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dissertation health patient public satisfaction service
Introduction

You can choose up to three answers. While reasons for satisfaction mainly centred on quality and the underlying structure of the NHS free at the point of use, with a wide range of services available , reasons for dissatisfaction mainly related to resourcing issues. Around a third of dissatisfied people said this was because of government reforms to the health service, and a quarter said their dissatisfaction was due to money being wasted in the NHS.

This shows that dissatisfaction was driven by negative views about decisions on resourcing, rather than negative views about the core principles of the NHS. It may be that media stories have an indirect impact on underlying attitudes that is not immediately obvious to the respondent. The survey has included these additional questions since , which means that changes in responses can now be tracked over time.

Figure 10 shows changes in the five most popular reasons for dissatisfaction with the NHS in , over the past three years. This data provides its richest insights when viewed over decades, rather than years. Looking at the data through that long-view lens reminds us that overall NHS satisfaction levels remain higher than they were in the s and early-to-mids. Nevertheless, the statistically significant fall in satisfaction and rise in dissatisfaction in took net satisfaction to its lowest level since With an increase over the last few years in the proportion of survey respondents reporting lack of funding as a reason for their dissatisfaction, it seems the public is increasingly aware of the reality of funding pressures that the NHS has experienced over the last seven years.

Given the many other differences between the NHS in these areas, it would seem important to be able to compare them. Thanks for your question. The survey covers England, Scotland and Wales. That is a disappointing response. Subsamples are regularly released for political polls, which recognise the difference in voting between the different countries. There is now a significant difference in the organisation of the different NHSs in the UK - so, it would not be surprising ot see differences in the various indicators between the different NHSs.

I see that small sample size has not prevented different results based upon the ethnicity of the respondent ie. White, Asian and Black. Given that according to the UKnational archives, that the population of Scotland was 8.

Given that subsamples can be produced in respect of ethnicity, it is difficult to see that sample size is a valid reason for failing to publish applicable Scottish subsamples.

Hi I work in Scotland and would be interested to see the differences in satisfaction with GP services between countries. If you send me your data set I would be happy to analyse it for you. If you cannot do this, please send me a copy of the questionnaire you used and I will apply it in Scotland to get statistically significant numbers for you I look forward to hearing from you soon Best wishes Chris Johnstone GP, paisley.

Your survey would be more valid had it attempted to assess a measure of realistic expectation from the NHS and the degree to which respondents did or felt they should take responsibility for own health management. Sadly politicians and bureaucrats have encouraged an unrealistic sense of entitlement in the public who have no interest in equating their contribution with the cost and receipt of services from the NHS.

Before judging the NHS on such surveys it would be helpful to give the respondents some idea of the cost of their expectation were it to be provided in the private sector. Thank you for the comments and follow up questions about country breaks for this data. The issue with breaking down geographically is not simply due to small sample sizes although that is a factor , but also because the sample is geographically clustered.

The data is published here: There is not an equivalent survey in Wales unfortunately. The National Survey for Wales asks about satisfaction with different services health, education on an point scale rather than a 5-point satisfaction scale.

One commenter asked about country figures for the GP satisfaction question. As this is asked to a smaller sample of respondents than the overall satisfaction question, the sample sizes for Scotland and Wales are even smaller - less than in both cases. The same points above on regional clustering also apply. Some of the many reasons why population are not happy with quality of health care provided.

This is tedious you seem to put the fact that people are dissatisfied with the NHS and want to abolish it NO! Where a difference or change is not statistically significant, we cannot be confident that it reflects a real change or difference in public views. Older people were more satisfied than younger people: Between and , satisfaction fell among all age groups. The four main reasons people gave for being satisfied with the NHS overall were: The four main reasons that people gave for being dissatisfied with the NHS overall were: The change from the previous year was not statistically significant.

Methodology Sample and approach The survey consisted of 3, interviews with a representative sample of adults in England, Scotland and Wales. Topics The topics covered by the survey change from year to year, depending on the identities and interests of its funders. Funding The survey is funded by a range of charitable and government sources, which change from year to year. How satisfied is the British public with the NHS overall?

