PATIENT SATISFACTION REGARDING HEALTHCARE SERVICES

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LOVELY PROFESSIONAL UNIVERSITY

DEPARTMENT OF MANAGEMENT

Report on Summer Training

PATIENT SATISFACTION REGARDING HEALTHCARE SERVICES PROVIDED

AT SEVEN HILLS HOSPITAL, VISAKHAPATNAM.

Submittedto Lovely Professional University

In partial fulfilment of the

Requirements for the award of Degree of

Master of Business Administration

Submitted by:

Tanna Sagar

Reg. no.: 11102615

Roll no.: Q2104 B30

DEPARTMENT OF MANAGEMENT

LOVELY PROFESSIONAL UNIVERSITY

JALANDHAR NEW DELHI GT ROAD

PHAGWARA

PUNJAB


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Declaration

I do, hereby, declare that the dissertation entitled PATIENT SATISFACTION REGARD-

ING HEALTHCARE SERVICES PROVIDED AT SEVEN HILLS HOSPITAL, VI-

SAKHAPATNAM is an authentic work developed by me at, SevenHills hospital, Visakha-

patnam, under the guidance of Mrs. Sunita Asst. Manager (Admin. Department) and Mr. G

Bhanu Murty (Asst. Manager) and is submitted as a partial fulfilment of the degree ofMBA

Hospital and Healthcare Management to be awarded by Lovely Professional University.

I also declare that, any or all contents incorporated in this dissertation have not been submit-

ted in any form for the award of any degree or diploma of any other institution or university.

TANNA SAGAR

Roll No. Q2104B30

MBA (Hospital and Healthcare Management)

Lovely Professional University


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Acknowledgement

I take this opportunity to express my profound sense of gratitude and respect to all those whohelped me throughout the duration of the project. I express my sincere gratitude and thank-

fulness towards Mr. M.R.S. Prasad Manager-HR and Mr. Rathnakar Gen. Manager for their

valuable time and guidance.

I feel privileged to offer my sincere thanks and deep sense of gratitude to my Guide

Resp. Mrs. Sunitha for expressing confidence in me and providing support, help & encour-

agement in completing the project.

I am grateful to all my friends for providing critical feedback & support whenever re-

quired.

Last but not the least I thank the Almighty for bestowing his blessings.

I regret any inadvertent omissions.

(Tanna Sagar)


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Table of content:

1. Abstract..3

2. About the Hospital.4

3. Patient Satisfaction 10

4. Need and objective of the study 12

5. Review of literature... 13

6. Research Methodology.. 17

7. Data Analysis.19

8. Problems Observed and Recommendations...24

9. Conclusion. 25

10. References26

11. Questionnaire... 28


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Chapter 1

Abstract

This project reports on the development and psychometric properties of the patients

receiving health care service. The instrument used contains 18 items tapping each of the sev-

en dimensions of satisfaction with medical care like general satisfaction, technical quality,

interpersonal manner, communication, financial aspects, time spent with doctor, and accessi-

bility and convenience.


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Chapter 2

Seven Hills Healthcare Private Limited

About

Seven Hills Group has over two decades of experience in the healthcare sector,

providing quality healthcare and valuable expertise, supported by a team of compas-

sionate and dedicated medical professionals offering state of the art in-patient and out-

patient facilities, focusing on the comfort and safety of our patients and their loved

ones.

Seven Hills Group currently has two hospitals, located in the cities of Mumbai,

Maharashtra and Visakhapatnam, Andhra Pradesh

Aim

To provide quality healthcare to the people in Visakhapatnam and its adjoining areas

Location

Seven Hills Hospital is situated on a panoramic hillock called Rockdale Lay-

out in the heart of the city very accessible from the airport and railway station. It is a

healthcare landmark and a household name for quality healthcare to more than 50 mil-

lion people across six states - Andhra Pradesh, Orissa, Chhattisgarh Jharkhand, and

parts of West Bengal and Bihar.


