EFFECTIVE MANAGEMENT OF APPOINTMENT SYSTEM AND

ITS EFFECT ON QUALITY OF CARE

(A CASE STUDY OF UNIVERSITY OF MEDICAL SCIENCES TEACHING

HOSPITAL, ONDOD STATE)

BY
ABIODUN TAIWO SUNMISOLA
CHTA/HIM/2020/316

A PROJECT SUBMITTED TO

THE DEPARTMENT OF HEALTH INFORMATION MANAGEMENT,

ONDO STATE COLLEGE OF HEALTH TECHNOLOGY, AKURE

May, 2023.

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 CHAPTER ONE

INTRODUCTION

1.1       Background to the Study

Appointment scheduling systems lie at the intersection of efficiency and timely access to

health services. Timely access is important for realizing good medical outcomes. It is also an

important determinant of patient satisfaction (Nilesh Jain et al, 2014). The ability to provide

timely access is determined by a variety of factors that include fundamental questions about how

many and which types of physical assets and equipment a health system should invest in, how

should it allocate resources among multiple sites, how should it staff each clinic or hospital site,

what rules best determine which providers and patients receive higher priority access to

resources, and how appointments are scheduled. The focus of this project is on appointment

system. We do not consider questions pertaining to the size of facilities, equipment and staff, and

to resource allocation in multiple-service-site systems. (Chao et al. (2013)

Appointment management serves as official memory of an organization as it documents

the first step of treatment which is consultation. It is also used for reference purpose and to

determine the course of action in line with actions of the predecessors. That is why Williams

(2016) postulates that records are those materials made or received by institutions in pursuance

of legal obligation or in the conducts of functions and preserved as evidence because that is used.

Accurate appointment management is vital in any organization because the solution to

any management problem requires the involvement of meticulous and accurate management of

records. Not only are sophisticated records management principles and practices necessary in

today's information-oriented society, they are also absolutely critical to its continued survival.

Unfortunately, it seems that most organizations have not yet realized the relationship between

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appointment and the management of this information through an appointment management

program (Cayirli and Veral, 2013).

Scheduled patient encounters include primary and specialty care visits, as well as elective

surgeries. In each of these environments, the process of scheduling appointments (assigning a

specific time when the patient is scheduled to start receiving care) is different, which we will

describe shortly. In addition, there are unscheduled encounters that include walk-ins and urgent

or emergency cases (Charnetski, 2013). The former, occurring mostly in primary care clinics,

can be directed to an alternate facility if the clinic in question is heavily booked. However,

urgent specialty care and surgical patients often need to be treated as soon as possible (Boadu,

2011). The goal of a well-designed appointment system is to deliver timely and convenient

access to health services for all patients. Appointment systems also smooth work flow, reduce

crowding in waiting.

The primary objective of a well-designed appointment system is to deliver appropriate

and timely health care service to the patients. An appointment system has to cater to the

requirements of both the patients and providers by matching the supply with the demand. They

also have the task of smoothening the work flow in clinics by reducing the crowding in the

waiting rooms (Gupta et al., 2018). An appointment scheduling is a tradeoff between the patient

wait time and provider idle time (Cayirli et al., 2014). One of the major complaints by patients in

outpatient clinics is the long wait times. A patient faces two types of wait times on scheduling an

appointment, the direct and the indirect delay. Direct delay is the waiting time that the patient

experiences upon arriving at the clinic (Gupta et al., 2018). The indirect delay is the period from

the time of scheduling an appointment to the actual time of the appointment. This indirect delay

3
that occurs in the clinic can cause a lot of dissatisfaction as it usually not known to patients

beforehand.

Apart from minimizing the waiting time of the patients, a good appointment system

reduces the provider idle time and the provider overtime. Provider idle time is defined as the

time when a provider is not consulting a patient because there are no patients waiting to be seen;

and provider overtime is the difference between the desired end time of a clinic and the actual

time the service is provided to the last patient (Cayirli et al., 2013). A bad appointment system

can be a source of frustration for providers, as they are affected by the ambiguity in the number

of appointments and also the mix of appointments on a given day. Most of the time providers

manage the variations and priority demands by shrinking their lunch times, practicing double

booking or working faster. Such factors usually affect the job satisfaction of the providers.

According to Cayirli et al. (2013), well designed appointments systems should have the

capability to increase the utilization of resources while minimizing the idle time of patients and

the provider.

1.2 Statement of the Problem

In Nigeria, the waiting times for securing healthcare services at healthcare institutions are

reported to be high. It is even higher in public hospitals and private hospitals which are

accredited with the National Health Insurance Scheme (NHIS). Tagbel, (2013) argued that there

is the likelihood that waiting times could have a negative effect on demand for healthcare in

public and some private hospitals. This view is supported by Boadu (2011) who pointed out from

the records of Nigeria Statistical Survey (2009) that 65% to 95% of unsatisfied but non-

complaining customers will never patronize the services of health institutions at a point in time.

Dissatisfied patient may resort to unaccredited healthcare institution or self-medication. This

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situation possesses a challenge to the utilization of modern health services. It rather worsens the

situation of disease control, thus contributing to more morbidity and mortality (Tagbel, 2013).

Studies have shown that in many developing countries in sub–Saharan Africa, more than four

hours has been reported as an average time patient take to wait in facilities.

From existing literature, minimizing the time patient spent at the hospital has been the

center of attention of numerous studies (Jessica Jitta, 2008 and Nabbuye-Sekandi et al., 2011).

The long waiting time leads to a lose-lose situation, because patients lose valuable time, the

hospital loses patients and reputation, and the staff experience tension and stress (Barlow, 2002).

in view of the aforementioned issues associated with patient waiting time, it interests the

researcher to investigate the effective management of appointment system and its effect on

quality of care with a case study of University of Medical Sciences Teaching hospital, Ondo

State.

1.3 Objective of the study

The broad objective of the study is to examine the effective management of appointment

system and its effect on quality of care in University of Medical Sciences Teaching hospital,

Ondo State.

The specific objectives of the study are to:

1. determine if effective management of appointment system has an impact on quality

health care delivery at University of Medical Sciences Teaching hospital, Ondo, Ondo

State

2. examine the challenges of effective management of appointment system in University of

Medical Sciences Teaching hospital, Ondo, Ondo State.

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 3. suggest ways of ensuring effective appointment system in University of Medical Sciences

Teaching hospital, Ondo, Ondo State

1.4 Research Questions

1. Does effective management of appointment system have an impact on quality health care

delivery at University of Medical Sciences Teaching hospital, Ondo, Ondo State?

2. What are the challenges of effective management of appointment system in University of

Medical Sciences Teaching hospital, Ondo, Ondo State?

3. What are the ways of ensuring effective appointment system in University of Medical

Sciences Teaching hospital, Ondo, Ondo State?

1.5 Scope of the Study

The study was conducted within the framework of evaluating the effective management

of appointment system and its effect on quality of care in University of Medical Sciences

Teaching hospital, Ondo town, Ondo State. The study would focus on health workers working in

University of Medical Sciences Teaching hospital, Ondo State.

1.6 Significance of the study

The study provides valuable assistance to stakeholders and hospital management in

implementing measures to effectively manage appointment systems by identifying the exact

areas where delays occur, the study is expected to facilitate the resolution of appointment system

delays and improve patient satisfaction. Additionally, the study would provide insights into the

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root causes of waiting time, which will help hospitals better understand how to minimize it.

Finally, the study would contribute to the literature on waiting time and serve as a useful

resource for students and researchers exploring this topic.

