Chapter I

INTRODUCTION

A. Background of the Study

Quality of care is the extent to which healthcare services provided to individuals

and patient populations improve desired health outcomes. In order to achieve this,
health care must be safe, effective, timely, efficient, equitable and people-centered
(World Health Organization, 2019). Health care organizations strive for their patients
to be satisfied not only with their health care and its outcomes but also with the non-
clinical aspects of their patient experiences (NEJM Catalyst, 2018). Hence, patient
satisfaction has become an important indicator to measure the quality of care rendered
to the patients while in hospital. In the Philippines, the healthcare system is of high
standard (Allianz Care, n.d).

Patient satisfaction is not a clearly defined concept, although it is identified as

an important quality outcome indicator to measure success of the services delivery
system (Al-Abri and Al-Balushi, 2014). Many authors tend to have different
perceptions of definitions of patient satisfaction. An instance is Donabedian's quality
measurement model. It defines patient satisfaction as patient-reported outcome measure
while the structures and processes of care can be measured by patient-reported
experiences. Jenkinson et al. (2002) and Ahmed et al. (2011) pointed out that patient
satisfaction mostly appears to represent attitudes towards care or aspects of care. The
quality of the Philippines’ state-subsidized public healthcare, although good, varies
widely between areas. Furthermore, despite having achieved universal healthcare, the
country struggles with unequal access to medical care.

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 Jean Folger (2019) in her article written in Investopedia, mentioned that in
Manila, healthcare is reasonably good and affordable. Furthermore, the U.S. Embassy
in Manila noted that hospitals in Manila and around Manila often offer a high-quality
medical care. However, many hospitals outside these areas may offer basic medical
care in rudimentary conditions. Access to and quality of public healthcare remains a
contentious issue (Expat Arrivals, n. d). This prompted the researchers to study
healthcare in public hospitals and discuss its relationship towards overall patient
satisfaction. Patient satisfaction is of current interest, since quality management by way
of research-based knowledge has become an increasingly common demand (Manag,
2000).

Kaneet et al. (1997) and Marley et al. stated that measuring satisfaction should
incorporate dimensions of technical, interpersonal, social, and moral aspects of care.
Particularly, technical dimension may include hospital equipment and clinical
competence; interpersonal dimension is comprised of doctor’s explanation and attitude;
social dimension relates to meaningful staff-patient relationships; and moral dimension
involves the concept of caring, its attentions, actions and its achievements. However,
Avedis Donabedian (1980) used amenities as a component instead of social and moral
that refers to cleanliness, access, patient flow and waiting periods. Since patient
satisfaction is not directly observable, patient satisfaction surveys are commonly used
as a measuring device. The researchers will be measuring patient satisfaction and
extracting useful and relevant information that involves determining which aspects of
patient satisfaction to measure, developing reliable and valid questions, randomly
sampling individuals from within a patient population, and using standard techniques.

2
B. Statement of the Problem

One of the major issues confronted by healthcare institutions is living up to

patient satisfaction. With the current situation of hospitals and the rising demand for
patient satisfaction that is researched based, it is wise to evaluate the standards of
medical care at a hospital before and after medical procedures. Measuring satisfaction
may help improve quality of care. With that being said, there is a prompt to piece
together a synthesis and conduct a new study.

Specifically, the study will answer the following questions:

1. What are the demographics or the personal characteristics of the patients
according to
a. Age
b. Sex
c. Civil Status
d. Educational Attainment
e. Monthly Allotment for Healthcare
2. How does the hospital meet patients’ needs?
3. How does the availability of hospital equipment and facilities impact
satisfaction?
4. What are the characteristics that the medical staff should possess to satisfy
the patients?
5. How high or low is the quality of the medical services provided by the
hospital based on patient satisfaction?
6. What is to be done to the quality of healthcare services to attain a good patient
satisfaction score?

