Patient’s Satisfaction Towards the Quality of Services Offered in Government

Hospitals in Western Districts of Tamil Nadu

T.Dheepa
Assistant Professor
Department of Management Studies
Kongu Engineering College, Erode, TN - India
N.Gayathri
Research Scholar
Department of Management Studies
Kongu Engineering College, Erode, TN - India
P.Karthikeyan
Assistant Professor (S.G)
Department of Management Studies
Kongu Engineering College, Erode, TN - India
Abstract
Service quality and patients satisfaction are important concepts to hospital industry. It is
therefore important for hospitals to know how to measure the patient’s satisfaction and more critical of
the quality of service they experience. The service quality offered by government hospitals on various
dimensions is discussed in this study and how it can be applied in the context of various other
hospitals. The data used were gathered from in-patients of government hospitals in the western
districts of Tamil Nadu. The purpose of the research was to identify patient’s satisfaction towards
various dimensions that influence the quality of service in the government hospitals in the western
districts of Tamil Nadu. Using a sample of 286 respondents, a self-completion questionnaire was given
to in-patients in government hospitals, to determine their satisfaction of service quality in government
hospitals. The results show that patient’s satisfaction is rather low and that there is still a room for
government hospitals to improve on their performance.

Keywords – Healthcare Industry; Service quality; patient satisfaction; government hospitals;

tangibility; assurance; empathy; responsiveness and reliability.

Introduction
Patient satisfaction is one of the important goals of any health system, but it is difficult to
measure the satisfaction and gauze responsiveness of health systems as not only the clinical but also
the non-clinical outcomes of care do influence the customer satisfaction1.
The quality of service in health means an inexpensive type of service with minimum side effects that
can cure or relieve the health problems of the patients. Patient satisfaction depends up on many factors
such as Quality of clinical services provided, availability of medicine, behavior of doctors and other
health staff, cost of services, hospital infrastructure, physical comfort, emotional support, and respect
for patient preferences2.
Patient satisfaction is increasingly considered to be one of the most important factors in the
measurement of quality of medical care. Monitoring consumer satisfaction of health care is an
important input to improving the quality of health services. Patients' priorities and views on quality
care are well-documented in Western countries but there is a dearth of research in this area in
developing countries like India3.
Health care organizations are operating in an extremely competitive environment, and patient
satisfaction has become a key to gaining and maintaining market share. Patient’s satisfaction regarding
medical care organizations like tertiary care hospital is important in the provision of services to
patients. So the researcher has made an attempt to measure the service quality in the government
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hospitals of western districts of TamilNadu. An empirical investigation was made by the researcher in
view of measuring the factors relating to their satisfaction towards the quality of services provided.
This study will throw a highlight of getting an insight into the patient’s satisfaction towards
government hospitals in the selected areas.
Service Quality in Hospitals
A hospital is an institution of health care providing treatment with specialized staff and
equipment, but not always providing for long-term patient stay. Today hospitals are centers of
professional health care provided by physicians and nurses. There are several kinds of hospitals. The
best-known is the general hospital, which is set up to deal with many kinds of diseases and injuries,
and typically has an emergency ward to deal with immediate threats to health and the capacity to
dispatch emergency medical services. A general hospital is typically the major health care facility in its
region, with a large number of beds for intensive care and long-term care, facilities for surgery and
childbirth, bio assay laboratories, and so forth. Larger cities may have many different hospitals of
varying sizes and facilities. Hospital services are different and distinct from boarding and grooming
services-yet both are easily accessible. Patients just come for diagnosis and/or therapy and then leave
(outpatients), but some others stay the nights (inpatients). Putting the patient first is a challenge that
requires not just a huge change in the mindset of all the stakeholders in health care provision, but also
the means by which to measure the levels of satisfaction of patients, and to discover what matters to
them before, during and after their visit to any hospital. Patient quality initiatives, with their softer,
experiential focus than clinical audit, with its precise and scientific methods of measurement, demand
different measurement techniques.
Customers perceive services in terms of quality of service and how satisfied they are with their
overall experience. These customer oriented terms quality and satisfaction have been the focus of
attention for executives and researchers alike over the last decade or more. Companies today recognize
that they can compete more effectively by distinguishing themselves with respect to service quality
and improved customer satisfaction.
Service quality is a critical element of customer perception. In the case of pure services, service
quality will be the dominant element in customer’s evaluations. In case, where customer’s service or
services are offered in combination with physical product, service quality may also be very critical in
determining customer satisfaction.

