International Journal of Health Care Quality Assurance College clinic service quality and patient satisfaction Pankaj Deshwal Vini Ranjan Geetika Mittal
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To cite this document: Pankaj Deshwal Vini Ranjan Geetika Mittal , (2014),"College clinic service quality and patient satisfaction", International Journal of Health Care Quality Assurance, Vol. 27 Iss 6 pp. 519 - 530 Permanent link to this document: http://dx.doi.org/10.1108/IJHCQA-06-2013-0070 Downloaded on: 31 December 2014, At: 17:05 (PT) References: this document contains references to 28 other documents. To copy this document: [email protected] The fulltext of this document has been downloaded 207 times since 2014*
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College clinic service quality and patient satisfaction
Service quality and patient satisfaction
Pankaj Deshwal Management Division, Netaji Subash Institute of Technology, New Delhi, India, and
Vini Ranjan and Geetika Mittal
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Electronics & Communication Division, Netaji Subash Institute of Technology, New Delhi, India
519 Received 18 August 2012 Revised 13 June 2013 Accepted 10 January 2014
Abstract Purpose – The purpose of this paper is to identify the service quality dimensions that play an important role in patient satisfaction in campus clinics in Delhi; assess student satisfaction with service; and suggests ways to improve areas of dissatisfaction. Design/methodology/approach – A questionnaire was distributed to students who had completed at least two consultations at the college clinic. Convenience sampling was used to approach respondents. The questionnaire uses modified SERVQUAL and other instruments, including original dimensions and those constructed through detailed discussions. Factor analyses, reliability tests and the Kaiser-Meyer-Olkin measure of sampling adequacy were conducted. The final sample had a total of 445 respondents. Findings – After factor analysis, the authors found that the dimensions affecting patient satisfaction are: staff professionalism; clinic staff reliability; clinic accessibility and basic facilities; tangibles; cleanliness; awareness of the clinic/diseases and how clinic staff deals with emergencies. Most students were satisfied with the professionalism of the clinic staff. More than 70 percent of the respondents reported that the clinic staff paid good attention to them. The campus clinic was deemed reliable by more than 50 percent of respondents. The students found the clinic’s location convenient, with more than 50 percent supporting its location. However, there was dissatisfaction among the students regarding the tangibles of the clinic, with more than 50 percent favoring upgrading. There was satisfaction among the respondents regarding the availability of the doctor after clinic hours, but contact details for the clinic staff were not easily accessible on campus. More than 60 percent of respondents were satisfied with the cleanliness of the campus clinic. More than 50 percent felt that the campus clinic was not equipped to deal with emergencies efficiently. At the same time, 90 percent of respondents reported the availability of referral facilities in case of emergencies. Originality/value – The authors believe that this is the first study conducted to assess patient satisfaction in the campus clinics of engineering institutes in Delhi region. This paper provides valuable information to college clinic administrators. Keywords Satisfaction, Service quality, Students, Questionnaires, Clinics, Patients Paper type Research paper
Introduction Indian healthcareis a US$65 billion industry and expected to reachUS$100 billion by 2015 (Overseas Indian Facilitation Centre, 2012). The Indian government will spend 2.5 percent of the country’s gross domestic product on healthcare during the 12th Five Year Plan (2012-2017), up from 1.4 percent today (OIFC, 2012). However, Indian healthcare is in a nascent development stage compared to other countries. Every Indian consumer has several choices where services are concerned; e.g., college students may use college clinics for treatment and shift to private clinics if college services are unsatisfactory. Thus, it is essential for campus clinic staff to provide quality services to students and campus residents to retain their customers.
International Journal of Health Care Quality Assurance Vol. 27 No. 6, 2014 pp. 519-530 r Emerald Group Publishing Limited 0952-6862 DOI 10.1108/IJHCQA-06-2013-0070
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Our research was conducted in several Delhi engineering colleges offering under- and post-graduate courses. The college campuses we surveyed had residential facilities where clinic staff provide non-critical healthcare to college students and staff members through appointment and walk-in services (treated on a first-come, first-serve basis). Services include general physical examination, tuberculosis testing, blood sugar checks, nebulizers, wound care and electrocardiograms. Immediate first aid is provided to emergency and critical cases following which they are referred to hospital. Clinic staff includes a full-time medical officer, registered nurse, receptionist, pharmacist, ambulance driver and security staff. The doctor resides on or near the campus. College managers also invite specialized medical practitioners such as cardiologists, eye surgeons, homeopathic consultants, nutrition experts and gynecologists once a week. Improving clinic service quality will have a positive impact on the college’s overall image, especially those with hostels. Studies have looked at hospitals/clinics in India (Bhattacharya et al., 2003; Singh et al., 2005; Duggirala et al., 2008; Sharma, 1999; Sharma et al., 2011) but none develops and validates perception-based service quality instruments for college clinics. Our study, therefore, focusses on students’ college clinic service-quality perceptions and aims to: (1)
identify the service quality dimensions that play an important role in Delhi college clinic user satisfaction;
(2)
assess student satisfaction; and
(3)
suggest ways to improve areas where users are dissatisfied.
