«117 EFFECTS OF WAITING TIME ON PATIENT SATISFACTION: NIGERIAN HOSPITALS EXPERIENCE JOHN KOLADE OBAMIRO Lagos State University, Nigeria Received: June ...»
3. Results and Discussion Of the 240 questionnaires distributed, a total 200 questionnaires were retrieved but some were partially filled and not suitable for research.. Overall, 85 copies of the questionnaires were properly filled which formed the basis of analysis of this paper. This results to a response rate of 35.42%, which falls within acceptance rate of similar past studies. Table 1 shows the patients’ social- demographic characteristics. The majority were female (65%), dominated with patients of 18 to 24 ages (45%), involving more single (59%) than married patient (41%). All the respondents are educated having at least SSCE/NCE/OND certificate (25%); with 54% B.Sc, 15% M.Sc./MBA while few of the respondents (6%) hold other certificates not captured in the study. This implies that the respondents are educated and understood the purpose and relevance of this study. However, this study did not evaluate the influence of gender, age, marital status, and educational level on patient satisfaction similar to the study conducted by Hall and Press (1996), believing that variables such as sex, age, marital status, education, gender do not have a strong influence on patient satisfaction.
However, studies have shown that demographic variables except gender have profound influence on satisfaction (Aragon and Gesell, 2003) while Soleimanpour, Gholipouri Salarilak, Raoufi, Vahidi, Rouhi, Ghafouri, Soleimanpour’s, (2011) demonstrated that those with higher education were less satisfied, but there was no significant relationship between marital status, occupation, gender, work shift and satisfaction level..
Issues Relating to Waiting Time and Quality Service Delivery Delivery of quality medical service is function of various components, of which waiting time is very important factor; formed the focus of the section. Six issues relating to waiting time and quality service delivery at the health centres were presented to the respondents to rank in order of seriousness. Percentage of the responses was calculated as shown in table 2. The findings reveal that forty percent (40%) of the respondents admitted that they experience waiting time on visits while 27% describe the waiting time as normal and adequate. 52% of patients considered the waiting time as long while the rest 32% were satisfied with the length of the queue. Those that considered the waiting time as normal (27%) and satisfied with the length of the queue (32%) may enjoy talking and watching television provided to reduce boredom while waiting.
More than half, 44% of respondents claimed satisfactory when service delivery is evaluated on time performance while 30% of patients were not satisfied with level of promptness in service delivery. This finding is similar to Omidvari, Shahidzadeh, Montazeri A, Azin, Harirchi,Souri ‘s (2008) report in Tehran and Senti and LeMire’s 20011) in Midwest that long waiting causes less satisfaction.
On the behavior of medical personnel towards the patients, 72.5% of the respondents rated their actions as been friendly and accommodative (i.e customer oriented). This implies that doctors carefully handled the patients, listen to their complaints and created an atmosphere of care and trust. Customer oriented service is paramount for quality care because it allows time for friendliness, listening; and respectful, professional care for every patient (Finch, 2005).
Previous studies (Senti and LeMire, 2011; Omidari, et al 2011; Gup, et al, 2012; Yeddula,
2012) supports this finding that customer oriented service environment enhances satisfaction.
Overall, majority of patient expressed satisfied with the service delivery in the health centres despite some patients dissatisfied with long waiting. This finding is similar to the outcomes of Soleimanpour (2011) and Gup, et al’s (2012). 62% of patients rated the service delivery of these medical centres superior than other similar hospitals in the neigbourhood.
Also 72% claimed their services are reliability. It means that majority of the respondents are not first time visit and have been provided quality services which implies that they will be willing to recommend the health centres to others.
Issues Relating to Hospitals, Doctors and Patient Satisfaction Table 3 depicts that the entire medical personnel responsiveness to patients’ requests are extremely satisfactory (89%). Also, a considerable number of patients (89%) rated the medical personnel professionalism high in delivery their services. These responses confirmed the evaluation of comparison of patient expectation with actual service delivery. Majority of the respondents claimed that their expectations were met (80%). Meeting patients’ expectations resulted to satisfaction with service delivery. This finding is in agreement but higher than Senti and Lemire’s (2012) report which indicated that when realistic expectations are met overall satisfaction scores should improve. The respondents rated the system approach to service delivery as good (87%), while 32 (16%) of them rated the overall approach as excellent. Despite satisfactory responses, it amazing to know that more than half, 104(52%) of the respondents had experiences one disappointment or others in service delivery of these health centres.
