m Healthcare Workers Satisfaction and Patients’ Satisfaction: An Effort to Find out Linkage

Healthcare Workers Satisfaction and Patients’ Satisfaction: An Effort to Find out Linkage

Dr. Dhananjay Mankar 1, Aditi Choudhary 2, Dr. Himani Gujar 3

Abstract

Background: Patient satisfaction is the real testimony to the efficiency of hospital administration. A patient is the ultimate consumer of the hospital. Therefore, patient satisfaction has become increasingly popular as a critical component in measuring the quality of care. Literature suggests the significant impact of employee satisfaction on patient satisfaction. Thus, the study’s objective is to determine the level of patient satisfaction towards OPD services with reference to Employee Satisfaction. Materials and Methods: Descriptive and analytical research designs were used to conduct the study. A stratified random sampling technique was used while selecting the samples. Twenty-five employees were interviewed according to a structured questionnaire. A patient satisfaction level questionnaire was administered to a sample of 50 patients. Descriptive statistics were used to express the categorical variables. Results: Patient feedback findings bring out positive responses from over 70% of the patients on this aspect. 56% reacted average/unhappy with the overall experience about referring the hospital. Employee satisfaction findings highlight dissatisfaction among hospital employeeson the grounds of exploiting work atmosphere, inadequate training provision, being overloaded, recognition of efforts, and lack of support from a supervisor. Positive feedback was obtained on the grounds of effective communication by the management, knowledge about the job profile, and training and development. Conclusion: Assessment of patient satisfaction can improve service quality. By viewing employees as ‘internal customers,’ efforts to create higher employee satisfaction can have desirable outcomes on enhanced care quality and increased patient satisfaction. Keywords: patient satisfaction, patient experience, employee satisfaction, out-patient department Conflict of Interest: None declared Source of funding: None declared

Introduction

Patient satisfaction is a fact that lies between a patient expectation of an ideal nursing home and his perception of the real nursing care that he receives.[1] As the hospital serves all the members of society, the users’ expectations differ from one individual to another because everyone carries a particular set of thoughts, feelings, and needs. Patient satisfaction is thus defined as a patient’s subjective evaluation of their cognitive and emotional reaction as a result of the interaction between their expectation regarding ideal nursing care and their perceptions of actual nursing care.[2]

In general, patient satisfaction is defined as a measure of patients’ contentedness with the health care they receive from their health care provider. Modern era patients are pretty aware and educated about the diseases, types of treatments, and available healthcare facilities, causing increased expectations from the healthcare system. The tremendous rise of competition among the health care providers with the rapidly growing health care industry makes it even more important for pro-

1 Assistant Professor, Mumbai Campus, Centre for Hospital Management, 2 Student, Mumbai campus, Masters of Public Health, Social epidemiology, 3 Student, Mumbai Campus, Masters of Hospital Administration, School of Health System Studies, Tata institute of Social Sciences Corresponding Author: Aditi Choudhary, Student, Mumbai campus, Masters of Public Health, Social epidemiology, School of Health System Studies, Tata institute of Social Sciences. Email: aditichoudhary287@gmail.com

viders to focus on excellent outcomes in terms of both treatment and patient satisfaction.

McNealy emphasised the importance of the ‘perception gap’ or the gap between patients’ perceptions of care and their needs and expectations. If this gap is nonexistent and the performance level is already at satisfaction or the ‘delight’ levels, patients will be happy and satisfied, as shown in Figure 1.

Figure 1: The Performance-Perception gap (Adapted from: Mohd A et al. Patient satisfaction with services of the outpatient department. MJAFI. 2014.)

Addressing this gap through quantitative measurement of customers’ perceptions of the performance and their needs/expectations can have strategic implications, like better marketing and merchandising services to potential customers.

The measurement of patient satisfaction as an essential tool for research, administration, and planning was emphasised by WHO in 1984. It is known to be one of the most important quality parameters as it helps determine the level of services catered by the medical staff. Patient satisfaction measurement adds important information on system performance, thus contributing organization’s total quality management. A satisfied patient is more willing to recommend the hospital to provide

Figure 2: Hypothesized model of contact-employee supports

(Adapted from: Yoon MH et al. Effects of contact employee supports on critical employee responses and customer service evaluation. JSM. 2004) care to others. As suggested by this wealth of findings, positive changes in employee attitudes lead to positive changes in customer satisfaction. A model developed by Yoon, Hyun Seo and Seog Yoon, indicates three antecedents affecting employee service quality through their effect on employee service effort and perceived job satisfaction,[4] as shown in Figure-2. Out of these three, perceived supervisory support is the most powerful predictor of job satisfaction and employee service effort. Job satisfaction is a more important predictor of employee service quality than effort.

