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Original Article

Patient Satisfaction at a Primary Level Health‑care Facility in a District

of West Bengal: Are Our Patients Really Satisfied?
Abantika Bhattacharya, Sita Chatterjee1, Abhishek De1, Somak Majumder1, Kanti Bhusan Chowdhury2, Mausumi Basu1

Department of Community Introduction: Many recent studies have shown an increased association between

Abstract
Medicine, Midnapore
Medical College and
patient’s satisfaction levels, patient’s compliance, and success of treatment.
Hospital, Midnapore, Aim: The aim of this study is to assess the level of satisfaction among patients who
1
Department of Community have utilized the outpatient department services provided in the primary care level
Medicine, IPGMER and health institution. Materials and Methods: A  health center‑based observational
SSKM Hospital, Kolkata, cross‑sectional study was conducted from July 2011 to October 2011 at Guskara
2
Department of Community Primary health center, Burdwan among 422 patients using a pre‑designed pre‑tested
Medicine, Calcutta National
Medical College, Kolkata,
structured schedule. Results: Overall, mean satisfaction score was 2.97  ±  0.37.
West Bengal, India Highest satisfaction scores were observed among 18–20  years, males were more
satisfied regarding technical quality of care, whereas females reported higher
satisfaction regarding interpersonal manner, unmarried/single group reported
the highest satisfaction with most of the services, literate group reported higher
satisfaction than the illiterate group, affluent patients reported higher satisfaction
regarding technical quality of care, financial aspect. Conclusions: Causes of
dissatisfaction were long waiting time, the inadequacy of seating arrangement in
the waiting area, inadequate cleanliness of surroundings, inadequate toilet facilities,
nonavailability of medicines, and behavior of doctor.
Received: 02‑09‑2017
Accepted: 08-01-2018 Keywords: Causes of dissatisfaction, patient satisfaction, primary care level

Introduction outcomes, patient retention, medical malpractice claims,

T he outcome of any disease is influenced by the
decisions to seek care, timely arrival at appropriate
diagnostic and treatment services and receipt of
adequate quality care from service providers.[1] The
quality care in health means an inexpensive type of
service with minimum side effects that can cure or
relieve the health problems of the patients.[2]
“Patient satisfaction” can be defined as “proportion/levels
of patient’s expectations fulfilled in regard to health‑care
services.” Recent studies have shown an increased
association between quality care, patient’s satisfaction
levels, patient’s compliance, and success of treatment.[3]
Therefore, a research on patient satisfaction can be an
important tool to improve the quality of services.[4]
Patient satisfaction is not only an important, effective
and commonly used indicator for measuring the quality
in health care but also measures the success of doctors
and hospitals. As patient satisfaction affects clinical
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and also affects the timely, efficient, and patient‑centered
delivery of quality health care.[5]
For a health‑care organization to be successful, monitoring
customer’s perception is a simple but important strategy
to assess and improve the organization’s performance.[6,7]
The sense of growing gap between what patients want
and what practitioners perceive as important results
in dissatisfaction of patients with health‑care systems.
Over a lifetime, patient’s expectations of health care
may change dramatically. Health‑care consumers today,
are more sophisticated than in the past and now demand
increasingly more accurate and valid evidence of health
plan quality.[1]
Address for correspondence: Dr. Mausumi Basu,
Department of Community Medicine,
IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
E‑mail: basu.mausumi544@gmail.com
This is an open access journal, and articles are distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit is
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For reprints contact: reprints@medknow.com

How to cite this article: Bhattacharya A, Chatterjee S, De A, Majumder S,

DOI: Chowdhury KB, Basu M. Patient satisfaction at a primary level health-care
10.4103/MJDRDYPU.MJDRDYPU_177_17 facility in a district of West Bengal: Are our patients really satisfied?. Med
J DY Patil Vidyapeeth 2018;11:326-31.

