Chapter # 01

CHAPTER # 01
INTRODUCTION
1
1.0 Introduction:
Living in the world of information technology, now-a-days patients are aware of their
needs and rights. They know that health care facilities are established to provide
satisfactory and quality health services to them. If the health care facilities fail to do
so, they are considered unsuccessful in implementing their assigned tasks. Health
care facility performance can be best assessed by measuring the level of patient
satisfaction. A completely satisfied patient believes that the organization has potential
in understanding patient needs and demands related to health care.
The objectives of health care have changed by the requirements of society and the
availability of resources and technology. The 19 th century was an era which was
“symptom-centered”. Health was being referred to the elements of empirical
perception/local understanding without any scientific examination. The early 20th
century was basic science or disease-centered era. Health was being referred to
scientific reasoning and experimenting on disease, including diagnosis and treatment
of diseases. In the middle of the 20 th century experienced clinical science or patient
centered era. Health was centered mainly in hospitals and clinics and diagnosis and
treatment of individuals was performed. Late of the 20th century was public health
science or community centered era. Health has been focused on the diagnosis and
treatment of community. End of the 21st century saw political health science or
people centered era. Health has become people’s matter and need public participation,
including proper allocation of resources responding to public needs. The World Health
Organization conference, supporting health for all, held in 1990 defined future
development in health to be human cantered. A lot of stress has been made on
investment in health, patient care and a patient’s right to delivery of quality health
care leading to patient satisfaction.
There is a general agreement that measurement of patient satisfaction fulfills several

distinct functions. Satisfaction can simply describe health care services from the
patient’s point of view and patient satisfaction may be thought of as a measure of the
“process” of care. Problem areas can be isolated and ideas towards solutions may be
generated. Evaluation of health care is regarded by many as the most important
function of patient satisfaction research. The function of patient satisfaction work was
2
wholly concerned with evaluation. At least four fields of evaluation need
consideration in the health care context. These are evaluation of specific treatment,
Patient satisfaction studies have proved valuable in all these fields. Bangladesh has
been developing health care services in order to improve the quality in every aspect
according to the patient needs. Many key performance indicators are used to monitor
and evaluate the results of working organizations and their staffs. Patient satisfaction
is the essential indicator that indicates the quality of health service at all levels of
health care facilities. Understanding the different influences on variation in patient
satisfaction is important. To improve health care provision, managers need to be able
to differentiate between a factor they control that is a part of a wider social and
political context.
Quality is one of the key parameters in order to measure the performance of a product
or service and ultimately it referred to organizational performance. Customers are the
key player, who played a significant role to measure the quality of the product or
services. However, to measure the quality of services is quite difficult as compared to
the product or service quality due to its intangible nature. This study is intended to
investigate the level of quality of hospital services delivered to patients by the
Gulshan Maa O Shishu Clinic Ltd
Quality has become an icon for both the quality of services or product and the
customers. During the last couple of decades, there is a rapid considered to be the
main indicator while assessing the growth in the service sector around the globe.
Service organizations like other manufacturing organizations are also focusing to
deliver the services that meet customer needs in order to make their customer happy.
Satisfaction is a psychological concept which is defined in different ways. Sometimes

satisfaction is considered as a judgment of individuals regarding any object or event
after gathering some experience over time. According to some theorists, satisfaction is
a cognitive response whereas some others consider the satisfaction as emotional
attachment of individuals.
Howard and Sheth (1969) explained customer satisfaction as a cognitive response of

the customers. Hunt (1977) defined consumer satisfaction on the basis of consumers’
3
evaluation of the consumption experience. On the other hand there are exponents
namely, Churchill and
Surprenant (1982) who have defined consumer satisfaction based on the cognitive and
affective dimensions of the concept. Further Oliver (1997) highlights definitions on
customer satisfaction that recognize the emotional bent of a consumer towards the
desired products or services. Mutawaet.al. (2006), in the conference paper, have
mentioned that service or product itself is one of the principal factors of customer
satisfaction; defined as a system that customer goes through to receive the value for
money.Newmanet.al. (2001) opined that customer service is a prerequisite for
customer satisfaction. The value of service consists of eight dimensions viz.
Reliability, assurance, access, communication, responsiveness, courtesy, empathy, and
tangibles.
In some literatures, customer satisfaction has been defined as a cyclical model which
explains the relationship between customer satisfaction and customer loyalty.
According McAlexander (2003) customer satisfaction is an antecedents of loyalty
where as Compton (2004) opined that the customer loyalty drives the expectation
value that eventually drives the value of customer satisfaction in future purchase
(Compton, 2004). Lee (2004) defined customer satisfaction as a ratio of customer
perception and customer expectation. According to the Centre for the Study of Social
Policy (2007), satisfaction is a personal assessment of customers which is affected by
both the expectation and the experience of customers. As noted from the above
writings, there is no consensus on defining the response to satisfy. In short,
satisfaction is an emotional response (Zineldin 2006). Some theoretical concepts point
out the disconfirmation of expectations model (Oliver, 1980, Carson et.al.1998).
Satisfaction is also described on the basis the value of products and services that
customers or patients evaluate depending on customers’ experience and perception
(Liljinder and, Strandvik, 1995). Smith and Swinehart (2001) pointed out a strong
relationship between quality of product or service and satisfaction of customers.
According to them, customers’ perception regarding quality of products or services
brings about satisfaction in their mind.
Patient satisfaction is one of the established yardsticks to measure success of the

services being provided in the health facilities. But it is difficult to measure the
4
satisfaction and the gauze responsiveness of the health systems as not only the clinical
but also the non-clinical outcomes of care do influence the customer satisfaction.
Satisfaction has been defined as a consumer’s emotional feelings about a specific
consumption experience. It is a judgment that a product or a services feature, or the
product or service itself, provides a pleasurable level of consumption related
fulfillment.
1.1 Background:
The report is originated to make a study on the Customer Satisfaction of Gulshan

Maa os Shishu Clinic Ltd. as a part of the fulfillment of internship program required
for the completion of MBA program of ADUST. As the part of MBA curriculum this
internship is assigned to me by Mr. Saifur Rahman Saif, (Manager), Gulshan Maa O
Shishu Clinic Ltd. and approved by the academic Supervision Prof. Dr. Md. Ashraf
Ali Khan, Chairman, Department of Business Administration, ADUST.
1.2 Problem Statement

