ORIGINAL ARTICLE ISRA MEDICAL JOURNAL | Volume 7 - Issue 3 | Jul - Sep 2015

ASSESSMENT OF OPD PATIENT'S SATISFACTION WITH

HEALTH CARE SERVICES AT AL-NAFEES MEDICAL HOSPITAL
FARAH AHMED1, IRAM YASIR1, KHALID HAMEEDI2, SAJJAD AHMED2, WASEEM AHMED2,
MAROOF2, SAMIULLAH2, USMAN NAJAF2, AMANULLAH2

ABSTRACT

OBJECTIVE: To determine socio-demographic profile among the OPD patients and the overall satisfaction level of the patients utilizing
the OPD.
STUDY DESIGN: A descriptive cross sectional study.
PLACE AND DURATION: Conducted in OPD of Al-Nafees Hospital Islamabad from 12th January -12th March 2015.
METHODOLOGY: Through convenient sampling a closed ended structured questionnaire was employed to collect the quantitative
data. OPD patients aged 18-64 who showed willingness to participate were included in the study. Indoor patients, patients below 18
and above 64 and those who were not willing were excluded.
RESULTS: The study was conducted on 209 patients. Overall satisfaction level of patients with the OPD health services was 86.2%.
Satisfaction level was found to be more in females than males. 42.6% had a family income of >15000 Rupees but satisfaction level
with OPD services was same among respondents falling in different categories of family income. Patients with primary level of
education were more satisfied. 41.1% waited 15-30 minutes for the examination by the doctor. 89% of the patients were satisfied
from the registration staff. 73.3% were satisfied with doctor's service. The satisfaction level from the nurses was 64.6%. 63.3% were
satisfied from the services provided by the pharmacy. 63.2% said that the medical expenses were affordable. 88% of the patients
agreed upon the cleanliness of the building of the hospital and 77% stated that that signs and boards were easy to follow.
CONCLUSION: In the current study it was found that majority of respondents were highly satisfied with the OPD services offered at Al-
Nafees Hospital. Patients were satisfied with the behavior of registration staff, Physicians' communication skills, waiting time for
examination, nursing care, pharmacy services and logistic arrangements.
KEY WORDS: Out Patient Department, Services, Satisfaction, Patient

INTRODUCTION what patient expected and what he/she experienced during the
provision of health care2.
Patient satisfaction has been given a lot of importance in recent Satisfaction can be defined as the extent of an individual's
years but still a lot more should be done in this field. Out Patient experience compared with his or her expectations3. There are
Department (OPD) is considered to be the first point of contact twelve essentials of patient satisfaction which are overall
of hospital with patients that's why it has significant influence satisfaction, satisfaction to approach, affordability, excellence,
on patient satisfaction level. Patient satisfaction has become a empathy, proficiency, guidance provided, technical
favorite debate for enhancing quality of OPD services however arrangement, physical services, consideration on psychological
it still needs a lot of improvement for the better delivery of and social aspects, permanence of care and effect of care4.
health care services1. Patient satisfaction with health care is important because of the
Outpatient department (OPD) is the first point of contact of the following factors: It influences patients' health seeking
hospital with patients. The care in the OPD is believed to behavior5. It is an indicator of long term viability and success6.
indicate the quality of services of a hospital and is reflected by Satisfied patients are more compliant to doctors'
patients' satisfaction with the services being provided. recommendations about the medical regiments, suitable use of
Satisfaction is actually determined by the interaction of two health care resources and recovering from disease as soon as
aspects i.e. patient hope and provision of the actual services. If possible7. Attention should be given to establish health service
health care is not according to what was expected, the patient is according to patient's satisfaction rather than just treating the
not satisfied and if it is according to their hope, then it is other disease8. The doctor knows that they are responsible for the
way round. Patient satisfaction is actually a contest between patient and answerable to administration as a result to accept
the patient's involvement in treatment decisions9.
1. Assistant Professor of Community Medicine The major barriers in the patient satisfaction are lack of doctor
2. Students of IV Year MBBS patient interpersonal communication, doctors and nursing staff
Al-Nafees Medical College & Hospital behavior, financial aspects, inadequately equipped facilities and
Isra University Islamabad Campus unavailability of adequate services10. The main hindrance to
better health care for the people living in developing countries is
Corresponding to:
deficiency of access to even essential health care. Other reasons
Farah Ahmed
Assistant Professor of Community Medicine are extended waiting time, unaffordable treatment cost and lab
Al-Nafees Medical College & Hospital investigation11. Along with this patient personality also have an
Isra University Islamabad Campus effect: older patients and those who are not much educated
E-mail: [email protected] appear to be more satisfied. In addition, psychosocial status

