A Study on Patients' Satisfaction in Private Sector Hospitals of Bangladesh

This paper aims at identifying the factors related to the satisfaction of patients in private hospitals of Bangladesh. Patient satisfaction has been measured by using five service quality dimensions suggested by Parasuramon and Ziethmal (1988). Questionnaire survey was conducted among the patients of 3 large private hospitals of Bangladesh located in Dhaka city. One hundred and fifty patients were interviewed with a structured questionnaire. Both descriptive and inferential statistics were used in analyzing data. Multivariate analysis techniques such as, Factor Analysis (FA) and Multiple Regression (MR) were performed to analyze the data. Results show that doctors' attention, patient caring, services of supporting staff, quality of catering services, and doctors' competence in providing services significantly affect the level of satisfaction of patients of private hospitals in Bangladesh.

1. eS

x study on Patients’ Satisfaction in Privat
Hospitals of Bangladesh

Md, Raihanul Hasan!

Dr. Nazrul Islan

Abstract

rei er can ang ee
ani M ee rae mao Re ew tat

Services, and do
San of patients of private hospitals in Bangladesh

Patient satisfaction, Doctor's attention, Patient caring, Services of
and Doctor's competence

Key Words:
poing staf, Catering servi

Background
Patient satisfaction is an important measure of service quality in health
fare systems of a country (Yildiz, 2004). It is a psychological
phenomenon concemed with happiness, contentment and experience of
The service receiver. It is an attitude towards a person's general
Orientation toward experience of health care. Satisfaction comprises both
Cognitive and emotional aspects towards previous experience,
expectations, and social networks (Keegan, et. al, 2003). It is the
function of cognitive and affective factors. Cognitive factors are related
to expected and perceived attribute performance that produce
isconfirmation while, affective factors are concemed with emotion,
tution of cause and equity of the service receivers (Oliver RL,
1993). Patient satisfaction is also defined as customer satisfaction

Senior Lecturer, Department of Business Studies, State University of Bangladesh,

Dhaka, Bangladesh. Email; rihanul@sub ed bd

2 Profesor & Dean, School of Business & Social Studies, State University of
Bangladesh, Dhaka, Bangladesh. Email: nazrllslam@sub edu bd

Jounal of SUB

2. vations and perceived performance of the services

Cate tem

he over
(Andale,
M Beten
(Ross et
substantially
performance, the patas

providers (Oliver, 1997). Aldana, Piechulek and Al-Sabir (2001) har
measured client satisfaction with general health-care clinic services yy
rural areas of Bangladesh. They found that perceptions of service
provider's behavior especially respect and politeness is strongly
associated with the satisfaction of the patients. Waiting time is algo an
important perception of the patients in Bangladesh. These aro ihe
expectations of the patients to the service providers which are the
prerequisites for the satisfaction (Figure 1). It shows that patient
satisfaction depends on the patients” characteristics, expectations about
the healthcare, feeling of satisfaction and ratings of healthcare. Patents
characteristics are influenced by health care provider and health care
received. A theoretical model of patient view is shown in Figure 1. The
concept of patent satisfaction has been treated differently by the studies
differently to measure the quality of health care services (Tomlinson &
Kao, 2006). The studies included the areas such as, access to care,
continity-of care, courtesy, emotional support, overall coordination,
patient education, patient preferences, pharmacy access, specialist care,
and visit coordination. Sekhar (2010) found that patient satisfaction is
dependent on, or influenced by, the referral pattem, period of stay,
previous exposure to the hospital’s services, sex, and age of the paient,
household income, or educational qualification.

3. Figure 1: A Theoretical Model of Patient Views (Pemeger TV, 2004)

Study also shows that the patients” satisfaction also depends on
healthcare providers and healthcare delivery system and hence, needs to
be periodically measured to enhance the quality of the services (Ifiekhar
Ahmed and Siraj ud Din, 2010). Choi et a. (2005) found that most past
studies on healthcare management adopted process quality in measuring
perceived service quality. GrOnroos (1990) analyzed that the
SERVQUAL instrument focuses on measuring service process which is
relevant to patient satisfaction. The SERVQUAL is a 22-item
measurement instrument used to measure consumers’ perception of
service quality. The 22-items were again averaged into five dimensions
such as, tangible, reliability, responsiveness, assurance, and empathy
(Parasuraman, Zeithaml, and Berry, 1988).

