«117 EFFECTS OF WAITING TIME ON PATIENT SATISFACTION: NIGERIAN HOSPITALS EXPERIENCE JOHN KOLADE OBAMIRO Lagos State University, Nigeria Received: June ...»
EFFECTS OF WAITING TIME ON PATIENT
SATISFACTION: NIGERIAN HOSPITALS
JOHN KOLADE OBAMIRO
Lagos State University, Nigeria
Received: June 21, 2013 Accepted: August 29, 2013 Online Published: October 10, 2013
The time spent waiting for services at outpatient department couple with some factors of quality care are major determinants of patient satisfaction. This study examines the relationship between waiting time and patient satisfaction. Data was obtained through structured questionnaire distributed to a randomly selected 240 outpatients of the selected public and private health centres to ascertain their views as regards to waiting time and evaluation of level of satisfaction with service delivery. Data obtained were analysed using descriptive statistics. This study has shown that a good numbers of the patients were satisfied with the service delivery despite experiencing long waiting time. Though, lengthy waiting line is evident in the public hospital than the other private hospitals. But this does not affect patient perception of quality care offered because long waiting time is a general occurrence in Nigerian hospitals especially in publicly funded health centres. Efforts should be made by hospital administrators and medical personnel to eliminate unnecessary delay in service delivery and where unavoidable; the waiting time should be made productive. Also, emphasis should be directed toward training of medical personnel on ways to create patient-oriented services and deliver more efficient services.
Keywords: Waiting Time; Healthcare Centre; Medical Personnel; Service Delivery; Quality care; Patient Satisfaction.
1. Introduction Ma Managing waiting time in healthcare settings is a concept that has been receiving attention among researchers, healthcare practitioners and administrators over the years (Anderson, Camacho and Balkrishnan, 2007; Umar, Oche and Umar,2007; Senti and Lemire, 2011; Gup, Ofoedu, Njoku, Odu, Ifedigbo and Iwuamanam, 2012). Waiting in line has become an integral part of healthcare services and it is considered to be central to assessing patient satisfaction.
Yeddula (2012) is of the opinion that as patients experience a greater squeeze on their time, short waits seem longer than even before. This queuing situation is worst in publicly funded or highly busy hospitals and managing it has become a serious challenge.
Waiting lines occur where resources (doctors, nurses, beds, etc.) are limited and demand for service exceeds supply. Patient waiting time can be described as the amount of time patient spent before being served. In hospitals, patients can wait for minutes, hours, days or months to receive services. Yeddula (2012) asserts that the amount of time patient wait during clinic visit is a source of dissatisfaction with healthcare. Generally, patients are annoying or not interested in waiting for services, they want to receive immediate services on arrival. In healthcare setting, waiting time can be described in two folds: waiting room wait time and exam room wait time. Waiting room wait time is described as the time spent between requesting the patient be seated in the waiting room and the time he/she was called to see the medical personnel such as nurse, doctor, pharmacist, etc. This can occur in between different services. Exam room wait time is described as the amount of time spent from the time the patient was seated in an exam room and the time the physicians, nurses, pharmacists, etc.
spent with patients (Micheal, schaffer, Egan, Little and Pritchard, 2011).
Nowadays, medical service delivery is patient-centred in which patients have become increasingly demanding, expecting high quality services at competitive price and delivered promptly. The general queue discipline adopted in hospital is that patients are served immediately on arrival on first come first serve or join a queue if the server is temporary engaged (Brahma, 2012). The length of time a patient spent waiting to be served affects the desired satisfaction and it’s central to patients’ evaluation of service delivery process. Afolabi and Erhun, (2003) assert that a patient’s experience of waiting can radically influence his/her perceptions of service quality. Several studies have documented that patients’ long waiting times are barriers to actually obtaining quality services (Kurata, Nogawa, Philips, Hoffman and Werblum 1992) which results to dissatisfaction with health care (Anderson, Barbara and Fildman, 2008) and patient frustration. Afolabi and Erhun’s, (2003) and Prasanna, Bashith and Sucharith’s (2009) revealed that excessive patient waiting time undermines system efficiency, patient satisfaction and patronage which lead to the loss of some patients to competitors. Unmanaged waiting lines in hospitals negatively affect the quality of care which in turn adversely affects patient satisfaction. Increased waiting time results to patient disappointment, frustration and decrease the patient's sense of control and lead to loss of patronage on the part of the hospital patronage.
