Arabian Journal of Business and Management Review (OMAN Chapter)
Vol. 4, No.7; February. 2015
AN EVALUATION ON IN-PATIENT SATISFACTION AT MERIDIAN
EQUATOR HOSPITAL (NAIROBI, KENYA)
Sheila Wangari Kioi
Graduate of the Regent Business School, Durban, Republic of South Africa
Richard Cowden
Dissertation Supervisor and Academic, Regent Business School, Durban, Republic of South Africa
Anis Mahomed Karodia (PhD)
Professor, Senior Academic and Researcher, Regent Business School , Durban, Republic of South Africa
ABSTRACT
The provision of high-quality, affordable, health care services is an increasingly difficult and
challenging venture. Due to the complexities of health care services and systems, investigating
and interpreting the use, costs, quality, accessibility, delivery, organization, financing, and
outcomes of health care services is key to informing government officials, insurers, providers,
consumers, and others making decisions about health-related issues. A major component of
quality of health care is patient satisfaction. Patient satisfaction is a crucial and critical indicator
of quality health care provisioning and function of a health facility. In addition, the analysis of
patient satisfaction and the correlation between various health care services is critical in planning
and management of health care organizations (World Health Organization, 2005).
Key Words: Satisfaction; In – Patient; Hospital; Healthcare; Systems; Costs; Quality;
Accessibility; Financing; Insurers; Consumers; Planning; Management
INTRODUCTION
The Objectives of the Study
The objectives of the study were;
1. To evaluate in-patients' level of satisfaction with the services provided within the
Hospital
2. To identify whether different clients have needs that depend on gender, age or patient
diagnosis.
3. To make recommendations for improving in-patient service provision.
LITERATURE REVIEW
Patient Satisfaction
Satisfaction of customers is a very subject term as it is dependent on individualist perceptions,
needs, wants and beliefs. Nevertheless, various measures are used to measure or denote
satisfaction. Gronroos (1989:55) noted that satisfaction from the consumption of services is often
measured based on technical and functional quality. He concluded that customer satisfaction is
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primarily based on the extent to which a service meets the needs, expectations and needs of the
customer. Sachdev and Verma (2004:156) noted that service quality can be measured in relations
to customer expectations, perceptions, attitude and satisfaction.
Quality of health care is an integral part of any government, health authority or consumer. These
stakeholders are increasingly taking interest in the measurement and quality of health care
(Smith et al., 2006:115). As a consequence, customers perceive higher levels of satisfaction due
to enhanced health services quality. However, Derose, Hays, McCaffrey, and Baker (2001:87)
found that patient satisfaction in the health sector is not a mere product of clinical effectiveness
and economic efficiency. However, quality of health services and consequently customer
satisfaction is a result of social acceptability of quality objective provided by a health institution
(Derose et al., 2001; 88).
In an attempt to enhance satisfaction across the health care stakeholders, various Hospitals and
health care providers have or an in the process of implement a quality management framework.
Lin and Clousing (1995:71) noted that quality health care management revolves around the
improvement of all sections and departments of the organization, dimensions of products and
services that are critical and inform customer satisfaction (Chase and Aquilano, 1992:192). It is
therefore imperative that health care providers develop strategies, services and products that are
responsive to customer needs and wants with the sole aim of enhancing customer satisfaction.
One widely adopted concept of enhancing quality health care across the globe is the
implementation of total quality management in health care institutions. According to Chase and
Aquilano (1992:191) total quality management in health care firms is centered on improvement
of existing products and services, introduction of new products and services with the sole aim of
enhancing customer satisfaction. As a consequence, total quality management in health care
institutions is informed by customer requirements, expectations and needs (Lin and Clousing,
1995:73). As more Hospitals have adopted total quality management, it has evolved from “a pure
statistical view of process control (Enrique, Miguel and Javier, 2003:425) towards a systematic
view (Juran, 1986:25)” premised upon a strong orientation on customer internal and external
expectations and needs (Etherington, 1992:129). All these efforts are all aimed at enhancing
customer satisfaction. As Milakovlch (1991:11) noted, it is the primary goal of any health care
to ensure patient satisfaction and therefore most of the health institutions efforts are geared
towards enhancing patient satisfaction.
Patient satisfaction toward services received at healthcare centers is considered to be an
important indicator for the quality of healthcare functioning. Assessment of patient satisfaction
and its various correlates is critical for efficient planning and monitoring of the healthcare
system. Health system responsiveness is a new concept developed by World Health Organization
(WHO), which specifically describes the social and operational environment to which a patient is
exposed while seeking treatment in a healthcare center (WHO, 2005). Patients' satisfaction is
also a powerful predictor of their health-related behavior like willingness to seek healthcare,
completion of prescribed treatment regime, compliance, switching providers, as well as their cooperation, which is explicitly indicated in the said article. All of these factors are expected to
influence treatment outcomes in turn.
Quality of care from the patient’s perspective is an important aspect in the development of health
services. In the current health care setting patient satisfaction is one of the main indicators.
Assessment of patient satisfaction is a useful parameter to predict the quality and availability of
health care services (Illana, 2003:259). Continuous effort should therefore be put to ensure high
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consumer satisfaction. By so doing, deficiencies in the delivery of health care services are
intervened to ensure patient satisfaction (Mira and Aranaz, 2000:29).
The WHO in 1948 defined health as "a state of complete physical, mental, and social well-being
not merely the absence of disease or infirmity" (WHO, 1948). While this definition is
comprehensive (though rather utopian and ambitious) it clearly indicates what should be the goal
of health care intervention. Medical professionals however tend to focus more narrowly on a
medical model of health care -a history and examination- followed by investigation and
treatment, and finally clinical measures of successful outcome. This approach has been criticized
for producing a paternalistic doctor-patient relationship (McKinstry, 1992:340; Detmar, Muller,
Schornagel and Wever, 2002:3029). The relative success of a given health care intervention may
differ significantly from a patient perspective vis-à-vis the health care provider's perspective.
When this occurs we may ask ourselves; has a health need been met? Was there care process
satisfactory? Has the burden of disease on the patient's quality of life been minimized?
Traditional Approach to Patient Satisfaction
This traditional approach to patient assessment, using clinical and laboratory evaluation, is
largely based on observer ratings by health professionals. In the 'medical model', there is an
optimal level of functioning and everybody below this could be assumed to suffer ill health.
However if these cases are examined carefully, physically-disabled individuals could be found
with better quality of life than individuals with optimal functioning, as quality of life refers to a
broader concept of health than has traditionally been defined. Modern medicine is slowly
beginning to recognize the importance of the perspective of the patient in health care and more
investigations are needed to understand the importance of the inter-relationships among health
needs, satisfaction, and quality of life.
No consensus seems to be existing about the meaning and concept of 'need' in health, sociology
and political literature (Cuvler, 1998:78; Asadi-Lari, Packham, and Gray, 2003:59; Lightfoot,
1995:105). The ambiguity of the concept of 'needs' and enormity of the task imposed upon
practitioners has made the transition from service-led to needs-led much harder (Parry-Jones and
Souls by, 2001:417); this vagueness is more apparent when a specific need fails to fall neatly
into 'health care' or 'social care' domains, each of which is correlated with the other. Patients with
depreciated perception of health status have more social needs (Asadi-Lari et al., 2003:60), thus
meeting social needs may have a direct impact on general health status, which eventually falls
into the health domain, perhaps indicating the 'holistic nature' of needs (Parry-Jones and Soulsby,
2001:416). For example, cancer patients may have a need to better understand their diagnosis
and the specific prognosis. However, they may feel guilty about interrupting a busy General
Practitioner, and so their needs are not met. This may raise the patient's level of anxiety, which in
turn may worsen their emotional health status (Wen and Gustafson, 2004:11; Tamburini,
Gangeri, Brunelli, Beltrami, Boeri, Borreani, Karmann, Greco, Miccinesi, Murru, and Trimigno,
2000:12; Tamburini, Gangeri, Brunelli, Beltrami, Boeri, Borreani, Karmann, Greco, Miccinesi,
Murru, and Trimigno, 2003:34).
'Need' may have a direct effect on satisfaction with care but the direction of the relationship is
not clear. For example, patients may have a need for more or better information on some aspect
of health. If this need is unmet, it may result in dissatisfaction with services. Alternatively, the
better informed patient tends to have higher expectations and so be dissatisfied with care (Wen
and Gustafson, 2004:11). Both of these scenarios directly influence quality of life (Asadi-Lari et
al., 2003:60).
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A current definition of need that has been occasionally published in the National Health Service
(NHS) documents indicates that need is the 'capacity to benefit from health care services'.
However this definition may be too restrictive as "legitimate" patient needs might be limited to
those that can be easily addressed within existing health services and that are considered
'medically necessary', maintaining the medical model which experience suggests has proven
unsatisfactory in meeting patient needs.
The pressure of political self-preservation obliges health decision makers to handle health issues
with no further increase in global health budget, thus they prefer to manipulate and introduce
rather strict and somewhat artificial definitions to justify shortages in resources devoted to the
health sector. Unfortunately using a more restrictive definition of 'need' masks the larger amount
of genuine health needs of the population. Satisfying all of these desired health needs would,
most certainly, require more monetary resources.
