1.

0 BACKGROUND

1.1 Malaysia initiative towards Sustainable Development Goals

In line with the initiative towards the sustainable development goals,

Malaysia is committed in achieving the target of Sustainable Development
Goals no 3 which is Good Health and Well Being. One of their main
objectives is to provide access to quality based oriented health care
services and safe, affordable medicine to the citizen. This goal can be
achieved first by improving the current patient’s satisfaction towards public
healthcare center.

1.2 Problems that contribute to the patient’s satisfaction factor in Hospital

Klang, Selangor.

To compare one’s experience with the expectation that has been

made in the beginning is the definition of satisfaction according to Pascoe
(1983). Rizal A.M et al (2006) states that patient’s satisfaction is where
healthcare is fulfilling the needs of an individuals by achieving the desired
satisfactory level. However, there are several factors that influence the
patient’s satisfaction. This research is proposing the influenced factors of
patient’s satisfaction in Hospital Klang, Selangor. With a population of 32.6
million in fourth quarter 2018, and total area of 8,104-kilometer square,
Selangor has become the most populated state in Malaysia.

Located in one of the busiest and crowded cities in Selangor,

Hospital Klang has always been the main medical centre for the Selangor
residents to get treatments and consults with medical officers. With a total
number of 879,867 population in Klang, it has made Hospital Klang as one
of the busiest government hospitals in Malaysia. The healthcare service in
Malaysia has always received bad perception from the public. Although
quite a number of patients registered daily, it seems like people demand a
high-quality service with very minimum cost in order to fully satisfied them
as the patient. Ganasegaran et al (2015) found that patients with high

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 school education is highly satisfied with the service provided by the
government hospitals as compared to higher education qualification
patients. These findings show that satisfaction is a subjective feeling that
was interpreted differently and how this study will aim to find the factors that
influence the patient’s satisfaction in Hospital Klang, Selangor.

2.0 LITERATURE REVIEW

2.1 Accessibility

According to Ganasegaran et al (2015) the Malaysian government

has always been helping the citizen by bearing the cost of treatment by
subsidizing nearly 95% of total healtcare cost. This allows the citizen to
have full access to utilize all the medical benefits provided. Hizlinda T et al
(2012) stated that patients are generally satisfied with the accessibility,
facilities and appointments due to the behaviour of the respondents who are
not into complaining and accepting the conditions as it is. Hizlinda also
mentioned that system-related factors such as accessibility did not give
much impact to the patient’s satisfaction as compared to interpersonal
relationship. However, the accessibility to government healthcare services
nowadays contributes to the patient’s satisfaction factor especially to those
in rural areas.

2.2 Hospital Facilities

Based on Azimatun N.A et al (2012), among the factor that influence

the satisfaction is when the hospital is well equipped with modern and
appropriate equipment for the patients. Many researchers believe that
hospital facilities are the most vital factors that will influence the satisfaction
level, but according to the study held at UKMMC Primary Care Clinic, 65.4%

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 were not satisfied with the facilities. Hizlinda T et al (2012), Rizal A.M et al
(2006) and Harvinderjit K et al (2016) for example stress that by improving
the respected factor, the satisfaction will be improved accordingly.

2.3 Technical Quality

According to Yogesh (2011) Doctor’s technical quality is judge based

on personal preferences, without having any respected knowledge in that
area. How the patients is satisfied or vice versa is purely based on the
treatment and diagnosed made by the doctor. He also added that how
patients did not have the ability to evaluate the technicality of the service
given by the doctors and medical officer. The study is purely based on, the
process of interaction with all subjects not entirely focused on doctors but
all those who are related to the medical services and their satisfactions level
towards their delivery.

3.0 PROBLEM STATEMENT

Public services in Malaysia has always been given a poor perspective by the
citizen especially in healthcare service. Although the Malaysia have many specialists that
attend to their patient with good consultation, patient would always felt dissatisfied
towards Malaysian healthcare services.

A detailed research needs to be conducted to find the root causes or sources of

the dissatisfaction to improve the quality and delivery; but also, to find what are the factors
that make them satisfy with the services for maintenance and improvement.

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4.0 RESEARCH OBJECTIVES

4.1 To study the effect of accessibility on patient satisfaction at Hospital Klang,

Selangor;
4.2 To study the effect of hospital facilities on patient satisfaction at Hospital
Klang, Selangor;
4.3 To study the effect of technical qualities on patient satisfaction at Hospital
Klang, Selangor.

