Customer Care as a Tool for Public Health Care Delivery among University Hospitals in Ghana - Thesis Example

CONCLUSION Summary This research work has been committed to finding the role care in accelerating public health care delivery in Ghanaian university hospitals. So far, it has been established that there a number of state assisted government universities in Ghana, all of which have public hospitals. Because these hospitals are open to the public, the need for them to ensure high levels of customer care is very relevant (Patton, 2012). Data collection was conducted using two major formats known as qualitative and quantitative data collection. Qualitatively, the researcher made use of literature review, where data were collected from secondary sources. Qualitatively also, the researcher made use of a questionnaire to collect primary data from a group of respondents. Among other things, the data collected has helped in establishing that university hospitals in Ghana have various mechanisms for implementing customer care services to patients. What is lacking however is the fact that evaluation in most of these university hospitals is not forth coming. To this end, it is not easy to determine whether or not these customer care policies are being implemented. Because of this trend, customers have not received the best of customer care from service providers. This has also hampered the level of accelerated growth that is expected from the public health facilities. The study was conducted with the purpose of finding out the customer care services which exist in various university hospitals in Ghana. This purpose was pursued based on the background that the form of customer care services practiced at the university hospitals has direct effect on the overall public healthcare service in Ghana. It was identified that in Ghana, there are several public universities with hospitals attached to these universities to serve a number of purposes (Addae, 2007). Traditionally, the university hospitals are expected to serve the health needs of the students (Ministry of Health, 2008). At university such as the Kwame Nkrumah University of Science and Technology, University of Ghana, University of Development Study Medical School, and University of Cape Coast Medical School, the hospital there double as practical or teaching hospital for medical students (Leighton & Foster, 2013). This traditional role notwithstanding, the needs that the hospitals currently serve been noted to be expanded. The expansion has taken place because the university hospitals are forced to expand their services to the general public, whether they are students or not (Mwangi, 2009). Due to this situation, it has been noted that there has been a lot of pressure on these university hospitals. Apart from the pressure that this situation has brought, the output of work from the hospitals has also been noted to affect generalised public health service. This is because apart from the care given to the public, even the students are considered an important part of the Ghanaian public, whose health outlook is measured as part of the overall public healthcare position of Ghana (Moynihan, 2003). With all these backgrounds noted, two major university hospitals were selected for the study. These two were the University of Ghana Hospital and the Cape Coast University Hospital. The two were selected as a representation of the other university hospitals in Ghana. The two were considered ideal for such a representation due to the fact that they serve a very large number of the total patient base of all the university hospitals (Abbiw, 2010). From these two university hospitals, a sample size made up of 192 respondents were set. The respondents were people who receive public health service from the hospital. The respondents were made to respond to various questions that bordered on the existing customer care practices of the hospitals, areas of customer services of the hospitals that require improvement, and the impact of the existing state of customer care at the university hospitals on public health care in Ghana. Data collection was done by the use of a questionnaire. Using the questionnaire made it possible to collect data in a quantitative manner. This means that the data collected focused on the need to draw empirical conclusions about the issues raised in the study while using mathematical and statistical tools. Analytically, the researcher employed the use of SPSS, which made it possible to present all data in a very elaborate manner. The findings made were presented in an analytical form, after which a discussion on the findings was undertaken. The findings showed that there are some gaps between accepted practice in the healthcare sector and what currently takes place in university hospitals in Ghana. Key Findings The study was built around four major themes, each of which was used to determine a special feature about customer service from university hospitals in Ghana. The first theme looked in the current state of customer satisfaction among university hospitals in Ghana. This theme was set to know how customers assessed the existing state of customer care practice from the university states (Leder, 2000). In terms of customer satisfaction on processing time, it was noted that customers are highly satisfied when it comes to timely performance of services but they are least satisfied with timely resolution of resolution at the university hospitals. In terms of satisfaction with the visual presence of the university hospitals, a very high level of satisfaction was recorded among customers in terms of the material associated with service delivery. They were however not pleased with the visual appeal of the place for safe keeping of their belongings. Also on the first theme, the issue of satisfaction with food services