my dessertation ppt

Dr. Priyanka SrivastavaDepartment of Hospital Administration

Sanjay Gandhi Post Graduate Institute of Medical SciencesLucknow

Study of Assessment of Satisfaction among the selected population utilizing Out-Patient

Services of The General Hospital of a Tertiary Care Teaching Institute in The State Capital of Uttar Pradesh

INTRODUCTION

“Hospital is an integral part of a social and medical

organization, the function of which is to provide the population

complete healthcare both curative and preventive with outpatient

services reaches out to the family in its own environment and also

to carry out training of health workers/functionaries and the bio

social research” – World Health Organization

The Outpatient Department (OPD) is first point of contact

between the hospital and the patient and patient satisfaction

depend on the standard of the health facility and care they

receive at the OPD.

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Patient’s satisfaction depends on many factors such as quality of

clinical services provided, availability of medicine, behavior of

doctor and other health staff, cost of services, hospital

infrastructure, physical comfort, emotional support and respect

for patient

Assessment of the patients’ satisfaction is important in order to

identify reasons for dissatisfaction and guide us to eliminate

them.

As an administrator to it is important to identify causes of

dissatisfaction in order to alleviate level of satisfaction among

clients.

.

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Multi sectorial development have increased level of information about medical facilities and Patients awareness about their rights.

Expectations from health care facilities are ever changing and scaling new heights.

It is important to understand causes of dissatisfaction among patients utilizing OPD services to take corrective measures. This study intends to find: Availability and extend of utilization of outpatient services in general hospital

by internal and external patients. Source of information for external patients. Reasons of satisfaction/dissatisfaction among the internal and external patient at

outpatient services. Waiting time for the internal and external patient at outpatient services in

various process and Recommend corrective measures to enhance the patient satisfaction

RATIONALE

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REVIEW OF LITERATURE

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Sonu Goel et al in their study to improve quality of care at public-

health facilities in Chandigarh Measuring patient satisfaction about

outpatient services and found out that among 1200 exit interview with

variable like general satisfaction, technical quality, interpersonal

behavior, communication, financial aspects, time spent with doctor,

accessibility and convenience etc.

Overall patients’ satisfaction on various parameters of quality of care

was 86%. (Sub centre- 95%, Dispensary- 89.5%, Community Health

Centers- 87.7%, General Hospital- 83.8% and Polyclinic-82%).

There was significantly more score of satisfaction in General hospital

as compared to other secondary level health facilities. However, the

difference in satisfaction score was not significant between different age

group.

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Talluru Sreenivas et al in their study “Patient Satisfaction - A

Comparative Study” conducted in three different selected hospitals in

Hyderabad city based on ownership.

270 respondents were selected out of 300 respondents of Osmania General

Hospital (Omanis), completely owned by Government, similarly 90 respondents

out of 100 respondents from Deccan Hospitals Corporation Limited (Deccan)

which runs under the control of private management and 240 respondents from

Nizam's Institute of Medical Sciences (Nizam's) which runs on corporate lines

under the control of State government were selected .

it is found that the t-value for all types of responses and for all pairs of hospital

under study were significant at 5% level

Journal of the Academy of Hospital AdministrationVol. 15, No. 2 (2003-07 - 2003-12)

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Study on Evaluation of Service Quality of Hospital OPD Services was conducted at a peripheral service hospital to ascertain any service gap between consumer expectations and perceptions in respect of the hospital service outpatient department.

Service quality gaps were identified to exist across all the five dimensions [expectations and perception, quality gaps, service quality, SERVQUAL(of the survey instrument, with statistically significant gaps across the dimensions of ‘tangibles’ and ‘responsiveness’) The quality gaps were further validated by a total unweighted SERVQUAL score of (-) 1.63.].

Significant service quality gaps existed in the delivery of the hospital OPD services, which need to be addressed by focused improvement efforts by the hospital management.