5.0 RESEARCH QUESTIONS

5.1 Does accessibility significantly influence the patient satisfaction at Hospital

Klang, Selangor?
5.2 Does hospital facilities significantly influence the patient satisfaction at
Hospital Klang, Selangor?
5.3 Does technical quality significantly influence the patient satisfaction at
Hospital Klang, Selangor?

6.0 THEORETICAL FRAMEWORK

1 Interpersonal Manner 1
2 Communication 2

3 Accessibility 3

4 Hospital facilities 4

5 Financial Aspects 5

6 Time spent with doctor 6 Patient

7 Satisfaction
7 Empathy
8
8 Waiting time
9
9 Service
10
10 Technical quality
11
11 Responsiveness
12
12 Doctors and nurses
Figure 1: Theoretical Framework

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 Based on the literature reviews, the theoretical framework is constructed to
determine the significant factors that contributes to the patient satisfaction. According to
Ganasegaran et al (2015) financial aspect and time spent with doctor contribute to the
patient satisfaction, whereas Ganasegaran et al (2015), Yogesh (2011) and Rezaian T et
al (2014) stressed that interpersonal manner and communication are among the factors
affect the satisfaction. Besides that, empathy and waiting time have been mentioned a
lot by the researchers such as Ang K.T et al (2012), Azimatun N.A (2012), Yogesh (2011)
and Lau B.T et al (2018). According to Hizlinda T et al (2012) accessibility, doctor and
nurse affect the satisfaction whereas Harvinderjit et al (2016) mentioned that they take
service into consideration in evaluating their level of satisfaction. Hospital facilities and
technical quality both have been mentioned by most of the researchers in their study.

7.0 HYPOTHESIS

7.1 Ha1: There is a significant relationship between accessibility and patient

satisfaction at Hospital Klang, Selangor.
7.2 Ha2: There is a significant relationship between hospital facilities and
patient satisfaction at Hospital Klang, Selangor.
7.3 Ha3: There is a significant relationship between technical quality and
patient satisfaction at Hospital Klang, Selangor

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8.0 RESEARCH DESIGN

Problem Literature Research Theoretical and

Objective/ Research
Identification Review Questions Framework

Data
Recommendation Conclusion Data Analysis
Collection

Figure 2: Research Design Flow

This research will be conducted by using quantitative method and follows the
research design from start until it is completed. All the relevant information is gathered
through literature review to identify related variables and hypothesis. One clear theoretical
and research framework is generated from the past research to focus down the research.
Data will be collected through questionnaire to selected respondents by using Simple
Random Sampling (SRS) and analyzed by using Statistical Package for the Social
Sciences (SPSS 20). The result obtained will generate the conclusion and a number of
suitable recommendations.

8.1 Research Framework

Through literature review, the research framework for this study is
constructed as in Figure 3. The Independent variables (IV) are accessibility,
hospital facilities and technical quality respectively whereas the dependent
variable (DV) is patient satisfaction.

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 ACCESIBILITY

HOSPITAL FACILITIES PATIENT SATISFACTION

TECHNICAL QUALITY

Figure 3 : Research Framework

9.0 MEASUREMENT: SCALING, RELIABILITY AND VALIDITY

9.1 Scaling

Scaling is the process where the object is assigned to numbers

according to a rule. To collect the demographic data of the respondents,
this research will be using nominal and ordinal type of measurement scale.
The factors that influenced the patient satisfaction is measured and scaled
by using interval type known as Likert scale. It will be divided into 3 parts
based on all the variables and will be measured by scale of 1 = strongly
disagree, 2 = disagree, 3 = neutral, 4 = agree and 5 = strongly agree.

9.2 Validity
The questionnaire is validated through 2 types of validity which are
face validity and content validity respectively. This research is focused on
human thoughts and feelings towards government hospital service,
therefore the instrument will be validated by the Director of Hospital Klang
himself, Dr Mohamad Sabri Bin Othman.

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9.3 Reliability

The reliability is determined by calculating the Cronbach’s Alpha, α

of all the independent variables. The value of α need to be more than 0.7 in
order to prove the reliability between the variables. The variable will be
removed if the score obtained is less than 0.7 as the consistency is poor
and unacceptable. This research will run a pilot study at the Hospital Klang,
Selangor where 30 respondents among the patients will be joining the
study.