3
C. Objectives of the Study

With the aforementioned background and the statement of the problem, the
researchers are prompted to study healthcare in public hospitals and discuss its
relationship towards overall patient satisfaction in addition to its impact on the quality
improvement process of healthcare organizations. This study generally aims to evaluate
the standards of medical care of the hospital before and after medical procedures,
through measuring patient satisfaction since it may help improve quality of care.

Specifically, this research aims to:

1. Obtain the demographics of the patient-respondents in terms of
a. Age
b. Sex
c. Civil Status
d. Educational Attainment
e. Monthly Allotment for Healthcare
2. Assess how a local hospital meets patients’ needs
3. Evaluate the impact of satisfaction on the availability of equipment and
facilities
4. Assess the specific characteristics that medical staffs should possess to satisfy
patients
5. Determine the quality of medical services provided by the hospital basing on
the satisfaction scores
6. Formulate suggestions to be done to the quality of healthcare services to attain
patient satisfaction

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D. Scope, Limitations and Delimitations

Information on the impact of health services to satisfy patients has to come from
the patient themselves. Survey participants will be the in-patients and their watchers
from Bislig District Hospital. The hospital is managed by the provincial government
and is located at National Highway, Bislig, Surigao del Sur. The data will be obtained
at the time of hospitalization. This is done to gather both patients and watchers’ level
of satisfaction since both get to access the health care in different ways.

The study is limited particularly to the constraints that researchers face. It is thus
imperative to take into account that there are conditions that are beyond the control of
the researchers. The researchers acknowledge their own inadequacies and incapacities
in conducting research projects. The researchers of the study are Senior High School
students that are financially constrained. Travelling from the school to the vicinity of
the hospital would cost money, as well as the data gathering materials. More so,
struggling with time since the study will only be conducted for five months from July
to November 2019.

Boundaries were also made by the researchers for the conduct of the study. This
study aims to determine the level of satisfaction of patients at Bislig District Hospital.
Of foremost concern is the sample size of the study, which will not be determined
through statistical methods such as Slovin’s formula, but by the research instructor. The
population is delimited to 100 respondents and the methodological procedure to be
utilized is the descriptive study design. The data needed for this investigation will be
gathered through specifically constructed means and/or adopted by the researchers.
Furthermore, the literature to be synthesized is also limited to the Philippine healthcare
scene and international body of knowledge on patient satisfaction. Significantly, the
limitations would allow the setting of parameters to assess the level of satisfaction.

The researchers would also like to claim that the study in no way implies that
patient satisfaction scores are reflections of the actual state of services within the health
institution, but it may, however, serve as a basis for improvement.

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E. Significance of the Study

Results of the study may be beneficial to the patient-respondents, staff, hospital

administrator, the hospital as an organization, the researchers themselves and other
researchers.

Patient-respondents. The study to be conducted will be significant to the

respondents for the process allows them to evaluate their satisfaction with the service
provided by the hospital institution. In return, their input will allow the hospital for
quality monitoring therefore benefiting them in the long run.

Medical Staff. The results of this study can serve as basis for the staff’s
evaluation of quality service, and enhance the effectiveness of care rendered to the
patients. This will provide basis for suggesting strategies in modifying aspects of work
environment to promote positive attitude.

Hospital Administrator. The results of this study can serve as basis for
administrators in monitoring the ongoing quality of care being delivered by improving
the services provided. This is to achieve its purpose of resulting to increase patient
satisfaction.

The hospital as an organization. The result will provide information that will
allow the institution to modify and enhance the facilities and health care services that
could lead to patient’s wellness and satisfaction.

Researchers. As student researchers, the study conducted could enhance one’s

skill in collating information which can be used as they reach higher level of education.

Future Researchers. This study may be further used as a baseline information

for future researchers. Also, the overall findings could lend support, or be a
contradiction to existing theories, or bring about the development of a better one.

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F. Definition of Terms

Healthcare: the maintenance or improvement of health via the prevention,

diagnosis, and treatment of disease, illness, injury, and other physical and mental
impairments in people (Thomas-Maclean R et al, 2014).