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The disciplines of medicines covered in the hospital are:

General Surgery Internal Medicine Obstetrics & Gynaecology Paediatrics Neonatology Ear-Nose-Throat Dental Surgery

Facio Maxillary Ophthalmology Anaesthesiology Cardiology Pulmonary Medicine Cardio Thoracic Surgery Gastroenterology Surgical Gastroenterology Laparoscopic Surgery Neurology Neuro Surgery Nephrology Renal Dialysis Urology Endocrinology Plastic Surgery Nuclear Medicine Surgical Oncology


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Outpatient services

Seven Hills Hospital has set a benchmark in unmatched features, world-class exper-

tise, quality care, ethical practice, and reasonable costs.

With the aim of providing world class quality care, the Out Patient area contains 40 air

conditioned outpatient clinics in all the disciplines of medicines with attached individ-

ual clinic patients waiting areas to ensure your comfort and privacy.

With full time morning and evening clinics Seven Hills provides for a large number of

patients due to convenience of timing.

Out Patient areas have been designed to minimize the risk of cross infection

Pharmacy:

The hospital has well stocked in-house pharmacy department that provides all medi-

cines directly to the respective floors and wards round the clock.

Welfare schemes

As a conscientious and responsible member of society, Seven Hills Hospital has con-

ducted regular multi specialty free mega camps in the hospital and at various placesoutside the hospital as well. These camps are conducted by the super specialists and

specialists of Seven Hills Hospital in order to screen the population for specific disor-

ders to enable early diagnosis, prevention and access to specialty treatment and cure.

These are camps conducted regularly and completely free of charge as a service to the

people of the area.


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Government health package

Congenital Heart Disease has been an excruciating problem with an acute need of at-

tention for a long time. Mortality and morbidity in infants and children was highest

and survivors lived highly restricted lives.

Govt of Andhra Pradesh perceived this need and has given Seven Hills Hospital the

unique opportunity to put an end to the long standing suffering of congenital heart dis-

ease patients, by sponsoring this project.

These delicate surgeries are performed at Seven Hills Hospital at an unmatched suc-

cess rate, improving the quality of life to those operated.

Numerous children of CHD below 12 years of age are operated on successfully with

the help of the Govt of Andhra Pradesh Health Package.


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Chapter 3

Patient Satisfaction

Patient satisfaction has emerged as ac critical outcome of medical care due to increas-

ing emphasis on consumers of services in the medical marketplace1. The extent to which dif-

ferent delivery system satisfy their patients is a major determinant of viability in this highly

competitive environment. Patient satisfaction has been associated with patient adherence to

medical recommendations2 , willingness to initiate malpractice litigation3, doctor shopping4 ,

and disenrollment from prepaid health plans5.

The major characteristics of providers and health and medical care services that influ-

ence patient satisfaction are

Art of care:

The most frequently measured dimension of satisfaction pertains to the amount of car-

ing shown towards patients, which is one of aspect of providers conduct. On the positive end

of the satisfaction continuum, questionnaire items focus on such providers characteristics asconcern, consideration, friendliness, patience, and sincerity in terms of abruptness, disrespect,

and the extent to which providers embarrass, hurt, insult or unnecessarily worry their patients

Technical quality:

This dimension which also pertains to provider conduct focuses on the competence of

providers and their adherence to high standards of diagnosis and treatment

1 Davies & Ware, 19882

Korsch, Gozzi, & Francis, 1968; Sherbourne, Hays, Ordway, Dimatteo, & Kravitz 19923 Vaccarino, 1977

4 Marquis, Davies, & Ware, 19835 Ware & Davies, 1983


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Accessibility and convenience:

Included in this dimension are all of the factors involved in arranging to receive medi-

cal care. Among the more frequently studied variable are time and effort required to get an

appointment, distant or proximity to site of care, time and effort required to get to the place

where the care is delivered, convince of location, hours during which care can be obtained, if

help is available over the telephone at home.

Finance:

Ability to pay for services or to arrange for payment is an important in the receipt of

care.

Physical environment:

Satisfaction with the physical environment in which care is delivered has usually been

studied in inpatient settings

Availability:

Satisfaction with availability of health and medical care services and providers has

rarely been measured in published surveys.

Continuity of care:

This is another infrequently measured dimension of patient satisfaction. It is generally

defined in the terms of regularity of care from the same facility, location or provider.

