Final thesis 2

PATIENT SATISFACTION TOWARDS THE OPD (OUT
PATIENT DEPARTMENT)
A STUDY IN FORTIS ESCORTS HOSPITAL, AMRITSAR
A DISSERTATION
SUBMITTED TO
DEPARTMENT OF SPORTS MEDICINE AND PHYSIOTHERAPY
GURU NANAK DEV UNIVERSITY, AMRITSAR
IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR
THE DEGREE OF
MASTERS IN HOSPITAL ADMINISTRATION
SUPERVISED BY: SUBMITTED BY:
DR.SHELLY MAHAJAN SNEHA VENNU
CO-SUPERVISED BY:
DR.H.P. SINGH

CERTIFICATE
This is to certify that dissertation entitled “Patient satisfaction towards the OPD services,
Fortis Escorts Hospital” submitted by Sneha Vennu is her original contribution and I
recommend that this project work is fit to be evaluated for the award of the “Masters In
Hospital Administration” in the Department of Sports Medicine and Physiotherapy, Guru
Nanak Dev University, Amritsar.
Dated: Dr. Shyamal Koley
Head, Sports Medicine and Physiotherapy
Guru Nanak Dev University,
Amritsar

CERTIFICATE
This is to certify that dissertation entitled “Patient satisfaction towards the OPD services
Fortis Escorts Hospital” submitted in the partial fulfilment of the requirement for the degree
of “Master in Hospital Administration” is original contribution carried out by Sneha Vennu
under my guidance and supervision. This is further certified that no part of this dissertation
has been submitted for any other degree to any university.
I recommend that the project be considered for evaluation leading to the award of
Master in Hospital Administration.
Dated: Dr. Shelly Mahajan,
Supervisor
Dept. of Sports Medicine and Physiotherapy
Guru Nanak University,
Amritsar.

CERTIFICATE
This is to certify that dissertation entitled “Patient satisfaction towards the OPD services
Fortis Escorts Hospital” submitted by Sneha Vennu is her original contribution and I
recommend that this project work is fit to be evaluated for the award of the “Masters In
Hospital Administration” in the Department of Sports Medicine and Physiotherapy, Guru
Nanak Dev University, Amritsar.
Dated: Dr. H. P. Singh
Co-Supervisor
Medical Superintendent
Fortis Escorts Hospital,
Amritsar.

ACKNOWLEDGEMENTS
I am thankful to All Mighty who blessed me with courage and health to take up this course on
Hospital Administration.
This thesis would not have been possible without the help and support of many people.
I express my deep sincere of gratitude to Dr. Shelly Mahajan, my major advisor and guide,
who offers me her endless support, valuable advice, suggestion, inspiration and remarkable
kindness from the beginning until the completion of my thesis.
I also would like to acknowledge and pay my special respect and my sincere thanks to my
HOD, Professor Shyamal koley, for his constructive comments and suggestions.
I thank enough Dr. HP Singh for giving us precious opportunity to become a humble part of
the highly reputed Fortis group.
I would like to acknowledge and pay my special thanks to Guru Nanak Dev University for
giving me this great opportunity to achieve my goals from this MHA course and gain
precious experience from here. I would never forget endless support given by staff working
in this university.
I would also like to express my thanks to Staff and patients who participated in the process of
data collection in Fortis Escorts and for giving their valuable time to complete the process
with limited time. I thank them for allowing and helping me to carry out this study
encouraging me during data collection.
I am eager to say “Thank you very much” to my best friends Sravanthi Reddy, Suman
Khurana and Naveen Nannu for supporting me and being there always for me and are the best
friends I have ever had in my life and I am so lucky to have you guys.
Also my all classmates who always inspire me, especially Maninder Singh Bedi and Amrita
Tickoo without your help I might not be successful to achieve this.
I would like to thank my love Naveen and my lovely brother Rahul vennu for encouraging
me and supporting me mentally.
Thank you so much my beloved most respected Father, I feel very blessed to be your
daughter and Mom because of your unconditional love and good bringing up, I could
overcome any kind of difficulties fearlessly without which I would not have any inspiration
and positive thoughts with the hard time facing.
SNEHA VENNU

INDEX
SERIAL NO. TOPIC PAGE NO.
1 INTRODUCTION
2 ORGANIZATION
PROFILE
3 REVIEW OF
LITERATURE
4 RESEARCH DESIGN
AND METHODOLOGY
5 DATA ANALYSIS AND
RESULT
6 CONCLUSION
BIBILOGAPHY
APPENDICES

CHAPTER-1
INTRODUCTION
A hospital is an institution that provides a broad range of medical services to sick,
injured, or pregnant patients. It employs medical, nursing, and support staff to provide
inpatient care to people who require close medical monitoring and an outpatient care to
people who need ambulatory care. Hospitals provide diagnosis and medical treatment of
physical and mental health problems, surgery, rehabilitation, health education programs, and
nursing and physician training. Many hospitals also serve as centres for innovative research
and medical training. However there is a current trend in hospital management to decrease in
patient service and to increase outpatient ambulatory care.
Out Patient Department in any hospital is considered to be a shop window of the
hospital (Kunders, 1998) referred to the hospital unit that a patient attended for treatment or
consultation and did not stay overnight in the hospital. Out Patient Department is one of the
departments of the hospital which cares for the ambulatory patient who comes for the
diagnosis. Now a days, patients are looking for hassle free and quick services. This demand is
only possible with optimum utility of the resources through multitasking in a single window
system of the OPD (Srinivasan, 2000). In the United States, it wasn’t long ago that
hospitalization was routine for most patients. But lengthy hospital stays are largely now a
thing of the past. Today, many patients receive much of their health care as outpatients—a
trend that many see as benefiting the health system. Much of the move toward outpatient care
in the US has been driven by third-party payers in an effort to control expenses. But this
change has been perhaps one of the benefits of managed care, in that it has challenged
healthcare providers to find safe and effective ways to deliver care on an outpatient basis,
which is clearly to the benefit of o patients (Onco Log 2004)
For every hospital, patients are the main users. The primary function of the hospital is
patient care. It is one of the yardsticks to measure the success of services that it produces.
Effectiveness of the hospital relates to provision of good patient care as intended. According
to Swamy (1975) patient satisfaction is the real testimony to the efficiency of hospital
administration. As the hospital serves all the members of the society, the expectations of the
users differ from one individual to another individual because everyone carries a particular
set of thoughts, feelings and needs. Hence determination of patient’s real feelings is very

difficult. It is the responsibility of the administrator team. "Put yourself in your patient's
shoes," was a proverb that explains how to proceed with a patient.
Living in the world of information and technology, nowadays patients are aware of their
needs and rights. They know that health care facilities are established to provide satisfactory
and quality health services to them. If the health care facilities fail to do so, they are
considered unsuccessful in implementing their assigned tasks.
Health care facility performance can be best assessed by measuring the level of Patient
satisfaction.
A completely satisfied patient believes that the organization has potential in
understanding patient needs and demands related to health care. The World Health
Organization conference, supporting health for all, held in 1990 defined future development
in health to be human centred. A lot of stress has been made on investment in health, patient
care and patient’s right to delivery of quality health care leading to patient satisfaction.
Patient satisfaction is essential due to multiple reasons. Any unsatisfied patient will not come
back to the hospital, and it will lead to loss of money of patient, as well as wastage of
government resources. High satisfaction level will indicate that hospital is working
efficiently. On the other hand, poor satisfaction level helps the management of a hospital to
improve on the health services.
Satisfaction is linked to quality of information, advice and general communication sensitivity,
perceived effectiveness, competence or professionalism, attitude of staff, including concern
for privacy, ease of access, waiting time, continuity of care, involvement in decision making
and benefit from the treatment or intervention.
There are multiple reasons to study the concept of patient satisfaction. It is considered
as an important outcome of the quality of healthcare. Getting views of the patients on the care
services is a much realistic tool to evaluate and improve the health care services since it is
based on direct experiences of the users. The rising strength of consumerism and quality
consciousness in the society with a shift from doctor-to-patient relationship to modern
provider-client attitude has highlighted the importance of recording patient views on
healthcare delivery. It is also the largest revenue generating department in the Hospital.
Patient satisfaction results in enhanced compliance of the patients to the medical regimens,
appropriate use of medical resources and quick recovery from illness besides, evaluation by
the patients makes medical staff aware about their shortcomings. The employees understand
that they will be held accountable to the patients as well as administration. As a result care

