Research proposal

A MEASUREMENT OF PATIENT EXPERIENCES IN PRIVATE HOSPITAL IN SAUDI ARABIA

Introduction

Quality of care is increasingly and continuously being recognized as important in health care. While a range of measures are used by doctors, health care givers, policy makers and patients themselves to evaluate the quality of service rendered in hospitals, patient experience is the most commonly used, even preferred. From these experiences, the resulting satisfaction becomes one of the key mechanisms or measures health care providers use to assess the quality as well as outcome of their services. Besides being important by itself, patient satisfaction has also been termed as an indicator of quality care in most developed countries as it has been found to contribute to improvement of health care strategies, as well as their services and delivery. The aim of this proposal therefore, is to determine how the experience of patients will impact on their satisfaction and consequently, their perception of the quality of health care and medical services in a privet hospital in the Kingdom of Saudi Arabia.

Aim

The aim of this study will be to evaluate the overall satisfaction of patients who have received health care services in a private hospital in the Kingdom of Saudi Arabia. To do this, the study will focus on the experiences of the patients as they seek health care and medical services, the factors that affect the patient experience and the perception of the patients with regard to the quality of service they receive.

Literature review

In order to ensure and promote better medical services and care for their patients and meet the standards for accreditation, Saudi Arabian hospitals and other health care centres have adopted different methods over the years.

To access medical care and services in the Kingdom of Saudi Arabia, patients can go through either if the two routes: they can use public health care centre services first being referred to secondary care centers, or they can seek services at emergency department (commonly referred to as ED) while bypassing primary health care centres and later on seeking further secondary care at outpatient clinics. Alyasin and Douglas (2014) in their study found that 65% of Saudi Arabian patients’ visits to the emergency departments were for cases that weren’t urgent. However, when asked if they had regular public health care centres that they visited for their medical needs, 63% of the patients said they didn’t have a regular public health facility whereas 44% of them said that the emergency department worked just fine for them since they provided better care than the other health facilities (Alyasin and Douglas, 2014). They further state that these statistics raise concern over the effectiveness of Saudi Arabian public health centres. This study will look at the quality of services in health care centres from the perspective of the patients while considering the likely differences between satisfaction and experience of the patients (Alyasin and Douglas, 2014).

A multi-faceted phenomenon, patient satisfaction is a reflection of the patients’ experience as they seek medical services and it is closely linked to the outcomes of treatments, while also being used as a way of measuring the quality of health care services. Several previous studies conducted all over the world have proved the usefulness of patient experience and satisfaction, as well as the benefits that they offer. Whereas experience will focus on what the patient experiences (or does not experience) while interacting with care givers (Berkowitz, 2016), patient satisfaction will evaluate the patient’s overall perceptions of their experience(s) (Batbaatar et al., 2017). To this end, patient satisfaction will be looked at as the extent to which the experiences of the patient compare with their expectations, depending on the level to which the general healthcare needs and patient-specific medical needs are met.

If the health care services and quality offered to the patient do not meet the standards expected by the patient, patient dissatisfaction will occur. When their experience of the services offered provide the patients with sufficient information on their condition and treatment, meet their needs or exceed their expectations there will be patient satisfaction (Senitan et al.,2018), and previous studies have shown that patients that record high satisfaction levels were more likely to have their treatment benefit them. In this way, patient satisfaction brings about the aspect of success of treatment. Among the benefits that patient satisfaction brings include: adherence to the health care procedure and plan by patients, improved medical results, reduced medical costs and expenses as a result of lesser visits to doctors reduced hospitalization and minimization of the frequency with which untoward medical outcomes occur. A number of recent studies have shown that patient satisfaction also leads to the patients complying with health advice and follow ups. Similar studies conducted in various medical and health care centres across the United Kingdom, Australia, the United States of America and Europe have reported high levels of satisfaction among patients whose needs and expectations were met and/or exceeded (Kumah, 2019). It is therefore expected that this study will post similar results, in the case of the Kingdom of Saudi Arabia.