326 © 2018 Medical Journal of Dr. D.Y. Patil Vidyapeeth | Published by Wolters Kluwer - Medknow
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Bhattacharya, et al.: Patient satisfaction at primary level
Some patients may place more emphasis on technical
competence whereas others, on fulfilment of personal
needs, comfort, dignity, and supportive services.
With this background, this study was conducted to assess
the level of satisfaction among patients who have utilized
the outpatient department (OPD.) services provided in the
primary care level health institution and to determine the
relationship between some sociodemographic factors and
the level of satisfaction (if any).
Materials and Methods
This was a health center‑based observational study,
cross‑sectional in design, duration of study being
3  months, from July 2011 to October 2011 done at
primary level health‑care facility at Guskara primary
health center, Guskara, Burdwan was chosen purposively
for the study.
Guskara primary health center
This is a 10‑bedded primary health care facility under
Block Ausgram I, District Burdwan and caters to a
population of around 28,000, has a general OPD, DOTS
clinic and immunization clinic. It is well connected by
railways, highway and is 32 km from Burdwan town.
New adult patients  (18  years and above) of both sex,
attending OPD and gave informed written consent
constituted our study population.
Seriously ill patients who were unable to participate in the
interview, patients who were deaf or mute or both, follow‑up
patients who worked in the same hospital or their relatives
and unwilling patients were excluded from the study.
Sampling:
i. Sample size: Sample size was determined using the
following formula.[1]
N = Z2pq/e2
N = estimated sample size
Z = 1.96 at 95% Confidence Limit
p = Prevalence of patient satisfaction
q = 1 − p
e = absolute allowable error
For this study, maximum variability was assumed,
P = 0.5
q = 0.5
e = 5%
Hence, the sample size was calculated to be 384.
Sampling technique was nonrandomized purposive.
Medical Journal of Dr. D.Y. Patil Vidyapeeth  ¦  Volume 11  ¦  Issue 4  ¦  July-August 2018
Nearly 10% of the estimated sample size was added for
incomplete answers, making the estimated sample size
to be 422.
Selection of patient  –  the patients attending the OPD of
that health‑care facility were selected for the interview by
systematic random sampling. Depending on the previous
attendance of the particular health facility, a random
number was chosen and every 4th  patient was selected
for the interview. This process was continued until the
required sample size was completed.
While selecting patients, it was observed from previous
records that average number of new patients attending
the OPD at Guskara PHC was around 100/day.
Two months were available for data collection. Two
days in a week were utilized for data collection
(total 17 days in 2 months), and a total number of patients
required to be interviewed at the primary level were 422.
Hence, per day 25 patients (in average) were interviewed.
In the OPD, the first patient fulfilling the inclusion criteria
was identified, and then, every 4th  patient  (who fulfilled
the inclusion criteria) was selected systematically. The
patients were interviewed maintaining privacy and
requested not to divulge any information to others.
Information was elicited by exit interview of patients
and review of records  (OPD tickets) and information
regarding the following variables were obtained: age,
sex, education, occupation, socioeconomic status, type of
family, religion, marital status, residence, and caste.
A predesigned and pretested interview schedule was
used to record information. The initial part of the
schedule  (Part A) was used to record information on the
various socio‑demographic characteristics of the patients.
Part  B of the schedule recorded information on patient’s
satisfaction. The questions of the schedule were adopted
from the short form patient satisfaction questionnaire
18[8] and the third part of schedule recorded the areas and
causes of patient dissatisfaction.
Some questions were modified after pre‑testing and were
validated by experts.
Permission to conduct the study was obtained from the
Institutional Review Board, Burdwan Medical College and
from the Chief Medical Officer of Health District Burdwan.
Informed written consent was obtained from all patients
before the interview after telling them the objective of
this study, approximate time that would be required for
interview and assuring the confidentiality and anonymity
of their identity. On the days of data collection, the
treating medical officer was kept unaware of the questions
in the schedule to avoid bias in his/her behavior with the
patient.
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Bhattacharya, et al.: Patient satisfaction at primary level
