Quality Health Care

10
Quality Health Care: What Do Patients Say

A Five-Year Experience of
Patient Satisfaction Surveys in a
Government Primary Care Health Center
Carl Abelardo T. Antonio MD MPH-cand, Armando C. Leeb
MD MS, Portia Fernandez-Marcelo MD MPH
Introduction
Community participation forms one of the fundamental tenets of the Declaration
of Alma-Ata, the first global attempt of governments to reform the health sector
in order to respond to stark health inequities, especially experienced by the poor
and vulnerable across countries. Good governance (i.e. strengthening the health
sector, addressing social determinants of health) and restoring community voice
(ensuring an empowered citizenship) are essential to lasting changes (Chan, 2008).
Governments, as the primary duty bearer of this right to health, has to ensure
that quality health care servicesappropriate and scientifically sound, accessible
and available, affordable and gender-fair
and culturally-appropriateare provided to
The Sentrong Sigla
all.
movement was one of
Quality of health care has been
the early local attempts
traditionally gauged through data routinely
at quality assurance
collected by existing health information
and continuous quality
systems that are focused on coverage,
improvement in the
morbidity and mortality. There is, however,
Philippines.
an increasing body of knowledge that these
fail to sufficiently capture, among others,
what the instituted reforms are achieving across the range of social values and the
associated outcomes that are central to PHC (primary health care): equity, peoplecentredness, protection of the health of communities and participation.(WHO,
2008:123)
The repercussions of poor quality care cannot be over-emphasized. In the
extreme, Brown, Franco, Rafeh, and Hatzell (n.d.) noted that if providers do not
offer quality services, they will fail to earn the populations trust, and clients will
turn to the health system only when in dire need of curative care.
The Philippines Sentrong Sigla Movement was one of the early local attempts
a Medical Officer, San Pablo Health Center, Pasay City Health Office
b Medical Officer, Malibay Health Center, Pasay City Health Office
172 Part 3: Local Health Systems Development

at quality assurance (QA) and continuous quality improvement (CQI) in the
Philippines. Initially intended for health facilities in the context of a devolved
health care system, it began in the late 1990s and provided certification and
public recognition for health facilities that meet quality standards set by the
Department of Health (DOH). This was subsequently merged with accreditation
standards of the Philippine Health Insurance Corporation (PhilHealth). One
component indicator in both standards is the existence of systematic means of
eliciting feedback from patients and their families regarding relevant aspects of
care received from a particular facility.
Pasay City, a highly urbanized city in Metro Manila, caters to more than
400,000 individuals in 14 public primary care facilities, 13 of which are Sentrong
Sigla-certified. While previously, methods of eliciting client satisfaction has been
limited to passive collection of data through provision of client comments box in
each health facility, the emergence of CQI standards in Sentrong Sigla, and later
PhilHealth, prompted the discussion and implementation of patient satisfaction
surveys for the health facilities.
This paper documents five years experience in conducting patient satisfaction
surveys in Malibay Health Center, one of primary care health facilities in Pasay
City run by the local government unit. The Center provides major priority health
programs of the government including but not limited to maternal and child health
care, tuberculosis management, etc. Daily consults at the health center range from
80 to 150 patients, mostly for health promotivedisease preventive maternal and
child health care services as well as care for acute respiratory infections. Malibay
serves a population of 45,516 in 21 barangays where a big bulk of the Citys urban
poor reside. There is only one physician, two nurses, three midwives, one dentist,
one medical technologist, one laboratory aide and an institutional worker; 20
BHWs augment the workforce especially for community health drives.
This paper elucidates the purpose of the patient satisfaction surveys embarked
on by the Malibay Health Center staff, processes on how the survey tool was
developed and how feedback was elicited from patients, outcomes of the surveys
and the response of the Malibay health center staff to survey findings, culled from
available documents and interviews of key informants. Available reports of the
UP Urban Health Team were studied. The Malibay health center experience
is compared with other similar health facilities through a review of literature.
Implications for local policy and options for scaling up and expansion are
discussed in latter sections.
Results
t Intentions of the PSS
The PSS was implemented to comply with the requirements of the Sentrong
Quality Care: What Do Patients Say
Figure 10.1. Comparison of mean scores for patient satisfaction survey

2008-2009, Malibay Health Center, Pasay City
Figure 10.2. Comparison of mean scores for patient satisfaction survey