Outcome of care:

This is measured in the terms of perception regarding the usefulness or helpfulness of

medical care provider and specific treatment regimens in improving or maintaining health

status


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Chapter 4

Need and Objective of the Study

The survey is used as dependent variable to evaluate provider services and facilities,

on assumption that patient satisfaction is an indicator of structure, process, and outcome of

care.

Objective

- To know the level of satisfaction of the patients regarding the medical care provided- To know the effectiveness of medical care provided


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Chapter 5

Review of literature

1. Barr, D. and Vergun, P. (2000). Using a New Method of Gathering Patient Satis-faction Data to Assess the Effects of Organizational Factors on Primary Care Quality.

Journal on Quality Improvement; 26(12): 713-723.

The authors of this article argue that conventional methods of assessing patient satisfaction

are insufficient. Traditionally, a survey (e.g. the nine-item Visit-Specific Satisfaction Ques-

tionnaire (VSQ)) is administered either after the encounter or by telephone at a later date.

However, such instruments cannot capture the patients perspectives of the encounter or ob-jective measurements of the system. The authors developed a means of collecting this infor-

mation via a 67-item questionnaire (included in the article) that collected patient demographic

information and health status, prior health care (continuity), and ancillary services utilized by

the patient. Targeted to patients coming to a primary care office visit at a large multispecialty

facility in northern California, the study achieved a response rate of 77.6 percent for a total

sample size of 291.

2. Hall, J., and Dornan, M. (1988). Meta-Analysis of Satisfaction with MedicalCare: Description of Research Domain and Analysis of Overall Satisfaction Levels. So-

cial Science and Medicine; 27(6): 637-644.

The authors conducted a meta-analysis of 221 studies to examine consumer satisfaction with

medical care. The authors begin by describing the general characteristics that could describe

satisfaction instruments. Directness of the question relates to how directly a patient was asked

about their satisfaction (how satisfied were you vs. describe the care you received). Specifici-

ty refers to how general of an encounter is being measured, ranging from measures of a

health system in general to measures of a specific visit. Type of care refers to the type of ser-

vice being accessed (e.g. ambulatory care). Dimensionality refers to the aspects of the care

being measured

Other results discussed included: patients were more satisfied

with physicians with less experience; general satisfaction stud-

ies had lower satisfaction ratings than specific event focusedstudies.


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The authors then present theories for results found. Presumably patients were more satisfied

with newer doctors because they spend more time with patients, and displayed more technical

and interpersonal competence (supported by other literature). They presented several hypoth-

eses for why more specific encounters were rated higher than studies focusing on satisfaction

with health care in general. The first is related to temporality and cognitive process, in that

negative experiences are remembered for a longer period of time. Since most general satisfac-

tion surveys were not administered immediately after an encounter, they may be influenced

by the more negative experiences of those being interviewed. Additionally, general satisfac-

tion survey respondents may draw on more generic (and potentially negative) views of health

care rather than a specific encounter with a health care provider, whereas patients evalu a-

tions of my care specifically may have more positive views. In either case, these attitudes

and perceptions could skew the results.

3. Hall, J. and Dornan, M. (1990). Patient Sociodemographic Characteristics asPredictors of Satisfaction with Medical Care: A Meta-Analysis. Social Science and Med-

icine; 30(7): 811-818.

This paper reviews the evidence of the relationship between patient satisfaction and patient

characteristics using quantitative meta-analytic techniques. The authors used standard and

accepted methods for identifying published quantitative analyses of patient satisfaction where

information on the association among patient characteristics and satisfaction were presented.

One hundred and ten published reports were included in the analysis that met the authors

criteria for inclusion. For each study, each correlation was extracted and coded as to which of

the 11 aspects of care it pertained to; the 11 aspects of care were: access, cost, overall quality

of care, humaneness of providers, competence of providers, information given by providers,

bureaucracy,

Physical facilities, providers attention to psychosocial problem, continuity of care and ou t-

come of care.

The paper also reports several interesting contrasts among variables, such as sex and ethnici-

ty. The authors conclude by stating that in overall terms, it appears that patient satisfaction is

associated with age and education and nearly significantly associated with social and marital

status. The authors continue to state that the associations may be due to response patterns on

the part of the groups identified or they may be mediated by events and processes that occur

during the medical care encounter.