The challenge therefore is to identify and target patients' genuine needs. Mobilizing resources to
meet these needs would certainly avoid further expenses, keep patients satisfied with services,
and lead to better quality of life. At the moment, there is no single definition of genuine health
needs precisely within the context of public health policy, yet it makes sense to describe this
inherently complex issue as 'what patients – and the population as a whole- desire to receive
from health care services to improve overall health'. Even this definition may leave practitioners
'open to making judgment based on implicit knowledge, rooted in professional training and
values, office culture and assumptive world' (Twigg and Atkin, 1994:205).
Healthcare accessibility, quality of care provided, and its cost are the three domains of high
priority which influence patients' health-related behavior (Bleich, Ozaltin and Murray,
2009:277). In India, the second populous country after China, providing affordable quality care
is a big challenge where 80% healthcare centers, both public and private, are located in urban
areas which cater only 30% population (Indian Health System, 2012). There is a huge disparity
in the demand of quality care and the actual supply. Majority of the healthcare centers are
understaffed, have poorly maintained medical equipment’s, and lack necessary laboratory
support (Bleich et al., 2009:275). For overall improvement of quality care and patient
satisfaction, there should be a continuity of care by integrating primary healthcare center with
district level Hospitals, more emphasis should be laid on women and child health, and the most
essential thing to do is proper identification along with timely and appropriate management of
emergency cases (Mahapatra, 2013:260).
The absence of a solid conceptual basis and consistent measurement tool for consumer
satisfaction has led, over the past 10 years, to a proliferation of surveys that focus exclusively
on patient experience, such as aspects of the care experience such as waiting times, the quality
of basic amenities, and communication with health-care providers, all of which help identify
tangible priorities for quality improvement. In the future, measures of patient experience,
intended to capture the “responsiveness” of the health system (Valentine, Darby and Bonsel.,
2008) a concept developed by WHO, are likely to receive even greater attention as physicians
and Hospitals come under growing pressure to improve the quality of care, enhance patient
safety and lower the cost of services. Health system responsiveness specifically refers to the
manner and environment in which people are treated when they seek health care.
The increasing importance of patient experience and the sustained interest in comparing
people’s satisfaction with the health system across different countries and time periods
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suggests the need to characterize the relationship between them. Research relating global
satisfaction ratings with patient experience has revealed strong associations between the two
(Young, Meterko and Desai, 2000:325). Yet, to what extent patient experience explains
satisfaction with the health-care system remains unclear. The literature suggests that much of
the remaining variation in health system satisfaction after adjusting for factors commonly
used to measure the concept is a reflection of patient experience.
Patient Satisfaction in Health Providing Institutions
Patient satisfaction has been an important issue for health care managers. Many previous
studies have developed and applied patient satisfaction as a quality improvement tool for
health care providers (Young et al., 2000:327). Following increased levels of competition and
the emphasis on consumerism, patient satisfaction has become an important measurement for
monitoring health care performance of health plans (Jatulis, Bundek and Legorreta, 1997:14).
This measurement has developed along with a new feature: the patient's perspective of quality
of care (Ross, Steward and Sinacore, 1995:330; Lee and Kasper, 1998:754; Kane,
Maciejewski and Finch, 1998:721).
The health sector is a service sector. Consequently, quality of services and customer
satisfaction is primarily driven by employee engagement (Peltier and Dahl, 2009:4). Love,
Revere and Black, (2008:56) further noted that most health institution administrators are
increasingly becoming conscious to the high quality health care concept which both the
customer and provider are satisfied while ensuring the attainment of other organization goals
and targets. Newman et al. (2001:167) further argued that patient satisfaction in the health
sector is a chain of events and activities which include internal conditions, staff capacity and
capability, nurse satisfaction, nurse retention, quality of patient care and ultimately customer
satisfaction.
Various dimensions of patient satisfaction have been identified, ranging from admission to
discharge services, as well as from medical care to interpersonal communication. Wellrecognized criteria include responsiveness, communication, attitude, clinical skill, comforting
skill, amenities, food services, and so forth (Carey and Seibert, 1993:934). It has also been
reported that the interpersonal and technical skills of health care provider are two unique
dimensions involved in patient assessment of Hospital care (Tokunaga, Imanaka and
Nobutomol, 2000:395).
Employee engagement and empowerment in the health sector is critical to the loyalty and
commitment of employees. In addition, employee loyalty and commitment has a direct
influence on the levels of patient satisfaction across nations (Peltier and Dahl, 2009:9).
Consequently, health institutions across the world are routinely seeking to motivate their
employees for example: doctors, nurses, laboratory technicians and support staff with the
ultimate aim of enhancing customer satisfaction (Peltier and Dahl, 2009:10). Some of the
strategies undertaken to empower and engage employees include: open leadership,
communication, training and development and better compensation (Peltier and Dahl,
2009:10). These factors have been found to have a positive impact on employee satisfaction,
commitment and patient satisfaction. In a study by Peltier, Nill, and Schibrowsky (2003:25)
on structural bonds enhancing patient satisfaction, the development of bonds between the
employee, the management and their customers, was found to be key to enhanced patient
satisfaction. The same findings were presented in a follow up study by Peltier, Pointer and
Schibrowsky (2007).
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Soleimanpour et al., (2011:1) undertook a study on emergency department patient satisfaction
in Imam Reza Hospital Iran that the most important factors influencing patient satisfaction in
the Hospital were communication between patients and doctors, courtesy of security guards,
communication between patients and nurses and the mean waiting time of patients. The study
further found that most patients in the Hospital had to wait for 24 minutes and 5 seconds
before they were attended to (Soleimanpour et al., 2011:1). Further, to the findings,
Soleimanpour et al., (2011:2) noted that it would be impossible to ensure satisfaction of all
patients and customers in the Hospital. However, it was practical to achieve high levels of
satisfaction through management and improvement on the indicators identified above.
Similar to the findings of Soleimanpour et al., (2011), investigations by Aragon on overall
customer satisfaction amongst patients in various Hospitals across USA was influenced by the
waiting time, level of nursing services and physicians courtesy. This therefore validates major
conceptions that the time taken between a physician and a customer/patient, the approach,
friendliness and courtesy of nurses as well as care and courtesy of support staff including
security guards has a direct influence on the levels of patient satisfaction (Hedges, Trout and
Magnusson, 2002:16).
A similar study conducted in Turkey using a total of 1,113 patients randomly selected from a
cross section of Hospitals had similar findings that the doctor’s skills, friendliness and
courtesy had a direct impact on the levels of patient satisfaction. In addition the study found
that the diagnosis process and time taken to undertake a diagnosis influenced the levels of
customer satisfaction. (Topacoglu, Karcioglu, Ozucelik, Ozsarac, Degerli. and Sari Kay,
2004:382). The role of nurses and support staff is further evident in patient satisfaction in the
study. Respondents to the study indicated that the levels of communication and courtesy
between patients and nurses enhanced their levels of satisfaction while the speed of discharge
and payment of Hospital bills was critical to their satisfaction levels. (Topacoglu et al.,
2004:382). In a similar study in Turkey utilizing 245 patients, the waiting time and quality of
interaction between patients, nurses, doctors and support staff was essentially in enhancing
higher levels of customer satisfaction (Yildirim, Kocoglu, Goksu, Gunay, and Savas,
2005:59). Therefore, doctors, nurses and other support staff had to offer quality services to
patients with the aim of enhancing patient satisfaction.
Press Ganey Report (2009) noted that the most important factor influencing customer
satisfaction in Hospitals was the waiting time. Customers who spent more than 2 hours in the
Hospital had lower levels of satisfaction than customers who were served within 2 hours. The
two hour wait according to Press Ganey Report (2009) was inclusive of the waiting time,
examination time, test time and discharge time. This therefore echoes the findings of other
studies that patient satisfaction was a product of all employees in the Hospital including
doctors, nurses, technicians and support staff.
Cleanliness, tidiness and the general environment are major factors influencing patient
satisfaction across various health institutions. Patients are desirous of being attended to in
comfortable, clean and tidy environments, rooms and wards. In a study on patient satisfaction
across various wards in teaching Hospitals across Iran (Solhi, Sirous, Yaghoubi and
Mehrabian, 2005:22) found that the cleanliness of admission wards, smartness and tidiness of
employees and appropriate environment that was noise free were major factors that
influenced customer satisfaction. Furthermore, the study found that Hospitals where wards,
the toilets and other public facilities were clean and tidy experienced higher levels of patient
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satisfaction than those that had untidy common areas and wards (Solhi et al., 2005:22). This
is similar to the findings of a different study conducted in Iran were the factors that influenced
patient satisfaction were rated as good or very good by various respondents in the Hospitals.
Medical and nursing care was rated to be a major factor influencing patient satisfaction by
78.6% of the respondents, 78.3% indicated that a clean and suitable environment was
important to their satisfaction levels while the health status, discharge time and courtesy was
identified as important by 73% of the respondents (Solhi et al., 2005:21). Due to the high
levels of respondents it can be deduced that the most important factors that influenced patient
satisfaction in Iranian Hospitals were: cleanliness and suitable environments, medical and
nursing care and communication, courtesy and health status of Hospitals.