Healthcare employee satisfaction has been found to have several impacts on the quality of care delivered, which ultimately influences the level of patient satisfaction. Employee’s satisfaction negatively impacts the quality of care and ultimately has an adverse effect on patient loyalty and in turn, hospital profitability, healthcare employee moral also demonstrates a strong relation with patient satisfaction.

Materials and Methods

The study uses employee surveys and customer surveys. Descriptive and analytical research designs were used to conduct the study. A structured questionnaire was administered to the employees, including patient and employee satisfaction questions. Another questionnaire was used to identify the patient satisfaction level in a sample of 50 patients. The observation was conducted on patient traffic control and front office staff absenteeism.

Study settings: The study was carried out over four weeks in a multispecialty private hospital in Telangana.

Sampling Technique: Stratified random sampling technique was used in selecting the samples.

Sample Size Calculation: The study population consisted of 50patients. Three types of patients were involved in the study, viz: cash patients, international patients and corporate patients. 25 employees across various positions participated in the study. The age group of the employee ranged from 24 to 45 Years. The personnel interviewed consisted of 10 assistant officers, 12 junior officers, 2 senior officers, and 1 executive. The sources from which information was derived were surveys, relevant file studies, registration data, appointment system, and referrals.

Method of Data Collection: The questionnaire developed for data collection contained both open-ended and closed-ended questions regarding the patient’s socio-demographic history, satisfaction with the doctor, location of the registration desk, adequate seats in the waiting area, behaviour of the staff and reasons for revisiting the hospital. It was pilot tested, and after ap-

propriate amendments, was used to collect data from the patients. Informed and voluntary consent was taken from the patients after explaining the purpose of the study to them.

Tool and Techniques used for Data Collection:

q Personal observation: direct & indirect observation q Interview with staff q Interview with patients/ relatives/ attendants and other external customers q Systemized feedback

Data routinely collected by the hospital was utilised in the study. The hospital regularly collected data on employee satisfaction and patient satisfaction. Employee satisfaction data were collected by the hospital as part of an annual employee survey. Patient satisfaction data were collected at the time of a patient’s discharge from the hospital. Both data sets were then matched at the department level to assess the relationship between employee satisfaction and patient satisfaction.

Data analysis: Descriptive statistical analysis was used to determine significant factors impacting patient and employee satisfaction.

Results

Patient Feedback Findings [Table 1]: 72% of patients/respondents were unhappy with the appointment systems. The Contact Centre of the hospital was relocated and was inadequate, which resulted in negative feedback and disappointments as a majority of the calls were unattended. It failed to create the desired first impression.

Table 1: Patient Satisfaction Survey results

38% of the respondents were extremely satisfied as they rated excellent, and 42% rated good for the front office team behaviour. The majority of the front office staff was polite and courteous as per their feedback. Regarding the registration and billing process experience, 20% of the respondents were happy, whereas 50% rated well. Explanation of treatment and treatment plan was experienced as extremely satisfying by the majority of the respondents as 70% ratings were excellent and 30% were good. 80% of the study population agreed that cleanliness was good. The sitting arrangement, signage and directions, drinking water and washroom facilities were also found to be good as per stated responses. However, 56% reacted average or unhappy with the overall experience as they would think on referring any near and dear ones.

Employee survey findings [Table 2]: Employee feedback survey reflected a great deal of dissatisfaction on the grounds of several parameters, making them feel less valued at work. Positive feedback was also captured by the survey on some grounds. The following results were drawn: 56% of the employees, that is, more than half of the total employees, revealed a negative feeling about team co-operation. Similarly, more than half of the employees (52%) believed that the hospital does not recognise contributing the most to the organisation. 60% of employees felt that they do not have the freedom to do the work their way, like assisting patients out of the way, which is not as per the SOP. Many employees, 68%, believed that the immediate supervisor is not friendly and reported unavailability during critical times. Upon asking if the place is friendly to work in, 52% of employees reported groupism among employees who do not wish to extend support or involve other team-mates. 68% of employees felt that they get unfair treatment from their supervisor. 24% of employees showed dissatisfaction regarding the organisation’s investment on employees, as they wished that the hospital should help them for higher studies by granting financial support as a loan. 32% of employees’ expressed dissatisfaction about the extension of consent by the management, when possible, to do so. 48% reported negatively about being treated fairly in terms of below aspects: • Mutual respect between all employees • Employees are treated courteously • Fairly and equitably rules to all • Proper approach • Equality

Table 2: Employee Satisfaction Survey Results

Nonetheless, counting on the positive feedback, 80% of the employees understood and knew the job profile. 76% of the employees believed that the management conveys proper communication. 76% of the employees felt that the organisation promotes ongoing learning, and the Learning and Development (L&D) department plays an active role in improving the necessary skills. 64% of employees felt that the supervisor follows ‘opendoor’ policy and is available to entertain any queries. They thought employees are welcomed to clarify issues. Lastly, 52% of the employees believed that the hospital treats them fairly.

