A presentation about:
The Patient Journey InThe Palestinian
Governmental Health System In Hebron
Prepared by :
Ins. Dr Hussein Jabareen
During our study about the patient journey in the
Palestinian governmental health system during the last two
months we met eight patients and took their opinion
about the health system in Hebron (Governmental Hebron
The results exceeded our expectation and desired
outcomes ,so we decide to show our research result as a
study of a phenomenon that has a direct and indirect
causes leading to a result.
The research objectives:
*exploring what patients think about their journey in the
governmental healthcare system?
*are the changes they need to make this journey smooth
*what driving these changes?
*how these will impact on service delivery in our
Palestinian health care system?
* What are the effect of this system on the patient?
The main themes that we explored initially
with the patients about were:
1.Attitudes toward the system and the health care staff
2.Anxiety that patients feel and its sources
3.The financial limitations and its effect on the patient and the
4.The degree of satisfaction from services
5. How we can improve the system quality and quantity
We used a qualitative design, a semi structural interview as
a tool to collect qualitative data .
The strength and important of using this approach of
research is that the qualitative research can provide a much
more holistic view of the problem under investigation
,including information that cannot be reduced to numbers
,also it allows researcher to interact with the research
subjects in their own language and on their own terms.This
approach a deeper understanding of the problems that the
patients faced in health care system.
Statistical tests that used in analyzing data process:
We used the 10 version of NVIVO program.
How the data were collected:
After we choose our sample according to the mentioned
criteria and take their consent to conduct the interview,
stating and explaining to them the main goal of the
interview and that recording is for purposes of scientific
research and also no one other than the research team
will listen to the tapes.
The interviews was emptied and formulated and then
translated to the English language have been introduced to
NVIVO program for analysis.
Anxiety from dealing with the system was a very big surprise
that all of the patients said that they feel anxious from dealing
with the system and emphasize on that the anxiety status
from the system is greater than anxiety from the disease
We found that there is a direct and indirect reasons for the
patients anxiety starting from the staff dealing with ,so we
study the patients attitude toward three segments of the staff
include doctors ,nurses, and administrative employees
,because they are dealing directly with the patients reflecting
the system policy and flexibility .
Many obstacles in the system make them feel
*starting from the registration process.
*the staff dealing with them.
*the long time to inspect and treat them.
*the lack and shortage in the equipment and
*the procrastination process to have some specific
* the environment and structure of the hospital.
Direct causes of the patient :
We found that the major sources of patients
anxiety were the staff of the system because they
are in a continuous direct contact with the patients
, so we asked the patients about their attitude
toward the three components of the staff:
Attitude toward administrative employees:
“the first line of the system that the patient faces”
The patients have a mixed attitude toward them, the
patients who has a negative attitude said that there is a
shortage in there manner of dealing with patients and
that there is a one window for registration, also patients
mentioned that they sometimes make a shortcut for
their relative or specific patient .But the other part of
the patients with positive attitude said that the of their
dealing comes from the huge number of patients.
"Their dealing was unstable due to the pressure"
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Attitude toward doctors:
The patients have nearly a negative attitude toward doctors as we
found in our study, the patient relating that to many causes like
*doctors take a long time to inspect and assess them and when they
do they did it is a not probable manner according to the patients
*the ambiguity of the doctors discussion
* the refusal of them to describe what happening to the patient lead
to form negative attitude toward them.
“But unfortunately, up till now, I have not seen the doctor and he
haven't told me anything about my case.”
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Attitude toward doctors:
But, also all the patient have a ppositive attitude toward
the doctors explaining this that they are a qualified
doctors and competitive, the patient said that huge
number of the patients that the doctor need to see daily
make the doctors dealing in the negative manner, in
addition to the shortage of the doctors number in the
system was a reason that the patient excuse the doctors
in their dealing.
“ I thought he did explain that due to the enormous
pressure for the patients.”
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Attitude toward nurses:
Those patients have a negative attitude toward nurses,
*they did not care about the patients and
*they make the patient wait a long time to give him/her
medications or care *when they do they do in a not serious
"They do not care about patient upon arriving to the
hospital, for example, they put the patient on the bed in
emergency department and procrastination starts from
doing examination and registration"
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The patients who have appositive attitude said that they are
good as doctors and dealing with the patients complaisance,
also there is a shortage in their number.
They are as good as doctors".
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The patients also mentioned other indirect causes that
increase their anxiety toward the system which we will
talk about in the subsequent slides which they are:
*Flexibility of the system
*The equipment efficiency
Flexibility of the system:
The patient's opinion fluctuates about the flexibility of the
Part of them see the system not flexible enough ,because of
the complex process to enter the system starting from the
registration process to the emergency room ,the lab and
other services like the services of the X-ray department
,ending in the difficult admission process.
"It is difficult.This process affected my health situation. I have
an experience happened with my grandson.We suffered a lot
to get a medical transference in Al-Ahli hospital. Until this
moment, we have not received it and we are not satisfied
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Another part of the patients saw the system as flexible and
easy to get the service from it with some obstacles that
fixed in the nature of any governmental system.
