal

Hospital Administrator
 Dr. Pradeep Kumar
 Dr. Madhulika Singh
 Dr. Saket Arora

No. of Doctors
 Dr. Pradeep Kumar – Nephrologist
 Dr. Vipin Kumar - Urologist
 Dr. Amit Pathak – Radiologist
 Dr. Virottam Tomar – General Physician
 Dr. Ruchi Kotpal – Microbiologist
 Dr. Abhishek Rathi - Anaesthesiology
 Dr. Avnish Kotpal - Anaesthetist
 Dr. Anupam Varshney - Pathologist
 Dr. Kumkum Rai - R.M.O.
 Dr. Pranav Teotia - R.M.O.
 Dr. Manisha Bansal - R.M.O.
 Dr. P.C. Sharma - R.M.O.
  Dr. Aditya Sharma - R.M.O.
 Dr. Rishabh - R.M.O.
 Dr. Vineet Bansal - Patient Educator
 Dr. Irshad - Floor Co-Ordinator
 Dr. Yusuf - I.C.U. Co- Ordinator
 Dr. Varun Partap - Physiotherapist
 Dr. Nitika Garg - Physiotherapist

No. of Nursing Staff

 Forty (40)

No. ward Boy/Aya

 6 ward boy
 5 ward aya
 5 Housekeeping Staff

BODY OF THE PROJECT

Surg Lt Cdr Athar Mohd , Brig Abhijit Chakravarty (2014) defines that Patients' satisfaction is a
useful measure to provide an indicator of quality in healthcare and thus needs to be measured
frequently.
Roush, S. E., &Sonstroem , R. J. (1999) states that patient satisfaction has become an
increasingly important issue in health care.Patient satisfaction has been conceptualized in recent
years as a multidimensional construct. The multidimensional nature means that a person may be
highly satisfied with one or more aspects of a health care encounter and simultaneously
dissatisfied with other aspects.
Williams, B. (1994). Client satisfaction is fundamental importance as a measure of the quality of
care because it gives information on the provider’s success at meeting those client values and
expectations which are matters on which the client is the ultimate authority. The measurement of
satisfaction is, therefore, an important tool for research, administration, and planning.
Beattie, P. F., Pinto, M. B., Nelson, M. K., & Nelson, R. (2002) Patient satisfaction is often
considered to be an abstract, multidimensional phenomenon.6,7,9,10. Because it usually is not
observable directly, patient satisfaction must often be measured in what we would consider an
indirect manner (ie, from self-report measures).1–4,6,11–14. A simple self report method for
assessing satisfaction is to ask global questions such as, “Overall, I am completely satisfied with
my care.”6 These questions, although easy to administer, do not provide information about why
a person is or is not satisfied; therefore, many authors1–4, 6,9,10 recommend the use of
multidimensional measures.
Gray, R., Rofail, D., Allen, J., &Newey, T. (2005) Treatment satisfaction is an important
indicator of the quality of services that patients are receiving. Treatment satisfaction is a complex
concept that, although widely used, is difficult to define. Most researchers agree that treatment
satisfaction is a multi-dimensional concept influenced by many different subjective factors that
may include: complexity of treatment regime; perceived benefits; side effects; involvement in
treatment decisions; understanding of treatment and effective communication with clinicians. A
patient satisfaction rating is both a measure of care and a measure of the patient who provides the
rating.
(Ware 1983)Unmet patient expectations may also affect satisfaction. While most patients have
specific expectations for their health care visit.
(Jackson 2001)Leiter, M.P. Harvie, P., &Frizzell, C(1998). Defined patient satisfaction as “a
health care recipient’s reaction to salient aspects of the context,process and result of their service
experience .
Boyer, L.,Francois, P.Doutre, E., Weil, G., & Labarere, J (2006). Patients’ perception of health
care has gained increasing attention over the past 20 years [1]. It is currently admitted that
patients’ opinion should supplement the usual indicators of quality in health care [2,3]. Patient
expression is an important source of information in screening for problems and developing an
effective plan of action for quality improvement in health care organizations.
Boudreaux, E. D.,& O'Hea, E. L. (2004). Patient satisfaction deserves attention not only because
it is an intrinsically worthy goal, but also because it is a potentially significant mediator for a
range of important outcomes. Satisfied patients may be more compliant with their medical
regimens, suggesting that satisfaction may be an important component in promoting health and
well-being.
Delbanco,(1996) As techniques to measure the quality of healthcare proliferate and improve,
health professionals are beginning to accept that patient/clients and their families hold unique
vantage points as expert witnesses of care.
White (1999) Prior to conducting a patient satisfaction survey, it is vital that an organization Be
prepared and that they embrace a quality improvement culture. It has been shown that patient
satisfaction is a measure of the quality of services being provided.
Sivalenka Srilata, 2000 in a patient satisfaction survey can help to show patients that a
Healthcare organization is interested in quality and in making improvements. It demonstrates an
organization’s commitment to its patients.
Prasanta(2001) this patient satisfaction survey is the first of its kind for public hospitals in India.
While the survey revealed depressing feedback, the motivation of APVVP top management to
identify areas of concern and measure patient satisfaction is a step in the right direction. There
would not be any scope to improve the services; unless such bold steps at measuring client
satisfaction is pursued. We feel, repeating such studies at regular interval of say six months will
be useful guide for managerial intervention.