Literature Review
Khanchitpol Yousapronpaiboon, William C. Johnson(2013) conducted a cross-sectional field
study among 400 hospital out-patients in Thailand indicates that SERVQUAL’s five latent dimensions
had a significant influence on overall service quality. Responsiveness had the most influence; followed
by empathy, tangibles, assurance; and finally reliability. It also demonstrated that service quality can
be assessed in diverse service settings such as hospital out-patient departments.
S.Sharmila, Dr.Jayasree Krishnan (2013) studied the patient satisfaction and its determinants,
measurement issues and present medical practices among 320 respondents. The result indicated that
the quality of services provided results in their repeated visits and increased patient satisfaction.
S.M. Irfan, Aamir Ijaz and M.M. Farooq (2012) investigated the quality of services delivered to
patients by public hospitals in Pakistan among 369 respondents with the dimensions, namely, empathy,
tangibles, timeliness, responsiveness and assurance. The study indicated that public hospitals are not
making visible efforts to deliver quality of services to their patients and meet their needs and wants.
Ramaiah Itumalla (2012) studied on how the hospitals could better manage their services and
harness information technologies to enhance their services among 210 patients who availed health
services from a private hospital in Hyderabad, India. By using a Consumer Satisfaction Index [CSI]
the researcher found that CSI score for service quality in selected hospital is 75.87 out of a
possible 100.

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 Annamalai Solayappan , Dr. Jothi Jayakrishnan , Sethu Velmani (2011) investigated the
perception and expectation of patients regarding hospital services by using service quality gap model
with 300 in-patients. It is found that there is a huge gap in the hospital services like physical
appearance, lack of interest in solving problems and personal care.
Dr Markanday Ahuja Vipin Mitta, Dr. Seema Mehlawat (2011), empirically explored the
relationship between hospital quality management and service quality performance for a sample of
patients of eye care hospitals in Haryana. It was interesting note that the service being provided were
perceived to be better than expectation for the dimensions like reliability, assurance and empathy.
Rajinder Singh (2010) found that consumer satisfaction is important to the hospital because it is
generally assumed to have a significant determinant of repeat visit, positive word-of-mouth, and
patients’ loyalty. Patients’ perceptions about health services seem to have been largely ignored by
health care providers in developing countries. The important reasons to visit government hospitals are
fewer charges, geographical proximity, recommended by their friends or relatives. Patients are found
to be dissatisfied with the doctors’ checkup.

Statement of the Problem

The hospitals have been established to provide a healthy well-being and alleviate the health
issues of the people which are faced today due to several reasons. The hospitals play a vital role in
providing prompt services on time being. But contrary to the above statements, the government
hospitals are not adhering to the patient’s expected service quality the government hospitals today, do
not having adequate facilities and infrastructure to provide timely medical treatment to patients lack
(or) poor infrastructure, non-availability of advanced medical facilities, inadequate competent doctors,
nurses and employees, poor service quality lack of efficient and effective service are some of the
common issues the are mostly talked among the public.
All the study emphasis that service quality measurement can be done on the dimensions like
tangibility, assurance, empathy, responsiveness and reliability. The study so far done pertains either to
hospitals in aboard or private hospitals where the service quality is perceived to be higher. The
researcher has made an attempt to measure the service quality with the existing dimensions in the
general hospitals among the in-patients.

Need For the Study

In a fast growth and necessity of hospital services, it becomes vital to know the delivery of
services provided by government hospitals like tangibles, reliability, responsiveness, assurance and
empathy. These service dimensions are prime for any service industry especially the hospital sector.
This study helps the hospital industry in understanding their position.
Majority of people are from rural background and they are not having enough education on
proper health, hygiene and sanitations. Since these people are from poor economic background, they
solely depend on the government hospitals for their treatments. The common man believes that the
government hospitals are providing low quality service to the patients. This factor made the researcher
to study the patient’s satisfaction towards the service quality offered by government hospitals in the
western districts of Tamilnadu.

Objectives of the Study

• To study the patients’ satisfaction towards the quality of service offered in government
hospitals in western districts of Tamilnadu.
• To find out the relationship between perceived quality of services and patient satisfaction.

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Methodology Adopted
The researcher has chosen the quantitative approach with the intention of testing some aspects
and dimensions of service quality that are most relevant to the government hospital service. A single
cross-sectional design was adopted with a goal to look in some characteristics of the government
hospital service and make assumptions and inferences about them.
The study was carried in 6 districts namely Karur, Erode, Trippur, Coimbatore, Salem and
Namakkal of TamilNadu. A multistage sampling method was used. In determining the sample size,
the number of beds in every hospital was considered to constitute the population size (N= 3568). The
sample size was estimated to be 346. respondents were estimated using the proportionate sampling
technique. Due to time constraints and non-responsive nature of the respondents, the sample was
decreased to 286 respondents and for this purpose the researcher has adopted convenience sampling
method. Data was collected through interview schedule. The collected data was analysed using
percentage analysis, factor analysis and multiple regressions.