Healthcare service quality Cardozo (1965) conducted the first consumer satisfaction study. Since then, several related articles have been published in trade and academic journals (Peterson and Wilson, 1992). Customer satisfaction studies gained pace in healthcare after the UKNHS Management Inquiry (1984) focussed on involving consumers in healthcare processes (Sharma et al., 2011). Customers are more concerned with perceived quality compared to objective quality as they value a product using what they receive (product volume, convenience, quality) and what they give (money, time) (Zeithaml, 1988). In healthcare, perceived is more important than objective service-quality as patients judge healthcare providers on what they observe or perceive. With many options available, consumers can easily switch to different providers if they are not satisfied with the current service. Customer satisfaction is preceded by service quality, which has a significant impact on customer intentions to purchase more (Cronin and Steven, 1992). Happier and satisfied employees lead to satisfied and loyal patients who then return to the same clinic (Atkins et al., 1996). As health care providers increase, service quality and patient satisfaction become crucial. Patients recommend a healthcare provider only if they are satisfied and feel that employees empathise with them (Ioannis and Lymperopoulos, 2009). Patient satisfaction is among any healthcare providers’ top priorities; i.e., ways to enhance patient loyalty and satisfaction. Physicians, for example, can augment user satisfaction by increasing the time they spend with patients, talking about non-medical issues and answering questions after they explain test results (Gross et al., 1998). Hospital and clinic service quality College clinic staff must maintain service quality or risk losing their significance in the college if service quality is poor. Before we developed our service quality dimensions,
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we reviewed other hospital/clinic dimensions and held extensive talks with clinic staff. Items were added after questioning students about clinic notices and opening hours. Following our literature review and discussion with students and clinic staff, seven constructs and 43 items were generated (Table I). Methodology Our study was conducted between January and February 2012. The authors developed the questionnaire and selected a convenience sample; i.e., only those students using clinic facilities at least twice were nominated, since one visit would have been insufficient for users to have a denite opinion about clinic services. The objectives were explained to the respondents, privacy and condentiality were assured. Reluctant or unwilling students were not included. Any doubts among respondents were clarified on the spot to ensure maximum quality response. Consequently, questionnaires were given to 500 students. Each was checked and 445 fully completed questionnaires were retained. We used a ve-point Likert scale from strongly agree to strongly disagree and the questionnaire concluded with one open-ended question about ways in which clinic service quality could be improved. These open-ended questions provided an opportunity for respondents to voice their concerns about other areas not covered in the instrument. We used SPSS 16.0 to analyze our data.
Service quality and patient satisfaction 521
Validity Two Delhi educational institute doctors and three professors checked the instrument’s content validity and suggested changes. The instrument was given to 20 under-and 20 post-graduate engineering students to test the instrument’s face validity. Findings Descriptive analysis In all, 100 respondents were female; Table II shows that 139 respondents were post-and 306 were under-graduate students. Most respondents were aged 20-25. Sampling A Kaiser-Meyer-Olkin test was used to measure sampling adequacy, generating an 0.783 index, which is appropriate for factor analysis (Tabachnick and Fidell, 1996).
Construct
Relevant literature
Staff professionalism
Camilleri and O’Callaghan (1998), Ovretveit (2000), Huseyin et al. (2008), Sharma et al. (2011) Parasuraman et al. (1985), Tomes and Ng (1995), Walters and Jones (2001) Tomes and Ng (1995), Camilleri and O’Callaghan (1998), Carman (2000), Rose et al. (2004), Sharma et al. (2011) Parasuraman et al. (1985), Tomes and Ng (1995), Duggirala et al. (2008) Sharma et al. (2011) Carman (2000), Hasin et al. (2001) Weinerman (1966), He et al. (2011)
Clinic reliability Clinic accessibility and basic facilities Clinic tangibles Clinic awareness Clinic cleanliness Emergency services
Table I. Clinic service quality – potential constructs
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Gender Characteristics
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Course Graduate Post-graduate Age 522 15-20 20-25 Table II. 25-30 Respondent demographics Gender
Male
Female
Total
241 104
65 35
306 139
75 245 25 345
23 56 21 100
98 301 46 445
Factor and reliability analyses We used a principal component extraction technique with Varimax rotation (Lewis, 1984); consequently, some items were deleted using the following criteria: (1)
if item to item correlation was below 0.35; and
(2)
if factor loading was below 0.45 (Hatcher, 1994).
Six items were eliminated leaving seven factors with 37 items: (1)
staff professionalism (eight items);
(2)
staff reliability (six items);
(3)
accessibility and basic facilities (eight items);
(4)
clinictangibles (four items);
(5)
clinic awareness (four items);
(6)
cleanliness (four items); and
(7)
emergency care (three items).
Cronbach’s a, used to test reliability, ranged from 0.7 to 0.83, which shows high internal consistency (Cronbach and Shavelson, 2004). Total variance explained by all seven factors was 78.6 percent (Table III). Participant satisfaction According to 83 percent of the respondents, the clinic doctor allotted sufficient time throughout treatment. More than 62 percent said that staff provided services correctly at the time they promised. Nearly 75 percent said that staffs were interested in their questions, which shows a positive attitude among staff, further enhancing patient satisfaction. More than 60 percent reported that staff gave them personal attention and nearly 60 percent said that staff responded to patient requests all the time. Good communication with patients is essential during diagnosis and treatment, and our findings show that staff communicated well with patients, which give a positive impression. However, a little o50 percent said that staff told them when they would perform services. More than 55 percent felt that staff wanted to solve their problems and a similar percentage said that staff performed the service correctly the first time (Table IV). More than 65 percent said that medicines prescribed were good quality. According to 75 percent, doctors had the required knowledge to perform their
Statements
Sufficient time given during treatment The clinic staff are punctual Doctors and staff take an interest in patient questions Doctors and staff give personal attention Doctors and staff respond to requests all the time Clinic employees tell you exactly when the services are performed When you have a problem, clinic staff show a sincere interest in solving it Clinic staff perform the service right the first time The medicine given by the doctor was good quality Doctors had the required knowledge to perform their duties Doctors are competent enough in performing their duties Staff are competent enough in performing their duties Doctor services were excellent Staff services were excellent Basic requirements like water, fans, lights, etc., were available Adequate space is available in the waiting area Adequate space is available in the examination room Washrooms are adequate Parking area near the clinic Sufficient parking space available The directions to the clinic are clear Clinic location is convenient Modern equipment is available Visually appealing physical facilities Sufficient chairs for patients
Items
(15) (16) (17) (18) (32) (33) (34) (5) (10) (11) (12) (13) (14) (19) (20) (25) (26) (27) (28) (29) (31) (30) (1) (2) (3)
1 0.60 0.56 0.64 0.78 0.61 0.49 0.77 0.47
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0.49 0.72 0.71 0.60 0.74 0.52
2
0.57 0.65 0.60 0.56 0.71 0.77 0.66 0.49 0.84 0.75 0.69
Factor loadings 3 4 5
7
(continued)
6
Service quality and patient satisfaction 523
Table III. Modified SERVQUAL – principal component analysis
Adequate beds are available in the clinic Notices regarding preventing seasonal diseases like dengue, malaria, etc., are displayed regularly Clinic hours are convenient for day and hostel students Doctors are available during holidays Information regarding staff contact details is well displayed in hostels and campus notice boards Washrooms are clean Examination room is clean Waiting area is clean Parking area is clean Clinic ambulance is well equipped with basic devices to deal with emergencies Clinic staff are trained to provide first aid in emergencies simultaneously in female and male hostels Referral facilities are available during emergencies
(4) (21) (22) (23) (24) (6) (7) (8) (9) (5) (36) (37)
Table III.
