Patient Satisfaction of Health Care Service Quality in Saudi Arabia - Research Proposal Example

Patient satisfaction of Health Care service quality in Saudi Arabia A qualitative study on Patient satisfaction of Health Care service quality in Saudi Arabia Abstract This research seeks to document the levels of satisfaction among patients in Saudi Arabia with the healthcare quality provided. In this research, there will be the determination of the numerous factors that influence the patients’ perception of quality healthcare service. Additionally, the study seeks to determine the relevant variables to the socio-demographics of the society in order to understand the satisfaction of the patients with the healthcare services offered. This research will document the role of patient satisfaction in either strengthening or weakening the relationship between healthcare service quality and trust patients have in healthcare service providers. The study that uses the recipients of the healthcare services as its respondents will also exhibit the cultural diversity in the country to ensure the sample is a representative of the general Saudi Arabian population. Questionnaires will be the key instrument for data collection and the obtained data will eventually be analyzed for the purposes and reflected upon in regard to subject under study. Conclusions and inferences will be made based on the accrued information for the purpose of recommending the suitable healthcare approaches for improving the service quality. Table of Contents Introduction Aims and Objectives Review of relevant literature Conceptualization of service quality Perceived Service Quality Quality in health care Patient satisfaction Demographic factors in determining patient satisfaction Methodology Study design Sampling Instrument development Data gathering procedure Data Analysis and Results Ethical Consideration Potential offence/distress to participants Procedures to ensure confidentiality and data protection Ethical Approval Limitations Bibliography Appendix Questionnaire Letter of consent Time frame Budget Introduction Patient satisfaction refers to the feelings of an individual in form of pleasure or disappointment as a result of comparing the perceived performance outcome of healthcare services in relation to the expectations of the individual. In this case, therefore, a performance that is way below the expectations of the patient results in dissatisfaction, whereas the service whose perceived quality is within the patient’s expectations results in satisfaction and delight (Nguyen Thi, Briancon, Empereur and Guillemin, 2002). In the recent days, the healthcare service providers have had to awaken to the challenges, quality, competition, and the marketing realities posed by the consumers of their services. In line with these changes, there has been the emergence of an equally important and related issue, which is the relationship between the care provider and the patient concerning the general evaluation of the quality of health care service (Andaleeb, 2001). There is a marked level of frustration among the patients, especially with the recent commercialization of the health care services, weakened relationship between the client and care provider, and the proliferation and bureaucratization of the health care system (Pakdil& Harwood, 2005). In order to realize patient satisfaction in the health care settings, there is need for the care providers to acknowledge the need for health care marketing. In this respect, clinics, hospitals, and the other providers of medical care services have to put efforts towards the development of relationship marketing with the patients, ensuring effective determination of the patients’ needs, as well as tailoring of the services provided to comply with the standards set by the clients (Badri, Attia&Ustadi, 2008). Being a psychological state of mind, satisfaction is dependent on the emotion around the disconfirmed expectations, together with the prior feelings by the consumer regarding the consumption experience (Naidu, 2009). Patient satisfaction is thus a major marker for the delivery of quality health care, and there is need for these globally acceptable factors to be effectively studied to ensure smooth functioning of the systems of care services in place (Malhotra, Ulgado, Agarwal, Shainesh& Wu, 2005). Appreciating the factors that pertain to satisfaction of patients is bound to lead to the implementation of programs that are custom made in line with the respective patients’ requirements, according to the perception of the service providers and the patients (Liu & McClure, 2001). In all this, however, the patient is regarded the best judge considering that it is him or her that assesses with accuracy the personal input towards the overall improvement of the healthcare quality through rectifying the weaknesses within the healthcare system by the authorities concerned. Involving the users of the healthcare services, who are in this case the patients, is seen as an ideal way of improving the outcomes of the same. Evidence suggests that satisfied patients demonstrate improved continuity, compliance, and eventual better health outcomes owing to the dependable and trustful contact between them and their health care providers (Lim& Tang, 2000). There has been a great focus onto improving of the patient care in the recent past, with the sole aim of attaining high patient satisfaction degree due to the ever growing demand for quality care by the general