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Original Article

Patient satisfaction with services of the outpatient

department

Surg Lt Cdr Athar Mohd a,*, Brig Abhijit Chakravarty b

a
Executive Officer, INHS Patanjali, Naval Base, Karwar 581308, Karnataka, India
b
Professor & Head, Department of Hospital Administration, Armed Forces Medical College, Pune 40, India

article info abstract

Article history: Background: Patients’ satisfaction is a useful measure to provide an indicator of quality in
Received 7 January 2013 healthcare and thus needs to be measured frequently. The aim of the study was to analyse
Accepted 30 June 2013 and compare the level of satisfaction of patients attending the Outpatient Department of a
Available online 25 June 2014 Hospital.
Methods: Study was conducted by using a pre-structured questionnaire with 120 samples.
Keywords: Samples were further stratified into sub-populations of Officers, Junior Commissioned
Patient satisfaction Officers (JCOs) and Other Ranks (ORs) including dependents as study population.
Outpatient department Results: JCOs predominantly expressed lower satisfaction judgement with several attri-
Quality indicator butes. Overall satisfaction judgement with Outpatient Department services were rated
lower by JCOs (2.56) when compared with Officers and ORs (3.10), the difference being
statistically significant.
Conclusion: Statistically significant differences have been identified by this study against
various study attributes as well as overall impression towards OPD services among the
study groups, which need to be addressed by the hospital leadership to achieve consumer
delight.
ª 2013, Armed Forces Medical Services (AFMS). All rights reserved.

Introduction outcome measure and patient satisfaction surveys are being

increasingly identified to be established yardsticks to measure
Measuring the quality of intangible service products has success of the service delivery system functional at hospitals.3
become a great challenge for managers and administrators in In general, patient satisfaction has been defined as an evalu-
the health services industry.1 Patient satisfaction or dissatis- ation that reflects the perceived differences between expec-
faction is a complicated phenomenon that is linked to patient tations of the patient to what is actually received during the
expectations, health status, personal characteristics as well as process of care.
health system characteristics.2 However, patient satisfaction Outpatient department (OPD) is the first point of contact of
as an indicator of quality of healthcare has evolved as an the hospital with patients and serves as the shop window to

* Corresponding author. Tel.: þ91 8105844802.

E-mail address: dratharm4u@yahoo.com (A. Mohd).
0377-1237/$ e see front matter ª 2013, Armed Forces Medical Services (AFMS). All rights reserved.
http://dx.doi.org/10.1016/j.mjafi.2013.06.010
238 m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 0 ( 2 0 1 4 ) 2 3 7 e2 4 2

any healthcare service provided to the community. The care estimation of level of satisfaction. Mean score of each ques-
in the OPD is believed to indicate the quality of services of a tion was calculated and converted into percentage of the
hospital and is reflected by patients’ satisfaction with the highest score for that question. Kruskal-Wallis test was
services being provided.4 utilised to understand the statistical significance of
Indian Armed Forces consist of a diverse population of difference of satisfaction level of various groups of patients
young healthy Indian soldiers and their dependents availing being studied.
medical facilities in service hospitals. The population has Data for the study was collected over a period of four
diverse socio-economic status based on their social, cultural months, every third patient reporting to the Main Dispensary
and educational background as well as the prevailing rank after OPD consultation being selected for the study. Every day
structure. Routine satisfaction surveys are being carried out one Officer, one JCO and one OR or their dependents were
by various service hospitals without trying to understand selected for exercising the study instrument to maintain the
difference in levels of satisfaction among diverse patient continuity and avoiding any bias during sample selection. All
groups utilising hospital services. The present study was respondents, who consented to participate in the study, were
conceived to undertake a satisfaction survey of personnel of assured of complete anonymity and confidentiality. Only
the Indian Armed Forces and their dependents visiting the serving personnel and their dependents attending various
OPD of a tertiary care service hospital. This study analyses and service OPDs were included for the study, whereas Ex-
compares the level of satisfaction among three different servicemen and in-patients were excluded. Moreover, it was
groups, namely Officers (Offrs), Junior Commissioned Officers ensured that all respondents answering the questionnaire
(JCOs) and Other Ranks (ORs) based on service hierarchy and have utilised service OPD of the hospital at least twice in last
socio-economic status, with a view to identify the Hospital one year. Statistical analysis of data was carried out using
OPD service attributes perceived to be sub-optimal in scope. Minitab version 16.0 software and logical conclusions drawn
Recognition of sub-optimal OPD service attributes is expected from such analysis.
to provide the basis of a diagnostic impression of hospital
operations in respect of OPD services as well as supply
important information to the hospital management for
improvement of such services. Results