Data were entered into Microsoft Excel sheet, checked
for accuracy, and analyzed using the software Epi Info
version  6 (CDC; Centers for Disease Control;1990
Atlanta, Georgia (US)) and Microsoft excel,
proportions, unpaired t‑test, mean, standard deviation,
and one‑way ANOVA was computed using SPSS
version 17.0 (SPSS Inc. Released 2008, Chicago).
Results
Patients belonging to 21–30  years age group were
found in highest numbers while the percentage of
patients above 60  years of age was the least, male
patients were more in number than females, higher
percentage of patients were from rural area, the highest
percentage of patients among Hindu belonged to the
general category and maximum proportion of patients
were married, while the least percentage belonged to
the widowed/separated/divorced category, homemakers
contributed to the highest percentage. According to
educational status, illiterates were in highest proportions,
patients belonging to Grade  IV socioeconomic status
were highest in number and highest percentage of
patients were from joint family.
Overall, mean satisfaction score at primary health‑care
facility was calculated to be 2.97 ± 0.37.
The highest mean satisfaction score was found regarding
interpersonal manner while least satisfaction was
observed regarding financial aspect [Table 1].
Patient satisfaction and age
The highest satisfaction scores were observed among the
age group of 18–20  years as compared to the other age
groups [Table 2].
Patient satisfaction and sex
Males were more satisfied regarding technical quality of
care, financial aspect, and time spent with doctor, whereas
females reported higher satisfaction regarding the
interpersonal manner, communication and accessibility
and convenience [Table 2].
Table 1: Patient satisfaction scores according to
subscales of satisfaction at primary level health‑care
facility (n=422)
Satisfaction sub‑scales Patient satisfaction
scores (mean±SD)
General satisfaction 2.83±0.47
Technical quality 3.25±0.34
Interpersonal manner 3.37±0.61
Communication 2.74±0.71
Financial aspects 2.68±0.95
Time spent with doctor 2.82±0.72
Accessibility and convenience 3.13±0.45
SD: Standard deviation
328 Medical Journal of Dr. D.Y. Patil Vidyapeeth  ¦  Volume 11  ¦  Issue 4  ¦  July-August 2018
Patient satisfaction and marital status
The unmarried/single group reported the highest satisfaction
with most of the services as compared to the others,
whereas the widowed group reported lowest satisfaction
scores. The married group were most satisfied group as far
as time spent with doctor was concerned [Table 3].
Patient satisfaction and literacy status
The literate group reported higher satisfaction than the
illiterate group of patients [Table 3].
Patient satisfaction and socioeconomic status
Affluent patients reported higher satisfaction regarding
technical quality of care, financial aspect while the less
affluent groups reported higher satisfaction regarding the
interpersonal manner, communication and accessibility
and convenience [Table 3].
Causes of dissatisfaction
The primary areas of complain of patients in descending
order were as follows: long waiting time  (97.6%), lack
of adequate drinking water in the waiting area  (87.2%),
inadequate toilet facilities  (82.5%), inadequacy of
seating arrangement in the waiting area  (79.1%),
inadequate privacy (65.7%), nonavailability of medicines
and investigations in hospital  (53.5%) l, inadequate
cleanliness of surroundings  (39.8%), inadequate
ventilation and fans in the waiting hall (21.8%), behavior
of doctor (6.6%), and lack of proper signboards/direction
guides (6.2%) [Table 4].
Discussion
The present study was attempted to assess the level of
satisfaction of the patients with the various aspects
of healthcare at a primary level health‑care facility of
Burdwan district. Very few similar studies have been
done in India and abroad, and therefore, we lack the data
for comparison.
The sociodemographic profile showed the importance
of hospital, as the majority of the respondents were in
the age group of 21–30  years which is economically
productive age group for the families belonging to
underserved, needy section of the society. Most of them
were illiterate, home makers and belonged to Grade  IV
socioeconomic status. This weaker section is largely
dependent on the Government sector hospitals and these
needy people do not have large expectations from the
hospital besides their medical treatment and provision
of basic amenities which is the right of every human
being that should be well considered and provided by the
Government.
The present study revealed that younger age group
were more satisfied than the older age group except
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Bhattacharya, et al.: Patient satisfaction at primary level