Literature shows that waiting time is one of the key predictors of patient satisfaction (Umar et al, 2011; Camacho, Anderson, Safrit, Jones and Hoffmann, 2006 Anderson, Camacho and Balkrishnan, 2007; Karaca, Erbil and Ozmen, 2011; Yeddula, 2012) and it is useful to evaluate system efficiency.
Waiting time reduces the efficiency of production time and adds to the indirect costs of both the patients and hospitals. Lovelock (1996) as cited in Karaca, et al. (2011) posited that American spent 37 billion hours per year waiting in emergency rooms. What is experienced in some departments (such as Outpatient Department, Pharmacy, Diagnostic, Ante-natal, etc.,) of the hospital is similar. The waiting time experience in developing country such Nigeria is worst than what is obtainable in developed country. In fact, it has been assumed to be part of health care delivery. The amount of time patients wasted waiting to receive medical service can be productivity invested. Yeddula (2012) found that if the healthcare organizations can improve patients’ perceptions of the time they spend waiting then patients will experience less frustration and may feel more satisfied with the services and results to improvement in hospital performance. Drain (2007) study reveals that reducing wait times can lead to improved financial performance of the practice.
Patient satisfaction is a highly desirable outcome of care in the health centres, but it is difficult to measure because it is a function of both clinical and non-clinical activities (Sodani, Kumar, Srivastava and Sharma, 2008). Though, it centres on patient’s judgment on the quality and goodness of care (Sixma, Spreeuwenberg and van der, 1998). So, healthcare resources should be channeled towards the outcomes that are consistent with patient values and preferences (Gup, Ofoedu, Njoku, Odu, Ifedigbo and Iwuamanam, 2012). Although, patient satisfaction is acclaimed to be subjective judgment of the quality of medical service (Merkouris, Andreadou, Athini, Hatzimbalasi, Rovithis, Papastavrou, 2013) but it has long been considered an important component in the assessment of health care quality (Harutyunyan, Demirchyan, Thompsonand Petrosyan 2010; Yeddula, 2012). Also, despite describing several methods of evaluating the quality of care (Hermida, Nicholas and Blummenfeld, 1999) and no universal accepted of assessing quality of care (Gup, et al, 2012), there is growing agreement that patient satisfaction survey will be the best to measure quality of care (Press, 2006; Turnbull and Hembree 2006; Merkouris, 2013).
Patients are satisfied when their numerous expectations are met and dissatisfied when they are not met. Bopp (1989) and Matulich and Finn (1989) reveal that patients expected free flow of information from servers. They expected equality in treatment and be treated in a caring, professional, and competent manner. They expected a reasonable and justifiable waiting time. Each factor encounter enhances or detracts from a patient's appraisal of overall service quality, hence patient satisfaction. In Senti and LeMire’ (2011) opinion, patient satisfaction is a function of the degree of agreement between the patient;s preconceived expectation and perceptions of the actual care. Furthermore, Jenkinson, Coulter, Bruster, Richards and Chandola (2002) assert that patient satisfaction is an attribute of many factors such as: quality of medical services provided, availability of medicine, behavior of doctors and other health staff, cost of services, hospital infrastructure, physical comfort, emotional support, and respect for patient preferences.
An important factor in assessing patient satisfaction is timely service delivery which can be achieved with reasonable waiting time. In Mowen, Licata and Mcphail’s (1993) opinion, there are four key attributes associated with patient satisfaction: trust, adequate communication flow, behavior of the service providers and waiting time. This study focuses more on the fourth attribute (waiting time) of Mowen et al’s (1993) study. This implies that in this research, patient satisfaction was defined importantly as satisfaction with waiting room wait time and exam room wait time, and other patient satisfaction indexes. Therefore, this study wants to investigate the relationship between waiting time and patient satisfaction of outpatients focusing on waiting experience and some satisfaction attributes. Although, few researches have been done on relationship between waiting time and patient satisfaction, with longer waiting times being associated with decreased patient satisfaction (Camacho, Anderson, Safrit, Jones and Hoffmann, 2006), but the degree of the association between waiting time and patient satisfaction varies across nations, hospitals and departments.