1.7 Operational Definition of Terms

Appointment system: An appointment system also known as appointment booking system or

appointment management, is a solution that makes it easy for service providers to manage

appointments

Quality of care: is the degree to which health services for individuals and populations increase

the likelihood of desired health outcomes.

Arrival time: This is the moment the patient presents him/herself to the health facility, thus first

point of services is the records unit.

Departure time: This is the moment the client or the patient exit the health facility (hospital).

Flow problems: a condition that occurs whereby there is availability of staff and patients but a

delay is occurring at a working area e.g. records.

Out-patient: means the patient accesses the hospital and exit the same day as soon as receiving

services (no admission at ward).

Patient flow: this occurs when there is a temporal blockage in the manner in which patients

moves from one working area to the other.

Queuing problems: this means that patients are not attended in an orderly (illogical) manner.

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Service time: this is the number of minutes a patient spends to acquire a service from a specific

unit at any of the working areas.

Total waiting time: the addition of all the time the patient spends to receive services at all the

various working areas.

Waiting time: the number of minutes or hours a patient spends to receive a service at the OPD.

Working areas: this means the various units at the hospital at the OPD where specific services

are provided to the patients.

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 CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction

A literature review is simply a summary of what existing scholarship knows about a particular

topic. It is always based on secondary sources, that is, what other people have already written on

the subject; it is not concerned about discovering new knowledge or information. This chapter

involves the process of reading, analyzing, evaluating and summarizing scholarly materials about

the research topic. This chapter is will be organized under the following sub headings:

 Concept of Appointment System

 Appointment Systems as a Quality Measure in Healthcare

 Specialty Clinic Appointments Scheduling

 Importance of Patient Satisfaction

 Factors Influencing Patient Satisfaction Healthcare services

 Improving patient Satisfaction with Effective Appointment System

2.1 Concept of Appointment System

Appointment systems can be a source of dissatisfaction, both for the patients and for the

providers. Patients are impacted by the lack of availability of timely and convenient appointment

slots, especially when their need is urgent. Clinicians are impacted by the uncertainty in the

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number of patient appointments from day to day, and the mix of appointments on any given day

(Lane, 2012). These factors can affect clinicians’ earnings as well as their job satisfaction levels.

In many instances, clinicians can handle high-priority demand, and variations in case mix, only

by stretching their schedules to absorb demand variation—i.e., by shrinking lunch time, pushing

back dinner and double booking (working faster) (Diane, 2015). (The soft nature of provider

capacity is one of the factors that differentiates health care delivery systems from manufacturing,

transportation and logistics systems.) Even with such strategies in place, it is sometimes

necessary to reschedule certain booked appointments for non-urgent services in order to take

care of urgent demand. Moreover, significant direct waiting time is not uncommon in

environments that deal with life-threatening urgent cases. Frequent involuntary changes in

appointments and long direct waits can cause dissatisfaction among patients who book in

advance (Andrew, 2016).

The primary objective of a well-designed appointment system is to deliver appropriate

and timely health care service to the patients. An appointment system has to cater to the

requirements of both the patients and providers by matching the supply with the demand. They

also have the task of smoothening the work flow in clinics by reducing the crowding in the

waiting rooms (Gupta et al., 2018). An appointment scheduling is a tradeoff between the patient

wait time and provider idle time (Cayirli et al., 2012). One of the major complaints by patients in

outpatient clinics is the long wait times. A patient faces two types of wait times on scheduling an

appointment, the direct and the indirect delay. Direct delay is the waiting time that the patient

experiences upon arriving at the clinic (Gupta et al., 2018). The indirect delay is the period from

the time of scheduling an appointment to the actual time of the appointment. This indirect delay

that occurs in the clinic can cause a lot of dissatisfaction as it usually not known to patients

10
beforehand. Apart from minimizing the wait time of the patients, a good appointment system

reduces the provider idle time and the provider overtime. Provider idle time is defined as the

time when a provider is not consulting a patient because there are no patients waiting to be seen;

and provider overtime is the difference between the desired end time of a clinic and the actual

time the service is provided to the last patient (Cayirli et al., 2013).

A bad appointment system can be a source of frustration for providers, as they are

affected by the ambiguity in the number of appointments and also the mix of appointments on a

given day. Most of the time providers manage the variations and priority demands by shrinking

their lunch times, practicing double booking or working faster. Such factors usually affect the job

satisfaction of the providers. According to Cayirli et al. (2013), well designed appointments

systems should have the capability to increase the utilization of resources while minimizing the

idle time of patients and the provider.

2.2 Appointment Systems as a Quality Measure in Healthcare

There are numerous definitions of quality linked to health care, but Donabedian (2010)

describes quality of care as demonstrated by the balance between implementation of biomedical

strategies and technology and its increase in benefit to the client with mitigation of risk. He

further notes the high standards of quality equate to a positive equilibrium between the expected

risks and benefits to the client. Simply put, the expectation of clients could be met with a

monitored, balanced primary health care service, in which standards are measured and both

community and staff actively participate in a quality improvement strategy to enhance care in the

context required.

Quality in healthcare services, as in other business sectors, being difficult to define, is

hard to set standards for and to control the level of performance (Ramirez & Crowe, 2007; Ware,

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2015) and difficult to measure due to the intangibility, heterogeneity and inseparability of its

components (Naidu, 2009; Parasuraman et al., 2015). Therefore, evaluating healthcare quality

raises a problem due to service size, complexity, the specialization of the organization and its

expertise (Eiriz &

Figueiredo, 2005). Customer-based determinants and perception of the quality of services

are the most important aspects in choosing a hospital (Lim & Tang, 2010). Therefore, a

hospital’s service quality measures should be determined by customers’ expectations. Patients

with service providers collectively set the hospitals’ service delivery specifications, because the

perceived service quality is the result of the service that the customers receive and how they

perceive what they are receiving (Parasuraman et al., 2015). Patients are experts on their own

personal circumstances and needs (Morgan & Murgatroyd, 2014).

In patient-oriented healthcare organizations, it is expected that patients' satisfaction will

be considered at every point of the planning, implementation and evaluation stages of the service

delivery; from a clinic’s working hours and counseling techniques to the decision about the

longest acceptable waiting time. Unquestionably, patients should be at the center of the

healthcare quality agenda. Meeting patients' needs and creating healthcare standards are crucial

to achieving high quality service (Ramachandran & Cram, 2005).

Argentero et al. (2008) carried out a study with an aim of assessing patient satisfaction

with perceived quality of health care among haemodialyzed patients which was conducted across

northern Italy. The study used a cross-sectional study of the relationship between burnout in

nephrologists and nurses and patient perceived quality of care. The study involved 68

Nephrologists, 334 nurses and 695 haemodialyzed patients who were randomly selected from 10

dialysis centers across northern Italy. The study outcome variable which was patient perception

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and satisfaction with quality of care was assessed by means of a multi-choice questionnaire that

incorporated 4 patient dimensions: completeness of medical information, emotional relationship

with health care staff, performance of dialysis center staff, and organizational aspects of health

care service.

There is a growing consensus that an important indicator of healthcare quality is patients’

satisfaction (Ramirez & Crowe, 2017) A widely used construct in healthcare management

research is the patient's perspective of quality, which has been linked to several performance

metrics, including patient satisfaction and recommendations for improvement (Andaleeb, 2014).

Patients’ satisfaction results from meeting or exceeding patient expectations (Thompson et al.,

2016). Patient satisfaction is a multidimensional 23 construct affected by several variables

(Farid, 2018; Hyde, 2014; Naidu, 2009; Sower et al., 2001).