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play a role in the form that patients report more satisfaction consultation, listened to the problems attentively, they gave an
than they actually experience because they fear that they will opportunity to know about their illness and believed that
not be treated well next time they seek health care12. doctor gave them sufficient time. Almost half of the patients
There are many factors which have an impact on patient agreed that the doctors performed physical examination with
satisfaction e.g. the type and number of investigative tests respect after taking permission.
performed, clear interaction with the doctors or nurses, their More that (n=135, 64.6%) patients believed that nurses and
compassion and empathy, accessibility to the service and time ayas treated them with respect. More than half of the patients
spent in the encounter. The patients expects quality health agreed that medical expenses were affordable and waiting time
services but if the setup is not well equipped and qualified and for the pharmacy was not long. Almost half of the patients
devoted staff is not present then this leads to patient believed that prescribed drugs were available.
discontent. There should be pleasant waiting area, adequate Almost (n=86, 41.1%) of the patients agreed that they had to
room temperature, purpose built hospital design, well wait for 15-30min to get themselves examined by the doctor
maintained washrooms and easily readable sign boards. and the total time spent to get complete health services was 30-
Keeping in mind the state of affairs regarding OPD satisfaction 60 minutes.
this study was conducted to determine socio-demographic More than (n=127, 60.8%) of the patients agreed that the
profile among the OPD patients and the overall satisfaction level hospital building was clean and direction boards were easy to
of the patients utilizing the OPD. follow. Almost half of the patients agreed that there were
enough sitting chairs in the waiting room.
METHODOLGY
3-Overall Satisfaction Level: When it was asked about the
This descriptive cross-sectional study was conducted on Out Satisfaction of patients with Outpatient Department services, it
Patient Department of Al-Nafees Hospital, Islamabad over a was found that out of 209 patients, (n=132, 63.2%) Patients
period of 2 months from 12th January to 12th March. OPD patients were satisfied and (n=48, 23.0%) patients strongly agreed to
aged 18-64 who were willing to participate in the study were the overall satisfaction level.
included by convenient sampling. A structured questionnaire When patients were asked to rate the Hospital services, it was
was administered to collect quantitative data comprising of found that out of 209 patients, (n=81, 38.8%) patients rated it as
sociodemographic profile, quality of OPD services and Overall good, (n=59, 28.2%) patients rated as very good, (n=38, 18.2%)
satisfaction level. The questionnaire was designed with the help patients rated as excellent, (n=24, 11.5%) patients rated as
of internet and previous studies, was administered in English Satisfactory and (n=7, 3.3%) patients rated as poor.
language and was filled in by the 4th year students under Out of 209 respondents, 127 were male members. Among 127
supervision of faculty of Department of Community Medicine. males 105 (82.6%) were satisfied while among 82 females 75
Indoor Patients were excluded from the study. Data was (91.2%) were satisfied. Our study results revealed that female
analyzed by using SPSS version 20 and frequencies were gender was more satisfied than males regarding OPD services
calculated and cross tabulation was done. Out of 209 respondents 10 fell in the category of family income
of < 5000 among which 8(80%) were satisfied with the OPD
RESULTS services.52 respondents fell in the category of family income of
5000-10000 among which 44(84.61%) were satisfied. 54
Socio-demographic profile of the patients: The Socio- respondents fell in the category of family income of 1000-15000
demographic profile of 209 patients showed that most of the among which 45(83.33%) were satisfied. 93 respondents fell in
patients were males (n=127, 60.8%), they were married (136, the category of family income of >15000 among which
65.1%), majority were matriculate and were earning more than 79(84.94%) were found to be satisfied with OPD services.
15000Rs (n=90, 43.0%). (n=77, 36.8%) were unemployed but According to our study results satisfaction level with OPD
97% were earning by being involved in some kind of occupation. services was same among respondents falling in different
categories of family income.
2-Patients' experiences & satisfaction with OPD Services: Out of 209 respondents 36 were illetrate, among which
When the patients were asked about the over-crowding at the 28(77.7%) were satisfied with OPD services. 44 were having
registration counter (n=84, 40.2%) agreed, and when they asked primary level of education among which 42(95.4%) were found
if they were treated with respect by the registration staff to be satisfied. 72 were matriculate, out of which 61(84.7%)
(n=138, 66%) agreed to the query. were satisfied with OPD services. 57 were graduates among
When asked about services provided by the doctors (n=136, which 49(85%) were satisfied.
65.1%) agreed that the doctors were available for the