providers tend to acknowledge patient rights and involve them in treatment decisions.
Patients’ suggestions also help policy makers and planners to identify bottlenecks in the
system, thereby introducing customized improvements in the service
Physical facilities are tangible facilities and preparation such as ease of location,
department’s cleanliness and tidiness, bed, ventilation and lighting system, waiting chair,
sanitary rest room, ventilation, light, noise, sitting facilities, clean toilets and sufficient
examination room adequate area space availability.
Doctor’s service is referred to the physicians’ communication and consultation skills
such as self-introduction, effective consultation techniques, attentiveness, time management,
physicians’ punctuation courtesy, respect of a doctor for a patient and time spent by the
doctor in physical examination.
Nurse’s service is referred to the nurses’ communication and assistance skills such as
polite and respectful manner towards the patients, feedback to patients ‘questions, patient-
referring process, and nurses’ punctuation
Pharmacy service is referred to the respect and attention shown by pharmacy staff,
drug preparation and explanation, adequate amount of drugs, and pharmacy staff’s
punctuation.
Registration staff services include the courtesy paid by the registration staff and
his/her good communication skills.
Working schedule is the effective working shifts designated to respond to patients’
need.
Service procedure is the effective service process in terms of time and good
coordination between relevant departments.
Accessibility to health care Services is comfort ability to access the health care
services in terms of distance from hospital, waiting time, and information received.
Distance from hospital included home distance from hospital, availability of public transport,
travelling time to reach hospital and money spent on travelling.
Waiting time included waiting time for doctor and total time spent in the OPD.
Information received included adequacy of OPD timing, general information about the
hospital and main source of introduction about the hospital.
Experience (perception) to health care services was an important variable because it
made the expectation of patient which in turn were dependant on perceptive image. A
common definition of perceived image is to become aware of something through ones senses
- touch, taste, smell, hearing or sight. It is understood to be the common general knowledge,

or knowledge acquired by self experience or other’s experience of utilization of health care
services. Experience to health care services was assessed with reference to convenience of
care, quality of care and expenses afforded for Medical care.
Convenience is referred to availability of care when needed such as convenient
hospital hours and availability of health care in need. In this research it included waiting time
for physical examination, waiting time for receiving medicines, convenience of medicine
receiving place, adequacy of treatment receiving place, adequacy of OPD timing, and
receiving medical services from one department to another department in OPD.
Quality of care is referred to the provider’s skill and ability in treatment and
sufficiency of health facilities. In this study, it included treatment received from doctor,
availability of prescribed medicines from hospital, skill of the nurse in using medical
equipment, opportunity provided by the doctor for asking about the illness, and attention paid
by the hospital officer in case of any problem.

CHAPTER-2-ORGANISATION PROFILE
The main objective of this research is to measure the satisfaction of OPD (Outpatient
Department) patients and identify the strategies to help the hospital to increase their patient
satisfaction scores and sustain patient loyalty on a long-term basis in FORTIS ESCORTS
hospital in Amritsar, Punjab in India.
Fortis Hospital, Amritsar, is a 154 bed multispecialty hospital with super specialty in Cardiac
Sciences. They commenced operations way back in 2003 and since then have been a familiar,
trusted and comforting presence, ministering to the healthcare needs of the community.
Spread over 5 acre, it is the only NABH accredited hospital in the region
The approach, based on patient centricity, state-of-the-art emergency response, integrity,
teamwork, ownership and innovation, combines compassionate patient care with clinical
excellence, to achieve a single-minded objective-Saving and enriching lives.
The super-speciality cardiac care institute covers total area of 4.6 acre and is fully functional
since January 2003. It is a hospital in the corporate sector catering health care needs of
patients. It is a multi-storey building with its own parking lot. Located at MajithaVerka
bypass about 8 km from the city thus away from population and howling noise of city. Yet
it’s easy access and comfortable approach makes it a preferable choice for the patients. It
renders its services to the patients coming from nearby or faraway to almost whole of Majha,
Doaba and Malva population and even patients from outside Punjab. Our neighbouring
countries like Pakistan is also been getting services from this hospital.
The hospital has a full-fledged heart station, heart command centre, cardiac catheterization
lab; OT’s and wards providing specialized cardiac centre in the form of OPD, IPD and
emergency cardiac services
Outpatient care is rich with quality offerings, accrediting agencies, and leadership
credentialing to promote excellence. However, what is needed is investment in stronger
oversight, mandatory licensing, leadership expectation, and standards across states and
outpatient service lines.

CLINICAL SPECIALITIES PROVIDED ARE:
 Anaesthesiology
 Chest medicine
 Dental
 ENT
 General surgery
 Internal medicine
 Oncology
 Ophthalmology
 Physiotherapy
 Plastic reconstruction surgery
 Pulmonology
 Radiology
Services provided by FEHA: Following are the services provided by FEHA:
Diagnostic services
 Detection of coronary artery disease (CAD)
 ECG
 Tread mill test(TMT)
 Blood chemistry
 Telemedicine(EHAS)
 Stress Echo
 Thallium study
 Angiography
Radio diagnostic and imaging
 X-Ray
 Echocardiography
 Ultrasonography
 CT scan
 Doppler study

 Thallium study
 Tilt test
 Endoscopy
 Upper GI endoscopy
 Colonoscopy
 Side viewing endoscopy
Lung function tests (PFT)
 Pulmonary function test
Treatment services
 Cardiology
Non- surgical:
 Coronary artery diseases (PTCA and stenting)
 Medical management
 Telemedicine (EHAS)
 AICD
 Valvotomies
 Permanent pacemaker implantation
 RF ablation for rhythm disorders
Surgical:
 Coronary bypass surgery (standard)
 Coronary bypass surgery (MIDCAB)
 Coronary bypass surgery (beating heart surgery)
 Carotid endarterectomy
 Valve repair & replacement surgery
 Cardiac tumour& pericardial diseases
 Peripheral vascular surgery (PVSS)
 Preventive cardiology and rehabilitation services
 Dietary counselling and heart diseases
 Management of high cholesterol and other lipids

 Stress management
 Relaxation therapy
 Care after heart surgery
 Exercise programme
 Lifestyle management programme
Gastroenterology
 Endoscopic variceal ligation
 Endoscopic stricture dilation
 Achalasia dilation
 Endoscopic injection therapy for bleeding peptic ulcer
 Metallic stenting
 Billiary stenting
 Nasobiliary drainage
 Stone extraction
Nephrology
 Haemodialysis
 Peritoneal dialysis
 CAPD
 AV Fistula
Endocrinology - Management of:
 Diabetes
 Obesity
 Delayed growth
 Osteoporosis and metabolic bone disorder
 Other hormonal disorder
 Paediatric heart care
 Diagnostic services
 Cardiac cath
 Foetal echo cardiography

Treatment services
Non –surgical
 ASD Device closure
 Valvotomies
 Coarctation of aorta
Surgical
 Repair of congenital heart disease
 Community outreach programme - The community outreach programme was initiated
five years back as a social commitment under the aegis of Dr.N.Trehan, chairman of
the institute with Dr. (Lt.Gen) Harcharan Singh Executive Director & Dr.H.P.Singh as
the individual’s doorstep. Various facilities like clinical examination, ECG, and
echocardiography are provided free of cost along-with advice by a team of highly
qualified and stuff.
The community outreach programme comprises of
 Free heart check-up camps
 Public awareness programme
 Continued medical education
 Training on basic life support system
 Corporate services
One way to prevent or detect early disease is by having periodic health evaluations. The
examinations and tests are designed to detect diseases and monitor the status of your
health. Screening tests may catch a problem at an early, treatable stage.
Emergency service- Ambulance service: FEHA has hi-tech mobile coronary care
ambulances to shift patients. Air Ambulance services: FEHA has a dedicated team trained
in aero-medical transport of critically ill cardiac patients with all the essential life saving
equipments like the ventilator, defibrillator, monitor, IABS and so on, is dispatched to the
designation in a 6-8 seated aircraft/helicopter. Apprehension, uncertainty, waiting,
expectation, fear of surprise, do a patient more harm than any exertion.

CHAPTER-3
REVIEW OF LITERATURE
Hospitals are now following the entrepreneur trend even though the commodity they market
is health services. The patient care has become extremely important in the health care
environment. Patients’ satisfaction and their expectations have become the valid indicators
for quality health care service. In which case, the patients become their most important clients
of the hospital. After all, it’s the patients that brings in the revenues for these hospitals hence
they should be satisfied.
Patient satisfaction has been an area of special interest for researchers involved in health
system research for almost half a century. Countless number of studies on this important
topic has been published since then.
Shore and Fran’s (1986) exemplified that Patient satisfaction is better defined as an
individual's evaluation of the quality of care in a specific medical-care situation; and not just
as a global attitude aggregated across episodes.
Inui and Carter (1985) advanced similar arguments that individual patient-physician
encounters are "she basic unit of medical care" (p. 580) and, therefore, assessing satisfaction
for "individual encounters may contribute so a fuller understanding of the nature of
physician-patient relationship".
Oliver (1981) argues that Consumer satisfaction literature take issue with the definition of
satisfaction as a cognitively based evaluation of product/service attributes. Instead, these
researchers contend that satisfaction is an emotional or affective response to a product or
service use (or consumption) situation.
Ross et al; (1987) argue that restricting patient satisfaction to perceptions of the "quality" of
health care received is an "inherent weakness." These researchers support their position by
noting that a segment of "healthy but unhappy" patients has been found in several empirical
studies. Thus, Ross et al. suggest that the conceptualization of the patient satisfaction should
be enlarged to include other evaluations (e.g., waiting time, costs, etc.) in addition to purely
quality perceptions.

