An Article o n

“A STUDY ON PATIENT SATISFACTION IN ICU OF A

TERTIARY CARE HOSPITAL IN DELHI”

Submitted by

HANUPRIYA NANGIA

PRN: 18040141044

Under the guidance of

Dr. Shrikrishna Dhale

Submitted to
Symbiosis Institute of Health Sciences,
(Symbiosis International University)
in partial fulfillment of the requirements for the award of the
Degree of Master of Business Administration
2018-2020

1
A study on patient satisfaction in the ICU of a tertiary care
hospital in Delhi
By Hanupriya Nangia

Abstract

Introduction: Patient satisfaction is an important concern for health care providers, patients themselves
(consumers) and other third-party players in the medical care industry. It is a constant endeavor on the part of
health care providers to ensure that demand is achieved. This is thus necessary for them to know the true state
of customer satisfaction. In do so, health care providers are conducting work aimed at detecting the emotions of
patients and seeking ways to help serve them. However, it is a big challenge for health care providers / researchers
to define the right tool and methods for the reliable measurement of patient satisfaction levels.

Objective: To evaluate the level of patient/relatives’ satisfaction in ICUs at a tertiary care hospital in Delhi and
determine the Net Promoter Score (NPS) for the hospital.

Method: It is a descriptive cross-sectional study, aimed at measuring the level of satisfaction among the patients
in ICU of tertiary care hospital in Delhi. Simple random sampling was used for the purpose of data collection.
The sample size of the study is 240 respondents. The method adopted for data collection was semi-structured
interviews.

Results and discussion: A total of 240 respondents were interviewed and their level of patient satisfaction was
analyzed by asking both quantitative as well as qualitative questions. The results were categorized into 5
parameters. The Net Promoter Score was also determined.

Introduction:-

Knowledge of patient satisfaction and its determinants is essential in order to improve patient
care. So far few researchers in intensive care medicine have focused on this subject. This
research aimed to assess the patient satisfaction level and to determine its contributing factors
in patients with ICU.

Patient satisfaction is an important concern for health care providers, patients themselves
(consumers) and other third-party players in the medical care industry. It is a constant
endeavor on the part of health care providers to ensure that demand is achieved. This is thus
necessary for them to know the true state of customer satisfaction. In do so, health care
providers are conducting work aimed at detecting the emotions of patients and seeking ways
to help serve them. However, it is a big challenge for health care providers /researchers to
define the right tool and methods for the reliable measurement of patient satisfaction levels.
This paper aims to explain what influences patient satisfaction and the method(s) adopted by

2
health care providers / researchers to unveil variables that are responsible for customer
satisfaction. The perspective of families inside the Intensive Care Unit (ICU) is of
considerable significance when determining the quality of care.

Conceptual Discussion:-

Patient satisfaction in the hospital depends on the quality and operation of the medical care
system. The operation of the medical care system is dependent on a number of psychological,
technological and physical dimensions. The framework of the medical care system is
influenced by the policy of the government and the form of government that prevails in the
region, while the operation depends primarily on those who administer the system. In a
welfare state like India, where the government assumes the burden of providing free medical
care to those who cannot afford it, free consultation, medications, and treatment facilities must
be given. Many receiving these services may be pleased with whatever services they receive
in hospitals, because they are cost-free. But once they know it's their right to receive these
services and it's the government's responsibility to look after their well-being, when they can't
afford it's uncontrollable to rise in their level of aspirations.

The concept of patient satisfaction

Although there are many studies conducted at the level of patient satisfaction within the
organization, the feedback system used by the organization and the services provided by the
organization is unique and different from each one. New patients are more informed and
trained and have much more knowledge and demands from the healthcare system.

The new health care system in the world is evolving from a solely provider-based system to a
receiver-based system. The recipient-based system is a customer feedback system in an
enterprise where patient satisfaction is perceived to be a key component of the quality
assurance in the hospital. It is important to consider the views of patients who are service
providers in a simple and inexpensive manner.

Importance of Patient Satisfaction:

Quality has been recognized as important in recent years and the views of patients are
perceived to be an essential component of quality assessment and development. It has also
helped to assess the quality of the company. It is important to measure the level of patient
satisfaction both as an outcome and as an indicator. There are many benefits associated with

3
assessing patient satisfaction, including that patient satisfaction will support treatment and
patients with less administrative work. The key is to understand and acknowledge the needs
of patients by their comments. The research has shown that practices with high patient
satisfaction are typically effective, have a better retention rate and generate more revenue.
Patient satisfaction helps to identify the weaknesses of the company and fix bottlenecks and
helps to improve their programs. This has also shown that pleased patients are more likely to
recommend the hospital to their friends and families if they are satisfied with the services
provided. Patient response information can contribute to patient engagement in health
services, improving the quality of health services, reviewing and meeting staff of healthcare
organizations, management and development, improving accountability and ensuring
compliance with standards. One of the management systems is the patient case management
system, which gathers and analyzes the complaint data.

