ISSN 0798 1015

Vol. 38 (Nº 33) Año 2017. Pág. 35

Estimation of the contentment of patients as consumers of medical services

Estimación de la satisfacción de los pacientes como consumidores de servicios médicos

Ludmila Stanislavovna LEONTIEVA 1; Tatiana Viktorovna KHALILOVA 2; Yekaterina Anatol'evna BATYUTA 3; Yulia Nikolaevna SOLOVAROVA 4; Aliia Alimzanovna IDRISOVA 5

Received: 20/05/2017 • Approved: 30/05/2017

Content

1. Introduction

2. Bibliography review

3. Research method

4. Result and discussion

5. Conclusion

References

1. Introduction

In compliance with the guidelines of World Health Organization, the notion of the quality of medical assistance includes, alongside with the adequacy and optimal character of the treatment and the used resources, also the patients’ contentment with the medical services. Besides, monitoring research of WHO in 2016 focused on the analysis of the coverage of population with medical services, their quality and accessibility (World Health Statistics 2016). Thus, the research of people’s attitude to the rendered medical services is, on the one hand, an implementation of the mentioned methodological guidelines of World Health Organization, and, on the other hand, serves as an analytical means of feedback between patient and medical personnel.

2. Bibliography review

The estimation of patients’ contentment with the quality of rendered services is an object of attention of not only researchers (Prakash 2010; Kupfer and Bond 2012; Leontieva, et. al. 2016; Poulas, et. al. 2008; Tang, et.al. 2013), but also of administrative-managerial personnel of medical institutions, like Republic Clinical Hospital #2 in Kazan (Republic of Tatarstan, Russia), which served as a site of empirical research for the authors of this paper.

In scientific literature, the research of patients’ contentment with the quality of rendered services has various angles of analysis. These are, first of all, the search of methodological approaches (Larsson 2000; Siburina, et. al. 2013; Spiridonov and Shulaev 2013), the analysis of correlation between patients’ contentment and their personal psychological features and living conditions (Findik, et. al. 2010; Rahmqvist and Bara  2010; Grøndahl, et. al. 2011), as well as other indicators within the notion of “quality of medical assistance” formulated by World Health Organization (Chatterjee, et. al. 2012; Glickman, et. al. 2010; Nanda and Andresen 1998). Alongside with the research specifying the quality of services in various spheres of medicine, one should highlight the scientific works which study the population’s contentment with medical services during large-scale events. These include, for example, revealing the specific problems of rendering medical services during large sports competitions (Razumovskaya, et. al. 2014; Mishakin, et. al. 2015).

3. Research method

Sociological polling of patients of a medical institution was carried out by the personnel from October to November 2015, following the Order of the State Autonomous Medical Establishment “Republic Clinical Hospital #2” of 22.09.2015 # 285/06. The sample volume was 434 patients, including: polyclinic patients – 149 (dentist’s – 48, consultative policlinics – 41, therapy divisions – 60); in-patients – 285 (on average 25 patients in each clinical department).

The polling objective was to obtain an independent evaluation of the quality of medical service rendering in Republic Clinical Hospital #2. For quality evaluation we used the indicators and calculation technique adopted by the Order of the Ministry of Healthcare of the Russian Federation of 28.11.2014 #787n “On indicators characterizing the general criteria of evaluating the quality of service rendering by medical institutions”. The numerical score system was used: 0 to 5 points depending on the percentage of patients who positively evaluated the aspect of the medical service quality:

The polyclinic patients’ questionnaire consisted of 10 questions, the maximal score was 50. The in-patient questionnaire consisted of 11 questions, the maximal score was 55.

4. Result and discussion

Contentment implies the correspondence of the received services to the patient’s expectations and is perceived if the patient’s needs are satisfied. That is why the poll questions were aimed at evaluating the fulfillment of the patient’s needs in informing, professionalism and timeliness of medical service rendering, as well as in organizational, hospital stay and emotional-psychological conditions.

Polyclinic patients in general gave 1204 positive answers out of 1440. Satisfaction amounted to 83.6%. The total score in the policlinics was 31 (Table 1), including in the consultative policlinics – 30 points, in the therapy department – 33 points, in the dentist’s department – 36 points.

Table 1. Results of polling the policlinics patients

The indicator “Amicability and competence of medical staff” received high points both in the policlinics in general and in its separate divisions: 4-5 points (Tab.1). Amicability of medical staff implies emotional-psychological stability, patience, ability to calm a patient who is often under stress, to explain the essence of the current situation and the algorithm of further actions. The lowest contentment with the rendered medical services (3 points) and a poor willingness to recommend the medical institution (3 points) was observed among the patients of consultative policlinics. Consultative policlinic is the first stage for a patient visiting a medical institution. Negative attitude or, all the more so, incompetent consultation may cause nihilism in the patient’s further actions or inadequate results of examination and diagnostics. The patients of the dentist’s department gave 5 points to both indicators, and the patients of the therapy department – 4 points.