Stephen (1993) and Swartz et al; from Advances in Service Marketing and Management
defined Clients’ satisfaction as the result of matching one’s expectation of healthcare services
with actual experiences whether it is pleasant or disappointed.
Swartz et al; (1993) states that the level of satisfaction will be low if the services do not meet
what the patients have wished. However, the patients will show a high level of satisfaction if
their expectations are met. In addition, patients will feel highly satisfied and delightful if
services are even better than what they have expected.
Swan et al; (1985) suggested that patients’ positive opinion about services they have received
is the process of matching between a set of generally accepted quality with their personal past
involvement. Many articles about patients’ satisfaction suggested the following significant
relationship:
- Satisfaction is the result of perceiving service implementation against expectation.
- Willingness to buy or come back to receive the same services is the effect of satisfaction.
- Expecting and willingness to have services create alternatives for patients.
The more the patients are pleased, the greater the level of satisfaction will be.
Mc Quity et al; (2000) from various articles suggested that most patients are very sensitive
about what is going on with their health condition. They honestly insist to know exactly what
the problems are, the ways treatment might be taken in account and the consequences that
might happen. They still do even though it might frighten or disappoint them in any ways.
Abdal et al; (2000) argue that Patient satisfaction studies have, however, received
comparatively little attention in public or government sponsored settings and in developing
countries in particular. In a study done in Qatar, it pointed to a number of deficiencies in
these dimensions; availability, convenience of services, facilities (physical environment),
humaneness of doctors, quality of care, and continuity of care and delivery of services in
government health facilities in the State of Qatar. It also surfaced methodological issues that
should be addressed in comparable studies of culturally diverse populations.

Lawthers et al; (1999) captured the quality dimensions by survey included access, patient
experience and clinical quality in a similar study entitled “Using patient survey to measure
the quality of outpatient care” done in Krakow, Poland, the study concluded that they were
able to demonstrate the feasibility of constructing indicators of multiple dimensions of the
quality of outpatient care using patient reported information.
Khandaker(2001) conducted a study at Bangladesh by compared the services offered by
private, public and foreign hospitals from a patient’s perspective. The results gave an
overview of the perspectives of Bangladeshi patients on the quality of service in three types
of hospitals. The quality of service in private hospitals scored higher than that in public
hospitals for nursing care, tangible hospital matters, i.e. cleanliness, supply of utilities, and
availability of drugs. The overall quality of service was better in the foreign hospitals
compared to that in the private hospitals in Bangladesh in all factors, despite the 'perceived
cost' factor.
Jawahar (2007) done study on out patient satisfaction at a super specialty hospital at India, it
concluded that the outpatient services have elicited problems like overcrowding, delay in
consultation, proper behaviour of staff etc. Whenever there is delay in consultation, it is to be
explored to elicit the problem. It is worthwhile to note that there is scope for improvement of
the Out Patient Department Services.
Rao et al; (2006) studied (i) To develop a reliable and valid scale to measure in-patient and
outpatient perceptions of quality in India and (ii) to identify aspects of perceived quality
which have large effects on patient satisfaction. Participates are Health facilities and patients
at clinics. Cross-sectional survey of health facilities and patients at clinics, Primary health
centers, community health centers, district hospitals, and female district hospitals in the state
of Uttar Pradesh in north India. Main outcomes are internal consistency, validity, and factor
structure of the scale is evaluated. The association between patient satisfaction and perceived
quality dimensions is examined. A 16-item scale having good reliability and validity is
developed. Five dimensions of perceived quality are identified-medicine availability, medical
information, staff behavior, doctor behavior, and hospital infrastructure.

Patient perceptions of quality at public health facilities are slightly better than neutral.
Multivariate regression analysis results indicate that for outpatients, doctor behavior has the
largest effect on general patient satisfaction followed by medicine availability, hospital
infrastructure, staff behavior, and medical information. For in-patients, staff behavior has the
largest effect followed by doctor behavior, medicine availability, medical information, and
hospital infrastructure .The scale developed can be used to measure perceived quality at a
range of facility types for outpatients and in-patients. Perceived quality at public facilities is
only marginally favorable, leaving much scope for improvement. Better staff and physician
interpersonal skills, facility infrastructure, and availability of drugs have the largest effect in
improving patient satisfaction at public health facilities.
Gasquet et al; (2004), conducted a survey with few questionnaires on outpatients' satisfaction
with hospital exist. The main objective was to develop, according to psychometric standards,
a self-administered generic outpatient questionnaire exploring opinion on quality of hospital
care. First, a qualitative phase was conducted to generate items and identify domains using
critical analysis incident technique and literature review. A list of easily comprehensible non-
redundant items was defined using Delphi technique and a pilot study on outpatients. This
phase involved outpatients, patient association representatives and experts. The second step
was a quantitative validation phase comprised a multicenter study in 3 hospitals, 10
departments and 1007 outpatients. It was designed to select items, identify dimensions,
measure reliability, internal and concurrent validity. Patients were randomized according to
the place of questionnaire completion (hospital v. home) (participation rate = 65%). Third, a
mail-back study on 2 departments and 248 outpatients was conducted to replicate the
validation (participation rate = 57%). A 27-item questionnaire comprising 4 subscales
(appointment making, reception facilities, waiting time and consultation with the doctor). The
factorial structure was satisfactory (loading >0.50 on each subscale for all items, except one
item). Inter scale correlations ranged from 0.42 to 0.59, Cronbach alpha coefficients ranged
from 0.79 to 0.94. All Item-scale correlations were higher than 0.40. Test-retest intra class
coefficients ranged from 0.69 to 0.85. A one-dimensional 9-item version was produced by
selection of one third of the items within each subscale with the strongest loading on the
principal component and the best item-scale correlation corrected for overlap.

Factors related to satisfaction level independent from departments were age, previous
consultations in the department and satisfaction with life. Completion at hospital immediately
after consultation led to an overestimation of satisfaction. No satisfaction score differences
existed between spontaneous respondents and patients responding after reminder(s). Good
estimation of patient opinion on hospital consultation performance was obtained with these
questionnaires when comparing performances between departments or the same department
over time scores need to be adjusted on 3 variables that influence satisfaction independently
from department. Completion of the questionnaire at home is preferable to completion in the
consultation facility and reminders are not necessary to produce non-biased data.
Gremigni et al; (2008) study is aimed at developing and providing preliminary validation of a
questionnaire to measure outpatients' experience of communication with hospital personnel
other than doctors. Participants are Outpatients and hospital staff. Small groups of outpatients
and hospital staffs were involved in identifying the domains and generating the items. A
quantitative validation phase involving 401 outpatients followed in order to verify the
hypothesized dimensionality of selected items and to measure reliability A 13-item
questionnaire emerged, comprising four components of outpatients' experience in the
healthcare communication domain: problem solving, respect, lack of hostility, and nonverbal
immediacy. Psychometric tests were promising as regards factorial validity, evaluated with
confirmatory factor analysis, and scales reliability. Factor scores were independent ofpatients'
gender, age, and education. The developed Health Care Communication Questionnaire
(HCCQ) is a self-administered brief measure with good psychometric properties. The HCCQ
gives information that could be taken as an indirect and subjective indicator of the quality of
hospital services as provided by non-medical staff. This aspect may have a role in local
quality improvement initiatives.
Hordacre et al;(2000) In their study entitled “Assessing patient satisfaction: implications for
South Australian public hospitals “, the results revealed that satisfaction was lowest in the
patients' assessment of their involvement in their own care and treatment. Three demographic
factors (younger age, female sex or tertiary education) predicted lower levels of satisfaction,
whereas livings with others, non-emergency admission or admission to smaller hospitals were
found to predict higher satisfaction.

Renzi (2001) argue that patient satisfaction is an important indicator in evaluating the quality
of the patient care in the outpatient department. In the context of total quality, serving the
customers/patients does not simply mean satisfying them. It implies satisfying their needs in
conformance to their requirements, and the specifications have to be stated explicitly by
customers to be satisfied. There is an increasing interest in assessing patients' satisfaction
with medical care in the United States and other countries.
Socio-Demographic Characteristics-
Doborah ( 1997) argue that many people have a strong belief that the high levels of positive
opinions of patients might be closely related to some independent factors such as standards of
living, gender, age groups, and even status of the patients whether they are single, married, or
widowed, etc. Nonetheless, some other researchers have concluded that there is little
relationship between socio-demographic characteristics with satisfaction levels.
Aday and Anderson ( 1981) state that some findings confirm that people who are from the
same ethnic groups tend to pay more attention or to help the people who are from the same
sources. This idea is also said to apply in the performance done by physicians who are from
the same groups as their patients.
Hall and Dornan (1990) say that there are also believes that some social advantages such as
educational backgrounds, employments, revenues, an warranty are the keys for clients to
decide which services to use.
Lebow (1983) argues suggestions regarding direct relationship between socio-demographic
characteristics have been well documented. Some researchers suggested that the high levels
of patients’ satisfaction are significantly related to the patients’ standards of living, namely
the family income. While some others mentioned that age is the most noticeable independent
variable that usually has very close relationship with patients’ positive opinions about
services. They believe that the older the patients are, the higher the level of satisfaction they
will show while the younger the patients are, the lower the level of satisfaction they will give.