public within the hostile and competitive health care environment. The aspect of patient satisfaction is inclusive of all factors of health care services as dictated by the perspective of system approach (Laroche, Ueltschy, Abe, Cleveland&Yannopoulos, 2004). The use of health care services is influenced by a variety of social, psychological, cultural, political, and economic forces. There are different studies done in relation to the range of variables related to topics that include behavior, cost, communication skills and competence of the professional providing health care (Ladhari, 2009). On the other hand, other factors that include the waiting time, cleanliness, consultation time, among other things, are important parameters upon which the quality of care provided within the healthcare setting is determined. There is evidence that shows that good service quality helps retain existing clients and attracts prospective ones. It lowers the cost of service provision, enhances corporate image, encourages positive recommendation by patients and raises organizational profitability (Badri, Attia&Ustadi, 2009. Many corporate strategies seek to secure and increase patient loyalty because getting new clients is costly, and retention of clients relates with long-term profitability (Andaleeb, 2001). Analyzing service quality would inform the management of health organizations in financial budgeting. This would help them channel funds to areas of operation that need improvement and that influence patient satisfaction of service quality in healthcare. Studies on patient satisfaction were never given the required attention before the late 1970s proceeding to the early 1980s (Pakdil& Harwood, 2005). This shift in perception in patient satisfaction evaluation could be attributed to medicine commercialization, together with the ever-growing interest by social scientists in individual experiences with health care services (Bang, Raymond, Taylor& Young, 2005). In the recent literatures, there has been a lot of insight into the broad areas considered important in designing, validation and implementation of the patient satisfaction survey. Aims and objectives This research aims at identifying the state of patient satisfaction of healthcare service quality in Saudi Arabia. This study will document the elements of primary healthcare that are important to Saudi Arabian patients in evaluating the quality of service. It will also expound on the determinant factors of patient satisfaction of healthcare service quality including socio-demographic factors. The objectives of this research include: a) To evaluate how the service quality of both private and public hospitals in Saudi Arab reflect the perception of patients about healthcare. It will expound on how the characteristics of Saudi Arabian patients lead to negative or positive judgment. This would help understand factors affecting patient satisfaction. b) To evaluate the relationship between the perceptions of patients about healthcare service quality and patient satisfaction. c) To investigate the impact of demographic factors in determining patient satisfaction and healthcare service quality. Literature Review Conceptualization of service quality A number of writings have documented important facts about service quality that is crucial in the marketing of services. According to Jaipaul and Rosenthal (2003), service quality denotes the delivery of exceptional services in relation to customer expectations. It is a multi-faceted construct, and a number of researchers have discussed many determinants of service quality. Technical service quality refers to what the service does for patients and functional service quality refers to the manner of service delivery (Bebko&Garg, 2005). There are studies that propose that service quality comes out well when studied using a number of elements. Nguyen (2002) mentions these as being inclusive of professionalism, credibility, trustworthiness, flexibility, reputation, service recovery, accessibility, skills, behavior, reliability and attitudes. Other studies split service quality into interactive, cooperate, and physical qualities. Interactive quality factors suggest that service quality is a function of the relationship between service-giver and service-recipient. Outcome quality has to do with an analysis of core services by consumers. Interaction quality denotes the way in which consumers evaluate the process of service delivery. Kang and James (2004) agree that physical environments quality entails consumers’ judgment of the tangible aspects of the services delivered. The consistent service outcome, its dependability and accuracy, makes up the reliability element of patient satisfaction. Willingness to serve patients and the promptness to do the same spells out the responsiveness dimension (Bowers, 2004). Empathy entails giving personalized attention, convenient service access, understanding patients’ needs and showing care for patients. Assurance dimension has to do with staff’s credibility, courtesy and competence that translate into patients’ confidence and trust (Nguyen, 2002). Perceived Service Quality Naidu (2009) moved that perceived service quality is the result of patients comparing their expectations with the services they receive. By implication, this means that the patient observes the perceived service against the expected service. This is the reason why it is relativistic as it involves people’s subjective response (Pakdil& Harwood, 2005). This attitude