Table 2: Sub‑scales of satisfaction and association with age and gender (n=422)

Satisfaction sub‑scale Patient satisfaction scores Statistical tests:
Age (years) (mean±SD) ANOVA
≤20 21‑30 31‑40 41‑50 51‑60 >60 F (P)
General satisfaction 3.3±0.27 2.62±0.54 2.93±0.47 2.86±0.35 2.86±0.35 2.75±0.27 5.740 (0.000)
Technical quality 3.55±0.11 3.25±0.40 3.41±0.46 3.17±0.14 3.17±0.14 3.06±0.32 7.992 (0.000)
Interpersonal manner 4.00±0.30 3.26±0.79 3.10±0.30 3.84±0.36 3.84±0.36 3.37±0.52 29.691 (0.000)
Communication 3.00±0.21 2.67±0.87 2.45±0.51 3.03±0.42 3.12±0.42 2.31±0.37 12.217 (0.000)
Financial aspects 2.20±0.45 2.73±1.06 3.13±1.15 2.63±0.57 2.63±0.57 2.00±0.20 13.905 (0.000)
Time spent with doctor 3.40±0.55 2.75±0.85 2.58±0.48 3.12±0.41 3.12±0.41 2±0.20 10.229 (0.000)
Accessibility and convenience 3.47±0.18 3.28±0.32 3.27±0.06 2.86±0.56 2.86±0.56 2.67±0.62 20.640 (0.000)
Satisfaction sub‑scale Gender (mean±SD) Unpaired t‑test
Male Female (df=420)
General satisfaction 2.79±0.47 2.88±0.49 1.969 (0.05)
Technical quality 3.51±0.26 3.20±0.39 6.135 (0.00)
Interpersonal manner 3.20±0.62 3.60±0.48 7.709 (0.00)
Communication 2.74±0.67 2.76±0.74 2.633 (0.00)
Financial aspects 2.94±0.86 2.32±0.96 6.873 (0.00)
Time spent with doctor 2.84±0.68 2.80±0.78 0.534 (0.59)
Accessibility and convenience 2.93±0.23 2.98±0.59 6.547 (0.00)
SD: Standard deviation

Table 3: Sub‑scales of satisfaction and association with various sociodemographic variables (n=422)

Satisfaction sub‑scale Patient satisfaction scores Statistical test: ANOVA
Marital status (mean±SD) F (P)
Currently married Unmarried/single Widow
General satisfaction 2.82±0.47 2.96±0.38 2.55±0.16 2.616 (0.07)
Technical quality 3.25±0.35 3.40±0.23 3.05±0.11 4.075 (0.01)
Interpersonal manner 3.36±0.61 3.60±0.49 3.00±0.21 3.893 (0.02)
Communication 2.76±0.70 2.76±0.67 2.16±0.35 4.662 (0.01)
Financial aspects 2.68±0.95 2.93±0.98 2.00±0.10 6.645 (0.00)
Time spent with doctor 2.85±0.73 2.73±0.57 2.00±0.21 6.572 (0.00)
Accessibility and convenience 3.16±0.42 3.20±0.51 2.60±0.70 7.810 (0.00)
Satisfaction sub‑scale Literacy status (mean±SD) ANOVA
Illiterate Primary Secondary Higher secondary and above F (P)
General satisfaction 2.91±0.49 2.51±0.39 3.04±0.41 2.97±0.31 32.516 (0.00)
Technical quality 3.14±0.38 3.31±0.20 3.40±0.15 3.59±0.38 41.255 (0.00)
Interpersonal manner 3.60±0.49 3.30±0.83 3.16±0.37 3.13±0.34 16.678 (0.00)
Communication 2.88±0.78 2.57±0.58 2.54±0.62 3.10±0.56 14.007 (0.00)
Financial aspects 2.42±0.98 2.44±0.53 3.21±0.98 3.23±0.96 24.756 (0.00)
Time spent with doctor 2.83±0.80 2.61±0.60 3.37±0.67 3.17±0.60 16.159 (0.00)
Accessibility and convenience 2.94±0.60 3.22±0.17 3.34±0.14 3.30±0.25 10.748 (0.00)
Satisfaction sub‑scale Socioeconomic status (mean±SD) ANOVA
II III IV V F (P)
General satisfaction 3.02±0.27 2.71±0.42 2.84±0.45 2.86±0.60 3.104 (0.02)
Technical quality 3.90±0.28 3.25±0.42 3.20±0.28 3.22±0.35 35.150 (0.00)
Interpersonal manner 3.00±0.30 3.36±0.51 3.42±0.63 3.36±0.66 3.506 (0.01)
Communication 3.02±0.25 3.12±0.55 2.60±0.62 2.70±0.92 11.750 (0.00)
Financial aspects 3.80±0.51 2.42±0.88 2.70±0.92 2.61±0.96 14.540 (0.00)
Time spent with doctor 2.87±0.34 3.15±0.80 2.71±0.57 2.78±0.91 8.144 (0.00)
Accessibility and convenience 3.32±0.07 3.73±0.28 3.01±0.52 3.23±0.35 17.788 (0.00)
SD: Standard deviation

regarding financial aspects. These findings were in were found to be more satisfied.[9] Contrast findings
contrast to findings of Ware et al. where older age were observed in another study by Matteo et al. where