Patient Demographics and Satisfaction
Determinants of patient satisfaction have been reported extensively. According to previous
studies, patient characteristics such as age and education may influence a patient's assessment
of Hospital performance (Hargraves, Wilson and Zaslavsky, 2001:636). A patient's health
status and the severity of illness are also important predictors of the patient's overall
satisfaction level (Covinsky, Rosenthal, Chren et al, 1998:224). Hospital features such as
Hospital size have been reported to be associated with consumer assessment of Hospital
quality (Finkelstein, Singh, Silvers, Neuhauser and Rosenthal, 1998:69). The relationship
between health care providers and patients, that is interpersonal skill, has been reported to be
the most influential factor for patient satisfaction (Hall and Dornan, 1990:812); however, the
findings were not totally conclusive (Lee and Kasper, 1998:745).
Omidvari, Shahidzadeh, Montazeri, Azin, Harirchi and Souri (2008:142) in a study on the
levels of satisfaction in five major Hospitals in Tehran Iran found that there were significant
relationships between the levels of education of patients and their levels of satisfaction.
Employees with higher levels of education indicated that they were less satisfied with the
services offered in the Hospitals as opposed to those with lower levels of education who
indicated higher levels of satisfaction. However, in their study they did not identify any
significant differences in the levels of satisfaction amongst patient demographics such as
marital status, occupation and gender (Omidvari et al., 2008:152). This is echoed by the
findings of Shaikhi and Javadi (2004:62) who found that there were meaningful differences in
the levels of satisfaction amongst patients of different ages, gender and education. Taylor and
Benger (2004:528) sought to review existing empirical evidence on the impact of gender,
race, education and occupation. In the qualitative paper, Taylor and Benger (2004: 531) noted
that age and race had significant influences on the level of patient satisfaction in most but not
of all the studies reviewed.
Patient diagnosis is another factor that influences patient satisfaction. According to
Boudreaux, Friedman, Chansky and Baumann, (2004:163) in a study undertaken at Cooper
Hospital New Jersey, patients with serious illnesses and diagnosis and those with emergency
needs were more satisfied with services offered than those with minor illnesses and cases.
However, this was attributed to the waiting time of the different set of diagnosis where
serious cases took lower waiting times than minor diagnosis and cases (Boudreaux et al.,
2004:165).
A lack of available information for consumers to choose a preferred health care provider is
commonplace in many countries. We also know that personal channels of communication with
relatives and friends are a major source of information for people wishing to obtain details
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concerning Hospital performance (Hsieh, Cheng and Lew-Ting, 2000:438). Therefore,
recommendations from family or friends become an important source of information for selecting
health care providers. Recommendation as well as satisfaction is based on personal experience
concerning the services that one has received from health providers (Rubin, 1990:267). Patient
satisfaction is multifaceted and a very challenging outcome to define. Patient expectations of care
and attitudes greatly contribute to satisfaction; other psychosocial factors, including pain and
depression, are also known to contribute to patient satisfaction scores (Brent, Perper, Moritz,
Allman, Friend, Roth and Baugher, 1993). Historically, physicians, especially surgeons, have
focused on surgical technique and objective outcomes as measures of “patient satisfaction,” while
patients place great value on the surgeon-patient interaction.
Target Population
McMillan and Schumacher (2006:119) defined a population as a set of elements or cases that
contain specific characteristics or criteria that is of interest to the researcher. Furthermore, the
population may be defined as the sum total of all cases, elements or objects to which
generalization of findings will be made (McMillan and Schumacher, 2006:119). The study
population was the in-patients admitted at the Hospital. This was an ideal group since they spent
some time at the Hospital and had made individual observations.
Sample Size
Sample size refers to the number of elements, individuals or cases that will be subject to research
(Bryman and Bell, 2011:141). Zikmund and Babin (2007:420) on the other hand noted the actual
sample size is dependent on various factors and variables such as the degree of variability, levels
of significance and levels of precision. Furthermore, factors such as heterogeneity or
homogeneity of data affect the actual sample size (Zikmund and Babin, 2007:419).
With the sample target being inpatients in a Hospital with a bed capacity of 65, the sample
population was 65 admitted patients from the various wards. The number of patients in each
ward was distributed with 20 coming from medical ward, 15 from surgical ward, 10 from
pediatric ward and 20 from maternity ward.
Limitations and Delimitations of the Study
There are various private Hospitals in Kenya which provide medical services. Nevertheless due
to time constraints as well as rigorous data access restrictions in medical facilities only the
Meridian Hospital was selected for inclusion in the study. The Meridian Hospital was however
justified for inclusion in this study as it was a medium sized Hospital and data access was easier
RESULTS, INTERPRETATION AND DISCUSSION OF FINDINGS
Response Rate
This study sought to include 65 respondents drawn from various departments of Meridian
Hospital. In total, 61 responses were derived from respondents indicating a 94% response rate
which is considered adequate for data validity, reliability and generalization of findings to the
population (Bryman and Bell, 2011:341).
Demographic Data
This section sought to present the background information including the demographic
characteristics of the respondents.
Age
This section presents to the age distribution of the respondents to this study. According to the
data, 50.8% of the respondents were aged between 21 – 40 years, 23% were aged between 41 –
65 years, 16.4% were aged between 0 – 13 years, 8.2% were aged above 65 years while 1.6%
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were aged between 14 – 20 years. This is as shown in Figure 4.1. These findings imply that
approximately half of the customers of Meridian Hospital are youths aged between 21 – 40 years
while people aged between 41 – 65 years were significant customers. Teens aged between 14 –
20 years represented the lowest source of customers for the Hospital.
Figure 4.1: Age Distribution of Respondents
Marital Status
According to this study, 83.3% of the respondents were married while 16.7% were not. These
findings imply that a very big proportion of customers of Meridian Hospital were married.
Table 4.1: Marital Status
Yes
Valid Percent
83.3
Cumulative Percent
83.3
No
16.7
100.0
Total
100
Gender
This section seeks to present the gender of respondents to the study. According to the data,
majority of the respondents (56.7%) were from the female gender while 43.3% were from the
male gender.
Figure 4.2: Gender
Doctors Care
This section presents the findings on customer’s level of satisfaction with doctor’s care and
professionalism
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Doctors Professionalism
66.7% of the respondents of this study indicated that the levels of doctor’s professionalism were
excellent. Further, 26.7% indicated that doctors care professionalism was very good, 5%
indicated it was good and 1.7% indicated it was fair. This implies that the levels of customer
satisfaction on doctor’s care at Meridian Equator Hospital are very high given the responses by
the customers.
Table 4.2: Doctors Care Professionalism
Valid
Frequency
40
Valid Percent
66.7
Cumulative
Percent
66.7
Very Good
16
26.7
93.3
Good
3
5.0
98.3
Fair
1
1.7
100.0
Total
60
100.0
Excellent
Doctors Care Information
According to 46.7% of the respondents to this study, doctors at Meridian Hospital were excellent
in providing care information. 38.3% percent indicated that doctors were very good in providing
care information, 13.3% rated the doctors as good while 1.7% rated the doctors fairly. This
denotes that doctors were efficient in providing care information to the customers which led to
high levels of satisfaction amongst the customers.
Figure 4.3: Doctors Care Information
Doctors Discharge Information
This section presents the satisfaction of customers with information provided by doctors during
discharge. According to 40% of the respondents, doctors were excellent in providing discharge
information, 31.4% indicated that doctors were very good, 17.1% indicated the doctors were
good, 5.7% indicated the doctors were fair and another 5.7% indicated that the doctors were poor
in providing discharge information. This is as shown in Table 4.3. It implies that levels of
customer satisfaction in doctors discharge information are high. However, there were customers,
though a very small fraction, who was not satisfied with the levels of information provided by
doctors during discharge.
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Table 4.3: Doctors Discharge Information
Valid
Frequency
14
Valid Percent
40.0
Cumulative
Percent
40.0
Very Good
11
31.4
71.4
Good
6
17.1
88.6
Fair
2
5.7
94.3
Poor
2
5.7
100.0
Total
35
100.0
Excellent
Overall Efficiency
Overall, most customers of Meridian Hospital were satisfied with the levels of efficiency,
information and service provided by doctors. This is deduced from the findings of this study that
55.2% of the customers rated the doctor’s services as excellent, 29.3% rated the services as very
good, 13.8% rated good and 1.7% rated doctor’s services as fair.
Figure 4.4: Overall Efficiency of Doctors Information and Services
Nurses Care
This section presents the findings of the study in relation to the customer’s level of satisfaction
with nurse’s professionalism and care.
Nurses Care Professionalism
70.5% of the customers indicated that nurse’s professionalism was excellent. In addition, 19.7%
of the customers indicated that the nurses professionalism was very good, 6.6% indicated it was
good and 3.3% indicated it was fair. Given the distribution of the responses, this study deduces
that most of the customers of the Hospital are satisfied with the nursing care provided by.
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Table 4.4: Nursing Care Professionalism
Valid
Frequency
43
Valid Percent
70.5
Cumulative Percent
70.5
Very Good
12
19.7
90.2
Good
4
6.6
96.7
Fair
2
3.3
100.0
Total
61
100.0
Excellent
Nurses Care Promptness in Attendance
Nursing care promptness was rated excellent by 60.7% of the respondents, very good by 24.6%
of the respondents, good by 11.5% of the respondents and fair by 3.3% of the respondents. The
findings denote that over 95% of the customers were satisfied with the levels of promptness by
nurses to attend to customers in the Hospital.
