12342Word Count 5363 Plagiarism Per

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Word Count: 5363
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sources:
5% match (publications)
Hassan Soleimanpour. "Emergency department patient
satisfaction survey in Imam Reza
Hospital, Tabriz, Iran", International Journal of Emergency
Medicine, 2011
< 1% match (Internet from 09-Dec-2012)
http://www.bignerds.com/tag/the-mega-church/79/
< 1% match (Internet from 06-Mar-2014)
http://publications.theseus.fi/bitstream/handle/10024/20401/jam
k_1209461503_7.pdf?

sequence=1
< 1% match (Internet from 13-Feb-2015)
http://w1219.cenbank.org/Out/2013/RSD/CBN%20Occasional%
20Paper%2041%20Inner.pdf
paper text:
Running head: PATIENT SATISFACTION IN SAUDI ARABIA
Patient satisfaction with emergency services
in Aliman Hospital in Saudi Arabia Author’s name Institutional
affiliation Contents Patient satisfaction with
emergency services in Aliman hospital in Saudi
Arabia......................... 3 1.0
Introduction............................................................................
...................................................
3 1.1 Research
objectives................................................................................
................................... 4 1.2
Research
questions.................................................................................
...................................
4 1.3 Research design
...............................................................................................
......................... 4
3.0 Literature
review.....................................................................................
.................................. 5 3.1 Some
of the challenges in the Emergency service
department................................................. 7 3.2 Reason why

patient satisfaction is
important............................................................................ 8
3.3 Strategies for
improving the clients
experience........................................................................ 9
javascript:openDSC(2061691080, 1390, '390');
http://dx.doi.org/10.1186/1865-1380-1-2
http://dx.doi.org/10.1186/1865-1380-1-2
http://www.bignerds.com/tag/the-mega-church/79/
k_1209461503_7.pdf?sequence=1
k_1209461503_7.pdf?sequence=1
http://w1219.cenbank.org/Out/2013/RSD/CBN%20Occasional%
20Paper%2041%20Inner.pdf
4
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4.0 Research
methodology............................................................................
................................
10 5.0 Results and
findings..................................................................................
.............................. 12
6.0
Discussion...............................................................................
................................................
14 7.0 Limitations of the study
...............................................................................................
........... 18 8.0
Conclusion
...............................................................................................
............................... 19
References..............................................................................
....................................................... 20 Patient
satisfaction with emergency services in Aliman hospital in
Saudi Arabia 1.0 Introduction Patient satisfaction
is a very significant issue when it comes to healthcare in the

modern era. Additionally, the Emergency
Service
Department (ED) is believed to act as one of
the primary gatekeepers of patient’s treatment. In this case, it
is acknowledged that EDs should establish a
way of achieving
customer satisfaction by offering quality services (Shelton,
2000).
Moreover, according to available statistics, the number of ED
patients is
increasing steadily. In other words, this is a clear indicator of
the significance of
establishing quality services’ plan based on
the patients’ needs and demands. To realize successful
planning, comprehending the needs, views and the
requirements of customers is an essential step. Moreover, the
most commonly employed tool for improving
the quality of services in the Emergency Service Department is
performing a client satisfaction survey so as
to explore the variables that may be affecting the clients’ levels
of satisfaction and the common causes of
dissatisfaction among patients and customers (Shelton, 2007).
In simple terms, it is believed that the
satisfaction level of customers
is a primary component in choosing an Emergency Service
Department for
receiving services or even making recommendations to others.

Although it

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is very impossible to make all the clients satisfied,
it is acknowledged that customer satisfaction can be achieved
through
working on related satisfaction indicators and trying
as much as possible to improve them. Studies obtained

from other global countries indicate that employing the findings
and results
from previous satisfaction surveys can
help in enhancing the quality of the emergency services
(Shelton, 2007). Therefore, in this research work,
the level of satisfaction of patients presented to the Emergency
Service Department of Aliman hospital. The
facility was one of the renowned Emerge ncy Department
centers in Saudi Arabia with over 30,000
admissions per year will be examined and analyzed to establish
possible ways of improving the quality of
care services so as to increase the level of patient satisfaction.
1.1 Research Objectives ? To investigate
the waiting time by patients before being examined ? To
determine the relationship between communication
skills of and the satisfaction levels among patients ? To explore
the challenges and problems facing
patients and clients of Aliman hospital ins Saudi Arabia as far
as patient satisfaction is concerned ? To
examine the educational background and the literacy levels of
the participants 1.2 Research questions ?
What are the educational background and the literacy status of
the respondents? ? What is the experience
of the patients with the Emergency Service Department? ?
What is the relationship that exists between
communication skills and the satisfaction levels of the
patients? ? What are some of the factors that
determine the effectiveness of service emergency department?
1.3 Research design In this joint cross-
sectional research work, the methodology that was adopted
encompassed both qualitative and quantitative
research methodology. In this case, qualitative research
methodology involves a subjective technique that
covers the identification of new ideas and knowledge,

fieldwork participation and the employment of the
person doing the research as the primary information and data
source. In this case, the researcher has the
responsibility of realizing the meaning of the phenomenon
involved in the research and the nature of reality.
In other words, the research personnel does not concentrate
much on the outcome of the study, but their
primary focus is on the research process. The questionnaires
that were employed in this research had
additional questions that enabled the respondents to provide
their personal perception of the influence of
the healthcare provider’s communication skills in improving
the patient satisfaction. Interviews were also
employed in this research work to help in establishing a trusted
environment between the researcher and
the interviewee making it easy to clarify and validate data and
information that is collected. The mixed
approach technique in this research aided in combining
research methodologies in collecting the same
information and data. In so doing, it helps in reducing errors
and the possibility of biases when it comes to
data collection. In this case, the employment of both secondary
and primary data collection methods which
in one way or the other ensured that the information that was
collected was more credible. Additionally, the
mixed research approach allowed for cross-checking and
clarification as far as any ambiguity in the
collection of data is concerned. Moreover, the questionnaires
were administered in a manner that permitted
participants to take approximately 24 hours in answering the
questions. In so doing, it gave the respondents
enough time and the privacy needed to respond to the questions
appropriately. Besides, the interviews that

were conducted consisted of structured questions that made it
possible for the researchers to collect the
desired information in the most efficient manner. In summary,
each research interview was allocated a
maximum of thirty minutes to ensure that both the researcher
and the interviewee utilized the time that they
were allocated in the most efficient way. 3.0 Literature review
It is universally acknowledged that the
Emergency Service Department is a unique context that in one
way or the other, presents some challenges
whenever there are attempts to improve the quality and the
experience of care (Shelton, 2000). However, it

is known that it is not fundamentally impossible to improve and
make the healthcare experience more
positive and in the process, generate a high level of patient
satisfaction (Dave, 2001). If taken seriously, so
many scholars believe that high level of patient satisfaction
will be the backbone of many healthcare
services including the ESD (Shelton, 2007). Additionally, it is
believed that research work findings and
results, suggestion and opinions are open to modifications and
if taken with the seriousness they deserve,
they are one of the crucial elements in improving the quality of
the Emergency Service Department. In this
case, some issues and challenges affecting the healthcare
department should be divided among teams to
identify and discuss organizational and behavioral changes that
would help the hospital improve the level of
client satisfaction. It is believed that most of the patient
satisfaction factors revolve around managing the
perceptions of the patients. However, the physical setting of
the healthcare facility and the hospital budget
as well; play a crucial role in impacting the level of patient
satisfaction when it comes to Emergency Service
Department though more attention is on the management of the
patient’s behavior and perceptions
(Shelton, 2007). Additionally, new and cheerful emergency
facilities, having an efficient and high-quality
radiology unit in the ED, which helps in speeding up the
diagnosis and increased staffing, are also important
in improving the satisfaction level of patients. However, not all
hospitals can accommodate or afford to have
all these improvements. Nevertheless, all institutions are in a
position to implement organizational and
behavioral changes that will help in enhancing the experience
and the quality of care without necessarily
incurring higher budgets (Shelton, 2000). In other words,
regardless of how new the healthcare facilities