(Medical Journal Armed Forces India volume 67, Issue 3, Pages 221-224, July 2011)

AIM AND OBJECTIVES

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AIM- Study of Assessment of Satisfaction among the selected population utilizing Out-Patients Services of General Hospital of a Tertiary Care Teaching Institute in The State Capital Of Uttar Pradesh.

OBJECTIVES:-

1. To study availability of Out-Patient Services and its extent of utilization by Internal and External Patients.

2. To find out the Source of information about the General Hospital to the External Patients.

3. To evaluate the waiting time and the reasons of dissatisfaction among the Internal and External patient at Out-Patient Services.

4. To recommend corrective measures to enhance the patient satisfaction.

METHODOLOGY

STUDY SETTING - Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow Study Area - General Hospital

STUDY DESIGN - Descriptive Study done Prospectively TIMELINE-

Study Span: November, 2012- June, 2013 Data Acquisition: January, 2013 - March, 2013

STUDY POPULATION – The Patients utilizing Out-Patients Services. SAMPLING TECHNIQUE – Population Proportion Sampling STUDY SAMPLE – Internal and External Patient SAMPLE SIZE -

The sample for observation was taken on the basis

Sample size (N) = (Z 2) * p (1-p)

d2

p = 0.12

q= (1-p) = 0.88

z =1.96 as per table of area under normal curve for confidence level of 95 %

d = allowable error, since estimate should be within 5% of true value=0.05

Sample size (N) = (1.96)2 * 0.05 (1 - 0.05) = 384

(0.05)2

Gen. Medicine27%

Gen. Surgery18%

Pediatrics12%

Gynea. & Obst. 21%

Dermatology21%N= 1,75,284

Internal ; 74.61

External; 25.39

Gen. Medicine

n=48,026

Internal ; 58.75

External; 41.25

Gen. Surgery

n=31,925

Internal 82.83

External; 17.17

Pediatrics

n=20,945Internal 41.15

External 58.85

Gynea. & Obst.

n=37,464Internal ; 61.60

External; 38.40

Dermatology

n=36,924

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Gen. Medicine In-ternal; 143

Gen. Medicine Ex-ternal; 49

Gen. Surgery In-ternal; 75

Gen. Surgery Ex-ternal; 53Pediatrics Internal; 69

Pediatrics External; 14

Gynea. & Obst. In-ternal; 62

Gynea. & Obst. Ex-ternal; 88

Dermatology In-ternal; 91

Dermatology External; 57

SAMPLE SIZE DISTRIBUTION

Sample size = 701

148

150

84127

192

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TOOLS AND TECHNIQUES:

Tools:Interview schedule for internal patients & external patients

Sample size calculated

Exit patient interview (It included questions about following categories- The general information such as Staff/non staff, name, age, sex. The profile of the patient as-District, resident either urban/rural Specific information as-Source of information, reason for selection of hospital The questions pertaining to patient satisfaction includes such as-Problems at registration counter and problem with behavior of registration clerk, seating arrangement, general cleanliness, drinking water facility , toilet facility, satisfaction with concern Doctor and sample collection technician

TECHNIQUECollection of Secondary data in the form of documents and records and registers

Question pertaining to waiting time in various process such as-Time in queue and process at registration counter, in doctor consultation, in laboratory, in pharmacy, in payment Entry and exit time in OPD and total time in OPD Suggestion if any)

Data acquisition

Data sorted and analyzed using Microsoft Office Excel and Statistical Package For Social Sciences (SPSS)

And following findings were observed

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OBSERVATION

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MALE, 27.96

FE-MALE, 72.03

EXTERNAL PATIENT

MALEFEMALE

MALE, 39.09

FEMALE, 60.9

INETRNAL PATIENT

MALEFEMALE

MALE35%

FEMALE65%

TOTAL

GENDER PROFILE OF THE PATIENTS UTILIZING OUTPATIENT SERVICES OF GENERAL HOSPITAL OF SGPGIMS

21GEN MEDIC

INE

GEN SURGERY

PEDIATRIC

S

GYNAE AND O

BS

DERMATOLOGY

TOTAL

97.92 100.00 98.0094.59

86.02

2.08 0.57

79.52

9.42

20.48

2.005.41 3.99

Age Profile of patients utilizing outpatient services (%)