Figure 4.5: Nurses Promptness in Attendance
Nursing Care Information Provided
According to 42.6% of the respondents to this study, nurses were excellent in providing nursing
care information, 32.8% indicated that the nurses were very good, 16.4% indicated they were
good, 4.9% indicated they were fair while 3.3% indicated that they were poor. This findings
denote that majority of the customers of the Hospital were satisfied with the levels of nursing
care information provided by nurses. However, a proportion of 8.2% was not satisfied with the
levels of nursing care information provided.
Table 4.5: Nursing Care Information Provided
Valid
Excellent
Very Good
Frequency
26
Valid Percent
42.6
Cumulative Percent
42.6
20
32.8
75.4
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Arabian Journal of Business and Management Review (OMAN Chapter)
Vol. 4, No.7; February. 2015
Good
10
16.4
91.8
Fair
3
4.9
96.7
Poor
2
3.3
100.0
Total
61
100.0
Nursing Care, Courtesy and Attitude
Over 95% of the customers of Meridian Hospital were satisfied with the levels of care, courtesy
and attitude exhibited by nurses towards the customers. This is deduced from the findings of this
study that 60.7% rated the nursing care, courtesy and attitude as excellent, 24.6% rated it as very
good, 13.1% rated it as good and 1.6% rated it as fair.
Figure 6: Nursing Care, Courtesy and Attitude
Nursing Overall Efficiency
Overall, 98.3% of the customers were satisfied with the levels of nursing care provide at
Meridian Hospital. This is shown in the cumulative frequency distribution in Table 4.6. Further,
the table shows that, 51.7% of the customers rated nursing overall efficiency as excellent, 22.4%
rated it as very good, 24.1% rated it as good and 1.7% rated it as fair. This implies that the
overall levels of satisfaction with the nursing care provided are very high amongst customers at
the Hospital.
Table 4.6: Overall Nursing Care Efficiency
Valid
Cumulative
Frequency
Percent
Percent
Valid
Excellent
30
51.7
51.7
Very Good
13
22.4
74.1
Good
14
24.1
98.3
Fair
1
1.7
100.0
Total
58
100.0
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Diagnostic Services
This section presents the findings of the study in relation to the levels of customer satisfaction
with the levels of diagnostic services provided by the Hospital. Specifically, this section deals
with the levels of satisfaction with the Radiology department that is X-ray and Ultra sound
diagnostic services.
Professionalism
Over 90% of the respondents to this study were satisfied with the levels of diagnostic services
provided at the Meridian Hospital. This is according to 50% of the respondents who rated
professionalism in diagnostic services as excellent, 27.5% who rated professionalism as very
good and 17.5% who rated professionalism as good. On the other hand, indicators of low levels
of satisfaction were evident with 2.5% of the respondents indicating professionalism to be fair
and another 2.5% as poor.
Table 4.7: Professionalism in Diagnostic Services
Valid
Frequency
20
Valid Percent
50.0
Cumulative Percent
50.0
Very Good
10
27.5
75.0
Good
7
17.5
92.5
Fair
1
2.5
95.0
Poor
1
2.5
97.5
Total
40
100.0
Excellent
4.1.1 Promptness in Attendance
According to 50% of the respondents, levels of promptness in attendance at the Diagnostic
department were excellent. 23.7% indicated that promptness was very good, 15.8% indicated it
was good, 15.8% indicated that it was good, 5.3% indicated it was fair and 5.3% indicated it was
poor. This implies that most respondents they were satisfied with the levels of promptness in the
diagnostic center while 10.6% were not satisfied with the levels of promptness.
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Vol. 4, No.7; February. 2015
Figure 4.7: Promptness in Attendance
Information Provided
86.4% of the total respondents were satisfied with the levels of information provided at the
diagnostic center. However, 13.5% of the respondents were not satisfied with the levels of
information provided. This implies that a significant proportion of the respondents in the
Hospital were not satisfied with the levels of information provided by the diagnostic team.
Nonetheless, 32.4% of the respondents indicated that diagnostic information provided was
excellent, 18.9% rated it as very good, 35.1% indicated it was good and 13.5% rated it as poor.
Figure 4.8: Diagnostic Information Provided
Courtesy and Attitude
39.5% of the respondents indicated that the levels of courtesy and attitude of staff at the
diagnostic center was excellent. Further, 21.1% of the respondents indicated it was very good,
34.2% indicated it was good, 2.6% indicated it was fair while 2.6% indicated it was poor. These
findings imply high levels of satisfaction with the levels of courtesy and attitude of staff at the
diagnostic center. Nevertheless, some of the customers were not satisfied with the levels of
courtesy and attitude.
Table 4.8: Courtesy and Attitude
Valid
Excellent
Very Good
Good
Fair
Frequency
15
Valid Percent
39.5
Cumulative Percent
39.5
8
12
1
21.1
34.2
2.6
60.5
92.1
94.7
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Arabian Journal of Business and Management Review (OMAN Chapter)
Poor
1
2.6
Total
38
100.0
Vol. 4, No.7; February. 2015
97.4
Overall Efficiency
Overall, most respondents to the study were satisfied with the levels of efficiency at the
diagnostic center. According to this study, over 97% of the customers were satisfied with the
levels of services provided at the diagnostic center of the Hospital. In addition, the study found
that, 37.8% of the customers rated the diagnostic services as excellent, 35.1% rated them as very
good, 24.3% rated them as good while 2.7% rated them as poor.
Figure 4.9: Overall Efficiency of the Diagnostic Services
Catering and Housekeeping
This section presents the findings of the study in relation to customer satisfaction with the levels
of services provided by the catering and housekeeping department.
Variety of Meals
The combination and provision of a variety of meals for customers at Meridian Hospital was
rated excellent by 33.3% of the respondents. 31.6 % rated it as very good, 29.8% rated it as good,
1.8% rated it as fair and 3.5% rated it as poor. This implies that the Hospital was efficient in
meeting most customers’ expectations on variety of foods. However, for 5.3% of the customers,
the Hospital did not meet the expectations and needs of the customers as they were not satisfied.
Table 4.9: Catering Variety of Meals
Valid
Frequency
19
Valid Percent
33.3
Cumulative Percent
33.3
Very Good
18
31.6
64.9
Good
17
29.8
94.7
Fair
1
1.8
96.5
Poor
2
3.5
100.0
Total
57
100.0
Excellent
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Portion Size
The portion size of the meals was rated excellent by 32.1% of the respondents, very good by
28.6%, good by 17.9%, fair by 14.3% and poor by 7.1%. This implies that most customers of
Hospital were satisfied with the portion size of the meals. However, a significant proportion of
22% was not satisfied with the portion size of meals provided by the Hospital.
Figure 4.10: Portions Size of Meals
Timeliness of Meals
82.1% of the respondents were satisfied with the timeliness of meals provided by the Hospital.
On the other hand, 18% of respondents were not satisfied with the timeliness of meals provided
by the Hospital. These deductions are implied from the findings of the study that 39.3% of the
respondents found the timeliness of meals to be excellent, 23.2% found them to be very good,
19.6% found them to be good, 7.1% found the time to be fair while 10.7% found the timelines
for meals to be poor.
Table 4.10: Timeliness of Meals
Frequency
Valid Percent Cumulative Percent
Excellent
22
39.3
39.3
Very Good
13
23.2
62.5
Good
11
19.6
82.1
Fair
4
7.1
89.3
Poor
6
10.7
100.0
Total
56
100.0
Cleanliness of Linen
Sixty one percent (61%) of the respondents of this study indicated that the levels of cleanliness
of linen was excellent. 27.1% indicated that the levels of cleanliness were very good, 5.1%
indicated they were good, 3.4% indicated they were fair and 3.4% indicated they were poor. This
implies that most customers were satisfied with the levels of cleanliness of linen in the Hospital
though a proportion of 6.8% was not satisfied with the levels of cleanliness on the linen.
Table 4.11: Cleanliness of Linen
Valid
Valid
Excellent
Frequency
36
48
Valid Percent
61.0
Cumulative Percent
61.0
Arabian Journal of Business and Management Review (OMAN Chapter)
Vol. 4, No.7; February. 2015
Very Good
16
27.1
88.1
Good
3
5.1
93.2
Fair
2
3.4
96.6
Poor
2
3.4
100.0
Total
59
100.0
Cleanliness of Utilities
In terms of cleanliness of utilities 6.9% of the respondents to this study were not satisfied with
the levels of the utilities cleanliness in the Hospital. Nevertheless, 93.1% of the respondents were
satisfied with the levels utilities cleanliness in the Hospital derived from 44.8% who rated
cleanliness as excellent, 34.5% who rated cleanliness as very good and 13.8% who rated it as
good. 1.7% rated the cleanliness of the utilities as fair and 5.2% rated it as poor.
Figure 4.11: Cleanliness of Utilities
Cleanliness of Environment
Overall the cleanliness of the environment was rated as excellent by 50.9% of the customers.