Cronbach’s Internal
Formula: alpha Consistency
𝑘ř α > 0.9 Excellent
𝛼=
1 + (𝑘 − 1)ř 0.8 ≤ α < 0.9 Good
0.7 ≤ α < 0.8 Acceptable
k = number of items 0.6 ≤ α < 0.7 Questionable
ř = average correlation 0.5 ≤ α < 0.6 Poor
among items α < 0.5 Unacceptable

Table 4: Cronbach’s alpha ranges

It turns out that the relationship between the variable is reliable since
the value is measured and obtained > 0.7 as per below data:

Variable N of items Cronbach’s alpha

Accessibility 5
Hospital Facilities 5 0.86
Technical Quality 5

Table 5: Research variables Cronbach’s alpha value.

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10.0 DATA COLLECTION METHOD AND SAMPLING TECHNIQUE

10.1 Data collection method

This research will collect the primary data through questionnaire as

the choice of instrument. The questionnaire is constructed and divided into
three sections, namely Section A, B and C where Section A will be focusing
on the demographic of the respondents and Section B will be asking more
on the variables which are the factors influencing the respondent’s
satisfactions at Hospital Klang, Selangor. Section B is separated by three
part of different variables; accessibility, hospital facilities and technical
quality respectively. Bahasa Melayu and English will be used in the
questionnaire for the respondent’s conveniences.

Before the questionnaire is distributed, a collaboration with the

Ministry of Health and Hospital Klang will be made to get the official
approval. Once the approval is received, the questionnaire will be
distributed in the Hospital Klang.

A total of 530 questionnaire is distributed to the respondents, where

30 responses is used in pilot study leaving the sample size to be 500 in
total. According to Krejcie & Morgan (1970), the sample must be in the
minimum of 384 when the population is more than 100,000. Therefore, 500
is enough to generate the results of this research. After data cleaning, the
number of fulfilled inclusion and exclusion criteria is 352 respondent’s
answer which resulted to the response rate of 92%.

10.2 Sampling technique

The sampling technique used for this research will be the Simple
Random Sampling (SRS) as the respondent will not be clustered into certain
group or any targeted age requirement. Questionnaire will be distributed

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 manually to a number of respondents who had been a patient in Hospital
Klang, Selangor. Hospital Klang has an admission rate of 260 patients daily
which made it more than enough to distribute the questionnaire. It will take
not more than 4 days to complete the questionnaire with the desired number
of respondents.

11.0 DATA ANALYSIS AND INTERPRETATION TECHNIQUE

11.1 Demographic analysis

Variable Category Frequency Percentage (%)

Gender Male 186 52.8
Female 166 47.2
Age (years) < 17 89 25.3
18 – 59 143 40.6
 60 120 34.1
Status Single 100 28.4
Married 252 71.6
Employment Unemployed 23 6.5
status Student 59 16.8
Employed 228 64.8
Retired 42 11.9
Monthly Below RM1000 51 14.5
income RM1001-RM2000 102 29.0
RM2001-RM3000 111 31.5
RM3001-RM4000 51 14.5
More than RM4001 37 10.5
How often do Every time when I fall sick 87 24.7
you go to More than 5 times a year 218 61.9
Hospital Klang Every month (checkup) 47 13.4

Table 6: Summary of Respondent’s Demographic Profile

From the respondent’s demographic view, it can be summarized that

52.8% were male respondent and 47.2% were female where most of them
are from 18 to 59 years old and married. Highest responses came from

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 employed respondents of 64.8%, followed by student of 16.8%, the retirees
11.9% and lastly the unemployed of 6.5%. 31.5% of them earns ranging
from RM2001 to RM3000, 29% of them has monthly income ranging from
RM1001 to RM2000, 14.5% has monthly income of below RM1000 and
RM3001-RM4000, and only 10.5% earns more than RM4001. The results
also showed that 61.9% visit the hospital more than five times in a year and
24.7% of them only visit the hospitals when they fell sick compared to 13.4%
that visit the hospital every month for follow-up and checkup.