THE CHAPTERS
1. Hospitals are now following the entrepreneur trend even though the commodity they
market is health services. The patient care has become extremely important in the health
care environment. Patients’ satisfaction and their expectations have become the valid
indicators for quality health care service. In which case, the patients become their most
important clients of the hospital. After all, it’s the patients that brings in the revenues for
these hospitals hence they should be satisfied. Patient satisfaction has been an area of
special interest for researchers involved in health system research for almost half a
century. Countless number of studies on this important topic has been published since
then. Shore and Fran’s (1986) exemplified that Patient satisfaction is better defined as an
individual's evaluation of the quality of care in a specific medical-care situation; and not
just as a global attitude aggregated across episodes. Inui and Carter (1985) advanced
similar arguments that individual patient-physician encounters are "she basic unit of
medical care" (p. 580) and, therefore, assessing satisfaction for "individual encounters
may contribute so a fuller understanding of the nature of physician-patient relationship".
Oliver (1981) argues that Consumer satisfaction literature take issue with the definition of
satisfaction as a cognitively based evaluation of product/service attributes. Instead, these
researchers contend that satisfaction is an emotional or affective response to a product or
service use (or consumption) situation. Ross et al; (1987) argue that restricting patient
satisfaction to perceptions of the "quality" of health care received is an "inherent
weakness." These researchers support their position by noting that a segment of "healthy
but unhappy" patients has been found in several empirical studies. Thus, Ross et al.
suggest that the conceptualization of the patient satisfaction should be enlarged to include
other evaluations (e.g., waiting time, costs, etc.) in addition to purely quality perceptions.

2. 17. Stephen (1993) and Swartz et al; from Advances in Service Marketing and
Management defined Clients’ satisfaction as the result of matching one’s expectation of
healthcare services with actual experiences whether it is pleasant or disappointed. Swartz
et al; (1993) states that the level of satisfaction will be low if the services do not meet
what the patients have wished. However, the patients will show a high level of
satisfaction if their expectations are met. In addition, patients will feel highly satisfied
and delightful if services are even better than what they have expected. Swan et al; (1985)
 suggested that patients’ positive opinion about services they have received is the process
of matching between a set of generally accepted quality with their personal past
involvement. Many articles about patients’ satisfaction suggested the following
significant relationship: - Satisfaction is the result of perceiving service implementation
against expectation. - Willingness to buy or come back to receive the same services is the
effect of satisfaction. - Expecting and willingness to have services create alternatives for
patients. The more the patients are pleased, the greater the level of satisfaction will be.
Mc Quity et al; (2000) from various articles suggested that most patients are very
sensitive about what is going on with their health condition. They honestly insist to know
exactly what the problems are, the ways treatment might be taken in account and the
consequences that might happen. They still do even though it might frighten or disappoint
them in any ways. Abdal et al; (2000) argue that Patient satisfaction studies have,
however, received comparatively little attention in public or government sponsored
settings and in developing countries in particular. In a study done in Qatar, it pointed to a
number of deficiencies in these dimensions; availability, convenience of services,
facilities (physical environment), humaneness of doctors, quality of care, and continuity
of care and delivery of services in government health facilities in the State of Qatar. It
also surfaced methodological issues that should be addressed in comparable studies of
culturally diverse populations.

3. 18. Lawthers et al; (1999) captured the quality dimensions by survey included access,
patient experience and clinical quality in a similar study entitled “Using patient survey to
measure the quality of outpatient care” done in Krakow, Poland, the study concluded that
they were able to demonstrate the feasibility of constructing indicators of multiple
dimensions of the quality of outpatient care using patient reported information.
Khandaker(2001) conducted a study at Bangladesh by compared the services offered by
private, public and foreign hospitals from a patient’s perspective. The results gave an
overview of the perspectives of Bangladeshi patients on the quality of service in three
types of hospitals. The quality of service in private hospitals scored higher than that in
public hospitals for nursing care, tangible hospital matters, i.e. cleanliness, supply of
utilities, and availability of drugs. The overall quality of service was better in the foreign
 hospitals compared to that in the private hospitals in Bangladesh in all factors, despite the
'perceived cost' factor. Jawahar (2007) done study on out patient satisfaction at a super
specialty hospital at India, it concluded that the outpatient services have elicited problems
like overcrowding, delay in consultation, proper behaviour of staff etc. Whenever there is
delay in consultation, it is to be explored to elicit the problem. It is worthwhile to note
that there is scope for improvement of the Out Patient Department Services. Rao et al;
(2006) studied (i) To develop a reliable and valid scale to measure in-patient and
outpatient perceptions of quality in India and (ii) to identify aspects of perceived quality
which have large effects on patient satisfaction. Participates are Health facilities and
patients at clinics. Cross-sectional survey of health facilities and patients at clinics,
Primary health centers, community health centers, district hospitals, and female district
hospitals in the state of Uttar Pradesh in north India. Main outcomes are internal
consistency, validity, and factor structure of the scale is evaluated. The association
between patient satisfaction and perceived quality dimensions is examined. A 16-item
scale having good reliability and validity is developed. Five dimensions of perceived
quality are identified-medicine availability, medical information, staff behavior, doctor
behavior, and hospital infrastructure.

