Patients' Perception on Healthcare Services from Alternative Healthcare Institutions: Evidence from the State of West Bengal, India

 

Dr. Somnath Chatterjee¹*, Dr. Arindam Laha²

¹Assistant Professor, Department of Management and Business Administration, Aliah University, ll-A/27, Action Area II, Newtown, Kolkata, West Bengal 700156, India

²Assistant Professor, Department of Commerce, University of Burdwan, Golapbag, Post: Rajbati, Burdwan, West Bengal 713104, India

 

ABSTRACT:

Objective: This study was carried out to evaluate the perception of the patients regarding the interface of major bottom line healthcare personnel, hygiene and others at three distinct categories of hospitals. Methods: Patients from three different categories of hospitals (sample size 250) were surveyed, using Likert scale; the hypothesis of the study was "patients of healthcare service have the same level of perception about the available healthcare personnel, hygiene and others in alternative healthcare institutions." The significance of the perception of the intended categories patients was judged by applying Kruskal Wallis method. Results: The responses were recorded from 100 patients at state government hospitals, 100 patients at other public hospitals and 50 patients at private hospitals. Result shows that significant variation on patient perception exists across patient categories. Conclusion: Perception of the patients on services provided by doctors, nurses, staffs and the level of hygiene as well as the overall perception varies across three categories of patients.

 

 

 

INTRODUCTION:

Among several challenges faced by the healthcare sector, one of the decisive challenges is to improve the quality and competence of patient care. The intensity of satisfaction and professed service quality persuade the patient’s eagerness to obtain healthcare service at future occasion, again from the particular healthcare service provider. Quality of performance is one the most important aggressive weapons in the service market (Zeithaml et al., 1992). Performance quality not only divides firms, but also produces loyal customer base who spread constructive voice for the organization (Youssef, 1996).

 

Perception regarding satisfaction or disappointment of the end users in healthcare sector is a measure on the quality of concern and care of the healthcare providers in its entire facets (Torcson, 2005). Level of satisfaction of the patients is believed to be inevitable in preparation, execution and estimation of healthcare service delivery process and matching the necessities of the end users (Badri et al., 2007)). Cleary et al (1988), Weiss et al (1989) etc. have conducted further researches and reveal that patient satisfaction is positively associated with the accessibility, availability, and ease of care. Under this backdrop of analysis, this article attempts to examine patient’s perception on healthcare service using evidence from primary survey on 250 patients in the district of Burdwan of West Bengal, India. The next section deals with objective and hypothesis. Methodological framework of the study is presented next. Result and discussion is presented thereafter. The concluding remarks have been presented at the end.

OBJECTIVE:

To evaluate the perception of the patients regarding the healthcare personnel, hygiene etc. at three distinct categories of hospitals.

 

HYPOTHESIS:

H₀ :

Regarding patient perception, it is postulated that end users (or, patients) of healthcare service have the same level of perception about the available healthcare facilities in alternative healthcare institutions.

 

METHODS:

To carry out the perception study on the patients, all sorts of analytical explanation provided by the patients are systematically recorded in tabular form. Likert scale1 is used to get the perception and responses of the respondents on the service offered by the healthcare providers. Five point Likert scale is used to get the perception of the patients on doctors, nurses, staffs, hygiene and cleanliness and as well as patients’ overall perception in this study. The data were collected from the patients of three distinct categories of hospitals. In order to represent three categories of hospitals in our sample, stratified random sampling method has been used. In the first stage, a comprehensive list of all the different types of hospitals of the district of Burdwan under state of West Bengal, India is constructed. Then the present institutional structure of healthcare providers are stratified into three strata (State Government Hospitals or SGH, Other Public Hospitals or OPuH and Private Hospitals or PrH) and from each stratum a representative sample of 40 percent is selected uniformly through random sampling method. Primary data on the basis of a total sample size of 25 hospitals have been collected from a comprehensive list of 66 hospitals in the particular district. In fact, the sample size is comprised of 10 state government hospitals, 10 other public hospitals and 5 private hospitals. A total of 250 patients, who were admitted during the time of field survey at the above mentioned hospitals, were surveyed. Accordingly the ultimate sample units i.e., in-patients are chosen in the proportion of 2: 2: 1. Thus, 100 patients have been chosen from State Government Hospitals, 100 patients from Other Public Hospitals or Public Sector Undertaking Hospitals and 50 patients from Private Hospitals. Considering the bed-size of the hospitals, proportionate representation of patients is surveyed. But, the bed sizes of the hospitals are found to be varying from a minimum of 20 to a maximum of 550. This wide variation in bed-size also reflects a considerable variation in the number of respondents to be surveyed from each hospital, which shows a minimum number of 1 and a maximum number of 37 respondents to be surveyed from a hospital. Thus, to have a representative sample size, we have chosen a floor of 5 respondents and a ceiling of 26 respondents at any hospital. As the respondents were the in-patients of hospitals, all of them could not respond properly because of their nature of illness. Thus, the judgment sampling has been used to find out the right respondent who can provide the necessary information about the services provided by the hospital. The survey was conducted with a structured questionnaire.