The internship paper program is required for the student of MBA. It is a program with
duration of three months. Students who have completed all the required courses are
eligible for this program. After completing my graduation as a student of MBA, Atish
Dipankar University of Science & Technology Major in marketing, I like to do
internship in a reputed hospital, which would be helpful for my future professional
career. I got the opportunity to perform my internship paper in the Walton
Bangladesh.”. It was a Three months long practical orientation program. This
internship is originated as the requirement of Gulshan Maa O Shishu Clinic Ltd. and
as well as my degree. As a result of the Patient satisfaction is one of the established
yardsticks to measure success of the services being provided in the health facilities.
But it is difficult to measure the satisfaction and the gauze responsiveness of the
health systems as not only the clinical but also the non-clinical outcomes of care do
influence the customer satisfaction. Satisfaction has been defined as a consumer’s
emotional feelings about a specific consumption experience. It is a judgment that a
product or a services feature, or the product or service itself, provides a pleasurable
level of consumption related fulfilment.
5
1.3 Rationale of the Study
The success of a program like MBA is determined by how successfully the student of
this program implemented in the practical life, which they learned from the program.
Universities take many steps to make a bridge between the academic knowledge and
actual business world event for MBA students, internship is one of them. The
internship is an integral part of MBA (Master of Business Administration) program in
Atish Dipankar University of Science & Technology and it contains 3 credits. This
program is actually a juncture of academic and professional life dealings. It is about to
get some experience of practical work environment and also be familiar with that. The
world has now become globalize so we have to sustain in the competitive world. We
must take the competitive advantage that’s why we cannot avoid the environment
while doing business. That’s why I feel very much interest in Customer satisfaction of
the Gulshan Maa O Shishu Clinic Ltd. And it has another importance to me that is
an implementation of my educational knowledge and theoretical knowledge to the
practical.
Living in the world of information and technology, nowadays patients are aware of
their need and rights. They know that health care facilities are established to provide
satisfactory and quality health to them. If the health care facilities fail to do so, they
are considered unsuccessful in implementing their assigned tasks. Healthcare facility
performance can be best assessed by measuring the level of patient satisfaction. A
completely satisfied patient believes that the organization has potential in
understanding patient needs and demands related to health care.
The objectives of health care have changed with the requirement of society and the
unavailability of resources and technology. Health was being referred to the elements
of empirical perception/local understanding without any scientific examination. The
early 20th was basic science or disease-centered era. Health was being referred to
scientific reasoning and experimenting on disease, including diagnosis and treatment
of diseases. In the middle of the 20 th century experienced clinical science or patient
centered era. Health was centered mainly in hospitals and clinics and diagnosis and
treatment of individuals was performed. Late of the 20th century was public health
science or community. End of the 21st century saw political health science or people
centered era. Health has become people’s matter and need public participation,
including proper allocation of resources responding to public needs. The World Health
6
Organization conference, supporting health for all, held in 1990 defined future
development in health to be human centered. A lot of stress has been made on
investment in health, patient care and a patient’s right to delivery of quality health
care leading to patient satisfaction.
There is a general agreement that measurement of patient satisfaction fulfills several
distinct functions. Satisfaction can simply describe health care services from the
patient’s point of view and patient satisfaction may be thought of as a measure of the
“process” of care. Problem areas can be isolated and ideas towards solutions may be
generated. Evaluation of health care is regarded by many as the most important
function of patient satisfaction research. The function of patient satisfaction work was
wholly concerned with evaluation. At last four fields of evaluation need consideration
in the health care context. These are evaluation of specific treatment, evaluation of
patterns of care for particular patient groups, evaluation of organizations, and
evaluation of health system. Patient satisfaction studies have proved valuable in all
these fields.
1.4 Objective of the Report

There are two types of objective in this report:
1.4.1 Board Objective
The main objective of the paper is to assess the Client Satisfaction of Gulshan Maa O
Shishu Clinic Ltd.
1.4.2 Specific Objective
There are some specific objectives also. These are:

1. To assess the level of importance, the patients of Gulshan Maa O Shishu
Clinic Ltd. put across various service attributes and also to determine how
well this Clinic is satisfying or dissatisfying the patients on those service
grounds and different service quality dimensions.
2. Analyze patient’s opinion regarding satisfaction through questioning patents.
3. To come up with possible ways of improving service quality and efficiency
that will lead to bring more patient satisfaction for the Gulshan Maa O
Shishu Clinic Ltd.
1.5 Research Questions
7
1. What is the broad objective of Customer Satisfaction of Gulshan Maa O Shishu
Clinic Ltd.
1.6 Limitations of the Study

Full proof study is always difficult to achieve; this study is also not free from such
limitations. The limitation that I faced to prepare this report as:
1. Exclusive Information: Some exclusive information was not available. For
example, I collected the information of subscriber quantity that is
approximately
2. Time: To prepare a successful report requires long time. Moreover, I did not
get enough time to complete the report. Time was so limited to prepare this
report.
3. Report Writing: Before this report I did not prepare this type of report. So,
the correct form of writing a formal report was not very clear to me
8
CHAPTER # 02
METHODOLOGY OF THE STUDY
2.0. Methodology of the Study:
9
Data were collected from investigative patients through structured questionnaires at
private clinic facilities in the sampled in Gulshan Maa O Shishu Clinic Ltd. While
some research is now available on Bangladesh's health care system, patient
satisfaction issues have barely been examined. Thus, additional secondary sources
were consulted from the developed world. We feel more research is needed to analyse
Bangladeshi patients’ satisfaction level in a comprehensive manner.
2.0.1 Research Design

Because of resource and time constraints, and the preliminary nature of this
investigation, only 50 interviews were planned from the Gulshan Maa O Shishu
Clinic Ltd. To obtain a probability sample, considerable effort was devoted to
selecting the appropriate sampling plan.
2.0.2 Sampling Design

The sample plan covers target population, sampling frame, sampling technique and
sample size. These are presented below:
2.02.1 Target population
The target population of this study included all patients who had utilized health
services at the Gulshan Maa O Shishu Clinic Ltd. from the present. The sample was
patients who consumed OPD clinic services of the Clinic and were available at the
time of data collection.
According to the Zikmund (2003), it is important to carefully define the target

population so that the proper source, from which the data is to be collected, can be
identified. The population of the research was defined as Bangladeshis who have been
inpatients in public and private clinic in Dhaka City or in Clinics in a foreign country
within the past year. In this study, target population can be identified as patients,
attendance with the patients, outdoor patients. The sampling frame was patients that
are consulted by healthcare workers at the two medical centers
2.02.2 Sampling Frame
There was no such structured sampling frame that could be gathered conveniently.
10
1.02.3 Sampling Procedure
In case of choosing the sampling method here the first priority is Convenience
sampling. This refers that samples are unrestricted and researchers or field workers
have the freedom to choose whomever they find; thus the name convenience. The
convenience sample may consist of respondents living in an easy accessible locality.
Undoubtedly, it is the simplest and the least reliable form of non probability sampling.
The primary virtue is its low cost. Considering this method in mind here, I have tried
to focus on those samples which are easy to get access.
2.02.4 Sample Size

One of the most important problems in planning a sample survey is that of
determining how large a sample is needed for the estimates to be reliable enough. Due
to resource and time constraints, a sample size of 50 is used in this research. At the
time of selecting the sample here the most considerable things are that the patients
who are staying at least seven days, who are in general wards, who are in the cabin,
the attendances of the patients, the outdoor patients etc. A total of 56 surveys was
completed; 50 of these are retained as 6 had excessive missing data.
2.0.3 Data Collection:

The data used to furnish this report has been collected from the Primary sources &
secondary sources.
2.0.3.1Primary sources:
The research initially conducted in-depth discussions with different patients about the
entire process that they underwent to obtain the necessary care when afflicted. It also
includes personal interviews, telephone interviews and self administrated
questionnaires.
2.0.3.2 Secondary sources:
11
While some research is now available on Maa O Shishu clinic, patient satisfaction
issues have barely been examined. Thus, additional secondary sources were consulted
from the developed world. Here information is collected from the different websites,
journal and textbook. I feel more research is needed to analyze Bangladeshi patients’
satisfaction level in a comprehensive manner.
2.3 Data Analysis and Presentation