Medical Staff: Professional medical personnel who provide care to patients in

an organized facility, institution or agency. (Fierce Healthcare, 2012) As used in the Commented [O1]: ALPHABETICAL?

study, it refers to doctors and nurses.

Patient: A patient is a person under health care.

Patient Satisfaction: defined as the measurement of stimuli, judgment and

responses of patients to the experience of health care through numerical representations
(Krowinski, Steiber 1996).

Quality: has been defined as excellence (Tuchman, 1980), valuevi,

conformance to specifications and meeting customer expectations (Ryall and Kruithof,
2001; ISO 9000, 2005)

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 Chapter II
REVIEW OF RELATED LITERATURE

Currently available national and international literature was reviewed to

understand the Philippine healthcare situation concept of patient satisfaction. This
chapter presents the related literature and studies after the thorough and in-depth search
done by the researchers. This will also present its synthesis.

A. Quality of Health Service

The World Health Organization (2019) defines health care as an overall

maintenance and solution to the health needs of a person, family, or community. It is a
system that addresses these health needs are fulfilled through prevention, treatment,
rehabilitation, and palliative care.

Hospitals complement and amplify the effectiveness of many other parts of the
health system, providing continuous availability of services for acute and complex
conditions. Hospitals concentrate scarce resources within well-planned referral
networks to respond efficiently to population health needs (World Health Organization,
2019).

According to Spok.com (2018), good quality of medical care is what every

patient deserve. Most of the top hospitals in the world share a common quality and
characteristic, which may be the reason behind their success. Putting patients first must
be a top priority of every medical institution. Every employee, whether or not they have
a clinical or patient-facing role, should have a patient-centric mindset. Patients are
searching for reassurance from healthcare professionals so delivering a compassionate
care is also a must. Medical staffs should also be fully committed in delivering the best
outcomes. Another good quality is the willingness to take risks and invest in innovation
to propel them to new heights. With these great qualities, only a few were able to
possess because of different aspects, which may involve the resources, budget, etc.

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 Quality of health services according to Donabedian (1980), in his
structure/process/outcome framework, is comprised of three components, namely:
technical, interpersonal and amenities.

a. Technical Component

Health inequities are continuously faced; more private hospitals are being built
or improved leaving the public hospitals behind despite their inadequate amount of
supply that could meet the patients’ needs. The standard of public healthcare in the
Philippines generally varies from excellent major centers to poor in local areas (Allianz
Care, 2019). According to Kennworthy, the public facilities in local areas are more run
down, these facilities have less medical staff and inferior supplies. Physical facilities
measure the patient’s perception about the quality of service in regard to the hospital’s
physical services. This measure includes: cleanliness and maintenance of the facility,
the availability of physical facility, such as resident rooms, technological capability,
diagnostic test rooms, blood banks, wards, beds, ambulance services, waiting rooms,
and operation theatres (Hussain et al., n.d).

Reviews also found that hospital design, particularly when single-bed rooms are
employed, can enhance patient safety and create environments that are healthier for
patients, families, and staff by preventing injury from falls, infections, and medical
errors; minimizing environmental stressors associated with noise and inefficient room
and unit layout; and using nature, color, light, and sound to control potential stressors
(Reiling et al., n.d). However, a report from Asian Development Bank was cited by
Medical Observer which described public hospitals with poor diagnosing, resulting in
repeat visits; medicines and supplies are inferior and rarely available; staff members
are often absent, especially in local areas, and are perceived to lack medical and people
skills; and waiting time is long, schedules are inconvenient, and facilities are rundown.”
Maintaining a safe environment reflects a level of competent healthcare that must be
fulfilled for patient safety (Saleh, n d.) It has been found that patients’ stress levels can
be kept low if they feel a strong sense of place in the hospital, and are easily able to
navigate their way around in it (Anna, 2017).