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TABLE-I: SOCIO-DEMOGRAPHIC PROFILE OF PATIENTS (n=209)

Gender
Male 127 (60.8%)
Female 82 (39.2%)
Marital Status
Single 60 (28.7%)
Married 136 (65.1%)
Widow / Widower 8 (3.8%)
Separated / Divorced 5 (2.4%)
Education
Illiterate 36 (17.2%)
Primary 57 (27.3%)
Matric 72 (34.4%)
Graduate 44 (21.1%)
Occupation
Not employed 77 (36.8%)
Government employee 24 (11.5%)
Private employee 39 (18.7%)
Business 19 (9.1%)
Agriculture 15 (7.2%)
Laborers/daily wages 35(16.7)
Family income per month in rupees
<5000 11 (5.2%)
>5000 19 (9.0%)
<10000 35 (16.7%)
>10000 25 (11.9%)
<15000 29 (13.8%)
>15000 90 (43.0%)

TABLE II: FREQUENCY OF PATIENTS' EXPERIENCES & SATISFACTION WITH OPD SERVICES.
Questions Answer N= %
Registration Staff:
Was the registration staff overcrowded? Agreed n=84 40.2%
Registration staff treats the patients with respect? Agreed n=138 66%
Doctor:
Your doctor was available for consultation? Agreed n=136 65.1%
The doctor listened to your problems attentively? Agreed n=119 56.9%
The doctor did your physical examination after taking you permission and with respect? Agreed n=102 48.8%
The doctor gave you an opportunity to know about your illness? Agreed n=128 61.2%
Do you believe the doctor gave you sufficient time? Agreed n=128 61.2%
How much time did you have to wait for examination by the doctor? 15-30 minutes n=86 41.1%
What was the total time you spent in the OPD for getting complete health services? 30-60 minutes n=85 40.7%
Nurses/Ayas :
Hospital Nurses/ Ayas treated the patients with respect? Agreed n=135 64.6%
Medical expenses
Expenses for routine lab tests were affordable? Agreed n=106 50.7%
Pharmacy:
Waiting time for receiving medicine from OPD was long? Disagreed n=90 43.1%
All of the prescribed drugs were available in pharmacy? Agreed n=101 48.3%
Logistic arrangements:
Building of this hospital is clean? Agreed n=126 60.3%
Waiting room has enough sitting chairs? Agreed n=100 47.8%
Sign and direction boards were easy to follow? Agreed n=127 60.8%

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TABLE: III: CROSS-TABULATION BETWEEN SOCIODEMOGRAPHIC CHARACTERISTICS AND PATIENT SATISFACTION

Satisfaction Level
Total
Strongly Agree Agree Disagree Undecided
Gender
Male 25 (19.6%) 80 (63%) 19 (15%) 3 (2.3%) 127
Female 23 (28%) 52 (63.4%) 5 (6.15) 2 (2.45) 82
Family Income
<5000 2 (20%) 6 (60%) 2 (20%) 0 (0%) 10
(5000 -10000) 11 (21.2%) 33 (60%) 6 (11.5%) 2 (3.9%) 52
(10000-15000) 11 (20.4%) 34 (63%) 6 (11.1%) 3 (5.5%) 54
>15000 24 (25.8%) 55 (59.1%) 9 (9.7%) 5 (5.4%) 93
Education
Illiterate 13 (36.1%) 15 (41.6%) 8 (22.2%) 0 (0%) 36
Primary 10 (22.7%) 32 (72.7%) 1 (2.3%) 1(2.3%) 44
Matric 12 (17%) 49 (68.1%) 9 (12.5%) 2 (2.8%) 72
Graduate 13 (22.8%) 36 (63.2%) 6 (10.5%) 2 (3.5%) 57