are, the physicians technical competence, or the number of
nurses and physicians. It is acknowledged that
patients are difficult to get satisfied with the delivery of the
Emergency Service Department. If they find it
hard to perceive that the doctors, nurses, and the overall
healthcare staff care a lot about their discomfort,
confusion, embarrassment, anxiety and delays they experience
while in the ESD (Dave, 2001). Moreover,
the healthcare staff also encompasses the physicians which
mean that, if they are in one way or the other
not fully committed, involved, and accountable for the
healthcare’s patient satisfaction, then the hospital
stands no chance of improving in this area. 3.1 Some of the
challenges in the Emergency service
department It is believed that, in any healthcare environment,
patients not only need just treatment, but they
also want care. By definition, care is acknowledged as the total
patient experience of both technical
elements which includes treatment, diagnosis, prescriptions,
tests, and personal elements which
encompass things like interaction, attitudes, empathy, and
explanation. In other words, the emergency
environment offers many challenges for staffs responsible for
managing the care experience (Shelton,
2000). Some of the problems include first, stressful
environment such that, regardless of the quality and
glitzy of the healthcare facility, the patients always find the ED
very stressful. In this case, they are strange
to the machinery used in the ED, the rituals employed, the lack
of privacy and most of the patients always
compete for the attention of the healthcare providers (Shelton,
2007). Second, there is an issue of divergent
views such that, the patients and the staff may possess different
opinions and views about the severity of
the complaint at hand. In such case, those employees that are
busy always find it very abusive when they

are presented with minor and petty complaints from patients
while simultaneously, patients who are
perceiving that the healthcare providers are not considering
their proposal, may feel disdained or rejected
(Glick, 2008. Third, there is an issue of conflicting therapy
opinions. In this case, the patients and staffs may
differ from the best and appropriate technique for treating the
health problem at hand. For instance, patients
postulate their medical beliefs norms, systems, and treatment
habits in the Emergency Service Department.
In other words, this behaviors and beliefs class with significant
scientific medical practices and knowledge
are resulting in communication breakdown and trust between
the staff and the patients (Georgopoulos &
Cooke, 1980). 3.2 Reason why patient satisfaction is essential
It is argued that patient satisfaction cannot
be managed if the healthcare staff is not part of the team.
However, not all personnel will be directly
committed to this initiative unless they are made to
comprehend the significance of the patient’s personal
experience with the healthcare facility to departmental,
individual and the institutional goals (Mayer & Cates,
2014). In other words, all Emergency Service Department’s
staff must become familiar with the benefits of
having highly satisfied patients. In so doing, the healthcare
facility should see to it that their entire staff
realizes that patient satisfaction is not only basically a
measurable care outcome but also a very necessary
care component (Shelton, 2000). For instance, treatment forms
part of the patient care, therefore, staff must
be able to convince, confront the patient, identify themselves,
and explain what is going to happen to the
patient. In simple terms, the process and the manner in which

all these procedures are conducted as well
as the interaction that exists between the healthcare
professional and the patient clearly explain the care
aspect of the patient treatment which plays a very crucial part
in patient satisfaction (Mayer & Cates, 2014).
The bottom line is that, whenever emergency patients well care
for, they are satisfied and in the process,
both the staff and the patient benefit. First, patient’s level of
stress is reduced such that they are calmer,
staff demand decreases, the likeliness of complications is also
diminished, and the Emergency
Department’s visits are easier and shorter to manage (Mayer &
Cates, 2014). Second the level of patients
trust towards the healthcare increases such that, those patients
who put their confidence in the healthcare
staff are likely to be more tolerant and cooperative when it
comes to scary and uncomfortable procedures
(Shelton, 2000). Furthermore, the patient’s chances of
complying with discharge instructions are high which
means minimal returns to the Emergency Department and better
care outcomes. Finally, a positive patient
experience with the Emergency Department helps in protecting
the image and the brand of the hospital. In
this case, satisfied clients are more than willing to recommend
and use the hospital facility again and again
for other purposes gender (Dave, 2001). It is believed that the
Emergency Service Department of any
healthcare facility represents the brand and image of the
hospital and an individual’s first encounter with it,
represents the client’s perception and opinion of that brand. In
other words, if the patients were less
impressed by the services at the hospital, the chances of using
the hospital again shortly is minimal.
Apparently, this can affect the image of the hospital in a
negative way as far as their budget, the staff’s
salary and jobs are concerned (Shelton, 2000). 3.3 Strategies

for improving the clients experience It is
universally known that most clients are unaware of the
technicalities involves in treatment such as the
proper antibiotics needed and the appropriate tests, the correct
sutures gauges (Olson & Simerson, 2015).
However, most patients recognize the level of care they are
afforded which in most cases, encompass the
treatment and the level of emotional context in which the
aspect of treatment is delivered (Georgopoulos &
Cooke, 1980). In other words, lower satisfaction levels of
patients clearly indicate that there is lower-quality
care regardless of how glitzy the technical capabilities of the
treatment are. During the initial or early stages
of service delivery, the level of patient satisfaction involves
how effective the healthcare facility can manage
the patient perception (Olson & Simerson, 2015). In other
words, the fact that the perception of the patients
is subjective does not necessarily mean that its impact is less
objective or less concrete (Shelton, 2000). In
simple terms, the moment that the patients enter the Emergency
Service Department room, the sights, the
events, sounds, and their interactions help in building their
experience. Addionnaly, how patients respond to
this situations plays a very crucial part on how their level of
stress, cooperation, trust, patience and
tolerance is impacted. In other words, the satisfaction level of
patients is hence categorized as a care
component of the healthcare facility and not just a healthcare
outcome (Mayer & Cates, 2014). 4.0
Research Methodology This is a cross-sectional study
employing a mixed research design that
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encompasses precise and descriptive aims. The participants of
this research work were mainly clients of
the Emergency Service Department. Additionally, this study
took into consideration the fact that; work busy
hours, personnel, shifts, type of client, the
day of the week, different providers and client complaints have
an implication
on the level
of patient satisfaction. In this case, therefore, the sample of the
study was selected factoring of the above
factors. Moreover, the sample distribution of 300 Emergency
Service Department’s clients was conducted
using quota random sampling. During the work research period,
the customer’s number was 1230 in a
week. During the morning shifts, the client’s number was 378,
in the evening the clients population was 431
and in the night clients were approximately 421. Furthermore,
because 300 emergency service department
patients were chosen randomly from the sample population, the
representation of the quota was 25.2 %,
37.5%, and 35.5 % respectively. Moreover, the technique was
used in selecting people in different shifts
was by assigning random numbers to the individuals. Besides,
the questionnaires were given to the clients
and patients after agreeing to complete them. In this case, there
was no clear

evidence of unwillingness and all patients consented to
cooperate. The
patient’s satisfaction questionnaire
designed and used by the Press Ganey Institute employed in
most hospitals in America with beds
amounting to over 100 was implemented in this research work.
According to some already established
literature, it is also evident that 49 Emergence Service
Departments have also used this Press Ganey
institute’s survey. Additionally; the investigation of this
institute has indicated the status of the satisfaction
levels of patients visiting the service emergency department
annually for the year 2004 using data and
information collected from 50 American states. However, in
this study, this questionnaire survey was
employed with minor modification because Saudi Arabia’s
visit, admission and the process of discharge are
unique and different from those witnessed in the United States.
The following were some of the research
elements that were added to the questionnaire: ? The
educational background and the literacy status of the
respondents ? Satisfaction levels of the respondents with
Emergence Service Department’s security guards
behavior and courtesy The validity of the
Press Ganey questionnaire was proven by distributing it to some
ESD
specialists as well as academic research members to confirm its
effectiveness in the study. In this study, a highly reliable and
valid questionnaire consisting of approximately
thirty standard questions were subdivided and organized into
four sections ? Physician care ? Waiting and

identification time ? Physical comfort, registration process, and
nursing care ? Overall patient
satisfaction with Emergency Department Interviews were also
conducted by the team members of the research. Additionally,
the language

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that was employed during this research work was Arabic, which
is the national language of Saudi Arabia.
Moreover, those individuals responsible for interviewing the
respondents did not put on any form of
uniforms or badges. In other words, the interviews commenced
immediately the patients were made aware
of the objectives of the research and in the process, expressed
their willingness to participate. The subjects
or rather the respondents were interviewed whenever they
exited the ESD including those who are being

discharged and the ones who were hospitalized in a ward.
Patient’s waiting time before being attended to
for the first examination was also measured during this study.
In this case, the specific patient’s arrival time
was recorded in their medical reports immediately they arrived
as well as the time they attended their first
examination by the physician. In other words, as per the
recorded waiting time records and reports, the
minutes the client spent waiting to be attended to by the
physician was also determined. Moreover, to deal
with interview biases, all the individuals responsible for
interviewing were oriented by academic members in
a session as far as unifying their communication, as well as the
patients' interviewing process, are
concerned. Furthermore, the data that was collected was
analyzed through the employment of
SPSS version 13. Both ordinal and nominal scale data were
presented in the study as
relative frequency and absolute, whereas normally distributed
data were
classified and given in the form of means standard deviations.
In other words, to determine the uniqueness
of groups, the data, and information that was collected was
analyzed and evaluated using Chi-Square test.
In this case, the odds ratio, as well as 95 percent confidence
interval, was analyzed to determine the
relationship that exists between all the variables that were
examined during the study. In other words, P <
0.05 value was categorized as being statistically significant.
5.0 Results and findings From data analysis, it
is clear that 300 patients out of the total patient’s referred to
the Emergency Service Department were

willing to participate in this research work. In this case, their
demographic characteristics were presented in
the form of a table as shown below. Additionally,
a small percentage of the data was reported as missing because
some of the
questionnaires were partly answered. Demographic
characteristics Gender Percentage (%) female 40 male
60 Educational level diploma 30 technician 20 degree 35 Under
diploma 15
Time of visit Morning 35 Evening 40 Night 25
The data clearly indicate that 10 percent of those who
participated in the research were patients, 88 % were
the patient relatives, and 2 % did not respond to the
questionnaires completely. It was also found out that,
only 35 %, 40%,

