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Patient satisfaction in a preoperative assessment
clinic: an analysis using SERVQUAL dimensions
Fatma Pakdil & Timothy N. Harwood
a
Department of Industrial Engineering, School of Engineering, Baskent University, Turkey
Version of record first published: 24 Jan 2007.
To cite this article: Fatma Pakdil & Timothy N. Harwood (2005): Patient satisfaction in a preoperative assessment clinic:
an analysis using SERVQUAL dimensions, Total Quality Management & Business Excellence, 16:1, 15-30
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Total Quality Management,
Vol. 16, No. 1, 15–30, January 2005
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Patient Satisfaction in a Preoperative
Assessment Clinic: An Analysis Using
SERVQUAL Dimensions
FATMA PAKDIL & TIMOTHY N. HARWOOD
Department of Industrial Engineering, School of Engineering, Baskent University, Turkey
A One of the most important quality dimensions and key success indicators in health
care is patient satisfaction. One way to measure patient satisfaction is by calculating the gap
that appears between patients’ expectations and perceptions about services delivered. In this
study, we focused on measuring this gap in a hospital-based preoperative assessment clinic. By
using the SERVQUAL model, we found that patients’ most highly ranked expectation is ‘adequate
information about their anesthesia and surgery’, and the second one is ‘adequate friendliness,
courtesy’. These areas contained relatively low gaps between perceptions and expectations. The
largest gap occurred between the expectation of clinic waiting time and overall quality perceived.
We found the SERVQUAL model to be useful in revealing differences between patients’
preferences and their actual experience.
K W: Health care quality, patient satisfaction, preoperative care, SERVQUAL, service
quality
Introduction
The service sector is the fastest growing area of the global economy. Goodsproducing activities (such as manufacturing and construction) employed only
19.1% of the labour force in 1992 (down from 26.1% in 1979); whereas serviceproducing activities employed 70% of all United States workers in 1992 (up from
62.2% in 1979) (Biema & Greenwald, 1997). One reason service quality has
become such an important issue is that America’s economy has become a
service economy. Service industries, however, have been slow to recognize the
implications of quality. This may be due to the problem of transferring production
quality concepts from the mechanical or engineering sector to the more humancentred service industry. Only recently have many service sector organizations
begun to see service quality as a potential source of sustainable competitive
advantage (Kuei, 1998). A search of the EBSCO Academic electronic database
yielded only 15 service quality-related studies between 1989 and 1991. This
number increased to 198 studies from 1997 through 1999, and 138 studies from
1999 through July 2001. This increase indicates that the concept of quality
improvement has become more important year by year in the service industry.
Correspondence Address: Fatma Pakdil, Baskent University, School of Engineering, Department of Industrial Engineering, Baglica, 06530, Ankara, Turkey. Email:
[email protected]
1478-3363 Print/ 1478-3371 Online/04/010015-16 © 2005 Taylor & Francis Ltd
DOI: 10.1080/1478336042000255622
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16
F. Pakdil & T. N. Harwood
Health care and hospital organizations have an important role in this growing
service industry. They are the only organizations that directly serve human health
care and affect it. Because of this importance, hospitals should deliver quality
and ‘zero defect’ service to their customers. Numerous and various quality
measures and indicators exist for measuring health care quality, of which one of
the most important indicators is patient (customer) satisfaction. Customer
satisfaction drives future profitability and is a vital measure of performance for
firms, industries, and national economies (Anderson & Fornell, 1994). Satisfying
patients can save hospitals money by reducing the amount of time spent resolving
patient complaints (Press et al., 1991). Health care quality can be improved by
eliciting patient preferences and customizing care to meet the needs of the patient
(Macario et al., 1999). Patients’ voices must begin to play a greater role in the
design of health care service delivery processes. In addition, the emerging health
care literature suggests that patient satisfaction is a dominant concern that is
intertwined with strategic decisions in the health services (Andaleeb, 2001).