Statements
1
2
0.63 0.59 0.63 0.57 0.70
Factor loadings 3 4 5
524
Items
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0.58 0.63 0.71 0.64
6
0.53 0.56 0.62
7
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Statements (15) Sufficient time given during your treatment (16) The clinic provides its service at the time it promises to do so (17) Doctors and staff members take an interest in patients’ questions (18) Doctors and staff members gave you personal attention (32) Doctors and staff members respond to requests all the time (33) Employees in the clinic tell you exactly when services are performed (34) When you have a problem, the clinic staff show a sincere interest in solving it (35) Clinic staff performs the service right the first time
Strongly agree
Strongly Agree Neither Disagree disagree
16.85
66.30
6.74
10.11
0
16.33
46.07
18.88
17.97
1.12
10.11
64.04
15.73
10.11
0
7.87
59.55
14.61
17.97
0
10.11
48.31
20.22
17.97
3.37
5.61
43.82
29.21
16.85
4.49
2.25
55.05
20.22
21.35
1.12
4.49
55.05
20.22
19.1
1.12
Service quality and patient satisfaction 525
Table IV. Satisfaction with staff professionalism (%)
duties. More than 60 percent reported that the clinic doctor and staff were competent. This demonstrates the faith students have in clinic staff. More than 50 percent were satisfied with clinic services (Table V). More than 60 percent said that basic facilities like fans, lights, water, etc., were available in the clinic and 40 percent reported that space in the waiting area and examination room was adequate. However, about 30 percent were unaware that a wash room existed in the college clinic. About 55 percent reported that parking was available and around 48 percent felt parking was sufficient. However, o50 percent reported that directions to the clinic were sufficient. More than 60 percent agreed that clinic location was convenient (Table VI). Patients were not satisfied with clinic facilities. More than 40 percent said that their clinic lacked modern equipment, sufficient chairs and beds and that facilities were not visually appealing (Table VII). More than 50 percent were unaware of notices regarding seasonal diseases, implying that information relating to dengue, malaria, etc., was not displayed properly.
Statements (10) The medicine given by the doctor was good quality (11) Doctors had the required knowledge to perform their duties (12) Doctors are competent enough in performing their duties (13) Staff are competent enough in performing their duties (14) Doctors services were excellent (19) Staff services were excellent
Strongly agree
Strongly Agree Neither Disagree disagree
13.48
52.8
19.10
12.36
2.25
19.10
57.3
15.73
7.87
0
10.11
53.9
19.10
14.61
2.25
3.37 2.25 4.49
59.5 48.3 46.1
21.35 24.72 28.09
12.36 21.35 16.85
3.37 3.37 4.49
Table V. Satisfaction with clinic reliability (%)
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Table VI. Satisfaction with clinic accessibility and basic facilities (%)
(20) Basic requirements like water, fan, light, etc. (25) Adequate space is available in the waiting area (26) Adequate space is available in the examination room (27) Adequate washrooms (28) Parking area near clinic (29) Sufficient parking space available (31) Directions to the clinic are sufficient (30) Clinic location is convenient
Statements
Table VII. Satisfaction with tangibles (%)
Strongly agree
Statements
(1) (2) (3) (4)
Agree Neither Disagree
Strongly disagree
4.49
58.43
26.97
6.74
3.37
3.37
44.94
23.6
23.6
4.49
5.61 2.25 7.87 6.74 4.49 6.74
58.43 30.34 49.44 42.7 43.82 56.18
19.1 30.34 21.35 26.97 21.35 8.99
13.48 25.84 19.1 21.35 20.22 20.22
3.37 8.99 2.25 2.25 10.11 7.87
Strongly agree Agree Neither Disagree Strongly disagree
Modern equipment Visually appealing physical facilities Enough chairs for patients Adequate beds available in the clinic
1.12 3.37 1.12 6.74
16.85 15.73 30.34 16.85
29.21 29.21 23.60 21.35
41.57 42.7 37.08 44.94
11.23 8.99 8.99 10.11
About 50 percent felt that clinic hours were convenient for both resident and day students. More than 60 percent reported that the doctor was available during holidays. However, most students said that the information regarding doctor, clinic staff and ambulance services were not displayed in hostels and on campus notice boards (Table VIII). More than 40 percent were satisfied with wash room cleanliness and about 75 percent were satisfied with examination room cleanliness; whereas more than 60 percent said the clinic waiting area was clean. A similar percentage reported clean clinic-parking areas (Table IX). Most students felt that their clinic could not provide emergency services. More than 50 percent said that the clinic ambulance was not equipped with basic devices to deal with emergencies and a similar percentage reported that the clinic staff was not equipped and trained to deal with emergencies. However, around 90 percent were satisfied with the referral facilities (Table X).