27.3% percent rated the level of cleanliness as very good, 14.5% rated environmental cleanliness
as good, 5.5% rated it as fair and 1.8% rated environmental cleanliness as poor. This shows that
92.7% of the customers were satisfied with the level of environmental cleanliness while 7.3% of
the customers were not satisfied with the levels of environmental cleanliness.
Table 4.12: Environmental Cleanliness
Valid
Frequency
28
Valid Percent
50.9
Cumulative Percent
50.9
Very Good
15
27.3
78.2
Good
Fair
Poor
8
3
1
14.5
5.5
1.8
92.7
98.2
100.0
Total
55
100.0
Excellent
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Accounts
This section presents the findings of the study in relation to customer satisfaction with the levels
of service provided at the accounts section.
Accounting Information Provided
According to 30.3% of the respondents in this study, the accounts information provided was
excellent, 36.4% indicated it was very good, 18.2% indicated it was good while 6.1% indicated it
was fair. On the other hand, 9.0% of the respondents indicated that the level of information
provided was poor. This shows that Meridian Hospital accounts department provided accounting
information that was satisfying to 84.9% of the respondents while 15.1% of the respondents were
not satisfied with the level of information provided.
Table 4.13: Accounting Information Provided
Valid
Frequency
10
Valid Percent
30.3
Cumulative Percent
30.3
Very Good
12
36.4
66.7
Good
6
18.2
84.8
Fair
Poor
2
3
6.1
9.0
90.9
100.0
Total
33
100.0
Excellent
Courtesy and Attitude
Courtesy and attitude of the accounts staff was rated excellent by 34.4% of the respondents. In
addition, 40.6% of the respondents rated courtesy and attitude in the department as very good,
21.9% rated it as good and 3.1% rated it as fair. These findings show that 96.9% of the
respondents were satisfied with the courtesy and attitude of employees while only 3.1% were not
satisfied.
Figure 4.12: Courtesy and Attitude
Admission Speed
80.6% of the total respondents were satisfied with the levels of admission speed at the Hospital.
On the other hand, 19.4% of the respondents were not satisfied with the admission speeds in the
Hospital. In addition, this study found that 33.3% of the respondents rated the admission speed as
excellent, 30.6% rated the admission speed as very good, and 16.7% rated the admission speed
as good.
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Vol. 4, No.7; February. 2015
Table 4.14: Accounts Admission Speed
Valid
Frequency
12
Valid Percent
33.3
Cumulative Percent
33.3
Very Good
11
30.6
63.9
Good
6
16.7
80.6
Fair
7
19.4
100.0
Total
36
100.0
Excellent
Discharge Speed
According to 21.4% of the respondents of this study, the discharge speeds of the accounts
department were excellent. A further 21.4% of the respondents rated the discharge speeds as very
good, 35.7% rated the discharge speeds as good, 14.3% rated them as fair and 7.1% rated them
as poor. This implies that 78.5% of the total customers are satisfied with the discharge speeds of
the Hospital while 21.4% of the respondents were not satisfied.
Figure 4.13: Discharge Speeds
Overall Efficiency
Overall, 92.8% of the respondents were satisfied with the levels of services offered by the
accounts department. On the other hand, 7.1% of the respondents were not satisfied with the
levels of efficiency and service delivery at the accounts department. Nevertheless, 35.7% rated
the overall accounts efficiency as excellent, 25.0% rated the accounts department efficiency as
very good, 32.1% rated it as good and 7.1% rated it as fair.
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Vol. 4, No.7; February. 2015
Figure 4.14: Overall Accounts Efficiency
Other Factors
This section presents other factors that influence customer satisfaction at Meridian Hospital.
These include comfort, cleanliness and knowledge of the Hospital.
Comfort
41% of the respondents were comfortable with the services provided at the Hospital. In addition,
36.1% of the respondents indicated that the Hospital was very comfortable. Nevertheless, 1.6%
of the respondents indicated that the Hospital should improve on the bathrooms while 1.6%
complained that the beds at the Hospital were too small.
Figure 4.15: Comfort of the Hospital
Cleanliness
According to 32.8% of the respondents, the Hospital was clean. Similarly, 39.3% of the
respondents indicated that the Hospital was very clean. On the other hand, 3.3% of the customers
indicated that the Hospital was not clean while 24.6% did not provide a response. These findings
imply that to most customers, the Hospital was clean thus enhancing their satisfaction.
Table 4.15: Cleanliness of the Hospital
Valid
Did not answer
Frequency
15
52
Valid Percent
24.6
Cumulative Percent
24.6
Arabian Journal of Business and Management Review (OMAN Chapter)
Vol. 4, No.7; February. 2015
Clean
20
32.8
57.4
not clean
2
3.3
60.7
Very clean
24
39.3
100.0
Total
61
100.0
Knowledge of the Hospital
According to 6.6% of the respondents, they became aware of the Hospital through family, 31.1%
knew the Hospital through friends, 3.3% through living near the Hospital, 1.6% through previous
experience and 41% through referrals. These findings imply that referrals are the biggest source
of customers for the Hospital and should form the bulk of the marketing plans of the Hospital. In
essence, these findings imply that over 75% of the customers of Meridian Hospital are generated
through referrals, friends and family which all form part of word of mouth and referral
marketing.
Figure 4. 16: Knowledge of the Hospital
Advanced Analysis
This section presents advanced analysis of the data for establishment of patterns, relationships
and trends in the data. The section presents analysis for descriptive statistics, correlation and Ttests.
Descriptive Statistics
Table 4.16 presents the overall statistics across the various departments of the Hospital. It
presents the mean rating of customer satisfaction with 1 representing excellent, 2 very well, 3
good, 4 fair and 5 poor. The findings show that doctors overall efficiency in enhancing customer
satisfaction had a mean rating of 1.64 which was the best. Other departments enhancing
customer satisfaction in their descending order of efficiency include: nursing overall efficiency
(1.77), diagnostic overall efficiency (1.86), catering cleanliness of environment (1.92) and
accounts overall efficiency (2.67). The findings imply that the accounts department services were
the least satisfying to the customers.
Table 4.16: Descriptive Statistics
N
Minimum
53
Maximum
Mean
Std. Deviation
Arabian Journal of Business and Management Review (OMAN Chapter)
Doctors information overall
efficiency
Nursing overall efficiency
Diagnostic overall
efficiency
Catering Cleanliness of
Environment
Accounts overall efficiency
Vol. 4, No.7; February. 2015
61
1
4
1.64
.775
61
1
4
1.77
.864
36
1
3
1.86
.798
61
1
5
1.92
1.021
61
1
5
2.67
.908
Correlation Analysis
Using Pearson’s correlation coefficient this study sought to investigate the relationship between
various factors in enhancing customer satisfaction in Meridian Hospital. According to the study,
accounts overall efficiency and diagnostic efficiency had the strongest positive significant
correlation in enhancing customer satisfaction (0.522). Other factors that had a positive
correlation in enhancing customer satisfaction were doctors overall efficiency and diagnostic
efficiency (0.493), nursing overall efficiency and diagnostic efficiency (0.400), nursing overall
efficiency and doctors overall efficiency (0.493), and accounts overall efficiency and nursing
overall efficiency (0.445).
Table 4.17: Correlation Analysis
Correlations
Doctors
Catering
information Nursing
Type
Cleanliness Accounts
overall
overall
overall
of
overall
efficiency efficiency efficiency Environment efficiency
Doctors
information
overall efficiency
Nursing overall
efficiency
Pearson
1
.378*
Correlation
Sig. (2-tailed)
.023
Pearson
.378*
1
Correlation
Sig. (2-tailed)
.023
Type overall
Pearson
.493**
.400*
efficiency
Correlation
Sig. (2-tailed)
.002
.016
Catering
Pearson
.089
.203
Cleanliness of
Correlation
Environment
Sig. (2-tailed)
.606
.235
Accounts overall Pearson
.279
.445**
efficiency
Correlation
Sig. (2-tailed)
.100
.007
*. Correlation is significant at the 0.05 level (2-tailed).
**. Correlation is significant at the 0.01 level (2-tailed).
c. List wise N=36
54
.493**
.089
.279
.002
.606
.100
.400*
.203
.445**
.016
.235
.007
1
-.057
.522**
.742
.001
1
-.047
-.057
.742
.785
.522**
-.047
.001
.785
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Arabian Journal of Business and Management Review (OMAN Chapter)
Vol. 4, No.7; February. 2015
ANOVA and T-Test Analysis
Analysis of Variance (ANOVA) analysis seeks to analyses significant differences between two
or more groups. Anova is used in this study is used to investigate whether there are significant
differences in customer satisfaction amongst various age groups while T-test are used to for
gender as it has only two groups.
T-Tests
T-tests are conducted for differences in the level of satisfaction across the genders. For the Ttests, the hypotheses to be tested were:
H0: There will be no difference between male and female perceived level of satisfaction
emanating from doctors, nursing, diagnostic, and catering and accounts efficiency.
H1: Female gender will perceive higher levels of satisfaction emanating from doctors, nursing,
diagnostic, and catering and accounts efficiency.