Majority of patients (40%) belonged to the age category of

Material and methods 30e45 years and only seven patients (6%) were more than 60
years of age. Patients were predominantly male (56%), 92% of
The study was conducted at a tertiary care service hospital respondents being married and 47% being graduates and
affiliated to a medical teaching institution in a big metropol- above, indicating higher educational status. Being a tertiary
itan city to elicit the satisfaction level of patients utilising care service hospital of the Armed Forces Medical Services,
the OPD Services of the hospital. The study was carried out maximum attending population consisted of Army personnel
over a period of four months and the study population con- (66%) followed by AirForce (30%) and Naval personnel (4%).
sisted of personnel of the Indian Armed Forces including their 50% of respondents have utilised the hospital OPD services for
dependents. more than 8 times in the last one year, showing high uti-
A pre-structured bi-lingual questionnaire was developed lisation of OPD services (Table 1).
as study instrument based on patient expectations, guidance All respondents expressed high degree of satisfaction for
being taken from questionnaires adopted in earlier studies in accessibility of the OPD and its location (81e86%); however,
India and abroad. A pilot study was conducted and sample Officers rated lower satisfaction judgement with the signage
size was estimated as 120 with 95% confidence interval of system (67%) and parking areas (66%) when compared to JCOs
mean satisfaction level and 10% error of margin. The sample and ORs (73e74%). The level of satisfaction of all respondents
size was further stratified into sub-populations of Officers in respect of Cafeteria facility was observed to be moderate
(Offrs), Junior Commissioned Officers (JCOs) and Other Ranks (60e65%), identifying a probable focus area for improvement
(ORs) including dependents based on percentage of past OPD (Table 2).
attendance in the last one year. The questionnaire was further Substantial perceptual difference existed among the re-
validated by estimating Cronbach’s Alpha co-efficient for in- spondents in respect of certain attributes like Information
ternal consistency, which was found to be 0.96, thus indi- received at the Registration counter (95e100% Officers and
cating high reliability of the study instrument.5 ORs against 88% JCOs) and the Queue system (61e64% of Of-
The questionnaire was divided into two parts; Part-I con- ficers and JCOs against 75% satisfaction among ORs), the dif-
tained details of socioedemographic profile of patients and ference being statistically significant. Moreover, Officers (91%)
Part-II was further subdivided into various constructs related were highly satisfied with Registration time when compared
to patient care provided in the OPD and support services. Each to JCOs and ORs (71e75%). All respondents expressed lower
of the study constructs was further elucidated by a set of satisfaction judgement against certain structural attributes
specific questions based on various attributes related to like waiting area (60e70%), seating facility (60e71%), toilet
satisfaction or dissatisfaction of patients. Each question has facilities (45e60%) and availability of TV and magazines
multiple options on a continuum and rated on a scale signi- (47e61%). However, one redeeming feature was the high level
fying lower to higher degree of satisfaction. A number was of satisfaction of all respondents (75e77%) in respect of
allotted to each option in increasing order for calculation and courteousness of staff at the Registration counter (Table 2).
 m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 0 ( 2 0 1 4 ) 2 3 7 e2 4 2 239

Table 1 e Socio-demographic detail of patients.