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Bhattacharya, et al.: Patient satisfaction at primary level
Table 4: Areas and causes of patient dissatisfaction at
primary level of health care facility (n=422)
Areas of complain
1. Long waiting time
2. Lack of adequate drinking water in the waiting area
3. Inadequate toilet facilities
4. Inadequacy of seating arrangement in the waiting area
5. Inadequate privacy
6. Nonavailability of medicines and investigations
7. Inadequate cleanliness of hospital surroundings
8. Inadequate ventilation and fans in the waiting area
9. Behavior of doctors
10. Lack of proper signboards/direction guides
older patients were found to be more satisfied than
younger ones.[10]
Few more studies also reported that elder respondents
generally record higher satisfaction.[11‑13] Age is a
well‑known determinant of the patient satisfaction index
with older patients scoring more highly and being more
satisfied than young and middle‑aged patients.[14,15]
On the contrary, Jenkinson et al. found age was only
weakly associated with satisfaction.[16]
In general, it was found that women were more
satisfied than males. Evidence about the effects of
gender, ethnicity, and socioeconomic status was
equivocal due to the small amount of literature
available on each.[17‑24] Some studies have indicated
that female report greater satisfaction than male. While
other studies have contradicted this finding.[25] Women
tended to rate their care more negatively than men in
some studies[26‑29]
The unmarried/singles were more satisfied as compared
to the widowed or the married.
Hulka et al. found no relationship between marital status
and satisfaction[30] while Bashur et al. reported that single
persons tended to be more satisfied with the technical
quality of care.[31]
Two of the four studies that correlated marital status with
satisfaction variable found no relationship.[29,30] Bashur
et al. reported that single persons were less satisfied
than married persons with a prepaid group practice while
another author reported the opposite.[30,32]
The literate group was more satisfied regarding all aspects
of care as compared to the illiterate group. Similar
findings were also observed by two such studies.[32,33]
In a study conducted by John Cuevas, the causes of
patient dissatisfaction were stated as follows: as for the
availability of medicines, laboratory and radiological
services, the availability of medicines got a poor
330 Medical Journal of Dr. D.Y. Patil Vidyapeeth  ¦  Volume 11  ¦  Issue 4  ¦  July-August 2018
satisfaction rating, compared to the availability of
laboratory tests and X‑ray, ultrasound and computed
n (%) tomography scans. For accessibility of basic health care,
412 (97.6) patients or respondents have low satisfaction ratings to
368 (87.2) access of hospital records and access to the laboratory.
348 (82.5) As for convenience of the basic health care provided by
334 (79.1) the OPD, the majority of the respondents gave a low
278 (65.7) satisfaction rating on the waiting time to get medical
226 (53.5) records as well as for the procedure to get medical
168 (39.8) records. The comfort of the X‑ray waiting area also
92 (21.8)
garnered low satisfaction.[34]
28 (6.6)
26 (6.2)
Conclusion and Recommendation
Overall mean satisfaction score was 2.97  ±  0.37.
Highest satisfaction scores were observed among
18–20  years, males were more satisfied regarding
technical quality of care while females reported
higher satisfaction regarding interpersonal manner,
unmarried/single group reported highest satisfaction
with most of the services, literate group reported higher
satisfaction than the illiterate group, affluent patients
reported higher satisfaction regarding technical quality
of care, financial aspect.
Causes of dissatisfaction were long waiting time,
inadequacy of seating arrangement in the waiting area,
inadequate cleanliness of surroundings, inadequate toilet
facilities, nonavailability of medicines, and behavior of
doctor.
Improvement of doctor–patient communication and cost
effectiveness of the services provided is important to
maintain the bond between the doctors and the patient
for the achievement of the optimal level of health of the
people.
Acknowledgment
The authors are highly thankful to
Dr. Krishnadas Bhattacharyya, Dr. Aditya Prasad Sarkar,
Prof. Indranil Saha, and Dr. Amiya Bhattacharya for their
support and guidance.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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