According to the Zikmund (2003), the two basic criteria a questionnaire must meet if
it is to achieve the researcher’s purpose are relevance and adequacy. A questionnaire
is relevant if no unnecessary information is collected, and if the information that is
needed to solve the business problem is obtained. The adequacy of the questionnaire
is determined by its being reliable and valid .The validity of the survey instrument
was assessed by a variety of techniques-
1. The face, content, and consensus validity was determined by literature review
and expert judgment.
2. Construct validity, (convergent validity and divergent validity) was assessed
using exploratory factor analysis and confirmed by item total correlations.
3. Predictive validity was examined by measuring the instrument’s ability to
predict patient’s intentions to recommend.
The questionnaire consisted of 12 questions. Here we developed questionnaire on the

basis of five point Likert scale and the point scale was, SA defines Strongly Agree, A
defines Agree, N defines Neutral, D defines Disagree and SD defines Strongly
Disagree. Where 1 refers Strongly Disagree, 2 refer Disagree, 3 refer Neutral, 4
refer Agree and 5 refer Strongly Agree. The self administered questionnaire could be
printed or electronic questionnaires. The self administered questionnaire method is
chosen for the new patients who have not been consulted before. The questionnaire
took on average about ten minutes to complete.
12
CHAPTER # 03
LITERATURE REVIEW
3.1 Literature Review
13
Services are intangible in nature and thus it is difficult to assess and measure as
compared to the products as it is an elusive and abstract concept and thus same for the
service quality. Service quality can be defined as “conformance to customer
specification”.
According to Gronroos, service quality is measured as technical and functional
quality. According to Parasuraman, Zeithaml, service quality is the difference between
customer perceptions and expectations. Whereas Zeithaml believes that service
quality is based on customer perception about the services delivered by the service
provider and how these services meet or exceed their expectations and it is purely
based on customer judgment. Expectations for the high quality of services had
increased in the lives of the people due to increase of economic share of the service
sector in almost all the economies of the world and it has reached in half sum of Gross
National Product’s (GNP’s). The key strategy for survival and success of any industry
or any business is aimed to deliver superior quality of services to their customers.
Due to intangible in nature service quality is difficult to measure and defining the
parameter to evaluate the quality of services delivered to the customer was the major
issue in the beginning. The first service quality model was presented by Parasuraman,
Zeithaml and authors explored that customer perception about the service quality is
influenced by 5 ‘gaps’ and it is also known as ‘gap’ model. Gap 1 shows the
difference between customer expectations and management perception of customer
expectations. Gap 2 is the difference between management perceptions about service
quality and service quality specifications. Gap 3 is the difference between service
quality specifications and service quality delivery. Gap 4 is the difference between
service delivery and external communication to customers and gap 5 is the difference
between expected and perceived service quality.
SERVQUAL model is based on gap 5 that was influenced by first four gaps. Earlier,
service quality was measured by comparing customer expectations with customer
perceptions on the basis of ten dimensions which includes; reliability, tangibility,
14
communication, security, credibility, competence, understanding, access,
understanding/knowing customers, responsiveness. Further, this model was refined by
Parasuraman, Berry and service quality can be measured on the basis of five
dimensions; reliability, tangible, responsiveness, assurance and empathy and these
five dimensions were further assessed by 22 items.
3.1.1 Concept of Patient Satisfaction
Linder-Pelz (1982) approached a definition of patient satisfaction through content

analysis of satisfaction studies. Five social- psychological variables were proposed as
probable determinants of satisfaction with health care. These are occurrences which
actually takes place and perhaps more importantly, the individual’s perception of what
occurred; value that is an evaluation in terms of good or bad of an attribute or an
aspect of a health care encounter; expectation which is belief about the probability of
certain attributes being associated with an event or object, and the perceived probable
outcome of that association; interpersonal comparisons in which an individual rates
the health care encounter by comparing with all such encounters known to or
experienced by him or her; entitlement that is an individual’s belief that she/he has
proper, accepted grounds for seeking or claiming a particular outcome.
Risser (1991) defined patient satisfaction as the degree of congruence between a
patient’s expectation of ideal nursing care and his perception of the real nursing care
that he receives. Swan (1985) suggested that patient satisfaction is a positive
emotional response that is desired from a cognitive process in which patients compare
their individual experience to a set of subjective standards. Linder-Pelz (1982) defined
patient satisfaction as an expression of an attitude, an effective response, which is
related to both the belief that the care possesses certain attribute
components/dimension and the patient’s evaluation of those attributes; and as the
Individual’s positive evaluations of distinct dimensions of health care.
3.1.3 Determinants of Satisfaction
Expectation
15
Expectations emerge repeatedly as having a fundamental role in expressions of
satisfaction. Stimson and Webb (1975) were among the first to suggest that
satisfaction is related to the perception of the benefits of care and the extent to which
these meet the patient’s expectations. Risser (1975) and Fitzpatrick (1984) mentioned
that the elemental bearing of expectations is reflected in several definitions of patient
satisfaction, and it is supported by research evidence. For example, Abramowitz et al
(1987) found that not only can patients hold different expectations and satisfaction
with specific aspects of care, but that expectations and satisfaction with specific of
care play independent roles in predicting patient satisfaction.
Expectations make more complex the concept of satisfaction as an evaluative tool. As

patient satisfaction is a recognized component of Quality Assurance, it is therefore
tempting to equate “high” levels of reported satisfaction with “high” levels of quality
of care. However, in considering patient satisfaction study results, it is necessary that
“expressions of satisfaction should always be interpreted in the context of some
understanding of the rationale that underlies those expressions rather than being taken
at face value”. In the nursing context, for example, several theories have disputed that
satisfaction can simply be equated with quality of nursing care. In addition to nursing
treatment, a patient’s quality of life is affected by environmental, informational,
personal or social variables, and that a mediating variable-perception- is necessary.
Bond and Thomas (1992) summarized the problem succinctly: different levels of
satisfaction may indicate different perspectives on nursing care quality rather than
different levels of satisfaction with the same experience.
Larsen and Rootman (1976) hypothesized that the more a doctor’s performance meets
a patient’s expectations, the more satisfied the patient will be with the physician’s
services (18). The hypothesis was strongly supported. The few later studies in which
the relationship between patient expectations and overall satisfaction has been
explored consistently suggest that patients with “lower expectations” tend to be more
satisfied.
3.1.4 Patient Characteristics
It is commonly believed that satisfaction with health care may be dependent on

variables such as social class, marital status, gender and age. A meta-analysis of work
16
reported before 1989, however, concluded that social-demographic are at best a minor
predictor of satisfaction. Fitzpatrick (1990) and Fox and Storms (1981) are among the
many reviewers who highlight the lack of consistency of the effects of these variables
in satisfaction studies.
Perhaps the most consistent determinant characteristic is patient age, with a body of
evidence from various countries to suggest that older people tend to be more satisfied
with health care than do younger people. Cartwright and Aderson (1981) found that
older respondents expected less information from their doctor. Hopton et al (1993)
and Khayat and Salter (1994) found that younger patients were less satisfied with
issues surrounding the consultation in the primary care setting. Younger patients were
also less likely to comply with prescriptions or medical advice. Older people have
also been found to be far more satisfied with most aspects of their hospital care than
younger or middle aged people.
Educational attainment has been identified as having a significant bearing on