The largest number of negative answers was given to the question about seeing a doctor at the appointed time - 1point (Tab.1). Almost 40.0% of the patients were not received at the appointed time. Analysis of this indicator by the policlinics departments shows that the patients’ negative attitude was formed due to the unsatisfactory functioning of consultative policlinics and therapy department, where 31% and 40% of the respondents, accordingly, were not received at the appointed time (0 points). An example of good organization is dentist’s department with 4 points (11.0 %), i.e. with a score higher than average in the medical institution. Probably, the unpunctuality of the doctors of some departments can be explained by the sectoral norms of the duration of a doctor’s appointment, which were introduced by the Russian Ministry of Healthcare. Physicians of the outpatient departments must spend 15 minutes per patient on average, neurologists - 22 minutes, ophthalmologists - 14 minutes, and otolaryngologists - 16 minutes. Such norms may lead to reducing the number of medical staff and increase of the workload per doctor. The growth of the “patient flow” will hardly improve the quality of medical service. This novelty will be advantageous not for patients but for the insurance companies within the General Medical Insurance system, as it simplifies the control over the doctor’s time regulation in medical institutions.

The problem zones for all departments are general conditions of hospital stay and informational richness of the web-site of the organization (2 points each) (Tab.1). While the conditions of hospital stay are directly connected with the budget funding, the rate of information supply can be increased by the administration of the medical institution independently. In the context of modern informational management, feedback is, according to the researchers (Gainullina and Leontyeva 2013; Leontieva, et. al. 2014), realization of the “right for communication” in “doctor-patient” system, which provides comfortable organizational and psychological situation for both parties.

The respondents who answered the open questions of the questionnaire gave full answers confirming the revealed problems. The visitors’ claims refer mainly to the duration of waiting time, even in case of a previous appointment: from 3-4 weeks to 3-4 months. Accordingly, the patients’ proposals come to simplifying the procedure of making an appointment with the doctor via the web-site and to fill the web-site with up-to-date information.

The inmates in general gave 2878 positive answers out of 3071. Contentment amounted to 93.7%. The total score in the hospital was 54 (Table 2), including in the cardiology department, therapy department #1, therapy department #3, surgery, maternity department – 54 points, therapy department #2, therapy department #4, gynecology department #1, gynecology department #2 – 53 points, neurology department #1 – 50 points, neurology department #2 – 49 points, endocrinology department – 44 points.

Table 2. Results of polling the inmates

The most important indicator – “professional competence” – is estimated as 100%, which confirms the efficiency and, according to some researchers (Ivanenko, et. al. 2015), competitiveness of the system of professional education and retraining of personnel. In the total evaluation of the hospital, all indicators were given maximal 5 points (Tab.2), i.e. more than 90% of the patients gave positive answers to each aspect of the services quality. One exception is the indicator of an average waiting time in the reception department (39 minutes, which corresponds to 4 points) (Tab.2). According to the technique proposed by the Russian Ministry of Healthcare, the ideal waiting time should be less than 30 minutes, which corresponds to 5 points; more than a half of all inmates reported such waiting time (55.4%) (Tab.2). In the hospital departments the situation is reverse. The minimal waiting time (32 minutes) in the reception department was reported by the patients of maternity department and therapy department #4 (80 % of the patients – less than 30 minutes). The longest waiting time (57 minutes) was reported in the gynecology department #2: a quarter of the patients waited for the appointment for 1 hour 15 minutes to 2 hours. Thus the patients’ proposals mainly refer to the timeliness of medical services and improving the hospital stay conditions – from variety of food to additional household appliances and to kiosks with essential commodities and newspapers and magazines. Alongside with proposals and claims, patients expressed gratitude for medical staff for their high professionalism and attentive service.

5. Conclusion

We can conclude that the level of patients’ contentment with the quality of medical service in Republic Clinical Hospital #2 of Kazan is rather high. The work of the hospital was positively evaluated by 93.7% respondents (Tab.2), while the medical services in polyclinics – by 83.6% respondents (Tab.1).

The analysis of the patients’ opinions allowed to reveal the “problem zones” in the process of medical service rendering. To increase the population’s contentment with the quality if medical service, it is necessary to focus the attention of the managerial personnel on the following spheres of the medical institutions functioning:

1. systematization of the procedure of making an appointment with the doctor in the policlinics, in order to reduce waiting time and eliminate queues;
2. increase of hospital stay comfort both in the outpatient-policlinics and in the inpatient departments;
3. systematic informational up-grade of the web-site of the medical institution with the up-to-date information, feedback development in the “doctor-patient” system. 

References

Chatterjee P, Joynt KE, Orav EJ, Jha AK. 2012. Patient experience in safety-net hospitals: implications for improving care and value-based purchasing. Arch Intern Med. 172(16): 1204-1210.

Findik, U. Y., Unsar, S. and Sut, N. 2010. Patient satisfaction with nursing care and its relationship with patient characteristics. Nurs Health Sci. 12(2):162-9.