Who is most satisfied with the NHS? How satisfied is the British public with different NHS and social care services? What drives public satisfaction? Blog Public satisfaction with GP services drops to lowest level in 35 years Ruth Robertson considers why public satisfaction with GP services has dropped to its lowest level in 35 years. Reply Link to comment. Dear John Thanks for your question.

I hope this is helpful. Studies in the developing world have shown a clear link between patient satisfaction and a variety of explanatory factors, among which service quality has been prominent Rao et al. We believe this link is important also in the health care sector in Bangladesh.

The framework, further embellished on the basis of focus group discussions, is as follows. In Bangladesh, reliability of the provider is often perceived as low for various reasons, such as the accusation that doctors recommend unnecessary medical tests, there is an irregular supply of drugs at the hospital premises, supervision of patients by care providers is irregular, and specialists are unavailable. Perceptions of reliability are also attenuated when doctors do not provide correct treatment the first time.

Patients expect hospital staff to respond promptly when needed. They also expect the required equipment to be available, functional and able to provide quick diagnoses of diseases. In addition, patients also expect prescribed drugs to be available and properly administered, as other indicators of responsiveness. Thus we posit that the greater the responsiveness of health care providers, the greater the satisfaction of patients.

For a service that is largely credence based Zeithaml and Bitner , where customers are unable to evaluate the quality of the services after purchase and consumption, the sense of assurance that is engendered can greatly influence patient satisfaction.

In the health care system, assurance is embodied in service providers who correctly interpret laboratory reports, diagnose the disease competently, provide appropriate explanations to queries, and generate a sense of safety.

Thus, the greater the perceived assurance from the health care providers, the greater will be the satisfaction of patients. Physical evidence that the hospital will provide satisfactory services is very important to patient satisfaction judgments.

Generally, good appearance tangibility of the physical facilities, equipment, personnel and written materials create positive impressions. Communication is also vital for patient satisfaction. If a patient feels alienated, uninformed or uncertain about her health status and outcomes, it may affect the healing process. When questions of concern can be readily discussed and when patients are consulted regarding the type of care they will be receiving, it can alleviate their feelings of uncertainty.

Appropriate communication and good rapport can, thus, help convey important information to influence patient satisfaction. In particular, patients expect doctors and nurses to communicate clearly and in a friendly manner regarding laboratory and other test results, diagnoses, prescriptions, health regimens, etc. Similarly, nurses are expected to understand patient problems and to communicate them to the doctor properly.

It is proposed that the better the quality of communication perceived by the patient, the greater will be their level of satisfaction. Patients desire doctors to be attentive and understanding towards them. Similarly patients expect nurses to provide personal care and mental support to them. We posit that the more empathy received from the service provider, the greater the satisfaction of the patients. Process features refer to an orderly management of the overall health care service process.

Updated patient records and standard patient release procedures also facilitate patient care. We feel that the better the process features at the hospitals, the higher will be the level of satisfaction of the patient. In addition to service factors, perceived treatment cost is another factor that patients may perceive as excessive. In the more affluent Western world, Schlossberg and Wong suggest that health care consumers have become much more sensitive to costs, despite health insurance coverage.

Wong also predicts that consumers will shop for the best value. In the developing world, especially Bangladesh, cost is a perennial concern among those seeking health care service, given their low earnings. Such costs include consultation fees, laboratory test charges, travel, drugs and accommodation. While basic health care service is supposed to be free in public hospitals, patients end up bearing the costs of medicine and laboratory tests, as well as some additional unseen costs.

Private hospitals are not free but their costs vary markedly across hospitals. We posit that the lower the perceived overall cost of health care services, the higher will be the level of patient satisfaction.

Thus, additional secondary sources were consulted from the developed world. The research team initially conducted in-depth discussions with 10 patients covering three types of hospitals about the entire process that they underwent to obtain the necessary care when afflicted. These discussions revealed a variety of factors that were grouped under the above nine constructs of the model, i.