satisfaction, the trend being that greater satisfaction is associated with lower levels of
education. Much of this evidence is from the U.S. Anderson and Zimmerman (1993)
found that level of education to be the only variable significantly related to patient
satisfaction with consultations in two Michigan clinics, patients with lower levels of
education being the most satisfied. Similarly, Schutzet al (1994) found that higher
educational attainment was strongly associated with dissatisfaction in patients
undergoing colonoscopy. The relationship between satisfaction and social “class” is
less consistent, a problem being that socioeconomic variables are often simply not
assessed. Hall and Dornan (1990) viewed social status as having “nearly significant
relations” with satisfaction, but as greater satisfaction were associated with higher
social status. The authors added that it was “perplexing, to say the least, “that results
for social status and education went in opposite directions.
It has generally been found that patient gender does not affect satisfaction values, a
conclusion reached also in the meta-analysis done by Hall and Dornan (1990). One or
two dissenting reports have appeared. Khayat and Salter (1994) reported that
significantly more men than women were satisfied overall with their general
practitioners. Another British study found that female inpatients were far more likely
to complain of rigid timetables and lack of privacy than men.
17
A number of “social-psychological artifacts” may affect expressions of patient
satisfaction. “Social desirability response bias” argues that patients may report greater
satisfaction than they actually feel because they believe positive comments are more
acceptable to survey administrators. Similarly, “ingratiating response bias” occurs
when patients use the satisfaction survey to ingratiate themselves with researchers or
medical staff, especially if there are any reservations over the anonymity of
respondents. A number of observers have suggested that patients may be reluctant to
complain for fear of unfavorable treatment in the future. Related to ingratiate response
bias is “self-interest bias”. This proposes that as most social programs-which includes
health care services- act as providers, clients are likely to perceive that expressions of
satisfaction will contribute to the continuation of the service which in turn will be in
their own self-interest. LeVois et al (1981) noted that this theory is supported by both
the “economic view”, that individuals seek to maximize their own self-interest, and
the “social exchange perspective”, that behavior is governed by an exchange of
activities. Two further phenomena are particularly interesting when considering
Williams’ (Williams, 1994) theory that dissatisfaction is only expressed when an
extreme negative event occurs. Firstly, “gratitude” as a phenomenon is well
recognized as confusing satisfaction results. In the U.K. gratitude has often been
associated with the more elderly population. An early study of hospital inpatient
satisfaction reported that 68% of the sample felt unable to express desires, fears, or
criticisms to the medical staff. The emphasis for these patients was on self-control, on
a minimum of dependency, on being “cooperative”, “undemanding”, “considerate”,
and “grateful”.Ley (1972) noted an additional phenomenon influencing response:
simple indifference. Patients may feel problems will not be remedied and so there
would be no point in commenting on them, either because the problem is too trivial or
perhaps too large.
3.1.5 Components of Satisfaction
Several classifications of components have been proposed, some appropriate only for
specific health care contexts, others aiming at broad applicability. Abdellah and
Levine (1965) attempted an early identification of key components, proposing
18
adequacy of the facilities, effectiveness of the organizational structure, professional
qualifications and competency of personnel and the effect of care on the consumers.
Reviewing U.S. patient satisfaction research conducted from 1957 to 1974, Risser
(1975) reported that four components emerged: cost, convenience, the provider’s
personal qualities and nature of the interpersonal relationship, and the provider’s
professional competence and perceived quality of care received.
Ware et al (1983), in a review, presented a more definitive taxonomy with eight

dimensions (40). They are as follows:
1. Interpersonal manner-features of the way in which providers interact

personally with patients (e.g. Respect, concern, friendliness, courtesy);
2. Technical quality of care-competence of providers and adherence to high

standards of diagnosis and treatment (e.g. Thoroughness, accuracy,
unnecessary risks, making mistakes);
3. Accessibility/convenience-factors involved in arranging to receive medical

care (e.g. Waiting times, ease of reaching providers);
4. Finances-factors involved in paying for medical services;
5. Efficacy/outcomes of care-the results of services provided (e.g. Improvements

in or maintenance of health);
6. Continuity of care-constancy in provider or location of care;
7. Physical environment-features of setting in which care is delivered (e.g.

Clarity of signs and directions, orderly facilities and equipment, pleasantness
of atmosphere); and
8. Availability-presence of medical care resources (e.g. Enough medical facilities

and providers) Ware’s classification has been the basis for much later work, as
statistical techniques such as factor analysis have been promoted as providing
“evidence” that satisfaction is a multidimensional construct. Fitzpatrick (1990)
19
proposed almost identical dimensions to Ware’s bar “finances” for the UK
setting.
However, as many satisfaction studies are conducted in very specific contexts it is
understandable that any standard classification never seems entirely appropriate.
Accessibility
In the standard Ware/Fitzpatrick framework, a broad definition of “accessibility”

includes issues such as physical access to hospitals, GP surgery hours, appointment
systems, receptionists, changing doctors, home visits, and appointment waiting lists.
Poor parking, public transport and waiting times at health centers have all been found
to relate to patient dissatisfaction. UK, outpatient departments seem particularly prone
to long waiting times.
Interpersonal Aspects of Care
The interpersonal aspects of care are regarded as the principal component of

satisfaction. Two aspects regarded as particularly important are communication and
empathy. Sociological models based on both psychoanalytical and Parsons’ analyses
of the health professional/patient relationship propose a spectrum of high to low
control in medical encounters. Central to these models is the balance of power. Power
is primarily related to status and competence: the doctor’s power is carried in a
generally higher social status, more medical knowledge and perceived competence.
Hypotheses that this balance of power may influence satisfaction with physicians
have, however, not been confirmed by research. Furthermore, there is evidence that
nurse - who has a lower social status than doctors - also rate badly in term satisfaction
with communication.
Successful interactions depend also on the social skills of the participants. Nonverbal
communication is often the primary mode of transmitting emotions and attitudes
which would be rarely spoken out loud. Body positioning-location, distance, and
posture-can transmit important perceptions of relative power. Lacrosse (1975) found
that nonverbal behavior such as leaning slightly forwards and nods of the head make
patients see doctors as warmer and more attractive, while Larsen and Smith
(1981) found doctors’ forward lean and body posture to be associated with higher
patient satisfaction. Eye contact is particularly important in establishing a rapport, in
20
monitoring reactions and in requesting feedback, and if eye contact is broken the
nature of the conversation is likely to become more formal, impersonal and brief.
Technical Aspect of Care
Fitzpatrick (1984) noted that many patients appear to have more confidence in
commenting on convenience, cost, and doctors’ and nurses’ personal quality than in
expressing dissatisfaction with medical skill. There is, however, some evidence that
patients are generally fairly good at assessing technical aspects of care or have a
reasonable level of medical knowledge. Fitton and Acheson (1979) found a positive
correlation between doctors’ and patients’ rating of the seriousness of their medical
condition, only a handful of patients misjudged the seriousness of their problem.
Stimson and Webb (1975) proposed several reasons why the competence gap should
not be seen as absolute. Firstly, the health professional’s knowledge is never
complete: the degree of knowledge about medicine I general, or a particular medical
problem, will vary from practitioner to practitioner. Secondly, physicians can never be
certain of the outcomes of their actions as medicine operates at the level of probable
cause of an illness and the probable effect of treatment. Thirdly, the doctor never has a
complete monopoly over relevant medical knowledge: patient can- and many do –
acquire knowledge from other sources, and some may well have as much knowledge
about their condition as does a junior doctor. Fourthly, the doctor may not always in
possession of all the information that may be relevant to a particular illness, especially
information held by the individual patient.
The main reason of satisfaction studies fail to emphasize the importance of the
technical quality of the care delivered is that patients assume a basic level of
competence in medical procedures undertaken upon them. If the medical procedures
are found to be deficient, thesis associated with patient complaints- a clear indicator
of dissatisfaction with a service.
3.1.6 Patient Education/Information
The patient’s right to be informed constitutes one of the most important rationales for
patient’s education. Beyond patient’s right, issues of patient education are relevant to
legal mandates, particularly regarding processes such as “informed consent”. Patient
education has further been shown to have cost-benefit to society in terms of reduced
number and/or length of hospital stays, more appropriate use of hospital services, less
absenteeism from school and work, reduction in accidents, and acquisition of health
21
awareness behavior. Patient education has been linked with positive clinical outcomes
such as improved adherence to a therapeutic regime, reduced anxiety, and enhanced
ability to cope with symptoms, enhanced recovery after surgery, and enhanced
recovery after outpatient procedures. In addition, enhanced information has been
found to improve satisfaction. An early study of GP patients found that satisfaction
related significantly to comprehension of information, and that greater comprehension
of information related to higher compliance with the doctor’s advice. Similarly,
patients dissatisfied with the information received at neurological outpatient clinics
were found to be far less likely to take medication as advised.
3.1.7 Satisfaction with Health Facilities among Thais
In the study of client satisfaction towards curative services in a general hospital in

