ORIGINAL PROF-2337

PATIENT SATISFACTION;
OPD services in a Tertiary Care Hospital of Lahore

Dr. Fatima Mukhtar, Dr. Aftab Anjum, Dr. Muhammad Aslam Bajwa, Shahzana Shahzad, Shahzeb Hamid, Zahra Masood, Ramsha Mustafa

ABSTRACT… Introduction: Patient satisfaction is a relative phenomenon, which embodies the patients perceived need, his expectations
from the health system, and experience of health care. Objective: To determine the level of patient satisfaction towards OPD services with
reference to doctor-patient interaction, registration desk, waiting area, and overall health facilities. Study Design: Descriptive cross
sectional study. Setting: Tertiary care hospital of Lahore. Study Period: April 2013. Material & Methods: A sample of 250 patients was
selected by employing systematic random sampling technique. The patients were interviewed and data was collected using a pretested
questionnaire. Data was analyzed using the statistical package for social sciences (SPSS) version 16.00. Data was presented in figures
and tables. It was described using frequencies, percentages and mean. Results: Majority of the patients i.e 232 (94%) reported being
satisfied with the doctor. A vast majority agreed that hospital was clean 233 (94%) and adequately ventilated 224 (90%). The hospital staff
in the waiting area was found to be respectful 220 (89%) and fair 198 (80%) towards the patients. The patients had no difficulty locating
the reception desk of the health facility 235 (95%). A large proportion of patients i.e.220 (89%) said they would re-visit the hospital.
Conclusions: The patients were highly satisfied with their doctors and were ready to re-visit the hospital. It is recommended that further
studies should be conducted to assess patient satisfaction in the secondary and primary care health facilities and efforts should be made
to get regular feedback from the patients.
Key words: Patient satisfaction, waiting area, doctor-patient interaction, health facility.

Article Citation
Mukhtar F, Anjum A, Bajwa MA, Shahzad S, Hamid S, Masood Z, Mustafa R. Patient satisfaction; OPD services in a Tertiary Care
Hospital of Lahore. Professional Med J 2013;20(6): 973-980.

INTRODUCTION affect patient satisfaction. These determinants can be

Patient satisfaction is a relative phenomenon, which either provider-related or patient-related. Some
has been around since 1960’s but active research on provider-related factors are physician's proficiency
the topic was initiated in late 1970’s and early 1980’s. and interpersonal communication skills, behavior of
This led to the replacement of the idea of 'quantity of hospital staff, access to care, basic facilities, and
life' by a more patient centered concept of 'quality of infrastructure. Patient-related factors include socio-
1
life' . Patient satisfaction embodies the patients demographic characteristics of patients, stage of their
perceived need, his expectations from the health disease as well as patients’ perception of a
system, and experience of health care. This multi- relationship of trust and feeling of being involved in
dimensional concept includes both medical and non- decisions about their care4,5,6.
2
medical aspects of health care . Various theories of
patient satisfaction in healthcare have been published. The modern day patient is more aware and educated,
These theories include the expectancy value theory, has access to information, and has expectations from
which proposes patients beliefs, values and prior the health system. Hence, it is more important today
expectations regarding care to influence patient than ever before to address issues related to service
7
satisfaction and another is the health care quality delivery in this context . A patient with positive
theory, which emphasizes that interpersonal process perceptions has a greater chance of translating it into
of care plays a paramount role in ensuring patient positive outcomes. Whereas, negative attitudes in the
3
satisfaction . patient and dissatisfaction with health care provided
leads to poor compliance and, in extreme cases,
The literature review highlights many factors that can patients resort to negative word-of-mouth that