Various approaches towards taking a Patient Feedback:

• Study in the United Kingdom, which focuses on improving the quality of services
carried out by polling as their main vehicle for gathering input from patients. The
survey may be used by companies to enhance possible resources. These surveys may
not only be used for that particular organization, but may also be used for other
organizations to understand the needs of the patient and to improve the quality of
service of the organization.
• In the modern era of rising technologies, input mechanisms are used in real time.
Touch-screen kiosks or hand-held devices are also used by organizations to respond
to patients. Few hospitals use tablets (iPads) as a way to get feedback from patients
with closed-ended questions.
• The questionnaires also play a key role in assessing the level of satisfaction of the
individual. Patients can use questionnaires to describe their low or high level of
satisfaction. Such questionnaires may be in the form of open-ended or closed-ended
questions and are given to patients on their way out of the hospital.
• One-on - one workshops are also held in a few organizations to understand the needs
of patients, and recommendations are accepted.

Not only can this benefit the agency, but these opinions of consumers can be conveyed to
healthcare providers in both the private and public sectors to identify areas that need change.

4
Net Promoter Score (NPS)

Net Promoter or Net Promoter Score (NPS) is a marketing metric that can be used to measure
the quality of a company's customer relationship. This is an alternative to standard customer
service measurement which is claimed to be associated with sales growth. NPS has been
broadly adopted with more than two-thirds of Fortune 1000 firms embracing metrics. The
purpose of the instrument is to calculate the trust between the supplier and the customer. The
manufacturer may be a corporation, an employer or some other individual. The supplier is the
party that is answering questions about the NPS survey. The client, contractor or respondent
of the NPS survey shall be the consumer. The metric was developed by Fred Reichheld, Bain
& Company and Satmetrix. In his 2003 Harvard Business Review post, "One Number You
Need to Rise," Reichheld was released. The Net Promoter Rating is calculated on the basis of
responses to a single question: how is it likely that you can recommend our company / product
/ service to a friend or colleague?

Those that answer with a score of 9 or 10 are labeled Promoters and are deemed likely or
show value-creating habits such as buying more, keeping customers longer, and having more
favorable connections to other prospective buyers. Those that answer with a score of 0 to 6
are Detractors. Responses 7 and 8 are called Passives, and their actions falls between
Proponents and Detractors. The Net Promoter Value is determined by subtracting the
percentage of clients who are Detractors from the percentage of clients who are Promoters.
For the intent of measuring the Net Promoter Ranking, the liabilities are counted against the
overall number of respondents, there by the ratio of detractors and promoters and bringing the
net score to 0.

Proponents of Net Promoter's analysis claim that the ranking should be used to motivate an
organization to focus more on producing premium goods and services. Many companies,
including Australia Post, Siemens, E.ON, Panasonic, GE, Apple Stores, American Express,
and Intuit, have followed the Net Promoter approach. This has also acted as a method of
assessing quality with web apps, as well as social media products.

5
Aims and objectives:-

Aim: To evaluate the level of patient/relatives’ satisfaction in ICUs of a tertiary care hospital
in Delhi and determine the Net Promoter Score (NPS) for the hospital.

Objectives:

• To study the level of patient satisfaction in ICU of a tertiary care hospital

• To study the different factors affecting patient satisfaction.
• To determine the Net Promoter Score (NPS) for the hospital.

Materials and Methodology:-

Methodology is a formal, analytical review of the processes used in the field of study. This
consists of a theoretical analysis of the body of approaches and concepts identified with the
information group. Usually, it includes terms such as theory, analytical model, process and
quantitative or qualitative techniques.