Variable Offrs n ¼ 22 (%) JCOs n ¼ 25 (%) ORs n ¼ 73 (%) Total N ¼ 120 (%)

Age
12e30 yr 5 (23) 10 (40) 31 (42) 46 (38)
30e45 yr 7 (31) 7 (28) 34 (46) 48 (40)
45e60 yr 5 (23) 7 (28) 7 (10) 19 (16)
60 yr 5 (23) 1 (4) 1 (2) 7 (6)
Sex
Male 10 (45) 12 (48) 45 (62) 67 (56)
Female 12 (55) 13 (52) 28 (38) 53 (44)
Marital status
Unmarried/widow 1 (5) 7 (28) 2 (3) 10 (8)
Married 21 (95) 18 (72) 71 (97) 110 (92)
Educational status
Primary (upto 5th) 1 (5) 1 (4) 6 (8) 8 (7)
Secondary (upto 10th) 1 (5) 5 (20) 14 (19) 20 (17)
Senior secondary (upto 12th) 1 (5) 9 (36) 25 (34) 35 (29)
Graduate and above 19 (85) 10 (40) 28 (39) 57 (47)
Service
Army 16 (72) 12 (48) 51 (70) 79 (66)
Navy 3 (14) 0 (0) 2 (3) 5 (4)
AirForce 3 (14) 13 (52) 20 (27) 36 (30)
Visit detail
2e4 times 6 (27) 10 (40) 23 (32) 39 (33)
5e7 times 2 (9) 7 (28) 12 (16) 21 (17)
8 times 14 (64) 8 (32) 38 (52) 60 (50)

Officers and ORs were highly satisfied (82e91%) with the statistically significant, revealing difference of perception in
number of doctors available, when compared to the JCOs respect of OPD services among the study groups (Table 2).
(68%). Officers also may have received preferential treatment,
being highly satisfied with waiting time for consultation (75%)
as against JCOs and ORs (53e58%). Officers and ORs are also Discussion
highly satisfied with the consultation room environment
(77e79%) when compared to the JCOs (70%), the difference Consumer satisfaction is recognised as an important param-
being found to be statistically significant. Similarly, 86% of eter for assessing the quality of patient care services being
Officers and ORs are highly satisfied with the consultation delivered by healthcare organisations. Satisfaction regarding
time, while only 73% JCOs expressed similar sentiments, the the attitude of providers toward these services is expected to
difference again being statistically significant. What is most affect treatment outcome and prognosis.6 Patient satisfaction
reassuring is the high level of satisfaction of all respondents is thus, a multidimensional concept and a subjective phe-
(72e91%) against the care attributes of communication about nomenon that is linked to perceived needs, expectations and
the disease process and respect of dignity and privacy of pa- experience of care.7
tients during consultation (Table 2). McNealy emphasizes the importance of “perception gap”
Satisfaction levels varied widely across certain attributes or the gap between patients’ perceptions of care and their
of the Dispensary. While Officers and ORs (66e86%) expressed needs and expectations (Fig. 2). If this gap is non-existent and
moderate to high satisfaction judgement for the Dispensary performance level is already at satisfaction or at the “delight”
counter and waiting area, JCOs (44e57%) were not so happy levels, patients will be happy and satisfied.8 Measuring pa-
about the same attribute, the difference being statistically tients’ satisfaction has many purposes, with such interviews
significant. Similarly statistically significant difference was helping to evaluate healthcare services from the patient’s
also observed about waiting time for collection of medicines, point of view, facilitate the identification of problem areas and
with 86% Officers being highly satisfied against moderate help generate ideas towards resolving those problems.9
satisfaction among JCOs and ORs (67e69%). However, majority The result of any service encounter in a hospital generates
of respondents (70e82%) have been highly satisfied with a consumer judgement e either of satisfaction or dissatis-
courteousness of staff, availability of drugs and explanation faction. When the perceived performance of the hospital
given to patients for dosages of prescribed medicines and meets or exceeds the expectations of consumers, the outcome
other necessary instructions (Table 2). is a satisfaction judgement and a dissatisfaction judgement
Most of the respondents rated overall feeling about visit to follows when perceived performance is below expectations.
hospital OPD services towards higher side of satisfaction level Easy accessibility and a good signage system for the OPD
(Fig. 1). Mean satisfaction level of 2.56 (64%) was lower among services provide a good image for the hospital.10 Satisfaction
JCOs followed by 3.10 (77%), the level being almost equal was found to be high among all study groups in respect of
among Officers and ORs. The difference in mean satisfaction accessibility and location of OPD Services, but found to be
level among the three study groups was found to be lower for certain structural variables like signage system,
240 m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 0 ( 2 0 1 4 ) 2 3 7 e2 4 2

