PATIENTS' SATISFACTION WITH THE QUALITY OF SERVICES IN THE GENERAL OUTPATIENTS' DEPARTMENT OF THE UNIVERSITY COLLEGE HOSPITAL, IBADAN

Abstract

At present there is a trend for all social services to become more client or consumer oriented. This is now pronounced in health care delivery in the western world. The underlying demand for higher standards of health care and the limitation of the resources available make it desirable to measure the satisfaction patients experience from health services at all levels of care. Care assessed to be of high quality according to clinical, economic or other providers' defined criteria is far from ideal if as a result of that care the patients is unhappy or dissatisfied. There is therefore a sound rationale for making the organisation and delivery of health care responsive to consumers' expectations. For these reasons, properly conducted patient satisfaction surveys are encouraged. Patient satisfaction is now recognised as a legitimate measure of health care quality. To determine the level of satisfaction of the users of the General Outpatients' Clinic, University College Hospital, Ibadan with the organisation of the clinic, consultation processes and personal attitude and performance, a descriptive study using both qualitative and quantitative methods was carried out. This was conducted between January and April 1998. Four hundred and seven patients were selected using a systematic sampling technique. Their level of satisfaction with the various aspects of the services was recorded using a 5-point Likert Scale. Focus Group Discussion sessions were held with 10 groups of patients representing various age groups and both sexes. The parametres for assessing patient satisfaction include the accessibility of care, perceived professional competence, organisation of the clinic, consultation process, ammenities provided and personnel-patient relationship. The mean age of the patients was 47(±17) years and them:f ration was 1:1.6. One hundred and seventy-eight (43.7%) of the patients never attended school while 92 (22.6%) and 83 (20.4%) of them attended primary and secondary school respectively. Training constituted the occupation of majority (49.1%) of the patients. The clinic was found to be easily accessible by 303 (74.4%) of the patients and majority 327 (80.5%) required N20.00 (Naira) or less to get to the hospital. Three hundred and ninety five (97.1%) of them, assessed the organisation of the clinic to be satisfactory. The mean waiting time before consultations was found to be 169 (±81) minutes. Two hundred and thirteen patients (52.3%) particularly students, teachers and the unemployed felt that this was too long. A mean waiting time of 67 (±39) minutes was deemed reasonable. The consultation process was opined to be very good by 160 (39.4%), good by 238 (58.5%) and fair by 9 (2.2%) of the patients. Two hundred and eighty patients (68.8%) found the follow-up consultation length to be a bit short and this had significant influence on the assessment of the items constituting the consultation process. A higher percentage of those seen for more than 5 minutes rated the consultation to be very good compared to those seen for less than 5 minutes. The depth of consultation was found to be deeper when the consultation length was more than 5 minutes and doctors that spend more than 5 minutes were significantly found to be warm and friendly p=0.04. Overall, the medical care received by the patients was found to be satisfactory by 378 (92.0%) of them. However, 86 (21.1%) and 321 (7.9%) of the patients perceived the patient-doctor-communication and the health promotion and disease prevention activities to be deficient respectively. The attitude of the nurses was perceived to be good by 378(92.0%) of the respondents. Some communication and attitudinal problems were identified, particularly among the records clerks. Only 39(9.6%) respondents identified barriers to further use of the facility and these include the long waiting time indicated by 21(53.9%); lack of water and fans by 5(12.8%). dirty toilets by 3(7.7%) and the paucity of doctors by 3(7.7%). The result of the Focus Group Discussion sessions corroborated most of the findings of the survey. The patients expressed satisfaction with the quality of service rendered and the cordial relations with most members of staff. They found some of the record clerks to be somewhat hostile. The dissatisfaction with the hall was better expressed at the FGD sessions. Other sources dissatisfaction were as found in the survey. The patients also expressed support for the introduction of an appointment system. The use of the qualitative and quantitative method enriched this study and made it possible to get more in-depth information. There was an overwhelmingly positive response to most of the questions. This type of result is similar to those found in the American and British literature on patients satisfaction and shows that very few patients express dissatisfaction with or are critical of their health care. lt highlighted a high level of patient satisfaction with most of the services provided in the General Outpatients' clinic, University College Hospital, Ibadan. The study also provided valuable information to assist in improving the quality of care at the clinic specifically, the long waiting, attitude of the records clerks, deficient patient-doctor communication skill and the dearth of basic amenities need to be addressed. It is recommended that training workshops and seminars be organised to improve the personel-patient relationship and the doctor-patient communication process. Consultations should start earlier than they do now and a time specific appointment system should be introduced. Basic amenities such as water, functioning toilets, fans and adequate seats in the waiting hall should be provided. It is also recommended that other studies be conducted to determine the patients' level of satisfaction in different settings at all levels of care.