• Study Area: Intensive Care Units at Dr B.L. Kapur Memorial Hospital, Delhi
• Study Period: 20th May,2019 - 20th June,2019
• Study Type: Descriptive Cross-Sectional Study
• Study Sample Size: 240 samples
• Sampling Type: Simple Random Sampling
• Method of Data Collection: Semi-Structured Interviews
• Tool Used: Checklist
• Type of Data Collection: Mixed ( Both qualitative and quantitative data was
collected)

6
Results and Findings:-

1. Count of Satisfied and Unsatisfied Patients

Graph No. 1

Count of SATISFIED (S) OR

UNSATISFIED (U) PATIENTS
S - 198

S
U

U - 42

Interpretation:

The above graph depicts: 82.5% of the patients/relatives were satisfied with all the services
of the hospital, while 17.5% were unsatisfied.
ICU NAME No. OF RESPONDENTS
CTVS ICU 48
ICCU – 1 21
ICCU – 2 27
MICU 72
NSICU 38
SICU 34
Total 240

2. Count of problem area of unsatisfied patients

Graph No. 2

7
 PROBLEM AREA of UNSATISFIED PATIENTS
NURSE - 5

MISCELLANEOUS, 6

FOOD AND BEVERAGES, 11

DOCTOR, 10

DIETICIAN, 10

Interpretation:

The above graph depicts: Out of 240 respondents, 42 were unsatisfied. Food and Beverage
department had highest number of complaints, whereas, the complaints regarding nursing
services were the least.

3. Average resolving time (ART) for each problem area

Graph No. 3

AVERAGE RESOLVING TIME FOR EACH PROBLEM

AREA

ART-
ART-DOCTORS ART-NURSES ART- DIETICIAN ART-F&B MISCELLANEOU
S
Series1 7.5 6 11 7.73 10.83

Interpretation:

8
The above graph depicts: Turn-Around Time (TAT) for resolving the issues was minimum
for issues related to nurses (6 minutes) and maximum for issues related to dietician (11
minutes).

4. Count of Satisfied/unsatisfied patients in CTVS ICU.

Graph No. 4

CTVS ICU

SATISFIED UNSATISFIED
42 6

Interpretation:

The above graph depicts: Out of 48 respondents, 42 (87.5%) respondents were satisfied with
the overall services provided to the patients in CTVS ICU, while 6 (12.5%) respondents were
not satisfied.

5. Count of Satisfied/unsatisfied patients in ICCU-1.

Graph No. 5

9
 ICCU-1

SATISFIED UNSATISFIED
Series1 14 7

Interpretation:

The above graph depicts: Out of 21 respondents, 14 (67%) respondents were satisfied with
the overall services provided to the patients in ICCU-1, while 7 (33%) respondents were not
satisfied.

6. Count of Satisfied/unsatisfied patients in ICCU-2.

Graph No. 6

ICCU-2

SATISFIED UNSATISFIED
Series1 20 7

Interpretation:

The above graph depicts: Out of 27 respondents, 20 (74%) respondents were satisfied with
the overall services provided to the patients in ICCU-2, while 7 (26%) respondents were not
satisfied.

10
7. Count of Satisfied/unsatisfied patients in MICU.

Graph No. 7

MICU

SATISFIED UNSATISFIED
Series1 62 10

Interpretation:

The above graph depicts: Out of 72 respondents, 62 (86%) respondents were satisfied with
the overall services provided to the patients in MICU, while 10 (14%) respondents were not
satisfied.

8. Count of Satisfied/unsatisfied patients in NSICU.

Graph No. 8

11
 NSICU

SATISFIED UNSATISFIED
Series1 34 4

Interpretation:

The above graph depicts: Out of 38 respondents, 34 (89%) respondents were satisfied with
the overall services provided to the patients in NSICU, while 4 (11%) respondents were not
satisfied.

9. Count of Satisfied/unsatisfied patients in SICU?

Graph No. 9

SICU

SATISFIED UNSATISFIED
Series1 26 8

Interpretation:

The above graph depicts: Out of 34 respondents, 26 (76%) respondents were satisfied with
the overall services provided to the patients in SICU, while 8 (24%) respondents were not
satisfied.

12
NSICU has highest satisfaction rate (87.5%), whereas ICCU-1 has lowest satisfaction
rate (67%).

10. How likely are you to recommend this hospital to your family, friends and
colleagues?

Graph No. 10

PASSIVES - 9% DETRACTORS -
1%

PROMOTERS
PASSIVES
DETRACTORS

PROMOTERS -
90%

Interpretation:-

The above pie chart depicts: 90% of the patients are promoters, whereas 9% are passives
and only 1% are detractors.

(Promoters give a score of 9/10, passives give a score of 7/8 and detractors give a score of 0
to 6)

Findings and Discussion:-

• Even the patients who were unsatisfied, had given a score of 9 when asked about
recommending this hospital to family, friends and colleagues. (17, i.e. 40% patients
gave a score of 9 even though they were unsatisfied with a few services).