2.3. Specialty Clinic Appointments Scheduling

Specialty care clinics are designed to deliver health services that are focused on specific,

often complex, diagnoses and treatments. In some cases, multiple medical specialties may be

integrated into a group practice which may have several departments, each specializing in a

different branch of medicine (Al-Omar, 2014). Rules governing access to specialists can vary by

the medical specialty, as well as by the health network (Turkson, 2013). Certain specialties such

as pediatrics and obstetrics are typically designated as open access. This means that patients can

call to book an appointment without the need for a referral first. Open access clinics are similar

to primary care clinics in terms of appointment scheduling. In fact, it is not uncommon to find a

shared call center, which serves all primary care and open access specialty clinics in a health care

network. Many specialty clinics do require referrals. In that case, the referring physician is often

the patient’s and his/her clinical assistant books an appointment for the patient. In many

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instances, a referral is required only for the first appointment, and the patient is able to directly

schedule all subsequent appointments (Vallabhjee, 2014).

Daily scheduling concerns taking care of deviations from planned clinic time and booked

appointments, both of which are common in specialty services. For example, when outpatient

clinics are attached to hospitals, specialists may serve as stand-by consultants and providers of

emergency care (Benjamin, 2014). They may also see patients on short notice to clear them as

surgical candidates, with the result that clinic managers face uncertainty in both demand and

physician availability. Managing short-term supply and demand imbalance in specialty care

environments is particularly difficult in rural or less populated areas. In such cases health care

providers may collaborate to pool resources, for instance, by having a rotating specialist-on-call

schedule (Chaka, 2014)

There are many factors that affect the ability of appointment schedulers to utilize

available providers’ time efficiently and effectively. Some examples include inter-arrival and

service time variability, cancelations and no-shows, patient preferences for a particular day of

week, time of day and for certain physicians, degree of flexibility permitted by the physicians in

the use of their time (e.g., some preauthorize double booking at certain times of the day if

demand is high, whereas others require the scheduler to call for approval each time), appropriate

level of information technology, and a smooth-running call center for managing patient requests.

In addition to these issues, we believe that a critical bottleneck lies with the application of

Industrial Engineering & Operations Research (IE/OR) models. Such models have the potential

to improve appointment scheduling via algorithmic decision support tools, similar to their

successful application in other service industries such as the airlines, car rental agencies and

hotels (Talluri and Van Ryzin (2004).

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 Patient service times in specialty care clinics tend to vary more depending on the

patients’ diagnoses and other characteristics. Therefore, provider time may not be divided into

standard time slots. Moreover, many specialty services require a referral from the primary care

physician. In such cases, appointments are booked by the medical assistant of the referring

doctor. Bookings may occur at periodic intervals (e.g., at the end of each day). Appointment

management for specialty care clinics is further complicated because of two reasons: (i) the need

to reserve capacity for urgent appointment requests that must be treated soon after they occur;

and (ii) the need to realize high utilization of more-expensive specialists’ time. Scheduling

surgical appointments is even more complex. Procedure times are variable, several pre-surgery

appointments may be required for necessary medical exams and a variety of service

providers/resources have to be simultaneously scheduled in order to deliver the desired services.

For example, in addition to the team of surgeons, a properly equipped surgery room, specialized

nursing staff and anesthesiologists have to be available at the desired start time. Therefore,

surgery scheduling sometimes occurs in two stages. Patients first choose from a menu of

available time windows (each may be a week-long) during which they prefer to have the

procedure performed. The physician’s office later confirms a specific day and surgery start time,

which we refer to as the appointment. Surgeons typically need to fit all procedures scheduled for

a day within a block of operating room time that is assigned for their use. They have preferences

with respect to which types of procedures they like to perform on specific days and times of

week. Such considerations can further complicate scheduling.

2.4 Importance of Patient Satisfaction

It is important to understand the expectations and needs of patients to improve healthcare

services. According to Hailu (2015), it is important for healthcare services to satisfy the needs of

15
patients. It is also important for healthcare services to meet the expectations of patients. For this

reason, it is therefore important for healthcare service providers to understand the experiences

that contribute to patients’ satisfaction. Hailu (2015) pointed out the behavior of support staff,

attitude of paramedic staff, competence of doctor, doctor patient relationship, hygienic condition

of the healthcare institution, and various services provided by the health care institution are

major experiences of patients.

Duggirala et al. (2008) argued that one of the standards of measuring patient perception

about health services is patient’s satisfaction. They further argued that patient satisfaction as a

standard of measuring the quality of healthcare services has been used to conduct remarkable

study over the decades. Some of these studies about patient satisfaction have been conducted by

academicians and practitioner with various motives. Hailu (2015) is off the view that the

behavior of patients is hard to predict which make them more sophisticated in terms of their

healthcare preference. Healthcare service provider are becoming very mindful about the

preference of patient, considering the fact that there is competition in the healthcare service

industry. For this reason, patient satisfaction is used as a tool to gather relevant information to

improve healthcare service delivery (Boyer et al. 2006). The outcome of patients through the

satisfaction study aids in improve their perception about the healthcare services under

investigation.

Patient satisfaction is significant improving the quality of healthcare service delivery

through gathering suggestions from patients and stakeholders (Hailu, 2015). Actions in relation

to satisfaction are thus relevant tools for forecasting and examination. Patient satisfaction is

important for taking decision of healthcare service delivery. This is due to the fact that a higher

level of satisfaction is associated with improved attendance at healthcare institution, superior

16
compliance, and better outcomes. Through a study that was conduct by Andrew & Erik (2009) it

was revealed that quality healthcare assessment was influence by decreased inequality with

respect to the healthcare systems. It was also revealed that the quality of healthcare assessment

was influenced by desire to improve healthcare service delivery. The study revealed the

healthcare assessment also intended to address key areas in relation to structure, process, and

outcome from the health service provider’s view point. From majority of researchers’ point of

view, patient satisfaction is an important technique in conducting research, and managing a

healthcare institution (Papanikolaou & Ntani, 2008).

Existing literature has generally agreed that studies on patient satisfaction has an impact

on improving the quality of healthcare service delivery. It has also agreed that patient satisfaction

study is an accurate too for providing chance for enhanced strategic decision making, reducing

cost, meeting the expectations of patient, improvement, providing a standard across healthcare

institutions, and monitoring healthcare performance (Hailu, 2015). Conducting a study on patient

satisfaction provides basic for making valued judgment on the healthcare service performance of

healthcare service personnel (Hailu, 2015). Again, patient satisfaction reveals the failure or

success of healthcare service policy development and implementation. As a complicated

principal, patient satisfaction is usually influenced by socioeconomic factors, personal

characters, physical and mental aspects, cause and effect of the services, and patient’s

expectations.

Despite the complex nature of patient satisfaction, measures of measuring it have been

proposed as: marketing strategies with respect to consumers’ satisfaction that have been brought

in the healthcare industry; accurate merging of the opinions of consumers about healthcare

service delivery for the sake of quality assurance and quality improvement; and increasing

17
compliance level with treatment, which originated from the vital study of the behaviors of

patients toward healthcare services. With respect to quality improvement, patient satisfaction

assessment becomes an important process of enlightening to discover the developments that have

better healthcare service set of qualified standards and performance, and are less expensive to

make (Hailu, 2015).