Bangkok, it was determined that the areas of dissatisfaction were long waiting time,
weak physician patient relationship, and poor cleaning and hospital settings.
The study on client satisfaction towards the health services of Lad Yao hospital in Lad
Yao district, Nakhonsawan province, revealed that the average score of client
satisfaction was 3.9 and only 52% of clients felt satisfied with the services. The
rehabilitation service achieved a client satisfaction level about 85% while promotion-
prevention and curative care services achieved 40% and 51% respectively. In this
study, patient attitude was found to be significantly associated with the satisfaction
level and identified as a predictive factor of satisfaction in all kinds of health services.
Besides, age, education level, actual expectation compared with the previous
expectation was found to be significantly associated with the satisfaction level of
patients. In the study of client satisfaction on outpatient medical care service in
Sampran community hospital, Thailand, it was found that older patients had higher
levels of satisfaction and age had associated with satisfaction. Female clients and
married clients were more satisfied with medical services than male and single clients.
The study on satisfaction with health care services and real reasons for health seeking
behavior among Thai people: a case of Klong Yong, Nakhon Pathom province,
reported that patients with acute illness used health services at the health center more
than those with chronic illness. Sita R.D., in his study about consumers’ satisfaction
towards health care services provided by a health center in Muang district, Loei
province of Thailand, found that repeat visitors had a higher proportion of higher
22
satisfaction than the first time visitors. The study of Roy reported that clients with
lower income were more satisfied than those with high income .
The survey conducted in April 2005 and 2006 by Wangnumyen Community Hospital
found that the overall satisfaction level reported by patients who had utilized the
outpatient department (OPD) clinic were 75.68% and 81.7% respectively. It was also
found that the quality of care at the OPD clinic, doctors’ manner, doctors’ attention
and respect paid to patients, nurses’ manner, time spent with patients, and physical
examination received satisfaction level 78% , 80.4%, 80%, 78.4%, 71.6%, and 73.6%
consecutively.
3.1.8 Satisfaction with Health Facilities in other Country
The study of Ansari about client satisfaction towards health center services in Urban
Islamabad reported that clients with low income were significantly more satisfied
with services than those with high income. In the study of patient satisfaction towards
outpatient department services at Pakistan Institute of Medical Services, Islamabad,
and the researcher found that 54% of patients had high satisfaction level. And 53% of
them were highly satisfied with physical facility.
3.1.9 Justification of the Criticality of SERVQUAL Model in Measuring Patient

Satisfaction
According to Sohail (2003), SERVQUAL instrument among several tools for

measuring patient satisfaction is the most widely used tools. From the above literature
survey, it is observed that some studies have proven the reliability of SERVQUAL
model. Some other studies have confirmed five generic quality dimensions of the
SERVQUAL instrument where as some studies have identified either less number of
23
dimensions or additional dimensions. On the basis of variation in dimensionalities,
researchers prefer to apply modified version of the same instrument. Initially, in 1985,
SERVQUAL instrument considered ten dimensions viz. Reliability, responsiveness,
competence, access, courtesy, communication, credibility, security,
understanding/knowing the customer, tangibles. In 1988, the same model has been
modified by reducing the number of dimensions from ten to five viz. Responsiveness,
reliability, assurance, tangibles and empathy. Later on some researchers modified the
same by replacing some dimensions of the new components which were never
considered earlier in the original model of SERVQUAL. From literature survey it has
been observed that some identifiable dimensions have been selected based on country
specific cultural practices. As for example, in hospitals of
Bangladesh, discipline, communication and ‘baksish’ (tips) to employees have been
considered as one of the dimensions. The SERVQUAL model helps obtain customer
rating of perception and expectation on the basis of ordinal scale. It has also been
found that the application of statistical tool with the ordinal data in the SERVQUAL
model is inappropriate.
3.2 The Theoretical Framework
The important components of hospital services in the context of Bangladesh, as

derived from theoretical considerations and the data structure, are as follows.
Service Factors
Reliability
24
Reliability is the ability to execute the promised services consistently and accurately.
In Bangladesh, reliability of the provider is often perceived as low for various
reasons, such as the accusation that doctors recommend unnecessary medical tests,
there is an irregular supply of drugs at the hospital premises, supervision of patients
by care providers is irregular, and specialists are unavailable. Perceptions of reliability
are also attenuated when doctors do not provide correct treatment the first time. In
view of these reliability drivers, we felt that the more reliable the health care
providers, the greater the patients’ satisfaction.
Responsiveness
Responsiveness is the degree of willingness to help and facilitate the customers by
providing prompt services to the customers. Patients expect hospital staff to respond
promptly when needed. They also expect the required equipment to be available,
functional and able to provide
quick diagnoses of diseases. In addition, patients also expect prescribed drugs to be