Statements
Table VIII. Satisfaction with the awareness about clinic/disease (%)
(21) Notices regarding seasonal diseases like dengue, malaria etc., are displayed (22) Clinic hours are convenient for day and resident students (23) Doctors are available during holidays (24) Information regarding staff contact details is well displayed in hostels and campus notice boards
Strongly agree
Agree
Neither
Disagree
Strongly disagree
7.87
19.10
32.58
25.84
14.61
7.87 32.60
49.44 34.7
12.36 23.5
14.61 9.10
15.73 0.10
2.25
23.60
20.22
32.58
21.35
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Conclusions We infer that most respondents are satisfied with staff professionalism; however, staff can improve service quality by responding promptly to patient requests. Although more than 50 percent rated their college clinic and its services reliable, half did not feel that services were excellent. Every patient wants to be heard whenever s/he visits the clinic, which forms a crucial aspect of patient satisfaction. Thus, it is important for healthcare providers to respond to patient requests. Such improvements can advance patient satisfaction. Half the respondents did not approve clinic facilities; i.e., patients felt that clinic equipment was not up-to-date or visually appealing. Old equipment and inadequate beds created a negative impact. Some students used healthcare providers outside the campus whenever they could as they did not have faith in clinic equipment. Upgrading equipment, therefore, is imperative as staff must win the students’ trust. The general impression was positive, as most respondents stated that clinic hours were convenient, but doctor availability during holidays or after hours was limited and only those who had a staff telephone number were able to make contact. It is crucial for patients to know that medical help is just a call away during an emergency. Thus, clinic staff contact details must be displayed on campus and hostel notice boards. Unclean premises can lead to health problems and diseases. Most participants were satisfied with clinic cleanliness, which is positive. Every healthcare center must be equipped to deal with emergencies as they are crucial healthcare services and can mean life and death for patients. Most students lacked confidence in the staff’s ability to deal with emergencies – a setback for college clinic staff – who should be trained to deal with emergencies. Moreover, the medical equipment required for emergencies must be present in the clinic along with an ambulance for transporting patients to the nearest hospital in case their condition deteriorates. An open-ended question was framed for the respondents to suggest improvements; often mentioned were: .
Service quality and patient satisfaction 527
Clinic staff contact details should be prominently displayed on campus and in hostels notice boards.
Statements (6) Washrooms are clean (7) Examination room is clean (8) Waiting area is clean (9) Parking area is clean
Strongly agree
Agree
Neither
Disagree
Strongly disagree
2.25 2.25 4.49 10.11
40.45 74.16 62.92 48.31
38.20 16.85 13.48 22.47
16.85 4.49 14.61 14.61
2.25 2.25 4.49 4.49
Strongly agree
Agree
Neither
Disagree
Strongly disagree
2.25
14.61
29.21
28.09
25.84
4.49
26.97
23.6
25.84
23.6
Statements (5) Ambulance is well equipped with basic devices to deal with emergencies (36) Clinic staff are trained to provide first aid in case of emergencies (37) Referral facilities are available in an emergency
30.5
59.4
6.50
2.40
Table IX. Satisfaction with cleanliness (%)
1.20
Table X. Satisfaction with emergency care (%)
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.
Specialists should visit regularly, especially dentists, ophthalmologists, dermatologists and dieticians. Visiting hours should be displayed in the clinic, on campus and hostel notice boards.
.
Clinics need more sophisticated and better instruments like x-ray machines, more spacious and improved examination rooms.
.
Students wanted better ambulance service to deal with emergencies along with better first-aid facilities in hostels to deal with mishaps.
.
Students wanted greater cleanliness; more hygienic facilities and direction boards specifying clinic locations.
Our results can be integrated into manager’s strategic planning processes with respect to budgeting for quality improvement projects. Survey outcomes indicate areas where clinic staff must invest. Other measures that can improve college clinic services are: .
regular interaction with students to determine what services they desire;
.
at least fort nightly staff meetings to discuss student suggestions, upgrading facilities or issues regarding clinic maintenance;
.
holding interactive sessions with students to educate them on common diseases;
.
providing facilities so that students can discuss their problems anonymously;
.
training clinic employees to put patients at ease; and
.
educating students about the clinic’s latest facilities.
Further study College clinic studies can be useful for college administrators, who can use conclusions to improve clinic standards. Moreover, such studies can be conducted at state, country and international levels to compare campus clinic facilities and outcomes can be compared with this study, which may lead to enhanced college clinic standards and better treatment. Our questionnaire can be used to develop instruments for other clinicbased research. References Atkins, P.M., Marsall, B.S. and Javalgi, R.G. (1996), “Happy employees lead to loyal patients”, Journal of Health Care Marketing, Vol. 16 No. 4, pp. 14-23. Bhattacharya, A., Menon, P., Koushal, V. and Rao, K.L.N. (2003), “Study of patient satisfaction in a tertiary referral hospital”, Journal of the Academy of Hospital Administration, Vol. 15 No. 1, pp. 1-3. Camilleri, D. and O’Callaghan, M. (1998), “Comparing public and private care service quality”, International Journal of HealthCare Quality Assurance, Vol. 11 No. 4, pp. 127-133. Cardozo, R. (1965), “An experimental study of consumer effort, expectation and satisfaction”, Journal of Market Research, Vol. 2 No. 3, pp. 244-249. Carman, J. (2000), “Patient perceptions of service quality: combining the dimensions”, Journal of Management in Medicine, Vol. 14 Nos 5/6, pp. 339-356. Cronbach, L.J. and Shavelson, R.J. (2004), “My current thoughts on coefficient alpha and successor procedure”, Educational and Psychological Measurement, Vol. 64 No. 3, pp. 391-418.