currently offered at the hospital was measured. Here, 45.8% of respondents were each satisfied with food services meeting health needs, and good taste of food and beverage. In terms of food services being right for the prices at which they were sold, only 42.2% of the respondents were satisfied. The last area that was focused on for the first theme on customer satisfaction level was with the impact of customer satisfaction. In this area, it was known that 70.3% of customers were willing to come again for service but only 47.4% were ready to accept to pay higher bills. The second theme of the study was on the various customer care practices that are currently in Ghanaian hospitals. This theme was set on the rationale of knowing the areas of customer care that the hospitals currently took priority in (Agyare, Mensah & Osei-Asante, 2008). This was different from the first because the first measured customer satisfaction level whiles this looked at areas that the hospitals themselves were seen to focus on. Under this second theme, the issue of patient education was emphasised. Here, it was noted that the aspect of patient education that the hospitals put much emphasis on was in terms of information on service procedure. The least area of patient education that the hospitals were noted to puts emphasis on was in terms of tips on safety and security. The area of patient-centred service was also looked at. In this area, 68.8% of the respondents opined that the area that the hospitals put much emphasis on was in terms of the hospitals giving enough direction to the hospitals. In the same area, 33.3% said where the hospitals put a lot of emphasis was accessibility to the hospital through mail. This means that mail related services was the least emphasised area of patient centred care. There was also the area of employee attitude. Here, it was found that the same level of emphasis was placed on employees being respectful, polite and courteous, and employees being credible, honest and trustworthy. The last area in this theme was employee competence, where less than 50% of the respondents agreed that the level of employee competence was sufficiently focused on by the hospitals. In the third theme, the researcher looked at ways in which university hospitals in Ghana can improve on their existing state of customer care practice. This theme was set with the aim of knowing how standardised the customer care practices given by the hospitals are and how such standards could be made better (MOH, 2009). The first area which was given focus in this theme was accessibility to the hospitals. In this area, 54.7% of respondents said there was reliable transportation but only 45.3% said there was interactive websites for the university hospitals. This means that the hospitals need to improve on the area of interactivity with their websites. There was also the issue of presence of social amenities at the university hospitals. For this area, 60.4% each agreed to the level of uninterrupted water supply and uninterrupted power supply being acceptable and up to standard. In terms of uninterrupted water supply however, 13% did not think the level of standard was acceptable, while 6.8% said same for uninterrupted power supply. In terms of the physical environment of the hospitals, 68.2% agreed that the surroundings were well maintained and attractive but a reduced number of 63% each said same for feeling physically safe and hospital being well lit. The last area under this theme was in terms of medical equipment at the hospitals. Responding to how standardised the medical equipment available were, 53.6% agreed that the standards could be considered as acceptable from a layman’s view point. 13.0% on the other hand disagreed with this position as such people felt that the standard of medical equipment were not good enough. The last theme was where the researcher generalised the customer care practices to public healthcare in Ghana. This theme was set to know the direct impact that patients or the populace of Ghana will have by having a good customer care system among the university hospitals (Kofi-Tsekpo, 2008). The first area of impact that was focused on in the study was guaranteed accurate outcome of public health service. In this area, 68.2% agreed that the customer care practices could lead to hospital keeping accurate record of patients. There were only 50% of respondents who felt that they could achieve accurate explanation of service to patients. There was also an area on achieving quick turnaround with service delivery. In this area, greater percentage of respondents indicated that quick turnaround with service delivery will be achieved because employees will be willing to attend to the needs of customers as part of customer care practices. There was however a reduced number of respondents who believed that quick turnaround with service delivery will be achieved with employees anticipating patient needs. In terms of guaranteed preventive healthcare, as many as 70.8% of respondents believed that this will be achieved through staff knowledge, experience and skills. A reduced 54.7% believed that they could attain preventive health due to assurance of problems not occurring again. The last area of this theme looked at professional service practice by employees. Over here, most respondents agreed that the best way for professional service practice to be attained in the public healthcare system is for there to be confidentiality with patient information. Conclusions Based on the summary given above, there are four major conclusions that can be drawn. In the first place, it can be concluded that there are varying customer care practices in Ghanaian universities that meet the health needs of customers. However, these customer care practices are not well integrated as part of the holistic organisational