Table 2 e Satisfaction level score in terms of Mean, S.D. and % of Mean Scores.
Question Offr JCO OR

Median S.D. (%) Median S.D. (%) Median S.D. (%)

General
Q1 Accessibility/location 3.00 0.72 (83) 3.00 0.72 (81) 4.00 0.78 (86)
Q2 Signage system 2.00 0.95 (67) 3.00 0.68 (74) 3.00 0.86 (74)
Q3 Parking facilities 3.00 0.79 (66) 3.00 0.64 (73) 3.00 0.68 (74)
Q4 Cafeteria facility* 2.00 0.91 (60) 2.00 0.82 (61) 3.00 0.76 (65)
Reception/registration
Q5 Information received* 3.00 0.21 (95) 1.00 0.33 (88) 1.00 0.00 (100)
Q6 Queue system* 3.00 0.80 (61) 2.00 0.87 (64) 2.00 0.63 (75)
Q7 Courteousness of staff 3.00 0.69 (75) 3.00 0.54 (74) 3.00 0.55 (77)
Q8 Registration time 3.00 0.66 (91) 3.00 0.91 (75) 3.00 1.08 (71)
Q9 Waiting area* 4.00 0.73 (65) 3.00 0.58 (60) 3.00 0.66 (70)
Q10 Seating facility 3.00 0.91 (65) 3.00 0.71 (60) 3.00 0.67 (71)
Q11 Drinking water 3.00 0.96 (64) 2.00 0.88 (53) 3.00 0.86 (59)
Q12 Toilets facility 3.00 1.05 (60) 2.00 0.76 (45) 3.00 0.94 (54)
Q13 Magazines/TV etc 2.00 0.92 (56) 2.00 0.88 (47) 3.00 0.93 (61)
Q14 Cleanliness 3.00 0.85 (66) 2.00 0.76 (66) 2.88 0.74 (72)
Doctorepatient relationship
Q15 Number of doctors 3.00 0.29 (91) 3.00 0.48 (68) 3.00 0.39 (82)
Q16 Waiting time* 3.00 1.02 (75) 2.00 1.13 (53) 3.00 1.10 (58)
Q17 Satisfaction level with waiting time 2.00 0.69 (74) 2.00 0.64 (64) 2.00 0.54 (74)
Q18 Doctors’ room environment 3.00 0.87 (77) 3.00 0.71 (70) 3.00 0.67 (79)
Q19 Consultation time 3.00 1.09 (66) 2.00 0.82 (61) 2.00 0.91 (65)
Q20 Satisfaction level with consultation time* 3.00 0.50 (86) 2.00 0.58 (73) 3.00 0.52 (86)
Q21 Explanation about sickness by doctor 4.00 0.73 (91) 3.00 0.84 (82) 4.00 0.73 (89)
Q22 Sense of concern 3.00 0.69 (81) 3.00 0.67 (72) 3.00 0.49 (77)
Q23 Dignity/privacy 3.00 0.46 (91) 3.00 0.65 (81) 3.00 0.56 (84)
Dispensary
Q24 Dispensing counters* 2.00 0.35 (86) 1.00 0.51 (44) 1.00 0.47 (67)
Q25 Waiting area* 3.00 0.85 (66) 2.00 0.84 (57) 3.00 0.69 (72)
Q26 Queue system 3.00 0.89 (67) 2.00 0.82 (60) 3.00 0.73 (72)
Q27 Courteousness of staff 3.00 0.79 (74) 3.00 0.80 (71) 3.00 0.59 (78)
Q28 Waiting time* 4.00 0.86 (86) 3.00 0.78 (69) 3.00 0.94 (67)
Q29 Availability of drugs 3.00 0.50 (80) 3.00 0.65 (70) 3.00 0.68 (72)
Q30 Explanation about medicines and dosages 3.00 0.81 (77) 3.00 0.79 (76) 3.00 0.56 (82)
Overall response
Q31 Overall feeling about visit to hospital* 3.09 0.68 (77) 2.56 0.65 (64) 3.10 0.56 (77)