Factors influencing patient experiences

According to (Alberto et al., 2014), various factors that have been found to relate to patient satisfaction include the patient’s age, their conditions, needs, past experiences, personal backgrounds, personality and expectations.

This study will serve as a situation analysis of the factors and components that affect patient satisfaction. These factors include: patient-doctor interactions, convenience, administrative efficiency and health care centre environment, person-focused care and other global items (Abalos-Fabia et al., 2016).

Under patient-doctor interactions component,I will look at aspects like communication and respect during the health service, the care provider’s courtesy or friendliness, the doctor listening to the patient, the doctor explaining to the patient their condition and course of action or medication, the doctor answering the patient’s questions and concerns or worries, inclusion of the patient in decision making by the doctor, advising the patient on the avoidance of future problems, giving the patient detailed instructions for their care at home and satisfaction of the treatment, and the patient’s confidence in the doctor. All these go along to satisfy the patient’s need for information. Previous studies have shown that the more information patients get from their health providers, the more satisfied they are likely to be. Patients also rank this provision of information by their health care providers higher compared to other factors that contribute to patient satisfaction.

management of the disease becomes easier for the patient when the person is involved with the treatment making decisions from the early phase of the disease. All the relevant information about the disease will be available from any of the source such as the online information, information provided by the concerned physician, health care service providers and voluntary organisations. This aspect of care is called self management which comprises of the tools and techniques to manage the health condition during the crisis moment in the daily life of the patient. Individuals suffering from the long term conditions are often associated with higher risk of mental health related problems but due to the lack of the awareness the patient may not undergo the treatment process. It is also observed that the patients of chronic diseases are likely to suffer 7 times more from depression in comparison to the normal individuals (Harrison, et al, 2015; Gately, et al, 2007).

For the component of access and convenience, I will focus on factors like: ease of getting the hospital on phone and scheduling an appointment, the convenience of the medical facility’s or office location, provision of convenient parking, office hours, information about any delays and the amount of time waited before seeing the doctor.A recent study had hypothesized that the amount of time a patient spent (whether scheduling an appointment or waiting for service) greatly contributed to overall patient satisfaction.

The quality time component will look at how long the patients waited before they saw the doctor, if the doctor spent sufficient time with the patients, and if the doctor addressed the patient’s concerns.

The person-focused care component will address factors including patient’s personal issues, facility’s and staff’s focus on patient safety, sensitivity to patient’s needs. Under administrative efficiency and environment, factors that will come into play include; waiting time, comfort of the waiting area, availability of medication, level of service provided by the care giver, cleanliness levels of the facilities, availability of up-to-date facilities and recommendations given. The other global items will take into account the patient’s overall assessment of the care they got in the course of their treatment, how satisfied they were by the care they got from the doctors, if they will go back to the same facility or doctor and if they could recommend them to others.

It will, however, be difficult to measure patient satisfaction and medical systems responsiveness since patient satisfaction is influenced by not only clinical, but also non-clinical results of the care and services rendered.

Significance of the study

The findings of this study will prove valuable to the manager of the private hospital as it will provide him with guidance on ways to improve the quality of their health services, and as a result, patient satisfaction as a measure or indicator of their quality.

Methodology

For the purposes of ethics, the researcher will first have to get an ethical approval from the ethical committee of the University of Hail to undertake this study. The study will use a cross-sectional study desing of patients who will have given their consent and agreed to participate. The cross-sectional study is crucial in that it will enable the researcher to conduct an unbiased evaluation of the impact of quality of care and patient experiences on their satisfaction (as perceived by the patients). I will recruit 200 - 250 patients who had received treatment in the private hospital facility in the Kingdom of Saudi Arabia to participate in this study.