Analysis & Findings

Demographic profile
The sample is almost divided into half with female respondents of 49% and male respondents
of 51%. The age parameter counted 36.01% falling under the age group of 40-60 followed by 31.12%
between 20 and 40 age group. In terms of educational qualification, 65% respondents have completed
their upper primary and 35% have completed their primary education. 32.5 % of the respondents
belong to worker category and 32.2 % of the respondents are either self-employed or jobless. 35 % of
the respondent have income more than Rs.5000 followed by 30% of the respondent with the income
range of Rs.2001-3000.

Service Quality Dimensions in Hospital

To find the dimensions of service quality the items are factor analyzed using principle
component extraction with a Varimax rotation. The researcher rotated the components 29 times to get
the significant variables under five factors namely Tangibility, Reliability, Responsiveness, Assurance
and Empathy. The Kaiser-Meyer-Olkin (KMO) measures of sampling adequacy in the study is 0.764.

Total Variance Explained

Extraction Sums of Squared Rotation Sums of Squared
Initial Eigen values Loadings Loadings
% of Cum % of Cum % of Cum
Component Total Variance % Total Variance % Total Variance %
1 5.267 18.162 18.162 5.267 18.162 18.162 2.672 9.214 9.214
2 1.684 5.806 23.968 1.684 5.806 23.968 2.636 9.090 18.304
3 1.489 5.136 29.104 1.489 5.136 29.104 2.386 8.228 56.532
4 1.432 4.936 34.040 1.432 4.936 34.040 1.932 6.661 33.193
5 1.303 4.493 38.533 1.303 4.493 38.533 1.548 5.340 68.533
6 1.251 4.316 42.848
7 1.195 4.122 46.970
8 1.147 3.956 50.926
9 1.094 3.773 54.699
10 1.081 3.726 58.425
11 1.011 3.486 61.912
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12 .976 3.365 65.277
13 .936 3.229 68.505
14 .912 3.145 71.650
15 .866 2.985 74.635
16 .808 2.785 77.420
17 .763 2.631 80.051
18 .652 2.248 82.299
19 .609 2.100 84.399
20 .587 2.025 86.424
21 .568 1.957 88.381
22 .549 1.892 90.272
23 .511 1.762 92.034
24 .495 1.707 93.742
25 .430 1.484 95.225
26 .392 1.352 96.578
27 .367 1.264 97.842
28 .329 1.133 98.975
29 .297 1.025 100.000
Extraction Method: Principal Component Analysis.

The Eigen values for factor 1,2,3,4 and 5 are 5.267, 1.684, 1.489, 1.432, and 1.303. Percentage
of variance for factors 1,2,3,4 and 5 are 18.162, 5.806, 5.136, 4.936, and 4.493 respectively. It
indicates that five factors are extracted from 29 factors which have cumulative percentage up to
68.553% of the total variance.
Rotated Component Matrix
Component
Service Quality Variables 1 2 3 4 5
Ease of convenience .621
Waiting place for op .546
Ct scan, mri scan, ultra sound .542
In patient’s room cleanliness .481
Bedspread & pillow cleanliness .432
Ward working system .731
Food quality .623
Doctors and workers availability .490
Blood bank operating system .478
Availability of enough medicine .449
Blood group availability in blood bank .442
Case history of patients given .732
Medicine quality .589
Psyche section treatment .540

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Quality of treatment provided by doctor .537
Nurse service towards patients .445
Doctor’s consultancy .621
Information about disease to patients .509
Sidda section treatment .496
Patients individual attention .464
Patient’ s safety & security .553
Patients satisfaction towards workers .459
Problem solving strategies .416
Extraction method: Principal Component Analysis.
Rotation method: Varimax with Kaiser normalization.
A. Rotation converged in 18 iterations.
Variables like convenience, waiting place for outpatients, Lab facilities for CT scan, MRI & ultra
sound, In-patients room and bed cleanliness are highly correlated with each other and they are grouped
in the factor ‘Tangibility’ (Factor 1). The variables ward system functioning, quality of food,
availability of doctors and workers, availability of blood banks, requirement of specific bloods on time
and availability of timely medicines are highly correlated with each other and they are classified under
‘Reliability’ (Factor 2). Quality of treatment given, treatment provided in various other sections, nurse
attention towards patients, quality of medicine supplied and presentation of case history are highly
related to each other and are group under ‘Responsiveness’ (Factor 3). Consultation with doctor’s,
diagnosing and information given to patients about diseases, attention paid to ever individuals and
services provided by siddha section are highly related with each other and classified under ‘Empathy’
(Factor 4). The variables patient’s safety and security, patient’s satisfaction towards workers and
hearing & solving patient’s problem are related to each other and grouped under ‘Assurance’ (Factor
5).