available and properly administered, as other indicators of responsiveness. Thus we
posit that the greater the responsiveness of health care providers, the greater the
satisfaction of patients.
Assurance
Assurance is about knowledge, skills and expertise of the employees involved in
delivering services and the ability to create trust and confidence among the customers.
Knowledge, skill and courtesy of the doctors and nurses can provide a sense of
assurance that they have the patient's best interest in mind and that they will deliver
services with integrity, fairness and beneficence. For a service that is largely credence
based (Zeithaml and Bitner 2000), where customers are unable to evaluate the quality
of the services after purchase and consumption, the sense of assurance that is
engendered can greatly influence patient satisfaction. In the health care system,
assurance is embodied in service providers who correctly interpret laboratory reports,
diagnose the disease competently, provide appropriate explanations to queries, and
generate a sense of safety. Nurses also play an important part in providing additional
support to patients’ feelings of assurance by being well-trained and by addressing
25
their needs competently. Thus, the greater the perceived assurance of the health care
providers, the greater will be the satisfaction of patients.
Tangibles
Tangible is about the physical facilities like infrastructure, labs, equipment and human
resources involved in delivering the services. Physical evidence that the hospital will
provide satisfactory services is very important to patient satisfaction judgments.
Generally, good appearance (tangibility) of the physical facilities, equipment,
personnel and written materials create positive impressions. A clean and organized
appearance of a hospital, its staff, its premises, restrooms, equipment, wards and beds
can influence patients’ impressions about the hospital. However, in Bangladesh, most
of the hospitals/clinics are lacking in many of the above attributes, thereby attenuating
patient satisfaction. We posit that the better the physical appearance (tangibility) of
the health care service facility and the service providers, the greater will be the
patients’ satisfaction.
Communication
Communication is also vital for patient satisfaction. If a patient feels alienated,
uninformed or uncertain about her health status and outcomes, it may affect the
healing process. When questions of concern can be readily discussed and when
patients are consulted regarding the type of care they will be receiving, it can alleviate
their feelings of uncertainty. Also, when the nature of the treatment is clearly
explained, patients’ awareness is heightened and they are better sensitized to expected
outcomes. Appropriate communication and good rapport can, thus, help convey
important information to influence patient satisfaction. In particular, patients expect
doctors and nurses to communicate clearly and in a friendly manner regarding
laboratory and other test results, diagnoses, prescriptions, health regimens, etc.
Similarly, nurses are expected to understand patient problems and to communicate
them to the doctor properly. It is proposed that the better the quality of
communication perceived by the patient, the greater will be their level of satisfaction.
Empathy
Empathy is about the individual attention and care provided to the customers by the
service provider and its human resource. Health care providers’ empathy and
26
understanding of patients’ problems and needs can greatly influence patient
satisfaction. Patients desire doctors to be attentive and understanding towards them.
Similarly patients expect nurses to provide personal care and mental support to them.
This reflects service providers’ empathy. We posit that the more empathy received
from the service provider, the greater the satisfaction of the patients.
Process Features
Process features refer to an orderly management of the overall health care service
process. This constitutes patients’ expectation that doctors will maintain proper
visiting schedules and that there will be structured visiting hours for relatives, friends,
etc. Updated patient records and standard patient release procedures also facilitate
patient care. The practice of paying ‘Baksheesh’ (an informal but small facilitation
payment), on the other hand, is an indication of process failures that can sometimes go
out of control. We feel that the better the process features at the hospitals, the higher
will be the level of satisfaction of the patient.
27
CHAPTER # 04
Data Analysis and Evaluation
4.1 Data Analysis Interpretation

The patient’s importance & level of satisfaction of “Clients Satisfaction Level in
Gulshan Maa O Shishu Clinic Ltd.” shown briefly. The results are produced
according to the various service quality dimensions. Each dimension consists of its
28
own specific questions. The results of the survey are presented according to these
questions that were asked to the respondents with the help of a structured
questionnaire. The results of this study are given below in the next page:
Q: 1 The Physical Structure at the Clinic is Visually Appealing
Respondents expressed their satisfaction as follows:

Here 0% patients are strongly disagree, 4% patients are disagree with this service,
34% patients are neutral, 58% are agree with this and 4% patients are strongly agree
with this point of view.
Rank Frequency Percentage

Strongly Disagree (1) 0 0%
Disagree (2) 2 4%
Neutral (3) 17 34%
Agree (4) 29 58%
Strongly Agree (5) 2 4%
Total =50 =100%
Table 1: The Physical Structure at the Clinic is Visually Appealing
Chart-1: The Physical Structure at the Clinic is Visually Appealing (Agree)
Here the table shows the physical structure of Clinic is visually appealing. From this
graph, we can see that the majority 58% respondents are agree with this statement. So
the Clinic should continue this beautification system by their physical structure.
29
Q2.The Clinic has modern equipments for Specialized Treatment.
Here 0% patients are strongly disagree,18% patients are disagree with this service,
with this point of view. The results are as follows:
Disagree (2) 6 12%
Neutral (3) 18 36%
Agree (4) 24 48%
Total =50 =100%
Table 2: The Clinic has Modern equipments for Specialized Treatment
Chart-2: The Clinic has Modern equipments for Specialized Treatment (Agree)
Here the table shows that the physical structure of Clinic is visually appealing. From
this graph, we can see the majority 48% respondents are agree with this statement. So
the Clinic should take some more steps to continue the modern equipment for
specialized treatment.
Q3. The Clinic has a number of Beds for The Patients.
30
Disagree (2) 21 42%
Neutral (3) 19 38%
Agree (4) 6 12%
Total =50 =100%
Table 3: The Clinic has sufficient number of Beds for the Patients
Chart-3: The Clinic has sufficient number of Beds for the Patents (Disagree)
Here the table shows the graph, we can see that the majority 42% respondents are
disagree with this statement and 38% respondents are neutral. So the Clinic should
increase a huge number of beds for the patients to improve its better quality.
Q4. The Clinic has adequate number of Doctors for the Patients.
31
Disagree (2) 17 34%
Neutral (3) 27 54%
Agree (4) 6 12%
Total =50 =100%
Table 4: The Clinic has adequate number of Doctors for the Patients
Chart-4: The Clinic has adequate number of Doctors for the Patients (neutral)
Here on the graph we can see that the majority 54% respondents are neutral and 34%
of respondents are disagree with this statement. So the Clinic should increase the
number of doctors for the patients in this Clinic. It will be better for improving the
service quality.
Q5. The prescription of the Doctors is Reliable to You

0% patients are strongly disagree, 10% patients are disagree with this service, 46%
patients are neutral, 40% are agree with this and 4% patients have strongly agreed
Disagree (2) 5 10%
Neutral (3) 23 46%
32
Agree (4) 20 40%
Total =50 =100%
Table 5: The prescription by the Doctors is Reliable to You
Chart-5: The prescription of the Doctors is Reliable to You (Neutral)

Here on the graph we see the majority 46% of respondents is neutral and 40% of
respondents are agreed. So Clinic should continue and they can try to increase
services if they want.
Q6. The registration procedure is Speedy Enough.

patients are neutral, 28% are agree with this and 0% patients are strongly agree with
this point of view. The results are as follows:
Disagree (2) 12 24%
Neutral (3) 24 48%
Agree (4) 14 28%
33
Total =50 =100%
Table 6: Registration procedure is Speedy Enough
Chart-6: Registration procedure is Speedy Enough

Here on the graph we see majority 48% of respondents is neutral and 24% of
respondents are disagree. So the Clinic should increase registration procedure is
speedy enough. It will be better for improving the service quality.
Q7. Test result in Clinic is Reliable.