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 b. Interpersonal Component

In health, the tools of the communicational mix are based on an interpersonal

communication. Interpersonal (inter-human) communication was the first human
spiritual tool of the socialization process (Florescu and Malcomete, 2003). It is defined
by Floyd as being the communication that occurs between two people in the context of
their relationship and that, as it evolves, helps to negotiate and define the relationship
(Floyd, 2013). In the medical aspect, training of medical staff and medical
advancements in the field of diagnosis and treatment, the human component is a very
important factor, over 40% of the therapy's success being provided by the patient-doctor
relationship (Ahmed et al., 2013). Taking into consideration the importance of the
information content of patient-doctor communication (the diagnostic process and
treatment), the emphasis is more on verbal communication in the medical system. Non-
verbal and paraverbal forms are important from the perspective of their emotional effect
and reliable capital formation and sympathy that must exist between the two sides, these
forms being devoid of semantic and logical values (Cosman, 2010).

The development of a good relationship is based on good communication and

interaction with the patient which not only helps in cure, but also makes the patient
comfortable right from the first visit. This is the foundation of a successful medical
practice which goes beyond the normal conventional medical paradigms. Interpersonal
communication is important not only to understand the patient, but to treat him as an
individual with his own needs and problems, rather than a disease condition. It also
helps to make the patient understand his medical condition and actively take part in
taking care of themselves (Schattner, 2009). A successful medical encounter with the
patient not only results in a positive healthcare outcome, but also leads to patient as
well as professional satisfaction. And, a good interpersonal relationship reduces the
chances of the patient withholding vital information, thus avoiding chances of error in
diagnosis and treatment by the treating medical staff (Levinson et al., 1997)

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 c. Amenities Component

Patients rate their hospitals based on the things they can most easily observe,
which are overwhelmingly hospitality features. The lens of ‘customer satisfaction’
focuses attention on aspects of quality that are most visible to patients, but less relevant
to patients’ health outcomes (Cristobal Young et al., 2018). According to The
FreeDictionary.com, amenities in medicine is an element of health care delivery that
increases patient satisfaction, whether or not it improves clinical outcomes.

Furthermore, according to John A. Romley, a senior author and a research

assistant professor in Policy, Planning and Development at U.S.C, amenities may be
important drivers of clinical outcomes and, more broadly, satisfaction with care.
Alongside the growing focus on patient satisfaction in medicine has been the rise of
hotel-like amenities and services in medical care (Goldman and Romley 2008; Reich
2014).

B. Public Hospitals as Healthcare Provider

Public hospitals or sector are said to be the major provider of healthcare in the
country to attain equitable and universal accessibility for its services according to an
international non-profit organization, Oxfam, in its report “Blind Optimism” (Basu et
al., 2012). There are instances wherein the emergency room is filled with sick and
disease-infected people that durations of waiting to be treated is long and usually last
in several hours (Villanueva, 2014). As per experience of a patient of a public hospital
stated in his article, there was a case wherein stress builds up that a medical staff cannot
help but scream at the poor patients of the whole room and refer other patients to
different hospitals but fortunately they were still treated as the hospital stood their
ground upon knowing the condition of the patient’s baby. This complaint was also
supported by an interview-based study in Ghana that the waiting hours in the public
hospitals would last for one to two hours (Basu et al.,2012). According to Basu’s
Systematic Review (2012), he discovered that some public sector healthcare workers
are competent in their workplace that resulted in three interview-based studies. Yet in
some studies, patients reported that the medical staff in public healthcare sector has the
worst hospitability and ranked as the lowest on a scale-based surveys where patients’
11
assessed the courtesy of staff, diagnostic explanation, cleanliness of facilities, capacity
building and the availability of certain medical inputs (Basu et al.,2012). Doctors are
also well-trained but unable to execute treatments and perform their specialized skills
on the patients because of the lack of facilities and equipment or even unfunctional
(TransferWise, 2017). Shortage of beds, bandage and other basic hospital supplies and
equipment that forces majority of the medical staff to transfer to a different sector or
hospital (Villanueva, 2014). This usually leads to patients left unattended or untreated
and unresolved in their healthcare needs (Jabonete et al., n. d). There are also cases
where some doctors do not take the patients’ concerns seriously that the prescribed
medication or antibiotics are inconsistent and shows no sign of improvements at all
(Britten, 2000). There are reports that there is a poor adherence to guidelines in
prescription practices that leads to receive unnecessary antibiotics or worse, prescribed
antibiotics incorrectly. In relation to this matter, a study was conducted in ten public
healthcare sector that determined that public healthcare providers were the worse in
adhering to national malaria treatment standards (Basu et al.,2012). Quality
improvement may need to address incentives to perform at high standards among
providers, one proposed approach is to link provider compensation with results from
patient outcomes, weighted by baseline disease risk in the patient population as what
Basu (2012) suggested in his study as he dwell deeper on this matter.