Research also identified scales that are psychometrically sound and
‘confirm that satisfaction results from a complex cognitive and affective
mechanism which will highlight the interactive characteristics of the
services (Helena Vinagre, José Neves, 2010). Monnin and Pemeger
(2002) developed 14-item scale used to assess the level of satisfaction of
patient especially in the physical therapy area. The items are: (i)
iy of administrative procedure, (ii) courteousness and
helpfulness of secretary, (ii) ease of scheduling, (iv) skill and ability of
physical therapist to put patient at their comfort level, (+) explaining
‘what the patients will go through during the treatment, (vi) receiving
Worthy information any patients need at the end of their treatment
concerning their future, (vi) the sense of security at every level of period
of the treatment, (viii) degree to which treatment meet the need of to

(mua

4. aves? pote, (eee ol access OF physic
patients? P therapy

mouth’, However, most reviews on patic ation
specific. There is wely any the ical or conceptual developme ofthe
patient satisfaction concept and measurem Het

has little standardiza n
Angeably with, and asa proxy for, perceived service quality,

ally different (Liz Gill and Lesley White, 2009),

used int
which is a concept
Patent satisfaction has two-fold importance from a country perspective,
Fr it helps as to know the feedback of the people about the health care
Kervicos of the country and second, the overall condition ofthe health
sector of the country. The health system of a country usually depends on
Service delivery, workforce, information, products, financing and
Stewardship. Patents’ status and future challenges of the health service
System in Bangladesh might be conceptualized within these six building
blocks. In Bangladesh, there are about 50,000 medical doctors (MBBS),
3,500 dental surgeons, 24,000 furses, 3,000 hospitals both in public and
private sectors, 18 government medical colleges, 41 private medical
Colleges, 15 postgraduate medical institutions’ university, and S00
district and thana hospitals.’ About 3% of GDP is used for the health
care purposes in Bangladesh out of which about 1.10% is contributed by
the government. The total health expenditure of Bangladesh is about
USS 12 per capita per year, of which the public health expenditure is
only around USS 4 dollars* The rest of the expenditure is incurred for
obtaining healthcare services from the private hospitals. This indicates
that the private sector hospitals are essential to provide health care
services and they are contributing more than the government sector in
Bangladesh. But the quality in providing health care services by the
private hospitals is hardly up to the expectation level of the patients
Hence, this study explores the factors related to the satisfaction of the
private hospital patients in Bangladesh

‘The main objective of this study is to identify the patient satisfaction
factors and the level of satisfaction in private hospitals of Bangladesh

5 pagadshDemogrpic and Heath Survey 207, Dial Bangladesh
up neha oe cesse on 25% Mach 2011

SRE 10: |

5. cif objectives are (i) to describe the

me Pe of Bangladesh, (i) to identify the ker pones Of private
hops” satisfaction in private hospitals, (ii 0 identify me et, affect

iv) to give

“ions to improve the health ser p
o Private hospitals of

of thy

ngldesh
esearch Methods

sis study deals with the patent satisfaction of private hospitals
Bangladesh located in Dhaka city. There ae 184 hompials amg 97
Pia city. The total beds of 184 private hospitals or line, nes it
18000. Three largest private hospitals were included I le
faving 1,500 beds and this study covered 10% of the total be ay
Pespials were selected based on researchers’ judgment onthe number
feds. Hospitals with minimum 500 beds were slid as “amos
hospals. Thereafter, convenience sampling method was applied ao
<quilly distribute 50 respondents to each of the three hosptsls under
study. Sample respondents were selected from the private hospital hy
using following formula suggested by Yamane (1967) i

y

n=-
1+N@
Where, n = Sample Size; N= Population; e = Level of Precision.

In calculating sample size, the assumptions used are: (i) Population size

>100,000 patients, (ii) Level of precision 10%, (ii) Degree of variability
(0) is assumed as 50%,

Note that, a proportion of 50% shows a greater level of variability. It
indicates the maximum variability in the population, which is used in
determining a more conservative sample size. The sample size may be
larger if the true variability of the population attribute were used. The
level of precision was used as 10% as this study is a new study in
Bangladesh.

Hu das gob access on 10° February 2011

6. Ihe individual respondent was selected on a random bass. To go

information, a survey method was used with structured questing ed

(Table 1)
Table 1 Sample Distibution
Hospital Name Total eds Naar
Tay Family Red Crescent 308
Medical College Hospital, Dhaka
BIRDEM Hospital, Dhaka 596 5
Ad-din Medical College Hospital, 500 Pr
Dhaka
Toul 150

The questionnaire of the survey comprises 3 parts. Questions were
developed based on the instruments used by Choi et al. (2005),
SERVQUAL (Parasuraman, et al. 1988), and its refined version
(Andaleeb, 1998). The first pat is a demographic profile which contains
questions about gender, age level, occupation, educational level and
monthly personal income level of the respondents. The second part
included five domains such a, doctors attention (seven items), patients
caring (thre items), staff support (wo items), quality of catering (wo
items), and doctors” competence (two items).This part was measured by
using five-point Likert scale. The third part comprises cost of treatment,
level of satisfaction, patients comments, ee.