0% patients are strongly disagree, 10% patients are disagree with this service,36%
Strongly Disagree 0 0%
(1)
Disagree (2) 5 10%
Neutral (3) 18 36%
Agree (4) 24 48%
34
Total =50 =100%
Table 7: Test result in Clinic is Reliable
Chart-7: Test result in Clinic is Reliable (Agree)
Here the table shows the physical structure of Clinic is visually appealing. From this
graph, we can see that the majority 48% respondents have agreed with this statement.
So the Clinic should keep and also continue this reliability position from the patients.
Q8. Employees in the Clinic are consistently Courteous with You

Disagree (2) 11 22%
Neutral (3) 23 46%
Agree (4) 16 32%
Total =50 =100%
35
Table 8: Employees in the Clinic are consistently Courteous with You
Chart-8: Employees in the Clinic are consistently Courteous with You (neural)
From this graph, we see the majority 46% respondents are neutral and 22%
respondents are disagree with this statement. So the employees should more courteous
with the patients in the Clinic. It will be better to improve its service quality.
Q9. The Clinic has Operating Hours Convenient for all its Patients
Disagree (2) 6 12%
Neutral (3) 31 62%
Agree (4) 13 26%
Total =50 =100%
36
Table-9. The Clinic has Operating Hours Convenient for all its Patients
Chart-9. The Clinic has Operating Hours Convenient for all its Patients (neural)
Here the table shows operating hours convenient for all its patients. From this graph,
we see majority 62% respondents are agree with this statement. So the Clinic should
continue for its patients.
Q10. Nurses Attended to You Sincerely when needed

Disagree (2) 3 6%
Neutral (3) 29 58%
Agree (4) 18 36%
Total =50 =100%
37
Table- 10. Nurses Attended to You Sincerely when needed
Chart-10. Nurses Attended to You Sincerely when needed (neural)
Here the table shows the Nurses attended to you sincerely when needed. From this
graph, we can see that the majority 58% respondents are neutral with this statement.
So the Clinic should somehow increase operating hours convenient to all its patients.
Q11. You were Pleased with the Clinic's Services

Disagree (2) 6 12%
Neutral (3) 21 42%
Agree (4) 22 44%
Total =50 =100%
38
Table-11. You were Pleased with the Clinic's Services
Chart-11. You were Pleased with the Clinic's Services (neural)
It’s a vital question and from this graph, we can see that the majority 44% respondents
are neutral and 42% respondents are disagree with this statement. So the Clinic should
increase the services anymore.
Q12. In future, if You feel one Sick, You will return to this Clinic for Services
48% patients are neutral, 34% are agreeing to this and 2% patients are strongly
agreeing with this point of view. The results are as follows:
Disagree (2) 7 14%
Neutral (3) 24 48%
Agree (4) 17 34%
Total =50 =100%
39
Table-12. In future, if You feel one Sick, You will return to this Clinic for Services
Chart-12. In future, if You feel one Sick, You will return to this Clinic for
Services (neural)
Here 48% of respondents are neutral with this segment. So for increasing reliability
about Clinic services and management should take immediate necessary steps for
patients' satisfaction.
40
CHAPTER # 05
Findings of the Study
5.1 Findings of the Study

Following are important findings of this study:
01. The Physical Structure at the Clinic is Visually Appealing
The physical structure of Clinic is visually appealing. From this graph, we can see that
the majority 58% respondents are agree with this statement. So the Clinic should
continue this beautification system by their physical structure.
Q2.The Clinic has modern equipments for Specialized Treatment.

The physical structure of Clinic is visually appealing. From this graph, we can see the
majority 48% respondents are agree with this statement. So the Clinic should take
some more steps to continue the modern equipment for specialized treatment.
03. The Clinic has a number of Beds for the Patients.
41
We can see that the majority 42% respondents are disagree with this statement and
38% respondents are neutral. So the Clinic should increase a huge number of beds for
the patients to improve its better quality.
04. The Clinic has adequate number of Doctors for the Patients.
We can see that the majority 54% respondents are neutral and 34% of respondents are
disagree with this statement. So the Clinic should increase the number of doctors for
the patients in this Clinic. It will be better for improving the service quality.
05. The prescription of the Doctors is Reliable to You

We see the majority 46% of respondents is neutral and 40% of respondents are agreed.
So Clinic should continue and they can try to increase services if they want.
06. The registration procedure is Speedy Enough.

We see majority 48% of respondents is neutral and 24% of respondents are disagree.
So the Clinic should increase registration procedure is speedy enough. It will be better
for improving the service quality.
07. Test result in Clinic is Reliable.

The physical structure of Clinic is visually appealing. From this graph, we can see that
the majority 48% respondents have agreed with this statement. So the Clinic should
keep and also continue this reliability position from the patients
08. Employees in the Clinic are consistently Courteous with You

We see the majority 46% respondents are neutral and 22% respondents are disagree
with this statement. So the employees should more courteous with the patients in the
Clinic. It will be better to improve its service quality.
09. The Clinic has Operating Hours Convenient for all its Patients
42
The operating hours convenient for all its patients. From this graph, we see majority
62% respondents are agree with this statement. So the Clinic should continue for its
patients.
10. Nurses Attended to You Sincerely when needed

The Nurses attended to you sincerely when needed. From this graph, we can see that
the majority 58% respondents are neutral with this statement. So the Clinic should
somehow increase operating hours convenient to all its patients
43
CHAPTER # 06
RECOMMENDATIONS & CONCLUSION
6.1 Recommendations:
This study leads to a number of recommendations for contributing to the improvement
of quality of health services at the OPD clinic of Gulshan Maa O Shishu Clinic Ltd
as follows:
1. The accessibility to health services at the OPD clinic has been the major
concern of patients, the researcher, therefore, strongly supports the comments
given by patients, in which the Clinic should consider waiting time for seeing
doctors and pharmacists as a priority issue that needs tube addressed as soon
as possible in order to meet the patient’s satisfaction. The Clinic should pay
more attention to the regulation of working hours of his OPD clinic and put
44
more efforts to reinforce the implementation of this regulation. And the
recruitment of more doctors should also be considered.
2. This study also revealed that quality of care needs to be improved, in

particular in the area of physical examination and treatment performed by
doctors, and the duration of time that doctors spend with patients. Medical
technical team of the clinic should review more often the physical examination
and tree performance by doctors, and the improvement of this performance
must be bound by the time that doctors spend with patients.
3. Networking between the community clinic and local health centers should be
strengthened in order to share the responsibility for providing health care to
patients. Patients with simple diseases such as common cold and headache
which were the leading cause of morbidity found in this study should be
treated at the local health centers. Besides, simple ANC cases also can be
taken care by the local health centers So that it will help to reduce the
workload of doctors at the OPD and ANC clinic. As a result, the doctors will
have more time to carefully examine and treat patients with complicated
diseases.
4. Interpersonal manner of doctors and nurses also should be considered to

improve as much as possible. Two way communication with politeness and
friendliness should be applied during the provision of medical care services to
patients. Good communicator model should be established for the OPD clinic
as soon as possible so that it will help to increase patient satisfaction level.
5. This study pointed out that patients less satisfied with their medical expense.
Even though the amount of patients who paid out of pocket was less than those
who did not pay anything, their satisfaction still needs to be considered and
improved by carefully discussing with patients on their ability to pay and
matching their need rather than their demand in case of their ability to pay is
limited. In addition, price of medications should be posted in front of the
pharmacy in order to keep patients informed for the sake of transparency, and
this will help the OPD clinic to satisfy his patients.
45
6.2 Conclusion:
Patient satisfaction is the key indicator that can reflect the health service quality at any
level of health care facilities. The objectives of this study were to assess the level of
patient satisfaction towards health services at the OPD clinic of Gulshan Maa O
Shishu Clinic Ltd. and to determine the association between dependent and
independent variables. The dependent variable of interest was the patient satisfaction
towards health services at the OPD clinic of Gulshan Maa O Shishu Clinic Ltd The
patient satisfaction was concerned with six components: interpersonal manner of
health service providers, accessibility, physical environment, availability of medical
care resources, quality of care and medical service expenses. The independent
variables were predisposing factors such as age, gender, education level, occupation,
marital status, and attitude; enabling resources including income, health insurance,
travelling time, and transportation cost; and the need factors such as health problems
and expectation. Patient attitude and expectation were separately studied in each
section of the questionnaire.
A structured questionnaire was used as a study instrument for data collection. There
were five sections in the questionnaire: general information regarding the patients,
patient expectation towards health services, patient attitude towards health services,
patient satisfaction towards health services, and patient suggestions/comments to
improve the quality of health services at the OPD clinic of Gulshan Maa O Shishu
Clinic Ltd. Despite considerable work undertaken in the area of measuring service
quality in healthcare, there is no consensus yet as to which one of the measurement
scales is robust enough for measuring and comparing service quality. In the face of
uncertainties, healthcare organizations have to be reprogrammed and renewed,
repositioning themselves for the future. Thus our questionnaire is an attempt to
reprogram and renew the dimensions which are influencing service quality. Although
it is argued that reality is there to be studied, captured and understood, it can never be
fully apprehended; only approximated. Thus the future studies need to adopt
triangulation – ‘use of several different research methods to test the same finding’ to
affirm the proposed conceptual framework. Every year government allotted lots of
funds only to develop the Clinic services but mismanagements, corruptions are the
major obstacles for improving the quality.
46
BIBLIOGRAPHY
Books & Journals