Last but not least, some researchers also stated that some patients tend to medical services
based on their reference groups’ ideas. For instance, if their group says this service is good to
use, they will be likely to decide to use this service rather than others.
Pasaribu (1996) Say that even though many trends of direct relationship between socio-
demographic characteristics and patients’ satisfaction are highly discussed among many
researchers, these independent variables are not used as the tool to predict the patients’
satisfaction in all cases. Sometimes, it is hard for the service providers to meet some patients’
high expectation. Some researchers have found out that the characters of socio demographic
factors vary vastly according to the actual aspects. The nature of patients’ expectation may be
widely different and complicated. One cannot base on a set of standard rules to satisfy
different groups of people and to expect that they will show a similar satisfaction level.
Therefore, significant factors around them might become effective tools to predict what they
really want. People with a low standard of living tend to experience a low level of health care
services when they have health problems. In addition, because they really have to work hard
to survive, they might not be able to follow more schedules of treatments. In some case, their
physicians do not treat them equally as the patients who have full coverage of insurance. This
factor unavoidably might lead them to have a low level of satisfaction.
Rodney et al; (1986) say that a significant trend is matching a low level of educational
background of the users with high level of satisfaction all over the world by satisfaction
research.
Thoma Perenger (1997) found that nervous effects from unclear reasons of health problems,
which patients have experienced, were suggested as a reason for patients to start their
visitation to hospital and even continue increasing the numbers of visitation in a period of
time. These effects are also said to be influenced by gender. It usually means that female
patients seem to pay more visitations to hospital than male ones. Dozens of research have
been done in order to find out the significant associations between socio-demographic
characteristics and the results of satisfaction researches in health care industry.

Setter (1996) found out that the trend of satisfaction seems to fall high on male respondents
rather than female respondents. Nonetheless, many other researches regarding patients’
opinion about services they have received provided statistical results that female patients
usually showed higher levels of satisfaction than male patients.
Doborah (1997) studied the concern about relationship between age groups and level of
satisfaction has also been studied. Some previous researchers have suggested that the older
respondents seem to give more scores to the service providers since they have been going
through the social services all their lives. They are said to be more understanding and
accepting than younger respondents who usually have less social and commercial experiences
of the real world and seem to judge things very quickly.
Wiadnyana et al; (1995) argue that more and more enthusiastic belief that age groups are
significant elements to predict a high level of satisfaction has been repeated over the times.
The elderly tends to be more satisfied that youngsters when they are receiving the same
services.
Channawangse et al ;( 1999) states that many reports have associated a low level of patients’
satisfaction with low family income. They say that people’s monthly incomes play important
roles in purchasing power of goods and services. It also classifies the users’ social status with
a set of standard quality of services, which is usually highly expected by the user of
healthcare services.
Sumtraprapoot (2000) in his study suggested that the respondents who have lower revenues
tended to have a higher level of satisfaction than those who have higher monthly incomes.
Normally, the patients who earned less revenue, experienced poor health conditions and it is
hard for them to get better health care services with less continuous follow-up through their
physicians. Moreover, they are thought to receive less care by physicians than those who
have been covered by any insurance schemes. All in all, they don’t have choices, but to feel
dissatisfied with the services provided.

Patients’ Experiences with Healthcare Service-
One significant dependent variable in the study of patients’ satisfaction is the patients’ own
experiences of the real service performances. This vital factor later also creates ones’ hopes
of receiving the same or a better quality of services than they get used to. People normally
base their judgment of the services on seeing, touching, listening, smelling and tasting than
the elements included in a set of quality service. For healthcare service, particularly patients
will decide whether they are low or highly satisfied with service through feeling the direct
elements of the services such as physical facility, physicians’ consultation and treatment skill,
nurses’ consoling skill, pharmacy service, registering service, and so on. Patients’ opinion
about qualify services would be instantly changed if the patient continuously experiences
same services with different ways of serving. Self involvement really matters in
determination of one’s’ way of perceiving quality of satisfaction regarding waiting time,
cleanliness, and the setting of infrastructure around.
Pasaribu(1996) stated that he found the causes of patients’ satisfaction, to be a low level of
quality of care and less amount drugs provided.
Physicians’ and Nurses’ Services-
Robert and Coale Redman (1987) found that physicians’ and nurses’ communication skills
with patients are the key components to a high level of patients’ satisfaction. In a research
done in Switzerland, physician-patient interaction has been suggested as the vital factor in
predicting patients’ satisfaction.
Afridi (2002) argue that likewise, way of raising voice, physical feeling, communication and
Personal behaviours of physicians really contribute in bringing a higher level of users’
satisfaction.
Barry(2001) mentioned in a study in Ireland that good interaction between physicians and
their patients is the milestone to reach clients’ satisfaction and continuous improvement of
quality of care Likun (1996).

Pharmacy, Registration and, Service Principles-
Additional services like pharmacy, registration and service flow are particularly mentioned to
significantly influence the level of patients’ satisfaction.
Phyunyathikum (1994) clarified in his research that the quality of pharmacy service including
numbers of personnel, rates of prescribing medicines and waiting time to receiving medicines
determine the result of patients’ satisfaction.
Accessibility to Healthcare Service-
Accessibility means physician-visiting structure, first-line reception, and availability of
different physicians, personal house visitation, and the follow-up visits. Many factors are
leading patients to feel frustrated when they are admitted to a hospital usually indicated as an
embarrassing aspect, is the absence of clinical staffs in any working shifts, especially at
night-time. Emergency cases can happen anytime without warning; therefore, punctual and
critical presence of necessary personnel must be under close monitoring.
Aday (1983) mentioned the trend of moving from public healthcare body to private one is
increasing day to day as the result of such neglect. Good communication and capability to
understand and share the feeling of others are now being perceived as the main aspects to
patients’ satisfaction. The activity of removing a person’s doubt or fear, capability to
understand and share the feeling of others, are among other significant factors to extend the
value of physician-patient interaction. However, a straight relationship between them and
satisfaction was not assured. Patients tend to give value to their physicians and nurses in term
of respects and friendly attitudes rather than technical matters. Removing a person’s doubt or
fear and capability to understand and share the feeling of others reflect the value of health
profession and are well recognized in treating patients with cancer.
Cockerham (1982) argued that demand for health care service is always there. Therefore,
healthcare service providers should be ready to serve anytime. Ease of accessing to health
care facilities has become a potential goal for policy makers throughout the world.
Nonetheless, attempt in conceptualize and assess the accessibility still vary based on people’s
perception.

Ross et al ;( 1993) findings provide evidences that most of the respondents decided to
prioritize clinical quality of care followed by physicians/nurses’ communication skills, and
ended up by the accessibility to healthcare facilities as their preferences. Likewise, the
respondents who prioritized the accessibility were from older-age group with a low
Educational background and low income.
Components of Patients’ Satisfaction-
The main elements of satisfaction proposed by the researcher in the Khmer-Soviet
Friendship Autonomous Hospital comprise of convenience, courtesy, and quality of care.
Convenience-
Convenience is defined as the comfort in approaching a set of standard quality of care such as
chances of seeing wanted physicians, adequate waiting time, ease of meeting the required
expectation and qualified services.
Kunarantnapruek and Boonpadoong (1989) mentioned that Users usually will come back to
receive services from where they used to be satisfied. Researchers can use this characteristic
to differentiate the quality of services provided. Furthermore, one main factor that should be
considered for predicting the level of convenience is waiting time.
Sriratanabul and Pimpakovit (1993) in a study of patients’ satisfaction in the Outpatient
Department of Chulalongkorn Hospital, argue that a significant factor led the majority of the
respondents to feel uncomfortable with the services provided was long waiting time. 83% of
the respondents showed positive feeling towards services provided in the department while
disappointed with very long waiting time to receiving services.
Likun(1996) mentioned waiting time services in a study of “Ways and Means to
Reduce the Waiting Time and Improve Patient Satisfaction”. He revealed that there was a
significant relationship between waiting time to receive service, and patients’ satisfaction
level. The majority of his respondents, 61% complained that waiting was not good for them.

Tessler et al ;( 1976) in a research in Ramathibodi Hospital, long waiting time was indicated
as the significant factor for a low level of satisfaction. There is a report that the Respondents
who were highly educated showed a low level of satisfaction in the Registration section while
similar effect also happened in the Pharmacy section.
Quality of Care-
Bashir and Armstrong (1991) argue that nowadays, hot issues like qualified health care
service and patients’ satisfaction are being crucially discussed throughout the world. Many
different institutions have adopted a means to reflect on their service providing. Hi-tech,
humanistic approach, educational backgrounds, communication, and means of transferring
qualified service quality to the patients constitute the vitality of patients’ satisfaction.
Donabedian(1993) suggests that Efficacy, effectiveness, efficiency, optimality, acceptability,
legitimacy, and equity are the seven main factors for patient satisfaction..
Williams and Calnan (1991) states significant changes in health care service evaluating and
enhancement are opening a new health care portrait for the service user. Formally accepted
principles and apparatus to assessing and improving of health care service users are dated to
the American College of Surgeon’s 1971, Hospital Standardization Program when it evolved
into the Joint Commission on Accreditation of Healthcare Organization Accreditation
Process.
Piyathida Sumtraprapoot (1997) mentions that a new trend in combining quality assurance
from other commercial industries with health care delivery strategies is the main indicator for
quality of care. Generally accepted and hi-tech methods of health care services have led the
industry to the contemporary way of qualified healthcare management.
Quality of hospital care was created by The American College of Surgeons as a fundamental
formula in 1933 and gradually this principle in 1917 became its hospital standardization
program. Furthermore, The Canadian Hospital Association with American College of
Physicians, The American Hospital Association, and American Medical Association has
established a Joint Commission on Accreditation of Hospital (JACHO) that originated the
criteria based audit method.