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discourages others from seeking health care from the sample of 250 patients. Every nth patient was selected
8,9
system . Studies have shown that individuals did not for the interview. This process was continued till the
visit their local centers of primary health care in Africa required sample size was completed. The
even for severe illness due to perceived low quality of questionnaire developed for data collection contained
8
healthcare at these centers . both open ended and closed ended questions
regarding patients socio-demographic history,
Thus, the reason for laying great emphasis on patient satisfaction with the doctor, location of registration
satisfaction is that it is linked to improved compliance desk, adequate seats in the waiting area, behavior of
of doctors instructions, timely care seeking by the the staff and reasons for re-visiting the hospital. It was
patient, and greater comprehension and retention of pilot tested, and after appropriate amendments was
information provided by the health care provider2. All used to collect data from the patients. Informed and
ensuring a favourable health outcome. Patient voluntary consent was taken from the patients after
satisfaction is also one of the indicators of the quality explaining the purpose of the study to them. Data was
of care. Its assessment can help in the improvement analyzed using the statistical package for social
of health care services and their delivery based on sciences (SPSS) version 16.00. Data was presented
10
input from the patient . in figures and tables. It was described using
frequencies, percentages and mean.
In Pakistan, some studies have been conducted on
patient satisfaction but with focus on specific areas RESULTS
11
such as the emergency department , day-care A total of 250 patients were sampled for the study, but
12 13
surgery or family medicine sections of the hospital . two questionnaires were incomplete, therefore, 248 of
This survey was conducted to study another important them were entered and analyzed. There was almost
area of services in hospital i.e. Out-Patient Department equal representation of males 127 (51%) and females
(OPD) of a hospital. Therefore, a tertiary level care 121 (49%). The mean age of the respondents was 34
hospital in Lahore was selected for this study with the + 1.58. The age category of 15-30 years comprised
objectives to determine the level of patient satisfaction of 110 (44%) of the respondents, whereas, 18 (7%)
towards OPD services with reference to doctor-patient were in the age category of 60-75 years. Of the total
interaction, registration desk, waiting area, and overall respondents, 159 (64%) were married, 86 (35%) were
health facilities. The results of the study will be useful never married and 3 (1%) were divorced/widowed.
for hospital administration and managers of health The education of the patients was categorized into five
system at different levels to institute meaningful categories: illiterate, primar y, secondar y,
interventions. undergraduate, and graduate. Among them 41 (17%)
were illiterate, 40 (16%) completed primary school, 74
METHODOLOGY (30%) completed secondary school, 78 (31%) were
A descriptive cross sectional study was conducted in a undergraduates and 15 (6%) were graduates. Majority
tertiary care hospital of Lahore in April 2013. The of the patients were unemployed i.e. 157 (63%), which
patients attending OPD services of the hospital among others included housewives and students. Of
comprised the study population. A sample of 250 the working population, 48 (19.4%) were involved in
patients was selected by employing systematic service, sales and elementary occupations, 10 (4.0%)
random sampling technique. The previous average were managers, 14 (5.6%) were professionals
OPD attendance was taken as the population size, to (doctors, engineers and highly skilled) and 11 (4.4%)
calculate the sampling interval or the nth number for a were involved with agriculture. Very few respondents

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 PATIENT SATISFACTION 3

worked as clerks i.e. 7 (2.8%) of them and one responded positively i.e.220 (89%) as is highlighted in
respondent belonged to the armed forces 1(0.4%). figure 2.

The patients were asked about their satisfaction with The patients were asked to identify their reasons for re-
the doctor and 232 (94%) patients reported visiting the hospital facility, and the open-ended
satisfaction with the doctor (figure 1). responses of the respondents are shown in table no.
III.

DISCUSSION
(6%)
The present study was an attempt to assess the level of
satisfaction of the patients with the various aspects of
health care in a tertiary care hospital of Lahore. Patient
satisfaction is a multi-dimensional concept, which is
not only influenced by physician related factors but
(94%)
also aspects of patient’s experience with the health
13
facility . This study looked at the level of satisfaction of
patients with their doctor, and it was seen that 94% of
the patients who visited the OPD were satisfied with
their doctor. This is a positive response and it is this
patient satisfaction, which is in turn responsible for
greater compliance with follow up visits and
prescribed medicine intake. Contrary results were
obtained from a study carried out in Scotland where
The doctor-patient interaction was explored and only 52% of patients were reasonably satisfied with
analyzed on a 5-point Likert Scale including: 1= their doctors14.
strongly agree, up to 5= strongly disagree. Various
aspects of doctor-patient interaction were explored, Patients’ views on various aspects of doctor-patient
including respect, privacy, confidentiality, interaction were ascertained. Majority of patients
communication skills, informed consent, and found the doctor to be courteous (98%), listened
addressing the patients’ queries (Table I). attentively to the patients (88%), gave patients an
opportunity to talk about their illness (87%), provided
The patient's responses towards general aspects of instructions regarding dose and time of medication
health facility and hospital staff are shown in table no. (82%), advised follow up to the patients (80%) and
II. A vast majority agreed that hospital was clean 233 made the patient comfortable during examination
(94%) and adequately ventilated 224 (90%). The (79%). This is comparable to other international
hospital staff in the waiting area was found to be studies which reported that 88–92% of their patients
respectful 220 (89%) and fair 198 (80%) towards the believed that they were treated with respect and
patients. The patients had no difficulty locating the dignity15,16. According to a study carried out in Karachi
reception desk of the health facility 235 (95%). 58.6% of patients said that consent was taken before
examination and 62.4% of the patients agreed that the
Patients were enquired if they would like to visit the doctor maintained privacy17. The quality of doctors
hospital again, to which a large proportion of patients communication during history taking and discussion