2008-2009, Malibay Health Center, Pasay City
173

Figure 10.3: Comparison of mean scores for patient satisfaction survey
2009-2010,Malibay Health Center, Pasay City
Figure 10.4: Comparison of mean scores for patient satisfaction survey

2009-2010,Malibay Health Center, Pasay City
175
Sigla Level II Certification process, which included, among others, documenting

and acting on patient feedback on services provided by the health center.
Guidelines of Sentrong Sigla did not dictate any specific format or parameters; the
health facilities were given free hand to develop their own feedback mechanism,
other than the traditional suggestion box.
t Process of development of the PSS tool and administration of
the survey, collation and presentation of results of the PSS
In 2006, a short written survey developed by the Bureau of Primary Health
Care (Health Resources and Services Administration, United States Department
of Health and Human Services) was adapted and translated to Filipino by Dr.
Rosario Bernardo, a senior resident physician of the Department of Family and
Community Medicine (DFCM) of the UP, rotating in Malibay Health Center for
the urban Community Medicine urban program.32 In order to allow patients to
freely give feedback, the Malibay medical officer thought a third party, not the
health center staff themselves, would be best to administer, organize and present
results of the survey. Due to the exigency of the situation (the Sentrong Sigla
accreditation team was due anytime), validation of the Filipino survey instrument
before it was formally introduced in Malibay Health Center was no longer
attempted.
The questionnaire was administered by the resident physican-rotators in 2006,
2007 and 2009; fourth year medical students of the UP, who likewise had their
Community Medicine rotation, administered this in 2008 and 2010. Survey
forms were given at various times during the second half of each year between
the periods 2006 to 2010 to a convenience sample of 100 individuals seeking
care in Malibay Health Center. There was neither standard script nor specific set
of instructions to the patients when the forms were administered. The medical
trainees devised their own strategies to get the patients to answer the forms while
they wait for their turns to be seen by the physician or nurse.
The questionnaire consists of two parts. For Part I, respondents were asked
to rate, on a scale of 1 to 5 (1 being the lowest, 5 being the highest), the level of
service received, and four aspects of service (e.g. ease of getting care, waiting, staffprovider, nurse/medical assistants, and facilities), which are each measured by at
least two parameters (or a total of 15 parameters, excluding general assessment of
service). Part II requested respondents to describe what they liked most, and liked
32 The Urban Community Medicine rotation for the DFCM resident physicians from January 2002 to
April 2010 had three components, one of which was health center-based. Aside from personal health care
and patient education, it provided service-learning opportunities for the medical trainees to concretely contribute to health systems and in this case clinic systems improvement based on needs articulated by the
patients and health center staff. In mid-2006, the Malibay Health Center was undergoing Sentrong Sigla
Level II accreditation; thus, Dr. Bernardo responded to the expressed need.