4. 19. Patient perceptions of quality at public health facilities are slightly better than neutral.
Multivariate regression analysis results indicate that for outpatients, doctor behavior has
the largest effect on general patient satisfaction followed by medicine availability,
hospital infrastructure, staff behavior, and medical information. For in-patients, staff
behavior has the largest effect followed by doctor behavior, medicine availability,
medical information, and hospital infrastructure .The scale developed can be used to
measure perceived quality at a range of facility types for outpatients and in-patients.
Perceived quality at public facilities is only marginally favorable, leaving much scope for
improvement. Better staff and physician interpersonal skills, facility infrastructure, and
availability of drugs have the largest effect in improving patient satisfaction at public
health facilities. Gasquet et al; (2004), conducted a survey with few questionnaires on
outpatients' satisfaction with hospital exist. The main objective was to develop, according
to psychometric standards, a self-administered generic outpatient questionnaire exploring
 opinion on quality of hospital care. First, a qualitative phase was conducted to generate
items and identify domains using critical analysis incident technique and literature
review. A list of easily comprehensible non- redundant items was defined using Delphi
technique and a pilot study on outpatients. This phase involved outpatients, patient
association representatives and experts. The second step was a quantitative validation
phase comprised a multicenter study in 3 hospitals, 10 departments and 1007 outpatients.
It was designed to select items, identify dimensions, measure reliability, internal and
concurrent validity. Patients were randomized according to the place of questionnaire
completion (hospital v. home) (participation rate = 65%). Third, a mail-back study on 2
departments and 248 outpatients was conducted to replicate the validation (participation
rate = 57%). A 27-item questionnaire comprising 4 subscales (appointment making,
reception facilities, waiting time and consultation with the doctor). The factorial structure
was satisfactory (loading >0.50 on each subscale for all items, except one item). Inter
scale correlations ranged from 0.42 to 0.59, Cronbach alpha coefficients ranged from
0.79 to 0.94. All Item-scale correlations were higher than 0.40. Test-retest intra class
coefficients ranged from 0.69 to 0.85. A one-dimensional 9-item version was produced
by selection of one third of the items within each subscale with the strongest loading on
the principal component and the best item-scale correlation corrected for overlap.

5. 20. Factors related to satisfaction level independent from departments were age, previous
consultations in the department and satisfaction with life. Completion at hospital
immediately after consultation led to an overestimation of satisfaction. No satisfaction
score differences existed between spontaneous respondents and patients responding after
reminder(s). Good estimation of patient opinion on hospital consultation performance
was obtained with these questionnaires when comparing performances between
departments or the same department over time scores need to be adjusted on 3 variables
that influence satisfaction independently from department. Completion of the
questionnaire at home is preferable to completion in the consultation facility and
reminders are not necessary to produce non-biased data. Gremigni et al; (2008) study is
aimed at developing and providing preliminary validation of a questionnaire to measure
outpatients' experience of communication with hospital personnel other than doctors.
 Participants are Outpatients and hospital staff. Small groups of outpatients and hospital
staffs were involved in identifying the domains and generating the items. A quantitative
validation phase involving 401 outpatients followed in order to verify the hypothesized
dimensionality of selected items and to measure reliability A 13-item questionnaire
emerged, comprising four components of outpatients' experience in the healthcare
communication domain: problem solving, respect, lack of hostility, and nonverbal
immediacy. Psychometric tests were promising as regards factorial validity, evaluated
with confirmatory factor analysis, and scales reliability. Factor scores were independent
ofpatients' gender, age, and education. The developed Health Care Communication
Questionnaire (HCCQ) is a self-administered brief measure with good psychometric
properties. The HCCQ gives information that could be taken as an indirect and subjective
indicator of the quality of hospital services as provided by non-medical staff. This aspect
may have a role in local quality improvement initiatives. Hordacre et al;(2000) In their
study entitled “Assessing patient satisfaction: implications for South Australian public
hospitals “, the results revealed that satisfaction was lowest in the patients' assessment of
their involvement in their own care and treatment. Three demographic factors (younger
age, female sex or tertiary education) predicted lower levels of satisfaction, whereas
livings with others, non-emergency admission or admission to smaller hospitals were
found to predict higher satisfaction.

6. 21. Renzi (2001) argue that patient satisfaction is an important indicator in evaluating the
quality of the patient care in the outpatient department. In the context of total quality,
serving the customers/patients does not simply mean satisfying them. It implies satisfying
their needs in conformance to their requirements, and the specifications have to be stated
explicitly by customers to be satisfied. There is an increasing interest in assessing
patients' satisfaction with medical care in the United States and other countries. Socio-
Demographic Characteristics- Doborah ( 1997) argue that many people have a strong
belief that the high levels of positive opinions of patients might be closely related to some
independent factors such as standards of living, gender, age groups, and even status of the
patients whether they are single, married, or widowed, etc. Nonetheless, some other
researchers have concluded that there is little relationship between socio-demographic
 characteristics with satisfaction levels. Aday and Anderson ( 1981) state that some
findings confirm that people who are from the same ethnic groups tend to pay more
attention or to help the people who are from the same sources. This idea is also said to
apply in the performance done by physicians who are from the same groups as their
patients. Hall and Dornan (1990) say that there are also believes that some social
advantages such as educational backgrounds, employments, revenues, an warranty are the
keys for clients to decide which services to use. Lebow (1983) argues suggestions
regarding direct relationship between socio-demographic characteristics have been well
documented. Some researchers suggested that the high levels of patients’ satisfaction are
significantly related to the patients’ standards of living, namely the family income. While
some others mentioned that age is the most noticeable independent variable that usually
has very close relationship with patients’ positive opinions about services. They believe
that the older the patients are, the higher the level of satisfaction they will show while the
younger the patients are, the lower the level of satisfaction they will give.