relates to but does not equate with satisfaction. Quality in healthcare Healthcare quality is difficult to define because it entails studying patients lives. A patient’s family and friends are important in assessing healthcare quality. These individuals are potential future patients, and as such, they come to influence patients’ choices of healthcare. Some researchers have deduced that patients’ perceived satisfaction is their view of quality (Crow, 2002). Others hold that quality has got to continual satisfaction of the requirements of patients. Malhotra (2005), observed that health care-givers’ competence makes up the technical aspect of healthcare. This embodies good clinical outcomes, thoroughness, operating and clinical skills. This manifests in the provision of relevant information, explanation of treatment, illness and healthcare providers warmth and courtesy (Pakdil& Harwood, 2005). Patients cannot analyze hospital staff’s technical competence accurately (Drain, 2001). As such, patients are only able to evaluate the interpersonal aspects of healthcare or the manner of care delivery. For instance, patients will consider the duration of time they take to be served in evaluating a hospital’s service quality. These aspects of service do not require any technical expertise as patients experience them directly (Bebko&Garg, 2005). A study by Drain (2001) suggests that interpersonal warmth, convenience, and information are some nonmedical elements that raise patient satisfaction. Patient satisfaction Ladhari (2009) asserts that satisfaction is an emotional response. Perceived service quality and patient satisfaction have high resemblance, yet they remain distinct. Satisfaction has a wide scope while service quality evaluation focuses on service dimensions only. Service quality has a cognitive component while satisfaction has both affective and cognitive components (Entwistle& Quick, 2006). Satisfaction is a response attitude that patients form in judging clinical encounters. It is also a global patient response with which patients reflect on the level of how pleased they are with the received service. Liu and McClure (2001) recorded that perceived service quality changes with progressive service experiences and it last longer than satisfaction. Even so, this is transitory and reflects given individual service experiences. According to some study, satisfaction is patients’ response of fulfillment and is a judgment patients give after seeing how the service received has been pleasant (Furrer, 2000). It is possible to observe patients’ satisfaction in terms of patients experience in a healthcare setting. Medical and health services are not technically comprehensive, and as such, the expectations and perceptions of patients are not automatically related. Patient satisfaction is a central element of quality healthcare. Kueh, (2007), assert that patient satisfaction is perhaps the most important outcome that healthcare seeks to achieve. Some researchers look at patient satisfaction as a dynamic and subjective perception of the level to which expected healthcare services received (Kilbourne, 2004). By and large, patient satisfaction mirrors the quality of health service delivery. Patients’ experience of satisfaction could be tied to patients’ happiness, prosperity, quality of life and prosperity (Gowen, 2006). Technically, patient satisfaction is a judgment passed by recipients of a given service that results only after its experience. Patient satisfaction requires continued enhancement and monitoring and failure hampers the ability of service delivery to meet patients’ needs. Laroche and others (2004) observed that failure to enhance and monitor also opens opportunities that can give opponents a competitive advantage. Healthcare providers can benefit from the insight that comes with understanding the organization and content of patients’ expectations. The ability of healthcare organizations to meet patients’ expectations is manifest in those organizations’ consistency in the provision of services (Hargraves, 2001). Patient satisfaction depends largely on the effectiveness of communication between a patient and a doctor. Jabnoun and Khalifa (2005) assert that this communication depends on a number of factors that include the age of the patient and patients’ functional status. Patient satisfaction can be applied for four different purposes. The first is the comparison of different healthcare systems and programs. It helps in identifying the elements of a service that need improvement so as to raise patient satisfaction. Jackson and others (2001) suggested that organizations use information about patient satisfaction to decide which customers to enrolland which to dis-enroll. Different studies evaluate patient satisfaction in terms of different factors. Lim and Tang (2000) observed that some studies require patients to indicate their level of satisfaction with the service they receive. Others require patients to indicate their satisfaction with healthcare determinants such as technical services, housekeeping, admissions, food, nursing care and discharge. For instance, Hiidenhovi (2002) measured patient satisfaction using a sixteen-item tool that tackled crucial aspects of patient satisfaction. These aspects included outcome of care, technical aspects, physical environment, interpersonal elements of care and accessibility (Hargraves, 2001). Other studies include other aspects such as communication, competence, professional credibility, and customization