least, in the health center, and were requested to provide comments or suggestions
to improve provision of service in the health center. Scores for each component
question were tabulated, and an over-all rating was computed by obtaining the
arithmetic mean of the mean parameter scores.
UP medical trainees would then collate and present preliminary findings of
the survey to Malibays medical officer, who is also charged with the responsibility
of health facility management. The findings would thus guide the choice of topic
for the Malibay Health Center staff development activity of the resident-rotator.
Summary of results of the survey conducted for the year would then be presented
to the rest of the health center staff by the medical trainee/s, feedback and reactions
are elicited, action points are decided on for improvement of services. The staff
development activity, another service-learning requirement in the rotation, is
supposed to be designed to provide additional cognitive handles for the health
center staff to respond to one aspect that needs improvement raised in the survey.
The summary of survey results would be provided to the Malibay medical officer.
This would also be included in their end-of-rotation final reports submitted to the
UP faculty.
These end-of-rotation reports had varied formats, however, and raw data no
longer available (except for 2010), precluding better analysis across five years by
these authors.
t What do patients say? Results of the 2006 to 2010 Surveys
A total of 500 respondents participated in the survey between 2006 and 2010.
Mean scores for each item in Part I of the survey are summarized in Table 1.
For this paper, five-year averages for each parameter and for the over-all score
were computed. For the second part of the survey, answers were categorized, and
frequencies of responses noted.
Based on the survey results, some observations can be made about the quality
of services in Malibay Health Center.
In general, services in Malibay Health Center were rated 4.27 out of a highest
possible score of 5.00 [range 3.80-4.47]. Highest scores were given by respondents
for the aspect Facility [mean score 4.27], followed by Ease of getting care
and Nurse/medical assistants [4.18], Staff-provider [4.16], while the lowest
score was given to Waiting [3.85]. Survey respondents felt that inside the center
madaling hanapin kung saan pupunta [4.43], and they reported that ang Center
ay bukas sa serbisyo ng pumunta kayo [4.42]. However, waiting time (particularly
time spent in the reception room, and between the consultation and treatment
rooms) was perceived to be long [3.70 and 3.85, respectively].
The surveys show that patients of Malibay Health Center are generally satisfied
with services available in their health facility, since all parameters were given
scores greater than 3 (adjectival rating Ok). In fact, 10 of the 15 parameters were
Table 10.1: Mean scores for patient satisfaction suvey, Malibay Health Center, Pasay City, 2006-2010 (n = 500)
Mga aspeto ng serbisyo
Year
2006
2007
2008
2009
2010
Five-year
Average
Kadalian na makakuha ng pangagalaga
Component
Average
4.18
a. Nakapasok agad sa Center para makita
4.14
4.16
3.45
3.60
4.16
3.90
b. Ang Center ay bukas sa serbisyo ng pumunta kayo
4.50
4.96
4.24
3.90
4.48
4.42
c. Ang lokasyon ng center ay madaling puntahan
4.40
4.73
3.77
3.60
4.56
4.21
a. Oras sa reception o waiting room
3.76
4.14
3.38
3.30
3.93
3.70
b. Oras sa consultation o treatment room
3.94
4.28
3.34
3.70
4.06
3.86
c. Paghihintay na may magawang examinasyon
3.86
4.15
3.71
4.10
3.94
3.95
d. Paghihintay makakuha ng resulta
3.82
4.14
3.72
3.80
4.00
3.90
Paghihintay
3.85
4.16
a. Nakikinig sa inyo
4.24
4.56
4.21
3.50
4.24
4.15
b. May sapat na oras para kausapin kayo
4.20
4.59
4.00
3.70
4.26
4.15
c. Naipaliwanag ang gusto ninyo malaman
4.10
4.59
4.11
3.60
4.48
4.18
d. Nagbibigay ng payo sa paggamot
3.88
4.64
4.19
3.70
4.39
4.16
a. Mabait, madaling lapitan at matulungin
4.20
4.62
3.54
3.90
4.39
4.13
b. Sumasagot sa inyong katanungan
4.22
4.57
3.95
4.00
4.41
4.23
Nurses at Medical Assistants
4.18
Pasilidad
4.27
4.34
4.63
3.78
3.60
4.20
4.11
b. Madaling hanapin kung saan pupunta
4.60
4.71
4.32
4.00
4.52
4.43
AVERAGE SCORE (FOR YEAR)
4.47
4.67
4.05
3.80
4.36
4.27
177
a. Malinis at masinop and center
Staff /Tagapagbigay alaga (physician, dentist, physician

assistant, nurse practitioner)

Table 10.2: Comparison of 2008 and 2009 mean scores for patient satisfaction suvey,
Malibay Health Center, Pasay City
Scores
2008
2009
2008-2009
Change
3.45
3.60
4.35%
4.24
3.90
-8.02%
3.77
3.60
-4.51%
3.38
3.30
-2.37%

-2.73%
Paghihintay
Component
Average
5.27%
3.34
3.70
10.78%
3.71
4.10
10.51%
3.72
3.80
2.15%
Staff /Tagapagbigay alaga (physician, dentist, physician assistant, nurse practitioner)

3.50
-12.12%
-16.86%
4.21
4.00
3.70
-7.50%
4.11
3.60
-12.41%
4.19
3.70
-11.69%
5.72%
3.54
3.90
10.17%
3.95
4.00
1.27%
3.78
3.60
-4.76%
4.32
4.00
-7.41%
4.05
3.80
-6.17%
Pasilidad
-6.08%
given scores greater than 4 (adjectival rating Good).