2.5 Factors Influencing Patient Satisfaction Healthcare services

Client satisfaction is an integral service-quality component that should be monitored

closely by health service providers. Empirical review indicated that many factors within and

outside the formal health system have significant influence on the perceived quality of health

services provided and hence customer satisfaction. The following studies discuss key factors

which play a key role in influencing overall patient satisfaction. Jabnoun and Chaker (2003)

conducted a study with an aim of assessing quality of care in public hospitals in Pakistan. The

study used facility-based cross-sectional design employing use of stratified sampling design to

select 369 respondents from patients seeking services from the public hospitals located in

Lahore, Pakistan. For this purpose, validated questionnaire was on modified using five service

quality dimensions (variables), namely; empathy, tangibles, timeliness, responsiveness and

assurance was used to assess the perceived quality of care. Data analysis using structural

equation modeling technique (SEM) indicate that public hospitals are not making visible efforts

to deliver quality of services to their patients and are not making any visible efforts to meet

patient’s needs and wants. Regression analysis showed that timeliness of service, friendliness of

staff, reliability of services, empathy, physical structures and availability of supplies are

important elements which enhance perception of service quality. Hutchinson et al. (2011) carried

out a study whose purpose was to quantify differences in the quality of family planning (FP)

18
services at public and private providers in three representative sub-Saharan African countries, to

assess how these quality differentials impact upon FP clients' satisfaction, and to suggest how

quality improvements can improve contraceptive continuation rates.

This study was done in three countries: Tanzania, Kenya and Ghana. The study

methodology used multi-stage cluster sampling design to select and study respondents. Indices of

technical, structural and process measures of quality were constructed from Service Provision

Assessments (SPAs) conducted in Tanzania (2006), Kenya (2004) and Ghana (2002) using direct

observation of facility attributes and client-provider interactions. Data analysis involved used of

marginal effects from multivariate regressions controlling for client characteristics and the multi-

stage cluster sample design was used to assess the relative importance of different measures of

structural and process quality at public and private facilities on client satisfaction. The study

variables used included client satisfaction scores, waiting times and availability of supplies.

Study results indicated that client satisfaction is associated with shorter waiting times, methods

and supplies. In addition, client satisfaction was associated with other factors which include

communication, respect and client-provider relationship. According to the study, patient

satisfaction is associated with shorter waiting time while in private facilities satisfaction has been

associated with consultation duration.

In 2011, Nabbuye and Makumbi conducted a study with an aim of identifying factors

associated with general satisfaction among clients attending outpatient clinics in a referral

hospital in Uganda. The study adopted a cross-sectional exit survey of patients and care-givers

on patient satisfaction with services in seven outpatient clinics at Mulago hospital in Uganda.

Quota sampling was used to select 347 patients for the administration of the exit interviews. The

main outcome variable of the survey was mean score of clients' general satisfaction with health-

19
care services while the independent variables included education level, costs, length of waiting

time, client's perceived technical competence of provider, accessibility, convenience and

availability of services especially prescribed drugs.

Tateke et al. (2012) conducted a study in Ethiopia with an aim of establishing

determinants of patient satisfaction with outpatient health services at public and private hospitals

in Addis Ababa, Ethiopia. The study incorporated use of a cross-sectional design to collect data

from a stratified random sample of ART clinics in four regions of Ethiopia. The study examined

how patient satisfaction (outcome variable) 28 was influenced by type of provider, cost of

services, perception of service quality and access to services. The cross-sectional study used data

that was collected using a timemotion study of patient services paired with 665 patient exit

interviews in a stratified random sample of antiretroviral therapy clinics in 21 hospitals and 40

health centers in 2012.

Most patients were satisfied or somewhat satisfied with the services received, but patients

who received services from nurses and health officers were significantly more likely to report

satisfaction than those who received services from doctors. Investments in the health facility

were associated with higher satisfaction, while increasing service costs to patients were

associated with lower satisfaction. Easy access to services was also associated with improved

patient satisfaction. The study showed high levels of patient satisfaction with task shifting. The

evidence shows acceptability of studies which support the inclusion of task shifting as a

mechanism for scaling-up health services to achieve universal health coverage, particularly for

underserved areas facing severe health worker shortages, as a service quality improvement

measure (Aljumah et al., 2014).

20
 Aljumah et al. (2014) conducted a study with an aim of investigating the relationship

between patient treatment satisfaction and adherence to antidepressants, and the role of patient

beliefs toward medication in patient treatment satisfaction. The study employed a facility-based

study design in which systematic sampling was used to select a total of 403 patients attending Al

Amal Psychiatric Hospital in Riyadh, Saudi Arabia. The study assessed how the outcome

variable which was patient satisfaction was associated with unavailability of doctors and nurses,

their negative attitudes and behaviors, lack of drugs, long travelling distances and the waiting

times for treatment are major hindrances to the utilization of services and a cause of decreasing

customer satisfaction in public hospitals. Patient outcomes of care are affected by rapport and

interpersonal quality of practicing health professionals. Medication adherence was assessed

using the eight-item risky Medication Adherence Scale, and treatment satisfaction was assessed

using the Treatment Satisfaction Questionnaire for Medication. Correlation and Chi-square

analysis was used to show existence of associations between variables and predict the outcome

of the relationship respectively. The results indicated that adherence to antidepressants was

associated with treatment satisfaction with the antidepressants, with a direct positive correlation.

Results of the study showed high treatment satisfaction scores among patients with major

depressive disorder, which correlated with adherence and patient beliefs about the necessity of

treatment. This finding revealed that understanding of the role of patient beliefs, and preferences

can help caregivers and other stakeholders to improve patient satisfaction (Harnett et al., 2010)

From the literature review, patient’s satisfaction as a patient's feelings of pleasure or

disappointment as a result of healthcare service delivery is a measure of the image and

performance of hospital or a health center. Waiting time has been a major factor affecting

patients’ satisfaction. Other factors affect patient satisfaction include: Socio-economic factors,

21
Convenience and Availability, Quality of Care, Courtesy, and Physical Environment. Patients

perceived reason for waiting time include: patient flow, operational efficiency; physical design;

emergency of bottlenecks, high workload, patients turn up in batches, lack of efficiency,

logistical problems, queuing problems, and arrival time of patients. In improving healthcare

service delivery, there is the need to improve on the long waiting time that patient spend at

various sections at the OPD of health centers (Raghda, 2015).

Waiting time has been a major factor affecting patients’ satisfaction. Other factors affect

patient satisfaction include: Socio-economic factors, Convenience and Availability, Quality of

Care, Courtesy, and Physical Environment. Patients perceived reason for waiting time include:

patient flow, operational efficiency; physical design; emergency of bottlenecks, high workload,

patients turn up in batches, lack of efficiency, logistical problems, queuing problems, and arrival

time of patients. In improving healthcare service delivery, there is the need to improve on the

long waiting time that patient spend at various sections at the OPD of health centers.

2.6 Improving patient Satisfaction with Effective Appointment System

Improving patient satisfaction has become an increasingly important goal for healthcare

providers in recent years. In addition to keeping your patients happy and healthy, improving your

patient satisfaction scores can also earn your practice a greater incentive payment under the

Hospital Value-Based Purchasing (VBP) Program. (Health Administrative Partners, 2019).

When hospitals focus on improving patient satisfaction and experience, they can enjoy greater

reimbursements that can then be used to further improve the quality of care they provide.

However, the benefits of improving patient satisfaction extend far beyond quality scores and

financial bonuses. Improved patient satisfaction is essential for building a strong patient-provider

relationship and may even have a positive impact on your patients’ health (Health Administrative

22
Partners, 2019). Patient satisfaction begins the first time a patient contacts your practice and

continues until their bill is paid. When determining how to improve patient satisfaction,

physicians and healthcare providers should keep this continuum of care in mind. Begin with your

appointment booking process and then examine each step of the care process to identify areas

where better care can be provided.