and core services. Demographic factors in determining patient satisfaction The American Health Institutions Accreditation Committee defines quality as the increasing level of desired treatment results by the patient, couple with decreased undesirable results. Satisfaction by the patient is a very crucial predictor of how compliant the healthcare services are with the psychological well-being of the patient at the time of recovery (Entwistle& Quick, 2006). The indefinite nature of quality determination by the patients is widely prompted by the diversity exhibited within the societies. For instance, the different expectations and satisfaction from healthcare services is varied based on age, sex, marital status, level of education, employment status, as well as the number of occupants with which an individual stays in a home (Gowen,Mcfadden, Hoobler&Tallon, 2006). The expected service quality is equally influenced by the enabling resources at the disposal of the patient (Jabnoun &Khalifa, 2005). For instance, it is observed that the monthly income of a given household, the distance between the patient’s place of residence and the health care center, the financial barriers of the patient, as well as the regular care sources are among the influential factors in predicting the quality of care expected by the patient. Other factors bound to determine the level of patient perception of the health care quality include the patient’s socio-cultural structures, the previous experiences of the patient, and the psychological being of the patient (Jabnoun&Khalifa, 2005). Methodology Study design This research work aims at developing a good understanding of patient satisfaction especially in relation to patient perception of healthcare service quality. It will focus on this from patients’ point of reference. The study will generally be descriptive and qualitative survey, with the aim of determining the varied aspects involved in patient satisfaction and what constitutes quality healthcare in the context of the Saudi Arabian population (Hiidenhovi, Nojonen&Laippala 2002). The data collected will thus put into consideration the attitudes, knowledge, and impacts of the different healthcare improvement strategies on the patients’ satisfaction within the country. There will be need to determine the link between patients’ perceptions and satisfaction with the quality of healthcare services together with the various demographic factors and their impact on patient satisfaction and healthcare service quality (Bowers, Swan& Koehler, 2004). The use of precise and clear questions in the research will be considered key in the acquisition of appropriate responses in regard to the study. The study design will employ the use of mailed questionnaires, telephone interviews, as well as personal interviews. In the interview approach, therefore, data will be collected from the respondent by use of face-to-face technique, based on the respective quality of information they are able to provide. The interview will thus allow the respondents to respond to the questions they can and ignore those they are not comfortable to respond to. Sampling The sampling technique will be purposeful sampling, and the sample shall be made up of all the clients that are currently receiving, or have initially received any form of healthcare services provided in the different departments of the hospital, which include; Surgery, Ob/Gynaecology, Orthopaedics, Emergency, Internal Medicine, Neurology, ENT, and Intensive Care, between August 2014 and December 2014. The participation of these respondents will be on voluntary basis, and their consent to participate will be signaled by their return of the filled questionnaires provided to them randomly at the time when they are given the health care services. The research aims at using 80 respondents in the study, all of whom will be notified concerning the study and be issued with the consent letters to which they can decline or approve their participation. Instrument development The instrument used in this study is the client satisfaction survey questionnaire. The satisfaction survey will consist of eleven aspects, ten of which are aimed at obtaining information from the client in regard to the personal perception towards certain issues within the service delivered by the different healthcare personnel in the different departments of the hospital. The eleventh aspect of the questionnaire will seek for a general comment from the respondent about concerning their overall view of the services offered in this facility. Data gathering procedure The questionnaire applied in the collection of data from the clients is the representative of the study instrument, and it will be issued to all respondents who have received the healthcare services from the hospital (Kueh& Ho Voon, 2007). As a way of encouraging respondents to reply to the questionnaires given, there will be a reply-paid self-addressed envelop that is sealed. This will be used for the purpose of assuring the confidentiality of the respondents, which is a key ethical factor in research studies. The returned questionnaires will then be filled in the research database, and the data will eventually be retrieved upon reception of permission from the trust committee of local ethics and the unit manager. Data Analysis and Results The analysis of the obtained qualitative data will be done by use of the statistical and descriptive inference techniques. Whereas the presentation of the results will be done in