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and 25% of the participants were admitted to the hospital during
the
morning hours, evening hours, and night
hours respectively. Those who were using the Emergency
Service Department for the first time were only
37% of the participants. AS far as the association analysis
between the satisfaction levels and waiting time
is concerned, P=0.003 represents the dissatisfaction of those
with longer waiting times. In this case, items
that boasted of a higher standard of satisfaction were; the
courtesy and behavior of the physicians which
attained 87% votes, followed by the courtesy of security guards
at 82% and finally, the courtesy and

behavior of nurses obtained 81%. On the other hand, items that
recorded higher levels of dissatisfaction
include the efforts of caregivers in trying to make
the patients get involved in decision making of their treatment
(26%).
This is followed by
waiting time taken for the first visit
patients 25% and finally, neatness and cleanness which
represented 22% of the total votes. The average
waiting time for a patient to be attended to by a specialist was
approximately 21 minutes which ranged between 30 minutes
representing the maximum time taken and
three minutes as the minimum waiting time. From the
information, it was certain that the living area either
rural or urban showed no any relationship to the participant’s
satisfaction levels. As far as work shifts were
concerned, it was clear that most participants were satisfied
with evening shifts (65%). Followed by night
shifts which boasted of 63% and finally, the morning shifts
which boasted of 62%. When it comes to
educational level, it was clear that those individuals who had
higher educational levels background
represented P=0.05, which means that they were more satisfied.
Additionally, whenever the respondents
were asked whether they could use Aliman Hospital’s ED again
or would refer others to it, 65 percent of the
participants indicated that they would use and apply it to others
while 18 percent indicated that they would
not recommend and refer it to it again. 6.0 Discussion
Satisfaction among patients is primarily one of the

most significant quality indicators when it comes to Emergency
Service Department (Olson & Simerson,
2015). Additionally, measurement of the satisfaction levels of
patients is very crucial in playing an
increasingly important role in the ever expanding need for
accountability when it comes to health care.
Moreover, considering the report postulated by Press Graney
Associates in the year 2009, the ESD is one
of the gatekeepers that is now accounting for approximately
half of Saudi Arabia’s admissions in hospitals.
In so doing it has placed a significant strain on many hospital
facilities because of the increasing service
demand which in most cases, is inappropriate when it comes to
delivery of healthcare service (Olson &
Simerson, 2015). As a result, it leads to unprecedented long
waiting times, ambulance diversions, crowded
conditions and highly variable outcomes and care. Because
Emergency Service Department is a particular

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department as far as medical services are concerned,
comprehension of the elements affecting the level of
satisfaction among patients is very essential (Olson &
Simerson, 2015). According to this study, it is clear
that there is a high degree of satisfaction among clients
although there are also so many unmet demands
and needs. For instance, according to this research work, 34 %
of the ED clients indicated very high overall
satisfaction as far as the performance of the Emergency Service
Department is concerned. Furthermore, by
analyzing the data further, it was found that 13% of the clients
have low satisfaction. In other words, in total,

the findings of the study indicated that 86% of the clients
believed the level of satisfaction is above average.
However, although it is challenging to keep all ED customers
satisfied, it is acknowledged that any
healthcare can realize this objective by trying to identify
potential indicators and working towards improving
them. The findings of this research work
also indicated that there is an existing association between
satisfaction
and educational level, being the relative of the patient,
residential area, and time of admission. On the other hand,
further evaluation and analysis acknowledge
that, apart from the interviewees themselves and their
backgrounds of education as their other two factors,
there is no interrelationship or meaningful association that
exists between satisfaction and other factors. In
this case, no relationship existed between the satisfaction level
of the relatives of the patients as compared
to the patient’s themselves. Moreover, the satisfaction
standards of the patients were much
lower in those patients with the higher educational background.
Gender
difference, time of admission and
residential area, possessed
no meaningful association with satisfaction level. For instance,
in
this study, those clients who were served between 2.00 pm and
8.00 pm recorded high satisfaction levels

as compared to those who were served between night hours and
morning hours. Nevertheless, there was
no significant statistical difference between the operational
hours of the day. For example,
in the Press Ganey report, the highest level of satisfaction was
realized in
the
morning hours and yet the influence of race, gender residential
place, and educational level on the degree
of patient’s satisfaction was not included in the assessment of
the report (Olson & Simerson, 2015).
Besides, Patient volume, staffing patterns as well as, the
severity of the condition of the patient, may impact
a large junk of these notable differences in the levels of
satisfaction. In simple terms, during night shifts,
waiting time may increase tremendously because, during the
day, the patient volumes may have been on
the rise. The study that was conducted

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by Hall and Press in the year 1996 indicated that variables such
as gender
and age do not have a profound influence on
the levels of patient satisfaction (Olson & Simerson, 2015).
Additionally, according to this study, it was also
clear that an association exists with the respect and courtesy
expressed by the physicians during waiting

times and the level of satisfaction. Another research work
acknowledged as Aragon’s study, also produced
similar results in the sense that, the general patients
satisfaction was the same irrespective of the clients
gender (Dave, 2001). Therefore, consistent with other previous
research work, the findings and the results
of this research work also indicated that the gender of the
client does not influence the level of satisfaction
among the ESD patients in Aliman hospital in Saudi Arabia.
Moreover, in another study that was conducted
in the year 2004 in New Jersey at Cooper Hospital, the level of
satisfaction was high in those patients with
emergency needs or severe illness. In other words, this study
also indicates that the less waiting time taken,
by patients in Aliman Hospital, the more satisfied a patient
was. Therefore, as compared with similar
research works, the findings of this research work indicated
that the waiting time was not much, but it was
ranked as a second dissatisfaction element. Apparently, those
items that reported high levels of patient’s
satisfaction revolved around the respect and the courtesy of the
physicians towards patients, the respect of
the security guards and the courtesy and the behavior of the
nurses towards patients. The findings and the
results of this study reveal that a high level of client
satisfaction can be realized through respect and
courtesy shown to patients and customers by the healthcare
staff. Additionally, effective communication
also seems to be a significant factor in the management of the
Emergency Service Department and may at
the same time improve the satisfaction levels of the patients.
To strengthen this assertion, a Hong Kong
study suggested that, a workshop on effective communication
can help in improving the abilities of
physicians when it comes to Emergency Services and in the
process, increasing the levels of patient’s

satisfaction and reduction in the complaints of the patients. The
findings of this study also postulate that
16% of the sample population was dissatisfied with the
interventions of the students during their
examination and treatment process. Thus, it is understood, for
healthcare department to improve the
satisfaction level of its clients, EDs need to ensure that their
processes are well defined most especially
those related to treatment and diagnosis, sorting emergency
patients, discharge, and admission. However,
Emergency Service Departments that cannot help in reduci ng
waiting time may as well assist in improving
client satisfaction levels by enhancing the comfort of the
patients in the clients’ waiting room (Shelton,
2007). Moreover, Emergency healthcare Departments can
improve the comfort level by listening and acting
on the comments of their client’s. For instance, simple things
like replacing worn out chairs and repairing air
conditioners may improve the perception of the patients as far
as ED is concerned. To clarify further, an
Australian study; Tailors study, suggests that it is clear that the
orientation of the staff through an
educational film on how to improve their communication skills
improves the satisfaction levels of the
patients (Shelton, 2007). In simple terms, although the respect,
friendliness and the ability of the health care
provider are a significant attribute
in patient’ s satisfaction, much effort should focus on improving
the
perceptions of the clients about ED and reducing the waiting
time. Additionally, as much as the frustration of
the patients were evident because of longer waiting times, there
was no tangible evidence on whether the
difference that was noted during waiting times reflected a clear

picture or rather a representation of the
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actual differences when it comes to clinical quality (Olson &
Simerson, 2015). 7.0 Limitations of the study
There were some confounding factors in this study.