Garpenby (1999), Sweden written an article regarding Resource Dependency mainly
indicated the relationship between the aspect of national-level clinical profession and patient
satisfaction level. It also suggested that service quality advancement should be the main focus
in order not to lose the public expectation. He also mentioned that the health care framework
should be regarded as in other industries by characterizing its quality profession. An accepted
set of qualified standards of care such as accessibility, availability, personnel’s qualifications,
and mutual understanding are not only the significant factors considered by the management
level, but also by the users of the healthcare services who are normally called clients.
Courtesy-
Courtesy is usually defined by respect, attentiveness, and care shown by the clinical
personnel.
Assessment of Patient Satisfaction in Healthcare Service
Assessment of users’ satisfaction in healthcare services is a means of evaluating the
healthcare service performances by clinical personnel. In addition, it also indicates the
success and failure of service implementation and development in a way of perceived
services.
Barry et al; (2001) states that Patient satisfaction is a very complicated principle, which is
usually affected by some significant factors such as socio-demographic factors, personal
characters, physical and mental aspects, cause and effect of the services, and patients’
expectations
In spite of these complexes, ways of assessing patients’ satisfaction have been proposed as:
 An accurate merging of consumers’ opinions about healthcare service for the sake of
quality improvement and assurance.
 Marketing strategies regarding consumers’ satisfaction that have been introduced in
the health care industry.
 Increasing the level of complying with treatment, originated from the vital study of
patients’ behaviours toward services.

By quality improvement, assessment of the patients’ satisfaction becomes a significant
educational process to find the developments that are inexpensive to make, have better
service performance and sets of qualified standards.
Theoretical Model for Constructing Conceptual Framework-
Aday and Anderson (1978) in the study of people’s satisfaction with health care delivery in
the United States of America from 1970 to 1975 pointed out six principles focusing on
patient satisfaction, and three of them are presented below:
1. Satisfaction in term of convenience:
- Waiting time to obtain service
- Available care when required
- Base of receiving care
2. Satisfaction in term of courtesy:
- Friendly and polite attitude of the service providers
- Provision of what is necessary for the welfare of a patient
3. Satisfaction in term of quality of care:
- The patients’ perception of the service performance.
In 1974, they also mentioned that patient satisfaction is the attitude of people who were
involved in the health care system that is different from the elements of the predisposing
variables, as it measures the people’s satisfaction against the amount of care and its quality.
Aday and Anderson (1983) Furthermore, also suggested that evaluation of the patient
satisfaction might be best performed in the form of relevant medical service seeking
behaviour, which is clear, up-to-date, and classifiable, in order to elicit the subjective
perception about access which points out the satisfaction with the convenience of service, its
correspondence and cost, courtesy of the servers, information the patients obtained about the
treatment, and the patients’ opinion based on the quality of care. Patients’ satisfaction is the
indicator of the outcome in a theoretical model of access, which indicated the use of the
services.

CHAPTER-4
RESEARCH DESIGN AND METHODOLOGY
The main objective of this research was to assess the level of patient satisfaction with
Medicine Outpatient Department’s services regarding physician –patient interaction; nurse-
patient interaction; and patients’ satisfaction in term of convenience, courtesy, and quality of
care of Fortis escorts hospital.
 Measure the satisfaction of OPD (Outpatient Department) patients and identify the
strategies to help the hospital to increase their patient satisfaction scores and sustain
patient loyalty on a long-term basis in FORTIS ESCORTS hospital in Amritsar,
Punjab in India.
Specific objectives:
 To assess the level of satisfaction with services provided by the Out Patient
Department in Fortis Hospital, Amritsar.
 To identify the strategies to help the hospital to increase their patient satisfaction
scores.
 To describe the patients opinions and suggestions on improving the services in OPD
of Fortis hospital, Amritsar.
Fortis Hospital, Amritsar, is a 154 bed multispecialty hospital with super specialty in Cardiac
Sciences. It commenced its operations way back in 2003 and since then have been a familiar,
trusted and comforting presence, ministering to the healthcare needs of the community.
Spread over 5 acre and are the only NABH accredited hospital in the region.

Study Design
A cross-sectional study design was employed on the designated date in the Outpatient
Department of the Fortis Hospital, Amritsar. This design is particularly aimed to find out the
levels of patients’ satisfaction and its significant relationships with socio-demographic
characteristics of the studied samples. Meanwhile, in order to achieve the set goals, a pre-
interviewed questionnaire adopted from a previous researcher has been comprehensively
justified, and applied, accordingly.
Study Population:
The Outpatient Department of the Fortis Hospital, Amritsar was selected as the study site.
Targeted samples were drawn from the patients who had visited the Outpatient Department of
Fortis Hospital, Amritsar at the time of data collection.
The patients matching the inclusion criteria are included in the study and were administered
the questionnaire during their visit to OPD of Fortis hospital
Sample Size and Sampling Technique:
The sample consists of 100 patients who attended the Outpatient Department of the Fortis
Hospital, Amritsar.
Ethical Consideration:
The patients were informed about the study before conducting the study and were told that
their participation will be voluntary.
Inclusion Criteria:
1. The outpatients of the Department whose age ranges are from 15 years to 85 years old.
2. The patients who were willing to give consent.
3. The patients who have at least visited Outpatient Department for times and pharmacy for 1
time.
4. The patients who were able to listen and understand local language.
Exclusion Criteria:
1. Patients who had mental problems.
2. Patients who needed emergency attention.
3. Patients who had not finished the interview process.

Socio-demographic Characteristics consisted of age, sex, marital status, occupation,
education and family size of the respondent. The age of the respondent counted in years on
last birth day. Age had four groups as follows-
 15-30
 30-45
 45-60
 60 and Above
Marital Status is whether the respondent was single, married, divorced, separated,
widow/widower. In this research we have four groups as single, married, widow/widower and
divorced/separated
Main Occupation is the nature of job of the respondent. For example
 Student
 Business
 Agriculture
 Government Employee
 Private Employee
 Others
Education is the academic or study qualification of the respondents. For example
 Illiterate
 Finished primary school
 Finished secondary school
 Finished Bachelors degree
 Others
Family size is the total members of the family living in house hold of the respondent.
Number of visits is the Total number of visits to hospital so far (during last 6 months) by the
respondent. (≤median and > median)
Satisfaction is individual feelings or perceptions towards out-patient department health care
services and the extent to which these services met the need of users. The satisfaction was
used as a composite variable and its level was determined by assessing satisfaction of patient
for physical facilities, doctor service, nurse service, pharmacy service, registration service
and expenses and time convenience to hospital.

Percentages were calculated for predisposing factors (sex, age, marital status, education
attainment, occupation)
In order to determine level of satisfaction - respondents were asked 20 questions and Likert’s
five points rating scaling was used for measuring satisfaction. The rating was done as follow:
5-COMPLETELY SATISFIED
4-SOME WHAT SATISFIED
3-NEUTRAL
2-SOME WHAT DISSATISFIED
1 -COMPLETELY DISSATISFIED
In satisfaction part, five-point Likert ranking scale was used for all the questions. Satisfaction
was computed as follows-
For example the responses from the patients from the overall rating of satisfaction of physical
facilities (about the sitting chairs in the waiting area) in OPD were 40(5) completely satisfied,
39(4) somewhat satisfied, 3(3) neutral, 9(2)somewhat dissatisfied , and 9(1)completely
dissatisfied.
The total no. of responses was equal to 100.
Satisfaction score = [40x5+39x4+3x3+9x2+9x1]/100=3.92.
In this study we divide into two levels of satisfaction as high and low by using mean score as
the cut- off point as best criteria.(from Amin Khan Mandokhail 4937996 ADPM/M).
Standard deviation (SD) (represented by the Greek letter sigma, σ) shows how much
variation or dispersion from the average exists.
Calculated by the formula-

CHAPTER-5
DATA ANALYSIS AND RESULT
PATIENT SATISFACTION TOWARDS OPD SERVICES
This study was conducted to determine the patient satisfaction with health services at the out-
patient department (OPD) of Fortis Escorts Hospital, Amritsar.
One Hundred patients were interviewed at the out-patient department. The data were
collected from 31st January2013 to 12th February 2014, 18per day.
Study variables:
Independent variables-
 Age
 Gender
 Marital status
 Education level
 Occupation
 No. of family members
 No. of visits to OPD.
Dependent variables-
 Physical facilities
 Doctors services
 Nursing services
 Pharmacy services
 Registration services
 Accessibility to OPD services
 Convinces
 Courtesy
The results were presented in tables and as well as descriptive form.
Socio-demographic characteristics of the patients-
For this study, socio-demographic characteristics were gender, age, marital status, education,
occupation and average no. of visits to the OPD.