the form of charts and graph, the calculations for the P-value of the respective satisfaction indicator will be done by use of the most effective non-parametric test (Kang& James, 2004). Similarly, there will be need to seek for statistic expertise in complementing the already available knowledge of the results. A P-value above 0.05 will not be admitted since the interval of confidence will be at 95%. On the other hand, the qualitative data aspect will be critically analyzed using the read and re-read of the response before categorization of these into themes (Pakdil& Harwood, 2005). This means there may be need for coding the emerging points by use of abbreviations and subsequent connections between the identified categories traced. There will be efforts to eradicate any potential form of bias, and this will be done through ensuring that each analysis stage is as objective as possible for interpretation. Ethical Consideration Potential offence/distress to participants The tool of collecting data in this study should not cause harm to the participants. If participants are not comfortable in providinganyinformation as may be required in the tool, they can pull out of the exercise at any point. Procedures to ensure confidentiality and data protection The tool used for data collection will not require the participants to indicate their names. Even so, the study will capture other demographic details including age and sex for the purposes of coming up with descriptive statistics. There are measures to ensure the safety, confidentiality and right use of the received information. Ethical Approval Thisproposal will go through the university’s ethics committees for approval, and the study will commence only after ethics approval Limitations Reliability and Validity The research findings bear an acceptable level of reliability due to the acceptability of the criteria used in the study. The random and unbiased sampling, together with the highly sufficient number of respondents is important factors that guarantee reliability of the research. The results obtained in this research would demonstrate consistency should it be redone at any other date. On the other hand, the research has a significant level of internal validity, since the relationship between the causes and effects of patient satisfaction can be ascertained with ease. As much as the study will apply all efforts necessary in ensuring that bias is reduced, other eventualities are beyond the ability of the research team to curb. For instance, cases of non-response would be anticipated from the respondents. For instance, some of the respondents are elderly, or some may just be unable to give their responses due to the severity of their health condition, which include problems with their eyesight, fragility, deficit of cognitive, or the general weaknesses of the patients (Pakdil& Harwood, 2005). On the other hand, there may be a language barrier, especially since the hospital serves different people from different geographical origins. Cases of misinterpretation of questions, especially due to illiteracy are anticipated. However, the research study aims at minimizing the limitations through carrying out validity and reliability tests on the questionnaires. Appendix I Participants’ Information Sheet Title of the study Patient satisfaction with healthcare service quality in Saudi Arabia The purpose of the study This study aims at documenting the state of patient satisfaction with healthcare service quality in Saudi Arabia and it is affected by patients’ perception of healthcare and other socio-demographic factors. Brief background to the study There have been attempts at studying patient satisfaction in different healthcare systems in different places of the world. This study seeks to add unto the existing body of knowledge about patient satisfaction with healthcare service quality. Invitation to participate Members of Qateef community are invited to take part in this study. The invitation that will take place is random. Benefits of participating in this study There is no monetary benefit that will result from participating in this study. Even so, this study will provide a platform for participants to air out their perception of the current state in the Saudi Arabian healthcare system. The information provided by respondents will help increase knowledge about the area of study. Risks involved in participating in this research There are any foreseen risks of participating in this study. Even so, participants are allowed to the right to withdraw from participating at any point of the research process. Voluntary participation Participating in this study is voluntary and participants will not be coerced or forced to take part in, or provide any information against their consent. The information obtained from respondents will be kept safe and confidential. Requirement to help take part in the study Potential participants that are willing to take part in this study will need to read, fill and sign the consent form. N/B: The questionnaire is in English but there will be the assistance of an interpreter just in case there is need for translation Appendix II Research Consent Form Patient Satisfaction with Healthcare Service Quality in Saudi Arabia Please read the questions and statements provided in this form and respond appropriately 1. Have you read the information sheet? YES/NO 2. Have you had a chance to contact those conducting this research to ask any question about the study? YES/NO 3. Are the answers