Across the study period, there was a noticeable decrease in patient scores for
nine of 15 parameters in 2009 [mean decrease of 6.17% compared to 2008 levels]
(Table 2). Highest decrement was noted for the aspect Staff-provider [12.12%],
followed by Facility [6.08%] and Ease of getting care [2.73%]. With respect
to particular parameters, decrease of patient satisfaction scores was most notable
(e.g. more than 10%) for three of four Staff-provider parameters: nakikinig
sa inyo [16.86%], naipaliwanag ang gusto ninyong malaman [12.41%], and
nagbibigay ng payo sa paggamot [11.69%].
Scores in 2010, however, increased by 14.74%, relevant to 2009 levels (Table
10.3). Score increase was highest for the aspects Staff-provider [19.84%] and
Ease of getting care [19.03%]. Parameters with significant (i.e. greater than
mean score) score increases were ang center ay madaling puntahan [26.67%],
naipaliwanag ang gusto ninyo malaman [24.44%], nakikinig sa inyo [21.14%],
oras sa reception o waiting room [19.09%], nagbibigay ng payo sa paggamot
179
Table 10.3: Comparison of 2009 and 2010 mean scores for patient satisfaction suvey,
Malibay Health Center, Pasay City
Scores
2008
2009
2008-2009
Change
3.60
4.16
15.56%

Component
Average
-2.73%
3.90
4.48
14.87%
3.60
4.56
26.67%
3.30
3.93
19.09%
3.70
4.06
9.73%
4.10
3.94
-3.90%
3.80
4.00
5.26%
Paghihintay
7.55%
Staff /Tagapagbigay alaga (physician, dentist, physician assistant, nurse practitioner)

3.50
4.24
21.14%
3.70
4.26
15.14%
3.60
4.48
24.44%
3.70
4.39
18.65%
19.84%
11.41%
3.90
4.39
12.56%
4.00
4.41
10.25%
3.60
4.20
16.67%
4.00
4.52
13.00%
3.80
4.36
14.74%
Pasilidad
14.83%
NOTES:
1. Respondents were asked to assign scores from 1 to 5 (1 being the lowest, 5 the
highest) for 15 survey parameters
2. Scores indicated in each cell represent the average score given by 100 respondents for
that particular year
3. Average Score (for year) represents the mean of the mean scores for all 15
parameters for that particular year
4. Component Average refers to mean score of parameters for that particular aspect
of service (i.e. average score for parameters malinis at masinop ang center and
madaling hanapin kung saan pupunta would correspond to component average for
Pasilidad)
5. Highlighted values in column 2008-2009 change indicate scores which are equal to or
lower than over-all score change
[18.65%], malinis at masinop ang center [16.67%], nakakapasok agad sa center

para makita [15.56%].
When asked what they liked most about the health center, respondents gave as
top answers the courteous manner of staff towards patients (mabait, maasikaso,
maayos makitungo), and the physical set-up (clean, air-conditioned center). On

the other hand, long waiting time (either on admission, or in transit from the
consultation and treatment rooms) was what patients least liked about the health
center, in addition to inadequate toilet facilities, and the feeling that the health
center was too crowded. Interestingly, at least 20 respondents for each survey
cycle reported that they did not dislike anything about the health center.
Suggestions to improve health center service include increasing number of
staff, facilitating entry-to-exit time of patients in the facility, and expanding the
facility so that it wouldnt be too crowded during consultation hours.
t Response of the Malibay Health Center Staff
Feedback on the survey was provided by data collectors to staff of Malibay
Health Center once all data has been collated and analyzed. This was held during
a specially convened meeting on a designated afternoon after the clinic staff has
attended to the centers bulk of patients While some patient feedback has been
critical of the health center and/or health center staff in certain parameters (i.e.
cleanliness, perceived inefficiency among staff), the staff nonetheless displayed
eagerness to rectify these perceptions or address these patient concerns.
For instance, in 2006, the first year of the survey, a major comment received
from patients was the staff s attitude towards those seeking care in their health
facility, with patients lamenting that some staff appeared cold or suplada. While
the staff came naturally on the defensive
after first hearing these comments,
Patients as expert
there was later on a consensus that
witnesses of care
this perception needs to be addressed.
Hence, subsequent staff development activities were tailored to this particular
topic.
Cleanliness of the health center was a recurrent patient concern over the
study period, and several mechanisms at ensuring cleanliness of work areas were
introduced thereafter. An initial strategy was dubbed Tapat Mo, Linis Mo which
emphasized that staff are responsible for ensuring cleanliness of their particular
work areas (somewhat similar to the clean-as-you-go mantra in some private
offices). This was later on improved to the 10 oclock habit where clean-up
activities were performed at this particular hour everyday; clinics were temporarily
suspended (for about five to 10 minutes) while the 10 oclock habit was being
performed. Finally, staff were provided a lecture on the 5S strategy to renew
behavior on orderliness, cleanliness, standards, and discipline in the workplace,
once it was noted that their practice of previous clean-up drives were flagging.
Discussion
Patient satisfaction surveys are acknowledged measures of health sector
181
accountability (specifically performance accountability) and community

