“IMPACT OF HOSPITAL SERVICES ON OUTPATIENT SATISFACTION”

SYNOPSIS FOR RESEARCH PROJECT

Submitted to the Board of Advanced Studies and Research

Dow University of Health Sciences
In partial fulfillment of the requirement
For the Degree of
Master of Business Administration
(Health Management)

By

Dr. Ishrat Nazir

Institute of Health Management

Dow University of Health Sciences

Karachi, Pakistan

May, 2017

SUPERVISOR

Mr. Mohammad Rizwan

Assistant Professor
MBA, MS
 CHAPTER 1

INTRODUCTION

1.1 Background of Research

The general procedure for a patient care can be seen in three steps i.e. waiting in OPD, during

consulting in doctor’s room and after taken service from the doctor. It is imperative for the

hospital to understand the whole processes included in the experience of the patient. The

experience of the patient includes various variables, for example, specialist's expertise, his

communication with the doctor, performance and behavior of the paramedical staff, different

medical services offered by the healthcare center, behavior of care staff, cleanliness and structure

of the hospital. Patient satisfaction and loyalty is an important performance measurement tool for

a private health care sector. There are various problems faced by the patients in outpatient

departments, like overcrowding, delay in consultations, lack of proper guidance that leads to

patient dissatisfaction. It is seen that like every other public healthcare sector, the patients have

received more attention and quality care; in private healthcare hospitals. The Hospitals effort to

maintain and establish relationship between patients and Hospital staff, has offered a great deal

of advantages, for example, surviving competitive competition, loyalty in patient, diminishing

the need to contend exclusively on cost premise and expanding new patient base by referrals.

This study will help the patients in enhancing and developing more comfortable and satisfied

association and loyal relationship with hospitals, and creating more trust and confidence towards

private healthcare hospitals.

1.1.1 Patient Satisfaction

Patient satisfaction is of prime importance when patients themselves make selection decisions.

Health care service dimensions and factors affecting patient satisfaction, researchers have studied
 on various service quality areas in which patient satisfaction are considered the most important

tool for evaluating the quality aspects of hospitals such as latest equipment, physical facilities,

ease of supplementary services, nature and response of doctors and medical staff. Today,

hospitals are forced to deliver a good quality service to the patient and how it could be best

measured. A key factor in establishing and delivering quality medical services is the need to

understand the patient’s desire and requirements in order to provide quality services which meet

those needs as per the resources available.

1.2 Research Objective

1. To study the out-patient’s perception towards the reliability private hospital services.

2. To study the impact of behavior and personal attention of doctors and staff on out-patients in

private hospitals.

3. To study the impact of healthcare services on the revisit and referral intentions of out-patients in

private hospitals.

1.3 Research Hypothesis

H01 The hospital facility has significant influence upon patient satisfaction.

H02 Behavioral and personal attention of doctors and paramedical staff has a significant

influence on patient satisfaction.

H03 Patient satisfaction has a significant influence on re-visit intention for medical services.

H04 Patient satisfaction has a significant influence for referring hospital to other patients.

1.4 Scope of Study

The scope of this study would be developing stronger and more comfortable relationship with the

provider, patient’s loyalty towards hospital based on significant interpersonal experience they

have with the doctors and nurses and about the quality of services of the hospital.
1.4.1 Inclusion Criteria

Patients in OPD, emergency, diagnostics and pharmacies. Patients whose age ranges are from

18-50 years old. Patients who are willing to give consent. Patients who are able to listen/read and

understand local language. Patients who visit the hospital as outpatient in the hospital.

1.4.2 Exclusion Criteria

Patients who have psychological illness, inpatients, gyne and ops, patients whose age ranges are

less than 18 or greater than 50 years. Patients who are not willing to give consent.

1.5 Justification of study

In this study, my aim is to investigate the factors of quality affecting the value of care and patient

satisfaction and to major relationship and patient loyalty towards hospitals.

1.6 Limitations

This study is conducted as a cross sectional study with a very short time from May to July 2017

so patient’s loyalty and revisits/referrals may also change over time.

CHAPTER 2

Literature Review

A review of the literature reveals many studies that have shown a positive relationship between

satisfactions and measures of buying intention and also between service quality perceptions and

satisfaction.

Researchers have identified several possible variables that may result in patient’s satisfaction

with the doctor’s services. (Fred David, Garner C. Alkin 2006): These factors have included

perceived doctor's ability, care and concern towards patients, cost of treatment and relationship

between doctor and patient. Many reviews show that a lower need is put on patient's perception

on patient's run clinical desires of service quality.

As indicated by the American Marketing Association (AMA), consumer loyalty is how much

the patient's desires are satisfied or outperformed by a quality or service.

(Gilmore Audrey, Goodman Bill Reidstead Man 2006): A practicing professionals knows that

patients view of quality service in health care is not precise due to the failure of patients to

analyze and judge the specialized capability of medical professionals with accuracy.

(Boonshoof and Gray 2004): Have performed the studies on the relationship between medical

service quality, consumer loyalty and satisfaction. The review of the study was to find out

whether hospital service quality and relationship between doctors and consumer satisfaction will

improve patients loyalty towards private health care industry.

Meaning of quality on healthcare system has been interpreted differently by different

researchers.

(Ovretveit, 1992) Identified three components of quality: patient, physicians and administration

Quality of care and service consist of structure, process and healthcare results (Peabody et al,

1999); and there are eight dimensions of healthcare service delivery: effectiveness, efficiency,

technical competence, interpersonal relations, and access to service, safety, continuity and

physical aspects of healthcare.