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 PATIENT SATISFACTION 4

with the patient has an impact on the health outcome of Patients were asked about hospital cleanliness,
the patient18. We also found that 119 (48%) and 82 adequate ventilation, location of the registration desk
(33%) patients were of the view that doctors didn’t and availability of seats and toilet facility in the waiting
explain the side effects of medication and didn’t area. Majority of the patients were found satisfied with
explain the reason for advising prescription respect to these facilities. In a study conducted by
respectively. University of North Carolina at Charlotte, patient

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 PATIENT SATISFACTION 5

satisfaction with waiting time, accessibility of

services, and cleanliness of the facility was also high
19
(mean score of 1.70 out of 2) . However, opposing
results were found in a study conducted by PIMS
Institute, Islamabad. Patient satisfaction with waiting
time, accessibility of services, confidentiality and
20
cleanliness of the facility was only 54% .

According to the protocol followed in the hospital,

patients have to obtain a slip from the reception desk
before they proceed for their check-up by the doctor.

Predominant number of patients found the reception

desk easy to locate. Once in the waiting area the patient
interacts with the attendant who is responsible for
sending patients inside the doctors room according to
their slip numbers. Patients reported being treated
fairly and respectfully by the staff in the waiting area.
patients can greatly influence the reputation of a
Such issues involving the attitude of hospital staff with hospital and is an important factor towards patient

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 PATIENT SATISFACTION 6

satisfaction. Similar results were obtained in the CONCLUSIONS

study conducted in Rawalpindi, Pakistan where The patients were highly satisfied with their doctors.
according to 92.3% of patents, registration and They found them courteous and attentive towards
documentation at the hospital reception was the patients. The health facility was clean and
convenient and 96% were satisfied with reception adequately ventilated. Majority of the patients were
staff attitude21. ready to re-visit the hospital.

A large proportion of patients (89%) were found to be RECOMMENDATIONS

satisfied and willing to re-visit the hospital. This was It is recommended that further studies should be
found to be a very encouraging response and conducted to assess patient satisfaction in the
portrays a high satisfaction of the patients with the secondary and primary care health facilities.
hospital. Patient satisfaction is an indirect or a proxy Efforts should be made to get regular feedback from
indicator of the quality of doctor or hospital the patients.
performance. This high satisfaction found by the Copyright© 07 Oct, 2013.
study could be attributed to the hospital being a
22
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AUTHOR(S): 4. Shahzana Shahzad

1. DR. FATIMA MUKHTAR 4th Year Student
MBBS, DTM&H, MPhil, PhD (Public health) student 5. Shahzeb Hamid
Associate Professor, 4th Year Student
Department of Community Medicine, 6. Zahra Masood
Lahore Medical & Dental College. 4th Year Student
2. DR. AFTAB ANJUM 7. Ramsha Mustafa
MBBS, MCPS, FCPS 4th Year Student
Associate Professor,
Department of Community Medicine, Correspondence Address:
Lahore Medical & Dental College. Dr. Fatima Mukhtar
3. DR. MUHAMMAD ASLAM BAJWA 7 Aziz Bhatti Road,
MBBS, FCPS Lahore Cantt, Lahore.
Assistant Professor, [email protected] Article received on: 29/08/2013
Department of Community Medicine, Accepted for Publication: 07/10/2013
Received after proof reading: 03/12/2013
Lahore Medical & Dental College.

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