1. Agrawal D. Health Sector Reforms: Relevance in India.Indian Journal of
Community Medicine 2006; 31:220-2
2. Andaleeb, S .S, Siddique, N, .Khandakar, S, (2007) patient satisfaction: a

matter of choice. Journal of Service Marketing, 14(7), 557-572.
3. Chanawongse K. Understanding primary health care management: from

theory to practical reality. Nakhon Phathom: ASEAN Institute for Health
Development, Mahidol University; 1994.
47
4. Medical Newsletter, January 2006, DTP, Medical Department, Beximco
Pharmaceuticals Ltd.
5. Ministry of Health and Family Welfare. Dhaka: Planning Wing, Ministry of

Health and Family Welfare, Government of Bangladesh; 2003. Health,
Nutrition and Population Sector Program, July 2003-June 2006.
6. P. Padma, C. Rajendran and L. S. Prakash, “A conceptual framework of

service quality in healthcare – Perspectives of Indian patients and their
attendants”, Benchmarking: An International Journal, vol.16, no.2,pp.157-
191, 2009.
7. Patient satisfaction with health services in Bangladesh by Syed Saad

Andalee ,Nazlee Siddiqui and Shahjahan Khandakar.
8. YEAR BOOK 2009.Ministry of Health and Family Welfare Government of

the Peoples Republic of Bangladesh.
Websites
 http://banglapedia.search.com.bd/HT/S_0267.htm Banglapedia
 http://nation.ittefaq.com/artman/publish/article_27661.shtml The
Daily New Nation Online Edition
 http://nation.ittefaq.com/artman/publish/printer_27661.shtml
 http://www.accessmylibrary.com/coms2/summary_0286-
15142476_ITM
 http://www.highbeam.com/doc/1G1-145450495.html
 wikipedia.org
 www.google.com
48
Appendix-1
Questionnaire
This Questionnaire has prepared for a internship paper on “Clients Satisfaction
Level in Gulshan Maa O Shishu Clinic Ltd.” An academic term paper designed to
access the service expectations at hospital. The information will be kept confidential
and the response will be aggregated for analysis. I appreciate your participation.
In the following scale, SA defines Strongly Agree, A defines Agree, N defines
Neutral, D defines Disagree, SD defines Strongly Disagree.
Put Mark ( ) on the best option
SD D N A SA
Number Variables
1. The Physical Structure at Hospital is visually
appealing to you.
2. The hospital has modern equipments for
specialized treatment.
3. The hospital has a number of beds for the
patients.
4. The hospital has adequate number of doctors
for the patients.
5. The prescription of the doctors is reliable to
you.
6. The registration procedure is speedy enough.
7. Test result in hospital is reliable.
8. Employees in the hospital are consistently
courteous with you.
9. The hospital has operating hours convenient
for all its patients.
10. Nurses attended to you sincerely when needed.
11. You were pleased with the hospital's services.
12. In future, if you feel one sick, you will return
to this hospital for services.
49

Chapter # 01

Uploaded by

Document Information

Original Title

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

Chapter # 01

Uploaded by

Copyright:

Available Formats

CHAPTER # 01

There is a general agreement that measurement of patient satisfaction fulfills several

Satisfaction is a psychological concept which is defined in different ways. Sometimes

Howard and Sheth (1969) explained customer satisfaction as a cognitive response of

Patient satisfaction is one of the established yardsticks to measure success of the

The report is originated to make a study on the Customer Satisfaction of Gulshan

1.2 Problem Statement

1.4 Objective of the Report

There are some specific objectives also. These are:

1.5 Research Questions

1.6 Limitations of the Study

METHODOLOGY OF THE STUDY

2.0. Methodology of the Study:

2.0.1 Research Design

2.0.2 Sampling Design

According to the Zikmund (2003), it is important to carefully define the target

2.02.2 Sampling Frame

2.02.4 Sample Size

2.0.3 Data Collection:

2.0.3.2 Secondary sources:

2.3 Data Analysis and Presentation

The questionnaire consisted of 12 questions. Here we developed questionnaire on the

3.1 Literature Review

3.1.1 Concept of Patient Satisfaction

Linder-Pelz (1982) approached a definition of patient satisfaction through content

3.1.3 Determinants of Satisfaction

Expectations make more complex the concept of satisfaction as an evaluative tool. As

3.1.4 Patient Characteristics

It is commonly believed that satisfaction with health care may be dependent on

Educational attainment has been identified as having a significant bearing on

3.1.5 Components of Satisfaction

Ware et al (1983), in a review, presented a more definitive taxonomy with eight

1. Interpersonal manner-features of the way in which providers interact

2. Technical quality of care-competence of providers and adherence to high

3. Accessibility/convenience-factors involved in arranging to receive medical

4. Finances-factors involved in paying for medical services;

5. Efficacy/outcomes of care-the results of services provided (e.g. Improvements

6. Continuity of care-constancy in provider or location of care;

7. Physical environment-features of setting in which care is delivered (e.g.

8. Availability-presence of medical care resources (e.g. Enough medical facilities

In the standard Ware/Fitzpatrick framework, a broad definition of “accessibility”

Interpersonal Aspects of Care

The interpersonal aspects of care are regarded as the principal component of

3.1.7 Satisfaction with Health Facilities among Thais

In the study of client satisfaction towards curative services in a general hospital in

3.1.8 Satisfaction with Health Facilities in other Country

3.1.9 Justification of the Criticality of SERVQUAL Model in Measuring Patient

According to Sohail (2003), SERVQUAL instrument among several tools for

3.2 The Theoretical Framework

The important components of hospital services in the context of Bangladesh, as

quick diagnoses of diseases. In addition, patients also expect prescribed drugs to be

Data Analysis and Evaluation

4.1 Data Analysis Interpretation

Q: 1 The Physical Structure at the Clinic is Visually Appealing

Respondents expressed their satisfaction as follows:

Rank Frequency Percentage

Table 1: The Physical Structure at the Clinic is Visually Appealing

Chart-1: The Physical Structure at the Clinic is Visually Appealing (Agree)

Table 2: The Clinic has Modern equipments for Specialized Treatment

Q5. The prescription of the Doctors is Reliable to You

Table 5: The prescription by the Doctors is Reliable to You

Chart-5: The prescription of the Doctors is Reliable to You (Neutral)

Q6. The registration procedure is Speedy Enough.