*P value < 0.05 considered statistically significant.

parking and cafeteria facilities. However, the old vintage of

the hospital building and the horizontal spread may have
contributed towards dissatisfaction in respect of such struc-
tural attributes of the OPD.
The patients intending to utilize the OPD Services will
have his or her first interface with the hospital at the OPD
Registration counter. It is vital for patients to receive adequate
information at the Registration counter, as many of them may
be utilising the OPD services for the first time. 95e100% of
Officers and ORs expressed satisfaction with the information
received with only 88% of JCOs being satisfied, the difference
being observed to be statistically significant.
Staff behaviour, particularly polite and courteous behav-
iour has been accepted as a necessity for hospital OPD services
and there is unanimity among all respondents in respect of
satisfaction judgement for this variable. Training of OPD staff
in soft skills might have started yielding positive results to-
wards higher satisfaction with staff behaviour in the study
Fig. 1 e Distribution of satisfaction judgement about hospital. Pawar found 90% patients remarked that OPD staff
hospital OPD services. was courteous and friendly, indicating politeness of
 m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 0 ( 2 0 1 4 ) 2 3 7 e2 4 2 241

Table 3 e Time spent by patients at relevant places.

Attribute Officer JCO OR
n ¼ 22 (%) n ¼ 25 (%) n ¼ 73 (%)