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4. Inui, T. and Carter, W. (1985). Problems and Prospects for Health Services Re-search on Provider-Patient Communication. Medical Care; 23(5): 521-538.

In this review of studies of provider-patient communication, the authors assert that even with

the vast knowledge available on biological processes and disease mechanisms, communica-

tion between health care provider and patient is an extremely important aspect of health care.

Attempting to measure this, however, requires interdisciplinary activities, since merely meas-

uring satisfaction at the conclusion of an interaction cannot measure all the nuances of com-

munication (both verbal and non-verbal). They then spend some time describing the methods

of systematic analysis of these interactions, citing that many of the methods have generic

similarities: strategies utilized direct observation; emphasis on specific processes such as ver-

bal communication; multiple classifications to categorize encounters; and an approach to

quantify the events. The authors also argue that it is important to understand pre-encounter

state in order to place post-encounter measures into perspective. This could include patient

expectations of the encounter, degree of prior exposure to the health care provider, and de-

mographic characteristics, all of which can ultimately affect how a patient interprets the en-

counter. The authors conclude that it is important to augment measures that categorize a spe-

cific type of interaction (the example they gave was verbal communication) with measures of

other types of interaction, such as body language. They also point out that for chronic diseas-

es, addressing symptoms and providing support rather than a cure is often the goal, once

again pointing to the importance of communicating effectively with patients through the

course of their treatment

5. Sitzia, J. and Wood, N. (1997). Patient Satisfaction: A Review of Issues and Con-cepts. Social Science and Medicine, 45: 1829-1843.

Sitzia and Wood review the literature and suggest that patient satisfaction could be assessed

by measuring 1) the degree to which patients believe that care possesses certain attributes and

2) the patients evaluation of those attributes. They suggest that satisfaction is not single co n-

cept made up of multiple determinants, but that there exists three independent models of sat-

isfaction, each associated with one determinant. Thus, there is the need for the familiar, the

goals of help-seeking and the importance of emotional needs. Furthermore, there is evi-

dence that there are two states of satisfaction, stable ones related to health care generally and

dynamic ones related to specific health care interactions.


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Components of satisfaction consist of: structural, technical and

interpersonal aspects of care.

Expectations are critical as they form the basis for the subjective assessment of care that is

the rating of satisfaction. There can be different expectations for different aspects of care and

patients with lower expectations tend to be more satisfied. Satisfaction cannot be interpreted

as a measure of quality of care and must be interpreted in the context


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Chapter 6

Research Methodology

Method is a way of doing something and methodology is a set of methods used in a particular

area of activity. The research methodology employed in the research is as given by Philip Ko-

tler.

Developing the problems and research objective Developing the information sources. Collecting and analyzing the information Presenting the information

Research problem:

Patient Satisfaction regarding Healthcare provided by Seven Hills Hospital

Research design:

Research Design is a series of advanced decisions that taken together comprise a mas-

ter plan or model for the conduct of an investigation. So research design provides a frame-

work of plan for study, which guides the collection, measurement, analysis, and interpretation

of the data. The research carried out here is descriptive in nature.

Study Design and Sampling

The prospective study was designed to examine the influence of specific characteris-tics of providers, patients, and health systems on outcomes of care. Briefly, data were ob-

tained from patients visiting physicians in Seven Hills Hospital (Seven Hills Health Care Pri-

vate ltd.) in Visakhapatnam. Samples of 60 patients consisting of adults (ages 18 and over)

were taken.

Subjects

With respect to demographic characteristics, study participants averaged 55 years of

age; 80% were male.

Measures

Patient satisfaction with medical care: Patient Satisfaction Questionnaire consists of

18 items tapping seven aspects of satisfaction with care: general satisfaction (2 items), tech-

nical quality (4 items), interpersonal manner (2 items), communication (2 items), financial

aspects (2 items), time spent with doctor (2 items), and accessibility and convenience (4

items). To control for acquiescent responding, the instrument contains both positively-worded

and negatively-worded items. Participants were asked to indicate how they feel about the

medical care they receive in general, with no reference to a specific time frame or visit. Re-

sponses to each item are given on a 5-point scale ranging from strongly agree to strongly dis-

agree


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Sampling method:

The sampling method involved is convenience sampling method.