Pie chart-1- Shows the Age of the respondent counted in years on last birth day.
Age had four groups as follows-
15 - 30were (3%), 30-45were (12%), 45-60were (43%) and 60 and above were (42%).
Pie chart-2- Shows the gender of the respondent’s males (66%) and females (34%).
3%
12%
43%
42%
Distribution of responseswith respectto age
15 to 30
30 to 45
45 to 60
Above 60
66%
34%
Distributionof responses withrespect togender
Male
Female

Pie chart-3- Shows the respondents’ marital status in four groups’ as single (2%), married
(92%),widow/widower (6%) and divorced/separated (0%).
Pie chart- 4- Shows the academic or study qualification of the respondents Illiterates (24%),
Finished primary school (20%),Finished secondary school (33%) and Finished Bachelors
degree (23%) .
2%
92%
6%
Distribution of responseswith respectto
marital status
Single
Married
Widow
24%
20%
33%
23%
education
Illiterate
Primary school
Secondary school
Bachelors

Pie-chart-5- Shows the natures of job of the respondent Student (1%), Agriculture
(19%),Government Employee (18%), Private Employee (14 %) and others (48%).
Pie chart-6- Shows the total members of the family living in house hold of the respondent 4
or less (38%), between 5 and 7 (50%) and 8 or more (12%)
19%
18%
14%
1%
48%
occupation
Agriculture
Govt. employee
Private employee
Student
Others
38%
50%
12%
number of familymembers
4 or less
Between 5 and 7
8 or more

Pie chart-7- Shows the Total number of visits to hospital so far (during last 6 months) by the
respondent is (≤median and > median).
To determine level of satisfaction- respondents were asked 20 questions and Likert’s five
points rating scaling was used for measuring satisfaction. The rating was done as follow:
5-COMPLETELY SATISFIED
4-SOME WHAT SATISFIED
3-NEUTRAL
2-SOME WHAT DISSATISFIED
1 -COMPLETELY DISSATISFIED
The satisfaction level was divided into three groups’ high and low based on the scores of the
respondents.
In satisfaction part, five-point Likert ranking scale was used for all the questions. Then
median, standard deviation, maximum score and minimum score was calculated after
summing up the total score. Higher score was considered as 70-100 and low 69 -20.
71%
29%
number of visits
≤median
> median

PHYSICAL FACILITIES-
Table no-1-shows the distribution of the responses about the physical facilities at OPD of
Fortis Hospital-
Completely
Satisfied
Somewhat
Satisfied
Neutral Somewhat
Dissatisfied
Completely
Dissatisfied
a) Sitting chairs in
waiting area of the
OPD for the
patients
40 39 3 9 9
b) Waiting area
cleanliness
99 0 1 0 0
c) Drinking water
facility in the
waiting area of
OPD for patients
83 2 0 7 8
d) Toilets
cleanliness
69 24 6 1 0
About the sitting chairs in the waiting area of the OPD for the patients, out of 100 responses,
40 responded completely satisfied, 39 responded somewhat satisfied, 3 are neutral, 9
responded somewhat dissatisfied and 9 are completely dissatisfied.

Graph-1-Shows the distribution of responses about the sitting chairs in the waiting area of the
OPD for the patients-
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
completely
dissatisfied
0
5
10
15
20
25
30
35
40
45
About sitting chairs in waiting area of OPD
About sitting chairs in waiting area
of OPD

About the Waiting area cleanliness of the OPD, out of 100 responses, 99 responded
completely satisfied and1 is neutral.
Graph-2-Shows the distribution of responses about the Waiting area cleanliness of the OPD-
completely
satisfied
somewhat
satisfied
neutral somwwhat
dissatisfied
completely
dissatisfied
0
20
40
60
80
100
120
about waiting area cleanliness of OPD
about waiting area cleanliness
of OPD

About Drinking water facility in the waiting area of OPD for patients, out of 100 responses,
83 responded completely satisfied, 2 responded somewhat satisfied, 7 responded somewhat
dissatisfies and 8 are completely dissatisfied.
Graph-3-Shows the distribution of responses about the Drinking water facility in the waiting
area of OPD for patients-
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
completely
dissatisfied
0
10
20
30
40
50
60
70
80
90
About Drinkingwater facility in the waiting
area of OPD
About Drinking water facility in
the waiting area of OPD

About the cleanliness of the toilets of the OPD for the patients, out of 100 responses,
69responded completely satisfied, 24 responded somewhat satisfied, 6 are neutral and 1
responded somewhat dissatisfied.
Graph-4-Shows the distribution of responses about the cleanliness of the toilets of the OPD
for the patients
DOCTOR SERVICES
Table no-2-shows the distribution of the responses about the doctor services at OPD of Fortis
Hospital-
Completely
Satisfied
Somewhat
Satisfied
Neutral Somewhat
Dissatisfied
Completely
Dissatisfied
a) Doctor spending
enough time with
you
98 2 0 0 0
b) Doctor giving
you the
opportunity to
discuss your
treatment with him
98 2 0 0 0
0
10
20
30
40
50
60
70
80
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About the cleanliness of the toilets of the
OPD
About the cleanliness of the
toilets of the OPD

From the past experience, about the Doctor spending enough time with patient, out of 100
responses, 98 responded completely satisfied and 2 responded somewhat satisfied.
Graph-5-Shows the distribution of responses about the Doctor spending enough time with
patient-
0
20
40
60
80
100
120
completely
satisfied
somewhat
dissatisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About the Doctor spending enough time
with patient
About the Doctor spending
enough time with patient

From the experience, doctor giving you the opportunity to discuss the treatment, out of 100
responses, 98 responded completely satisfied and 2 responded somewhat satisfied.
Graph-6-Shows the distribution of responses about the doctor giving you the opportunity to
discuss the treatment
NURSING SERVICES-Table no-3-shows the distribution of the responses about the
nursing services at OPD of Fortis Hospital
Completely
Satisfied
Somewhat
Satisfied
Neutral Somewhat
Dissatisfied
Completely
Dissatisfied
a) Nurse listening
to your health
problem and
explaining to you
any treatment that
you need
72 24 2 2 0
b) Helpfulness of
the nurses
to you
100 0 0 0 0
0
20
40
60
80
100
120
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About the Doctor, giving you the opportunity
to discuss your treatment with him
About the Doctor, giving you the
opportunity to discuss your
treatment with him

From the past experience, about the Nurses listening to your health problem and explaining
patient any treatment that needed out of 100 responses, 72responded completely satisfied, 24
responded somewhat satisfied, 2 are neutral and 2 responded somewhat dissatisfied.
Graph-7-Shows the distribution of responses about the Nurses listening to your health
problem and explaining patient any treatment that needed-
0
10
20
30
40
50
60
70
80
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About the Nurseslistening to your health problem
and explaining patient any treatment that needed
About the Nurses listening to your
health problem and explaining
patient any treatment that needed

From the past experience, about the Helpfulness of the nurses out of 100 responses,
100responded completely satisfied.
Graph-8-Shows the distribution of responses about the Helpfulness of the nurses-
PHARMACY SERVICES-
Table no-4-shows the distribution of the responses about the pharmacy services at OPD of
Fortis Hospital-
Completely
Satisfied
Somewhat
Satisfied
Neutral Somewhat
Dissatisfied
Completely
Dissatisfied
a) Costs of the
drugs for you in
the pharmacy
28 28 16 13 15
b) Communication
skills of the
pharmacists
100 0 0 0 0
0
20
40
60
80
100
120
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About the Helpfulnessof the nurses
About the Helpfulness of the
nurses

From the past experience, about the appropriateness of Costs of the drugs for you in the
pharmacy, out of 100 responses, 28 responded completely satisfied, 28 responded somewhat
satisfied, 16 are neutral, 13 responded somewhat dissatisfied and 15 are completely
dissatisfied.
Graph-9-Shows the distribution of responses about the appropriateness of Costs of the drugs-
0
5
10
15
20
25
30
completely
satisfied
somewhat
dissatisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About the appropriatenessof Costs of the drugs
for you in the pharmacy
About the appropriateness of
Costs of the drugs for you in the
pharmacy

From the past experience, about the, Communication skills of the pharmacists out of 100
responses, 100 are completely satisfied.
Graph-10-Shows the distribution of responses about the about the, Communication skills of
the pharmacists-
REGISTRATION SERVICE
Table no-5-shows the distribution of the responses about the registration services at OPD of
Fortis Hospital-
Completely
Satisfied
Somewhat
Satisfied
Neutral Somewhat
Dissatisfied
Completely
Dissatisfied
a) Registration staff
available in OPD
65 24 0 8 3
b) Cooperativeness
of registration staff
99 0 0 1 0
0
20
40
60
80
100
120
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About the Communicationskills of the
pharmacists
About the Communication skills
of the pharmacists

From the past experience, about the Registration staff available in OPD, out of 100 responses,
65 responded completely satisfied, 24 responded somewhat satisfied, 8 responded somewhat
dissatisfied and 3 are completely dissatisfied.
Graph-11-Shows the distribution of responses about the about the Registration staff available
in OPD-
0
10
20
30
40
50
60
70
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About the Registration staff available in OPD
About the Registration staff
available in OPD

From the past experience, about the Cooperativeness of registration staff, out of 100
responses, 99 responded completely satisfied and 1 responded somewhat dissatisfied.
Graph-12-Shows the distribution of responses about the about the Cooperativeness of
registration staff-
WAITING TIME
Table no-6-shows the distribution of the responses about the waiting time at OPD of Fortis
Hospital-
Completely
Satisfied
Somewhat
Satisfied
Neutral Somewhat
Dissatisfied
Completely
Dissatisfied
a) Waiting time
before meeting the
doctor for you
62 0 5 33 0
0
20
40
60
80
100
120
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About the Cooperativeness of registration staff
About the Cooperativeness of
registration staff