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Corresponding author Pankaj Deshwal can be contacted at: [email protected]
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To cite this document: Pankaj Deshwal Vini Ranjan Geetika Mittal , (2014),"College clinic service quality and patient satisfaction", International Journal of Health Care Quality Assurance, Vol. 27 Iss 6 pp. 519 - 530 Permanent link to this document: http://dx.doi.org/10.1108/IJHCQA-06-2013-0070 Downloaded on: 31 December 2014, At: 17:05 (PT) References: this document contains references to 28 other documents. To copy this document: [email protected] The fulltext of this document has been downloaded 207 times since 2014*
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College clinic service quality and patient satisfaction
Service quality and patient satisfaction
Pankaj Deshwal Management Division, Netaji Subash Institute of Technology, New Delhi, India, and
Vini Ranjan and Geetika Mittal
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Electronics & Communication Division, Netaji Subash Institute of Technology, New Delhi, India
519 Received 18 August 2012 Revised 13 June 2013 Accepted 10 January 2014
Abstract Purpose – The purpose of this paper is to identify the service quality dimensions that play an important role in patient satisfaction in campus clinics in Delhi; assess student satisfaction with service; and suggests ways to improve areas of dissatisfaction. Design/methodology/approach – A questionnaire was distributed to students who had completed at least two consultations at the college clinic. Convenience sampling was used to approach respondents. The questionnaire uses modified SERVQUAL and other instruments, including original dimensions and those constructed through detailed discussions. Factor analyses, reliability tests and the Kaiser-Meyer-Olkin measure of sampling adequacy were conducted. The final sample had a total of 445 respondents. Findings – After factor analysis, the authors found that the dimensions affecting patient satisfaction are: staff professionalism; clinic staff reliability; clinic accessibility and basic facilities; tangibles; cleanliness; awareness of the clinic/diseases and how clinic staff deals with emergencies. Most students were satisfied with the professionalism of the clinic staff. More than 70 percent of the respondents reported that the clinic staff paid good attention to them. The campus clinic was deemed reliable by more than 50 percent of respondents. The students found the clinic’s location convenient, with more than 50 percent supporting its location. However, there was dissatisfaction among the students regarding the tangibles of the clinic, with more than 50 percent favoring upgrading. There was satisfaction among the respondents regarding the availability of the doctor after clinic hours, but contact details for the clinic staff were not easily accessible on campus. More than 60 percent of respondents were satisfied with the cleanliness of the campus clinic. More than 50 percent felt that the campus clinic was not equipped to deal with emergencies efficiently. At the same time, 90 percent of respondents reported the availability of referral facilities in case of emergencies. Originality/value – The authors believe that this is the first study conducted to assess patient satisfaction in the campus clinics of engineering institutes in Delhi region. This paper provides valuable information to college clinic administrators. Keywords Satisfaction, Service quality, Students, Questionnaires, Clinics, Patients Paper type Research paper
Introduction Indian healthcareis a US$65 billion industry and expected to reachUS$100 billion by 2015 (Overseas Indian Facilitation Centre, 2012). The Indian government will spend 2.5 percent of the country’s gross domestic product on healthcare during the 12th Five Year Plan (2012-2017), up from 1.4 percent today (OIFC, 2012). However, Indian healthcare is in a nascent development stage compared to other countries. Every Indian consumer has several choices where services are concerned; e.g., college students may use college clinics for treatment and shift to private clinics if college services are unsatisfactory. Thus, it is essential for campus clinic staff to provide quality services to students and campus residents to retain their customers.
International Journal of Health Care Quality Assurance Vol. 27 No. 6, 2014 pp. 519-530 r Emerald Group Publishing Limited 0952-6862 DOI 10.1108/IJHCQA-06-2013-0070
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Our research was conducted in several Delhi engineering colleges offering under- and post-graduate courses. The college campuses we surveyed had residential facilities where clinic staff provide non-critical healthcare to college students and staff members through appointment and walk-in services (treated on a first-come, first-serve basis). Services include general physical examination, tuberculosis testing, blood sugar checks, nebulizers, wound care and electrocardiograms. Immediate first aid is provided to emergency and critical cases following which they are referred to hospital. Clinic staff includes a full-time medical officer, registered nurse, receptionist, pharmacist, ambulance driver and security staff. The doctor resides on or near the campus. College managers also invite specialized medical practitioners such as cardiologists, eye surgeons, homeopathic consultants, nutrition experts and gynecologists once a week. Improving clinic service quality will have a positive impact on the college’s overall image, especially those with hostels. Studies have looked at hospitals/clinics in India (Bhattacharya et al., 2003; Singh et al., 2005; Duggirala et al., 2008; Sharma, 1999; Sharma et al., 2011) but none develops and validates perception-based service quality instruments for college clinics. Our study, therefore, focusses on students’ college clinic service-quality perceptions and aims to: (1)
identify the service quality dimensions that play an important role in Delhi college clinic user satisfaction;
(2)
assess student satisfaction; and
(3)
suggest ways to improve areas where users are dissatisfied.