Method of data collection

It can be done through primary. To collect primary data a survey will be conducted on Patient

Satisfaction through a questionnaire, which will be filled by the patients and their attendees in

SevenHills hospital. Various questions will be asked to gain maximum information from the

respondents.

Scaling technique

Scaling techniques is used in this survey, for understanding the relation between patient satis-

faction with care provided in the hospital and its effects. Answers of the respondents are elu-

cidated by asking them to indicate their level of agreement on a given five point Likert scale

with values ranging from 1 (strongly disagree) to 5 (strongly agree).


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Chapter 7

Data AnalysisPatient satisfaction survey data analysis

Demographic profile: 60 samples were taken to conduct study of which 47 were males and

13 are female

Results:

Aspects

General satisfaction

Technical Quality

Communication

Financial aspect

Questionnaire

3. The medical care I have been receiving is

just about perfect

17. I am dissatisfied with some things about

the medical care I receive

2. I think my doctors office has everything

needed to provide complete medical care

4. Sometimes doctors make me wonder if their

diagnosis is correct

6. When I go for medical care, they are careful

to check everything when treating and examin-

ing me

14. I have some doubts about the ability of the

doctors who treat me

1. Doctors are good about explaining the

reason for medical tests

13. Doctors sometimes ignore what I tell them

5. I feel confident that I can get the medical

care I need without being set back financially

7. I have to pay for more of my medical care

than I can afford

Mean

3.2

2.8

3.1

3.2

3.1

3.9

3.3

2.7

3.2

3.5


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Time spent

Accessibility and

Convenience

12. Those who provide me medical care some-

times hurry too much when they treat me

15. Doctors usually spend plenty of time with

me

8. I have easy access to medical specialists I

need

9. Where I get medical care people have to

wait too long for emergency treatment

16. I find it hard to get an appointment for

medical care right away

18. I am able to get medical care whenever I

need it

3.3

3.9

3.0

2.8

2.5

3.4

Interpretation:

From the survey,

Aspect 1 2 3 4 5

Generalsatisfaction

12% 28% 40% 12%

40 percent of the patients are uncertain if they are receiving perfect medical care ornot. 28 percent agrees with this and feels that the medical care provided is good.

General satisfactionstrongly

agreeagree

incertain

disagree

stronglydisagree


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Aspect 1 2 3 4 5

Technicalquality

40% 10% 50%

Most of the patients disagrees that the physicians office has everything that is re-

quired for providing complete medical care.

Technical quality stronglyagreeagree

incertain

disagree

strongly

disagree


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Aspect 1 2 3 4 5

Intrapersonalmanner

20% 30% 50%

50 percent of the patient disagrees with the statement that their doctor acts too busi-

nesslike and impersonal with them

Aspect 1 2 3 4 5

Communication 12% 28% 40% 12%

The patients agree that doctors explain them the reason for undergoing medical diagnosis.

Intrapersonal manner stronglyagreeagree

incertain

disagree

strongly

disagree

Communication stronglyagreeagree

incertain

disagree

stronglydisagree


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Aspect 1 2 3 4 5

Financial as-pect

50% 10% 40%

The hospital is producing the medical services at affordable prices which is denoted by 50 percent

patients agrees it

Financial aspect stronglyagreeagree

incertai

ndisagree

strongly

disagree


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Problems observed & Recommendations

During the training period in the hospital the following are few observations in inpa-

tient and outpatient departments.

The registration facilities for outpatient dept. is well placed in the hospital one near theentrance and other near the doctors cabins but the patients are facing problems in getting

the information regarding the physicians details

The outpatient dept. is located in the first floor and the only way is by staircase which pos-es difficulty for the patients to reach the physicians.

Wastage of time is observed when the patient is needed to undergo any diagnostic proce-dure and has to return to the physician.