From the past experience, about the Waiting time before meeting the doctor for patient , out
of 100 responses, 62 responded completely satisfied, 5 are neutral and 33 responded
somewhat dissatisfied.
Graph-13-Shows the distribution of responses about the Waiting time before meeting the
doctor-
SERVICE PROCESS
Table no-7-shows the distribution of the responses about the service process at OPD of Fortis
Hospital-
Completely
Satisfied
Somewhat
Satisfied
Neutral Somewhat
Dissatisfied
Completely
Dissatisfied
a) Service process of
registration
99 0 0 1 0
0
10
20
30
40
50
60
70
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About the Waiting time before meeting the
doctor for patient
About the Waiting time before
meeting the doctor for patient

From the past experience, about the Service process of registration, out of 100 responses, 99
responded completely satisfied and 1 somewhat dissatisfied.
Graph-14-Shows the distribution of responses about the Service process of registration-
WORKING HOURS OF OPD SEVICES
Table no-8-Shows the distribution of the responses about the working hours of OPD in Fortis
Hospital-
Completely
Satisfied
Somewhat
Satisfied
Neutral Somewhat
Dissatisfied
Completely
Dissatisfied
a) Medical staff
availability during
the working hours of
OPD
91 0 2 7 0
0
20
40
60
80
100
120
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
About the Service processof registration
About the Service process of
registration

From the past experience, about the Medical staff availability during the working hours of
OPD, out of 100 responses, 91 responded completely satisfied, 2 are neutral and 7 somewhat
dissatisfied.
Graph-15-Shows the distribution of responses about the Medical staff availability during the
working hours of OPD-
CONVENIENCE
Table no-9-shows the distribution of the responses about the convenience OPD of Fortis
Hospital-
Completely
Satisfied
Somewhat
Satisfied
Neutral Somewhat
Dissatisfied
Completely
Dissatisfied
a) Ease of finding
OPD section in
hospital for you
100 0 0 0 0
b) In terms of
expenses and time
convenience of
going from your
house to OPD
26 25 2 24 23
0
20
40
60
80
100
completely
satisfied
somewhat
dissatisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About the Medical staffavailability during
the workinghours of OPD
About the Medical staff
availability during the working
hours of OPD

From the past experience, about the, Ease of finding OPD section in hospital for you out of
100 responses, 100 are completely satisfied.
Graph-16-Shows the distribution of responses about the Ease of finding OPD section in
hospital-
0
20
40
60
80
100
120
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About the Ease of finding OPD section in
hospital
About the Ease of finding OPD
section in hospital

From the past experience, about (In terms of) expenses and time convenience of going from
your house to OPD, out of 100 responses, 26 responded completely satisfied, 25 responded
somewhat satisfied, 2 are neutral, 24 responded somewhat dissatisfied and 23 are completely
dissatisfied.
Graph-17-Shows the distribution of responses about the (In terms of) expenses and time
convenience of going from your house to OPD-
0
5
10
15
20
25
30
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About (In terms of) expenses and time
convenience of going from your house to
OPD
About (In terms of) expenses
and time convenience of going
from your house to OPD

COURTESY
Table no-10-shows the distribution of the responses about the courtesy-
Completely
Satisfied
Somewhat
Satisfied
Neutral Somewhat
Dissatisfied
Completely
Dissatisfied
a) Friendliness and
readiness of doctor
to help
100 0 0 0 0
b) Courtesy from
nursing staff
97 0 2 1 0
c) Privacy from
doctors and nurses
during the
examination
98 2 0 0 0
From the past experience, about the, Friendliness and readiness of doctor to help out of 100
responses, 100 are completely satisfied.
Graph-18-Shows the distribution of responses about the, Friendliness and readiness of doctor
to help-

From the past experience, about Courtesy from nursing staff, out of 100 responses, 97
responded completely satisfied, 2 are neutral and 1 responded somewhat dissatisfied.
Graph-19-Shows the distribution of responses about the Courtesy from nursing staff-
From the past experience, about the, Privacy from doctors and nurses during the examination
out of 100 responses, 98 are completely satisfied and 2 are somewhat satisfied.
Graph-20-Shows the distribution of responses about the Privacy from doctors and nurses
during the examination-
0
20
40
60
80
100
120
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About the Friendlinessand readiness of
doctor to help
About the Friendliness and
readiness of doctor to help
0
20
40
60
80
100
120
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About Courtesyfrom nursingstaff
About Courtesy from nursing
staff

After the data analysis the results are-
PHYSICAL FACILITIES
Table –no- 1- Shows the satisfaction scores obtained about the physical facilities-
Completely
Satisfied
5
Somewhat
Satisfied
4
Neutral
3
Somewhat
Dissatisfied
2
Completely
Dissatisfied
1
Satisfaction score
a) Sitting chairs
in waiting area of
the OPD for the
patients
40 *5=200 39*4=156 3*3=9 9*2=18 9*1=9 (200+156+9+18+9)
/100=3.92
b) Waiting area
cleanliness
99 0 1 0 0 4.98
c) Drinking water
facility in the
waiting area of
OPD for patients
83 2 0 7 8 4.45
d) Toilets
cleanliness
69 24 6 1 0 4.61
0
20
40
60
80
100
120
completely
satisfied
somewhat
satisfied
neutral somewhat
dissatisfied
completely
dissatisfied
About the Privacy fromdoctors and nurses
during the examination
About the Privacy from doctors
and nurses during the
examination

Satisfaction Score for the physical facilities provided in OPD of Fortis Escorts for the Sitting
chairs in waiting area of the OPD for the patients is 3.92 , for waiting area cleanliness is 4.98
, for the drinking water facility in the waiting area of OPD for patients is 4.45, for the toilets
cleanliness is 4.61.
DOCTOR SERVICES
Table –no- 2- Shows the satisfaction scores obtained about the doctor services-
Completely
Satisfied
5
Somewhat
Satisfied
4
Neutral
3
Somewhat
Dissatisfied
2
Completely
Dissatisfied
1
Satisfaction
score
a) Doctor spending
enough time with
you
98 2 0 0 0 4.98
b) Doctor giving
you the
opportunity to
discuss your
treatment with him
98 2 0 0 0 4.98
Satisfaction Score for the doctor services in OPD about the Doctor spending enough time
with patient is 4.98 and about the Doctor giving the opportunity to discuss your treatment
with patient is 4.98

NURSING SERVICES
Table –no- 3- Shows the satisfaction scores obtained about the nursing services-
Completely
Satisfied
5
Somewhat
Satisfied
4
Neutral
3
Somewhat
Dissatisfied
2
Completely
Dissatisfied
1
Satisfaction
score
a) Nurse listening
to your health
problem and
explaining to you
any treatment that
you need
72 24 2 2 0 4.66
b) Helpfulness of
the nurses
to you
100 0 0 0 0 5.00
Satisfaction Score for the Nursing services in OPD about the Nurse listening to patient health
problem and explaining any treatment that patient needs is 4.66 and about the Helpfulness of
the nurses is 5.00.

PHARMACY SERVICES
Table –no- 4- Shows the satisfaction scores obtained about the pharmacy services-
Completely
Satisfied
5
Somewhat
Satisfied
4
Neutral
3
Somewhat
Dissatisfied
2
Completely
Dissatisfied
1
Satisfaction
score
a) Costs of the
drugs for you in
the pharmacy
28 28 16 13 15 3.41
b) Communication
skills of the
pharmacists
100 0 0 0 0 5.00
Satisfaction Score for the Pharmacy services in OPD about the costs of the drugs in pharmacy
is 3.14 and about the communication skills of the pharmacists is 5.00.
REGISTRATION SERVICE
Table –no- 6- Shows the satisfaction scores obtained about the registration service-
Completely
Satisfied
5
Somewhat
Satisfied
4
Neutral
3
Somewhat
Dissatisfied
2
Completely
Dissatisfied
1
Satisfaction
score
a) Registration staff
available in OPD
65 24 0 8 3 4.40
b) Cooperativeness
of registration staff
99 0 0 1 0 4.97
Satisfaction Score for the Registration services in OPD about the registration staff availability
in OPD is 4.40 and about the cooperativeness of the registration staff is 4.97.