As is evident from the group statistics table, the difference in the means of male and female
across the various customer satisfaction factors vary. That is, the mean difference between
doctors efficiency (Means: 1.54 and 1.74) with standard deviation differences (0.706 and 0.828),
nursing overall efficiency (Means: 1.65 and 1.88) with standard deviation differences (0.846 and
0.880), diagnostic overall efficiency (Means: 1.63 and 2.12) with standard deviation differences
(0.761 and 0.781), catering overall cleanliness (Means: 2.04 and 1.85) with standard deviation
differences (0..958 and 1.077) and accounts overall efficiency (Means: 2.38 and 2.88) with
standard deviation differences (0.852 and 0.913) imply that the null hypothesis is not
substantiated. This therefore means that the female gender perceives higher levels of satisfaction
from the consumption of doctors, nursing, diagnostic, catering and accounts services at the
Hospital. This is illustrated in Table 4.18 and 4.19 below.
Table 4.18: Group Statistics
Group Statistics
Gender
Male
N
26
Mean
1.54
Std. Deviation
.706
Std. Error Mean
.138
Female
34
1.74
.828
.142
Male
26
1.65
.846
.166
Female
34
1.88
.880
.151
Male
19
1.63
.761
.175
Female
17
2.12
.781
.189
Catering Cleanliness of
Environment
Male
26
2.04
.958
.188
Female
34
1.85
1.077
.185
Accounts overall efficiency
Male
26
2.38
.852
.167
Female
34
2.88
.913
.157
Doctors information overall
efficiency
Nursing overall efficiency
Diagnostic overall efficiency
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Vol. 4, No.7; February. 2015
Table 4.19: Independent Sample Tests
Independent Samples Test
Levene's Test for
Equality of Variances
Doctors information Equal variances
overall efficiency
assumed
Equal variances not
assumed
Nursing overall
Equal variances
efficiency
assumed
Equal variances not
assumed
Type overall
Equal variances
efficiency
assumed
Equal variances not
assumed
Catering Cleanliness Equal variances
of Environment
assumed
Equal variances not
assumed
Accounts overall
Equal variances
efficiency
assumed
Equal variances not
assumed
t-test for Equality of Means
95% Confidence
Interval of the
Difference
Lower
Upper
F
Sig.
t
df
Sig. (2tailed)
Mean
Difference
Std. Error
Difference
.488
.488
-.971
58
.335
-.197
.203
-.602
.209
-.993
57.257
.325
-.197
.198
-.594
.200
-1.014
58
.315
-.229
.225
-.680
.223
-1.019
54.967
.313
-.229
.224
-.678
.221
-1.890
34
.067
-.486
.257
-1.009
.037
-1.887
33.338
.068
-.486
.258
-1.010
.038
.693
58
.491
.186
.268
-.350
.721
.704
56.604
.484
.186
.263
-.342
.713
-2.153
58
.036
-.498
.231
-.961
-.035
-2.173
55.671
.034
-.498
.229
-.957
-.039
.062
.104
.059
1.841
.804
.750
.809
.180
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Vol. 4, No.7; February. 2015
Analysis of Variance
Analysis of variance sought to test the hypothesis below:
H0: Customer satisfaction across all age groups will be same irrespective of the level of doctors,
nursing, diagnostic, and catering and accounts efficiency
H1: Customer satisfaction across all age groups will not be same irrespective of the level of
doctors, nursing, diagnostic, and catering and accounts efficiency
From Table 4.20 below it is evident that F value (1.586) for doctors information overall
efficiency is not significant at 0.05 significance levels. Similarly, Nursing overall efficiency F
value (1.686), Diagnostic overall efficiency (0.790), catering overall cleanliness (.447) and
accounts overall efficiency (1.013) are not significant at 0.05 significance levels. This implies
that the hypothesis is not substantiated. As consequence the null hypothesis, Customer
satisfaction across all age groups will not be the same irrespective of the level of doctors,
nursing, diagnostic, catering and accounts efficiency is substantiated. This means that the various
customer age groups have different levels of satisfaction emanating for the provision of efficient
doctors information and services, nursing services, accounts services, catering and housekeeping
services and diagnostic services, that is, each age group perceives differing levels of satisfaction
from the services offered.
Table 4.20: ANOVA Analysis
ANOVA
Doctors information
overall efficiency
Nursing overall
efficiency
Diagnostic overall
efficiency
Sum of
Squares
df
Mean
Square
F
Sig.
Between
Groups
3.670
4
.917
1.586
.191
Within Groups
32.396
56
.578
Total
36.066
60
4.813
4
1.203
1.686
.166
39.974
44.787
56
60
.714
2.064
4
.516
.790
.540
20.241
22.306
31
35
.653
1.937
4
.484
.447
.774
60.653
62.590
56
60
1.083
3.337
4
.834
1.013
.408
Between
Groups
Within Groups
Total
Between
Groups
Within Groups
Total
Catering Cleanliness of Between
Environment
Groups
Within Groups
Total
Accounts overall
Between
efficiency
Groups
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Arabian Journal of Business and Management Review (OMAN Chapter)
Within Groups
46.106
56
Total
49.443
60
Vol. 4, No.7; February. 2015
.823
Discussion of Findings
This study sough to evaluate the levels of satisfaction with the services provided within the
Hospital. Secondly, the study sought to identify whether different clients have different needs
depending on the gender and age.
Levels of Customer Satisfaction
Customer satisfaction in Hospital also referred to as patient satisfaction is a crucial and critical
indicator of quality health care provisioning and function of a health facility. It is a firm primary
business to make sure that all its stakeholders are satisfied. This is inclusive of the customers of
the business. According to the WHO, the analysis of patient satisfaction and the correlation
between various health care services is critical in planning and management of health care
organizations (WHO, 2005). In the measurement of patient satisfaction, various measures and
indicators can be used. Nonetheless Carey and Seibert (1993:934), Tokunaga et al. (2000:395)
and Kane et al., (1998:721) advocated for the use of a Well-recognized criteria include
responsiveness, communication, attitude, clinical skill, comforting skill, amenities, food services
as well as medical care, interpersonal and discharge services. These were the factors utilized in
this study to investigate the level of satisfaction by customers.
According to the study customers satisfaction was enhanced by doctors care and professionalism,
doctors care information provision, doctors discharge information provided and overall
efficiency of doctors. Indeed, as shown in Figure 4.4 over 95% of the respondents indicated that
they were satisfied with the level of doctors overall efficiency and care provided. This is
reinforced by findings in Table 4.16 which shows that doctor’s efficiency was the most
important factor enhancing customer satisfaction. These findings are consistent with the
explanations of quality health service provision by McKinstry (1992:340) and Detmar et al.
(2002:3029) who found that a quality approach to health provision must focus on providing
proper health care intervention. This is often referred to as the paternalistic doctor patient
relationship which when well nurtured and managed can lead to customer satisfaction.
Nevertheless, this is critiqued as a narrow definition of quality health care provision and ignores
other important functions and aspects of health care delivery (Shaikhi and Javadi, 2004:62;
Soleimanpour et al., 2011:2; Taylor and Benger, 2004:531; Tokunaga et al., 2000:395;
Topacoglu et al., 2004:382; Valentine et al., 2008; Yildirim et al., 2005:59).
Nursing care provided was also an important factor that enhances customer satisfaction at
Meridian Hospital. According to the study, nursing actions such as professionalism in care,
nurse’s promptness in attending to clients, provision of nursing care information, nursing care,
courtesy and attitude and overall nursing care were instrumental in enhancing customer/patient
satisfaction. Similarly, Table 4.16 summarizes that nursing care was an important factor in
enhancing patient satisfaction though it was not the most important. Similar to the findings of
this study, Young et al. (2000:325) found that nursing care or the provision of health care by
nurses is of critical importance to forming customer satisfaction. According to Young et al.
(2000:327), patient satisfaction is the function of many factors coming merging to form a unitary
perception of satisfaction. Nevertheless, nursing care and doctor services are among the most
important factors informing patient satisfaction and which every health care provider must seek
to manage (Soleimanpour et al., 2011:2; Taylor and Benger 2004:531; Topacoglu et al.,
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2004:382). Nevertheless, nursing care and doctor services are not the only important factors
influencing customer satisfaction in patients.
Diagnostic services play a critical role in enhancing patient satisfaction. This is according to the
findings of this study which noted that diagnostic services had a strong correlation with nursing
care, accounting and doctor’s services in enhancing patient satisfaction. Furthermore, diagnostic
services such as professionalism in service delivery, promptness in service delivery, provision of
information, courtesy, attitude and overall efficiency were instrumental in enhancing patient
satisfaction in the Hospital. Mira and Aranaz (2000:29) had similar conclusions and findings to
those of this study in their findings. According to Mira and Aranaz (2000:30) the ability of a
health care provide to provide accurate diagnostic services, provision of prompt and quality
services are critical in forming customer satisfaction. This is further validated by the findings of
Yildirim et al. (2005:59); Topacoglu et al. (2004:382); Asadi Lari et al., (2003:60), Parry Jones
and Soulsby (2001:417) and Wen and Gustafson (2004:11) who noted that for some customers
the provision of adequate and accurate diagnosis as well as adequate information to understand
their diagnosis has a direct impact on the level of satisfaction amongst the customers.