Additionally, it was evident
that evidence-based interventions can be employed based on the
findings
of such research surveys. On the
other hand, the survey results cannot be taken to represent the
whole population because of the differences
that exist in different regions. In this case, the time spent in the
Emergency Service Department was not
measured right from the arrival of the patients until
disposition. In simple terms, this factor is also a
noticeable element that can be influential to the level of patient
satisfaction. In other words, satisfaction
different rates may also be realized with various presentations
of the patients
and the severity of patient cases may also influence
the rate of appreciation (Shelton, 2007). Furthermore,
variation in measurement satisfaction tools prevents making
satisfaction a
particular element of the quality equation.
In other words, it is acknowledged that data as far as patient
satisfaction is concerned are being collected
using different types of questionnaires most especiall y by using
the Press Ganey Institute questionnaire and
Picker Institute which concentrates on the care process of
patients and can also be employed in related
studies. In simple terms, by applying one of this questionnaires
means that the research work will be more
restricted to what had already been done. However, this

research designed tried to curb this challenge by
adding some modifying elements in the Press Ganey Institute.
8.0 Conclusion Results and findings of this
research work indicated that for the Emergency Service
Department of Aliman hospital in Saudi Arabia to
improve on the patient’s level of
satisfaction. Research-based interventions are paramount in
areas such
as nursing services, treatment of patients, staff behavior,
waiting for time, physical environment, and clinical care
processes. In other words, this improvement can
only be achieved by institutionalizing the quality of
management in healthcare services and employing the
complaints, and the feedback obtained from this interventions
in a systematic way. In so doing they can
help in influencing patient satisfaction and the efficiency of the
Emergency Service Department. Although
some patients indicated a notable degree of satisfaction with
Aliman hospital’s ED, it was evident that some
demands of the patients were unmet. Therefore, the healthcare
hospital should establish a way of
incorporating patient satisfaction as one of the core values of
the hospital. References Dave, P. K. (2001).
Emergency medical services and disaster management: A
holistic approach. New Delhi: Jaypee.
Georgopoulos, B. S., & Cooke, R. A. (1980). A comparative
study of the organization and performance of

hospital emergency services: Selected descriptive findings and
the research instruments. Ann Arbor, Mich:
Organisational Behavior Program, Survey Research Center,
Institute for Social Research, University of
Michigan. Glick, R. L. (2008). Emergency psychiatry:

Principles and practice. Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins. Mayer, T. A., & Cates,
R. J. (2014). Leadership for great customer
service: Satisfied employees, satisfied patients. Chicago.
Illinois: Health Administration Press Olson, A. K.,
& Simerson, B. K. (2015). Leading with strategic thinking:
Four ways effective leaders gain insight, drive
change, and get results. Hoboken: Wiley Shelton, P. J. (2000).
Measuring and improving patient
satisfaction. Gaithersburg, Md: Aspen Publishers. Shelton, P. J.
(2007). Measuring and improving patient
satisfaction. Gaithersburg, Md: Aspen Publishers 1 PATIENT
SATISFACTION SAUDI ARABIA 2 PATIENT
SATISFACTION
SAUDI ARABIA 5 PATIENT SATISFACTION SAUDI
ARABIA 6 PATIENT SATISFACTION SAUDI ARABIA
7 PATIENT SATISFACTION SAUDI ARABIA 8 PATIENT
SATISFACTION SAUDI ARABIA 20
FNSACC505A – Final Assessment task 2015
Using this template

Before you complete this business plan template and start using
it, consider the following:
1. Do your research. You will need to make quite a few
decisions about your business including structure, marketing
strategies and finances before you can complete the template.
By having the right information to hand you also can be more
accurate in your forecasts and analysis.
2. Determine who the plan is for. Does it have more than one
purpose? Will it be used internally or will third parties be
involved? Deciding the purpose of the plan can help you target
your answers. If third parties are involved, what are they
interested in? Although don’t assume they are just interested in
the finance part of your business. They will be looking for the
whole package.
3. Do not attempt to fill in the template from start to finish.
First decide which sections are relevant for your business and
set aside the sections that don’t apply. You can always go back
to the other sections later.
4. Use the [italicised text]. The italicised text is there to help
guide you by providing some more detailed questions you may
like to answer when preparing your response. Please note: If a
question does not apply to your circumstances it can be ignored.
5. Download the Business Plan Guide. The business plan guide
contains general advice on business planning, a complete
overview of the business plan template and a glossary
explaining the main terms used throughout this template.
6. Get some help. If you aren’t confident in completing the plan
yourself, you can enlist the help of a professional (i.e.
Enterprise Connect Centre, Business Enterprise Centre, business
adviser, or accountant) to look through your plan and provide
you with advice.

7. Actual vs. expected figures. Existing businesses can include
actual figures in the plan, but if your business is just starting
out and you are using expected figures for turnover and finances
you will need to clearly show that these are expected figures or
estimates.
8. Review. Review. Review. Your business plan is there to make
a good impression. Errors will only detract from your
professional image. So ask a number of impartial people to
proofread your final plan.
For advice and examples on how to complete this template,
please download the business.gov.au Business Plan guide from
www.business.gov.au/businessplan.
Scan to watch our business planning video:
[Your Name]
[Student number]
[Business Name]
[Main Business Address]
ABN: [Made up]
[Signature]
[Kelly’s Accountant]
Business Plan
Prepared: [Date of submission]
Table of Contents

3The Business
3Business details
3Registration details
3Business premises
4Organisation chart
4Management & ownership
4Key personnel
5Products/services
6Insurance
6Risk management
6Legal considerations
7Operations
8The Market
8Market research
8Market targets
8Environmental/industry analysis
8Your customers
9S.W.O.T. analysis
10Your competitors
11Advertising & sales
12The Future
12Vision statement
12Mission statement
12Goals/objectives
12Action plan
13The Finances
13Key objectives & financial review
13Assumptions
14Start-up costs for [YEAR]
15Profit and loss forecast
16Expected cash flow
The Business
Business details
Products/services: [What products/services are you selling?

What is the anticipated demand for your products/services?]
Registration details
Business name:
Kelly's Accountant
Business premises
Business location: [Describe the location and space
occupied/required. What is the size of the space you
occupy/require? Which city or town? Where in relation to
landmarks/main areas? If you have a retail business, where are
you in relation to other shops? What is the retail traffic like?]
Location in Melbourne Australia
Organisation chart
[Outline your business structure in the chart below.]
Management & ownership
Names of owners: Kelly
Key personnel
Current staff
[List your current staff in the table below.]
Job Title
Name
Expected staff turnover
Skills or strengths
[e.g. Marketing/ Sales Manager]
[Mr Chris Brantley]
[12-18 months]
[Relevant qualifications in Sales/Marketing. At least 5 years

experience in the industry. Award in marketing excellence.]
Products/services
Product/Service
Description
Price
[Product/service name]
[Brief product/service description]
[Price including GST]
Market position: [Where do your products/services fit in the
market? Are they high-end, competitive or budget? How does
this compare to your competitors?]
Insurance
Workers compensation: [Provide details if you have workers
compensation insurance? This is mandatory if you have

employees.]
Risk management
[List the potential risks (in order of likelihood) that could
impact your business.]
Risk
Likelihood
Impact
Strategy
[Description of the risk and the potential impact to your
business.]
[Highly Unlikely, Unlikely,
Likely,
Highly Likely]
[High,
Medium,
Low]
[What actions will you take to minimise/mitiga te the potential
risk to your business?]

Legal considerations
[List the legislation which will have some impact on the
running of your business. For example: consumer law, business
law, or specific legislation to your industry.]
Operations
Suppliers
[Who are your main suppliers? What do they supply to your
business?How will you maintain a good relationship with
them?]
Plant & equipment
[List your current plant and equipment purchases. These can
include vehicles, computer equipment, phones and fax
machines.]
Equipment
Purchase date
Purchase price
Running cost
Computer
Pinter
The Market
Market research

[What statistical research have you completed to help you
analyse your market? Did you use a survey/questionnaire? If so,
you may like to attach a copy of your survey/questionnaire to
the back of this plan.]
Your customers
Key customers
[Identify your key customers. (These can be large consumers of
your products or individuals whose satisfaction is key to the
success of your business.) How will you target your
products/service to them?]
S.W.O.T. analysis
[List each of your businesses strengths, weaknesses,
opportunities or threats in the table below and then outline how
you plan to address each of the weaknesses/threats.]
Strengths
Weaknesses
Opportunities
Threats
Your competitors
[How do you rate against your competitors? How can your
business improve on what they offer?]
Competitor details
[List at least 5 competitors in the table below.]
Competitor

Established date
Size
Market share (%)
Value to customers
Strengths
Weaknesses
[Competitor name]
[When were they established?]
[Number of staff and/or turnover]
[Estimated percentage of market share]
[Unique value to customers. E.g. convenience, quality, price or
service?]
[What are your competitor's main strengths?]
[What are your competitor's main weaknesses?]

