The Assessment of Patient’s Satisfaction and Opinions of their Experience during Admission in the Tertiary Care Hospital

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Introduction
Satisfaction from anyone is important as it is an important feedback and outcome. Patient satisfaction is central in all health care systems as always first glance leaves everlasting impression patients admission in a tertiary care hospital same as form the bases of their experiences that develop next in form of their perceptions regarding admissions in tertiary care hospitals. Patient satisfaction on admission is defined as "inpatients personal evaluation of health care services and providers while on admission ,it is about the way the patient is treated and the facilities offered to him while on admission in a hospital" As now the public have become more conscious regarding the provision of services which are being provided to them (Delbanco, 1996) their awareness regarding health care system is much more evident . There are some factors that determine the patient satisfaction at the time of admission these, (1) doctor nurses' attitudes (2) food (3) sanitation (4) Quality of services (5) Medication services. But now the health policy makers are more concerned regarding patient views of their experiences of stay in hospital as well as the sufferings at the time of admission Thus, they are more conscious in making the strategies that utilize the services in effective manner. As continue quality improvement id directly linked to the patient satisfaction. Every researcher has its own idea and views regarding patient experience of hospital admission in a tertiary care hospital. In Pakistan studies have only discuss the specific areas e: g emergency departments (Qidwai , 2005) day care surgeries Ahmed et al , ( 2005) but our study focused mainly on assessing patient satisfaction and opinions on experience about admission in tertiary care hospital Pakistan. Study will help in identifying the areas that cause least satisfaction I the patient at the time of admission. So that an effective change can be brought out in the continue health services for the improvement of satisfaction in the patient at the time of admission or overall stay in hospital, as in one study the most highly dissatisfied areas in the Pakistan were the financial aspects .Pakistan is a developing countries technology is not much advance as require , overcrowding , lack of survives , less number of health care providers is also an issue these are the things that cause dissatisfaction.

Objective
1. To assess the patient satisfaction and their opinions at the time of admission in tertiary hospitals of Pakistan. 2. To assess the patient opinion regarding admission in a tertiary care hospital of Pakistan.

Problem Statement
Patient knowledge and expectation from the health care services had totally been changed now they become more demanding regarding their health services, their provision and sustainability ,their views have been changed they want attention , approach , accessibility , and resources as well as proper communication channels .patient satisfaction at the time of admission in a tertiary care hospital is a main indicator that determine all theses ,and the basic responsibility of any health care setting is also a patient satisfaction. Modification and change in health care strategies and policies now have been become more evident to achieve all these satisfactions but the need is to know which things are require bringing all these satisfaction and positive opinions of the patients at least about at the time of admission that directly or indirectly increase all these. In Pakistan as there is a major problem of overcrowding ,poor number of health care providers as compare to patient ratio , poor hygienic conditions ,slow technological advancement keeping in mind all these it's become very important to achieve and maintain patient satisfaction Significance Present study in patient satisfaction and opinions of their experience at the time of admission in tertiary care hospitals in Pakistan will give knowledge and understanding regarding this aspect and we will be able to know the areas of satisfaction as well as dissatisfaction. The study will also help in modifying the policies accordingly. The present study will also provide a help for the future research. Basically, this study is a different paradigm as patient satisfaction is a basic component and focus of any health care system as public become more aware regarding their health and demanding for their health care services provision. Moreover, Patient satisfaction id require for their well beings, present study will improve understanding regarding all these factors that cause satisfaction and dissatisfaction , determinants that determine their opinions and policies that will help in the improvement of patient satisfaction. It will also provide learning areas for the future studies it will also provide deep sense of these variables that further support patient satisfaction.

Literature Review
In this section we will review the literatures on patient satisfaction and opinions of their experience on their admission in tertiary care hospitals in Pakistan. Only few studies have been conducted in the Pakistan on the patient satisfaction, but the main focus was emergency care or department this will study will cover another area of patient satisfaction that is related to the hospital admission the study results will help in the administration of the hospital as well as hospital management.

Patient Satisfaction
Patient satisfaction is a global concern and the focus of health care system as well. The first research was started on this burning issue on 1970s and early 1980s.Patient satisfaction combine two things patient needs and patient expectations as well as the level of quality of care that is being provided to the patient level either it can achieve the patient expectations level or not. Patient satisfaction also linked to the compliance with medical treatment. It can be justifying by saying this phenomenon contains both medical as well as non-medical issues. Patient satisfaction is a key indicator that determines the quality of care that being provided at the time of admission (Singh, 1989). patient satisfaction is not only influenced by the clinical factors but there are also many other non-clinical factors too that influence patient satisfaction (Agrawal, 2006). Patient satisfaction also act as a tool for the measurement of quality of care that is being provided Alam (2008). Clinical factors are availability of medicines, doctors and nurses behaviors, cost of resources, hospital management, patient privacy , physical ease , emotional support as well as respect .as public become more active need assessment is the need of hour in order to prevent any type of mismatch between patient expectations and the services which are being provided that can be a cause of dissatisfaction thus , it is necessary to understand the patient views , needs , feelings and perspectives. Patient feedback must be accepted and respected to bring changes in the sustaining policies accordingly. So, that their satisfaction level can be assessed, and modification brings accordingly Boyer et al, 2006. Pakistan is a country with the people of low income population is growing much faster as compared to the development of country literacy rate is also an issue which is higher in the urban areas as compared to the rural areas which also helps a lot in developing patient experiences regarding their admission in the hospitals Pakistan Economy Survey, 2011. When services match patient expectations that help in the development of patient satisfaction when services fall patient become dissatisfied. Patient satisfaction decide the future of health care providers and health care system that periodically measured by the health policy makers (Pasuraman, et al., 1985).