CHILDHOOD(0-12) ADOLOSCENT(13-18)ADULT(19-60) SENIOR CITIZEN(>60)

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GEN MEDICINE

20%

GEN SURGERY

20%GYNAE AND OBS20%

DER-MA-

TOLOGY40%

NEPAL

GEN MEDICINE

28%

GEN SURGER

Y18%

PEDIATRICS12%

GYNAE AND OBS21%

DERMA-TOLOGY21%

UPGEN MEDICINE

12%

GEN SURGERY

24%

PEDIATRICS4%GYNAE AND OBS

28%

DERMA-TOLOGY

32%

BIHAR

JHARKHAND -1(Dermatology) MP-1 (Dermatology) UTTRAKHAND-2 (Gen surgery)

NAME OF THE STATAE OF THE PATIENTS UTLIZING OUTPATIENT SERVICES (%)

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FINDINGS

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OBJECTIVE 1-

To study availability and extent of utilization of outpatient services in general hospital by staff and non staff patients

Gen.Medicine Gen. Surgery Pediatrics Gynea. & Obst. Dermatology Grand Total0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

12,193 13,1703,596

22,04714,178

72,410INTERNAL PATIENTS

No.

of

pts.

GEN MEDICINE GEN SURGERY PEDIATRICS GYNAE N OBS DERMATOLOGY GRAND TOTAL0

20,000

40,000

60,000

80,000

100,000

120,000

35,833

18,755 17,349 15,417 22,746

110,100

No.

of

pts.

EXTERNAL PATIENTS

Extent of Utilization of Outpatient Services of General Hospital, SGPGIMS (2008-2012)

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2008 2009 2010 2011 20120

20

40

60

80

100

120

140

TREND OF OUPATIENT SERVICES UTILIZED BY IN-TERNAL AND EXTERNAL PATIENTS (2008-2012)

Gen.Medicine Internal Gen.Medicine External Gen. Surgery Internal

Gen. Surgery External Pediatrics Internal Pediatrics External

Gynea. & Obst. Internal Gynea. & Obst. External Dermatology Internal

Dermatology External

No.

of

Pat

ien

ts in

,00

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OBJECTIVE-To Explore The Source Of Information For External Patients Utilizing OPD

Services at General Hospital Of SGPGIMS

EMPLOYEE OF SGPGI

OLD PATIENT REFERRAL NEWS PAPER HEALTH PERSONAL

OTHERs0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

5.0

20.3

62.8

1.9 2.3

7.7

external patient

external patient

IN P

ER

CE

NT

AG

E

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OBJECTIVE-To evaluate the waiting time and the reasons of dissatisfaction among the Internal

and External patient at Out-Patient Services

Response of the patients about the behavior of registration clerk

STAFF NON STAFF

STAFF NON STAFF

STAFF NON STAFF

STAFF NON STAFF

STAFF NON STAFF

GEN MED GEN SURGERY PEDIATRICS GYNAE N OBS DERMATOLOGY

0

20

40

60

80

100

120

140

4 1 2 0 4 1 1 5 2 1

139

48

73

53

65

13

61

8389

56

PROBLEM REGISTRATION CLERK YES PROBLEM REGISTRATION CLERK NO

Nu

mb

er o

f p

ts.

Reason – Rude / Partial behavior

INTERNAL PATIENT

EXTERNAL PATIENT

INTERNAL PATIENT

EXTERNAL PATIENT

INTERNAL PATIENT

EXTERNAL PATIENT

INTERNAL PATIENT

EXTERNAL PATIENT

INTERNAL PATIENT

EXTERNAL PATIENT


0

20

40

60

80

100

120

140138

49

75

53

68

14

62

8690

57

50 0 0 1 0 0 2 1 0

YES NO

Nu

mb

er o

f p

ts.