13
 • The doctors and consultants did not meet the relatives of the patients at least once a
day, thus the relatives complained about doctors.
• The temperature of the food was not checked before serving it to the patient, thus
patients complained about cold food being served.
• The dietician did not ask the patients about their food choices, thus some patients did
not eat their meals as it was not according to their choice.

Recommendations:-

• The temperature of the food should be checked before serving it to the patient.
• The doctors and consultants should meet the relatives of the patients at least once a
day without fail.
• The dietician should ask the patient about his food choices.
• Patients/relatives who gave a score of 7/8, their problems/issues should be resolved
and rectified as they can also become our promoters.

Conclusion:-

Both family members and patients were equally or rather satisfied with patient treatment,
social support, expertise and decision-making, but places with scope for growth were also
found. Even though few patients were unsatisfied with some of the areas, still they gave a
score of 9/10 when asked about recommending the hospital to others. Thus, the issues faced
by them were not that major and were rectified then and there. This lead to improved quality
care given to the patients.

References:-

[1]. Codman EA. A Study of hospital efficiency: the first five years. Boston Thomas Todd
Co, 1916

14
[2]. Doyle JC. Unnecessary Ovariectomies. J Am Med Assoc 1952;148(13). Hysterectomies.
J Am Med Assoc 1953;151(5):360-5.
[3]. Hendrickson G, Kovner CT, Knickman JR, Finkler SA. Implementation of a variety of
computerized bedside nursing information systems in 17 New Jersey hospitals. Comput Nurs
1995;13(3):96-102.
[4]. Blegen MA, Reiter RC, Goode CJ, Murphy RR. Outcomes of hospital-based managed
care: a multivariate analysis of cost and quality. Obstet Gynecol 1995;86(5): 809-14. [5]. Cock
DJ. Continuous Quality Study, McMaster University, Faculty of Health Sciences, Ontario.
[6]. Houston CS, Pasanen WE. Patients’ perceptions of hospital care. Hospitals
1972;46(8):70-4.
[7]. Jain VC, Prasad BG. A study of hospitalised patients, attitude towards ward facilities and
ward services in the general medical wards of a teaching hospital. Ind Med Gazette, Calcutta
1969;9(8):3-16.
[8]. Bhatia AK. Patient perception of needs and problems in the Hospital setup. Int J Health
Educ 1971;14: 145-50.
[9]. Timmappaya et al. Patient satisfaction and Ward Social System, NIHFW Research
Monograph, New Delhi; 1971.
[10]. Chopra V. Participant Observations in Patient’s Role in a Small Hospital, NIHFW
Research Project Report No-5.
[11]. Brown TA. Confirmatory factor analysis for applied research. 2nd ed. NY: The Guilford
Press; 2015. 23. Edwards JR, Bagozzi RP. On the nature and direction of relationships
between constructs and measures. Psychol Methods. 2000;5:155–74.
[12]. Bollen KA, Bauldry S. Three Cs in measurement models: causal indicators, composite
indicators, and covariates. Psychol Methods. 2011;16:265–84.
[13]. Jarvis CB, Mackenzie SB, Podsakoff PM. A critical review of construct indicators and
measurement model misspecification in marketing and consumer research. J Consum Res.
2013;30:199–218.
[14]. Schwarzkopf D, Behrend S, Skupin H, et al. Family satisfaction in the intensive care
unit: a quantitative and qualitative analysis. Intensive Care Med. 2013; 39:1071–9.
[15]. Wright SE, Walmsley E, Harvey SE, et al. Family-Reported Experiences Evaluation
(FREE) study: a mixed-methods study to evaluate families’ satisfaction with adult critical care
services in the NHS. NIHR Journals Library: Southampton; 2015. [1]. Codman EA. A Study
of hospital efficiency: the first five years. Boston Thomas Todd Co, 1916

15
[16]. Downey L, Curtis JR, Lafferty WE, et al. The Quality of Dying and Death Questionnaire
(QODD): empirical domains and theoretical perspectives. J Pain Symptom Manage. 2010.
[17]. Moselli NM, Debernardi F, Piovano F. Forgoing life sustaining treatments: differences
and similarities between North America and Europe. Acta Anaesthesiol Scand. 2006;
50:1177–86.
[18]. Gerritsen RT, Hofhuis JG, Koopmans M, et al. Perception by family members and ICU
staff of the quality of dying and death in the ICU: a prospective multicenter study in The
Netherlands.
[19]. Jensen HI, Gerritsen RT, Koopmans M, et al. Families’ experiences of intensive care unit
quality of care: Development and validation of a European questionnaire (euroQ2). J Crit
Care. 2015;30:884–90.

16
17