practice of these hospitals. This therefore undermines the overall idea of having a customer care practice in place. Secondly, the absence of supervision in the various university hospitals is as a result of a coherent human resource training program for staff of the hospitals. This is because according to literature reviewed, it is possible that specialised training will be given to staff of the hospitals, including supervision of customer care practices to ensure that activities of all employees in the area of customer care are well monitored (Twumasi, 2011). Furthermore, it can be concluded that the impact of customer care practices as outlined in the literature review and as pointed out by respondents who were interviewed is presently not achieved because of the absence of a well structured customer care policy. Finally, it can be concluded that if urgent interventions that are aimed at having customer care departments as part of the organisational structure of the various universities are not implemented. Accelerated public health care delivery will not be achieved. The first research question wanted to know the current state of customer satisfaction among university hospitals in Ghana. In this regard, it can be concluded with the findings that the current state of customer satisfaction is generally acceptable and satisfactory. This is because 70.3% of respondents were willing to come again for services. The state of satisfaction notwithstanding, the customers did not believe that the satisfaction was outstanding enough for them to buy for more on the services they received from the hospitals. This is because less than 50% of respondents were willing to buy more as a result of customer care they received from the hospitals. With said, Buor (2013) noted that patients of hospitals will only be willing to buy more for their services when they are convinced that the service they receive is outstanding. In the absence of this, the willingness to buy for more will be limited because patients see good or satisfactory customer service as a responsibility of the hospitals (Agyepong et al. (2010). For the university hospitals in Ghana therefore, they should take pride in their levels of customer care as a social responsibility that they give to the public (Patton, 2012). For the hospitals to expect higher revenues through increased prices that makes it possible to implement projects, the best way to achieve this will be by further improving levels of customer care (Oliver, 2010). There was also a research question that focused on knowing the various customer care practices that are in Ghanaian university hospitals that need to be promoted and those that need to be revised. In this area, the data collected can be used to conclude that the area of customer care among the hospitals that need to be promoted has to do with the extent to which the hospitals offer accessibility to the public or service users. This is because the availability of sufficient direction to the hospitals, as well as the provision of sufficient transportation services were noted to be the two most pleasing areas of care. Akerele (2007) however wanted hospitals to be more focused on the output of work rather than input. Meanwhile, these two areas that were rated highly are all seen to be at the input level of care as they lead to service reception (Parsons, 2011). Until now therefore, it can be said that there is a form of misplaced priority by the university hospitals in terms of the customer care practice that needs to be promoted. In terms of the area that needs to be revised, employee competence can be pointed to. This is because less than 50% of respondents were convinced of the employee competence at the hospitals. This is a very disturbing situation according to Ndulo (2011) because the level of competence of employees directly affects the output of work. The more competent the employees are, the more likely it is that they will be well placed address the exact health needs of their patients (Pfeffer, 2004). One other important research question wanted to know the ways in which the university hospitals in Ghana can improve on their existing state of customer care practices. To know the best way in which service can be offered, it is important to focus on what may currently be hindering the successful delivery of quality service (Delanyo et al., 2012). Meanwhile, the summary of findings given above showed that on the use of interactive internet, only 45.3% of respondents were satisfied. Meanwhile, the role of interactive websites in the provision of medical care in any modern hospital cannot be underestimated (Oliver, 2000). Parsons (2011) stressed that the websites of hospitals can serve as an important point of call for patients to receive information which is useful enough for them to avoid personal visits to the hospitals. The extent of information received from the websites get even better and better directed at needs of patients if there can be means by which the customers can also interact as part of using the websites (Oliver, 2000). With this said, it will be concluded that one of the best ways for the hospitals to improve on their customer care practice is to upgrade their websites to make them more interactive, informative and educative. It will be very important for the hospitals to appreciate the modern trend with new media, including the use of social media to achieve public service delivery and preventive healthcare campaign (Descartes, 2002). Until this is done, most of the services offered by the hospitals will have to be centred on the physical presence of the hospitals and this can be very distressing for the hospitals in some cases (The Ghanaian Times, 2008). The last research question was on the impacts of customer care on public health care delivery in Ghana as a nation. As a nation, Ghana