Advertising & sales
Advertising & promotional strategy
[What strategies do you have for promoting and advertising
your products/services in the next 12 months?]
Planned promotion /advertising type
Expected business improvement
Cost ($)
Target date
[Print media advertising, online advertising, mail-out,
giveaway, media release, social media campaign or event.]
[How do you expect it will improve your business success?]
[$]
[Month/Year]
The Future

Vision statement
[What is your business' vision statement? It should briefly
outline your future plan for the business and include your
overall goals.]
Mission statement
[What is your business' mission statement? I.e. how will you
achieve your vision?]
Goals/objectives
[What are your short & long term goals? What activities will
you undertake to meet them?]
Action plan
Please note: This table does not include sustainability
milestones as they are listed in the sustainability section above.
Milestone
Date of expected completion
Person responsible
[What are the business milestones that you need to complete
starting from today?]
[When do you expect to complete them?]
[Who is responsible for delivering this milestone?]
The Finances

Key objectives & financial review
Financial objectives
[List your key financial objectives. These can be in the form of
sales or profit targets. You could also list your main financial
management goals such as cost reduction targets.]
Finance required
[How much money up-front do you need? Where will you obtain
the funds? What portion will you be seeking from loans,
investors, business partners, friends or relatives, venture capital
or government funding? How much of your own money are you
contributing towards the business?]
Assumptions
The financial tables on the subsequent pages are based on
the assumptions listed below:
· [List your financial assumptions. These can include seasonal
adjustments, drought or interest rates etc.]
Chart of Accounts
· Considering the tables below prepare a simple, number based
chart of accounts. This may be in any format you like and may
be completed separately and attached as an appendix.
Documentation
· Include a brief list of the financial documentation you will be
required to keep in your business. Also indicate the length of
time you would need to keep it
Security
· You have decided to use an MYOB system to run your
business. Please provide a detailed analysis of the security
requirements you will use to protect both the MYOB data, other

data and physical records that you hold in your business.
Start-up costs for [YEAR]
[Double-click the table below to enter your details or attach
your own start up costing sheet at the back of this business
plan.]
START-UP COSTSCost ($)EQUIPMENT/CAPITAL
COSTSCost ($)
Registrations Business purchase price
Business nameFranchise fees
LicencesStart-up capital
PermitsPlant & equipment
Domain namesVehicles
Trade marks/designs/ patentsComputer equipment
Vehicle registrationComputer software
More…Phones
Membership feesFax machine
Accountant feesMore…
Solicitor feesSecurity system
Rental lease cost (Rent advance/deposit)Office equipment
Utility connections & bonds (Electricity, gas, water)Furniture
Phone connectionShop fitout
Internet connectionMore…
Computer software
Training
Wages
Stock/raw materials
Insurance
Building & contents
Vehicle
Public liability
Professional indemnity
Product liability
Workers compensation

Business assets
Business revenue
Printing
Stationery & office supplies
Marketing & advertising
More…
Total start-up costs$0Total equipment/capital costs$0
Profit and loss forecast
your own profit & loss sheet at the back of this business plan]
PROFIT & LOSS FORECAST[Year 1][Year 2][Year 3]
Sales
less cost of goods sold
More…
Gross profit/net sales$0$0$0
Expenses
Accountant fees
Advertising & marketing
Bank fees & charges
Bank interest
Credit card fees
Utilities (electricity, gas, water)
Telephone
Lease/loan payments
Rent & rates
Motor vehicle expenses
Repairs & maintenance
Stationery & printing
Insurance
Superannuation
Income tax
Wages (including PAYG)
More…

Total expenses$0$0$0
NET PROFIT$0$0$0
Expected cash flow
your own expected cash flow sheet at the back of this business
plan]
EXPECTED CASHFLOW
[YEAR]
JanFebMarAprMayJunJulAugSepOctNovDec
OPENING BALANCE$0$0$0$0$0$0$0$0$0$0$0$0
Cash incoming
Sales
Asset sales
Debtor receipts
Other income
Total incoming$0$0$0$0$0$0$0$0$0$0$0$0
Cash outgoing
Purchases (Stock etc)
Accountant fees
Solicitor fees
Advertising & marketing
Bank fees & charges
Interest paid
Credit card fees
Utilities (electricity, gas,
water)
Telephone
Lease/loan payments
Rent & rates
Motor vehicle expenses
Repairs & maintenance
Stationery & printing
Membership & affiliation fees

Licensing
Insurance
Superannuation
Income tax
Wages (including PAYG)
More…
Total outgoing$0$0$0$0$0$0$0$0$0$0$0$0
Monthly cash balance$0$0$0$0$0$0$0$0$0$0$0$0
CLOSING BALANCE$0$0$0$0$0$0$0$0$0$0$0$0
Kelly
Owner
[Mr Jo Stevens
Operations]
[Mr Chris Brantley
Marketing Manager]
[Mrs Cherie Laws

Office Manager]
_1371288868.xls
Sheet1START-UP COSTSCost ($)EQUIPMENT/CAPITAL
COSTSCost ($)RegistrationsBusiness purchase priceBusiness
nameFranchise feesLicencesStart-up capitalPermitsPlant &
equipmentDomain namesVehiclesTrade
marks/designs/patentsComputer equipmentVehicle
registrationComputer softwareMore…PhonesMembership
feesFax machineAccountant feesMore…Solicitor feesSecurity
systemRental lease cost (Rent advance/deposit)Office
equipmentUtility connections & bonds (Electricity, gas,
water)FurniturePhone connectionShop fitoutInternet
connectionMore…Computer softwareTrainingWagesStock/raw
materialsInsuranceBuilding & contentsVehiclePublic
liabilityProfessional indemnityProduct liabilityWorkers
compensationBusiness assetsBusiness revenuePrintingStationery
& office suppliesMarketing & advertisingMore…Total start-up
costs$0Total equipment/capital costs$0
_1486193883.xls
Sheet1EXPECTED CASHFLOW
[YEAR]JanFebMarAprMayJunJulAugSepOctNovDecOPENING
BALANCE$0$0$0$0$0$0$0$0$0$0$0$0Cash
incomingSalesAsset salesDebtor receiptsOther incomeTotal
incoming$0$0$0$0$0$0$0$0$0$0$0$0Cash outgoingPurchases
(Stock etc)Accountant feesSolicitor feesAdvertising &
marketingBank fees & chargesInterest paidCredit card
feesUtilities (electricity, gas, water)TelephoneLease/loan
paymentsRent & ratesMotor vehicle expensesRepairs &
maintenanceStationery & printingMembership & affiliation
feesLicensingInsuranceSuperannuationIncome taxWages

(including PAYG)More…Total
outgoing$0$0$0$0$0$0$0$0$0$0$0$0Monthly cash
balance$0$0$0$0$0$0$0$0$0$0$0$0CLOSING
BALANCE$0$0$0$0$0$0$0$0$0$0$0$0
_1371288685.xls
Sheet1PROFIT & LOSS FORECAST[Year 1][Year 2][Year
3]Salesless cost of goods soldMore…Gross profit/net
sales$0$0$0ExpensesAccountant feesAdvertising &
marketingBank fees & chargesBank interestCredit card
feesUtilities (electricity, gas, water)TelephoneLease/loan
paymentsRent & ratesMotor vehicle expensesRepairs &
maintenanceStationery &
printingInsuranceSuperannuationIncome taxWages (including
PAYG)More…Total expenses$0$0$0NET PROFIT$0$0$0
Running head: PATIENT SATISFACTION IN SAUDI ARABIA
1
PATIENT SATISFACTION SAUDI ARABIA
4
Patient satisfaction with emergency services in Aliman Hospital
in Saudi Arabia
Author’s name
Institutional affiliation

Contents
Patient satisfaction with emergency services in Aliman hospital
in Saudi Arabia3
1.0 Introduction3
1.1 Research objectives4
1.2 Research questions4
1.3 Research design5
3.0 Literature review6
3.1 Some of the challenges in the Emergency service
department7
3.2 Reason why patient satisfaction is important8
3.3 Strategies for improving the clients experience10
4.0 Research methodology10
5.0 Results and findings13
6.0 Discussion15
7.0 Limitations of the study19
8.0 Conclusion20
References21
Patient satisfaction with emergency services in Aliman hospital
in Saudi Arabia
1.0 Introduction