Healthcare service quality Cardozo (1965) conducted the first consumer satisfaction study. Since then, several related articles have been published in trade and academic journals (Peterson and Wilson, 1992). Customer satisfaction studies gained pace in healthcare after the UKNHS Management Inquiry (1984) focussed on involving consumers in healthcare processes (Sharma et al., 2011). Customers are more concerned with perceived quality compared to objective quality as they value a product using what they receive (product volume, convenience, quality) and what they give (money, time) (Zeithaml, 1988). In healthcare, perceived is more important than objective service-quality as patients judge healthcare providers on what they observe or perceive. With many options available, consumers can easily switch to different providers if they are not satisfied with the current service. Customer satisfaction is preceded by service quality, which has a significant impact on customer intentions to purchase more (Cronin and Steven, 1992). Happier and satisfied employees lead to satisfied and loyal patients who then return to the same clinic (Atkins et al., 1996). As health care providers increase, service quality and patient satisfaction become crucial. Patients recommend a healthcare provider only if they are satisfied and feel that employees empathise with them (Ioannis and Lymperopoulos, 2009). Patient satisfaction is among any healthcare providers’ top priorities; i.e., ways to enhance patient loyalty and satisfaction. Physicians, for example, can augment user satisfaction by increasing the time they spend with patients, talking about non-medical issues and answering questions after they explain test results (Gross et al., 1998). Hospital and clinic service quality College clinic staff must maintain service quality or risk losing their significance in the college if service quality is poor. Before we developed our service quality dimensions,
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we reviewed other hospital/clinic dimensions and held extensive talks with clinic staff. Items were added after questioning students about clinic notices and opening hours. Following our literature review and discussion with students and clinic staff, seven constructs and 43 items were generated (Table I). Methodology Our study was conducted between January and February 2012. The authors developed the questionnaire and selected a convenience sample; i.e., only those students using clinic facilities at least twice were nominated, since one visit would have been insufficient for users to have a denite opinion about clinic services. The objectives were explained to the respondents, privacy and condentiality were assured. Reluctant or unwilling students were not included. Any doubts among respondents were clarified on the spot to ensure maximum quality response. Consequently, questionnaires were given to 500 students. Each was checked and 445 fully completed questionnaires were retained. We used a ve-point Likert scale from strongly agree to strongly disagree and the questionnaire concluded with one open-ended question about ways in which clinic service quality could be improved. These open-ended questions provided an opportunity for respondents to voice their concerns about other areas not covered in the instrument. We used SPSS 16.0 to analyze our data.
Service quality and patient satisfaction 521
Validity Two Delhi educational institute doctors and three professors checked the instrument’s content validity and suggested changes. The instrument was given to 20 under-and 20 post-graduate engineering students to test the instrument’s face validity. Findings Descriptive analysis In all, 100 respondents were female; Table II shows that 139 respondents were post-and 306 were under-graduate students. Most respondents were aged 20-25. Sampling A Kaiser-Meyer-Olkin test was used to measure sampling adequacy, generating an 0.783 index, which is appropriate for factor analysis (Tabachnick and Fidell, 1996).
Construct
Relevant literature
Staff professionalism
Camilleri and O’Callaghan (1998), Ovretveit (2000), Huseyin et al. (2008), Sharma et al. (2011) Parasuraman et al. (1985), Tomes and Ng (1995), Walters and Jones (2001) Tomes and Ng (1995), Camilleri and O’Callaghan (1998), Carman (2000), Rose et al. (2004), Sharma et al. (2011) Parasuraman et al. (1985), Tomes and Ng (1995), Duggirala et al. (2008) Sharma et al. (2011) Carman (2000), Hasin et al. (2001) Weinerman (1966), He et al. (2011)
Clinic reliability Clinic accessibility and basic facilities Clinic tangibles Clinic awareness Clinic cleanliness Emergency services
Table I. Clinic service quality – potential constructs
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Gender Characteristics
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Course Graduate Post-graduate Age 522 15-20 20-25 Table II. 25-30 Respondent demographics Gender
Male
Female
Total
241 104
65 35
306 139
75 245 25 345
23 56 21 100
98 301 46 445
Factor and reliability analyses We used a principal component extraction technique with Varimax rotation (Lewis, 1984); consequently, some items were deleted using the following criteria: (1)
if item to item correlation was below 0.35; and
(2)
if factor loading was below 0.45 (Hatcher, 1994).
Six items were eliminated leaving seven factors with 37 items: (1)
staff professionalism (eight items);
(2)
staff reliability (six items);
(3)
accessibility and basic facilities (eight items);
(4)
clinictangibles (four items);
(5)
clinic awareness (four items);
(6)
cleanliness (four items); and
(7)
emergency care (three items).
Cronbach’s a, used to test reliability, ranged from 0.7 to 0.83, which shows high internal consistency (Cronbach and Shavelson, 2004). Total variance explained by all seven factors was 78.6 percent (Table III). Participant satisfaction According to 83 percent of the respondents, the clinic doctor allotted sufficient time throughout treatment. More than 62 percent said that staff provided services correctly at the time they promised. Nearly 75 percent said that staffs were interested in their questions, which shows a positive attitude among staff, further enhancing patient satisfaction. More than 60 percent reported that staff gave them personal attention and nearly 60 percent said that staff responded to patient requests all the time. Good communication with patients is essential during diagnosis and treatment, and our findings show that staff communicated well with patients, which give a positive impression. However, a little o50 percent said that staff told them when they would perform services. More than 55 percent felt that staff wanted to solve their problems and a similar percentage said that staff performed the service correctly the first time (Table IV). More than 65 percent said that medicines prescribed were good quality. According to 75 percent, doctors had the required knowledge to perform their
Statements
Sufficient time given during treatment The clinic staff are punctual Doctors and staff take an interest in patient questions Doctors and staff give personal attention Doctors and staff respond to requests all the time Clinic employees tell you exactly when the services are performed When you have a problem, clinic staff show a sincere interest in solving it Clinic staff perform the service right the first time The medicine given by the doctor was good quality Doctors had the required knowledge to perform their duties Doctors are competent enough in performing their duties Staff are competent enough in performing their duties Doctor services were excellent Staff services were excellent Basic requirements like water, fans, lights, etc., were available Adequate space is available in the waiting area Adequate space is available in the examination room Washrooms are adequate Parking area near the clinic Sufficient parking space available The directions to the clinic are clear Clinic location is convenient Modern equipment is available Visually appealing physical facilities Sufficient chairs for patients
Items
(15) (16) (17) (18) (32) (33) (34) (5) (10) (11) (12) (13) (14) (19) (20) (25) (26) (27) (28) (29) (31) (30) (1) (2) (3)
1 0.60 0.56 0.64 0.78 0.61 0.49 0.77 0.47
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0.49 0.72 0.71 0.60 0.74 0.52
2
0.57 0.65 0.60 0.56 0.71 0.77 0.66 0.49 0.84 0.75 0.69
Factor loadings 3 4 5
7
(continued)
6
Service quality and patient satisfaction 523
Table III. Modified SERVQUAL – principal component analysis
Adequate beds are available in the clinic Notices regarding preventing seasonal diseases like dengue, malaria, etc., are displayed regularly Clinic hours are convenient for day and hostel students Doctors are available during holidays Information regarding staff contact details is well displayed in hostels and campus notice boards Washrooms are clean Examination room is clean Waiting area is clean Parking area is clean Clinic ambulance is well equipped with basic devices to deal with emergencies Clinic staff are trained to provide first aid in emergencies simultaneously in female and male hostels Referral facilities are available during emergencies
(4) (21) (22) (23) (24) (6) (7) (8) (9) (5) (36) (37)
Table III.