11.2 Pearson Moment Product Correlation

The data analysis process is continued by using Pearson Moment

Product Correlation to examine the correlated relationship between the
independent and dependent variable. The analysis has been conducted,
the result of correlation measure is calculated by using the Statistical
Package for the Social Sciences (SPSS) software. Table 4 shows the P
values, Correlation Coefficients, r and the degree of correlation

Correlation Degree of
Variables P-values Conclusion
Coefficients, r Correlation
0.021
Accessibility 0.82 Very strong Significant
P < α = 0.05 (positive)
Hospital 0.005
0.85 Very strong Significant
facilities P < α = 0.05 (positive)
Technical 0.011
0.88 Very strong Significant
quality P < α = 0.05 (positive)

Table 7: Sample of Pearson Correlation (Note that α = 0.05 is used as the

cutoff for significance)

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 From Table 7, P-values for accessibility, hospital facilities and
technical quality are 0.021, 0.005 and 0.011 respectively. The result shows
that all the independent variables P-values is smaller than the value of cutoff
for significance alpha α (0.05). Since the value is smaller than α, Ho is
rejected which shows that there is a significant relationship between
accessibility, hospital facilities, technical quality and patient satisfaction at
Hospital Klang, Selangor. Ha1, Ha2, and Ha3 is accepted for this research.

12.0 SIGNIFICANCE OF THE PROPOSED RESEARCH

This research proposal should be conducted in order to help the government

improved the healthcare services in Malaysia in terms of accessibility, hospital facilities
and technical quality. This study would help to find the main factor contributes to both
satisfaction and dissatisfaction of patient in one of the government hospitals.

The results and findings also help the government to create a constructive plan to
help serve the citizen not only with high quality service but also results to high
satisfactions. Through this research also, it would bring down the poor perspective
towards public services once all the factors are tackled and handled with great solutions.

13.0 CONCLUSION

From the analysis made throughout this research, factors that influencing the
satisfaction factors of patients in Hospital Klang is finally determined. The government
can mirror the results obtained and finding a better solution to tackle the dissatisfaction
factor not only in Hospital Klang, but to other government hospital also. Although the
demographic data of other area will be slightly different from this research, the findings
might be useful to assist in improving the healthcare services.

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 In line with the government moves and commitment towards reaching the
Sustainable Development Goals, it is imperative that this study should be conducted to
achieve the desired goals of SDG3, which some of it are by having access to quality
essential healthcare services and access to safe, effective quality medicine. 2030 is the
year for the government to achieve, and this research is one of the starting points to many
changes that may come in the future.

One of satisfaction factors that are very alarming and need immediate attention is
how the technical qualities of our Doctors in government hospitals is affected. Over the
years, there are more good Doctors leaving the public for private Hospitals as they offered
better pay. Government is left with very young and inexperienced Doctors to treat many
patients daily which cause overcrowded due to the accessibility and cheaper options.

A detailed research should be conducted to study the main cause of this

satisfaction factor so that the correct remedies could be apply hence solving the main
problems.

14.0 RECOMMENDATIONS

It is recommended that this research needs to be conducted as soon as possible.

Patient satisfaction is too literal and the measurement of satisfaction from everyone is
different based on their preferences self rating. By conducting the research, the factors
are well determined and proved. From time to time, the people need is different and
varied, it is easier to tackle the issue at the soonest with solutions that may be invalid or
irrelevant to use in the future.

The government also might need to review the Doctor’s scheme in order to prevent
them from leaving the public service once the contract has ended. By offering more
benefits, it will make them to stay in service, which will maintain and preserve the technical
quality of government hospital doctors. By doing so, the satisfaction would be increase
due to lower doubts of incompetency towards them during treatment and consultations.