Patient satisfaction is a very significant issue when it
comes to healthcare in the modern era. Additionally, the
Emergency Service Department (ED) is believed to act as one of
the primary gatekeepers of patient’s treatment. In this case, it is
acknowledged that EDs should establish a way of achieving
customer satisfaction by offering quality services (Shelton,
2000). Moreover, according to available statistics, the number
of ED patients is increasing steadily. In other words, this is a
clear indicator of the significance of establishing quality
services’ plan based on the patients’ needs and demands. To
realize successful planning, comprehending the needs, views
and the requirements of customers is an essential step.
Moreover, the most commonly employed tool for improving the
quality of services in the Emergency Service Department is
performing a client satisfaction survey so as to explore the
variables that may be affecting the clients’ levels of satisfaction
and the common causes of dissatisfaction among patients and
customers (Shelton, 2007). In simple terms, it is believed that
the satisfaction level of customers is a primary component in
choosing an Emergency Service Department for receiving
services or even making recommendations to others.
Although it is very impossible to make all the clients
satisfied, it is acknowledged that customer satisfaction can be
achieved through working on related satisfaction indicators and
trying as much as possible to improve them. Studies obtained
from other global countries indicate that employing the findings
and results from previous satisfaction surveys can help in
enhancing the quality of the emergency services (Shelton,
2007). Therefore, in this research work, the level of satisfaction
of patients presented to the Emergency Service Department of
Aliman hospital. The facility was one of the renowned
Emergency Department centers in Saudi Arabia with over
30,000 admissions per year will be examined and analyzed to
establish possible ways of improving the quality of care
services so as to increase the level of patient satisfaction.
1.1 Research Objectives

· To investigate the waiting time by patients before being
examined
· To determine the relationship between communication skills of
and the satisfaction levels among patients
· To explore the challenges and problems facing patients and
clients of Aliman hospital ins Saudi Arabia as far as patient
satisfaction is concerned
· To examine the educational background and the literacy levels
of the participants
1.2 Research questions
· What are the educational background and the literacy status of
the respondents?
· What is the experience of the patients with the Emergency
Service Department?
· What is the relationship that exists between communication
skills and the satisfaction levels of the patients?
· What are some of the factors that determine the effectiveness
of service emergency department?
1.3 Research design
In this joint cross-sectional research work, the
methodology that was adopted encompassed both qualitative
and quantitative research methodology. In this case, qualitative
research methodology involves a subjective technique that
covers the identification of new ideas and knowledge, fieldwork
participation and the employment of the person doing the
research as the primary information and data source. In this
case, the researcher has the responsibility of realizing the
meaning of the phenomenon involved in the research and the
nature of reality. In other words, the research personnel does
not concentrate much on the outcome of the study, but their
primary focus is on the research process. The questionnaires
that were employed in this research had additional questions
that enabled the respondents to provide their personal
perception of the influence of the healthcare provider’s
communication skills in improving the patient satisfaction.
Interviews were also employed in this research work to help in

establishing a trusted environment between the researcher and
the interviewee making it easy to clarify and validate data and
information that is collected.
The mixed approach technique in this research aided in
combining research methodologies in collecting the same
information and data. In so doing, it helps in reducing errors
and the possibility of biases when it comes to data collection. In
this case, the employment of both secondary and primary data
collection methods which in one way or the other ensured that
the information that was collected was more credible.
Additionally, the mixed research approach allowed for cross -
checking and clarification as far as any ambiguity in the
collection of data is concerned. Moreover, the questionnaires
were administered in a manner that permitted participants to
take approximately 24 hours in answering the questions. In so
doing, it gave the respondents enough time and the privacy
needed to respond to the questions appropriately. Besides, the
interviews that were conducted consisted of structured questions
that made it possible for the researchers to collect the desired
information in the most efficient manner. In summary, each
research interview was allocated a maximum of thirty minutes
to ensure that both the researcher and the interviewee utilized
the time that they were allocated in the most efficient way.
3.0 Literature review
It is universally acknowledged that the Emergency Service
Department is a unique context that in one way or the other,
presents some challenges whenever there are attempts to
improve the quality and the experience of care (Shelton, 2000).
However, it is known that it is not fundamentally impossible to
improve and make the healthcare experience more positive and
in the process, generate a high level of patient satisfaction
(Dave, 2001). If taken seriously, so many scholars believe that
high level of patient satisfaction will be the backbone of many
healthcare services including the ESD (Shelton, 2007).
Additionally, it is believed that research work findings and
results, suggestion and opinions are open to modifications and

if taken with the seriousness they deserve, they are one of the
crucial elements in improving the quality of the Emergency
Service Department. In this case, some issues and challenges
affecting the healthcare department should be divided among
teams to identify and discuss organizational and behavioral
changes that would help the hospital improve the level of client
satisfaction.
It is believed that most of the patient satisfaction factors
revolve around managing the perceptions of the patients.
However, the physical setting of the healthcare facility and the
hospital budget as well; play a crucial role in impacting the
level of patient satisfaction when it comes to Emergency
Service Department though more attention is on the
management of the patient’s behavior and perceptions (Shelton,
2007). Additionally, new and cheerful emergency facilities,
having an efficient and high-quality radiology unit in the ED,
which helps in speeding up the diagnosis and increased staffing,
are also important in improving the satisfaction level of
patients. However, not all hospitals can accommodate or afford
to have all these improvements. Nevertheless, all institutions
are in a position to implement organizational and behavioral
changes that will help in enhancing the experience and the
quality of care without necessarily incurring higher budgets
(Shelton, 2000). In other words, regardless of how new the
healthcare facilities are, the physicians technical competence, or
the number of nurses and physicians. It is acknowledged that
patients are difficult to get satisfied with the delivery of the
Emergency Service Department. If they find it hard to perceive
that the doctors, nurses, and the overall healthcare staff care a
lot about their discomfort, confusion, embarrassment, anxiety
and delays they experience while in the ESD (Dave, 2001).
Moreover, the healthcare staff also encompasses the physicians
which mean that, if they are in one way or the other not fully
committed, involved, and accountable for the healthcare’s
patient satisfaction, then the hospital stands no chance of
improving in this area.

3.1 Some of the challenges in the Emergency service department
It is believed that, in any healthcare environment, patients
not only need just treatment, but they also want care. By
definition, care is acknowledged as the total patient experience
of both technical elements which includes treatment, diagnosis,
prescriptions, tests, and personal elements which encompass
things like interaction, attitudes, empathy, and explanation. In
other words, the emergency environment offers many challenges
for staffs responsible for managing the care experience
(Shelton, 2000). Some of the problems include first, stressful
environment such that, regardless of the quality and glitzy of
the healthcare facility, the patients always find the ED very
stressful. In this case, they are strange to the machinery used in
the ED, the rituals employed, the lack of privacy and most of
the patients always compete for the attention of the healthcare
providers (Shelton, 2007). Second, there is an issue of divergent
views such that, the patients and the staff may possess different
opinions and views about the severity of the complaint at hand.
In such case, those employees that are busy always find it very
abusive when they are presented with minor and petty
complaints from patients while simultaneously, patients who are
perceiving that the healthcare providers are not considering
their proposal, may feel disdained or rejected (Glick, 2008.
Third, there is an issue of conflicting therapy opinions. In this
case, the patients and staffs may differ from the best and
appropriate technique for treating the health problem at hand.
For instance, patients postulate their medical beliefs norms,
systems, and treatment habits in the Emergency Service
Department. In other words, this behaviors and beliefs class
with significant scientific medical practices and knowledge are
resulting in communication breakdown and trust between the
staff and the patients (Georgopoulos & Cooke, 1980).
3.2 Reason why patient satisfaction is essential
It is argued that patient satisfaction cannot be managed if
the healthcare staff is not part of the team. However, not all
personnel will be directly committed to this initiative unless

they are made to comprehend the significance of the patient’s
personal experience with the healthcare facility to departmental,
individual and the institutional goals (Mayer & Cates, 2014). In
other words, all Emergency Service Department’s staff must
become familiar with the benefits of having highly satisfied
patients. In so doing, the healthcare facility should see to it that
their entire staff realizes that patient satisfaction is not only
basically a measurable care outcome but also a very necessary
care component (Shelton, 2000). For instance, treatment forms
part of the patient care, therefore, staff must be able to
convince, confront the patient, identify themselves, and explain
what is going to happen to the patient. In simple terms, the
process and the manner in which all these procedures are
conducted as well as the interaction that exists between the
healthcare professional and the patient clearly explain the care
aspect of the patient treatment which plays a very crucial part in
patient satisfaction (Mayer & Cates, 2014).
The bottom line is that, whenever emergency patients well
care for, they are satisfied and in the process, both the staff and
the patient benefit. First, patient’s level of stress is reduced
such that they are calmer, staff demand decreases, the likeliness
of complications is also diminished, and the Emergency
Department’s visits are easier and shorter to manage (Mayer &
Cates, 2014). Second the level of patients trust towards the
healthcare increases such that, those patients who put their
confidence in the healthcare staff are likely to be more tolerant
and cooperative when it comes to scary and uncomfortable
procedures (Shelton, 2000). Furthermore, the patient’s chances
of complying with discharge instructions are high which means
minimal returns to the Emergency Department and better care
outcomes. Finally, a positive patient experience with the
Emergency Department helps in protecting the image and the
brand of the hospital. In this case, satisfied clients are more
than willing to recommend and use the hospital facility again
and again for other purposes gender (Dave, 2001). It is believed
that the Emergency Service Department of any healthcare