Catering and housekeeping were instrumental factors enhancing customer satisfaction amongst
patients in Meridian Hospital. According to this study, catering and housekeeping enhanced
patient satisfaction through provision of a variety of meals, provision of adequate portions of
meals, excellent timelines for meals, and cleanliness of linen, cleanliness of utilities and general
environmental cleanliness. Wen and Gustafson (2004:12), Soleimanpour et al. (2011:2), and
Yildirim et al. 2005:59 in their study noted that other than medical and related services, customer
satisfaction in health institutions may be driven by other social amenities such as cleanliness in
the organization, accommodation, meals and socialization in the health institutions. This is to
denote that, catering and housekeeping factors have a significant influence on the satisfaction of
customers as is the finding of this study. Other scholars who had similar findings to those of this
study include: Tamburini et al. (2000:34), National Health Service (NHS: 2010), Valentine et al.
(2008) and Twigg and Atkin, (1994:205). Carey and Seibert (1993:934) and Tokunaga et al.
(2000:395) further support this findings by noting that for effective customer satisfaction, health
care providers must focus on provision of responsive services, communication, proper attitude,
clinical skills, comforting skills, amenities, food services etc. This is similar to the housekeeping
and catering services identified in this study.
Accounting was the least contributing factor towards customer satisfaction in Meridian Hospital.
This is derived from the correlation analysis in Table 4.17 and descriptive statistics in Table
4.16. This implies that most of the unsatisfied customers attributed it to accounting policies and
practices. Nevertheless, through provision of accounting information, efficient admission and
discharge of patients, courtesy and attitude of employees and general efficiency in the accounting
practices, customer satisfaction was enhanced. Valentine et al. (2008) in his study noted that over
the last 10 years, studies of patient satisfaction have shifted from medical and related services to
health care experiences. He noted that patient experiences such as waiting times, quality of basic
amenities and communication in the health care providers are important drivers of customer
satisfaction. The WHO further validates this findings by arguing that patient satisfaction must
encompass responsiveness of the health organization to speedy admission and discharge of
patients, provision of accounting information and efficiency in provision of supporting services
to the customers. This is similar to the findings of this study.
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It is critical to note that a major factor consistent in all the variables is communication.
Availability and communication between the patients and doctors, patients and support staff such
as nurses and patients and the accounting department is a major factor influencing customer
satisfaction. This implies that the level of communication is a moderating factor that moderates
the levels of customer satisfaction and other variables. Essentially this implies that Customer –
Hospital communication is very important in customer satisfaction. Similarly, Hall and Dornan
(1990:812) noted that the communication relationship between the patient and Hospital is a
major variable influencing customer satisfaction. Furthermore, Carey and Seibert (1993:934)
argued that the level of socialization between the patient and the Hospital had a direct impact on
the levels of customer satisfaction. Socialization in the case of Carey and Seibert (1993:935)
implies to the level of interaction between the customer and patient. Interaction is indicative of
the level of communication between the two parties. Lee and Kasper (1998:745) had similar
findings and noted that the levels of interpersonal as well as communication skills between the
customer and the Hospital were critical in forming positive perceptions of the Hospital and
products or services provided. These positive perceptions were instrumental in enhancing
customer satisfaction. In summary, the importance of communication between patients, doctors,
management and support staff was also emphasized by Hsieh et al. (2000:438) and Rubin
(1990:267) who argued that the availability of communication systems and channels in health
care management facilities was very important in enhancing customer satisfaction.
Customer Needs Differences by Age and Gender
Various studies have sought to investigate the levels of satisfaction across various groups of
stakeholders or demographic populations. Nevertheless, there has been little consensus on the
magnitude and level of satisfaction across various groups. In this study the level of satisfaction
varied across various age groups comprising the customer’s at Meridian Hospital. According to
the study, customers across various age groups had different levels of satisfaction from the
consumption of doctor, nursing, catering and housekeeping, accounting and diagnostic services
of the Hospital. Similarly, there were differences in the levels of consumption between the
female and male gender. According to this study, the female gender perceived higher levels of
satisfaction from consumption of services than the male gender.
These findings are synonymous with the findings of Hargraves et al. (2001:636) who noted that
the levels of patient satisfaction differed as the patient characteristics such as gender, and age and
education differed. This was informed by the difference in quality assessment in the customers.
Similar, Covinsky et al. (1998:78) found that the levels of patient satisfaction differed though his
contributing factor was different to that of this study. Covinsky et al. (1998:80) noted that the
patients’ health status and severity of the illness were major factors informing the level of
satisfaction in health provider’s services. Other scholars with similar findings to those of this
study on the differing levels of satisfaction between customers included Finkelstein et al.
(1998:69) who identified the informing factor to be Hospital size and interpersonal skills
identified by Hall and Dornan (1990:812).
CONCLUSIONS AND RECOMMENDATIONS
Findings from the Study
This section presents the key findings of the study. The findings are discussed under two main
sub headings: findings from the literature review and findings from primary study.
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Findings from the Literature Review
From review of the existing literature on customer satisfaction in health providers, various
factors were identified to influence the levels of customer satisfaction. These factors are
summarized below:
Customer Satisfaction
It is vital for every health service provider to ensure that its customers are satisfied with the level
of services provided (WHO, 2005). As a consequence most of the health care efforts, actions and
activities are aimed at enhancing customer satisfaction (Lin and Clousing, 1995:71). Similarly,
the products and services offered by health care institutions must be informed by customer
expectations, needs and wants. This is the strategy towards enhancing customer satisfaction
(Chase and Aquilano, 1992:193).
Customer satisfaction is critical for the attraction and retention of customers as well as reducing
the marketing costs associated with seeking new customers (Kane et al., 1998:721). Kotler
(2010) noted that the retention of customers is cheaper than the attraction of new customers.
Therefore, the firm must make efforts to ensure that its current customers are content and
satisfied with the services and products provided. This is also a strategy towards enhancing
customer loyalty (Kotler, 2010). The analysis of customer satisfaction in health service providers
is also critical in informing decision making for the management, planning, direction and control
of services as part of the management process (Tokunaga et al., 2000:395). Analysis of customer
satisfaction and the factors influencing customer satisfaction in health service providers also
helps the management to develop appropriate strategic alternatives and plan to acquire a
competitive edge and market the business to new and potential customers (Carey and Sibert,
1993:934).
Doctors Care and Professionalism
Doctor’s care and professionalism is very critical in informing the customer satisfaction levels.
Doctor’s care and professionalism is instrumental in forming paternalistic doctor patient
relationship which is instrumental in enhancing customer satisfaction amongst customers
(McKinstry, 1992:340). Furthermore, doctor’s care and professionalism is important in
enhancing holistic quality healthcare provision by health care institutions (Detmar et al.,
2002:3029). Nevertheless, this view of doctor’s role as the only important factor in enhancing
customer satisfaction is deemed too simplistic and narrow for effective customer satisfaction
measurement (Asadi-Lari et al., 2003:59; McKinstry, 1992:340; Parry-Jones and Soulsby,
2001:417).
Doctor’s professionalism is also a major factor influencing customer satisfaction levels (Greener,
2008:58). Doctor’s professionalism revolves around the activities of the doctor, the relationship
of the doctor and the patient and that of the doctor of managers in the Hospital as well as support
staff for example Nurses and Laboratory technicians (Greener, 2008:59). This relationship is
influential in informing customer expectations and confidence in the Hospital. A customer
confident about a doctor will have higher levels of satisfaction than a customer with lower levels
of confidence (Greener, 2008:59). Furthermore, the customer’s Hospital trust is greatly
influenced by the doctor’s actions and professionalism (Muller, Kane, Shamliyan, Duval and
Wilt, 2007). The interpretation of the doctor’s actions and professionalism by the customer will
highly influence the level of trust of the Hospital in the customers mind and effectively the
patient’s level of satisfaction.
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Diagnostic Services and Professionalism
Proper diagnosis of patients and the communication of the diagnosis information is a critical
driver of customer satisfaction (Mira and Aranaz, 2000:29). While treatment may form important
perceptions of quality health care, some patients may not be interested in the level and type of
treatment. Rather the patients may be more interested in the diagnosis and how this information
translates to their health and well-being (Asadi-Lari et al., 2003:59; McKinstry, 1992:340). This
therefore denotes that diagnosis services provide a major factor that influences the level of
satisfaction amongst some customers in health institutions.
Support Services
Support services are critical in informing customer satisfaction across patients in health service
providers. According to Wen and Gustafson (2004:11) customer satisfaction in health facilities is
informed by support services provided in the Hospitals such as comfortable beds, food and
nutrition, accommodation, socialization, cleanliness and comfort offered in the Hospitals. These
are secondary services offered by the Hospital to enhance their customer satisfaction and are
critical in informing customer satisfaction. This is according to Tamburini et al. (2000:34),
National Health Service (NHS; 2010), Valentine et al., (2008) and Twigg and Atkin, (1994:205).
Carey and Seibert (1993:934) and Tokunaga et al. (2000:395) who found that provision of
responsive services, communication, proper attitude, clinical skills, comforting skills, amenities,
food services etc. are instrumental in enhancing customer satisfaction. Other support services
instrumental in enhancing customer satisfaction include speedy admission and discharge,
provision of information and positive attitude of employees involved in service delivery.