The study will employ the use of conventional sampling to acquire the 200 – 250 participants, outpatient . A self-administered questionnaire will be the most effective and efficient tool for collecting the needed information. One sets of questionnaires, for outpatient will be used. The questionnaires will be in either English or Arabic, and will take less than 15 minutes to complete. The questionnaires will be developed in a manner such that it is able to evaluate patient satisfaction on various matters such as the availability, convenience as well as accessibility of medical care and services; their perceptions of behavior of medical service providers, patient provider interactions, care providers’ competence, communication and respect, quality time, tests and treatments, personal care, privacy and safety during service, cleanliness of service areas, type of hospital facilities or amenities that they deemed important to them among others.

The questionnaires will also be drafted with a 5-point response scale which ranges from 1 (Very Good) to 5 (Very Poor). 4 will represent ‘Good’, 3 ‘Fair’ and 2 ‘Poor’. A mixture of statements and questions, both positive and negative, was set so as to do away with the aspect of a standard way of answering. This will require that the correspondents carefully read through each item before they respond. In order to have only relevant questions, a subset of respondents could be used to pilot test the questionnaires, after which questions deemed to be irrelevant to the study are dropped. The questionnaire will be administered privately, with the researcher close by to offer guidance. Once all duly completed and the necessary data collected, version 21.0 of the SPSS will be used to analyze the data. The data for categorical and quantitative variables will described through the use of descriptive statistics and will be presented in percentage and frequency forms. Pearson’s chi-square test will then be employed to analyze how the categorical variables’ distributions compare. To be considered significant, a variable will have to show a p-value that is 0.05 or less. Data for continuous variables will be presented as mean and standard deviation. Mean satisfaction percentages will be used as a way of estimating the general ranking of patients’ personal satisfaction ‘disciplines’ (components).

Result

The researchers of the present study used a cross-sectional study design of patients who had given their consent and had agreed to participate. The patient response was obtained through the self administration questionnaire for the evaluation of the outpatient data. The questionnaire of the study was both in English and Arabic language and took a very short time to solve. The reason for keeping both the language is to provide uniformity in the study and to the patients. Varied ranges of parameters, as evident from the literature review of the study, were included in the questionnaire. The findings of the study were analyzed using the version 21.0 of the SPSS. The categorical and quantitative variables were described through the use of descriptive statistics and therefore presented in the forms of percentage and frequency analysis. Pearson’s chi-square test was employed to analyze and compare the distribution of the categorical variables. The data of the demographic profile of the patients reported that 63 (48%) and 67 (52%) out of 130 patients (total) visited the hospital for the “first time” and “not for the first time” respectively. Among them 77 (36%) were male and 134 (64%) belongs to female gender. The age of the patients were in the distributed in the following ranges mentioned along with the distribution rate such as 0 -17 years (28, 13%), 18 -34 years (77, 36%), 35-49 years (73, 35%), 50 -64 years (21, 10%), 65-79 years (10, 5%) and 80+ years (2, 1%). A total of 211 patients gave response through the paper mode. Out of 211 patients mean access was found to be 87.3, mean of the moving through visit achieved was 78.7, mean number of nurse assistants were 83.4, mean number of care providers were 86.2, mean number of personal issues reported were 86.1, mean of the overall assessment achieved was 85.2, mean number of lab tests conducted were 85.4, mean number of radiology tests (X-rays) conducted were 82.8 and pharmacy was 84.8. The frequency analysis of the above mentioned parameters were expressed into five categories: very poor, poor, fair, good and very good. The frequency analyses of the overall parameter were 4.1%, 3.0%, 8.9%, 15.3% and 68.6% in the order mentioned above. The frequency analyses of access were 3.1%, 1.5%, 8.3%, 17.9% and 69.2%. The moving through visit frequency analyses were found to be 9.4%, 4.1%, 9.8%, 16.3% and 60.4% respectively. The frequency analyses of nurse visit were found to be 4.9%, 5.8%, 6.2%, 14.4% and 68.7%. The frequency analyses of the care provider were 4.9%, 3.5%, 6.3%, 12.5% and 72.8%. The frequency analyses of personal issues were 2.1%, 2.7%, 11.7%, 15.8% and 67.7%. The frequency analyses of the overall assessment were 3.6%, 2.1%, 10.9%, 16.0% and 67.4%. Similarly the frequency analyses of lab tests were 2.8%, 3.7%, 9.3%, 17.6% and 66.7%. For radiology tests were 7%, 1.4%, 11.3%, 14.1% and 66.2% respectively. Pharmacy frequency analyses were 1.9%, 2.5%, 13.1%, 19.4% and 63.1% respectively. The data were expressed in the form of pie charts and bar charts. The mean data were used for the calculation.