needs to attain a highly improved and advanced public healthcare system so as to address most of the developmental challenges that face the nation (DeLancey, 2008). This is said because of the direct relationship between the health of individuals and their productivity levels (Puig-Junoy and Ortun, 2003). Through the summary of the findings, it was noted that 70.8% of respondents believed that when the knowledge, experience and skills of employees at the hospitals are improved, there can be improved public healthcare through preventive healthcare. This resonate earlier conclusions made on the low level of satisfaction made about the competence of the employees. Indeed, as the levels of competence of employees have already been said to be below expectation, it can be concluded that it will be very difficult for the university hospitals in Ghana to champion public healthcare. This is because it through the skills, experience and knowledge of these same employees that the respondents believe that improved public health care can be achieved. Up to this stage, the outcome of the study can be generalised by saying that even though the university hospitals have exhibited accepted levels of customer care practices, most of these are not focused on output of care such as employee competence and use of standardised medical equipment. This is thus a situation that directly confronts the need for the hospitals to champion the improvement of public healthcare for the ordinary Ghanaian (Royal College of Surgeons of England, 2010). Recommendations for Professional Practice Based on the conclusions made above, there are a number of recommendations that will be made for the university hospitals in Ghana to pursue as part of their efforts to providing excellent customer care practices to the public. The first major recommendation is for the hospitals to look at the need to improving upon its current state of customer care, which has been concluded to be satisfactory but not outstanding. It will be very important for the university hospitals to have a means by which they will improve their current flow of revenue. Such increases in revenue can ensure that it is possible to provide expanded scope of service to the public (Keane and Moffitt, 1998). But in its current form, chances that the public will be willing to pay more for the service they receive are less. It is therefore expected that there will be the introduction of outstanding and prestige services that can guarantee that the hospitals will have some form of moral right to ask for more in terms of how much the public pays for the services offered by the hospitals. From the second conclusion that was made, it will be strongly recommended for the university hospitals to prioritise their existing customer care practices. The fact that the hospitals have made attempts to achieve satisfactory customer care, which in most cases was measured above 70%, is commendable. But clearly, the hospitals seem to be putting round pegs in square holes and this is tantamount to displeased service outcome (Twumasi, 2011). It will thus be recommended that instead of focusing more on customer care practices that attract customers to the hospitals, they should rather be channelling most of their energies to customer care practices that guarantee excellent outcome of care. Whiles doing this, the need to maintain the standards with those care practices that look at the input services must also not be abandoned. In effect, there must be a specialised system by which the hospitals can ensure a balance between its inputs oriented care practices and output oriented care practices. One way to achieve this is to use various evaluation exercises such as field surveys to measure outcomes with services. The third conclusion that was drawn about ways in which the hospitals can improve their customer care practices mentioned that the hospitals have currently failed to take advantage of technological advancement to make its websites interactive. Once there are very interactive and well regulated websites, these websites will be doing most of the work that personnel must be assigned at the hospitals to do (Dovlo & Nyonator, 2009). By so doing, the hospital can cut down cost on human resource remuneration so that these monies can be directed at different areas of care. Based on this, it is recommended that the hospitals must take a second look at the issue of new media and advanced technology in general. With advancement in technology, it should be possible for the university hospitals in Ghana to serve as models where Tele-medicine will be practiced in Ghana. Tele-medicine as used in this context refers to a situation where the hospitals offer distant care to patients through the use of telecommunication technology. Such actions will ensure that the extent to which patients visit the hospital in person for care will reduce and thus pressure on the facilities of the hospitals will be likewise reduced. Such models of Tele-medicine will also be very ideal for ensuring that public healthcare is improved because the number of people that can be served through this means can be improved. Whiles doing this, the number of emergency cases that the hospitals handle will be reduced because it will be possible to provide supplementary care before cases get to such emergency stages. The conclusion on public health improvement also makes it very clear that until the state of competencies with employees within the hospitals are improved, it will be very difficult to achieve improved public healthcare in Ghana. Meanwhile, until there is such improvement in the public healthcare outlook of the country, the country’s dreams of becoming a developed nation can hardly be achieved. Based on this, it is being recommended for practice for the hospitals to take a second look at the