The following are the major factor that can improve patient satisfaction in the hospital and this

will be discussed extensively as follows:

2.6.1 Easy Appointment Booking

Improving patient satisfaction begins with creating a simple and convenient appointment

booking process. Establish a booking system which allows patients to make appointments by

whatever method they prefer, whether it is over the phone, via email, online or in person. Make

sure your online appointment scheduling system looks professional and is easy to navigate. Your

website may be the first impression some potential patients have of your practice, so provide

ample resources and valuable tools. Strive to keep your phone lines open throughout the entire

day, including during lunch hours. When answering phone calls, try to be prompt and avoid

keeping your patients on hold longer than necessary.

After a patient has booked their appointment, send them a reminder about a week before with

directions to reach your facility. This allows time for the patient to reschedule if necessary or

contact your office with any questions they may have. If the patient is coming in for a surgery or

more complicated procedure, be sure to provide any necessary instructions about how they

should prepare for their appointment. Remember that a procedure which is routine for you may

23
be confusing and possibly frightening for your patient. Ease their anxiety by providing a clear

description of what they should expect on the day of their appointment.

2.6.2 Fast Appointment Check-in and Shorter Wait Time

When your patient arrives for their scheduled appointment, the front desk staff should greet them

with a friendly face and help them check-in quickly. Patients should be directed to a waiting area

and given an estimated wait time. As much as possible, try to stick to your appointment schedule

and do not keep patients waiting longer than expected. If an emergency arises, be sure to inform

patients of the situation and provide an updated wait time.

Long wait times can be a major source of frustration for your patients and can lead to poor scores

on patient satisfaction surveys. However, often what makes patients unhappy is feeling they have

been waiting a long time rather than the actual wait time. This is good news for hospitals as there

are many measures you can take reduce perceived wait times, even when it is not possible to

reduce actual wait times.

Here are a few ways to reduce patients’ perceived wait time before an appointment:

1. Provide explanations for long waits: Explained waits often feel shorter than unexplained

waits, so keep your patients in the loop if an emergency arises or appointment runs longer than

expected.

2. Create a comfortable waiting area: Invest in comfortable seating and decorations that make

your waiting room more pleasant. When patients feel more relaxed, they will not feel like they

have been waiting as long.

24
3. Reassure patients who appear anxious: If patients appear nervous or uncomfortable, front

desk staff can offer reassurance and support. Wait times can feel very long when a patient is

concerned about their appointment or procedure.

4. Provide entertainment or activities: Give your patients something to keep them occupied,

such as books, magazines or television. Even asking your patient to fill out forms while they wait

can help reduce perceived wait time.

5. Provide valuable service during the appointment: Another way to reduce perceived wait

time is to provide exceptional value when the patient sees the physician. High-quality care will

be well worth the wait.

By taking steps to reduce perceived wait time and give your patients a friendly welcome to your

practice, you start on the right foot for better patient satisfaction.

2.6.3 Positive Interactions with Doctors and Staff

Perhaps the most critical factor influencing patient satisfaction is the quality of patients’

interactions with physicians and staff members. While providing high-quality care may seem

more important than providing good customer service, the reality is many patients cannot

accurately gauge the quality of care they are receiving. This means that even if exceptional care

is provided, patients may still report low satisfaction if their interactions with doctors or staff

were not positive.

Luckily, physicians can easily improve patient satisfaction by following a few simple guidelines

for better customer service and more compassionate care:

2.6.3.1 Improve Communication

25
Good communication begins when a patient contacts you to book their first appointment and

continues throughout their entire relationship with your practice. All members of your staff must

be committed to facilitating caring and respectful interactions with patients at every stage of their

visit. Here are a few tips for improving patient communication with doctors, nurses and staff:

 Be clear and direct: Provide patients with clear directions and instructions during their

visit. While administering care, inform patients about what you are doing throughout the

procedure.

 Answer questions: Provide ample opportunities for patients to ask questions about their

care and offer direct and thorough answers. Take time to make sure your patient

understands their treatment before moving on to the next appointment.

 Initiate interactions: Staff should go out of their way to engage with patients and create

positive interactions by greeting patients promptly when they arrive and pausing to assist

patients who seem lost or confused.

 Stay in character: While providing care, staff and doctors should avoid holding

conversations about their weekend plans or a new television show they like. Stay in

character as a care provider and keep communication centered on the patient.

2.6.3.2 Extend Time Spent with Your Patients

Patients who feel rushed during their appointment are much more likely to be dissatisfied with

their care, especially if they waited a long time. A study of 1,486 ambulatory visits revealed

patients were significantly less satisfied with their visit if they estimated that they spent less time

with their physician than they expected. On the other hand, when patients estimated that they

spent more time with their primary care provider than they had expected, their satisfaction

increased significantly.
26
Longer appointment times may even be able to make up for long waiting times. A study of 2,444

visits showed a correlation between wait time, visit length and provider ratings. When visits were

more than five minutes, provider ratings decreased by just 0.1 points for every 10 minutes of

additional wait time, but when visits were five minutes or less, ratings decreased by 0.3 points

for every 10-minute increase in wait time. By spending more valuable time with patients, you

can improve patient satisfaction and build better patient-physician relationships.

2.6.3.3 Take a Seat and Use Eye Contact

Whenever possible, doctors should sit while talking to patients, especially if they are sharing a

bad diagnosis. A survey showed that patients prefer doctors to sit while delivering bad news and

view doctors as more compassionate if they do so. Sitting to talk to your patients can also

increase their perceived visit time, which can, in turn, increase their visit satisfaction. A study of

234 patients revealed that patients overestimated time spent with physicians by 1.3 minutes on

average when the physician was seated, but underestimated by 0.6 minutes when the physician

remained standing.

Physicians and nurses should also make eye contact with patients as much as possible to show

they are engaged and focused on the patient’s care. Avoid talking to patients while distracted by

charts or while looking at x-rays. Offering eye contact while sharing bad news can also convey

compassion and care.

2.6.3.4 Track Your Progress and Reward Success

When working to improve interactions with patients, be sure to keep your hospital staff

accountable for providing excellent service. Use patient satisfaction surveys to track how happy

27
your patients are with the quality of their interactions with staff and doctors. Acknowledge staff

members who are excelling and address any problems you observe.

Under the Hospital VBP Program, patient experience of care is determined by a patient

satisfaction survey, specifically the Hospital Consumer Assessment of Healthcare Providers and

Systems (HCAHPS) survey. This standardized, national survey covers eight factors of hospital

quality, including the quality of communication with nurses and doctors, how responsive the

hospital staff was and if the patient feels they were treated with courtesy and respect.

Practitioners can use these quality metrics as guidance for creating more positive relationships

between patients, physicians and hospital staff, while also improving their practice’s VBP score.

2.6.4 Convenient and Straightforward Payments

Even if a patient has received excellent care and enjoyed their visit, a complicated or

inconvenient billing process can still lead to dissatisfaction and a poor review of your practice.

Patient frustration can arise from bills that arrive late, bills with charges they did not expect, bills

with errors or an outdated payment process which makes it difficult for them to pay for their

care. If a patient has a question about their bill, but your office cannot provide an answer, this

can also lead to frustration and may make them less likely to pay their bill.

Here are a few ways your practice can improve your payment process to boost patient

satisfaction and optimize your revenue flow:

2.6.4.1 Educate Staff to Answer Billing Questions

When a patient contacts your practice with a question about their bill, someone in your office

should be able to address their concern or connect them quickly to someone who can. Educate

your front office staff to be able to answer patient questions about their charges, payment options

28
and other general billing questions. You may even want to hire or designate a staff member to

serve as a financial advocate who can assist your patients in understanding their charges or serve

as a liaison to your third-party billing service.