Research has shown that the quality of service provided by a company or
institution can be measured by determining the discrepancy between what the
customer wants (customer expectations) and how the customer experiences the
service (customer perceptions). Customer expectations are formed by word-ofmouth communications, personal needs, past experience, and what and how the
staff communicates to the customer (Zeithaml et al., 1990). Customer perceptions
are formed by the customer experiencing so-called moments of truth. A ‘moment
of truth’ is the basic atom of service and is used to describe each episode in
which a customer comes into contact with any aspect of the organization
(www.phoneix.imt.za/grater/gaps.html). Customer perceptions are formed by
how they have been served. Customers evaluate the quality of service by the gap
that develops between their expectations and perceptions.
Expectations serve as a major determinant of a consumer’s service quality
evaluations, satisfaction, and provider choice decisions (O’Connor et al., 2000).
Although most patients have specific expectations for their health care visit,
physicians are frequently unaware of these desires and consequently fail to
recognize or address expectations 18–42% of the time (Jackson et al., 2001).
Such unmet expectations can have costly repercussions. A recent study by the
Technical Assistance Research Program (TARP) in Washington, DC, found that
satisfied consumers tell four to five other customers about their experience.
Dissatisfied customers tell an average of nine to ten people, and 13% of dissatisfied
customers tell more than 20 people. The annual cost of dissatisfaction with
hospital services for a hospital with 5000 annual discharges has been estimated
at more than $750,000 (Press et al., 1991).
There is growing evidence that the perceived quality of health care services
has a relatively greater influence on patient behaviours (satisfaction, referrals,
choice, usage, etc) compared with access and cost (Andaleeb, 2001). Petersen
challenges this view by suggesting that it is not important whether the patient is
right or wrong; what is important is how the patient felt even though the
caregiver’s perception of reality may be quite different (Andaleeb, 2001). Patients
make judgements about their care. Their judgements are based largely on their
perceptions of how care is administered, not on the hospitals definition of
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Patient Satisfaction in a Preoperative Assessment Clinic
17
appropriate management (Press et al., 1991). Patients’ service quality perceptions
are believed to influence patient satisfaction positively, which in turn positively
influences the patient’s decision to choose a specific health care provider (Taylor,
1994). Hospital administrators, insurance companies, community groups, and
researchers have all begun to recognize the value of the insights that patients
can provide. According to O’Connor et al., ‘It’s the patient’s perspective that
increasingly is being viewed as a meaningful indicator of health services quality
and may, in fact, represent the most important perspective’ (Andaleeb, 2001).
A popular generic instrument for evaluating service quality is the SERVQUAL
scale. SERVQUAL has been used and studied extensively in both the health and
non-health service industries (O’Connor et al., 2000). The development of the
SERVQUAL scale by Parasuraman et al. (1988) has provided an instrument for
measuring functional service quality that is applicable across a broad range of
services. In its original form, SERVQUAL contains 22 pairs of Likert-type items.
One-half of these items measure the respondents’ expected levels of service for a
particular service industry. The other half measure the perceived level of service
provided by a particular organization within that service industry. Service quality
is measured by the difference in scores (the gap scores) between the perceived
level and the expected level of service provide (Lam, 1997). For depicting these
gaps, Parasuraman et al. (1988) determined five main gaps that occur in the
service process. These five gaps are depicted in Figure 1 and summarized in
Table 1.
The SERVQUAL model measures five main dimensions of service quality
(Zeithaml et al., 1990). These dimensions are tangibles, reliability, responsiveness,
assurance, and empathy. On the other hand, there is another classification
that creates a total of ten detailed dimensions of the service quality. These
dimensions are:
(1) Tangibles: Appearance of physical facilities, equipment, personnel printed
and visual materials,
(2) Reliability: Ability to perform the promised service reliable and accurately,
(3) Responsiveness: Willingness to help customers and provide prompt service,
(4) Competence: Possession of required skill and knowledge to perform service,
(5) Courtesy: Politeness, respect, consideration and friendliness of contact
personnel,
(6) Credibility: Trustworthiness, believability, honesty of the service provider,
(7) Security: Freedom from danger, risk, or doubt,
(8) Access: Approachability and ease of contact,
(9) Communication: Listening to customers and acknowledging their comments; keeping customers informed in a language they can understand,
(10) Understanding the customer: Making the effort to know customers and
their needs (Zeithaml et al., 1990).
After the SERVQUAL model was developed, Scardina (1994), Bowers et al.