education were more satisfied as compared to higher levels of

Overall Satisfaction
education. This is consistent with a study conducted in Malaysia
showed that patients with high school education perceived a
significantly higher service satisfaction in comparison to
graduates11. Similarly, another study showed that those with no
education or only primary education had higher satisfaction
levels10.
Another important factor in satisfaction is level of income.
According to our study results satisfaction level with OPD
services was same among respondents falling in different
categories of family income, this differs with the results of
another study conducted by Ganasegeran K, which showed
significantly higher service satisfaction among patients with a
lower income in comparison to those with higher income11.
Waiting time, for examination by the doctor is an important
LEVEL OF SATISFACTION
area to address for increasing overall satisfaction ratings12. Most
of patient in our study waited (15-30 minutes) for examination
FIGURE 1: FREQUENCY OF OPINIONS BY LEVEL
OF OVERALL SATISFACTION IN OPD and (30-60 minutes) for getting complete OPD services
(investigations), however this is contrary to a study by Ahmed I
DISCUSSION where patients had to wait for a much longer time4.
Trakroo listed some of the factors which affect the satisfaction
Patient satisfaction with the health services is an important level of OPD patients. Some of them are long waiting time at
indicator for determining quality of care provided in the out- registration table, short-tempered behavior of registration staff,
patient department. The different attributes of demography in lack of seating area for waiting, too long waiting time for
our study were gender, marital status, education, occupation doctors' opinion, unwelcome behavior of doctors and lack of
and family income however identity of the patients were kept proper doctor- patient interaction18.
confidential. Our study results showed that most of OPD In our study most of the patients were satisfied from the
patients were married and that female patients tended to have registration staff behavior. Regarding the doctors behavior our
higher level of satisfaction than the male patients. This may be study showed that (majority of the patients were satisfied. This
due to the reason that in our setup females are almost always is supported by another study conducted by Karstensen B,
accompanied by male attendants, and all discussion about their which showed good satisfaction level with doctors' behavior.
investigations and management occur between doctor and the This study also showed that empathy and competence by the
attendant, and most of the times they have no opinion in this staff on the patient's OPD visit was positively related to health
discussion and they are satisfied with whatever they are education, physical examination and patient management. In
offered2. Our study differs with another study that showed that our study, only a few patients suggested that number of doctors
men tended to have higher satisfaction scores than women10. should be increased to reduce the waiting time. A few patients
Our study showed that the patients with primary level of also thought that the methods of providing the medicines to the