facility represents the brand and image of the hospital and an
individual’s first encounter with it, represents the client’s
perception and opinion of that brand. In other words, if the
patients were less impressed by the services at the hospital, the
chances of using the hospital again shortly is minimal.
Apparently, this can affect the image of the hospital in a
negative way as far as their budget, the staff’s salary and jobs
are concerned (Shelton, 2000).
3.3 Strategies for improving the clients experience
It is universally known that most clients are unaware of the
technicalities involves in treatment such as the proper
antibiotics needed and the appropriate tests, the correct sutures
gauges (Olson & Simerson, 2015). However, most patients
recognize the level of care they are afforded which in most
cases, encompass the treatment and the level of emotional
context in which the aspect of treatment is delivered
(Georgopoulos & Cooke, 1980). In other words, lower
satisfaction levels of patients clearly indicate that there is
lower-quality care regardless of how glitzy the technical
capabilities of the treatment are.
During the initial or early stages of service delivery, the
level of patient satisfaction involves how effective the
healthcare facility can manage the patient perception (Olson &
Simerson, 2015). In other words, the fact that the perception of
the patients is subjective does not necessarily mean that its
impact is less objective or less concrete (Shelton, 2000). In
simple terms, the moment that the patients enter the Emergency
Service Department room, the sights, the events, sounds, and
their interactions help in building their experience. Addionnaly,
how patients respond to this situations plays a very crucial part
on how their level of stress, cooperation, trust, patience and
tolerance is impacted. In other words, the satisfaction level of
patients is hence categorized as a care component of the
healthcare facility and not just a healthcare outcome (Mayer &
Cates, 2014).
4.0 Research Methodology

This is a cross-sectional study employing a mixed research
design that encompasses precise and descriptive aims. The
participants of this research work were mainly clients of the
Emergency Service Department. Additionally, this study took
into consideration the fact that; work busy hours, personnel,
shifts, type of client, the day of the week, different providers
and client complaints have an implication on the level of patient
satisfaction. In this case, therefore, the sample of the study was
selected factoring of the above factors. Moreover, the sample
distribution of 300 Emergency Service Department’s clients was
conducted using quota random sampling. During the work
research period, the customer’s number was 1230 in a week.
During the morning shifts, the client’s number was 378, in the
evening the clients population was 431 and in the night clients
were approximately 421. Furthermore, because 300 emergency
service department patients were chosen randomly from the
sample population, the representation of the quota was 25.2 %,
37.5%, and 35.5 % respectively. Moreover, the technique was
used in selecting people in different shifts was by assigning
random numbers to the individuals. Besides, the questionnaires
were given to the clients and patients after agreeing to complete
them. In this case, there was no clear evidence of unwillingness
and all patients consented to cooperate.
The patient’s satisfaction questionnaire designed and used
by the Press Ganey Institute employed in most hospitals in
America with beds amounting to over 100 was implemented in
this research work. According to some already established
literature, it is also evident that 49 Emergence Service
Departments have also used this Press Ganey institute’s survey.
Additionally; the investigation of this institute has indicated the
status of the satisfaction levels of patients visiting the service
emergency department annually for the year 2004 using data
and information collected from 50 American states. However, in
this study, this questionnaire survey was employed with minor
modification because Saudi Arabia’s visit, admission and the
process of discharge are unique and different from those

witnessed in the United States. The following were some of the
research elements that were added to the questionnaire:
· The educational background and the literacy status of the
respondents
· Satisfaction levels of the respondents with Emergence Service
Department’s security guards behavior and courtesy
The validity of the Press Ganey questionnaire was proven
by distributing it to some ESD specialists as well as academic
research members to confirm its effectiveness in the study. In
this study, a highly reliable and valid questionnaire consisting
of approximately thirty standard questions were subdivided and
organized into four sections
· Physician care
· Waiting and identification time
· Physical comfort, registration process, and nursing care
· Overall patient satisfaction with Emergency Department
Interviews were also conducted by the team members of
the research. Additionally, the language that was employed
during this research work was Arabic, which is the national
language of Saudi Arabia. Moreover, those individuals
responsible for interviewing the respondents did not put on any
form of uniforms or badges. In other words, the interviews
commenced immediately the patients were made aware of the
objectives of the research and in the process, expressed their
willingness to participate. The subjects or rather the
respondents were interviewed whenever they exited the ESD
including those who are being discharged and the ones who
were hospitalized in a ward.
Patient’s waiting time before being attended to for the first
examination was also measured during this study. In this case,
the specific patient’s arrival time was recorded in their medical
reports immediately they arrived as well as the time they
attended their first examination by the physician. In other
words, as per the recorded waiting time records and reports, the
minutes the client spent waiting to be attended to by the
physician was also determined. Moreover, to deal with

interview biases, all the individuals responsible for interviewing
were oriented by academic members in a session as far as
unifying their communication, as well as the patients'
interviewing process, are concerned. Furthermore, the data that
was collected was analyzed through the employment of SPSS
version 13. Both ordinal and nominal scale data were presented
in the study as relative frequency and absolute, whereas
normally distributed data were classified and given in the form
of means standard deviations. In other words, to determine the
uniqueness of groups, the data, and information that was
collected was analyzed and evaluated using Chi-Square test. In
this case, the odds ratio, as well as 95 percent confidence
interval, was analyzed to determine the relationship that exists
between all the variables that were examined during the study.
In other words, P < 0.05 value was categorized as being
statistically significant.
5.0 Results and findings
From data analysis, it is clear that 300 patients out of the
total patient’s referred to the Emergency Service Department
were willing to participate in this research work. In this case,
their demographic characteristics were presented in the form of
a table as shown below. Additionally, a small percentage of the
data was reported as missing because some of the questionnaires
were partly answered.
Demographic characteristics
Gender
Percentage (%)
female
40
male
60
Educational level
diploma
30

technician
20
degree
35
Under diploma
15
Time of visit
Morning
35
Evening
40
Night
25
The data clearly indicate that 10 percent of those who
participated in the research were patients, 88 % were the patient
relatives, and 2 % did not respond to the questionnaires
completely. It was also found out that, only 35 %, 40%, and
25% of the participants were admitted to the hospital during the
morning hours, evening hours, and night hours respectively.
Those who were using the Emergency Service Department for
the first time were only 37% of the participants.
AS far as the association analysis between the satisfaction
levels and waiting time is concerned, P=0.003 represents the
dissatisfaction of those with longer waiting times. In this case,
items that boasted of a higher standard of satisfaction were; the
courtesy and behavior of the physicians which attained 87%
votes, followed by the courtesy of security guards at 82% and
finally, the courtesy and behavior of nurses obtained 81%. On
the other hand, items that recorded higher levels of
dissatisfaction include the efforts of caregivers in trying to
make the patients get involved in decision making of their
treatment (26%). This is followed by waiting time taken for the
first visit patients 25% and finally, neatness and cleanness

which represented 22% of the total votes.
The average waiting time for a patient to be attended to by
a specialist was approximately 21 minutes which ranged
between 30 minutes representing the maximum time taken and
three minutes as the minimum waiting time. From the
information, it was certain that the living area either rural or
urban showed no any relationship to the participant’s
satisfaction levels. As far as work shifts were concerned, it was
clear that most participants were satisfied with evening shifts
(65%). Followed by night shifts which boasted of 63% and
finally, the morning shifts which boasted of 62%. When it
comes to educational level, it was clear that those individuals
who had higher educational levels background represented
P=0.05, which means that they were more satisfied.
Additionally, whenever the respondents were asked whether
they could use Aliman Hospital’s ED again or would refer
others to it, 65 percent of the participants indicated that they
would use and apply it to others while 18 percent indicated that
they would not recommend and refer it to it again.
6.0 Discussion
Satisfaction among patients is primarily one of the most
significant quality indicators when it comes to Emergency
Service Department (Olson & Simerson, 2015). Additionally,
measurement of the satisfaction levels of patients is very crucial
in playing an increasingly important role in the ever expanding
need for accountability when it comes to health care. Moreover,
considering the report postulated by Press Graney Associates in
the year 2009, the ESD is one of the gatekeepers that is now
accounting for approximately half of Saudi Arabia’s admissions
in hospitals. In so doing it has placed a significant strain on
many hospital facilities because of the increasing service
demand which in most cases, is inappropriate when it comes to
delivery of healthcare service (Olson & Simerson, 2015). As a
result, it leads to unprecedented long waiting times, ambulance
diversions, crowded conditions and highly variable outcomes
and care. Because Emergency Service Department is a particular