(1994), Lam (1997), Jun et al. (1998), O’Connor et al. (2000), Andaleeb (2001),
and Ma et al. (2001) used it to measure health care quality and patient
satisfaction. What was required next was to test whether the SERVQUAL model
completely included health care quality dimensions. SERVQUAL has been tested
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F. Pakdil & T. N. Harwood
Figure 1. The gaps model of service quality (Zeithaml, 1990)
Table 1. The gaps in the SERVQUAL Model
Gaps
Definition of the gaps
Gap 1
Gap 2
The discrepancy between customer expectations and management perceptions.
The discrepancy between management’s perception and customer expectations and
service specifications.
The discrepancy between the service delivered and the service specifications.
The discrepancy between the promised service and the service provided.
The potential discrepancy between the expectations and perceptions of the
customer.
Gap 3
Gap 4
Gap 5
in health care settings and the findings have been mixed (Peyrot et al., 1993).
Babakus & Mangold (1989) reported that SERVQUAL demonstrated adequate
reliability and validity. I another study, Babakus & Mangold (1992) determined
that SERVQUAL ‘is reliable and valid in the hospital environment’. Bowers et
al. (1994) tested whether SERVQUAL dimensions are sufficient for the measurement of health care quality. They found that each of the ten dimensions was
Patient Satisfaction in a Preoperative Assessment Clinic
19
contained in the patients’ discussion of their hospital care and added two
dimensions to the SERVQUAL (Bowers et al., 1994). The additional dimensions
represent aspects of service quality that did not appear to be captured by the
generic quality dimensions, and two major categories emerged: caring and patient
outcomes (Bowers et al., 1994).
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Objectives
This study was done as a part of a larger surgery process performance measurement at Wake Forest University Baptist Medical Center (WFUBMC). In the
pre-surgery process, one of the primary processes is evaluation in the Preoperative
Assessment Clinic (PAC). In a surgical process, the patient cannot evaluate total
process performance during the service delivery. For example, patients cannot
directly evaluate the operating room performance or much about the surgical
procedure. They can easily evaluate subjective quality, but not technical quality.
With this approach, the PAC and perioperative surgical care are the only two
sub-processes that include the subjective quality indicators for surgery patients.
Le May et al. (2001) propose the concept that patient satisfaction is an attribute
of quality of care in anaesthesia. Our main objective with this study was to
discover patients’ perceptions, expectations, and their opinions for improving
(PAC) services.
Research Method
Questionnaire Design
At our Medical Center we mandate that all patients arriving for ‘same-day’
surgery make a visit to the PAC. This includes an evaluation by anaesthesia care
providers and dissemination of information regarding the patients’ surgery and
anaesthetic care. To achieve the main objective of this study, we chose to measure
service quality, and patients’ expectations and perceptions using SERVQUAL
dimensions. We employed the SERVQUAL model due to its extensive use in the
patient satisfaction literature previously mentioned. In our study, we focused on
Gap 5, specifically the difference between perception and expectation. We did
not add the suggested additional dimensions (caring and patient outcomes)
previously mentioned above because we aimed to measure only patients’ expectations, perceptions, and opinions about improvement needs. Preoperative assessment does not generally include the extra dimensions of ‘caring’ or measuring
patient outcomes from therapy. We planned to measure these items by patientdriven evaluations. In summary, we designed a questionnaire using SERVQUAL
items specifically to meet our survey objectives.
Previous studies of satisfaction with anaesthetic care have used various
methods to assess this concept. Le May et al. (2001) searched Medline, Current
Contents, the Cochrane Data Base, and Dissertation Abstracts for studies
published between 1980 and March 2000 about patient satisfaction with anaesthesia services. In this study they found that three studies used interviews, six either
mailed or handed questionnaires to patients, and five used a combination of
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20
F. Pakdil & T. N. Harwood
interview and a paper-and-pencil questionnaire. Almost all the authors developed
their own questionnaire (or questions) for measuring patient satisfaction with
anaesthesia services (Le May, 2001). Because of the non-validated methodologies
used in these studies, we developed a paper-and-pencil and self-administered
questionnaire based upon the more validated SERVQUAL methods described
previously.