2.6.4.2 Strive for Price Transparency

A major source of patient frustration is receiving surprise charges on their medical bills. Patients

may have expected a service to be covered by their insurance provider, or they may simply be

surprised by a cost that was much higher than anticipated. Offering tools that improve price

transparency can help reduce these unpleasant surprises and empower patients to make educated

decisions about their care.

Price transparency tools allow patients to get an idea of how much a procedure or treatment will

cost before their visit. Patients should be able to access these resources on your website so they

can better prepare for their medical expenses. Effective price transparency tools can also allow

patients to compare different treatment options that offer quality care at different price points.

Using these tools alongside payment plans can help patients choose quality care affordable for

them.

2.6.4.3 Offer Payment Plans

Payment plans can significantly improve your patients’ satisfaction with your billing process by

breaking expensive bills into manageable increments. With patients paying more and more out-

of-pocket for their medical bills, payment plans have become a standard and expected option.

Payment plans also provide peace of mind for patients and encourage them to receive the care

they need regardless of the cost. This can lead to more positive health outcomes as well as

greater patient satisfaction with their quality of care.

29
2.6.4.4 Streamline and Simplify the Billing Process

When you make it easy for your patients to pay their bill, they are more likely to pay on time,

pay in full and be content with your services. Allow patients to pay their bills online so they can

complete payments more quickly, which improves cash flow for your practice. Online billing

services also allow you to send bills more efficiently and track payments more accurately.

Another essential aspect of offering a streamlined billing process is to ensure your bills are

correct. Errors on hospital bills can be frustrating for patients who then need to jump through

hoops to try to correct those errors. This stalls the payment process which inconveniences the

patient and slows your practice’s revenue flow. Coding errors can also lead to compliance issues,

causing even greater problems for your practice.

CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Introduction

Research methodology is a process through which the research was conducted involving

the procedures adopted in the course of this research work. This chapter focuses on the research

methodology adopted in the conduct of the study. This chapter explain the following

subheadings:

 Research Design

 Population of the Study

30
  Sample Size and Sample Techniques

 Data Collection Instrument

 Validity and Reliability of the Instrument

 Data collection Procedure

 Method of Data Analysis.

3.2 Research Design.

Research design refers to the overall strategy choosen to integrate the different

components of the study in a coherent and logical way, thereby, ensuring you will effectively

address the research problem.

The research method adopted for this study was a descriptive survey research. It was

designed to examine the effective management of appointment system and its effect on

quality of care in University of Medical Sciences Teaching hospital, Ondo town, Ondo State.

3.3 Population of the Study

The research work was conducted at University of Medical Sciences Teaching Hospital,

Ondo, Ondo State. The study population consists 785 targeted health workers working in

University of Medical Sciences Teaching Hospital, Ondo, Ondo State. The table below shows

the breakdown of the targeted health workers in the study area.

PROFESSION POPULATION
1 DOCTORS 125
2 NURSES 387
3 HIM 123
4 MLS 103
5 PHARMACY 47

31
 TOTAL 785

3.4 Sample Size and Sampling Techniques

The researcher used Taro Yamane’s formula to determine the sample size from the population.

Taro Yamane’s formula is given as;

n = N

1+N (e)2

Where N = Population of study (785)

n = Sample size (?)

e = Level of significance at 7% (0.07)

1 = Constant

n = 785 = 785 = 785

1 + 785 (0.07)2 1+785 x (0.0049) 1+ 785 x 0.0049

n = 785 = 157
5
n = 157

Based on the calculations, 157 targeted health workers were selected from the study area.

Probability sampling method was employed with the use of stratified random

sampling technique. It is a method of sampling that involves dividing a population into smaller

groups–called strata. The groups or strata are organized based on the shared characteristics or

attributes of the members in the group. 

3.5 Data Collection Instrument

32
 The instrument used for this study was a well-structured questionnaire. The data were

obtained through questionnaire. The questionnaire was structured to consist mostly of closed

ended type of questions. The questionnaire is divided into sections, which are:

Section A: examine the demographic characteristics of the respondents

Section B: examined the impact of effective appointment system on quality health care delivery

Section C: identified the challenges affecting the effective management of appointment system

Section D: explored suggestion on the ways of ensuring effective appointment system

3.6 Reliability and Validity of Instruments

The questionnaire prepared to explore information for the study was validated by the

supervisor after a critical assessment and correction which helped to greatly modify the

questionnaire for the purpose of achieving the set objectives of the research. A trial test was also

conducted for the validation of the instrument.

3.7 Data Collection Procedure

A letter of introduction was given to the researcher for formal introduction to the target

population before administering the questionnaire using self-administered method. A verbal

introduction was done at the point of administering the questionnaire. An opening statement was

written at the beginning of the questionnaire; the subjects were briefed about the purpose of the

study and they were guided on how to fill the questionnaire correctly. The respondents were

assured about confidentiality of their information

3.8 Method of Data Analysis

33
 The data from the questionnaire was edited to detect and correct possible errors and

omissions that were likely to occur and to ensure consistency across respondents. Data was

presented in frequency table and simple percentage.

CHAPTER FOUR

DATA ANALYSIS, RESULT AND DISCUSSION OF FINDINGS

4.0. Introduction

34
 This chapter involves the analysis and interpretation of data collected from the field of

study and presentation of the results. A total of 157 questionnaires were designed and

administered. Analysis was made based on the total number of 130 questionnaires retrieved from

the respondents.

Section 1: Demographic Information

Table 4.1: Demographic Characteristics of the Respondents

Variable Response Options Frequency (N) Percentage (%)

Age 18 – 25 64 54.5%

26 – 30 49 30.3%

35 – 40 14 13.2%

41 and above 3 5%

Total 130 100

Sex Male 50 39.3%

Female 80 60.7%

Total 130 100

Ethnicity Christianity 100 73.1%

Muslim 30 26.9%

Total 130 100

Profession Doctors 15 13.6%

Nurses 35 23.5%

HIM 40 35%

MLS 29 19.4%

35
 Pharmacist 11 8.5%

Total 130 100

Qualification OND/PD 45 34.3%

HND/BSc 72 54.5%

Masters 10 6.3%

PhD 3 5%

Total 130 100

Source: Field survey, 2023.

The table above shows the distribution of responses on demographic characteristics of the

respondents. Out of the 130 respondents, 64 (54.5%) are between the age of 18 – 25, 49 (30.3%)

are of 26 – 30 years, 14 (13.2%) are aged 35-40, while 3(5%) are of age 41 and above.

50 (39.3%) of the respondents are males, while 80 (60.7%) are females.

Regarding their ethnicity, 100 (73.1%) of the respondents are Christians, while 30

(26.9%) are Muslims.

In regards to their profession, 15 (13.6%) of the respondents are Doctors, 35(23.5%) are

Nurses, 40(35%) are HIM, 29 (19.4%) of the respondents are Med Lab Scientist, while 11(8.5%)

of the respondents are Pharmacist.

On the basis of qualification, majority of the respondents were HND/BSc holders with 75

(54.5%), 45 (34.3%) have OND/PD qualifications, 10 (6.3%) of the respondents have a Master's

degree, while 3(5%) are PhD holders.