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consumers should be improved and there should also be an with patient satisfaction level.
improvement in the attitude of OPD auxiliary staff and they
wanted more time with the doctors. The way health care REFERENCES
providers behave with the patients play a major role in the
patients' satisfaction. In a study (21%) patients were not 1. Tasneem A, Shaukat S, Amin F. Patient satisfaction ; a
satisfied with the approach and manner with which comparative study at teaching Versus DHQ level hospital in
doctors/paramedical staff behaved.3 Short contact time with Lahore. J. Pharm. Sci. & Res. Pakistan 2010; 2 (11):767-74.
healthcare personnel is a common source of patient 2. Asghar S, Fatima F, Ali A, Amanat N. Assessment of patient's
dissatisfaction with the consultation process14 however this is satisfaction about dental treatment. Pakistan Oral & Dental
contrary to our study which showed that majority patients were Journal. Pakistan 2013; 33:535
satisfied with time given by doctors. 3. Raza S, Mahmood Ur Rahman, Rizvi F, Afzal M. Patients'
In our study 82.5% of the patients were satisfied from hospital Satisfaction with Health care Delivery in the Outpatient
nurses behavior. Another study showed that doctor and nurse Department of Military Hospital, Rawalpindi. Ann Pak Inst
interaction with patients was important for patients' Med Sci 2008; 4(2): 97-100.
satisfaction15. Contact of patients with nurses and nursing staff 4. Ahmad I, Nawaz A, Khan S. Predictors of Patient
is more significant for the patients because nurses have more Satisfaction. Gomal J of Med Sci 2011; 9(2):183.
early and frequent contact with the patients than doctors in 5. Dayasiri MBKC, Lekamge ELS. Predictors of patient
case of distress or if they have any queries16. satisfaction with quality of health care in Asian hospitals.
The majority of patients (67.4%) were satisfied regarding Australasian Medical Journal Sri Lanka 2010; 3(11): 739-44.
pharmacy services. This is contrary to one of the study 6. Fenton JJ, Jerant AF, Bertakis KD, Franks P. A National Study
conducted by Leonard KL revealed that high price of medicine of Patient Satisfaction, Health Care Utilization,
was a dilemma for the patients as they anticipated to pay lesser Expenditures, and Mortality. Arch Intern Med, 2012;
amount, most of the patients were satisfied with the care 172(5): 405-11.
provided at subsequent visits and treatment given4. 7. Taye BW, Yassin MO, Kebede ZT. Quality of emergency
According to our study the patients were satisfied with the medical care in Gondar University Referral Hospital,
cleanliness of the hospital and waiting area conditions. Northwest Ethiopia: a survey of patients' perspectives.
Whereas another study showed that the cleanliness of the BMC Emergency Medicine 2014; 14 (2) 2-8.
wards was the worst senario4. According to results of our study 8. Khamis K, Njau B. Patients' level of satisfaction on quality of
76.8 % of patients were satisfied from environmental attributes. health care at Mwananyamala hospital in Dar es
A study by Quintana showed that the factors leading to Salaam,Tanzania. BMC Health Services Research 2014;
dissatisfaction from environmental aspects were poor water 14:400.
supply, lack of proper lights and fans etc., and poorly maintained 9. Schoenfelder T, Klewer J, Kugler J. Determinants of patient
and dirty toilets10. The results of our study are not in line with satisfaction: a study among 39 hospitals in an in-patient
this survey and majority of the patients were satisfied by quality setting in Germany. Int J for Quality in Health Care 2011;
of services in Al-Nafees hospital. 23:503-09.
Patients' satisfaction relationship to quality as reported by 10. Quintana JM, González N, Bilbao A, Aizpuru F. Predictors of
Leonard (2008) in a study done in Arusha Tanzania showed that patient satisfaction with hospital health care. BMC Health
patient satisfaction is not directly associated with quality, but Services Research 2006; 6:102.
improvement in quality do lead to changes in satisfaction, as 11. Ganasegeran K, Perianayagam W, Manaf RA. Patient
patients notices improvements17. Satisfaction in Malaysia's Busiest Outpatient Medical Care.
Finally our study showed that Majority of patients received Scienti?c World Malaysia, 2015: 1(1) 1-6.
quality OPD services from Al- Nafees Hospital. The gap between 12. Mohd A, Chakravarty A. Patient satisfaction with services of
expected and received service quality among OPD patients was the outpatient department. Med J Armed Forces India
not present among most of the patients' satisfaction level and 2014; 70:237-42.
overall satisfaction level of the patients utilizing the OPD was 13. Karstensen B, Glennas A, Andrup O, Clarke Jenssen O,
good however there is always a room for improvement and we Thoen J, Busby G et al. Quality of an outpatient
recommend that continuous efforts for further improvements rheumatology clinic. Consumer evaluation of medical
should always be made. aspects and service. Tidsskr Nor Laegeforen 1993;
113:1603-06.
CONCLUSION 14. Cape J. Consultation length, patient estimated consultation
length, and satisfaction with the consultation. Br J Gen
Majority of respondents were highly satisfied with the OPD Pract.2002; 52:1004-06
services offered at Al-Nafees Hospital. Patients were satisfied 15. Hassan S, Changiz G, Shaker S. Emergency department
with the behavior of registration staff, Physicians' patient satisfaction survey in Imam Reza Hospital, Tabriz,
communication skills, waiting time for examination, nursing Iran. Int J Emerg Ment Med 2011; 4(2):1-2.
care, pharmacy services and logistic arrangements. Female 16. Elliott MN, Kanouse DE, Edwards CA. Components of care
gender and primary education had a significant relationship vary in importance for overall patient-reported experience

158
Farah Ahmed et al. ISRA MEDICAL JOURNAL | Volume 7 - Issue 3 | Jul - Sep 2015

by type of hospitalization. Med Care 2009; 47:842-49. 18. Trakroo PL, Reaction of the patients toward the evening
17. Leonard KL. Is patient satisfaction sensitive to the changes O.P.D. Services in hospital of Delhi, J of Hospital
in the quality of care? An exploitation of the Hawthorne Administration. 1977; 14: 213-21.
effect. J of Health Economies 2008; 27(2):444-59.

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