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15.0 BIBLIOGRAPHY

Al-Haddad MS, Hassali A, Mohamed Ibrahim MI, Shafie AA. PIH17 General public
satisfaction toward the provision of health-care delivery by government
hospitals and clinics in the state of Penang. Value Health, 2010,
13(7):A542-A543.
Ang KT, Roslinah A, Roslan J, Noriah B; Nor Filzatun B, Mohd Idris O.
(2010) Patient Satisfaction in Government Hospitals Are we improving?
Azimatun NA, Salmiah B, Ahamad J (2012) Kajian Keratan Rentas Perbandingan
Kepuasan Pelanggan Di Antara Klinik-Klinik Kesihatan Primer Luar
Bandar Dan Bandar Di Daerah Hulu Langat Dan Faktor-Faktor Yang
Mempengaruhi.
Boon-Tiang Lau , Abdul-Rani Nurul-Nadiah-Auni , Siew-Yen Ng , Shuen-Nie
Wong (2018) Satisfaction of patients receiving value added-services
compared to traditional counter service for prescription refills in Malaysia
Cheraghi-Sohi S, Hole AR, Mead N, McDonald R, Whalley
D, Bower P, Roland M. What patients want from primary care
consultations: a discrete choice experiment to identify patients' priorities.
Ann Fam Med 2008, 6(2):107-115.
Ganasegeran K, Perianayagam W, Manaf R.A, Jadoo S.A.L,4 and Al-Dubai
S.A.R (2015). Patient Satisfaction in Malaysia’s Busiest Outpatient
Medical Care.
Hailey BJ, Pargeon K, Crawford V. (2000) Can healthcare providers at a
university health clinic predict patient satisfaction? J Am Coll Health
49:111-117.
Harvinderjit Kaur Basauhra Singh, Subramanian Pathmawathi, Mei Chan Chong
and Thandar Soe (2016) Survey on Patient’s Satisfaction on the Service
Quality in an Emergency Department in Malaysia
Hizlinda T, Teoh Sy, Siti Nurbaiyah Ke, Azrina As, Mohamad Hafizzudin Mt,
Chang Lh, Noraliza Ma (2012) A Cross-Sectional Study on Patient
Satisfaction with Universiti Kebangsaan Malaysia Medical Centre
(UKMMC) Primary Care Clinic.

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Mohammed Azmi Hassali, Alian A. Alrasheedy, Basyirah Afifah Ab Razak,
Saleh Karamah AL-Tamimi, Fahad Saleem, Noman Ul Haq, Hisham
Aljadhey (2014) Assessment of general public satisfaction with public
healthcare services in Kedah, Malaysia.
Nurul Izzatty Ismail , Nor Hazana Abdullah (2018) A Systematic Review of
Patient Satisfaction on Health Information Exchange in Malaysian Public
Healthcare Organizations.
Pascoe GC: Patient satisfaction in primary health care: a literature review and
analysis. Eval Prog Plan 6, 185-210 (1983)
Roslinah A, et al. Is the contact time between patient and health care personnel
in ministry of health hospitals Malaysia appropriate? Malaysian Journal of
Public Health Medicine. 2010;10:14-
S. Dyah Pitaloka and A.M. Rizal (2006) Patients’ satisfaction in Antenatal Clinic
Hospital Universiti Kebangsaan Malaysia
Shahab Rezaian and Harihodin Selamat (2014) Patient Patient Satisfaction in a
Health Center: A Malaysian Study
Yogesh PP, Gaurav R, Satyanarayana C (2011) Factors Affecting In-patient
Satisfaction in Hospital-A Case Study.
Yunus M, Nasir M, Nor Afiah M, Sherina M, Faizah M. Patient satisfaction: a
comparison between government and private clinics in Mukim Labu,
Sepang, Selangor. Malaysian Journal of Public Health Medicine 2004,
4(2):6-11.

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APPENDIX-Questionnaire

Program Diploma Pengurusan Awam

Institut Tadbiran Awam Negara, Bukit Kiara

FACTORS INFLUENCING PATIENT’S SATISFACTION AT

HOSPITAL KLANG, SELANGOR
Dear Sir/Madam,

I am a student of Program Diploma Pengurusan Awam from Institut Tadbiran Awam

Negara, Bukit Kiara. I am currently conducting a study on Factors Influencing the
Entrepreneurial Intention among Youth in Malaysia.

I highly appreciated your time and effort for completing this questionnaire. There is no
wrong or right answer for this questionnaire. All the answer will be kept and treated as
private and confidential.

Your honest answer will be very helpful in completing my study. Thank you.

Instruction
This questionnaire consists of three sections. Please answer all the questions
carefully.

Section A : Demographic

Please complete each of the following items by filling [ / ] on the relevant or related
answer.