Therefore, patient care is always a multi-dimensional process, so the hospital’s

endowment with equipment, medication and qualified medical staff plays an essential
post-operative role.

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C. Patient Satisfaction

Quality is the most overused yet underachieved concept in health care

(Enriquez, 2002). According to Johannsson et al. (2002), to evaluate and improve the
quality of care provided, it is of vital importance to investigate the quality of care in the
context of health care. Patient satisfaction is a significant indicator of the quality of
care. Consequently, quality work includes investigations that map out patient
satisfaction. Moreover, patient satisfaction is a person’s positive feeling of pleasure or
disappointment resulting for comparing a product or services perceived performance or
outcome in relation to his or her expectations (Habbal, 2007). In addition, patient’s
satisfaction is fundamental importance as a measure of the quality of care because it
gives information on the provider’s success at meeting those client values and
expectations which are matters on which the client is the ultimate authority
(Donabedian, 1988).

Lleva (2010) identified that Filipino patient satisfaction can be attributed to

nurses’ professional qualities, communication skills, professional competence in the
job and interest and commitment in the job. This was supported by Alfonso (2008) who
in a study concluded that Filipino patients’ satisfaction is credited to the compassionate,
kind and competent nurses. Patient’s satisfaction also appears to have a nurses provide
care in a standard way which is averagely rated with related costs. Patient’s find it more
satisfying when nurses are happy, when there is less stress, approved leaves of absence,
and standard work load. Also the findings discovered that the patients rated their
satisfaction of nursing care as highly base on the satisfaction when there is affective
comfort and compassion showed by nurses (Dey, 2016; Merill et al., 2012 and Tang et
al., 2013).

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 According to Coser (1956), there is a little more than half of the patients saw
the good doctor as one provided kindness, love, and security. On the other hand, some
of the patients focused on the doctor’s scientific and professional competence.
Moreover, trust is the main antecedent of satisfaction in medical care and that
improving communication skills and developing better patient rapport skills for dealing
with adverse patient behavior are essential determinants of patient’s satisfaction
(Habbal, 2007). Also, to improve patient satisfaction, hospital and health system leaders
should ensure they are taking a holistic, team approach that uses their organization’s
available resources, including the health care physical environment and the
professionals who manage those spaces (Sara Heath, 2016). Therefore, patient
satisfaction in healthcare is evolving from the quality of care of the hospital services.

One of the predictors of patient satisfaction is the sociodemographic of the

respondent that is comprised of: age, sex, civil status, educational attainment and the
monthly allotment for healthcare. Age is a well-known determinant of the patient
satisfaction index (PSI) with older patients scoring more highly and being satisfied than
young and middle-aged patients (Mikael Ramqvhist, 2001). As supported by Al-windi
(2005), that age under 65 years and healthcare need were the strongest predictors of
dissatisfaction with health care. Thus, patient age is associated with style of interaction,
which is, in turn, associated with patient satisfaction (Mitchcell Peck, 2011). Patient
satisfaction is also related to educational level. Minnick et al. (1997) found in their
research that the average patient that had more education were less satisfied with the
care. To support, Jamshidi et al. (2014) pointed out that patients with higher level of
education are less satisfied, since they have higher education, higher incomes and social
status. Thus, their expectations are higher and literacy and income of clients seems to
have a significant effect of patient satisfaction.

