To determine the variables of patient’s satisfaction in Aga Khan University Hospital (AKUH) To assess the level of services provided

by the management To assess cause of customer satisfaction and retention of patient in AKUH To assess Key satisfaction parameters and Key value parameters.

Problem statement
What factors determine the patient satisfaction in Aga Khan University Hospital Karachi?

Research Objectives
To determine the variables of patient’s satisfaction with hospitals. To understand the patients’ point of view regarding the attitudes and behavior of management of the hospital. To assess the level of services provided by the management. To assess cause of customer satisfaction and retention of patient in Aga Khan Hospital. To highlight the consequences of enhancement in the quality of services provided by Aga khan hospital each year. To provide recommendation for further improvement of services of Aga Khan Hospital. Highlight the hindrances in the way of quality service and facilities which they want to provide to their patients.

Background
The Aga Khan University Hospital (AKUH) is committed to provide exemplary care that meets or exceeds the needs and expectations of the service users so we conduct an external research to help out in capturing, analyzing and monitoring patient satisfaction through on-going patient’s satisfaction surveys outpatient, inpatient, diagnostic and emergency services. Patients’ feedback is regularly disseminated. This report with detailed analysis of the satisfaction data are sent to the needed official. This report is based on the analysis of patient feedback captured in the last quarter and the month of October (M1) and of November (M1) 2011.

1

Sampling design
We used separate questionnaire to capture patient’s feedback for each service. We capture patient’s feedback of multiple dimensions of the service quality and on their overall satisfaction with the service. Simple and stratified random sampling from hospital’s computerized database. Considering the patient’s ability to answer, and to help keep the questionnaire administrable on telephone, only a limited number of favorable statements on different dimensions of the selected service are included in the questionnaires. Patients are requested to respond in terms of percentage fields 0%, 20%, 60%, 80% and 100%. Each questionnaire comprised of close-ended questions.

Research Design
Using the deductive approach, we have carried out a comprehensive medical survey analysis and gathered qualitative and quantitative data. Samples of patients were interviewed about their satisfaction regarding the services provided in Aga Khan Hospital.

Data Collection and its Analysis
In the last quarter of 2011, we interviewed a total about 10 patients in each of the five departments. Service wise breakup of the sample size is done and is elaborated in the following pages. Methods of data collection for each service are tabulated below: Sr# 1 Services Executive Clinic Method of Data Collection Patients were interviewed on telephone within 7 to 10 days of the utilization of the service Face-to-face interviews were conducted in the waiting area after patients had utilized the service. Sampling Method Simple and stratified random sampling from the Hospital’s computerized database Simple random sampling

2

Pharmacy, Physiotherapy, Cardiopulmonary and Neurophysiology.

2

Limitations
Time Limitations Because of limited time period as specified in the research proposal, we had to keep the scope of research limited and cover all the topics mentioned in the proposal within the specified time. Budget Limitations We had a limited budget to carry out the research process and we had to manage the expenses within reasonable while doing research. We managed to cover interviews and sample surveys within 2 visits to Aga Khan Hospital. Policies of Aga Khan Hospital: We were not allowed to do interviewing with the officials of AKUH a significant, adequate and social links. We could only do survey with the sample patients.

3

Managerial Indicator for Patient Satisfaction with Cardiopulmonary Service M2-2011
Measure: Patient Satisfaction We capture, analyze and monitor patient satisfaction for AKUH Cardiopulmonary service through ongoing patient satisfaction surveys. Definition: All patients included in the sample are requested to respond the question, “were you overall satisfied with the quality of the service you received”, in terms of percentage fields 0%, 20%, 60%, 80% and 100%. Those who respond this questions in terms of strongly agree and agree are classified as overall satisfied patients. Numerator: No. of overall satisfied patients Denominator: Total patients in the sample Target Goal: M1-2011 M2-2011 Numerator 8 9 Denominator 10 10 % 80 90 Reporting Schedule: Patients’ feedback is regularly disseminated. Quarterly reports with detailed analysis of the satisfaction data are sent to all service providers and senior leadership for information and action.

% of overall satisfied patients
9.2 9 8.8 8.6 8.4 8.2 8 7.8 7.6 7.4 Q1-2011 Q2-2011

Analysis: 1. Patient Satisfaction ratings on individual service attributes: On average Patient satisfaction ratings on individual attributes of the cardiopulmonary service ranged from -8 points in distance from parking area and receptionist were courteous to -1 points in charges were reasonable during M2-2011. Average satisfaction rating increased to 8 from 9 in M2-2011. 2. Key Satisfaction Parameter: ‘Instructions prior to tests’ and ‘help during test’ were identified as key satisfaction predictor for the service Patients’ average rating on these two items increased by 5 satisfaction points and 4 satisfaction points respectively in M2-2011. 3. Major issues: Major issues in Cardiopulmonary as identified by the patients through the question on “needed improvements” suggested enhancing the waiting area, adequate parking should be available for patients and ECG rooms should be increased.