Statements
1
2
0.63 0.59 0.63 0.57 0.70
Factor loadings 3 4 5
524
Items
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0.58 0.63 0.71 0.64
6
0.53 0.56 0.62
7
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Statements (15) Sufficient time given during your treatment (16) The clinic provides its service at the time it promises to do so (17) Doctors and staff members take an interest in patients’ questions (18) Doctors and staff members gave you personal attention (32) Doctors and staff members respond to requests all the time (33) Employees in the clinic tell you exactly when services are performed (34) When you have a problem, the clinic staff show a sincere interest in solving it (35) Clinic staff performs the service right the first time
Strongly agree
Strongly Agree Neither Disagree disagree
16.85
66.30
6.74
10.11
0
16.33
46.07
18.88
17.97
1.12
10.11
64.04
15.73
10.11
0
7.87
59.55
14.61
17.97
0
10.11
48.31
20.22
17.97
3.37
5.61
43.82
29.21
16.85
4.49
2.25
55.05
20.22
21.35
1.12
4.49
55.05
20.22
19.1
1.12
Service quality and patient satisfaction 525
Table IV. Satisfaction with staff professionalism (%)
duties. More than 60 percent reported that the clinic doctor and staff were competent. This demonstrates the faith students have in clinic staff. More than 50 percent were satisfied with clinic services (Table V). More than 60 percent said that basic facilities like fans, lights, water, etc., were available in the clinic and 40 percent reported that space in the waiting area and examination room was adequate. However, about 30 percent were unaware that a wash room existed in the college clinic. About 55 percent reported that parking was available and around 48 percent felt parking was sufficient. However, o50 percent reported that directions to the clinic were sufficient. More than 60 percent agreed that clinic location was convenient (Table VI). Patients were not satisfied with clinic facilities. More than 40 percent said that their clinic lacked modern equipment, sufficient chairs and beds and that facilities were not visually appealing (Table VII). More than 50 percent were unaware of notices regarding seasonal diseases, implying that information relating to dengue, malaria, etc., was not displayed properly.
Statements (10) The medicine given by the doctor was good quality (11) Doctors had the required knowledge to perform their duties (12) Doctors are competent enough in performing their duties (13) Staff are competent enough in performing their duties (14) Doctors services were excellent (19) Staff services were excellent
Strongly agree
Strongly Agree Neither Disagree disagree
13.48
52.8
19.10
12.36
2.25
19.10
57.3
15.73
7.87
0
10.11
53.9
19.10
14.61
2.25
3.37 2.25 4.49
59.5 48.3 46.1
21.35 24.72 28.09
12.36 21.35 16.85
3.37 3.37 4.49
Table V. Satisfaction with clinic reliability (%)
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Table VI. Satisfaction with clinic accessibility and basic facilities (%)
(20) Basic requirements like water, fan, light, etc. (25) Adequate space is available in the waiting area (26) Adequate space is available in the examination room (27) Adequate washrooms (28) Parking area near clinic (29) Sufficient parking space available (31) Directions to the clinic are sufficient (30) Clinic location is convenient
Statements
Table VII. Satisfaction with tangibles (%)
Strongly agree
Statements
(1) (2) (3) (4)
Agree Neither Disagree
Strongly disagree
4.49
58.43
26.97
6.74
3.37
3.37
44.94
23.6
23.6
4.49
5.61 2.25 7.87 6.74 4.49 6.74
58.43 30.34 49.44 42.7 43.82 56.18
19.1 30.34 21.35 26.97 21.35 8.99
13.48 25.84 19.1 21.35 20.22 20.22
3.37 8.99 2.25 2.25 10.11 7.87
Strongly agree Agree Neither Disagree Strongly disagree
Modern equipment Visually appealing physical facilities Enough chairs for patients Adequate beds available in the clinic
1.12 3.37 1.12 6.74
16.85 15.73 30.34 16.85
29.21 29.21 23.60 21.35
41.57 42.7 37.08 44.94
11.23 8.99 8.99 10.11
About 50 percent felt that clinic hours were convenient for both resident and day students. More than 60 percent reported that the doctor was available during holidays. However, most students said that the information regarding doctor, clinic staff and ambulance services were not displayed in hostels and on campus notice boards (Table VIII). More than 40 percent were satisfied with wash room cleanliness and about 75 percent were satisfied with examination room cleanliness; whereas more than 60 percent said the clinic waiting area was clean. A similar percentage reported clean clinic-parking areas (Table IX). Most students felt that their clinic could not provide emergency services. More than 50 percent said that the clinic ambulance was not equipped with basic devices to deal with emergencies and a similar percentage reported that the clinic staff was not equipped and trained to deal with emergencies. However, around 90 percent were satisfied with the referral facilities (Table X).