7. 22. Last but not least, some researchers also stated that some patients tend to medical
services based on their reference groups’ ideas. For instance, if their group says this
service is good to use, they will be likely to decide to use this service rather than others.
Pasaribu (1996) Say that even though many trends of direct relationship between socio-
demographic characteristics and patients’ satisfaction are highly discussed among many
researchers, these independent variables are not used as the tool to predict the patients’
satisfaction in all cases. Sometimes, it is hard for the service providers to meet some
patients’ high expectation. Some researchers have found out that the characters of socio
demographic factors vary vastly according to the actual aspects. The nature of patients’
expectation may be widely different and complicated. One cannot base on a set of
standard rules to satisfy different groups of people and to expect that they will show a
similar satisfaction level. Therefore, significant factors around them might become
effective tools to predict what they really want. People with a low standard of living tend
to experience a low level of health care services when they have health problems. In
addition, because they really have to work hard to survive, they might not be able to
follow more schedules of treatments. In some case, their physicians do not treat them
 equally as the patients who have full coverage of insurance. This factor unavoidably
might lead them to have a low level of satisfaction. Rodney et al; (1986) say that a
significant trend is matching a low level of educational background of the users with high
level of satisfaction all over the world by satisfaction research. Thoma Perenger (1997)
found that nervous effects from unclear reasons of health problems, which patients have
experienced, were suggested as a reason for patients to start their visitation to hospital
and even continue increasing the numbers of visitation in a period of time. These effects
are also said to be influenced by gender. It usually means that female patients seem to
pay more visitations to hospital than male ones. Dozens of research have been done in
order to find out the significant associations between socio-demographic characteristics
and the results of satisfaction researches in health care industry.

8. 23. Setter (1996) found out that the trend of satisfaction seems to fall high on male
respondents rather than female respondents. Nonetheless, many other researches
regarding patients’ opinion about services they have received provided statistical results
that female patients usually showed higher levels of satisfaction than male patients.
Doborah (1997) studied the concern about relationship between age groups and level of
satisfaction has also been studied. Some previous researchers have suggested that the
older respondents seem to give more scores to the service providers since they have been
going through the social services all their lives. They are said to be more understanding
and accepting than younger respondents who usually have less social and commercial
experiences of the real world and seem to judge things very quickly. Wiadnyana et al;
(1995) argue that more and more enthusiastic belief that age groups are significant
elements to predict a high level of satisfaction has been repeated over the times. The
elderly tends to be more satisfied that youngsters when they are receiving the same
services. Channawangse et al ;( 1999) states that many reports have associated a low
level of patients’ satisfaction with low family income. They say that people’s monthly
incomes play important roles in purchasing power of goods and services. It also classifies
the users’ social status with a set of standard quality of services, which is usually highly
expected by the user of healthcare services. Sumtraprapoot (2000) in his study suggested
that the respondents who have lower revenues tended to have a higher level of
 satisfaction than those who have higher monthly incomes. Normally, the patients who
earned less revenue, experienced poor health conditions and it is hard for them to get
better health care services with less continuous follow-up through their physicians.
Moreover, they are thought to receive less care by physicians than those who have been
covered by any insurance schemes. All in all, they don’t have choices, but to feel
dissatisfied with the services provided.