We constructed seven expectation-related items, 15 perception-related questions, and one open-ended question regarding any comments patients might have
about their visit. According to Le May et al.’s (2001) research, when patients
are given an opportunity to express themselves freely, they may note certain
unsatisfactory elements in the care received from the anaesthesiologist. We
therefore added one open-ended question to allow for such comments. Demographic questions were used to obtain information about the patient’s gender,
age, medical record number, and the number of visits to our PAC. Expectationrelated questions were rated on a three-choice scale as ‘very important’, ‘important’ and ‘not important’. Perception-related questions were rated on a five-point
Likert scale (1óexcellent, 2óvery good, 3ógood, 4ófair, 5ópoor). One openended question was used to learn patients’ general opinions about the PAC
process. Consequently, our perception items were formed as listed in Table 2.
We asked patients to record the length of time they waited in the clinic to be
evaluated by the staff. We also asked them to state why they chose this medical
centre for this surgical procedure.
Sampling and Data Collection
The survey procedure included all patients who came to the PAC between
22 March, 2001, and 19 April, 2001. Survey forms were given to patients by
clinic staff (PAC nurses) during their PAC visit. All questions were responded to
by either patients or their family members. These respondents completed the
form in privacy at the end of their visit to the PAC and returned it to the PAC
staff as they left. After the responding process, all responses were entered into a
Microsoft Access Database and then evaluated. Spearman rank correlations with
an alpha level statistical significance of 0.05 were performed to test for associations between age group, visit number, gender, and the survey questions.
Results
This study involved 669 patients’ responses. In our survey, 54% of patients were
female and 46% male. Twenty-one percent of patients were more than 66 years
old. The second largest group was \18 years of age (19%) (Table 3).
Of those who responded to the questions, 69% were patients themselves, and
the rest were patient family or relatives. Sixty percent of 669 patients had never
visited the PAC before.
Of our subjects, 60.3% were covered by commercial insurance, 19.8% by
Medicare, and 17.6% by Medicaid.
Patient Satisfaction in a Preoperative Assessment Clinic
Table 2. Comparison between SERVQUAL dimensions and perception items
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SERVQUAL dimensions
Item number
Perception items
Tangibles
3
2
PAC appearance
PAC location
Reliability
10
11
13
14
4
1
Responsiveness
Competence
Courtesy
5
8
7
9
6
10
12
13
5
8
7
9
6
Explanations
Time with MD/PA
RN performance
Wait for MD/PA
Hours of operation
Convenience of appointment time
MD/PA friendliness
MD/PA thoroughness
Nurse friendliness
Nurse thoroughness
Other staff friendliness
Explanations
How well MD/PA performed
RN performance
MD/PA friendliness
MD/PA thoroughness
Nurse friendliness
Nurse thoroughness
Other staff friendliness
Credibility
10
15
Explanations
Overall quality
Security
10
12
13
Explanations
How well MD/PA performed
RN performance
Access
2
5
8
7
9
6
PAC location
MD/PA friendliness
MD/PA thoroughness
Nurse friendliness
Nurse thoroughness
Other staff friendliness
Communication
5
8
7
9
6
10
1
MD/PA friendliness
MD/PA thoroughness
Nurse friendliness
Nurse thoroughness
Other staff friendliness
Explanation
Convenience of appointment time
Understanding the customer
1
15
10
Convenience of appointment time
Overall quality
Explanations
21
22
F. Pakdil & T. N. Harwood
Table 3. Patient demographics
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Items
Volume
Percent (%)
Gender (nó669)
Male
Female
Missing*
302
359
8
45
54
1
Age (yrs) (nó669)
Less than 18
19–25
26–30
31–35
36–45
46–55
55–65
More than 65
Missing*
121
28
33
33
95
98
91
131
39
18
4
5
5
14
15
14
20
6
Patient or Family (nó669)
Patient
Family member
Missing*
459
181
29
69
27
4
Number of Visit (nó669)
First
More than one
Missing*
402
257
10
60
39
1
*The missing values represent the patients who did not respond to specific item questions.
Expectations
After examining this basic information, we wished to learn patients’ expectations
about the PAC. Customers’ (internal or external) expectations and their needs
are important factors in evaluating their satisfaction. When we examined the
subjects’ expectations, we determined that the most important item for them was
to obtain ‘adequate information about their anaesthesia and surgery’ (Table 4).