department as far as medical services are concerned,
comprehension of the elements affecting the level of
satisfaction among patients is very essential (Olson & Simerson,
2015).
According to this study, it is clear that there is a high
degree of satisfaction among clients although there are also so
many unmet demands and needs. For instance, according to this
research work, 34 % of the ED clients indicated very high
overall satisfaction as far as the performance of the Emergency
Service Department is concerned. Furthermore, by analyzing the
data further, it was found that 13% of the clients have low
satisfaction. In other words, in total, the findings of the study
indicated that 86% of the clients believed the level of
satisfaction is above average. However, although it is
challenging to keep all ED customers satisfied, it is
acknowledged that any healthcare can realize this objective by
trying to identify potential indicators and working towards
improving them. The findings of this research work also
indicated that there is an existing association between
satisfaction and educational level, being the relative of the
patient, residential area, and time of admission. On the other
hand, further evaluation and analysis acknowledge that, apart
from the interviewees themselves and their backgrounds of
education as their other two factors, there is no interrelationship
or meaningful association that exists between satisfaction and
other factors. In this case, no relationship existed between the
satisfaction level of the relatives of the patients as compared to
the patient’s themselves. Moreover, the satisfaction standards of
the patients were much lower in those patients with the higher
educational background. Gender difference, time of admission
and residential area, possessed no meaningful association with
satisfaction level. For instance, in this study, those clients who
were served between 2.00 pm and 8.00 pm recorded high
satisfaction levels as compared to those who were served
between night hours and morning hours. Nevertheless, there was
no significant statistical difference between the operational

hours of the day. For example, in the Press Ganey report, the
highest level of satisfaction was realized in the morning hours
and yet the influence of race, gender residential place, and
educational level on the degree of patient’s satisfaction was not
included in the assessment of the report (Olson & Simerson,
2015). Besides, Patient volume, staffing patterns as well as, the
severity of the condition of the patient, may impact a large junk
of these notable differences in the levels of satisfaction. In
simple terms, during night shifts, waiting time may increase
tremendously because, during the day, the patient volumes may
have been on the rise.
The study that was conducted by Hall and Press in the year
1996 indicated that variables such as gender and age do not
have a profound influence on the levels of patient satisfaction
(Olson & Simerson, 2015). Additionally, according to this
study, it was also clear that an association exists with the
respect and courtesy expressed by the physicians during waiting
times and the level of satisfaction. Another research work
acknowledged as Aragon’s study, also produced similar results
in the sense that, the general patients satisfaction was the same
irrespective of the clients gender (Dave, 2001). Therefore,
consistent with other previous research work, the findings and
the results of this research work also indicated that the gender
of the client does not influence the level of satisfaction among
the ESD patients in Aliman hospital in Saudi Arabia. Moreover,
in another study that was conducted in the year 2004 in New
Jersey at Cooper Hospital, the level of satisfaction was high in
those patients with emergency needs or severe illness. In other
words, this study also indicates that the less waiting time taken,
by patients in Aliman Hospital, the more satisfied a patient was.
Therefore, as compared with similar research works, the
findings of this research work indicated that the waiting time
was not much, but it was ranked as a second dissatisfaction
element. Apparently, those items that reported high levels of
patient’s satisfaction revolved around the respect and the
courtesy of the physicians towards patients, the respect of the

security guards and the courtesy and the behavior of the nurses
towards patients.
The findings and the results of this study reveal that a high
level of client satisfaction can be realized through respect and
courtesy shown to patients and customers by the healthcare
staff. Additionally, effective communication also seems to be a
significant factor in the management of the Emergency Service
Department and may at the same time improve the satisfaction
levels of the patients. To strengthen this assertion, a Hong Kong
study suggested that, a workshop on effective communication
can help in improving the abilities of physicians when it comes
to Emergency Services and in the process, increasing the levels
of patient’s satisfaction and reduction in the complaints of the
patients.
The findings of this study also postulate that 16% of the
sample population was dissatisfied with the interventions of the
students during their examination and treatment process. Thus,
it is understood, for healthcare department to improve the
satisfaction level of its clients, EDs need to ensure that their
processes are well defined most especially those related to
treatment and diagnosis, sorting emergency patients, discharge,
and admission. However, Emergency Service Departments that
cannot help in reducing waiting time may as well assist in
improving client satisfaction levels by enhancing the comfort of
the patients in the clients’ waiting room (Shelton, 2007).
Moreover, Emergency healthcare Departments can improve the
comfort level by listening and acting on the comments of their
client’s. For instance, simple things like replacing worn out
chairs and repairing air conditioners may improve the
perception of the patients as far as ED is concerned. To clarify
further, an Australian study; Tailors study, suggests that it is
clear that the orientation of the staff through an educational
film on how to improve their communication skills improves the
satisfaction levels of the patients (Shelton, 2007).
In simple terms, although the respect, friendliness and the
ability of the health care provider are a significant attribute in

patient’s satisfaction, much effort should focus on improving
the perceptions of the clients about ED and reducing the waiting
time. Additionally, as much as the frustration of the patients
were evident because of longer waiting times, there was no
tangible evidence on whether the difference that was noted
during waiting times reflected a clear picture or rather a
representation of the actual differences when it comes to
clinical quality (Olson & Simerson, 2015).
7.0 Limitations of the study
There were some confounding factors in this study.
Additionally, it was evident that evidence-based interventions
can be employed based on the findings of such research surveys.
On the other hand, the survey results cannot be taken to
represent the whole population because of the differences that
exist in different regions. In this case, the time spent in the
Emergency Service Department was not measured right from the
arrival of the patients until disposition. In simple terms, this
factor is also a noticeable element that can be influential to the
level of patient satisfaction. In other words, satisfaction
different rates may also be realized with various presentations
of the patients and the severity of patient cases may also
influence the rate of appreciation (Shelton, 2007). Furthermore,
variation in measurement satisfaction tools prevents making
satisfaction a particular element of the quality equation. In
other words, it is acknowledged that data as far as patient
satisfaction is concerned are being collected using different
types of questionnaires most especially by using the Press
Ganey Institute questionnaire and Picker Institute which
concentrates on the care process of patients and can also be
employed in related studies. In simple terms, by applying one of
this questionnaires means that the research work will be more
restricted to what had already been done. However, this
research designed tried to curb this challenge by adding some
modifying elements in the Press Ganey Institute.
8.0 Conclusion
Results and findings of this research work indicated that

for the Emergency Service Department of Aliman hospital in
Saudi Arabia to improve on the patient’s level of satisfaction.
Research-based interventions are paramount in areas such as
nursing services, treatment of patients, staff behavior, waiting
for time, physical environment, and clinical care processes. In
other words, this improvement can only be achieved by
institutionalizing the quality of management in healthcare
services and employing the complaints, and the feedback
obtained from this interventions in a systematic way. In so
doing they can help in influencing patient satisfaction and the
efficiency of the Emergency Service Department. Although
some patients indicated a notable degree of satisfaction with
Aliman hospital’s ED, it was evident that some demands of the
patients were unmet. Therefore, the healthcare hospital should
establish a way of incorporating patient satisfaction as one of
the core values of the hospital.
References
Dave, P. K. (2001). Emergency medical services and disaster
management: A holistic approach. New Delhi: Jaypee.
Georgopoulos, B. S., & Cooke, R. A. (1980). A comparative
study of the organization and performance of hospital
emergency services: Selected descriptive findings and the
research instruments. Ann Arbor, Mich: Organisational
Behavior Program, Survey Research Center, Institute for Social
Research, University of Michigan.
Glick, R. L. (2008). Emergency psychiatry: Principles and
practice. Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins.
Mayer, T. A., & Cates, R. J. (2014). Leadership for great
customer service: Satisfied employees, satisfied patients.
Chicago. Illinois: Health Administration Press
Olson, A. K., & Simerson, B. K. (2015). Leading with strategic
thinking: Four ways effective leaders gain insight, drive change,
and get results. Hoboken: Wiley
Shelton, P. J. (2000). Measuring and improving patient

satisfaction. Gaithersburg, Md: Aspen Publishers.
Shelton, P. J. (2007). Measuring and improving patient
satisfaction. Gaithersburg, Md: Aspen Publishers

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