Q. 8: Registration time
1 h 0 (0) 2 (8) 11 (15)
30 mine1 h 2 (9) 4 (16) 15 (21)
15e30 min 4 (18) 11 (44) 21 (29)
15 min 16 (73) 8 (32) 26 (35)
Q. 16: Waiting time for consultation
1 h 2 (9) 10 (40) 22 (30)
30 mine1 h 5 (23) 6 (24) 21 (29)
15e30 min 6 (27) 5 (20) 16 (22)
15 min 9 (41) 4 (16) 14 (19)
Fig. 2 e The making of patient satisfaction happen. Q. 19: Consultation time with doctor
5 min 4 (19) 3 (12) 7 (10)
5e10 min 6 (27) 10 (40) 30 (41)
10e15 min 6 (27) 10 (40) 22 (30)
15 min 6 (27) 2 (8) 14 (19)
paramedical staff in service hospitals, the finding being Q. 28: Waiting time to get medicines
similar to this study.11 61% Officers and 64% JCOs are satisfied 1 h 1 (5) 1 (4) 8 (11)
with the Queue system at the Registration counter with 75% 30 mine1 h 2 (9) 8 (32) 23 (31)
15e30 min 5 (23) 12 (48) 26 (36)
ORs expressing satisfaction judgement, the difference being
15 min 14 (63) 4 (16) 16 (22)
statistically significant. Non-availability of separate queue for
Officers and JCOs in certain OPDs may be responsible for lower
satisfaction score among these study sub-groups.
Waiting time, regardless of the length of the actual wait is structural attributes. Only 65% Officers were satisfied with
an important area to address for enhancing overall satisfac- the waiting area or seating and drinking facilities. Similarly,
tion ratings. It was observed that Officers are generally 45% of JCOs expressed satisfaction with sanitary facilities and
satisfied with the waiting time at various interfaces with the 61% ORs recorded similar sentiments about availability of
hospital services, with 91% expressing satisfaction with Magazines and Television in the waiting rooms. Provisions of
Registration time, 75% with waiting time for consultation and these amenities are well within the reach of hospital man-
86% for collection of medicines at the Dispensary. However, agement and need to be addressed with certain amount of
such high satisfaction is not replicated among other groups, urgency to remove sources of dissatisfaction among its
with 71e75% of JCOs and ORs satisfied with Registration time, consumers.
53e58% with waiting time for consultation and 67e69% for Satisfaction level with doctors’ room environment was
collection of medicines, the difference in satisfaction level found to be high among Officers and ORs with lower satis-
being observed to be statistically significant across certain faction among JCOs, the difference being statistically signifi-
parameters. While majority of Officers have received service cant. Pawar in his study also found that 96% of patients to
within 30 min (91% for Registration, 68% for consultation and have observed the examination room to be clean and orderly,
86% for collecting medicines), time for receiving services by findings that are similar to our study findings.11
JCOs and ORs have often exceeded 1 h (8e15% for Registra- Consultation time spent with doctor is an important
tion, 30e40% for consultation and 4e11% for collecting med- attribute to determine satisfaction level among patients.
icines). This obvious bias towards Officers for receiving Studies indicated that longer contact time have been signifi-
service at various interfaces may be explained by the official cantly associated with better recognition and handling of
hierarchy of the Indian Armed Forces with emphasis on physical problems and patient empowerment.12 Short contact
earlier service to this particular group of patients (Table 3). time with healthcare personnel is a common source of patient
Increased waiting time could be addressed by application of dissatisfaction with the consultation process.13 In this study,
Queuing model at the Registration area, Consultation rooms maximum respondents across all three groups have spent
and Dispensary counter to appreciate need for additional consultation time between 5 and 15 min, which is an
service stations. Separate counter for JCOs at various bottle- encouraging indicator towards patient satisfaction (Table 3).
necks may be a long term solution to address their concern at However, level of satisfaction in respect of JCOs was found to
various interfaces. However, certain miscellaneous measures be lower than that of Officers and ORs, the difference being
like strict adherence of queue discipline, no queue jumping statistically significant. Our study findings was similar to that
and First In First Out (FIFO) policy may be considered to of Ranjeeta et al, who observed the consultation time to be (6.6
reduce the waiting time and associated dissatisfaction with  3.7 min) with 85.2% patients satisfied with such
this attribute among JCOs. consultation.14
When waiting time becomes inevitable, waiting rooms Attributes that hold steady for good doctorepatient rela-
need to be supplied with television sets, newspapers, maga- tionship are sympathy and kindness, good communication
zines and adequate sanitary facilities to reduce the monotony between patients and doctors and patience and shared re-
of waiting. All the three groups involved with the study were sponsibility in managing illness of the patient. Privacy and
unanimous about their lower degree of satisfaction for these confidentiality are not only basic rights of patients but also
242 m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 0 ( 2 0 1 4 ) 2 3 7 e2 4 2

serve towards a trustful, frank and open relationship with the departments or services with case-mix and risk adjustment
doctor, thus improving patient care.15 In this study, satisfac- techniques be conducted to improve the quality and outcome
tion level was high regarding explanation about sickness to of such studies.5
patients and maintaining respect, privacy and dignity during
the consultation process among all the study groups.
Main Dispensary is the usual exit point, where patients Conflicts of interest
arrive after OPD consultation, collect medicines and depart. It
is also one of the bottlenecks in the process flow of the hospital, All authors have none to declare.
congestion expected due to convergence of patients from
various OPDs during peak time. JCOs expressed strong dissat-
isfaction judgement about Dispensary Counters followed by Acknowledgement
higher rating by Officers and ORs, the difference in rating being
statistically significant. The difference in satisfaction level is The author wishes to acknowledge the contributions by Dr
possibly because of non-availability of separate dispensing Dashrath R Basannar, Scientist ‘E’ towards drafting of ques-
counters for JCOs and their dependents. Then again, JCOs were tionnaire and data analysis of this study.
dissatisfied with the waiting area, when compared to the Of-
ficers and ORs, the difference being statistically significant.
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