competencies of their staff. Particularly, the data collected showed that the group of staff with most questionable levels of competence were the non-medical staff. Meanwhile, the roles played by such non-medical staff are equally important as the medical staff. The need for there to be more avenues for such staff to improve on their levels of knowledge, skills and experience will be recommended. For the medical staff, it is recommended that further training among them must be enforced by the hospitals. For example, after every number of years of practice, medical staff should be made to take up advanced studies in their field of study. This will ensure that the staffs come to terms with changing trends in their area of practice so that they can serve customers better by using more advanced, modern and sophisticated tools in their service delivery. Above all, the following listed recommendations are also necessary. 1. All university hospitals should have customer care divisions that are not directly cushioned under the Ministry of Health but the Ministry of Manpower and Social Welfare. This is believed to ensure independence and accountability in the area of customer care in the various hospitals. 2. Periodic research and development is needed by all the university hospitals so as to come out with constant and timely evidence based report on the level of progress with the practice of customer care in the various university hospitals. 3. Supervisory, evaluation and monitoring roles should all be intensified to ensure that service providers adhere to laid down instructions and principles on customer care 4. It is recommended that constant training and development be given to the staff of these university hospitals to ensure that they are well equipped with modern trends and theories in customer care administration, as far as the field of health care delivery is concerned. Professional and Personal Development Whiles performing this study, there were both professional and personal developments that were experienced. Professionally, the study has been very important in exposing the researcher to areas of healthcare that are of most critical need to patients especially those that lead to customer satisfaction. Until now, it is known that most patients are very worried and focused on the competency of medical and non-medical staff of hospitals. This gives the researcher a major challenge on the need to seek avenues of expanding on existing academic and professional competence. With the knowledge of professional needs of patients that have been acquired from this study, the researcher shall become more committed to the provision of customer-centred care once field practice begins. Also on the professional development, the research has been very useful in establishing that the there are input based customer care practices and output based customer care practices. Of the two however, emphasising more on output based practice can be more result oriented. Again, there have also been some personal developments that can be attributed to the successful completion of the current study. The first area of personal development that can be referred to is communication skills. Communication skills of the researcher have been improved because the researcher offered the opportunity for the researcher to constantly interact with people both verbally and non-verbally. As a researcher, it was important to exhibit the highest form of communication expediency so that respondents and other stakeholders involved in the study could easily contribute their quota to the study. One other area of personal development has to do with interpersonal relations. Ahead of the study, the researcher had some difficulties easily socialising with others and getting needs of the researcher put across to them. Up to this point, this fear can be said to have been overcome. This is because the researcher was given the chance of interacting with people of different socials standings as part of the study. Once professional practice begins, it will be possible to interact well with patients as part of knowing their needs and solving them. Limitations and Suggestions for Further Research Even though the purpose of the study can be said to have been achieved very successfully, there were some limitations that were faced while doing this. Improving each of these in the future will ensure that researchers have an easier turn around with their research. A major area of limitation that was found had to do with the generalisation of findings. This limitation was faced because the number of university hospitals included in the study was very small. With about 8 public universities in Ghana, there were only 2 that were included in the study. This makes the need to generalise the outcome of the study for all the university hospitals very difficult. It is therefore suggested for future researchers to expand the number of hospitals included in their study. It would be more beneficial to have more hospitals with fewer respondents from each of the hospitals so that there can be even representation of the hospitals. Once this is done, it will be very easy to generalise the outcomes of the study. References Abbiw, D. K. (2010). Useful Plants of Ghana: West African uses of wild and cultivated plants. London: Intermediate Technology Publications. Addae, S. (2007). History of Western medicine in Ghana: 1880-1960. Edinburgh, Scotland: Durham Academic Press. Agyare, C., Mensah, A. Y., & Osei-Asante, S. (2008). Antimicrobial activity and phytochemical studies of some medicinal plants from Ghana. Boletin Latinoamericano y del Caribe de Plantas Medicinales y aromaticas, Chile. Agyepong, I. A. et al. (2010). Health worker (internal customer) satisfaction and motivation in the public sector in Ghana. 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