 

Kruskal and Wallis test (1952) is employed in our study to test similarity or dissimilarity of the perception of different categories of patients on the healthcare service. For the purpose patients are categorized on the basis of their access to public, other public or private hospitals. The statement that the patients surveyed at three categories of hospitals are having similar perception on five issues of service delivery (i.e., patients’ perception about doctors, nurses, staffs, hygiene and patients’ overall perception) is considered as the hypothesis for testing in this study.

 

H₀: µ_SGH = µ_OPuH  = µ_PrH (i.e., there is no significant difference in the mean perception score of the patients at three hospital categories in respect of five healthcare services),

 

where,

μ_SGH  =  perception of patients about different issues at state government hospitals,

μ_OPuH  =  perception of patients about different issues at other public hospitals and

μ_PrH  =  perception of patients about different issues at private hospitals.

 

To conduct the test all the 250 respondents of three categories of hospitals on specific healthcare service are pooled together and their rankings are obtained by arranging them in the ascending order. Let r_i  be the observed sum of the ranks of the elements of the i ^th sample. The Kruskal-Wallis test uses the   - test to evaluate the null hypothesis. The test statistic is given by 

 

r₁ =  sum of the ranks of responses of 100 respondents at  SGH

r₂ =  sum of the ranks of responses of 100 respondents at OPuH

r₃ =  sum of the ranks of responses of 50 respondents at  PrH

 

The statistic H follows a  distribution with (k-1) degrees of freedom. The critical value for H is obtained from the  Table with (k-1) degrees of freedom, k being the number of samples. The null hypothesis is rejected if the calculated value of H is greater than critical value of.

 

RESULT AND DISCUSSION:

Patients’ perception on Facilities of Hospital:

The patients’ perception on different issues related to healthcare delivery process has been obtained with the help of five point Likert scale and is ranked in five points; but in the table the last point i.e., ‘worst’ is not considered due to negligible responses; thus those negligible responses are merged with the ‘poor’ perception point. So the Table represents only four perception points that include ‘excellent’, ‘good’, ‘average’ and ‘poor’ and for sake of simplicity, the same is presented in the form of frequency distribution in Table 1.

 

Table 1. Frequency Distribution of Patients’ Perception on Facilities of Hospitals

Source: Field Survey, 2013-14

 

 

A consistent and continuous commitment towards the quality of healthcare service is important for any healthcare service provider to attract and retain customers in the world of competition. Thus, it is imperative to assess the end result for which the healthcare service consumers accept different categories of healthcare service providers. So, in this section of study, the customers’ perception at three groups of hospitals is examined. As the healthcare service is considered under a core service sector, the role of people or human activities is vital in this industry. The human resource issues i.e., doctors, nurses and staffs of the hospitals and their activities, behavior, presence are deeply focused and patients were asked to rank their opinions at five point Likert scale. Other than human resources, the hygiene and cleanliness are given utmost importance. Overall perceptions from all the respondents are also surveyed. The surveyed data on the aforesaid issues of patients’ perception are represented in terms of Figure 1.

 

Testing Difference in the Perception of the Patients:

Kruskal Wallis test is employed to examine the difference in the perception levels of the patients grouped at three hospitals on different heads. A parametric ANOVA test is also done with the same data set, but the results are placed at appendix (Table A.1).

 

The intangible services provided by the doctors are considered as the most crucial aspects of any healthcare services. They are allied with the healthcare service providers predominantly by a convention for the dispensation to care for patients and responsible for the quality of care. Doctor-patient bonding is essential for healthcare service providers, for both the patient and the doctor to get a human and systematic interface. Table 2 shows that the result on patients’ perception on doctor is significant. So, considering perception of the customers on doctors, significant difference exists among patients belonging to three groups of hospitals. Among all three categories of patients perception on doctor is the best for the patients of private hospitals, followed by perception of the patients having access to other public hospitals and state government hospitals; though the difference between perception of patients on doctor at other public hospitals and state government hospitals is very narrow.