9. 24. Patients’ Experiences with Healthcare Service- One significant dependent variable in
the study of patients’ satisfaction is the patients’ own experiences of the real service
performances. This vital factor later also creates ones’ hopes of receiving the same or a
better quality of services than they get used to. People normally base their judgment of
the services on seeing, touching, listening, smelling and tasting than the elements
included in a set of quality service. For healthcare service, particularly patients will
decide whether they are low or highly satisfied with service through feeling the direct
elements of the services such as physical facility, physicians’ consultation and treatment
skill, nurses’ consoling skill, pharmacy service, registering service, and so on. Patients’
opinion about qualify services would be instantly changed if the patient continuously
experiences same services with different ways of serving. Self involvement really matters
in determination of one’s’ way of perceiving quality of satisfaction regarding waiting
time, cleanliness, and the setting of infrastructure around. Pasaribu(1996) stated that he
found the causes of patients’ satisfaction, to be a low level of quality of care and less
amount drugs provided. Physicians’ and Nurses’ Services- Robert and Coale Redman
(1987) found that physicians’ and nurses’ communication skills with patients are the key
components to a high level of patients’ satisfaction. In a research done in Switzerland,
physician-patient interaction has been suggested as the vital factor in predicting patients’
satisfaction. Afridi (2002) argue that likewise, way of raising voice, physical feeling,
communication and Personal behaviours of physicians really contribute in bringing a
higher level of users’ satisfaction. Barry(2001) mentioned in a study in Ireland that good
interaction between physicians and their patients is the milestone to reach clients’
satisfaction and continuous improvement of quality of care Likun (1996).
10. 25. Pharmacy, Registration and, Service Principles- Additional services like pharmacy,
registration and service flow are particularly mentioned to significantly influence the
level of patients’ satisfaction. Phyunyathikum (1994) clarified in his research that the
quality of pharmacy service including numbers of personnel, rates of prescribing
medicines and waiting time to receiving medicines determine the result of patients’
satisfaction. Accessibility to Healthcare Service- Accessibility means physician-visiting
structure, first-line reception, and availability of different physicians, personal house
visitation, and the follow-up visits. Many factors are leading patients to feel frustrated
when they are admitted to a hospital usually indicated as an embarrassing aspect, is the
absence of clinical staffs in any working shifts, especially at night-time. Emergency cases
can happen anytime without warning; therefore, punctual and critical presence of
necessary personnel must be under close monitoring. Aday (1983) mentioned the trend of
moving from public healthcare body to private one is increasing day to day as the result
of such neglect. Good communication and capability to understand and share the feeling
of others are now being perceived as the main aspects to patients’ satisfaction. The
activity of removing a person’s doubt or fear, capability to understand and share the
feeling of others, are among other significant factors to extend the value of physician-
patient interaction. However, a straight relationship between them and satisfaction was
not assured. Patients tend to give value to their physicians and nurses in term of respects
and friendly attitudes rather than technical matters. Removing a person’s doubt or fear
and capability to understand and share the feeling of others reflect the value of health
profession and are well recognized in treating patients with cancer. Cockerham (1982)
argued that demand for health care service is always there. Therefore, healthcare service
providers should be ready to serve anytime. Ease of accessing to health care facilities has
become a potential goal for policy makers throughout the world. Nonetheless, attempt in
conceptualize and assess the accessibility still vary based on people’s perception.

11. 26. Ross et al ;( 1993) findings provide evidences that most of the respondents decided to
prioritize clinical quality of care followed by physicians/nurses’ communication skills,
and ended up by the accessibility to healthcare facilities as their preferences. Likewise,
the respondents who prioritized the accessibility were from older-age group with a low
 Educational background and low income. Components of Patients’ Satisfaction- The
main elements of satisfaction proposed by the researcher in the Khmer-Soviet Friendship
Autonomous Hospital comprise of convenience, courtesy, and quality of care.
Convenience- Convenience is defined as the comfort in approaching a set of standard
quality of care such as chances of seeing wanted physicians, adequate waiting time, ease
of meeting the required expectation and qualified services. Kunarantnapruek and
Boonpadoong (1989) mentioned that Users usually will come back to receive services
from where they used to be satisfied. Researchers can use this characteristic to
differentiate the quality of services provided. Furthermore, one main factor that should be
considered for predicting the level of convenience is waiting time. Sriratanabul and
Pimpakovit (1993) in a study of patients’ satisfaction in the Outpatient Department of
Chulalongkorn Hospital, argue that a significant factor led the majority of the
respondents to feel uncomfortable with the services provided was long waiting time. 83%
of the respondents showed positive feeling towards services provided in the department
while disappointed with very long waiting time to receiving services. Likun(1996)
mentioned waiting time services in a study of “Ways and Means to Reduce the Waiting
Time and Improve Patient Satisfaction”. He revealed that there was a significant
relationship between waiting time to receive service, and patients’ satisfaction level. The
majority of his respondents, 61% complained that waiting was not good for them.

12. 27. Tessler et al ;( 1976) in a research in Ramathibodi Hospital, long waiting time was
indicated as the significant factor for a low level of satisfaction. There is a report that the
Respondents who were highly educated showed a low level of satisfaction in the
Registration section while similar effect also happened in the Pharmacy section. Quality
of Care- Bashir and Armstrong (1991) argue that nowadays, hot issues like qualified
health care service and patients’ satisfaction are being crucially discussed throughout the
world. Many different institutions have adopted a means to reflect on their service
providing. Hi-tech, humanistic approach, educational backgrounds, communication, and
means of transferring qualified service quality to the patients constitute the vitality of
patients’ satisfaction. Donabedian(1993) suggests that Efficacy, effectiveness, efficiency,
optimality, acceptability, legitimacy, and equity are the seven main factors for patient
 satisfaction.. Williams and Calnan (1991) states significant changes in health care service
evaluating and enhancement are opening a new health care portrait for the service user.
Formally accepted principles and apparatus to assessing and improving of health care
service users are dated to the American College of Surgeon’s 1971, Hospital
Standardization Program when it evolved into the Joint Commission on Accreditation of
Healthcare Organization Accreditation Process. Piyathida Sumtraprapoot (1997)
mentions that a new trend in combining quality assurance from other commercial
industries with health care delivery strategies is the main indicator for quality of care.
Generally accepted and hi-tech methods of health care services have led the industry to
the contemporary way of qualified healthcare management. Quality of hospital care was
created by The American College of Surgeons as a fundamental formula in 1933 and
gradually this principle in 1917 became its hospital standardization program.
Furthermore, The Canadian Hospital Association with American College of Physicians,
The American Hospital Association, and American Medical Association has established a
Joint Commission on Accreditation of Hospital (JACHO) that originated the criteria
based audit method.