A preliminary questionnaire was first developed in English using Likert scales, then translated into Bengali and retranslated several times until it was user friendly and captured the desired constructs.

The questionnaire was pre-tested several times to arrive at appropriate wording, format, length and sequencing of the questions. Pre-test feedback was used to refine the questionnaire until it was ready for data collection. A member team of final year students of East West University were recruited for data collection.

They were briefed about the objective of the study and the questionnaire. They were also trained rigorously to collect unbiased and meaningful data.

A permission letter from the Ministry of Health and Family Welfare MOHFW was forwarded to the respective hospitals so they would provide the necessary help and cooperation to the data collectors.

Researchers supervised the data collecting teams at different hospitals and assisted with obtaining the list of patients to be released, as well as with data collection. Upon receipt of the list of patients to be released, the data collectors used random sampling procedures to select the respondents and obtain data via personal interviews at the hospital premises on the day of discharge. Reasons for the study, complete confidentiality guarantees, the right of refusal to answer specific questions, and contact information were provided to the respondents according to internationally accepted research protocol.

The population of the research was defined as Bangladeshis who have been inpatients in public and private hospitals in Dhaka City or in hospitals in a foreign country within the past year.

Due to resource and time constraints, a sample size of was targeted. From the former list, Dhaka Medical College and Mitford Hospital were chosen purposively as these two hospitals are reputed to handle patients from all classes and with various health problems. In addition, three hospitals were also purposively chosen from the list of private hospitals. To ensure representation, sample sizes of were planned to be collected from the public and private hospitals.

The list of patients ready to be released on a particular date was obtained from the respective ward-in-charge of the public hospitals and the patient relations in-charge of the private hospitals. Using simple random sampling, patients were selected from this list. Data for the patients availing foreign hospital care were hard to collect using probability sampling as no lists were available for this category of patients.

A sample size of was decided for this stratum and the snowball sampling method was used. The main countries where Bangladeshis obtain hospital services include Thailand, Singapore and India. Data were collected only from those respondents who had been admitted as inpatients.

A total of surveys were completed; of these were retained as 13 had excessive missing data. Frequency distributions were obtained to check for data entry errors and to obtain means and standard deviations for each construct across three categories of public, private and foreign hospitals see Table 1.

To affirm the dimensions of the selected measures, principal components factor analysis was performed. Items loading together on a common factor with Eigenvalues equal to or greater than 1. All items for each factor were also factor analysed separately. In all cases a single factor was recovered, indicating convergent validity.

The final factors were somewhat different from the ones expected. However, most of the scale items purported to measure the original service dimensions were retained for the analysis; their loadings made clear sense.

Varimax rotation and the final rotated solution resulted in eight factors comprised of 40 items see Table 2 that explained Rotated component matrix a.

Given the recommendations of Nunnally , that alpha values should be 0. The values are as follows:. Means and standard deviations are presented in Table 1. The mean of satisfaction for the full sample is 3. When broken down by public, private and foreign hospitals, the satisfaction rating for foreign hospitals came out substantially higher.

Yet, it was surprising that, after all the woes reported about health services in Bangladesh, both public and private hospitals in Bangladesh scored commendably 3. We feel this is because the two public hospitals chosen—Dhaka Medical College Hospital and Mitford Hospital—are among the oldest hospitals in the country. The three private hospitals are also well-reputed.

As a result, there may be a positivity bias in the mean rating of public hospitals that may not hold for other public hospitals, especially in the semi-urban and rural centres. Also, except for two constructs, the standard deviations for the public hospitals in Bangladesh are the highest. From Table 1 , we note that the doctor and nurse service orientation composites were rated high in all three categories see means as were tangibles staff and access.

The similarity in the mean scores for doctors in the public and private hospitals in Bangladesh may be explained by the fact that, given the dearth of doctors, they offer their services to both sectors. A similar finding was reported by Andaleeb b. Essentially, patients are being served by the same doctors in the public and private sectors.