empowerment8,9. Patient satisfaction harnesses the unique vantage point offered
by patients as expert witnesses of care in the same way that private sector (i.e.
hotels, banks, etc) and even politicians are seeking client feedback to collate
information about their services10,11. By using a structured instrument, health
managers may be able to screen aspects of care that warrant improvement, and
solicit inputs from patients themselves on how to address these problems12. A
World Health Organization report (2006) noted that engagement of patients and
populations
is critical to quality improvement, because individuals and communities play so
many roles within health systems. Either directly or indirectly, they will be financing
care, they will be working in partnership with health workers to manage their own
care, and they will sometimes be the final arbiter of what is acceptable and what is
not across all the dimensions of quality.
The challenge to health systems is to ensure that engagement with patients and
the population is at the heart of all policies and strategies for quality improvement,
and that this commitment is translated into meaningful action. Strategies to this
end include those which target improving health literacy, self-care, and patients
experience with the health system. Communities and service users will want to be
involved in the governance arrangements of the health system; they will want their
views and preferences to be heard and taken into account in decision-making; and
they will want to share the responsibility for their own health.13
What do patients say?

The surveys show that patients of Malibay Health Center are generally satisfied
with services available in their health facility. On a scale of 1 to 5, with 5 being
the highest, all parameters were given scores greater than 3 (equivalent to OK).
In fact, 10 of the 15 parameters were given
scores greater than 4 (equivalent to a rating
The surveys show that
of Good). These annual surveys have
patients of Malibay
affirmed work of the health staff although
Health Center are
they know more is still expected of them.
generally satisfied with
While the patient satisfaction survey
services available in their
documented in this paper was the first
health facility.
systematic attempt at capturing patients
perceptions with regards the quality of
care they are receiving as far as Pasay City is concerned, the extent to which
generalizations can be made from available data are, however, precluded by several
methodological limitations.
Improvements needed
First, while the survey instrument used in the conduct of the surveys was
adapted from an existing, validated, and patient- and health care professionaldeveloped tool in use since 19997, it is best that its translation into a Filipino
checklist should still have been validated.
While the parameters of quality care used in the survey generally hold true and
are applicable for all health systems, evidence from literature and local context
need to be taken into account in the formulation of criteria or components for the
survey. For instance, accessibility, waiting time, time spent with care provider, and
providers technical and interpersonal skills were deemed important indicators
of quality care14,15,16. Westaway, Rheeder, Van, and Seager (2003) suggested
that patient satisfaction was strongly determined by interpersonal relations (e.g.
Age, gender, socioeconomic, and ethnic differences in patients assessments
of primary health care) and organizational characteristics (e.g. Age, gender,
socioeconomic, and ethnic differences in patients assessments of primary health
care); hence efforts at constructing patient satisfaction surveys must integrate
and highlight these two domains17. Patient input, however, need to be viewed
with respect to their expectations of the health team, current health status, and
other sociodemographic factors (e.g. age, educational attainment, gender)18,19.
It cannot be overemphasized that the construction of the survey instrument must
be guided by input from patients themselves, since the very essence of a patient
satisfaction survey is to capture what individuals value, and what they are looking
for when they seek care in a health facility.
Second, sample size determination using acceptable statistical methodologies
was not formally conducted for the survey. The sample size of 100 was an arbitrary
figure, deemed appropriate and sufficiently large enough to account for biases or
errors in sampling.
Lack of randomization, and limitation of survey respondents to those who are
seeking care at the time data collectors are conveniently present in Malibay Health
Center, may have disenfranchised some segments of the patient population who
might be able to provide more insightful comments regarding the quality of
services in the health facility. The feeling of a congested health center atmosphere,
with more patients waiting behind them, might have also influenced survey
respondents to quickly complete the survey without much thought on the quality,
and accuracy, of answer being provided.
Since there is a constant shift of resident- and medical student-rotators,
methods of patient selection, respondent orientation, and data collection varied
through the five-year study period. The manner in which enumerators introduced
the tool to respondents may have a bearing on the respondents understanding of
the value and use of the survey questionnaire.
183
Essential respondent demographic information was noticeably absent in