Perceived Causes of Long Queues Table 4 reveals the observed causes for long waiting time in these health centres. These factors are found in most Nigerian Hospitals, especially university and public funded health centres. In Nigeria, University Hospitals and General (Government) Health Centres have the high patient’s patronage. Reasons have been that University Hospitals are endowed with more modern technologies and qualified personnel for effective and efficient medical service delivery while General Hospitals is a place of visit for common man. Therefore, large number of patients is received by these Health Centres on a daily basis. It was notice that few numbers of Doctors serve a high population of patients at these hospitals. Though, this has been a general trend in most standard hospital in Nigeria (Afolabi and Erhun, 2003; Thatcher, 2005;
Umar, et al, 2011).
Patients jumping queue through the help of some staff was high in General Hospital.
University Health Centre and Medicare have adopted the use of information technology in their operations. This really helps in managing patient waiting time and facilitating patient flow. But the situation is different in General Hospital that still relies on manual operations which results to long search of patient card, physical movement of card from one office to another and patients wandering around from one unit to another.
Medical practitioners and health institute (Institute of Medicine) acknowledged that long waiting time results to patient dissatisfaction and had therefore recommended that majority ( not less 90%) of patients should be served within 30 minutes of their scheduled appointment time (O’ malley, Fletcher, Fletcher and Earp, 1993; Senti and Lemire, 2012 Gup, et al, 2012;
Yeddula, 2012). This recommendation is difficult to achieved in General Outpatient Department of University Hospitals and Public Hospitals in developed countries talk less of developing country like Nigeria who has a ratio of doctor to patient as one per 25,000 against the World Health Organization (WHO) target of a doctor to 1000 patients (Latonte, Labonte, Sander, Schrecker, 2004).
This overcrowding situation accounted for the reason while the some respondents claimed that they had experienced disappointment with service delivery in time past. This is in contrast with the satisfactory responses indicated by majority of respondents on issues relating doctors, hospital and patients (see Table 3). Our findings revealed that despite the fact that patients experience waiting time (see Table 2), high percentage of respondents are satisfied with overall service delivery in these selected hospitals. This claim is consistent with the findings of Afolabi and Erhun (2003); Camacho, et al, (2006); Prasanna, Bashith and Sucharitha (2009) Senti and Lemire, (2012) Merkouris, et al (2013) but in contrast with Umar et al’s (2011) findings where majority of patients were dissatisfied with service delivery because of long waiting time.
The waiting time before seeing the nurse, doctor, pharmacist, etc., should be made productive by organizing waiting process in line with patient’s perspective by; (i) medically engage the patients by encouraging them to describe their previous medical experience and providing relevant health education on important issues and not allowing them to watching television, chatting, etc. (ii) equality treatment procedure; this reduces preferential treatment.
(iii) Increase interaction with patients by providing more adequate communication with them.
(iv) Medical personnel should be more friendly, caring, listen to patient’s complaints and arrive in time and avoid unnecessary delay in service delivery.
Further research is required to examine other variables of patient satisfaction not included in this study and the concept of patient perception of waiting time in relation to patient satisfaction. This study was conducted at the moderate-sized hospitals in Sango-Ota, Ogun State, Nigeria, and hence, the findings may not be generally applicable in other settings not similar to these hospitals. However, despite these barriers, the study depicted how waiting time is an important factor of quality service delivery and patient satisfaction in this setting.
Our findings agree with other studies in literature that revealed that there is relationship between waiting time and patient satisfaction (Camacho, et al, 2006; Prasanna, et al, 2009;
Umar et al, 2011).
Table 4 – Perceived Causes of Long Queues
1. Large number of patients
2. Late arrival of Doctors
3. Fewer number of Doctor
4. Preferential treatment by medical personnel
5. Operations not computerized
6. Doctor waste time in seeing a patient
4. Conclusions As we move towards patient-centred service delivery where more emphasize is on managing patients waiting time, time spent with the doctors, nurses, pharmacists, etc., and the entire service delivery process.
Reduced waiting time, adequate health care, professionalism, responsiveness to patients, friendly, adequate and purposive communication are among some important factors that improve patient satisfaction. 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 public hospital than the other private hospitals as demonstrated in the study. But this does not affect patient perception of quality care offered.
Part of the reasons may be because long waiting time is a general occurrence in Nigerian hospitals especially 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 how to design a productive waiting time process and deliver timely services. This implies that hospitals that manage wait times effectively and efficiently will experience significant improvement in patient satisfaction.
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