you got from the researchers satisfactory? YES/NO 4. Do you understand that you have the right to withdraw from this study at any point in the research process, without providing your reasons, and without any risks or threats? YES/NO I am willing to participate in this study YES/NO Signature _______________________________________________________________ Date ___________________________________________________________________ Name in block letters______________________________________________________ Address_______________________________________________________________________________________________________________________________________________________________Postal code________________________________________ Telephone Number________________________________________________________ Appendix III Questionnaire for satisfaction with healthcare service quality in Saudi Arabia SECTION A Background Information of Respondent (Please tick appropriately) 1. Gender Male [ ] Female [ ] 2. Age Below 20 [ ] Between 21 – 25 [ ] Between 26 – 30 [ ] Between 31 – 35 [ ] Between 36 – 40 [ ] Above 41 years [ ] 3. Race Indian [ ] White [ ] Black [ ] 4. Status single [ ] married [ ] others [ ] 5. Monthly income (SR) Below 1000 [ ] between 1000 – 2000 [ ] between 2001 – 3000 [ ] between 30001 – 4000 [ ] above 4001 [ ] 6. Occupation executive [ ] non-executive [ ] self-employed [ ] others [ ] SECTION B General Information 1. Type service Outpatient [ ] Inpatient [ ] 2. What encourages you to seek healthcare service with the preferred hospital or healthcare center? Advertisement [ ] proximity to place of residence [ ] recommendation by family/friends [ ] SECTION C Service Quality Dimensions In this section, you are required to indicate your level of agreement or disagreement with the given statements TANGIBILITY Strongly Disagree Disagree Moderate Agree Strongly agree 1. Waiting area is clean 1 2 3 4 5 2. The hospital/healthcare center has modern equipment 1 2 3 4 5 3. The hospital’s/healthcare center’s atmosphere and décor is appealing 1 2 3 4 5 4. The health workers in are neat 1 2 3 4 5 5. There are important pieces of information in the hospital’s/health center’s notice boards 1 2 3 4 5 RELIABILITY Strongly Disagree Disagree Moderate Agree Strongly agree 1. The hospital/healthcare center provides services timely 1 2 3 4 5 2. The hospital/healthcare center is accessible 1 2 3 4 5 3. When I enquire information about any issue, the center/hospital provides sufficient information 1 2 3 4 5 4. The communication lines of the center/hospital are ever open 1 2 3 4 5 5. The communication lines are easily accessible 1 2 3 4 5 RESPONSIVENESS Strongly Disagree Disagree Moderate Agree Strongly agree 1. Health workers in the center/hospital respond with immediacy 1 2 3 4 5 2. Health workers in the center/hospital provide relevant information 1 2 3 4 5 3. Health workers in the center/hospital provide prompt service 1 2 3 4 5 4. Health workers in the center/hospital address patients’ problems with willingness 1 2 3 4 5 5. The health workers in the center/hospital are not too busy to approach 1 2 3 4 5 ASSURANCE Strongly Disagree Disagree Moderate Agree Strongly agree 1. Healthcare center’s/hospital’s workers are knowledgeable about their services 1 2 3 4 5 2. Healthcare center’s/hospital’s workers are able to satisfactorily address my issues 1 2 3 4 5 3. Health workers in the center/hospital are helpful 1 2 3 4 5 4. Health workers in the center or hospital approach me warmly 1 2 3 4 5 5. The conduct of the healthcare workers inspire confidence in me 1 2 3 4 5 6. Health workers are always courteous to me 1 2 3 4 5 EMPATHY Strongly Disagree Disagree Moderate Agree Strongly agree 1. Healthcare workers listen carefully to my issues 1 2 3 4 5 2. Healthcare workers give me individual attention 1 2 3 4 5 3. The center’s/hospital’s has convenient working hours for its clients 1 2 3 4 5 4. I receive personal attention from the healthcare workers 1 2 3 4 5 5. The healthcare center/hospital prioritizes my interest 1 2 3 4 5 6. The healthcare workers understand my specific needs 1 2 3 4 5 SERVICE QUALITY Strongly Disagree Disagree Moderate Agree Strongly agree 1. The healthcare center/hospital maintains good quality service to its clients 1 2 3 4 5 2. I am satisfied with the service I receive from the healthcare center/hospital 1 2 3 4 5 3. I will continue seeking healthcare service from the healthcare center/hospital 1 2 3 4 5 4. I will recommend the healthcare center/hospital to my friends and family 1 2 3 4 5 Time frame May 2014 Ethical Approval Letters to be sent to hospital directors June 2014 Sending questionnaires to participants July 2014 - Nov 2014 Transcription and coding of the questionnaires December 2014 Analysis and contextualization February 2015 Sending report back to hospitals for feedback Budget All the activities involved in the study, among which is production of questionnaires, letters, costs of travelling, participants’ incentives and stationary are estimated to require £ 3600 References Andaleeb, S. S. (2001). Service quality perceptions and patient satisfaction: a study of hospitals in a developing country. Social Science Medicine, 52 (49), 1359–1370. Badri, M., Attia, S., & Ustadi, A. (2008). Testing the not so obvious models in healthcare quality. International Journal for Quality in Healthcare, 21(2), 159-74. Badri, M., Attia, S., & Ustadi, A. (2009). 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Total Quality Management, 16(1), 15–30. Read More