the reported survey summaries made available to the authors, and no data was
available for Part II of the survey for the years 2006 and 2007.
Finally, while what was provided the authors were computed mean parameter
scores, and some trends can be deduced from these, analysis of patterns and
ranges of scores given for each parameter would have provided more insightful
and relevant information for stakeholders.
Despite all these limitations, however, it must be emphasized that the activity
documented in this paper is the first attempt at institutionalizing patient satisfaction
survey in the context of the Pasay City health system. Hence, while flaws may be
present in the methodology of the survey, the pioneering nature of this endeavor
means that it can be used as the basis for the development of a more systematic
and scientifically-sound survey in Pasay City in the future.
It must be noted that for years prior to 2006, the only mechanism available
in Pasay City health centers for patients to be heard were through comments/
suggestions boxes placed inside health centers, or through personal reports or
letters addressed to health facility staff or supervisors. Utilization of either channel
has been low, with the latter being used as a last resort for perceived grave offenses
or serious cases of staff demeanor.
Actively soliciting feedback, on the other hand yields a robust throve of
information, as documented in this paper, which can be, and is actually, used for
instituting critical reforms, particularly on aspects of service patients feel need
improvement, but which staff may not perceive as a problem. Patient feedback
in Malibay Health Center, for instance, prompted the institution of a five-minute
break in health center operations to maintain cleanliness and order in the health
center.
Institutionalizing a student requirement into a systemic and
systematic process for CQI
The presence of academic partners and student affiliates of the Pasay
city Health Office should be maximized, especially since the education
sector equally values research towards continuous quality improvement.
As partners of the City Health Office, the faculty can be engaged as
stakeholder to standardize this system for student involvement in this
regular QA activity.
Conduct of survey by third-party individuals or groups appear to be essential

to obtaining patient feedback. The residents and medical students who conducted
the survey may have been perceived by patients as bearing no direct interest in
obtaining only positive comments. Alternatively, respondents may have felt that

providing negative or critical feedback to residents and medical students will not
threaten or affect future staff attitudes towards these patients since (a) personal
information of respondents will be kept confidential, and (b) data collectors are
only assigned in the health facility for a limited period, compared to staff who are
permanently assigned (or at least given long-term posts) in the health center.
A post script on Patient Satisfaction Surveys

While a patient satisfaction survey is able to capture essential feedback on
services from individuals seeking care in a health facility, it must be noted that the
PSS, by its very nature, limits itself only to those individuals seeking care in a health
facility, naturally excluding the voice of
patients who are not seeking carea
A patient satisfaction survey
contravention of the fundamental idea
is able to capture essential
of community participation and health
feedback on services but
for all. Using the Three Delays Model
is limited only to those
developed for analyzing maternal
individuals seeking care in
mortality, it must be emphasized that
a health facility
the decision to seek care is a composite
of various factors, the most important
of which is the quality of care being provided in a facility (which in turn may be
attributed to staff competence and behavior, availability of essential drugs and
supplies, facility management)20.
Hence, it is imperative that any attempt at conducting PSS in a health facility be
complemented with community-based surveys especially intended for those who
are not seeking care in that health center. With these, a more comprehensive and
complete picture of the quality of care may begin to emerge, facilitating the health
workers appreciation of patients perception of services they are providing, and
ultimately, guiding policy development and institution of needed change in all
levels of the health system to truly embody the call made 30 years ago in Alma-ata
of ensuring health for all peoples.
Prospectus
Pasay Citys vision of being home to self-reliant, healthy and morally upright
people will be operationalized in the next five years through the City-wide
Investment Plan for Health 2011-201521. A key intervention in the said Plan is
the institutionalization of patient satisfaction surveys in the Pasay City health
system over the medium-term. This is part of the nationwide continuing reforms
of the health system towards the promised universal health care.
With the experience of conducting patient satisfaction surveys in Malibay
Health Center, we recommend the following:
185
development of a more appropriate survey questionnaire by both health