Relationship between Patient’s Satisfaction & Service Quality Dimensions

The dependent variable (criterion) for regression analysis was the overall patient’s satisfaction
and as independent variables (predictors) were each of the above said service quality dimensions.
Because of the fact that each dimension has varied items, a mean was computed for each of the
dimensions and this mean was used in each test. The names adopted for these means were Tangibles,
Reliability, Responsiveness, Assurance, and Empathy. Also, this analysis was based on the answers of
perceptions since the research interest revolves around the real experience. The hypotheses are
presented above are in parallel with the tables, so as to base the arguments of whether they are
supported or not:
Model Summary

Model R R Square Adjusted R Square Std. Error of the Estimate

a
1 .634 .402 .391 .784
a. Predictors: (Constant), empathy, responsiveness, assurance, tangibility, Reliability

The R square of variance in the dependent variable (patient’s satisfaction) could be explained
by the independent variables (Tangibility, Reliability, Responsiveness, Assurance and Empathy). The
R-square of .402 shows a correlation between the variables.

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 Coefficients
Standardized
Unstandardized Coefficients Coefficients
Model B Std. Error Beta T Sig.
1 (Constant) -.330 .252 -1.307 .192
Tangibility .430 .095 .285 4.549 .000
Reliability .200 .102 .126 1.957 .041
Assurance .256 .069 .204 3.697 .000
Responsiveness .129 .061 .111 2.108 .036
Empathy .216 .105 .126 2.057 .041
a. Dependent Variable: Service Quality of the hospital

From the analysis, the results of the R-square value (0.402) show good correlation
between the patient’s satisfaction and service quality dimensions (Tangibles, Reliability, Assurance,
Responsiveness, Empathy).
The six dimension’s Beta value (Tangibles=0.430, Reliability=0.200, Assurance=0.256,
Responsiveness=0.129, Empathy=0.216), shows a positive correlation between the patients satisfaction
and service quality dimensions. Tangibility and assurance is statistically significant at the 1%
significance level, and reliability, responsiveness and empathy is statistically significant at the 5%
significance level. Since the significance value also supports the hypotheses, it is concluded that there
is a significant relationship between patient’s satisfaction and the service quality dimensions
(Tangibles, Reliability, Assurance Responsiveness, Empathy).From the multiple regression analysis
we form the following regression equation.
Patient’s satisfaction (y) = -0.330 + 0.430 * Tangibility + 0.200 * Reliability + 0.256 *
Assurance + 0.129 * Responsiveness + 0.216 * Empathy

SUMMARY & CONCLUSION

The government hospital is performing good but still it need to focus on certain areas which
increases satisfaction level of patients and maintaining good relationship with the patients at all levels.
Dissatisfactions arise when expectations are not met. Alternatively, a survey on patients' satisfaction
should be done every three months to know the changing needs of the patients. It is also good for the
hospital to know their drawbacks. Government hospitals should develop modern operation theatre and
the doctor should spend more time with patients.
The expectations of the patients are found to be higher in all aspects. It is more important for the
superintendent to consider the fact and take necessary actions to improve the overall service to get
satisfied patients. Since almost all the hospitals are under government control, the government has to
make an initiative in achieving the patient’s satisfaction. Since cleanliness is the most priority in
hospitals the government could take more initiative by appointing an officer for premises maintenance.
Inspection should be carried out by the concern authority on a regular basis. The ward working system
of the hospital is considered to be the most difficult task since proper information about the relevant
ward is not provided on timely basis. So, a centralisation system can be maintained to get information
on the working system of ward for overcoming the difficulties. Some of the patients feel that the nurse
interaction towards patients is indifferent. The orientation classes or interaction classes can be
conducted to motivate the nurses to practice a good interaction with patients. Availability of doctor’s
and their consultancy in many government hospitals is considered to be less. Appointing new and
dedicated doctors can be done to provide a special care.
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 All in consideration, the government hospital should focus on all the dimensions of service quality.
Efforts to improve these dimensions can improve performance, which in turn will lead to higher
service quality and patients satisfaction. Hospital superintendent should, therefore, regularly measure
service quality to acknowledge patients’ satisfaction and hence make necessary adjustments in
performance.

The analysis or the empirical results showed that patients’ satisfaction and the service quality is
most important for hospital industry. The result also shows that there is a significant difference
between patients’ satisfaction and the service quality dimensions. So the patient’s satisfaction of
government hospital on service quality is an important in the competitive scenario. The study also
reveals that the service quality is influenced by the various nature of the patients. Even one percentage
of increase in quality service increases the satisfied patient’s percent.

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