Next in importance were ‘adequate friendliness, courtesy’ and ‘not to wait too
long for their surgery procedure’. These items were rated as ‘very important’ by
64% and 62% of respondents, respectively. Even though patients complained
about waiting times, they did not express the ‘not having to wait too long’
expectation option as the most important criteria. The correlation values are
displayed in Table 5.
Waiting Times
How long our patients waited to see the medical staff is displayed in Figure 2.
The largest group of patients (46%) had to wait between 6 and 15 minutes.
Although patients wait in PAC an average of only 6 to 15 minutes, their waiting
Patient Satisfaction in a Preoperative Assessment Clinic
23
Table 4. Percentages of patients’ ages
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Expectation items
Very important
(1) (%)
Important (2)
(%)
Not important
(3) (%)
54
41
5
62
36
2
50
44
6
84
64
57
15
34
41
1
2
2
1. Not have to wait too long to receive
my PAC appointment
2. Not have to wait too long for my
surgery procedure
3. Not have to wait too long here during
my visit
4. Adequate information about my
anaesthesia and surgery
5. Adequate friendliness and courtesy
6. A comfortable clinic to be in
Table 5. Spearman Rank Correlation values between expectation items
Expectations
1
2
3
4
5
6
1
2
3
4
5
6
—
—
—
—
—
—
0.73
—
—
—
—
—
0.78
0.71
—
—
—
—
0.57
0.62
0.60
—
—
—
0.62
0.60
0.66
0.67
—
—
0.63
0.63
0.66
0.63
0.79
—
p-values for results all \0.0001.
Figure 2. Percentages of patients’ ages
time during the whole preoperative process can be over 2 hours due to other
sites visited before or after their PAC visit (surgeon’s clinic, laboratory, etc).
Reasons for Choosing
In the same survey procedure, we aimed to discover why patients choose
WFUBMC for their surgery procedure. Figure 3 reflects their reasons for choice.
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24
F. Pakdil & T. N. Harwood
Figure 3. Reasons for choosing Wake Forest Baptist Medical Center
As seen from the graph, the most important reason is ‘Physician Recommendations’. The second most important reason is ‘Reputation of Hospital’. The second
reason confirms clearly the importance of word-of-mouth communications.
Perception Results
Our subjects’ opinions about PAC services are presented in Figure 4 and in Table
6. The questions and subsequent graph were formed using a Likert Scale. A ‘1’
refers to a very satisfactory level while ‘5’ refers to a very unsatisfactory level.
According to this scaling, the best score belongs to ‘Friendliness and Courtesy
Shown by MD/PA’ with 1.28 points. The worst score belongs to ‘Convenience of
PAC location’ with 1.88 points. We discovered the same result from the patients’
general comments. While they are quite satisfied with courtesy and friendliness
shown by the staff, they are dissatisfied with waiting area conditions, locations,
and directions. Friendliness and courtesy criteria are a part of ‘responsiveness’
and ‘courtesy’ dimensions of SERVQUAL. At the same time, it is commendable
that none of the items have a score below 1.88 points.
To correlate the scores of patients’ expectations and perceptions, we grouped
the Perception ranking of ‘Excellent’ and ‘Very good’ into one category in order
to compare them with the ‘Very important’ category within Expectations.
‘Good’ in the Perceptions area was considered analogous to ‘Important’ in the
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Patient Satisfaction in a Preoperative Assessment Clinic
25
Figure 4. Patients’ perceptions about PAC by SERVQUAL dimensions in Likert Scale
Expectations group. Finally, ‘Fair’ and ‘Poor’ in the Perceptions group was
related to ‘Not important’ under Expectations. We then made a comparison
between patients’ expectations and perceptions by paired t-test, and the results
are listed in Table 7. A gap equals perception minus expectation. Since the
highest perception or expectation is 1 and the lowest is 5, if perceptions are
ranked more ‘highly’ than expectations, the result is a ‘negative’. So, according
to results, the negative values mean that patients’ perceptions are higher than
their expectations. Thus, the largest gaps existing between the items are (1)
overall quality and waiting for the appointment (ñ0.39); and (2) overall quality
and waiting within the clinic to be seen (ñ0.42). This reflects the relatively lower
expectation of reliability (including waiting times) versus other dimensions such
as competence, courtesy, etc.