A total of 163 surveys were completed and 150 of those were retained as
13 had excessive missing data. Both descriptive and inferential statistics
were used in analyzing data. Factor analysis was performed to identify
the factors of patients’ satisfaction of the hospitals. Multiple Regressions
were performed to identify the relationship between the overall
satisfaction and the satisfaction factors identified through Factor
Analysis. Data has been analyzed by using SPSS version 16.0.

sen
ne
sie

A red questionnaire on in which he questions asked ar precisely decide in
‘When usd a an nrvewing method, te quesos are asked eracly s thy ae
the sme sequence, sing the same eye fr all interviews, Nontees de sn
Aston an sometimes be LR à bit open fo th nterviener (0 ame su à

[ESE 105

7. cussions

patin satisfaction is an important asp
in Bangladesh. Study shows thatthe variables Y
measuring the patient satisfaction of private pues
ery high eommunalities? sig

have very hil ies’ among them (Table 2
thatthe variables developed on the topic is highly come, 5 Mdicates
of the patient satisfaction, ed and depicts

N ofthe private hospital busin

ere developed for

Pitals of Bangladesh
angladesh
Th

ah real pie

Patient Satisfaction Factors in Private Hospicat

The ests Show that 16 variables of patent sation hy

imo groups or actor. These ae ale patient Embed
is ofthe cto det aer On cn. Te
(2336), staff support services (1.814), quality of cheng CE
(1.346) and doctor's competence (1.015) serios

Table 2 Communaliie of the Patent Satisfaction Variables

Patient Satisfaction Variables Cane
Doctors Interest in patients” A
questions 82
Effectiveness of prescribed drug 791
Willingness to listen patients 694

Time spent for patients 855
Waiting area 855
Physical care facilities 72
Cleanliness OB
Response to question 957
Individual attention given 957
Keeping informed 854
Helpfulness of staff m2
Hygiene of Food $35
Ability to provide personal choice 993
Presentation of Meal 993
Doctors’ Professional training 838
Explanation about treatment #17 =

Source: Survey data

he a variable.

8. Mason ofthe variables inthe analysis. The most import

al pa etalon vote ro of as ot

eration lo de patients followed By patents exe
ne and ost’ Campes a

support services, quality of

tor of Private Hospitals
iianc Cumulative

Table 3 Patient Satisfaction Fe

Factors
is € (%) Variance (9%)

T. Doctors” Attention 7.005 43.783 4378

2, Patients? Caring 2336 14600 — 58.383

3. Staff Support Services 1.814 11337 69.720

4, Quality of Catering 1.346 8410 78.130

Services
5. Doctors’ Competence 1.015 6345 84.745

Source: Survey dat

Independent factor variance shows that the doctor's attention is number
one factor in patient satisfaction of private hospitals in Bangladesh
(Table 4). This factor was constituted by the variables such as, doctors
interest in patients” questions (852), effectiveness of prescribed drugs
(852), willingness to listen to the patients (847), time spent for patients
(744), waiting area (726), physical care facilities (.726), and cleanliness
(610), The factors loadings of the variables are very high indicating that
the variables have very high correlation with the factor.

The second important patient satisfaction factor for the private hospitals
of Bangladesh is patient caring (Table 4). This factor was formed with
three variables such as, response to question (921), individual attention
(921), and keeping informed (.826). Third important factor for patient
satisfaction in private hospitals of Bangladesh is staff support services
‘and cooperation forthe help of the patients (Table 4)

"The cigenvlue for a given acto measures the variance in all he variables which is accord
for y that actor. The ratio of egemalus ithe ratio of explanatory importance ofthe aio
wh respecto arab, I factor has low eigenvalue, then cout le oe
alain of varones in he variables and may be ignored a redundant wih mae important
fos: Fiona meni the out of vr nthe tal sal sco ey à

ERE

9. Table 4 Factors, V
Variables

atiables and the y

“actor Loadings

Doctors interest in pation
Effectiveness of prescrite)
Doctors Willingness tite pa
Attention to — Time spent for pat
the Patients Waiting arca
Physical care facitt
‘Cleanliness