Statements
Table VIII. Satisfaction with the awareness about clinic/disease (%)
(21) Notices regarding seasonal diseases like dengue, malaria etc., are displayed (22) Clinic hours are convenient for day and resident students (23) Doctors are available during holidays (24) Information regarding staff contact details is well displayed in hostels and campus notice boards
Strongly agree
Agree
Neither
Disagree
Strongly disagree
7.87
19.10
32.58
25.84
14.61
7.87 32.60
49.44 34.7
12.36 23.5
14.61 9.10
15.73 0.10
2.25
23.60
20.22
32.58
21.35
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Conclusions We infer that most respondents are satisfied with staff professionalism; however, staff can improve service quality by responding promptly to patient requests. Although more than 50 percent rated their college clinic and its services reliable, half did not feel that services were excellent. Every patient wants to be heard whenever s/he visits the clinic, which forms a crucial aspect of patient satisfaction. Thus, it is important for healthcare providers to respond to patient requests. Such improvements can advance patient satisfaction. Half the respondents did not approve clinic facilities; i.e., patients felt that clinic equipment was not up-to-date or visually appealing. Old equipment and inadequate beds created a negative impact. Some students used healthcare providers outside the campus whenever they could as they did not have faith in clinic equipment. Upgrading equipment, therefore, is imperative as staff must win the students’ trust. The general impression was positive, as most respondents stated that clinic hours were convenient, but doctor availability during holidays or after hours was limited and only those who had a staff telephone number were able to make contact. It is crucial for patients to know that medical help is just a call away during an emergency. Thus, clinic staff contact details must be displayed on campus and hostel notice boards. Unclean premises can lead to health problems and diseases. Most participants were satisfied with clinic cleanliness, which is positive. Every healthcare center must be equipped to deal with emergencies as they are crucial healthcare services and can mean life and death for patients. Most students lacked confidence in the staff’s ability to deal with emergencies – a setback for college clinic staff – who should be trained to deal with emergencies. Moreover, the medical equipment required for emergencies must be present in the clinic along with an ambulance for transporting patients to the nearest hospital in case their condition deteriorates. An open-ended question was framed for the respondents to suggest improvements; often mentioned were: .
Service quality and patient satisfaction 527
Clinic staff contact details should be prominently displayed on campus and in hostels notice boards.
Statements (6) Washrooms are clean (7) Examination room is clean (8) Waiting area is clean (9) Parking area is clean
Strongly agree
Agree
Neither
Disagree
Strongly disagree
2.25 2.25 4.49 10.11
40.45 74.16 62.92 48.31
38.20 16.85 13.48 22.47
16.85 4.49 14.61 14.61
2.25 2.25 4.49 4.49
Strongly agree
Agree
Neither
Disagree
Strongly disagree
2.25
14.61
29.21
28.09
25.84
4.49
26.97
23.6
25.84
23.6
Statements (5) Ambulance is well equipped with basic devices to deal with emergencies (36) Clinic staff are trained to provide first aid in case of emergencies (37) Referral facilities are available in an emergency
30.5
59.4
6.50
2.40
Table IX. Satisfaction with cleanliness (%)
1.20
Table X. Satisfaction with emergency care (%)
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.
Specialists should visit regularly, especially dentists, ophthalmologists, dermatologists and dieticians. Visiting hours should be displayed in the clinic, on campus and hostel notice boards.
.
Clinics need more sophisticated and better instruments like x-ray machines, more spacious and improved examination rooms.
.
Students wanted better ambulance service to deal with emergencies along with better first-aid facilities in hostels to deal with mishaps.
.
Students wanted greater cleanliness; more hygienic facilities and direction boards specifying clinic locations.
Our results can be integrated into manager’s strategic planning processes with respect to budgeting for quality improvement projects. Survey outcomes indicate areas where clinic staff must invest. Other measures that can improve college clinic services are: .
regular interaction with students to determine what services they desire;
.
at least fort nightly staff meetings to discuss student suggestions, upgrading facilities or issues regarding clinic maintenance;
.
holding interactive sessions with students to educate them on common diseases;
.
providing facilities so that students can discuss their problems anonymously;
.
training clinic employees to put patients at ease; and
.
educating students about the clinic’s latest facilities.
Further study College clinic studies can be useful for college administrators, who can use conclusions to improve clinic standards. Moreover, such studies can be conducted at state, country and international levels to compare campus clinic facilities and outcomes can be compared with this study, which may lead to enhanced college clinic standards and better treatment. Our questionnaire can be used to develop instruments for other clinicbased research. References Atkins, P.M., Marsall, B.S. and Javalgi, R.G. (1996), “Happy employees lead to loyal patients”, Journal of Health Care Marketing, Vol. 16 No. 4, pp. 14-23. Bhattacharya, A., Menon, P., Koushal, V. and Rao, K.L.N. (2003), “Study of patient satisfaction in a tertiary referral hospital”, Journal of the Academy of Hospital Administration, Vol. 15 No. 1, pp. 1-3. Camilleri, D. and O’Callaghan, M. (1998), “Comparing public and private care service quality”, International Journal of HealthCare Quality Assurance, Vol. 11 No. 4, pp. 127-133. Cardozo, R. (1965), “An experimental study of consumer effort, expectation and satisfaction”, Journal of Market Research, Vol. 2 No. 3, pp. 244-249. Carman, J. (2000), “Patient perceptions of service quality: combining the dimensions”, Journal of Management in Medicine, Vol. 14 Nos 5/6, pp. 339-356. Cronbach, L.J. and Shavelson, R.J. (2004), “My current thoughts on coefficient alpha and successor procedure”, Educational and Psychological Measurement, Vol. 64 No. 3, pp. 391-418.
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Corresponding author Pankaj Deshwal can be contacted at: [email protected]
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