36
4.1.2. Impact of Effective Appointment System on Quality Health Care Delivery

Table 4.2: Impact of Effective Appointment System on Quality Health Care Delivery

Effectiveness of Appointment System on Strongly Agree Disagree Strongly

Quality Health Care Delivery Agree Disagree

Effective appointment system reduces patient 80 25 15 10

waiting time. (66.8%) (16.6% (10.0%) (6.6%)

Effective appointment system enhances 25 100 5 0

positive interactions between the patient and (23.9%) (60.0% (16.1%) (0%)

health professionals. )

Effective appointment system enhances 69 32 15 14

continuity of care. (39.9%) (21.3% (19.6%) (19.3%)

Good appointment system decreases medical 100 30 0 0

mistakes and also decreases the number of (70.9%) (29.1% (0.0%) (0%)

displeased patients. )

Good appointment system increases health 25 80 15 10

workers’ efficiency (23%) (55%) (13.2%) (8.8%)

Field Survey, 2023

Table 4.2 above assessed the effectiveness of appointment system on quality health care

delivery, the findings showed that, 80(66.8%) of the respondent strongly agreed that effective

appointment system reduces patient waiting time, 25 (16.6%) of the respondent also agreed to

37
the fact that effective appointment system reduces patient waiting time, 15(10.0%) disagreed,

while 10 (6.6%) strongly disagreed. Respondents were asked if effective appointment system

enhances positive interactions between patient and health professionals, 25 (23.9%) strongly

agreed, majority 100(60.0%) agreed, 5(16.1%) disagreed while 0(0%) strongly disagreed.

69(39.9%) strongly agreed that effective appointment system enhances continuity of health care,

32(20.3%) agreed, 15(19.6%) disagreed while 15(20.3%) strongly disagreed with the claim.

Respondents were further asked if the use of good appointment system decreases medical

mistakes and also decreases the number of displeased patients, majority 100(70.9%) strongly

agreed, 30(29.1%) agreed, 0(0%) strongly disagreed while (0%) strongly disagreed. Lastly,

respondents were asked if good appointment system increases health workers’ efficiency, 25

(23%) strongly agreed, 80 (55%), 15 (13.2%) disagreed, while 10 (8.8%) strongly disagreed.

4.1.3. Challenges Affecting the Effective Management of Appointment System

Table 4.3: Challenges Affecting the Effective Management of Appointment System

Challenges Affecting the Effective Strongly Agree Disagree Strongly

Management of Appointment System Agree Disagree

Poor administration affects the proper 90 20 12 8

management of appointment system. (36.2%) (23.3%) (18.3%) (17.9%)

Shortage of staff leads to ineffective 92 29 8 0

appointment management system. (69.1) (21.9%) (10.0) (0%)

Inadequate filling spaces affects the proper 20 50 55 5

management of appointment system. (24.7%) (30.6%) (36.4%) (8.3%)

Lack of proper communication leads to 25 90 10 5

38
 ineffective appointment management system. (23.9%) (60.0%) (12.1%) (4%)

Source: Field Survey, 2023

Table 4.3 above shows that 90(36.2%) of the respondents strongly agreed that poor

administration often affects the proper management of appointment system 20(23.3%) also

agreed to the fact poor administration is indeed a major challenge of appointment management

system, 12(18.3) disagree, while 8(17.9%) strongly disagree. Majority of the respondents

92(69.1%) strongly agreed that shortage of staff leads to ineffective appointment management

system, 29(21.9) agreed, 8(10.0) disagreed and 0(0%) strongly disagreed. Respondents were also

asked if inadequate filling spaces affects the proper management of appointment system,

20(24/7%) strongly agreed, 50(30.6%) agreed, 55(36.4%) disagreed, while 5(8.3%) strongly

disagreed. Respondents were further asked if lack of proper communication leads to ineffective

appointment management system 25(23.9%) agreed, 90(60.0) strongly agreed, 10(12.1%)

disagreed while 5(4%) strongly disagreed.

4.1.4. Ways of Ensuring Effective Appointment System

Table 4.4: Ways of Ensuring Effective Appointment System

Ways of Ensuring Effective Appointment Strongly Agree Disagree Strongly

System Agree Disagree

Skilled professionals are necessary to ensure 30 85 15 0

effective appointment system. (29.4%) (57.6% (13.0%) (0%)

Good administration is essential for ensuring 100 10 20 0

39
 effective appointment system. (80.2%) (4%) (15.8%) (0%)

Proper follow-up is necessary to ensure 115 5 3 7

effective management of appointment system. (90%) (3.0%) (2.0%) (5.0%)

Provision of necessary appointment 45 75 20 0

management tools can enhance effective (20.5%) (59.7% (19.8%) (0%)

appointment system. )

Source: Field Survey, 2023

Table 4.4 above shows that 30(29.4%) of the respondents strongly agreed that skilled

professionals are necessary to ensure effective appointment system, 85(57.6%) also agreed to the

fact that skilled professionals are very much necessary in order to ensure effective appointment,

15(13.0) disagree, while 0(0% strongly disagree. Majority of the respondents 100(80.2%)

strongly agreed that good administration is essential for ensuring effective appointment system,

10(4%) agreed, 20(15.8%) disagreed and 0(0%) strongly disagreed. Respondents were asked if

proper follow-up is necessary to ensure effective management of appointment system, 115(90%)

strongly agreed, 5(3.0%) agreed, 3(2.0%) disagreed, while 7(5.0%) strongly disagreed.

Respondents were further asked if provision of necessary appointment tools can enhance

effective appointment system 45(20.5%) strongly agreed 75(59.7) agreed, 20(19.8%) disagreed

while 0(0%) strongly disagreed.

4.5. Discussion of Findings

The results of findings on the demographical information of respondents shows that, the

age range of the respondents were majorly age 18 – 25 with 64(54,5%), 26 – 30 years were

40
49(30.3%), 35 – 40 (13.2%), while 41 and above were 3(5%). This shows that the respondents

are of young age. On the gender of the respondents majority 60.7% of the respondents are

female, with 39.3% being male. Furthermore, majority of the Respondents are Christians with

73.1% while 26.9% were found to be Muslims. Additionally, a significant number of the

respondents have HND/B.Sc. degrees, which is expected given that the role of Health

Information professionals requires a certain level of educational qualification. Furthermore, the

distribution of prfoession among the respondents is also representative with Doctors having

13.6%, Nurses 23.5% Health Information Professionals being the majority with 35%, Medical

Laboratory Scientist with 19.4%, and lastly Pharmacist with 8.5%.

The findings of the study on the impact of effective appointment system on quality health

care delivery indicate that majority of the respondents believe effective appointment system

reduces waiting time, which is consistent with the findings of other studies that have examined

the impact of effective appointment system (e.g., Liu et al, 2017) in his study stated that effective

appointment system helps in minimizing patient times, thereby resulting in improved patient

satisfaction and experience. Furthermore, the majority of the respondents attest that effective

appointment system enhances positive interactions between patient and health professionals,

which is also consistent with the findings of previous studies. For instance, a study by Kaur &

Ganesh, (2018) found that the appointment system effectively manages patient appointments

thereby ensures that patients can easily access healthcare services in timely manner. The fact that

70% of the respondents strongly believed that good appointment system decreases medical

mistakes and its numbers of displeased patients is also consistent with the findings of other

studies. Razaee et al (2019) found that good appointment system facilitates efficient workflow

and patients flow within healthcare settings. It further suggest that by properly managing

41
appointment schedules, healthcare providers can streamline their operations, reduce bottlenecks,

and improve overall efficiency of care delivery.

The findings on the challenges affecting the effective management of appointment

system, it reveals that a large majority of respondents believed that poor administration affects

the proper management of appointment system. Specifically, 69.1% of respondents believe that

shortage of staff leads contributes to the ineffectiveness of appointment management system.