13. 28. Increasing the level of complying with treatment, originated from the vital study of
patients’ behaviours toward services. Marketing strategies regarding consumers’
satisfaction that have been introduced in the health care industry.  An accurate merging
of consumers’ opinions about healthcare service for the sake of quality improvement and
assurance. Garpenby (1999), Sweden written an article regarding Resource Dependency
mainly indicated the relationship between the aspect of national-level clinical profession
and patient satisfaction level. It also suggested that service quality advancement should
be the main focus in order not to lose the public expectation. He also mentioned that the
health care framework should be regarded as in other industries by characterizing its
quality profession. An accepted set of qualified standards of care such as accessibility,
availability, personnel’s qualifications, and mutual understanding are not only the
significant factors considered by the management level, but also by the users of the
healthcare services who are normally called clients. Courtesy- Courtesy is usually defined
by respect, attentiveness, and care shown by the clinical personnel. Assessment of Patient
 Satisfaction in Healthcare Service Assessment of users’ satisfaction in healthcare services
is a means of evaluating the healthcare service performances by clinical personnel. In
addition, it also indicates the success and failure of service implementation and
development in a way of perceived services. Barry et al; (2001) states that Patient
satisfaction is a very complicated principle, which is usually affected by some significant
factors such as socio-demographic factors, personal characters, physical and mental
aspects, cause and effect of the services, and patients’ expectations In spite of these
complexes, ways of assessing patients’ satisfaction have been proposed as:

14. 29. By quality improvement, assessment of the patients’ satisfaction becomes a

significant educational process to find the developments that are inexpensive to make,
have better service performance and sets of qualified standards. Theoretical Model for
Constructing Conceptual Framework- Aday and Anderson (1978) in the study of people’s
satisfaction with health care delivery in the United States of America from 1970 to 1975
pointed out six principles focusing on patient satisfaction, and three of them are presented
below: 1. Satisfaction in term of convenience: - Waiting time to obtain service -
Available care when required - Base of receiving care 2. Satisfaction in term of courtesy:
- Friendly and polite attitude of the service providers - Provision of what is necessary for
the welfare of a patient 3. Satisfaction in term of quality of care: - The patients’
perception of the service performance. In 1974, they also mentioned that patient
satisfaction is the attitude of people who were involved in the health care system that is
different from the elements of the predisposing variables, as it measures the people’s
satisfaction against the amount of care and its quality. Aday and Anderson (1983)
Furthermore, also suggested that evaluation of the patient satisfaction might be best
performed in the form of relevant medical service seeking behaviour, which is clear, up-
to-date, and classifiable, in order to elicit the subjective perception about access which
points out the satisfaction with the convenience of service, its correspondence and cost,
courtesy of the servers, information the patients obtained about the treatment, and the
patients’ opinion based on the quality of care. Patients’ satisfaction is the indicator of the
outcome in a theoretical model of access, which indicated the use of the services.
 EXPERIMENTS OR RESEARCH METHODOLOGY

RESEARCH DESIGN

The main objective of this research was to assess the level of patient satisfaction with Medicine
Outpatient Department’s services regarding physician – patient interaction; nurse - patient
interaction; and patients’ satisfaction in term of convenience, courtesy, and quality of care of
Meerut Kidney Hospital.

A research design is the plan of a research study. The design of a study defines the study type
(descriptive, correlational, semi-experimental, experimental, review, meta-analytic) and sub-type
(e.g., descriptive-longitudinal case study), research question, hypotheses, independent and
dependent variables, experimental design, and, if applicable, data collection methods and a
statistical analysis plan. Research design is the framework that has been created to seek answers
to research questions.

STUDY DESIGN
A cross-sectional study design was employed on the designated date in the Outpatient
Department of the MEERUT KIDNEY HOSPITAL, Meerut. This design is particularly aimed to
find out the levels of patients’ satisfaction and its significant relationships with socio-
demographic characteristics of the studied samples. Meanwhile, in order to achieve the set goals,
a pre- interviewed questionnaire adopted from a previous researcher has been comprehensively
justified, and applied, accordingly.

STUDY POPULATION
The Outpatient Department of the Meerut Kidney Hospital, Meerut was selected as the study
site. Targeted samples were drawn from the patients who had visited the Outpatient Department
of Meerut Kidney Hospital, Meerut at the time of data collection. The patients matching the
inclusion criteria are included in the study and were administered the questionnaire during their
visit to OPD of Meerut Kidney Hospital.

ETHICAL CONSIDERATION
The patients were informed about the study before conducting the study and were told that their
participation will be voluntary.

INCLUSION CRITERIA
1. The outpatients of the Department whose age ranges are from 15 years to 85 years old.
2. The patients who were willing to give consent.
3. The patients who have at least visited Outpatient Department for times and pharmacy for
1 time.
4. The patients who were able to listen and understand local language.

EXCLUSION CRITERIA
1. Patients who had mental problems.
2. Patients who needed emergency attention.
3. Patients who had not finished the interview process.