Discussion

The study agreed that measuring patient satisfaction has a bearing on quality improvement of care. As found in the study by Al-Abri et al., [5] patients’ evaluation of care is a practical tool to provide an opportunity for improvement, enhance strategic decision making, reduce cost, meet patients’ expectations, frame strategies for effective management, monitor healthcare performance of health plans and provide benchmarking across the healthcare institutions. In another study conducted in AIIMS, Bhubaneshwar agrees that the satisfaction level of patients, from the patient’s perspective, facilitates identifying the areas of improvement, and helps generate ideas towards resolving these problems.[6] A recent study carried out in a tertiary care teaching hospital in South India complies with the finding, that patient satisfaction surveys may be a good audit tool and should be used to improve the standard of services.[7] Contrary to this study, where 95.5% of patients agreed to recommend the hospital to others, our study showed lesser satisfaction (56%) when asked for a referral. In our study, 72% of patients/respondents were unhappy with the appointment systems. Negative feedback and disappointments resulted as most calls were unattended. However, in the study by Nilakantam et al. in the Mysore tertiary care teaching hospital, a small proportion of 7.3% of the respondents faced difficulties in the registration process. 80% of the respondents in our study were satisfied with the Front office team behaviour, as compared to 95% in the study by Nilakantam et al. [7] Results as per observation show that the OPD waiting area was not adequate to cater to the footfall. A study at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India, showed 93% patient satisfaction with the waiting area. A good response regarding the signage system was found, contrary to the study at AIIMS, Bhubaneshwar, where only 50% of patients utilise signage for guidance and navigation. Satisfaction was found to be high (80%) in the study group regarding the cleanliness of OPD services. A similar study was conducted in the outpatient department of Tertiary care hospital, Jabalpur, Madhya Pradesh, India, which indicated that 70% of patients are satisfied with the cleanliness of the OPD.[8]

A study by Tan, Foo and Kwek,[9] also recognizes that the emotions displayed by employees in in-service settings have implications for customer satisfaction. The way employees feel about their job impacts their work experience, thereby impacting their quality-of-service delivery. However, they are more likely to do so if they are satisfied with their job. Employees were dissatisfied with numerous aspects of job satisfaction, which was reflected in customer feedback. As described by Berry [10], patients will be loyal if the service provider is able to attract, maintain, and enhance customer relationships. Pauli et al., explains the importance of word of mouth in the health sector emphasising the linkage with employee satisfaction, “Patient loyalty is linked to employee satisfaction and also influences the recruiting of new

patients and new employees”.[11] Satisfied employees have high energy and willingness to give good service: at a very minimum, they can deliver a more positive perception of the service/product provided.

Health care is an extremely people-based industry. Because of this, human resource is believed to be the greatest asset of all, and an empowered, motivated, and satisfied workforce can bring indissoluble strength to the organisation.

Conclusion

Patient satisfaction is significantly a dependent factor of the quality of services provided at the outpatient department. It was observed that apart from medical and nursing care, other support facilities provided by the hospital, front office/customer care play a major role in customer satisfaction. Although, patients were found to be satisfied with both the physical and behavioural dimensions of service, and the overall patient satisfaction was average, they were found to be dissatisfied/unhappy about the front office services. Patient satisfaction is greatly influenced by staff behaviour, which in turn is determined by employee satisfaction and motivation. Employees were having some internal disputes among each other, as well as with the organisation, which reflected in their work. Employee satisfaction needs to be addressed by the organisation. In addition to what health care workers do, emphasis needs to be placed on how the employees feel about what they do.

Recommendations

• Hospital waiting room facility is not enough to satisfy patients as the level of satisfaction is only 70%.

Attendants of the patients who are in ICU are also waiting in the OPD waiting area, which crowds the area and there is no separate facility for them. Free space on the first floor can be utilized by the hospital to create waiting area for attendants, thus decrowding OPD waiting area. • For enhancing more cohesive company culture, the hospital should been couraging and training teams to work well together, thus increasing workplace productivity. • An open-door policy should be adopted by the managerial staff. It is a communication policy in which the higher authorities leave their office door ‘open’ to encourage openness and transparency with the employees of that company. • A company-wide email acknowledgment, or shoutout in a meeting, can go a long when it comes to recognition and appreciation of efforts, creating motivation. • Key Performance Indicators as a long-term goal-de-

fining process should be developed to inculcate better role clarity among employees and accomplishment of tasks within clear time limits.

Limitations of the study

1. Our study comprises people belonging only to a particular part of India living in southern part of the country. 2. Reluctance of patient to express their true feelings about the care they received, and also the generosity factor acts as intervening factors. 3. The present study only estimates, but does not infer the effect of employee satisfaction and customer satisfaction on tangible business outcomes. 4. As this study was conducted over a limited period of time, we were not able to include post treatment outcome and post treatment quality of life.

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