Patient Experience on Admission
Patients experience help as a tool in developing future actions plans (Wensing, et al, 2003). Pakistan is a developing country and as like other developing countries it's also need improvement in the health care system. Provision must be compatible with the patient wishes and needs in accordance to their satisfaction. As different patient has different perceptions they also have different views regarding their care of health care organizations and also regarding for the health care providers either they are nurse or doctors. Patient came in emergency and outpatient departments with different problems ranging from minor ailment to highly fetal diseases they must be treated according as normally said first impression always last long perceptions overcrowded emergencies irritated health care providers effect a lot on the patient experiences because they are suffering pains that time. Overcrowding prevalently and adversely effects patient experiences on admission.

Research Methodology
This study is conducted to assess the patient satisfaction and opinions of experience on admission in tertiary care hospitals a descriptive cross-sectional research design will be used for the study to assess patient satisfaction and opinions on experience on admission in a tertiary care hospital in Pakistan

Total population and size
The research design based on descriptive and cross-sectional study. The population of the study was 200 patient of Jinnah hospital Lahore. The total sample size of 200 patients was selected randomly from total population.

Research Instrument
This is a descriptive study as self-administer and modified version of questionnaire of the article "Patient satisfaction and opinions of their experience during admission in a tertiary care hospitals in Pakistan -Cross sectional study" consisted of two sections section (A) contain demographic data section (B) contain questions section B composed of five scale likert scale that elicited response from the participants with response options strongly disagree (SD) Disagree(D) neutral(N) agree (A) strongly agree(SA).

Setting Of study
Setting of the study will be the patient of the Jinnah Hospital Lahore. The participant will be belonging to the different socioeconomically status and different demographic be ground the participant will be male and female.

Sample size and Sampling technique
Data will be collected from the participants' through self-administered questionnaire and the participant selected through simple random sampling ,sample size foe the study was 200 which was calculated from Slovin\s formula of calculation which is mentioned here. Total Number of the Participants If N =population n=Sample size E=Margin of error (150) (150) n=151/1.375 n=110

Method of Data Collection
Data was collected through survey and the questionnaire was floated by the researcher herself. The 120 copies of questionnaire were circulated to the students and recovered on the spot.

Data Analysis
Inferential statistics of Chi-square(X2) were used to analyses the association between the variable. Reliability assessed using Cranach's Alpha AND ITS VALUE OF 0.65 was demonstrated that the questionnaire was reliable. Regression amylases were carried out to determine whether there was the linear trend between the variable. And sensitivity analyses were used to examine the result. In the end, all the data were put into the software SPSS21 version and the finding and result were drawn on the basis of statistical procedure.         Table 9: shows percentage of the respondents who are strongly disagree 0.909% those who are disagree 11.82% neutral 42.73% agree are 40% and strongly agree are 4.545%.            Table: 21 shows percentage of the respondents who are strongly disagree is 0.000% disagree is 18.18% neutral is 18.18% agree is 59.09% strongly agree are 3.636%.   Table 23 shows that the total number of the respondents who are strongly disagree are 4.545% who are disagree 13.64^ neutral are 6.364% agree are 60% and strongly agre are 15.4 Table: 24

Results
Not involved in decisions about care and treatment as much as the patient wanted  Table26: shows percentage of respondent in the regard of they did not find anyone on staff to talk to about worried and fears disagree are 5.455% neutral is 2.727% agree 80% and strongly agree is 11.82%.  Table 27 shows the percentage of the respondents those who are disagree are 0.909% those who are neutral 6.364% those who are agree 89.09% those who are strongly agree 3.636%.   .000 Table shows that the instrument consist on variables it shows that KMO value is above .50 and Bartlett test is significant p value is less than 0.05 so that the whole criteria fulfilled and the study is valid.

Discussion
Study revealed that patient satisfaction is an important factor for the positives of their opinion regarding hospital admission but, while talking about the admission in a tertiary care hospital this component requires attention. As Pakistan is a developing country there are existences of many factors that effect on this satisfaction as well as patient's opinions regarding hospital admission these are low income, over population, illiteracy, cultural differences. Health care system in the Pakistan is on the journey of progress and the standard of tertiary hospitals are still not satisfactory all these effects patient satisfaction that lead to the positive and negative direction of their opinions. But as different people have different level of thinking and perceiving so their opinion regarding hospital admission in tertiary care hospitals are differ it can be justifying by saying that level of thinking also affects all these. as now these days patients become more aware and concerning related to their health their demands also touch the heights that lead to the high level of expectations in a territory care hospital health facilities are not readily available that put the pressure on the patient satisfaction. Satisfaction can be used as tool for measuring the standard of health care system as well as quality of care. Patient's satisfaction from the bases of policy making strategies.

Conclusion
Patient satisfaction is one of the prominent indicators that present the level and standard of quality of care to the patient. Privacy should be provided to the patients during their treatment in the hospital and Doctors and nurses should communicate with the patient in effective way. Psychological support should provide to the patient by the health care provider so that patient can share their panic situation with the staff.

Limitation
These are some limitations that came in front while interpreting the findings. Short population size that cause limitation in data collection. Cultural and traditional difference cause hindrance in data collection from female patients. Time and cost consumption. Difficulty in measuring test.