RESEARCH TECHNIQUE

1. By Observation : This method implies the collection of information by way of

investigator’s own observation, without interviewing the respondent. The information
obtained related to what is currently happening and is not complicated by either the past
behavior or future intentions or attitudes of respondents. This method is not doubt an
expensive method and the information provided by this method is also very limited. As
such this method is not suitable in inquiries where large samples are concerned.

2. Through personal interview : The investigator follows a rigid procedure and seeks
answers to a set of pre-conceived questions through personal interviews. This method of
 collecting data is usually carried out in a structured way where output depends upon the
ability of the interviewer to a large extent.

3. Through telephone interview : This method of collecting information involves

contacting the respondents on telephone itself.

4. By mailing of questionnaires : The researcher and the respondent do come in contact

with each other if this method of survey is adopted. Questionnaires are mailed to the
respondents with a request to return after completing the same. It is most widely used
method in various economic and business surveys.

5. Through schedules : Under this method the enumerators are appointed and given
training. They are provided with schedules containing relevant questionnaires. These
enumerators go to respondent with schedules. Data are collected by filling up the
schedules by enumerators on the basis of replies given by respondents.

“Structured Questionnaire and personal interview research technique was used in the
project.”

TYPE OF DATA

PRIMARY DATA:
Data collected by administering questionnaire.
SAMPLE SIZE AND SAMPLING TECHNIQUE
Questionnaires are collected from 50 respondents who attended the outpatient department of the
Meerut Kidney Hospital.

PERIOD OF SURVEY
The period of survey is from 15th June 2018 to 14th July 2018.

CONVENIENT SAMPLING
A convenient sample is a type of non-probability sampling method where the sample is taken
from a group of people easy to contact or to reach. For example, standing at a mall or a grocery
store and asking people to answer questions would be an example of a convenience sample. This
type of sampling is also known as grabbed sampling or availability sampling. There are no other
criteria to the sampling method except that people be available and willing to participate. In
addition, this type of sampling method does not require that a simple random sample is
generated, since the only criteria is whether the participants agree to participate.

DATA ANALYSIS
The data collected from the primary sourced were arranged sequentially and tabulated in
systematic order.
TOOLS USED FOR DATA ANALYSIS
one way-ANOVA TEST

percentage analysis

DATA ANALYSIS & INTERPRETATION

ANOVA ONE WAY

1. ANALYSIS OF GENDER AND WAITING TIME IN RECEPTION

H0: There is no significant difference among the Gender of patients with respect to waiting
time in reception
H1: There is a significant difference among the Gender of patients with respect to waiting
time in reception

Table 1 : ANOVA
Gender of the Sum of Df Mean Square F Sig.
patient Squares
Between 1.057 5 .211 .826 .538
Groups
Within 11.263 44 .256
Groups
Total 12.320 49

INTERPRETATION:
Table shows that the significant value is>0.05 so there is no significant difference among the
Gender of patients with respect to waiting time in reception.

2. ANALYSIS OF MONTHLY INCOME AND MEDICAL BILLS

H0: There is no significant difference among the monthly income of customers with respect
to medical bills.
H1: There is a significant difference among the monthly income of customers with respect to
medical bills.
Table 2 : ANOVA

What is the monthly income of the patient

Sum of Df Mean Square F. Sig.
Squares
Between 37.055 2 18.527 4.779 .013
Groups
Within 182.225 47 3.877
Groups
Total 219.280 49

INTERPRETATION:
Table shows that the significant value is<0.05 so there is significant difference among the
monthly income of the patient and the medical bill. Lesser monthly income of patients feel
medical bill in hospital is high.

3. ANALYSIS OF EDUCATIONAL QUALIFICATION OF PATIENTS

AND SUITABLE MAGAZINES /TV / NEWSPAPER FACILITY

H0: There is no significant difference among the different educational qualification with
suitable magazines/TV/newspaper facility.
H1: There is a significant difference among the different educational qualification with
suitable magazines/TV/newspaper facility.

Table 3: ANOVA

What is the highest level of formal education you have completed

Sum of Df Mean Square F Sig.
Squares
Between 10.515 2 5.258 4.952 .011
Groups
Within 49.905 47 1.062
Groups
Total 60.420 49

INTERPRETATION:
The table shows that the significant value is lesser than 0.05 and hence there is significant
association between the educational qualification of the patients and suitable
magazines/newspapers/TV facility.

4. PERCENTAGE ANALYSIS

i) Gender of the patients

TABLE 4 : Gender of the patient
Valid Frequency Percent Valid Percent Cumulative
Percent
Male 22 44.0 44.0 44.0
Female 28 56.0 56.0 100.0
Total 50 100.0 100.0

Figure 1 :

Gender of Patient

Male
Female

INTERPRETATION :

The above table and the pie chart show that majority of the patient are female 56.0% and
44.0% are male.

ii) AGE OF THE PATIENTS :

Table 5 :
Age of the
Patients
Frequency Percentage Valid Cumulative
Percentage Percentage
 18-24 7 14.0 14.0 14.0
25-34 14 28.0 28.0 42.0
Valid 35-44 8 16.0 16.0 58.0
45-54 10 20.0 20.0 78.0
55-64 6 12.0 12.0 90.0
65 or above 5 10.0 10.0 100.0
Total 50 100.0 100.0
Figure2

Age of Patients

18-24
25-34
35-44
45-54
55-64
65 or above

INTERPRETATION
The above table shows that 28% of the patients are between the age 25-34 ,20% are between
the age of 45-54, 16% are between 35- 44, 14% are between 18- 24, 12% are between 55- 64.