4

Patient Satisfaction with Cardiopulmonary Service M2-2011 Sample Size M2-2011: 10

Distance of the service from the parking area is easy to cover by walking

The receptionists were efficient

The receptionists were courteous

The staff gave good instructions proir to the test/procedure

The staff provided all necessary help during your procedure

The waiting area has adequate seats

Charges were reasonable

Average satisfaction

Recommend this Cardiopulmonary service to family and friends, if needed M1-2011 M2-2011 0 20 40 60 80 100

5

Managerial Indicator for Patient Satisfaction with Neurophysiology Service M2-2011
Measure: Patient Satisfaction We capture, analyze and monitor patient satisfaction for AKUH Neurophysiology service through ongoing patient satisfaction surveys. Definition: All patients included in the sample are requested to respond the question, “were you overall satisfied with the quality of the service you received”, in terms of percentage fields 0%, 20%, 60%, 80% and 100%. Those who respond this questions in terms of strongly agree and agree are classified as overall satisfied patients. Numerator: No. of overall satisfied patients Denominator: Total patients in the sample Target Goal:

M1-2011
Numerator Denominator % Reporting Schedule: Patients’ feedback is regularly disseminated. Quarterly reports with detailed analysis of the satisfaction data are sent to all service providers and senior leadership for information and action. 9 10 90

M2-2011
8 10 80

% of overall satisfied patients
92 90 88 86 84 82 80 78 76 74 M1-2011 M2-2011

Analysis: 4. Patient Satisfaction ratings on individual service attributes: On average Patient satisfaction ratings on individual attributes ranged from +7 points in waiting area have adequate seats to -14 points in distance from parking area and recommending the service to family/friends during M2 2011. Average rating for the neurophysiology service decreased by -7 satisfaction points to 7 from 8 in M2 2011. 5. Major issues: Major issues in Neurophysiology as identified by the patients through the question on “needed improvements” suggested reducing the waiting time and charges, enhancing parking facility and staff should be polite, caring and efficient.

6

Patient Satisfaction with Neurophysiology Service M2-2011 Sample Size: 10

Distance of service from the parking area is easy to cover by walking The receptionists were efficient

The technologists were polite You were given good instructions prior the test/procedure Receptionist The staff gave good instructions proir to the test/procedure Technologist

The staff provided all necessary help during your procedure by neurophysiology staff
The waiting area has adequate seats The results were delivered on specified date Charges were reasonable

Average satisfaction Recommend this Cardiopulmonary service to family and friends, if needed M1-2011 M2-2011 0 20 40 60 80 100

7

Measure: Patient Satisfaction We capture, analyze and monitor patient satisfaction for AKUH Physiotherapy service through on-going patient satisfaction surveys. Definition: All patients included in the sample are requested to respond the question, “were you overall satisfied

Managerial Indicator for Patient Satisfaction with Physiotherapy Service M2-2011

8

with the quality of the service you received”, in terms of percentage fields 0%, 20%, 60%, 80% and 100%. Those who respond this questions in terms of strongly agree and agree are classified as overall satisfied patients. Numerator: No. of overall satisfied patients Denominator: Total patients in the sample Target Goal: M1-2008 M2-2011 Numerator 9 9 Denominator 10 10 % 90 90 Reporting Schedule: Patients’ feedback is regularly disseminated. Quarterly reports with detailed analysis of the satisfaction data are sent to all service providers and senior leadership for information and action. Responsible: Marketing Department

% of overall satisfied patients
100 80 60 40 20 0 M1-2011 M2-2011

Analysis: 1. Patient Satisfaction ratings on individual service attributes: Patient satisfaction ratings on individual attributes ranged from +11 points in satisfaction with the explanation of treatment to 3 points in therapy has been beneficial in improving patient’s condition in M2-2011. Average rating for physiotherapy service remains constant. 2. Major issues: Major issues in Physiotherapy as identified by the patients through the question on “needed improvements” suggested therapy timing should be extended according to charges.

Patient Satisfaction with Physiotherapy Service M2-2011

9

Distance of the service from the parking area is easy to cover by walking

The receptionists were efficient

The receptionists were courteous

The staff gave good instructions proir to the test/procedure

The staff provided all necessary help during your procedure

The waiting area has adequate seats

Charges were reasonable

Average satisfaction

Recommend this physiotheraphy service to family and friends, if needed
M1-2011 M2-2011 0 20 40 60 80 100

Managerial Indicator for Patient Satisfaction with Pharmacy Service M2-2011

10

Measure: Patient Satisfaction We capture, analyze and monitor patient satisfaction for AKUH Pharmacy service through on-going patient satisfaction surveys. Definition: All patients included in the sample are requested to respond the question, “were you overall satisfied with the quality of the service you received”, in terms of percentage fields 0%, 20%, 60%, 80% and 100%. Those who respond this questions in terms of strongly agree and agree are classified as overall satisfied patients. Numerator: No. of overall satisfied patients Denominator: Total patients in the sample Target Goal: Numerator Denominator % Reporting Schedule: Patients’ feedback is regularly disseminated. Quarterly reports with detailed analysis of the satisfaction data are sent to all service providers and senior leadership for information and action. M1-2011 9 10 90 M2-2011 9 10 90