Future studies should include a wider set of hospitals to determine whether the obtained service evaluations are corroborated. We also note that the physical evidence of cleanliness in the public hospitals was rated lower than in the other two categories. Treatment cost is also perceived as low in both public and foreign hospitals, which may be attributed to the different clientele served and their relative income bases.

Those opting for foreign hospitals are from the upper income group who are generally much better off. Even so, they may not all be using the very best hospitals overseas, hence the perception of low cost of treatment. For example, many of the Indian hospitals are close by and are deemed better in terms of service but their price may actually be low; however, total costs are inflated by travel, food and accommodation costs.

By partitioning the data into the three hospital categories, we found all three models were significant, as indicated by the F-statistics and the R 2 values. The results suggest that a monolithic and standardized health care system is not what patients desire; the needs of each segment differ.

For the local public hospitals, for example, five significant factors explained patient satisfaction. In order of importance reflected in the standardized beta values , they are: For local private hospitals, in order of importance, there were four significant variables: Finally, for foreign private hospitals, there were four significant variables: Surprisingly, the service orientation of nurses was not significant.

We attribute this to the likelihood that it is the doctors that draw patients to foreign hospitals, where their stay may not be very long. Since all concerns are discussed directly with the doctors, who probably give patients more time and attention than at home, the relevance or importance of the nurses diminishes.

Tangible evidence of the facilities also had a relatively strong effect on satisfaction. However, surprisingly, tangibles staff had a negative coefficient, suggesting that when doctors and nurses were neat in appearance, patient satisfaction was attenuated.

This finding is counterintuitive. We feel that in foreign hospitals, the two concepts—tangibles facilities and tangibles staff —are not very distinct and blend into each other. However, in Bangladesh, hospital facilities and their staff especially doctors and nurses are distinct. To confirm this view we checked the correlations between the two variables.

The coefficient correlations are 0. In the case of foreign hospitals, the high correlation coefficient value suggests, as conjectured, the presence of multicollinearity.

Based on our sample, the service orientation of doctors has the greatest effect on patient satisfaction across all three types of hospitals.

This factor deserves the most attention from administrators and policy makers responsible for building a better and more patient-centric health care delivery system. Tangibles facilities , or the visible aspect of hospitals, was also important in the case of both public hospitals where looks can often be quite unsightly and foreign hospitals where looks are expected to be prim and proper.

The service orientation of nurses is an important factor for ensuring patient satisfaction in Bangladesh. The dearth of nurses, however, is a real problem in the country and the demands made on them are likely to be very substantial. The expectation of consistent services from them, therefore, is an issue that warrants further study. Interestingly, process features also explained satisfaction with private hospitals in Bangladesh and with foreign hospitals.

For the extra costs incurred, patients using these facilities expect the processes to be efficient. The cost of services is important to the users of public hospitals but not to the users of private or foreign hospitals. To the latter usually from the upper strata , cost may not be as important in explaining satisfaction as is service quality, lacking which they go overseas. Access to health care, surprisingly, had no significant effect on patient satisfaction for any of the hospitals, despite evidence to the contrary.

The zero-order correlations, however, were significant and had the correct signs. This finding may be attributed to the fact that we interviewed patients who had been released from hospital and who had access; hence this factor may not have been significant in explaining patient satisfaction. Patients seeking health care services in the public hospitals may have accounted for this under treatment costs. In foreign hospitals, patients do not expect to make facilitation payments as the cost of treatment covers and ensures good and consistent services.

A comprehensive model of patient satisfaction has many policy implications in regard to identifying patient needs, developing standards, designing services systems and processes, establishing employee and patient roles in service delivery, enhancing training programmes, managing demand and capacity, and delivering the needed quality of services. To these ends, measuring service quality and satisfaction is very important. As might be expected, service orientation of doctors came out as the strongest factor influencing patient satisfaction in all three types of hospitals.

This is not surprising. Since most of the reputed physicians in the country serve multiple hospitals, they are incapable of giving due time and attention to patients. Previous studies from Aldana et al. Yet, the overall ratings of doctors in our study are positive.

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