The admission process is done in the ground floor, and the patient has to come there fromthe physician which is incontinent for the patients and a time taking process

Due to the deficiency of equipment, time consumption is more The shifting process from admission dept. delays a great deal if any diagnostic procedures

are advice by the physician.

Recommendations

Information centres can be placed near the entrance to help and guide the patients. Construction of a way which can be used only by patients Providing serial numbers for the patients at the counters before undergoing the diagnostic

procedures, which should be don orderly

Admission dept. can be shifted near to the outpatient dept. which decreases the inconti-nence to the patients

Supply of required equipments.


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Conclusions

From the survey in SevenHills hospital, the medical care provided by the hospital is

satisfactory. But being a super speciality hospital, there are areas that should be improved to

provide the patients a well satisfied feel from the hospital. By implementing the recommen-

dations the most important factor time loss can be minimized.


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References

1. Baker R. Development of a questionnaire to assess patients' satisfaction with consul-tations in general practice. Br J Gen Pract 1990; 40: 487-490.

2. Baker R. The reliability and criterion validity of a measure of patients' satisfactionwith their general practice. Fam Pract 1991; 8: 171-177.

3. Department of Health and the Welsh Office. General practice in the National HealthService: a new contract. London: HMSO, 1989.

4.

Department of Health. Medical audit in the family practitioner services. HC (FP)

(90)8. London: DoH, 1990.

5. Fitzpatrick R. Measures of patient satisfaction. In: Hopkins A, Costain D (Eds).Measuring the outcome of medical care. London: Royal College of Physicians of

London, 1990.

6. Fitzpatrick R. Surveys of patient satisfaction. I: important general considerations.BMJ 1991; 302: 887-889.

7. Hulka B, Zyzanski S, Cassel J, Thompson S. Scale for measurement of attitudes to-wards physicians and primary health care. Med Care 1970; 8: 429-433.

8. Mitchie S, Kidd J. Happy ever after. Health Serv J 1994; 3: 27.9. Ware J, Snyder M, Wright W, Davies A. Defining and measuring patient satisfaction

with medical care. Evaluation Program Plann 1983; 6: 247-263.

10.Williams B. Patient satisfaction: a valid concept? Soc Sci Med 1994; 38: 509-516.


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Sir/Madam,

On the following pages are some things people say about medical care.

Please read each one carefully, keeping in mind the medical care you are receivingnow. (If you have not received care recently, think about what you would expect if

you needed care today.). We are interested in your feelings, good or bad, about the

medical care you have received.

Name: Age/Sex:

How strongly do you AGREE or DISAGREE with each of the following statements?

(Circle one number on each line)

Strongly Strongly

agree agree Uncertain Disagree disagree

1. Doctors are good about explainingthe reason for medical tests 1 2 3 4 5

2. I think my doctors office haseverything needed to provide

complete medical care 1 2 3 4 5

3. The medical care I have beenreceiving is just about perfect 1 2 3 4 5

4. Sometimes doctors make mewonder if their diagnosis is correct 1 2 3 4 5

5. I feel confident that I can get themedical care I need without being

set back financially 1 2 3 4 5

6. When I go for medical care, theyare careful to check everything

when treating and examining me 1 2 3 4 5

7. I have to pay for more of mymedical care than I can afford 1 2 3 4 5


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Strongly Strongly

agree agree Uncertain Disagree disagree

8. I have easy access to medicalspecialists I need 1 2 3 4 5

9. Where I get medical care peoplehave to wait too long for emergency

treatment 1 2 3 4 5

10.Doctors act too businesslike andimpersonal towards me 1 2 3 4 5

11.My doctors treat me in veryfriendly and courteous manner 1 2 3 4 5

12.Those who provide me medicalcare sometimes hurry too much

when they treat me 1 2 3 4 5

13.Doctors sometimes ignorewhat I tell them 1 2 3 4 5

14. I have some doubts about theability of the doctors who treat

me 1 2 3 4 5

15.Doctors usually spend plentyof time with me 1 2 3 4 5

16. I find it hard to get anappointment for medical careright away 1 2 3 4 5

17. I am dissatisfied with somethings about the medical care

I receive 1 2 3 4 5

18. I am able to get medical carewhenever I need it 1 2 3 4 5


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