Gainullina, L.F. and Leontyeva, L.S. 2013. Pravo na kommunikaciyu dolzhnoe i sushchee [Right for communication: the due and the actual]. Actual problems of Economics and Law, 4 (28): 217–225.

Glickman, S.W., Boulding, W. and Manary, M., et al. 2010. Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction. Circ Cardiovasc Qual Outcomes, 3(2):188-195.

Grøndahl, V. A., Karlsson, I., Hall-Lord, M. L., Appelgren, J. and Wilde-Larsson, B. 2011. Quality of care from patients’ perspective: impact of the combination of person-related and external objective care conditions. Journal of Clinical Nursing, 20(17-18): 2540–2551.

Ivanenko, N., Khairova, I., Fajzrakhmanova, A., Kharisova, G., Khalilova, T., Lisitzina T. and Shaimukhametova, S. 2015. Competitiveness of Professional Education: Purposes, Tasks and Factors of Its Participation in the International Educational Services Market. Asian Social Science, 11(1), 2015: 369-375.

Kupfer, J.M. and Bond, E.U. 2012. Patient satisfaction and patient-centered care: necessary but not equal. JAMA, 308(2):139-140.

Larsson, B. W. 2000. Does the method of data collection affect patients' evaluations of quality of care? Volume 6, Issue 6. December 2000. Pages 284–291.

Leontieva, L.S., Khalilova, T.V. and Kurgaeva, Zh.Yu. 2016. Udovletvorennost naseleniya medicinskimi uslugami kak indikator kachestva sistemy zdravoohraneniya [The satisfaction with medical services as an indicator of the quality of health care]. Health and education XXI century, 18: 133-138

Leontieva, L. C., Gaynullina, L. F. and Cherepanova, E.S. 2014. Legal Boundaries of Communication in Russia: Current Approaches to Research. World Applied Sciences Journal, 30 (2), 147-151.

Mishakin, T., Razumovskaya, E., Berdnikova, O. and Popov, M. 2015. Medical Care Delivery at the XXVII World Summer Universiade Kazan 2013 (2015). Smart Innovation, Systems and Technologies. Springerlink, 45: 95-200.

Nanda, U. and Andresen, E.M. 1998. Health-related quality of life. A guide for the health professional. Eval. and Health Prof. 21(2):179-215.

Poulas, G. A., Brodell, R.T. and Mostow, E.N. 2008. Improving quality and patient satisfaction in dermatology office practice. Arch Dermatol. 144(2):263-5.

Prakash, B. 2010. Patient Satisfaction. J Cutan Aesthet Surg. 2010 Sep-Dec; 3(3): 151–155

Rahmqvist, M. and Bara, A.C. 2010. Patient characteristics and quality dimensions related to patient satisfaction. Int J Qual Health Care. 22(2):86-92.

Razumovskaya, E.M., Mishakin, T.S., Popov, M.L. and Kucevol, N.G. 2014. Medical services during the XXVII World Summer Universiade 2013 in Kazan (2014) Mediterranean Journal of Social Sciences, 5 (18 SPEC. ISSUE): 17-20.

Siburina, T.A., Barskova, G.N. and Laktionova, L.V. 2013. Metodicheskie podhody k issledovaniyu udovletvorennosti pacientov vysokotekhnologichnoj medicinskoj pomoshchyu [Methodological approaches to the study of patients’ contentment with high-tech medical assistance]. Social aspects of health. 1. http://vestnik.mednet.ru/content/view/454/30/lang,ru/ (access date: 30.09.2016).

Spiridonov, A.V. and Shulaev, A.V. 2013. Metod ocenki udovletvorennosti pacientov kachestvom stacionarnyh uslug v usloviyah modernizacii zdravoohraneniya [Technique of the study of patients’ contentment with the quality of in-hospital services under modernization of healthcare]. Modern issues of science and education, 4. http://www.science-education.ru/ru/article/view?id=10001 (access date: 28.09.2016).

Tang, W. M., Soong, C.-Y. and Lim, W. C. 2013. Patient Satisfaction with Nursing Care: A Descriptive Study Using Interaction Model of Client Health Behavior. International Journal of Nursing Science, 3(2): 51-56.

World Health Statistics 2016: Monitoring health for the SDGs. Universal health coverage – at the centre of the health goal. WHO, 2016. - http://www.who.int/gho/publications/world_health_statistics/2016/en/ (access date: 30.09.2016)

1. Kazan (Volga region) Federal University, Institute for Management, Economics and Finance, Russia, Tatarstan, 420800, Kazan, Kremlevskaya Street, 18. Email: leontyeval@icloud.com.

2. Kazan (Volga region) Federal University, Institute for Management, Economics and Finance, Russia, Tatarstan, 420800, Kazan, Kremlevskaya Street, 18.

3. Ural Federal University, Mira Street, 19, Ekaterinburg, Russian Federation.

4. Kazan National Research Technological University, Russia, Tatarstan, 420015, Kazan, Karl Marx street, 68

5. Kazan National Research Technological University, Russia, Tatarstan, 420015, Kazan, Karl Marx street, 68.