The relationship between the health care providers and patients is a factor that has a huge impact
on the customer satisfaction levels (Hall and Dornan, 1990:812). This is synonymous with the
findings of Carey and Seibert (1993:934) who noted that socialization in the Hospitals is a major
factor impacting on the level of customer satisfaction. Socialization is affected by the
interpersonal and communication skills and levels between the patients and employees (Lee and
Kasper, 1998:754). Customers have higher levels of satisfaction where the level of
communication between the provider and the customer is very high (Hsieh et al., 2000:438). This
was validated by Rubin (1990:267) who noted that the availability of communication channels in
a Hospital is instrumental in forming positive customer perceptions and ultimately customer
satisfaction.
Findings from the Primary Study
Findings of from this study are discussed in relation to the research objectives of the study.
Inpatients level of Satisfaction in Services Provided
Customers of Meridian Hospital were overall satisfied with the level of services offered by the
health institution. According to this study majority of the customers were satisfied with the
doctor services offered, the nursing care, diagnostic service, catering and housekeeping and
accounting services offered by the health institution. Nevertheless, doctor’s efficient services
were the major source of customer satisfaction. Nursing care, diagnostic, housekeeping and
catering and accounting followed in the descending order of contribution to customer’s
satisfaction.
Doctor’s services enhancing customer satisfaction included: provision of doctors care and
professionalism, doctors care information provision, doctors discharge information provided and
overall efficiency of doctors. Nursing care services enhancing customer satisfaction included
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professionalism in care, nurse’s promptness in attending to clients, provision of nursing care
information, nursing care, courtesy and attitude and overall nursing care.
Diagnostic services enhancing customer satisfaction were professionalism in service delivery,
promptness in service delivery, provision of information, courtesy, attitude and overall
efficiency. Catering and housekeeping services enhancing customer satisfaction were provision
of a variety of meals, provision of adequate portions of meals, excellent timelines for meals, and
cleanliness of linen, cleanliness of utilities and general environmental cleanliness. Finally,
accounting services that enhanced customer satisfaction were provision of accounting
information, efficient admission and discharge of patients, courtesy and attitude of employees
and general efficiency in the accounting practices.
Differences in the Level of Satisfaction across Various Customer Demographics
There are major differences in the level of satisfaction across various customer demographics in
the health sector. This study found that customers of different age groups perceived varying
levels of satisfaction informed by the perceptions, preferences and expectations of the differing
age groups as enumerated in the differing characteristics, preferences and needs of different
generations (William and Page, 2010). According to the study, customers of different age groups
had different levels of satisfaction from consumption of doctor’s services, nursing, diagnostic,
catering and housekeeping and accounting services.
Similarly, this study found that the levels of satisfaction between the different genders differed.
According to the study the female gender perceived higher levels of satisfaction from the
consumption of doctor nursing, diagnostic, catering and housekeeping and accounting services
than their male counter parts.
Other factors identified as influencing the level of satisfaction in customers were the level of
cleanliness and comfort provided by the Hospital especially, the beds and attitude of employees.
Conclusion
The main aim of this study was to evaluate the levels of satisfaction in inpatient customers at
Meridian Hospital. Further, the study sought to investigate whether the level of satisfaction in
customers differed as the customer demographics varied. The study concludes that majority of
the customers of Meridian Hospital are satisfied with the level of services offered by the
Hospital. Furthermore, the level of satisfaction in the doctors’ services is highest while that
derived from accounting services is lowest. Nevertheless, majority of the customers are satisfied.
Secondly, this study concludes that nursing services, diagnostic services and catering and
housekeeping services are instrumental in enhancing customer satisfaction. Nevertheless,
customer satisfaction cannot be achieved through the provision of certain or select services that
enhance customer satisfaction. On the contrary, this study concludes that high levels of
consumption in customers can only be achieved through the provision of quality services across
all the major facets of services delivery, that is, health institutions must provide quality services
in doctors’ services, nursing, housekeeping and catering, diagnosis and accounting.
Further, this study concludes that the interaction of the various facets of services have differing
impacts on the perception of satisfaction across various customer markets. This implies that the
actions and services of the health provider have a differing impact on customer satisfaction
across the youth, teens, the aged or the children. Similarly, service provision in Hospitals has
differing impacts on customer satisfaction for men and women. Generally, women have higher
levels of satisfaction from the consumption of services than men.
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This study has identified the levels of satisfaction of inpatient customers at Meridian Hospital. In
addition, the study has found that there are differing levels of customer satisfaction across
various customer demographics. Given the findings of the study, Meridian Hospital and other
Hospital can draw upon the findings and develop appropriate customer service management
policies, customer relationship management strategies and marketing plans. Essentially, the
findings of this study will be instrumental in informing the Hospitals that word of mouth
advertisements and referrals are the major sources of business and customers.
Recommendations
The third objective of this study was to make recommendations on how the organization can
improve in patient service delivery. The recommendations made for this study is therefore
generated from the findings and issues identified in the study. Specifically, the recommendations
will draw from the findings which indicated high levels of unsatisfied customers. This will be the
areas that the Hospital can draw from to improve customer satisfaction and enhance customer
relationship management. They include:
a. Information Dissemination and provision – Information dissemination is a major
challenge facing the Hospital. The Hospital must therefore develop a communication
policy detailing the type, when and where the employees provide information to the
patients. Specifically, the Doctors should enhance their provision of information when
discharging patients. Specifically, doctors must provide information on when, why and
the after discharge procedures to be followed by the patient. This will enhance the level
of customer satisfaction. Secondly, Nurses must be willing to provide information on the
nursing care. Diagnostic services must provide information on diagnosis, implications
and diagnosis and way forward to patients. Accounting department is also a major poor
performer in the provision of quality accounting information to the customers. This must
be enhanced through the development of a communication plan/strategy or the revision of
the existing communication strategy.
b. Enhancement of Professionalism in service Delivery- Meridian Hospital must enhance
professionalism in service delivery. This is especially in the diagnosis sector which was
identified as major weakness and the accounting department. Professionalism in the
sectors must ensure efficiency and effectiveness in attendance to patients, admission and
discharge of patients and attitude of employees towards patients.
c. Provisions of quality support services – Support services are critical in enhancing
customer satisfaction. Specifically, this study recommends that the Hospital must
enhance support services such as provision of a variety of meals, revise the timelines
followed during meal times, provide ample and comfortable space, and provide comfort
and counseling to patients as well as enhancing the size of beds for some of the customers
who perceive them uncomfortable.
d. Cleanliness – Cleanliness is a major factor informing customer satisfaction. This is
evident from the findings of this study. As a consequence, this study recommends that the
Hospital must enhance the cleanliness of linen and utilities which some of the customers
perceive as poor. In addition, the Hospital must enhance environmental cleanliness.
e. This study further recommends that the Hospital must develop appropriate actions and
strategies to enhance customer satisfaction amongst the male customers. Due to low
customer perception of satisfaction by male customers, the levels of male customers is
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lower. The Hospital must therefore develop appropriate marketing strategies to appease
this critical customer segment.
f. Finally, this study recommends that the Hospital must develop a marketing strategy that
enhances the manipulation of the 4 P’s of marketing that is, place, price, position and
promotion. The marketing plan must be centered along use of referral marketing and
word of mouth to enhance customer attraction. This is based on the findings of the study
that referrals were the major source of customers.
Areas for Further Studies
Based on the findings of this study the following recommendations for further studies:
i. This study should be replicated in other health institutions for comparison of the findings.
Due to the lack of similar studies in the field, this study should be replicated to other
health institutions especially public health providers since the case of this study was a
private health provider. This will be instrumental in comparison of findings.
ii. While customer satisfaction is one of the goals of any organization, health institutions
have other responsibilities to other stakeholders including shareholders, government,
community and suppliers. Furthermore, it is the goal of any organization to post positive
returns and profits. This study therefore recommends further analysis on the impact of
customer satisfaction on organization financial performance using a health institution as
the case of the study. The findings of the study will be instrumental in forming opinion on
whether health institutions should pursue customer satisfaction at the expense of financial
performance.
iii. Finally, this study makes recommendations for further studies on the impact of
management action on customer satisfaction. This study has noted that doctor’s services,
nursing, diagnostic, accounting, catering and housekeeping have an effect on the level of
customer satisfaction. However, one critical factor has not been analyzed management
action. Management action has an impact on all the above factors and could therefore have
a moderating effect on the levels of customer satisfaction. Further studies should therefore
be undertaken to investigate the impact of management action on customer satisfaction in
health service providers.
Conclusion
This study sought to evaluate the levels of satisfaction amongst in patients at Meridian Equator
Hospital. The study has achieved its objectives as it has identified high levels of satisfaction
with the services (doctor’s care, diagnostic services, nursing care and other services for example
accounting and catering and housekeeping services). In addition, the study has achieved its
second objective of identifying whether there are differences in the levels of satisfaction amongst
differing customer demographics such as age, diagnostics and gender. This study found that the
levels of satisfaction with services offered differed amongst the various customer demographics.
NOTE: This study was presented as a dissertation by the principal author in 2014 to the
Regent Business School for the award of the Master of Business Administration Degree
(MBA). The dissertation was supervised by Richard Cowden and edited by Professor Anis
Mahomed Karodia for purposes of producing a publishable journal article.
Kindly note that the full bibliography is cited within this article and that references
applicable to this article are cited within the full bibliography cited.
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