"Regarding coordination between departments, I can say it
is a good one"
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This is another aspect that we found it increasing and
exceeding the patient's anxiety feeling, in which the patient
emphasized that many of the important equipments always
are not efficient
"When I needed x-rays, I used to go to Shawar center.The
x-rays and televised images were not available in the
hospital and we used to do them outside“
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This is one of the important matters that annoying the
patients and made them to complain all the time.
They said that it is a major problem that they cannot find
their necessary medications in the hospital, so they forced
to buy them from out sources from their own money.
"Most of the time not, I used to buy medicine from outside"
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The patients who said that they get their medicine from the
system said that they just find the analgesics and some
necessary drugs that they need.
"The expensive drugs don't find in the pharmacy just the
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Aiding causes :
There is another cluster of factors that emphasize the
anxious state of the patients, but they occupied little space in
the patient's concentration, we can put them in the category
All of the patients complain from the very long waiting
time to achieve the service from the system, many of them
named the day of the registration or admission as a
"What bothers me most is the long waiting time that
lasted sometimes between 4 to 5 hours“
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There is another patient that saw the waiting time as
acceptable rationalizing by the huge number of patients.
Environment &Waiting room:
The waiting room is the first place that the patient spends
several times in it, so it has to be suitable and comfortable.
The patient complains about the narrow space of the
room and the shortage in the seats and other
componetnce that help them to spend time.
"This is exactly the core problem and the basis of suffering.
We used to come early with the first hours of dawn.There
were large and big queues, rather massive, and we used to
make turns between us in order to facilitate registration, in
addition, we used to wait for long times."
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This lead to talk about the whole environment of the
hospital in which the patients opinions fluctuate but many
of them see that it is a good environment with a good
hygiene emphasizing on the problem of crowded people
that give no chance to achieve more better environment
by organizing the system and the process of cleaning.
"The cleanliness of the place is bad due to overcrowding
section with devices and people who prevent to reach the
Janitorial acquired degree.“
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The results of the previous issues on the patients
All the discussed factors that lead to the anxious state of
the patients result in many important manners that we try
to measure across our sample
*Loss of confidence in the system
*Low satisfaction state
•*The treatment achievement
*A personal financial problem
Satisfaction & Confendtiality:
All of the patient are not satisfied about the system staff and
services. Using their experience in dealing with the system
to form this picture ,they said that there is a chance to
improve the system and existing process can be modified to
be more efficient ,flexible, and productive,
"I can touch a shortage in the number of doctors and nurses,
the matter that affects the value of the treatment provided
to the patients due to the large number of patients and
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The mentioned speech and description move us to talk
about a related items that is fixed with satisfaction which
Many of our patients showed an acceptable level of
confidence even through one of them who had a
complication due to diagnostic mistake said that he still
believe in the system, but dealing with it carefully.
All of the patients said that they achieved their treatment
even so in a minimum degree but they are satisfied about
"The most important thing to me is to do the kidney
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One of the major and important aspect that the
patients talked about it repeatedly and put it as
desktop to their problem, because the poor financial
state of our patients they was forced and have no
choice to deal with an alternative health system and
all of them have a governmental insurance that make
them pay little money to get the service.
" His financial situation does not allow us to buy
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Another aspect that lead to the financial problem
among the patient the lack of equipments and
medications which made them to seek an outdoor
alternative service that cost them a lot.
From our study we found that the system affect directly the
patients that deal with it .leading to put the patients in an anxious
state come from the manner of staff dealing that make the
patients have a negative attitude toward the system and its staff.
The patients think that the circumstances which lead to anxiety
are modified and can be improved to a good state if the system try
to invest more effort on it .
We conclude that the system can improve its services by making
the patient journey smoother and easy by building up a matrix that
fit the Palestinian patients and separate the facilities of the
ministry with wide responsibilities for each facility to cover the
large number of patients that need the system services.
As of our patients said " it’s a good system but it can be better".
•The long time to get the ministry approvement
•There was no separated space to interview our patients
•There was no previous studies that talk about our issue
•There was no accurate fresh data measuring the
patients attitudes and satisfaction
* the waste of time trying to get the envivo program
Because the kind of our study we found that it's better to
write down the recommendations of our patients because
any modifying in the system affects them directly.
*I can suggest more windows for the registration
*Having larger number of medics in each department of
the outpatient clinics and emergency.
*The availability of ECHO device.
*Expanding the space of outpatient clinics with more than
one window for registrations.
* Improving the administrative side, transference, shortage
of doctors, and some medications and equipments.
*It would be better if we have more seats.
*Regulating the distribution of medicines to whoever needs
them urgently, and whoever has the same medicines at home
shall not get them.
*Increasing the number of caretakers and security guards.
* By having special committee to decide who need the Ext
hospital rapidly more than others.
*I think it should have a doctor for each patient who has a
kidney dialysis to help him in the case of emergency.
* By building an infrastructure; for example, kidney
department in Alia Hospital is not suitable where was
expanded through patching and imperceptibly boring.
* I would like to put doctor in the right place and the
specialist attendants with patient. He should replay to the
patient's inquiries.The crews' dealing is easier and more
The research team recommendations:
*take the patients recommendations and try to use them in
improving the system.
*put a suitable plan that makes the patient journey
* find a source of information about the patient journey in
Palestine that we did not find when we did our study.
* The staff should be more effective when dealing with the
*explain every procedure to the patient to remove the
•Sys is not
• non efficient
*long waiting time
Personal financial problem