Most of these studies were conducted in developed nations and few that were conducted in Nigeria focused mostly on Government funded University Teaching Hospitals.
Furthermore, it is evident in Nigeria that patient and society comments negatively about public hospitals operations ranging from long waiting time, unpleasant behaviours and negligence of staff, incompetence and discontinuity of care. These negative experiences and comments have resulted to poor public confidence in public hospitals and increased the patronage of private hospitals. Despite the relevance of these negative comments especially concerning waiting time management to practice outcomes and patient satisfaction, timeliness of care has not been taken serious and among the least studied in Nigeria.
There is limited publication in the Western Nigerian on the relationship between prompt service delivery and patient satisfaction in both public and private hospitals. It is against this development that this study focuses on how efficient waiting time can improve quality of care and patients satisfaction in the selected hospitals (i.e. both public and private).
2. Materials and Methods A survey method was carried out at the outpatient units of the selected hospitals which are located in Ogun State. Ogun State is a bounder state to Lagos; Nigeria’s biggest commercial centre and former federal capital. Covenant University Health Centre is situated at the entrance of Covenant University, Ota, and it provides medical services to the students and staff of the university. Also, it services the staff and families of Living faith Church, Ota, Nigeria.
Covenant University is one of the leading private universities in Nigeria, with population of over 7000 (staff and students). Medicare is one of the best private hospitals in Ota, AdoOdo-Ota, Local Government, Nigeria. It provides services for workers of numerous national and multinational companies, and elite people of Sango-Ota. Ota General Hospital is a publicly funded health centre that caters for both elite and low income earners of Ado-OdoOta, Local Government. The selected hospitals serve as referral centres in Sango-Ota. Also, by virtue of their locations in areas that accommodate many people working in Lagos, the patients’ visits to these health centres are high.
Data were collected from patients who visited the outpatient units of these hospitals through observation and well structured questionnaire. Owing to the constraint of fund being a self sponsored paper, a sample of 240 patients (i.e. 80 patients per centre) was randomly selected over the study period (i.e. three months). The questionnaire sought information related to patient's demographic characteristics such as patient's age, sex, educational and occupational levels. Information about patient’s waiting time obtained include; time spent waiting to see server, length of queues, causes of long queues and rating of service delivery on time performance. These questions were rated on a five-point Likert scale, 5(strongly agree) to 1 (strongly disagree). Any ratings involving strongly disagree and disagree were considered as disagreement overall, while rating involving agree and strongly agree was considered as agreement overall for purposes of average ratings. The analysis ignored the undecided responses in order to avoid the problem of central tendency and to gain more effective screening power (Sin and Tse, 2002). Also, the survey asked patients to rate their hospitals and medical personnel (especially the doctors and nurses) on several issues relating to their satisfaction like respect for patient, level of doctors and nurses’ responsiveness, professionalism in handling the patients, trust in services, doctor friendliness and accommodating, quality of service to meet patient’s expectations, etc. For patient satisfaction questions, respondents were asked to indicate their answers on a scale of 1 (poor) to 5 (excellent). For easily analysis, ratings involving good, satisfaction, very good and excellent were good overall. Data were analyzed by SPSS.
The in-depth review of literature on waiting time and patient satisfaction confirmed the sufficient validity. This means that the response was not due to chance but resulting to the relationship tested. Clark and Watson’s (2007) opinion of measuring the internal consistency of the research instrument using Cronbach Alpha Coefficient (1951) recommended at least 70% reliability level. This was used to test the reliability of questionnaires and it resulted to a score of 0.87 (87%). Therefore the research instrument is reliable and accepted because the score is higher than the recommended 70%.