Gaps existed between all five expectation categories and ‘overall perception’
of quality. The direction of the gaps indicated higher perceived quality than
expected (all statistically significant) with waiting for a clinic appointment time
and waiting to be seen inside the clinic demonstrating the largest favourable gaps.
Dissatisfaction Results
Subjects were asked if they had any dissatisfaction with the PAC process. The
percentage of patients who stated any dissatisfaction was only 5.8% (39 patients
of 669 patients). The reasons for dissatisfaction are displayed in Table 8. As seen
from the table, the most common reason listed by patients is that they ‘have to
wait too long for appointments’. Two percent of the patients said they would
not prefer this hospital (14 of 588 patients). Eighty-one patients did not give any
response to this question.
26
F. Pakdil & T. N. Harwood
Table 6. Patients’ perceptions
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No. Perception items
1 Convenience of
appointment time
2 Convenience of PAC
location
3 Appearance of PAC waiting
area
4 Hours when PAC is open
5 Friendliness and courtesy
shown to you by physicians
6 Friendliness and courtesy
shown to you by the other
staff
7 Friendliness and courtesy
shown to you by the other
nurses
8 The thoroughness of care
you received from your
doctor
9 The thoroughness of care
you received from your
nurse
10 Explanations about your
anaesthesia and surgery
11 The amount of time spent
with your doctor
12 How well were your
questions answered by your
doctor?
13 How well were your
questions answered by your
nurse?
14 How long did you wait to
see the doctor after arriving
at the PAC?
15 The overall quality of the
care you received
Excellent (1)
(%)
Very good
(2) (%)
Good (3) Fair (4)
(%)
(%)
Poor (5)
(%)
37.4
35.1
23.8
3.2
0.5
31.9
38.0
25.4
4.3
0.5
31.5
31.7
41.3
40.1
23.8
26.6
3.0
1.5
0.3
0
64.0
27.4
8.1
0.5
0
64.5
27.2
7.7
0.5
0.2
63.7
27.6
8.3
0.3
0
60.7
29.8
8.8
0.7
0
63.0
28.3
8.2
0.5
0
58.8
29.3
11.1
0.8
0
47.8
36.0
14.6
1.5
0
54.1
34.7
10.2
1.0
0
55.1
33.7
10.2
1.0
0
36.8
34.3
22.0
5.3
1.5
54.4
34.8
9.8
1.0
0
Patients’ Comments
Twenty-two percent of all patients openly expressed their feelings and opinions
about PAC services. These comments concerned improvement needs, appreciations, and complaints. Of all comments expressed, 81% were positive and
primarily dealt with courtesy, good quality service, and appreciation for services
rendered. The remainder of the comments focuses on the need for various
improvements (Table 9).
Patient Satisfaction in a Preoperative Assessment Clinic
27
Table 7. Gaps between patients’ expectation and perceptions
Expectations
Wait for
appointment
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Perceptions
Convenience of
appointment time
Hours of operation
Wait for MD/PA
MD/PA thoroughness
Nurse thoroughness
Explanations given
Time with MD/PA
Information from
MD/PA
Information from
nurse
MD/PA friendliness
Staff friendliness
Nurse friendliness
PAC location
PAC appearance
Overall quality
p-value (ó0.05)
Not have to
wait during
visit
Adequate Friendly and Comfortable
information courteous
clinic
ñ0.21
ñ0.23
ñ0.23
ñ0.06
ñ0.07
ñ0.04
ñ0.002
ñ0.04
ñ0.05
ñ0.26
ñ0.28
ñ0.28
ñ0.39
\0.001
ñ0.42
\0.001
ñ0.04
\0.05
ñ0.24
\0.01
ñ0.11
ñ0.16
ñ0.32
\0.01\
Expectation and Perception dimensions are grouped by shaded areas, and the mean gaps are displayed
only for those categories within the same dimension. Gaps between the various expectations and overall
quality perception are displayed in the bottom bar along with the results of analysis.