RESPONSE OF THE PATIENTS ABOUT THE SEATING ARRANGEMENT

Reason –Less / Dirty chairs

INTERNAL PATIENT

EXTERNAL PATIENT

INTERNAL PATIENT

EXTERNAL PATIENT

INTERNAL PATIENT

EXTERNAL PATIENT

INTERNAL PATIENT

EXTERNAL PATIENT

INTERNAL PATIENT

EXTERNAL PATIENT


0

20

40

60

80

100

120

140138

49

75

53

68

14

62

8690

57

50 0 0 1 0 0 2 1 0

SATISFIED WITH GENERAL CLEANLINESS YES SATISFIED WITH GENERAL CLEANLINESS NO

Nu

mb

er o

f p

ts.

RESPONSE OF THE PATIENTS ABOUT THE GENERAL CLEANLINESS

Reason - Unhygienic

INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNAL INTERNAL EXTERNALGEN MED GENERAL SURGERY PEDIATRICS GYNEA AND OBST DERMATOLOGY

0

20

40

60

80

100

120

140137

46

66

48

61

14

59

77 78

56

6 39

5 8

03

11 13

1

YES

NO

Nu

mb

er o

f p

ts.

RESPONSE OF THE PATIENTS ABOUT THE TOILET FACILITY

Reason –Unhygienic / Fewer in number

SATISFACTION/DISSATISFACTION WITH CONCERN DOCTOR


0

20

40

60

80

100

120

140

160142

48

75

53

68

13

61

87 88

56

1 1 0 0 1 1 1 1 3 1

YES NO

Reason –Unpunctual/Unavailability

Nu

mb

er o

f p

ts.

SATISFACTION/DISSATISFACTION WITH SAMPLE COLLECTIONTECHNICIAN


0

20

40

60

80

100

120

140

160 142

48

75

5268

14

62

86 90

57

1 1 0 1 1 0 0 2 1 0

YES NO

Reason – Unpunctual / Unavailability

No

of p

atie

nts

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OBJECTIVE- TO STUDY WAITING TIME FOR THE EXTERNAL AND INTERNAL PATIENT AT

OUTPATIENT SERVICES

TOTAL TIME SPENT IN OUTPATIENT SERVICES BY INTERNAL AND EXTERNAL PATIENT INCLUDING PHARMACY


0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

65.0

42.9

26.029.3

76.8

92.9

69.4

29.5

92.3

80.7

29.434.7

12.0 14.5

23.2

7.1

24.2

51.1

7.7

15.8

5.6

22.4

1.0

17.3

6.5

19.3

0.03.5

<=2Hrs >2-4Hrs >4Hrs

%

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TIME SPENT IN OUTPATIENT SERVICES WITHOUT PHARMACY BY INTERNAL AND EXTERNAL PATIENTS


0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

77.6

49.0

76.0

43.4

92.8 92.9

79.0

29.5

95.6

80.7

21.7

38.8

21.3

32.1

7.2 7.1

19.4

55.7

4.4

15.8

0.7

12.2

2.7

24.5

1.6

14.8

0.03.5

<=2hrs >2-4 hrs >4hrs

%

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OBJECTIVE-TO RECOMMEND THE CORRECTIVE MEASURES TO ENHANCE THE PATIENT SATISFACTION

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OBJECTIVE-TO RECOMMEND THE CORRECTIVE MEASURES TO ENHANCE THE PATIENTSATISFACTION

Enquiry counter and hospital map should be present Transport facility should be provided from main gate to the general hospital USG and X-RAY facility should be provided In the hospital Token system should be present for queue and registration Manpower should be increased PHARMACY COUNTER- Manpower should increased All counter should be open All medicine should be available Worker should behave proper

HOSPITAL INFORMATION SYSTEM(HIS)- Don’t work properly Takes too much time AMBULANCE FACILITY- Not available at time

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OBJECTIVE-TO RECOMMEND THE CORRECTIVE MEASURES TO ENHANCE THE PATIENTSATISFACTION

TOILET FACILITY- Hygiene should be maintained Number and ladies toilet should be increased Cantene facility should be increased SEATING ARRANGEMENT – Number and space should be increased Behavior and punctuality-

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Thank you