14
 Previous studies have documented significant satisfaction of patient in health
care according to patient socioeconomic status (SES). Studies of the effect of patient's
SES on satisfaction with health care have reported mixed findings, but it has been noted
that patients having less income have less expectations and shows more satisfaction
with healthcare providers (Fiscella K, Goodwin, 2002). A study conducted by Ibraheem
et al. (2013), the lesser the level of incomes the higher the assessments of individuals
on health service satisfaction. Meaning that the poorer the people are the lower are their
expectations for health service qualities, less educated and poorer individuals have
shown higher satisfaction toward the health services provided. Also, according to
Weisman et al. (2000), civil status was significantly related to patient satisfaction score.
They found out that single patients had significantly less satisfaction score as compared
with married or separated patients.

A study conducted by Garcia (n. d.) showed that there was a small but definite
relationship between age, civil status, and family monthly income in relation to the level
of satisfaction; meanwhile, there was a very dependable relationship between sex and
educational attainment in relation to the level of satisfaction.

With the statements stated above, it can be understood how the healthcare
scenario works particularly in public hospital is essential in assessing the level of patient
satisfaction. This is significant because in order to understand, underlying causes and
factors should be taken into account such as hospital structure and patient expectations
and capabilities. There has been much research and discussion conducted on hospitals,
staffs and patients with most of the research found was on individual specifications of
the abovementioned. More research and testing is required to gain a better assessment
of the interrelatedness of hospital over-all structure in relation to patient satisfaction as
measurement of quality care.

15
 Chapter III
METHODOLOGY

Measurement of patient satisfaction is a legitimate indicator for improving the

services and strategic goals for all healthcare organizations (Elaine et al. 2002).
Therefore, getting the views of the patients on the care services is a much realistic tool
to evaluate and improve the health care services since it is based on direct experiences
of the users. However, since patient satisfaction is not directly observable, patient
satisfaction surveys are commonly used as a measuring device. Patient satisfaction
surveys attempt to translate subjective results into meaningful, quantifiable, and
actionable data (NEJM Catalyst, 2018).

A. Conceptual Framework

Quality of Health Services

Technical Interpersonal Amenities

Patient Satisfaction
Fig. I Conceptual Framework.

Figure 1 shows the quality of health services according to Donabedian (1980).

It is comprised of three components, namely: technical, interpersonal and amenities.
Donabedian constructed a structure/process/outcome framework that has provided a
comprehensive typology of quality dimensions that have been used and again by
researchers attempting to analyze healthcare service quality. The matrix clarifies the
interaction of structure, process and outcome with the technical, interpersonal and
environmental / physical elements in health care service delivery. The technical element
encompasses equipment & facilities, qualifications and expertise, diagnosis/treatment
and practice; interpersonal includes roles and relationships of patients and healthcare
providers; and amenities refer to cleanliness, access, patient flow and waiting periods.

16
B. Research Design

This study will utilize a descriptive research design to assess the quality of
health service provided by public healthcare institutions in relation to patient
satisfaction. Nasajji (2015) defines descriptive research as a design that “describes a
phenomenon and its characteristics and is more concerned with what rather than how
or why something has happened”. The study will be analyzed quantitatively, using
frequencies, percentages, averages, or other statistical analyses to determine
relationships.

The study seeks to evaluate the standards of medical care at a hospital before
and after medical procedures as well as to know and describe the current situation of
public local hospital. Furthermore, the researchers aim to assess whether the medical
services offered by a public hospital meets the satisfaction level of patients who have
gone through medical care.