Discussion

The above study is a cross sectional one and used the conventional way of sampling to acquire the data of around 211 patients. The patient response was obtained through the self administration questionnaire for the evaluation of the outpatient data. The patient satisfaction data were expressed as 1 (Very Good) to 5 (Very Poor). 4 will represent ‘Good’, 3 ‘Fair’ and 2 ‘Poor’. The result section reported that 48% patients visited the hospital for the first time and 52% reported that they had previously visited the above mentioned hospital. Among them 77 were male and 134 were females. The number of patients that reported to the hospital were of varied age and the highest number of patients belongs to the age range of 18 -34 years (77, 36%). The frequency analysis of the overall parameter was found to be very good (68.6%). Similarly the frequency analysis of the access, moving through visit, nurse visits, care providers, personal issues, overall assessment, lab tests, radiology tests and pharmacy were found to be in the category of very good of the frequency analysis.

Conclusion

The above study was conducted with aim to investigate the overall satisfaction of patients who have received health care services in a private hospital in the Kingdom of Saudi Arabia. Therefore the study had focused on the experiences of the patients as they seek health care and medical services, the factors that affect the patient experience and the perception of the patients with regard to the quality of service they receive. The various factors that influence the patient satisfaction level were the patient’s age, their conditions, and needs, past experiences, personal backgrounds, personality and expectations. According to the findings of the previous studies the various factors that lead to patient satisfaction were all covered in this present study. It is now known to everybody that the patient satisfaction is related to these factors when they visit the hospital to seek the medical advice and also depends upon the health outcome of the patients. Several studies have also correlated the patient satisfaction parameter with the beneficial services that are provided in the hospital and based on the overall experience of the patient in regards to the benefits that have been provided. In the present study a varied range of parameters have been analyzed to assess the satisfaction level of the patients and most of the parameters reported “very good” in their frequency analysis. The researchers got the ethical permission for conducting the study from the ethical committee of the University of Hail. The study used a cross-sectional study design of patients who had given their consent and had agreed to participate. The cross-sectional study was crucial in that it had enabled the researcher to conduct an unbiased evaluation of the impact of quality of care and patient experiences on their satisfaction (as perceived by the patients).

Based on the isolated units available within the hospitals a researcher conducted a study using the discrete-event simulation model to evaluate the surgical intensive care unit in terms of several bed levels and the future needs. When the outcome was analysed it can be seen that the volume of the unit comprises mostly of week day patients or the routine admissions and therefore to ensure a good average occupancy level overall would not be possible without giving any strain on the system.

At last it can be concluded that the findings of the study proved to be beneficial to the administration section of the hospital as they would be able to evaluate their service and can also perform better in future to improve the present condition so that the quality of care service can be enhanced.

REFERENCES

• Al-Abri, R. and Al-Balushi, A., 2014. Patient satisfaction survey as a tool towards quality improvement. Oman medical journal, 29(1), p.3.
• Alberto Sánchez, C., Javier Prado-Galbarro, F., García-Pérez, S. and Sarría Santamera, A., 2014. Factors associated with patient satisfaction with primary care in Europe: results from the EUprimecare project. Quality in primary care, 22(3).