professionals and patient groups. While the focus on patient satisfaction
and the short, easily administered nature of the current questionnaire
should undoubtedly be retained, it is imperative that parameters, based on
inputs by stakeholders, be tailored to the local context. The input by patients
on what they liked most and liked least culled from the five year studies
should be further complemented by focused group discussions. Likewise,
input of the health staff, health administrators, government administrators
including politicians should be factored in. Furthermore, validation of the
tool must be undertaken prior to its wide-scale use.
determination of statistically acceptable and logistically feasible survey
methodology (e.g. sample size, sampling design, frequency of data
collection, means of data analysis and interpretation)
continuation of the conduct of survey by student affiliates / medical trainees
trained in data collection using the patient satisfaction survey questionnaire.
Standard scripts will have to be developed (1) for use of the Health Center
physician or nurse to orient the faculty and students on the purpose of the
QA activity, and processes associated with it (2) for use of the students as
they administer the surveys to patients, explaining purpose and process to
fill out the forms. Furthermore, a standard way of data collation, reporting
and storage must be set in place.
designation of a quality assurance program coordinator who will be incharge of managing processes related to conduct of regular - either annual
or biannual - patient satisfaction surveys. Budgets must be alloted, and /
or external resources tapped to ensure that CQI activities such as this is
regularly held as a standard management activity of the City Health Office.
In summary, we have presented Malibay Health Centers experience in
conducting patient satisfaction surveys, highlighting strengths and limitations
of the current system, which may be used as springboards for discussion and
development of a better patient satisfaction survey that will be implemented on a
city-wide scale.
Acknowledgement
The authors would like to acknowledge the contribution of residents of
the Department of Family and Community Medicine, Philippine General
Hospital, as well as medical clerks of the University of the Philippines College
of Medicine, in providing collated results of surveys they conducted over
the five-year study period. They likewise provided a review of literature
on the topic. Special mention is accorded to Dr. Ma. Rosario C. Bernardo
who initiated in 2006 what would become the basis for subsequent patient
satisfaction surveys conducted in Malibay Health Center, and to the faculty
of the Section of Community Medicine who encouraged and supervised
continual conduct of surveys through the years.
Salamat din!
Dr. Hector SM Dionisio, Dr. Louie R. Ocampo,
Clinical Clerks Serrano, Sese, Simbulan, Sobrio, Suarez, Suguitan,
Sumalapaoi, Sy, Sy, Taladua, Tan, Tanayan, Tanchuling, Tiu, Totanes,
Abello, Abuel, Adala, Agustin, Aman, Amurao, Arada, Bacena, Baclay,
Bismark, Bragais
187
REFERENCES
Declaration of Alma-Ata. International Conference on Primary Health Care; 1978 Sep 6-12;
Alma-Ata, USSR. Geneva: World Health Organization.
Chan M. Return to Alma-Ata. Lancet. 2008 Sep 13;372(9642):865-6.
The world health report 2008: primary health care now more than ever. Geneva: World Health
Organization; 2008. 123 p.
Brown L, Franco L, Rafeh N, Hatzell T. Quality Assurance Methodology Refinement Series:
Quality Assurance of Health Care In Developing Countries. Bethesda, MD: Quality
Assurance Project; n.d. 33 p.
Sentrong Sigla: Health ang Una [Internet]. Manila, Philippines: Department of Health; n.d.
[cited 2010 Nov 9]. Available from http://210.14.7.232/sentrong_sigla/index.html.
Department of Health Memorandum Circular No. 2006-0038, Re: Adoption of a policy
harmonizing Sentrong Sigla (SS) certification standards and Philippine Health Insurance
Corporation (PhilHealth) accreditation standards for rural health units/health centers
(RHUs/HCs). 2006 Jun 6.
Bureau of Primary Health Care [Internet]. Patient Satisfaction Survey. [cited 2010 Nov 9].
Available from http://bphc.hrsa.gov/patientsurvey/
Brinkerhoff, Derick. January 2003. Accountability and Health Systems: Overview, Framework,
and Strategies. Bethesda, MD: The Partners for Health Reformplus Project, Abt Associates
Inc.
Vuori H. Patient satisfaction: Does it matter? Int J Qual Health Care. 1991; 3(3):183-189.
Delbanco T. Quality of care through the patients eyes. BMJ. 1996 Oct 5;313:832-833
Managed Care magazing [Internet]. Bolus R, Pitts J. Patient Satisfaction: The Indispensable
Outcome. Managed Care. 1999 Apr [cited 2010 Nov 14]. Available from http://www.
managedcaremag.com/archives/9904/9904.patsatis.html
Delbanco T. Enriching the doctor-patient relationship by inviting the patients perspective. Ann
Intern Med. 1992 Mar 1; 116(5):414-418.
Quality of care : a process for making strategic choices in health systems. Geneva: World Health
Organization; 2006. 38 p.
Anderson R, Camacho F, Balkrishnan R. Willing to wait?: The influence of patient wait time on
satisfaction with primary care. BMC Health Serv Res. 2007;7:31.
Shou-sia C, Ming-chin Y, Tung-liang C. Patient satisfaction with and recommendation of a
hospital: effects of interpersonal and technical aspects of hospital care. Int J Qual Health
Care. 2003;15(4):345-355.
Cheraghi-Sohi S, Hole A, 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;6:107-115.
Westaway M, Rheeder P, Van Zyl D, Seager J. Interpersonal and organizational dimensions
of patient satisfaction: the moderating effects of health status. Int J Qual Health Care.
2003;15(4):337-344.
Bleich S, zaltin E, Murray C. How does satisfaction with the health-care system relate to
patient experience? Bull World Health Organ. 2009;87:271278.
Campbell J, Ramsay J, Green J. Age, gender, socioeconomic, and ethnic differences in patients
assessments of primary health care. Qual Health Care. 2001;10:90-95.
Thaddeus S, Maine D. Too far to walk: maternal mortality in context. 1994 Apr;38(8):1091110.
Pasay City Urban Health Systems Development Project Technical Working Group. City-wide
Investment Plan for Health 2010-2015, Pasay City, Metro Manila. Pasay City, Philippines:
City Government of Pasay; 2010. 41 p. Supported by the Department of Health Center for
Health DevelopmentMetro Manila.