D. Research Locale

Figure 2. Map of Bislig where Bislig District Hospital is located

The researchers of this study will be conducting a survey in a public hospital
located in Bislig City, specifically the Bislig District Hospital (BDH). With its
assistance from the government and availability to the public, a huge number of patients
are expected to consume its medical services offered.

17
D. Sampling Method

The researchers will use simple random sampling method. The researchers will
randomly pick respondents to a given list of patients. This method is typically used in
quantitative research study and the most popular method for choosing a sample among
population for a wide range purposes. Simple random sampling also removes bias from
the selection procedure, which is a requirement in quantitative research study to
maintain objectivity. Moreover, research findings resulting from the application of
simple random sampling can be generalized due to representativeness of this sampling
technique and a little relevance of bias since this sampling method is the purest and the
most straightforward probability sampling strategy (Gravetter et al. 2011).

E. Research Instrument

The researchers will use a standardized questionnaire. Patients will be

administered of an adopted standardized patient satisfaction questionnaire (PSQ)
assessing 3 components of health service quality by Donabedian (1980). Questionnaires
that will be used in this study are designed to obtain information on patient satisfaction.

18
F. Statistical Treatment

In order to assess the three components of health service quality, the researchers
will be using Likert scale. Likert scale is one of the most reliable ways to measure
opinions, perception, and behaviors (Survey Monkey, 2019). Likert scales have the
advantage that they do not expect a simple yes or no from the respondent, but rather
allow for degrees of opinion and even no opinion at all. Therefore, quantitative data is
obtained. The range that will be used is from 1- 5. This range gives the weight of the
responses. The scale range is 1 = highly satisfactory, 2 = satisfactory, 3 = neutral, 4 =
unsatisfactory, and 5 = highly unsatisfactory.

The statistical treatment to be utilized is the weighted mean, a type of statistical

analysis where some data points have more weight than the other, and is often used in
descriptive researches.
𝑛𝑓1+𝑛𝑓2+𝑛𝑓3+𝑛𝑓4+𝑛𝑓5
𝑥̅ =
𝑛

Where:
𝑥̅ = weighted mean
𝑛 = number of respondents
fn = frequency number

19
G. Validity of Research Instrument

A survey questionnaire that assess whether the respondents' accumulation of

the medical services offered by the hospital meets their satisfactory rate/rating. To
quantify the data, there is an adaptation of a standardized patient satisfaction
questionnaire in a Likert Scale format that weighs the respondents’ responses in a form
of ratings that range from a specific number with a specific value.

To validate the survey questionnaire, a Cronbach’s Alpha test was used.

According to University of Virginia Library (2019), Cronbach’s alpha is a measure
used to assess the reliability, or internal consistency, of a set of scale or test items. In
other words, the reliability of any given measurement refers to the extent to which it is
a consistent measure of a concept, and Cronbach’s alpha is one way of measuring the
strength of that consistency. The researchers conducted a pilot survey test among
respondents selected with convenience. A total of 15 answered the pilot survey of the
Likert scale on patient satisfaction on health service quality.

After the initial data collection and statistical analysis, the adapted Liker scale
received a Cronbach’s alpha (α) coefficient of 0.916, indicating that the survey is
acceptable and valid.

H. Ethical Consideration
Knowing that the study involves the hospital, its healthcare professionals and
patients, ethical considerations must be dealt. Before conducting the data gathering, a
letter of request must be first sent to the Chief of Hospital to ask permission to conduct
a survey among its patients. Patients’ consent is required before the conduct of the
survey; they are not obliged to answer if it is against their will. Moreover, they will be
given an adequate time for their participation.
Since hospital files are confidential, patients’ anonymity must be observed at all
times. Information provided will be used solely for academic purpose and utmost
confidentiality will be maintained.

20
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Alfonso, Y. (2008). Level of Patient Satisfaction in the Health Care Delivery System
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