(Lovelock and Wright, 1999): Assure the patients to realize and believe in hospital service

quality and best service delivery where patients utilize and gain the best outcome of hospital

service.

Enhancing the service quality of medical care becomes an important concern for patients, and, in

order to achieve and provide perfect health care service to patients, service quality has turned

into most important concern for hospitals to achieve loyalty of patients towards organization

(Alhashem et al., 2011; Arasli et al., 2008).

Understanding outpatient’s evaluation of hospital service quality performance will show

relationship of loyal patients to their hospitals (Kessler and Mylod, 2011).

Failure to understand the importance of patient satisfaction and providing quality service may

loss the revisiting and referral loyalty of patient (Padma et al., 2010).

Patient satisfaction is being a critical factor to competitive advantage and nowadays, patients are

more knowledgeable with health care services, so quality services may not be able to ensure a

long term relationship between patients and hospital (Gaur et al., 2011).

Even Woodside et al. (1989) defined the Hospital medical services quality as a gap between

patient’s expectations and the real performance and very confidently verified a practical model

leading to satisfaction and intention to buy a particular service based upon medical services

quality measurements using the SERVQUAL model.

 Proposed Concept Model

Independent Variable Dependent Variable

Parasuraman et al., (1988) has initiated a lot of discussions and debates on medical services quality

from the perspective of patients. He suggested measuring the quality of services provided to

customers through recognized performance by users and of expectations based upon the five

dimensions of service quality i.e. tangibles, reliability, responsiveness, assurance and empathy.

(1) Tangibles. Physical facilities, equipment and appearance of personnel.

(2) Reliability. Ability to perform the promised service dependably and accurately.

(3) Responsiveness. Willingness to help customers and provide prompt service.

(4) Assurance (including competence, courtesy, credibility and security). Knowledge and

courtesy of employees and their ability to inspire trust and confidence.

(5) Empathy (including access, communication, understanding the customer). Caring and

individualized attention that the firm provides to its customers.

 CHAPTER 3

Research Methodology

3.1 Research strategy:

A quantitative/descriptive survey will be conducted, in this survey hospital services is the

independent variable and patient satisfaction is the dependent variable. Using a modified

questionnaire of service quality sample size will be approximately visiting the outpatient

department of Murshid hospital. The questionnaire will measure statements of patient

expectation and perception to the actual services provided by hospital and their loyalty towards

hospital in form of revisits and referrals.

3.2 Definition of Population

The overall population of this research study consists of the patients visiting the Murshid hospital

and mother and child healthcare hospital Karachi, Pakistan

3.3 Sampling Technique

A non-probability judgmental sampling will be performed.

3.4 Methods for administering survey

A self-administered survey will be administered to collect data

3.5 Survey Instrument

A structured/close-ended questionnaire, with five-point Likert scale will be administered

3.6 Methods for data analysis:

Data will be analyzed through SPSS version 20. Descriptive and/or inferential analysis will be

used to analyze and interpret data.

 CHAPTER 4

Questionnaire

1. What is the patient’s age?

a. 18-25

b. 26-30

c. 31-40

d. 41-50

2. What is the patient’s gender?

a. Male

b. Female

3. What is the educational status?

a. Educated

b. Non-educated

Tangibles

4. Does the hospital have all latest equipments?

a. Yes

b. No

5. Physical facilities are visually appealing?

a. Strongly Agree

b. Agree

c. Disagree

d. Strongly Agree
6. Place where you can get medical service are conveniently located?

a. Strongly Agree

b. Agree

c. Disagree

d. Strongly Disagree

Reliability

7. Doctors and staff spend enough time with patient to evaluate the diseases?

a. Strongly Agree

b. Agree

c. Disagree

d. Strongly Disagree

8. Doctors and staff take efforts to maintain accurate records?

a. Strongly Agree

b. Agree

c. Disagree

d. Strongly Disagree

9. Your expectations are fully met with regards to service?

a. Strongly Agree

b. Agree

c. Disagree

d. Strongly Disagree

Responsiveness

10. Doctors and staff respond to patients in waiting room/examination room quickly?
 a. Strongly Agree

b. Agree

c. Disagree

d. Strongly Disagree

11. Doctor and staff are easily accessible to patient’s medical problems?

a. Strongly Agree

b. Agree

c. Disagree

d. Strongly Disagree

12. Staff of reception counter is cooperative and helpful?

a. Strongly Agree

b. Agree

c. Disagree

d. Strongly Disagree

Assurance

13. Patient feels relaxed and assured while services are being provided?

a. Strongly Agree

b. Agree

c. Disagree

d. Strongly Disagree

14. Behavior of doctor and staff is very friendly and courteous manner?

a. Strongly Agree

b. Agree
 c. Disagree

d. Strongly Disagree

Empathy

15. Doctor and staff have priority for patient problem?

a. Strongly Agree

b. Agree

c. Disagree

d. Strongly Disagree

16. Doctor and staff treat patient with care and affection?

a. Strongly Agree

b. Agree

c. Disagree

d. Strongly Disagree

17. Doctor and staff show concern and respect to patient and his/her family?

a. Strongly Agree

b. Agree

c. Disagree

d. Strongly Disagree

Revisit and Referral

18. Are you satisfied with the medical services availed to re-visit again?

a. Strongly Agree

b. Agree

c. Disagree
 d. Strongly Disagree

19. Would you recommend the services to your family and friends?

a. Strongly Agree

b. Agree

c. Disagree

d. Strongly Disagree
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