Table 8. Reasons for dissatisfaction stated by the patients
Reasons for dissatisfaction
Have to wait too long for appointments
Not enough time spent with physician
Do not see a need for this visit
Waiting on nurse
Outdated magazines
Financial reasons
Nurse has poor communication skills
Number (39)
Percent (%)
27
2
6
1
2
1
1
68
5
16
2
5
2
2
Discussion
Measuring the degree of patient satisfaction can help facilitate hospital service
provision and management, as well as increase and maintain the quality of the
service provision (providing a closer focus on customer needs and desires). In
this study, we focused on patients’ expectations, perceptions, and satisfaction by
using the SERVQUAL model. Employing this framework, we measured overall
28
F. Pakdil & T. N. Harwood
Table 9. Patients’ comments about service improvement needs
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Comments
Long waiting time
Lack of magazines in the waiting area
Inconvenient scheduling
Cold waiting area
Lack of cleanliness
Crowded waiting area
Lack of directions
Insufficient parking
Insufficient staff
Unnecessary visit to PAC
Long distance to the Medical Centre
Staff behaviours
Number (26)
Percent (%)
7
3
2
1
1
4
2
1
1
2
1
1
27
12
8
4
4
15
8
4
4
8
4
4
customer satisfaction in several ways, including accessibility and availability of
the PAC visit, and self-reported satisfaction with clinic staff and physician care.
For accessibility and availability of service provision at this facility, opinions
appear to be split. A minority of our customers rate accessibility and availability
of service provision as less than excellent, with nearly 7% of the patients
expressing some discontent (they felt the wait was fair or poor), although only
13% of these reported waiting in excess of 30 minutes. When these customers
perceived the wait as unreasonable, they were more dissatisfied and assumed a
more critical position when viewing the other services provided. The perception
of waiting time, regardless of the length of the actual wait, is an important area
to address to enhance overall satisfaction ratings. It is important to help establish
waiting times that are considered reasonable to the majority of the customers
served regardless of whether the waiting times need to be longer than usual for
associated tests such as laboratory work. To assist with decreasing waiting times,
requiring patients and providers to remain on schedule as much as possible is
advisable. In addition, if waiting areas are considered suitable for spending time
there, less open dissatisfaction with scheduled or unscheduled waiting times may
be voiced. Moreover, waiting rooms need to be supplied with television sets,
outside telephones, and games for children. All of these conveniences would assist
customers in feeling more comfortable when waiting for services is unavoidable.
With respect to customer satisfaction and care, an interesting association was
found between measuring the degree of information dispersal and the customer–
physician–staff relationship. In a study by Chung et al. (1999), it was found that
one of the most important predictors of patient satisfaction was ‘the quality of
the patient–physician interaction’. Our study has determined the same result.
When establishing this relationship, the degree of satisfaction with physicians/
PAs tended to be the most highly rated perception. Positive physician–customer
relationships, more than any other provider customer relationship, were found
to be important for increasing satisfaction.
One important factor to be considered for improving this relationship is to
provide and make accessible education and training materials to enhance cus-
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Patient Satisfaction in a Preoperative Assessment Clinic
29
tomer knowledge. For example, a study conducted by Williams & Calnan (1991)
in England found that 35% of the customers surveyed thought the information
given by physicians to be inadequate. In this study, overall relationship satisfaction was rated highly, and 78% of the recipients reported that the necessary
information was provided by their physicians; however, upon further examination, cross-tabulation revealed a significant association between self-reported
education level and customer–physician relationships. The higher the level of
education, the less satisfaction was noted. This could be important information
for physicians, especially if poorly educated customers are intimidated by the
physician’s education and are uncomfortable with asking for additional information and clarification. Lower education levels also present a challenge for
physicians with regard to ensuring that customers really do understand and
participate in self-care health and wellness pursuits.
Organizational issues and the physical structure of a facility can be directly
related to customer satisfaction. In this study, satisfaction about the appointment
time convenience, clinic location, and clinic appearance turned out to be low.
Moreover, there were a number of complaints about the physical environment
being unsuitable. Some possible reasons for this may be inadequacies in the
physical structure of the building or its location as both services and the number
of recipients requiring evaluation increases. In addition, there are other problems
in getting hospital management to recognize specific building and service modifications that could enhance overall customer satisfaction. In closing, this modern, university-affiliated hospital appears to have made a positive overall
impression on most of the customers it has served. Despite the negative and
divided comments, 99% of customers reported their overall satisfaction with the
clinic as good or higher. As indicated by the demographic information presented
(particularly insurance and geographic location), these customers did have other
options for medical care available to them.
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