Patient Caring Response to question

questions
drug

ents

by the Individual attention given
Doctors Keeping informed

Staff Support Helpfulness of staff
Services Hygiene of Food

Quality of Ability to provide personal choice or
Catering services
Services Presentation of Meal

Dacios" Doctor’ Poesonal ing se
Competence — Explanation about the treatment 840
in Providing

Services

Source Suey Ga

Two variables constituted this factor including helpfulness of the
hospital staff (.771) and hygiene of the food supplied by the hospital
canteen to the patients (756)

‘The next important factor for patient satisfaction is quality of catering
services at the hospitals (Table 4). Two variables such as, ability to
provide personal choice (.966) and presentation of meals (966)
constituted the factor.

The least important factor for patient satisfaction is doctor's competence
10 give the medication to the patients (Table 4). The variables formed the
factor are doctors professional training (.844) and explanation about the
treatment tothe patients (840).

10. Relationship between the Satisfaction Factors and typ

Satisfaction of the Patients Or

The relationship between the satisfaction factors and th

satisfaction of the patients has been identified through’ nl
mile

quality of catering, and doctors compet
of the patients,

© Patient

ne Suppor,
are significantly related,

postive change in sacos wl led 0 the postive cs de
imate pts Tate) E

Table 5 Relationship between Satisfaction Factors and the Overall
tisfaction of the Patients

Factors Regression Std. Error ted Sig.
“Constant ‘81166 000 —
Doctors" 7399 000
Attention

Patients’ Caring 324 036 6.063 000
Staff Support 482 036 9.005 .000*
Quality of 192 036 3.631, 000%
Catering

Doctors 238 036 4457 000
Competence _ .

Findiates te level of

Model summary shows that the correlation between the satisfaction
factors and overall satisfaction is 0.767 and the R square value is 0.588
(Table 6). This indicates that the overall satisfaction of the patients is
58.80% explained by the satisfaction factors identified by this research.
Hence, this model is an important model to measure the patient
satisfaction in private hospitals of Bangladesh,

_Table 6 Model Summary

Model R R ‘Adjusted R Sid. Errorof
Square Square the Estimate

Patient 0.767 058 0.574 0.44262

Satisfa dr az

11. ANOVA shows

wate hospitals of Ban,

Residual (28.212)
Total 68.

Conclusions and Recommendations

This

«dy identified the satisfaction factors of
Is in Bangladesh. The results show thatthe 16 he
variables have formed five factors such as, dost”
patient's caring, staff support, quality of ‘catering al te

Sompetene. The mos imporant use on ator np
of Bangladesh is doctors” attention to the patients followed by patos
caring, staff support, quality of catering and doctors compstence o

Patients of private

Multiple regression analysis shows that the factors relat

satisfaction such as,

by the positive chang
the overall satisfaction of the patients. The factors are
significantly related to the overall satisfaction of the pe
services from the private hospitals.

Doctors’ attention” to the patient is very important factor that aif
patient's satisfaction in private hospitals of Bangladesh, Therefore, the
management of private hos nd well
known doctors to serve their patients who will be serious towards the
Patients. Moreover, the doctors should be trained on interpersonal skills
80 as to provide politeness, comfort, and individual attention to the
patients. “Staff support is the second most important factor affecting
patient satisfaction. The management should hire a service minted!
nursing staff who will be willing to provide better and expected service
The nursing and other hospital staff should be trained to improve

12. ¿ntepersonal skills in order to provide intensive cae with pa
us the patents, Futhemre “hospi «with potes a
influencing. patients’ satisfaction in ame et

os y members and attendants 10 spend their time when they are ana
Is should provide poda heya

privat hospitals, Private Hostal
ri care for showing professionalism to their patient
“Al heir patients. In addition,

amd ar SE be Improved because thi factor has lso inf
ps rd este ce a
aint cs dat about service quali of patents ona nd
Comings order to know thei feedback to improve the quality of

5" satisfaction’

cote ices e te Mn Mole ame aa
Competence of the doctors are the least important factors in pri bo
compere: aneladsh This indicates thatthe patients ar moe
hosel lo receive behavioral and psychological treatment than
interes nent The reasons might be attributed bythe psychologie
mei ea he pains. Bangladeshi patents become hopes hen
eri ek an hospitalized at the private hostal. Honra
e scope 10 conduct study on his topic by aking more
at er lo come up wih a mor elective sitcin

measurement model.

ate

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