WAITING TIME
Table –no- 7- Shows the satisfaction scores obtained about the waiting time-
Completely
Satisfied
5
Somewhat
Satisfied
4
Neutral
3
Somewhat
Dissatisfied
2
Completely
Dissatisfied
1
Satisfaction
score
a) Waiting time
before meeting the
doctor for you
62 0 5 33 0 3.91
Satisfaction Score for the waiting time before meeting the doctor in OPD is 3.91
SERVICE PROCESS
Table –no- 8- Shows the satisfaction scores obtained about the service process-
Completely
Satisfied
5
Somewhat
Satisfied
4
Neutral
3
Somewhat
Dissatisfied
2
Completely
Dissatisfied
1
Satisfaction
score
a) Service process of
registration
99 0 0 1 0 4.97
Satisfaction Score for the Service process of registration in OPD is 4.97.
WORKING HOURS OF OPD SEVICES

Table –no- 8- Shows the satisfaction scores obtained about the working hours of OPD-
Completely
Satisfied
5
Somewhat
Satisfied
4
Neutral
3
Somewhat
Dissatisfied
2
Completely
Dissatisfied
1
Satisfaction
score
a) Medical staff
availability during
the working hours of
OPD
91 0 2 7 0 4.75
Satisfaction Score for the medical staff availability during working hours in OPD is 4.75.
CONVENIENCE
Table –no- 9- Shows the satisfaction scores obtained about the convenience-
Completely
Satisfied
5
Somewhat
Satisfied
4
Neutral
3
Somewhat
Dissatisfied
2
Completely
Dissatisfied
1
Satisfaction
score
a) Ease of finding
OPD section in
hospital for you
100 0 0 0 0 5.00
b) In terms of
expenses and time
convenience of
going from your
house to OPD
26 25 2 24 23 3.07
Satisfaction Score for the Ease of finding OPD section for the patient is 5.00 and In terms of
expenses and time convenience of going from patient house to OPD is 3.07.
COURTESY
Table –no-10- Shows the satisfaction scores obtained about the courtesy-

Completely
Satisfied
5
Somewhat
Satisfied
4
Neutral
3
Somewhat
Dissatisfied
2
Completely
Dissatisfied
1
Satisfaction
score
a) Friendliness and
readiness of doctor
to help
100 0 0 0 0 5.00
b) Courtesy from
nursing staff
97 0 2 1 0 4.93
c) Privacy from
doctors and nurses
during the
examination
98 2 0 0 0 4.98
Satisfaction Score for the friendliness of doctor to help is 5.00, about the Courtesy from
nursing staff is 4.93 and about the Privacy from doctors and nurses during the examination is
4.98.
The Mean is calculated from the scores of satisfaction and is 4.59.Minimum Score is 3.07
Maximum Score is 5.00.The standard deviation SD is calculated and found to be 0.56.
High satisfaction is considered when score is found to be greater than the mean using best
criteria. (High Satisfaction >Mean) (i.e. >4.59)
Low satisfaction is considered when score is found to be less than the mean using best
criteria. (Low satisfaction <Mean) (i.e. <4.59)
Satisfaction Frequency Percentage
High Satisfaction >4.59 70 70
Low <4.59 30 30

CHAPTER-5- CONCLUSION
Patient attending each hospital are responsible for spreading the good image of hospital and
therefore satisfaction of patients attending the hospital is equally important for hospital
management.
Patient satisfaction is the key indicator that can reflect the health service quality at any level
of health care facilities.
The objectives of this study were to assess the level of patient satisfaction towards OPD
services in Fortis Escorts, Amritsar.
The patient satisfaction was concerned with components-
 The patient satisfaction was Socio-demographic characteristics of the patients,
 Experiences of patients about medicine outpatient department
a. Physical facilities,
b. Physician-patient interaction,
c. Nurse-patient interaction,
d. Experiences with pharmacy,
e. Experiences with Registration.
 Accessibility to Medicine Outpatient Department
a. Waiting time,
b. Working schedule,
c. Service procedure.
 Patient Satisfaction towards Outpatient Department
a. Accessibility,
b. Courtesy,
c.Quality of care, and last but not least
 Suggestion and comment for the improvement of Outpatient department.
Independent variables were predisposing factors such as age, gender, education level,
occupation, and marital status, no. of visits to OPD and no. of members in their family.

A structured questionnaire was used as a study instrument for data collection.
The results were presented by using frequency, percentage, minima, maxima, mean, median
and standard deviation.
The result revealed that the age of the patients was in between 15 - 30were (3%), 30-45 were
(12%), 45-60 were (43%) and 60 and above were (42%).The male respondents are about
(66%) and females are (34%). Marital status of the respondents are single (2%), married
(92%), widow/widower (6%) and divorced/separated (0%). The academic or study
qualification of the respondents are Illiterates are( 24%),Finished primary school are
(20%),Finished secondary school are (33)% and Finished Bachelors degree are( 23%).
The natures of job of the respondent Student are (1%), Agriculture are (19%) Government
Employees are (18%), Private Employees are (14 %) and others are (48%).
The total members of the family living in house hold of the respondent 4 or less are (38%),
between 5 and 7 are (50%) and 8 or more are (12%).
Total number of visits to hospital so far (during last 6 months) by the respondent is [≤median
(29%) and > median (71%)].
The result of overall satisfaction level showed that the patients with high satisfaction and low
satisfaction were 70% and 30% respectively.
Regarding the distribution of satisfaction level about the physical facilities, it was found that
patients showed low satisfaction (3.92) regarding the in waiting area Sitting chairs of the
OPD for the patients, regarding the waiting area cleanliness they are highly satisfied (4.98),
regarding the drinking water facility in the waiting area of OPD they showed low satisfaction
(4.45) and regarding the toilets cleanliness are highly satisfied (4.61).
The distribution of satisfaction level about the doctor services in OPD, it was found that
regarding the Doctor spending enough time with patient they are highly satisfied (4.98)and
regarding the Doctor giving the opportunity to discuss the treatment with patient they are
highly satisfied (4.98).

The distribution of satisfaction level about the Nursing services in OPD, regarding the Nurse
listening to patient health problem and explaining any treatment that patient needs they are
highly satisfied (4.66) and regarding the Helpfulness of the nurses they are highly satisfied
(5.00).
The distribution of satisfaction level about the Pharmacy services in OPD, regarding the costs
of the drugs in pharmacy, they showed low satisfaction (3.14) and regarding the
communication skills of the pharmacists they are highly satisfied (5.00).
The distribution of satisfaction level about the Registration services in OPD, regarding the
registration staff availability in OPD they showed low satisfaction (4.40) and regarding the
cooperativeness of the registration staff they are highly satisfied (4.97).
Regarding the waiting time before meeting the doctor in OPD they showed low satisfaction
(3.91).
Regarding the Service process of registration in OPD patients are highly satisfied (4.97).
Regarding the medical staff availability during working hours in OPD they are highly
satisfied (4.75).
The distribution of satisfaction level about the convenience, regarding the Ease of finding
OPD section for the patient they are highly satisfied (5.00) and they showed low satisfaction
(3.07) in terms of expenses and time convenience of going from patient house to OPD.
The distribution of satisfaction level about the courtesy, regarding the friendliness of doctor
to help they are highly satisfied (5.00), regarding the Courtesy from nursing staff they are
highly satisfied (4.93) and regarding the Privacy from doctors and nurses during the
examination highly satisfied (4.98).
Patients provided suggestions and comments which were mostly concerned regarding the
sitting chairs in the waiting area of the OPD for the patients and the drinking water facility in
the waiting area of OPD for improvement, also regarding the costs of the drugs in pharmacy,
registration staff availability in OPD, the waiting time before meeting the doctor finally in
terms of expenses and time convenience of going from patient house to OPD they are
expecting improvement in these areas.

RECOMMENDATIONS
Recommendations which were mostly concerned regarding in terms of expenses and time
convenience of going from patient house to OPD is first priority area for the improvement.
Second priority area to be improved is the costs of the drugs in pharmacy of OPD.
The provisions for reducing the waiting time before meeting the doctor is the third priority
area for the improvement.
There after comes the sitting chairs in the waiting area of the OPD for the patients should be
increased specially during the peak rush hours in the OPD.
Provision for the adequate Drinking water facility in the waiting area of OPD should be
made.
Finally the Registration staff availability in OPD must be improved.

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(2006).

APPENDICIES
RESEARCH INSTRUMENT
The research instrument used by the researcher in collecting data was a pre structured
questionnaire –
 Socio-demographic characteristics of the patients,
 Experiences of patients about medicine outpatient department
a. Physical facilities,
b. Physician-patient interaction,
c. Nurse-patient interaction,
d. Experiences with pharmacy,
e. Experiences with Registration.
 Accessibility to Medicine Outpatient Department
a. Waiting time,
b. Working schedule,
c. Service procedure.
 Patient Satisfaction towards Outpatient Department
a. Accessibility,
b. Courtesy,
C.Quality of care, and last but not least
 Suggestion and comment for the improvement of Outpatient department.

QUESTIONNAIRE
PATIENT SATISTACTION TOWARDS OPD- SERVICES
Your response will be for the purpose of research and will not be exposed to any other
purpose. The information provides will help in improving the services of health care.
Therefore honesty on the part of respondent is expected.
SERIAL NO: ___________
DATE OF THE INTERVIEW: ________________
PART –A -SOCIO DEMOGRAPHIC FACTORS:
1. What is your gender?
Male Female
2. What is your Age? __________
3. What is your marital status?
Single Married
Widow Separated
4. What is your highest educational level?
Illiterate Finished primary school
Finished secondary school Finished vocational degree
Finished bachelors degree If other _____________

5. What is your current occupation?
Unemployed Govt. employed
Labour Non- govt. employed
Agriculture Student
Others________
5. What is the total members currently living in your family? _____________
6. Total number of visits to hospital so far (during last 6 months)? ___________
PART-B: EXPERIENCE OF PATIENT ABOUT OPD SERVICES IN FORTIS
1- COMPLETELY SATISFIED
2- SOME WHAT SATISFIED
3 -NEUTRAL
4 - SOME WHAT DISSATISFIED
5 - COMPLETELY DISSATISFIED
PHYSICAL FACILITIES –
7. From your past experience, are there 1 2 3 4 5
enough sitting chairs and toilets in waiting
area of the OPD for the patients?
8. From your past experience, is the waiting 1 2 3 4 5
area clean?

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