% of overall satisfied patients
100 50 0 M1-2011 M2-2011

Analysis: 1. Patient Satisfaction ratings on individual service attributes: On average Patient satisfaction ratings on individual attributes of the pharmacy service varied from +5 in pharmacy staff was quick/efficient to -2 in pharmacy staff was helpful in M2-2011. Average satisfaction rating remains same. 2. Key Satisfaction Parameter: Availability of all requested medicine was identified as the key satisfaction predictor for pharmacy service – patient satisfaction rating increased by 3 satisfaction points to 8 from 7 in M2-2011. 3. Major issues: Major issues in Pharmacy as identified by the patients through the on “needed improvements” suggested reducing waiting time in queue as the major issue at Stadium Road campus. A number of prescribed medicines were not available and discount of 5%-10% available outside should be offered to AKUH patients as well. Numerous respondents suggested that prescriptions should be returned to patients for their reference and records.

11

Patient Satisfaction with Pharmacy Service M2-2011

The pharmacy staff was quick/efficient

The pharmacy staff was helpful

The pharmacy staff was polite/courteous

All requested medicines were available

Medicines were available on market price

Average satisfaction

M1-2011 M2-2011

0

20

40

60

80

100

12

Managerial Indicator for Patient Satisfaction with Executive Clinic Service M2-2011
Measure: Patient Satisfaction We capture, analyze and monitor patient satisfaction for AKUH Executive Clinic service through on-going patient satisfaction surveys. Definition: All patients included in the sample are requested to respond the question, “were you overall satisfied with the quality of the service you received”, in terms of percentage fields 0%, 20%, 60%, 80% and 100%. Those who respond this questions in terms of strongly agree and agree are classified as overall satisfied patients. Numerator: No. of overall satisfied patients Denominator: Total patients in the sample Target Goal: M1-2011 M2-2011 Numerator 8 9 Denominator 10 10 % 80 90 Reporting Schedule: Patients’ feedback is regularly disseminated. Quarterly reports with detailed analysis of the satisfaction data are sent to all service providers and senior leadership for information and action.

% of overall satisfied patients
95 94 93 92 91 90 89 88 M1-2011 M2-2011

Analysis: 1. Patient Satisfaction ratings on individual service attributes: On average Patient satisfaction rating on individual service attributes pharmacy service varied from +5 in pharmacy staff was quick/efficient to -2 in pharmacy staff was helpful in M2-2011. Average satisfaction rating improved by 1 satisfaction point during this the last month. 2. Key Satisfaction Predictor: Availability of all requested medicine was identified as the key satisfaction predictor for pharmacy service – patient satisfaction rating increased by 3 satisfaction points in M2-2011. 3. Major issues: Major issues in Pharmacy as identified by the patients through question on “needed improvements” suggested reducing waiting time in queue as the major issue at Stadium Road campus. A number of prescribed medicines were not available and discount of 5%-10% available outside should be offered to AKUH patients as well. Numerous respondents suggested that prescriptions should be returned to patients for their reference and records.

13

Patient Satisfaction with Executive Clinic Service M2-2011 Sample Size: 10

The counter staff was

The nursing staf

Your consultant were courteous Your consultantlisten what you had to say Your consultant answered all your questions to your satisfaction Your consultant clearly explained your condition to you

The executive clinic waiting area was comfortable
The quality of breakfast/lunch/dinner was up to your expression Executive clinic charges were reasonable

Average satisfaction Recommend this Executive Clininc service to family and friends, if needed M1-2011 M2-2011 0 20 40 60 80 100

14

Summary and Conclusions
Patient satisfaction is an important indicator of the quality of care and service delivery in the Hospital. The study findings indicated that the key satisfaction predictors of Aga Khan in several areas such as medical care, nursing care, courtesy of staff, physical comfort and waiting time has been improved from the previous year. However it is necessary for the management of Aga khan that their efforts should focus on shortening waiting intervals and improving patients’ perceptions about waiting in the several departments, and also improving their services so that they will be matched with the charges they are taking from their patients.

15

Recommendations
Doctors should give more time; explain condition and treatment to patients by listening to their issues and complaints. Enhancing waiting area and Waiting area needs improvement. Appointments should be given at the earliest. Quality of food needs improvement and it should be given according to the patient’s condition service should be more prompt. Doctors should give timely response to patient. Nurses should be trained properly for cannula insertion. Reducing the waiting time during admission and discharge process, improve discharge process. Doctors should be polite, caring and concerned. Doctors should discuss and communicate with patients about their condition, diagnostic reports, medication and treatment. Patient should be given immediate treatment in EMS and availability of a senior doctor at all times. Counter staff should be polite caring and efficient. Increase the number of counter staff (to avoid extended queues) Washrooms should be clean at all times. Proper parking area and should be available with shades Reducing the waiting times and charges. A number of prescribed medicines were not available and discount of 5%-10% available outside should be offered to AKUH patients as well. Numerous respondents suggested that prescriptions should be returned to patients for their reference and records. Therapy timing should be extended according to charges. ECG rooms should be increased.

16