5. CONVENIENCE OF THE PATIENT IN LOCATING THE OUTPATIENT

BUILDING IN HOSPITAL PREMISES.

Table 6 : Convenience of the patient in locating the outpatient

building in hospital premises.
Valid Frequency Percentage Valid Percentage Cumulative
Percentage
Yes 28 56.0 56.0 56.0
No 22 44.0 44.0 100.0
Total 50 100.0 100.0

Figure 3

Convenience of the patient in locating the

outpatient building in hospital premises

Convinient
Non Convinient

INTERPRETATION
The above table shows that 56.0% of the patients are able to locate outpatient department
building in hospital premises and 44.0% of the patients are not able to locate.

6. WAITING TIME IN RECEPTION

TABLE 7 : Waiting time in the reception area

Valid Frequency Percentage Valid Cumulative

 Percentage Percentage
Extremeley 1 2.0 2.0 2.0
Dissatisfied
Very Dissatisfied 3 6.0 6.0 8.0
Dissatisfied 17 34.0 34.0 42.0
Satisfied 20 40.0 40.0 82.0
Very Satisfied 7 14.0 14.0 96.0

Extremely 2 4.0 4.0 100.0

Satisfied
Total 50 100.0 100.0

Figure4

Waiting time in reception area

Extremely dissatisfied
Very dissatisfied
Dissatisfied
Satisfied
Very satisfied
Extremely satisfied

INTERPRETATION
The table shows that 40.0% of the patients are satisfied, 34.0% of the patients are dissatisfied,
14% are very satisfied, 6% are very dissatisfied, 4% are extremely satisfied about the waiting
time in reception.
 RESULTS OR FINDINGS

FINDINGS FROM ANOVA:

There is no significant difference among the Gender of patients with respect to waiting
time in reception.
There is significant difference among the monthly income of the patient and the
medical bill. Lesser monthly income of patients feel medical bill in hospital is high.
There is significant association between the educational qualification of the patients
and suitable magazines/newspapers/ TV facility.so health awareness related magazine
can be provided in both languages (Tamil and English).

FINDINGS FROM PERCENTAGE ANALYSIS:

The majority of the patient are female 56.0% and 44.0% are male.
The above table shows that 28% of the patients are between the age 25-34 ,20% are
between the age of 45-54, 16% are between 35- 44, 14% are between 18- 24, 12% are
between 55- 64, 10% are between 60 and above.
The 56.0% of the patients are able to locate outpatient building in hospital premises
and 44.0% of the patients are not able to locate.
The 40.0% of the patients are satisfied and 34.0% of the patients are dissatisfied about
the waiting time in reception.

RECOMMENDATIONS OR SUGGESTIONS

Recommendations which were mostly concerned regarding in terms of expenses and time
convenience of going from patient house to OPD is first priority area for the improvement.
Second priority area to be improved is the costs of the drugs in pharmacy of OPD. The
provisions for reducing the waiting time before meeting the doctor is the third priority area for
the improvement. There after comes the sitting chairs in the waiting area of the OPD for the
patients should be increased specially during the peak rush hours in the OPD. Provision for the
adequate Drinking water facility in the waiting area of OPD should be made. Finally the
Registration staff availability in OPD must be improved.

Information desk can be provided.

Vital signs can be checked doing the waiting time, this may minimise the waiting time
of patient during consultation.
Since the majority of the patient are educated, therefore the outpatient reception could
provide with magazines and newspaper related to health care, awareness of different
disease condition and preventive actions to be taken by patient and health education
etc., both in Tamil and English.
Since most of the patients are dissatisfied with the waiting time in the reception, the
hospital could take proper care for this problem by improving software regarding
appointment timing.
Improve Wi-Fi facility in hospital waiting area.
 Improving toilet facility, drinking water facility and approach to the pharmacist.
 Hospital should develop patient feedback system which is vital for quality of services.

CONCLUSION

Patients attending each hospital are responsible for spreading the good image of the hospital and
therefore satisfaction of patients attending the hospital is equally important for hospital
management. Various studies about Out Patient Services have elicited problems like
overcrowding, delay in consultation, proper behaviour of staff etc. The project is conducted to
study about the patients satisfaction in Private multi-speciality hospital .In this study, it is found
that majority of the patients are satisfied with the services provided. They were satisfied with the
guidance, logistic arrangements, support services, nursing care, Doctors consultation etc. Though
few patients were not satisfied with the waiting time in the reception .It is worthwhile to note that
there is scope for improvement of the Out Patient Department Services. Therefore it can be
concluded that the OPD services form an important component of Hospital services and
feedback of patients are vital in quality improvement.
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.
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APPENDICES
1. RESEARCH INSTRUMENT

The research instrument used by the researcher in collecting data was a pre structured
questionnaire –

QUESTIONNAIRE PATIENT SATISTACTION TOWARDS OPD- SERVICES

OPD FEEDBACK FORM – MEERUT KIDNEY HOSPITAL.

2. INTERNSHIP CERTIFICATE - MEERUT KIDNEY HOSPITAL