Quality Health Care

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Quality Health Care

Uploaded by

Copyright:

Available Formats

10

Quality Health Care: What Do Patients Say

172 Part 3: Local Health Systems Development

Quality Care: What Do Patients Say

Figure 10.1. Comparison of mean scores for patient satisfaction survey

Figure 10.2. Comparison of mean scores for patient satisfaction survey

174 Part 3: Local Health Systems Development

Figure 10.4: Comparison of mean scores for patient satisfaction survey

Quality Care: What Do Patients Say

Sigla Level II Certification process, which included, among others, documenting

176 Part 3: Local Health Systems Development

Mga aspeto ng serbisyo

Kadalian na makakuha ng pangagalaga

a. Nakapasok agad sa Center para makita

b. Ang Center ay bukas sa serbisyo ng pumunta kayo

c. Ang lokasyon ng center ay madaling puntahan

a. Oras sa reception o waiting room

b. Oras sa consultation o treatment room

c. Paghihintay na may magawang examinasyon

d. Paghihintay makakuha ng resulta

b. May sapat na oras para kausapin kayo

c. Naipaliwanag ang gusto ninyo malaman

d. Nagbibigay ng payo sa paggamot

a. Mabait, madaling lapitan at matulungin

b. Sumasagot sa inyong katanungan

Nurses at Medical Assistants

b. Madaling hanapin kung saan pupunta

AVERAGE SCORE (FOR YEAR)

a. Malinis at masinop and center

Quality Care: What Do Patients Say

Staff /Tagapagbigay alaga (physician, dentist, physician

178 Part 3: Local Health Systems Development

b. Ang Center ay bukas sa serbisyo ng pumunta kayo

c. Ang lokasyon ng center ay madaling puntahan

Mga aspeto ng serbisyo

b. Oras sa consultation o treatment room

c. Paghihintay na may magawang examinasyon

d. Paghihintay makakuha ng resulta

Staff /Tagapagbigay alaga (physician, dentist, physician assistant, nurse practitioner)

b. May sapat na oras para kausapin kayo

c. Naipaliwanag ang gusto ninyo malaman

d. Nagbibigay ng payo sa paggamot

Nurses at Medical Assistants

a. Mabait, madaling lapitan at matulungin

b. Sumasagot sa inyong katanungan

a. Malinis at masinop and center

b. Madaling hanapin kung saan pupunta

AVERAGE SCORE (FOR YEAR)

given scores greater than 4 (adjectival rating Good).

Quality Care: What Do Patients Say

Kadalian na makakuha ng pangagalaga

b. Ang Center ay bukas sa serbisyo ng pumunta kayo

c. Ang lokasyon ng center ay madaling puntahan

a. Oras sa reception o waiting room

b. Oras sa consultation o treatment room

c. Paghihintay na may magawang examinasyon

d. Paghihintay makakuha ng resulta

Staff /Tagapagbigay alaga (physician, dentist, physician assistant, nurse practitioner)

b. May sapat na oras para kausapin kayo

c. Naipaliwanag ang gusto ninyo malaman

d. Nagbibigay ng payo sa paggamot

Nurses at Medical Assistants

a. Mabait, madaling lapitan at matulungin

b. Sumasagot sa inyong katanungan