Gender
a. Male
b. Female

Age (years)
a. < 17 c.  60
b. 18 -59

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 Status
a. Single
b. Married

Employment Status
a. Unemployed c. Student
b. Student d. Retired

Monthly Income
a. Below RM1000 d. RM3001-RM4000
b. RM1001-RM2000 e. More than RM4001
c. RM2001-RM3000

How often do you go to Hospital Klang

a. Every time when I fall sick
b. More than 5 times a year
b. Every month (checkup)

Section B :

Part 1 : Accessibility

Strongly Strongly
No Questions Disagree Neutral Agree
disagree agree
I have all the access to get to
the hospital because of its
strategic location.
1 1 2 3 4 5
Saya ada pelbagai akses untuk
ke hospital kerana lokasinya
strategic
I am able to get all the medical
services that is suitable for my
need in this hospital
2 1 2 3 4 5
Saya boleh mendapatkan
semua perkidmatan perubatan
dengan mudah di hospital ini

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 It is easier to set the Doctor’s
appointment for my medical
check-up and follow up.
3 1 2 3 4 5
Ianya mudah bagi saya untuk
membuat temujanji berkaitan
dengan kesihatan saya.
I have easy access when I
require any medical specialists
in this hospital.
4 1 2 3 4 5
Saya mudah untuk
mendapatkan perkhidmatan
pakar perubatan di hospital ini.
It is easier to find any related
information in this hospital
5 Saya mudah untuk 1 2 3 4 5
mendapatkan informasi
berkaitan di hospital ini.

Part 2 : Hospital facilities

Strongly Strongly
No Questions Disagree Neutral Agree
disagree agree
All the facilities provided in the
hospital is user friendly
1 Semua kemudahan yang 1 2 3 4 5
disediakan oleh pihak hospital
mesra pengguna
The hospital is well equipped
with the latest technology.
2 Hospital ini dilengkapi dengan 1 2 3 4 5
kemudahan teknologi yang
terkini.
I felt safe wherever I am in the
building or Hospital compound
3 Saya berasa selamat apabila 1 2 3 4 5
berada di dalam Hospital dan
kawasan sekitarnya.
The bed and other furnitures
4 are in a good condition and not 1 2 3 4 5
dangerous to the user

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 Katil dan lain-lain perabot
berada dalam keadaan yang
baik dan tidak membahayakan
The facilities of this hospital is
well maintained by the
management
5 1 2 3 4 5
Kemudahan di hospital ini di
selenggara dengan baik oleh
pihak pengurusan.

Part 3 : Technical quality

Strongly Strongly
No Questions Disagree Neutral Agree
disagree agree
I am confident with the
qualification of all the medical
staff and specialist in this
1 hospital. 1 2 3 4 5
Saya yakin dengan kelayakan
semua pakar dan pekerja
perubatan.di hospital ini.
They took care of me very well
when they attend to my
medical needs.
2 1 2 3 4 5
Saya dijaga dengan baik sekali
sepanjang menerima rawatan
di hospital ini.
I never doubt the decision
made by my Doctor or any
medical staff during my
treatment.
3 Saya tidak pernah meragui 1 2 3 4 5
segala keputusan yang telah
dibuat oleh Doktor dan
pegawai perubatan yang lain
semasa menerima rawatan..
I never went to get second
opinion after receiving my
consultation with the Doctor.
4 Saya tidak pernah 1 2 3 4 5
mendapatkan pedapat kedua
selepas mendapatkan rawatan
dan nasihat dari Doktor di sini.

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 I think the medical care that I
received is more than what it
costs me in my medical bills
5 1 2 3 4 5
Rawatan dan jagaan yang saya
terima melebihi kos perubatan
yang saya bayar.

Section C :

Strongly Strongly
No Questions Disagree Neutral Agree
disagree agree
I am happy with the medical
care that I get from this
hospital
1 1 2 3 4 5
Saya gembira dengan rawatan
yang saya terima di hospital
ini
I am satisfied with the
Hospital accessibility
2 Saya berpuas hati dengan 1 2 3 4 5
kebolehcapaian terhadap
hospital ini
I am satisfied with the
Hospital facilities
3 1 2 3 4 5
Saya berpuas hati dengan
kemudahan hospital ini
I am satisfied with the
technical quality of the
Doctors in this hospital
4 Saya berpuas hati dengan 1 2 3 4 5
kualiti teknikal yang
ditunjukkan doctor di hospital
ini.
I am happy with the service
provided by the hospital
5 Saya gembira dengan servis 1 2 3 4 5
yang disediakan oleh hospital
ini

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