 

 

Fig. 1: Bar Diagram Showing Patients’ Perception on Doctor, Nurse, Staff, Hygiene and Their Overall Perception at Different Categories of Hospitals

 

Table 2. Testing Differences in the Perception of Healthcare Facilities among Different Categories of Patients

Source: Field Survey 2013-14

NOTE: ^aKruskal Wallis Test ^bGrouping Variable: Hospital Type

SGH: State Government Hospital; OPuH: Other Public Hospital; PrH: Private Hospital: df: Degree of freedom

 

 

By and large the scrutiny reveals that all the factors of perception on doctors, perception on nurses, perception on staffs, perception on hygiene and the overall perception are found to be significant. Hence, a broad hypothesis that there is no significant variation among the healthcare service providers as observed in the perception of the customers in the quality of healthcare service they obtain from the hospitals is rejected. It implies that variation exists among perception of patients in three types of hospitals and the perception is the best among patients of private hospitals, followed by perception of the patients having access to other public hospitals and state government hospitals.

 

The study has scrutinized the health-seeking behavior of the health service consumers. End users judge quality service as a prerequisite to their satisfaction. Hospital as a vital healthcare service provider requires identifying the magnitude of patients’ preference on access. Patient satisfaction procedures should be utilized to observe the execution of health services particularly for hospital. Hospital personnel should identify patients, who are the consumers, as the most significant trade associates. But, a large amount of the disappointment in patient relationships arises from the complexity in achieving that trust of the patients. Successful healthcare service providers continuously make every effort for superior intensity of patient service. Health service providers should constantly assess and verify the requirements of the patients. Patients’ satisfaction to a health service provider guarantees benefits not only their persistent visit to the healthcare institution but also provides a better perception and the subsequent satisfaction which might take a positive step in the process of recovery from the disease. There must be competition at intra category level for private hospitals. But when the three separate categories of hospitals i.e. state government hospitals, other public hospitals and private hospitals with their uniquely directed objective of providing healthcare service to all the people of the state with no pay or negligible pay, providing healthcare service to own employees in majority and providing healthcare with pay and profit motive respectively, the major concern is providing better care and speedy healing of the patients. In our study, the patient satisfaction is not the main objective to get a competitive advantage among rival healthcare service providers; rather it leads to better patient care and service. A financial incentive or an open recognition scheme may be pioneered in this connection. A training module may be scheduled to improve the relationship between the patients and the human resource personnel (i.e. doctors, nurse and staffs) by the higher authority to upgrade the perception level of the patients, especially at state government hospitals and other public hospitals.

 

Regarding hygiene and cleanliness, private participation is observed in many cases, but there should be more supervision from the hospital administration. Again, as the consumerism is gaining potency in healthcare domain, the notion of patient satisfaction should also be taken into consideration.

 

REFERENCES:

1.        Badri M, Attia ST, Ustadi AM. Testing Models for Care Quality for Discharged Patients. Paper presented at POMS 18th Annual Conference. [cited 2015 July 26]. Available from: www.pdffactory.com.

2.        Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry. 1988; 25(1): 25-36.

3.        Kruskal, Wallis. Use of ranks in one-criterion variance analysis. Journal of the American Statistical Association. 1952;47(260): 583–621.

4.        Torcson PJ. Patient satisfaction: the hospitalist’s role. [cited 2013 August 07]. 07.08.2013 Available from: http://www.the-hospitalist.org/details/article/256805/Patient_Satisfaction_the_Hospitalists_Role.html.

5.        Weiss GL, Ramsey CA. Regular Source of Primary Medical Care and Patient Satisfaction. Quality Review Bulletin. 1989: 180-184.

6.        Youssef FN. Health care quality in NHS hospitals. International. Journal of Health Care Quality Assurance. 1996;9(1): 15-28.

7.        Zeithaml VA, Berry LL, Parasuraman A. Strategic Positioning On The Dimensions Of Service Quality. In T. A. Swartz, D. E. Bowen, and S. W. Brown (Ed.), Advances In Services Marketing and Management. JAI Press, Greenwich. 1992: 207-28.

 

Appendix

Table A.1 Measurement of Differences among Patients’ Perception about Hospitals (with ANOVA Framework)

Source: Field Survey 2013-14

Note: df implies degree of freedom

 

 

 

 

 

 

Accepted on 20.08.2017          © A&V Publications all right reserved