36.4% agreed that inadequate filling spaces affects proper management of appointment system,

and 60% believed that lack of proper communication leads to ineffective appointment system.

These findings are in line with previous studies that have highlighted the challenges affecting the

effective management of appointment system. According to Meijer et al., (2020) he stated that

the use of outdated or inadequate technology and infrastructure can impede the effective

management of appointment systems. This includes issues such as, unreliable scheduling

software, poor communication tools, or insufficient data management systems. Therefore

recommends the importance of robust technology infrastructure to support efficient appointment

scheduling, improve communication, and enhance the overall management of healthcare

services.

The findings on ways of ensuring effective appointment systems, indicate that it is

important to implement efficient appointment scheduling practices as it will help optimize the

use of resources and improve patient access. This is consistent with the views of other

researchers who have highlighted ways of ensuring appointment system to be effective (Assem

et al., 2020). The high level of agreement among respondents suggests that there is a shared

understanding of the role of Health Information professionals in this regard. Majority of the

respondents agreed that skilled professionals are necessary to ensure effective appointment. In

42
addition, there is high level of agreement among respondents that good administration is

essential for ensuring effective appointment system. Furthermore, majority of the respondent

believed that proper follow-up is necessary to ensure effective management of appointment

system. This corroborates the study of Anzola et al (2019) who opined that implementing

reminder system, such as automated phone calls, text messages or email notification, can help

reduce no-shows and improve appointment adherence. Lastly majority of the respondent agreed

that provision of necessary appointment management tools can enhance effective management

systems.

43
 CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATION

5.1 Introduction

This chapter present the summary, conclusion and recommendations made on the

effective management of appointment system and its effect on quality of care in Univristy of

Medical Sciences Teaching Hospital, Ondo State.

5.2. Summary

The descriptive survey research design was adopted for the study, the population of the

study involved is one hundred and thirty (130) Health professionals that comprises of Doctors,

Nurses, Health Information professionals, Medical Laboratory Scientist, and Pharmacist.

Complete enumeration was used in place of sample size for the study. Self-structured

questionnaire, validation was used for data collection in the study area as research instrument,

the questionnaire was structured to consist mostly of closed ended type of questions. Frequency

tables and simple percentages were used for data presentation.

The study found that one of the key benefits of an effective appointment system is that it

reduces patient wait times, which can have significant impact on patient satisfaction. By

managing the scheduling process, healthcare providers can ensure that patient are seen promptly

and that their time is respected.

44
 The study also found that effective appointment system helps improve patient outcomes,

by ensuring that patients receive care as at when due, health professionals can thereby prevent

conditions from worsening, reduce hospitalizations, and improve overall health populations.

Also, the study revealed that appointment system facilitates efficient workflow and

patients flow within healthcare settings. It further suggest that by properly managing

appointment schedules, healthcare providers can streamline their operations, reduce bottlenecks,

and improve overall efficiency of care delivery.

Lastly, the results of this study showed that poor administration affects the proper

management of appointment system. Specifically, 69.1% of respondents believe that shortage of

staff leads contributes to the ineffectiveness of appointment management system. Therefore

effective management of appointment system is essential for providing high quality healthcare

services.

5.3. Conclusion

The usage of effective management system is vital in UNIMEDTH, with a high

proportion of respondents rating it as effective.

Effective management system is beneficial to the hospital, as it implements an advanced

appointment scheduling system. By investing in user-friendly software that can handle complex

scheduling requirements, UNIMEDTH can streamline the appointment process and minimize

errors as this will result in improved efficiency and reduced wait times for patients.

However, barriers and challenges such as patient wait times, shortages of staffs, poor

administration can hinder the effectiveness of appointment system. Therefore, developing

efficient templates that consider the needs of different providers and patients, UNIMEDTH can

45
maximize resource utilization and minimize patient wait times, as these will ensure appointments

are scheduled appropriately, taking into account factors such as duration, availability, and

specific requirements.

Lastly, Healthcare organization play an important role in delivering high quality care and

improve patient outcomes. By implementing efficient scheduling practices and utilizing modern

technology, healthcare providers can enhance the overall patient experience and optimize

utilization of appointment systems.

5.4. Recommendation

Based on the findings of the study, the following are hereby recommended:

1. To address the challenge of implementing an advanced appointment scheduling system,

investing in a robust user-friendly appointment scheduling software can help in handling

complex scheduling requirements, such as multiple providers, different appointment

types, and varying durations.

2. To address the issue of appointment, healthcare providers should be encouraged to book

appointment online through a secure portal or mobile app.

3. Hospitals should prioritize the establishment of reminder system to reduce the number of

missed appointments. Sending reminders via email, text messages, or phone calls to

patients, ensures they are aware of their upcoming appointments. This can significantly

reduce no-show rates and improve appointment adherence.

4. Health Information Professionals should be giving training, they should be adequately

trained in appointment management procedures, including the effective use of scheduling

software communication with patients.

46
5. Regular appointment data should be enabled to review appointment data in order to

identify trends, bottlenecks, and areas for improvement.

6. Further research is needed to explore the effectiveness of appointment system on

healthcare workers, as well as to identify best practices for its implementation and use in

different healthcare settings.

47
 HEALTH INFORMATION MANAGEMENT DEPARTMENT
ONDO STATE COLLEGE OF HEALTH TECHNOLOGY AKURE, ONDO STATE
RESEARCH QUESTIONNAIRE
Dear Respondents,
I am a final year student of the above-named institution. I am collecting information on

my research project titled “Effective management of appointment system and its effect on

quality of care in University of Medical Sciences Teaching hospital, Ondo State.”

The questionnaire is meant for academic purpose only, hence, your response shall be

treated with uttermost confidentiality. Please, answer the questions as honest as you can.

Thank you
Instruction: Please, tick (√) the correct options as it applies.

Section A: Demographic Data

1. Age: (a) 18 – 23 (b) 24 – 28 (c) 29 – 33 (d) 34 – 39 (e) 40 – 45 (f) 46 above
2. Sex: (a) Male (b) Female
3. Ethnicity: (a) Yoruba (b) Igbo (c) Hausa (d) Others
4. Religion: (a) Christianity (b) Islamic
5. Profession ______________
6. Qualification: (a) OND/PD (b) HND/BSc (c) Masters (d) PhD
SECTION C: Impact of Effective Appointment System on Quality Health Care Delivery
Question Strongly Agre Disagree Strongly
Agree e Disagree
7. Effective appointment system reduces patient waiting
time.
8. Effective appointment system enhances positive
interactions between the patient and health professionals.
9. Effective appointment system enhances continuity of
care.

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 10. Good appointment system decreases medical mistakes
and also decreases the number of displeased patients.
11. Good appointment system increases health workers'
efficiency.

Section C: Challenges Affecting the Effective Management of Appointment System

Statement Strongly Agree Disagre Strongly

Agree e Disagree
12. Poor administration affects the proper
management of appointment system.
13. Shortage of staff leads to ineffective
appointment management system.
14. Inadequate filling spaces affects the proper
management of appointment system.
15. Lack of proper communication leads to
ineffective appointment management system.

Section D: Ways of ensuring Effective Appointment System

Questions Strongly Agre Disagree Strongly
Agree e Disagree
16. Skilled professionals are necessary to ensure
effective appointment system.
17. Good administration is essential for ensuring
effective appointment system.
18. Proper follow-up is necessary to ensure
effective management of appointment system.
19. Provision of necessary appointment
management tools can enhance effective
appointment system.

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