SEEKING WHAT MATTERS: DETERMINANTS OF CLIENTS’ SATISFACTION IN OBSTETRIC CARE SERVICES IN PAKISTAN

Authors

  • Moazzam Ali
  • Muhammad Suleman Qazi
  • Armando Seuc

Abstract

Background: Aim of this study was to determine the dimensions of the service quality in the public hospitals and evaluate the determinants of client satisfaction in obstetric health in the context of Pakistan. Methods: The present research evaluates the application of an integrated client satisfaction model that draws mainly from the original SERVQUAL framework in obstetric health services. We conducted a cross-sectional study, in four public district hospitals in Pakistan, enrolling 1101 clients attending obstetric health care services. Measures of service quality and determinants of client satisfaction were factor-analysed and multiple regression analysis was used to test the hypothesis. Results: The client satisfaction increased significantly with increases in respondent's age, number of children, number of visits and with decrease in educational status. Factor analysis revealed five service quality dimensions; and multiple regression analysis showed that all five dimensions of service quality in obstetric care were significant in explaining client satisfaction. The most powerful predictor for client satisfaction was provider communication with clients, followed by responsiveness and discipline. Conclusions: Interventions aimed at improving client provider interaction would not only advance the clinical provision of services, but would also result in greater patient satisfaction with the services provided, leading to higher levels of facility utilization and continuity of care. Better client provider interaction can be accomplished at hospital’s level through focused training of all cadre of service providers sensitizing them on clients’ needs. Results also showed that the proposed framework is a valid and flexible instrument in assessing and monitoring service quality and enabling staff to identify where improvements are needed, from the clients' perspective.Keywords: Service quality, client satisfaction, obstetric health care, SERVQUAL, Pakistan

References

United Nations: Program of Action of the United Nations. International Conference on Population and Development. UN ICPD, Cairo, Egypt. 1994:http://www.iisd.ca/cairo.html. (Accessed on October 24, 2013)

Graham, WJ. Outcomes and effectiveness in reproductive health. Soc Sci Med 1998;47(12):1925–36.

Gilbert FW, Lumpkin JR, Dant RP. Adaptation and customer expectation of health care options. J Health Care Mark 1992;12:46–55.

WHO, UNICEF, UNFPA, The World Bank: Trends in maternal mortality: 1990 to 2010. 2012 [http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Trends_in_maternal_mortality_A4-1.pdf].

Filippi V, Ronsmans C, Campbell OM, Graham WJ, Mills A, Borghi J, et al: Maternal health in poor countries: the broader context and a call for action. Lancet 2006;368:1535–41.

Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF: WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367:1066–74.

Sitzia JS, Wood N. Patient satisfaction: a review of issues and concepts. Soc Sci Med 1997;45(12):1829–43.

Anderson LA, Zimmerman MA. Patient and physician perceptions of their relationship and patient satisfaction: a study of chronic disease management. Patient Educ Couns 1993;20(1):27–36.

Taylor SA, Cronin JJ Jr. Modeling patient satisfaction and service quality. J Health Care Mark 1994;14(1):34–44.

Willam T, Schutt-Ainé J, Cuca Y. Measuring family planning service quality through client satisfaction exit interviews. Int J Fam Plan Perspect 2000;26(2):63–71.

Säilä T, Mattila E, Kaila M, Aalto P, Kaunonen M. Measuring patient assessments of the quality of outpatient care: a systematic review. J Eval Clin Pract 2008;14(1):148–54.

Newcomer LN. Measuring of trust in health care. Health Aff (Millwood) 1997;16(1):50–1.

Ettinger WH Jr. Consumer-perceived value: the key to a successful business strategy in the healthcare marketplace. J Am Geriatr Soc 1998;46(1):111–3.

Donabedian A. Quality assessment and assurance: unity of purpose, diversity of means. Inquiry 1988;25:175–92.

William B. Patient satisfaction: a valid concept? Soc Sci Med 1994; 38(4):509–16.

Carr-Hill RA. The measurement of patient satisfaction. J Pub Health Med 1992;14(3):236–49.

Elnicki DM, Morris DK, Shockcor WT. Patient-perceived barriers to preventive health care among indigent, rural Appalachian patients. Arch Intern Med 1995;155(4):421–4.

Newman RD, Gloyd S, Nyangezi JM, Machlobo F, Muiser J. Satisfaction with outpatient health care services in Manica Province, Mozambique. Health Policy Plan 1998;13(2):174–80.

El Shabrawy Ali M. A study of patient satisfaction as an evaluation parameter for utilization of primary health care services. J R Soc Health 1992;112(2):64–7.

Andaleeb SS. Service quality perceptions and patient satisfaction: a study of hospitals in a developing country. Soc Sci Med 2001;52:1359–70.

Peyrot M, Cooper PD, Schnapf D. A consumer satisfaction and perceived quality of outpatient health services. J Health Care Mark 1993;13(1):24–33.

Zeithaml VA. Service quality, profitability, and the economic worth of customers: what we know and what we need to learn. J Acad Mark Sci 2000;28(1):67–85.

Calnan M. Towards a conceptual framework of lay evaluation of health care. Soc Sci Med 1988;27(9):927–33.

Parasuraman A, Berry LL, Zeithaml VA. SERVQUAL: A multiple item scale for measuring consumer perception of service quality. J Retail 1988;64:12–40.

Caruana A, Ewing MT, Ramaseshan B. Assessment of the three-column format SERVQUAL: An experimental approach. J Bus Res 2000;49:57–65.

Babakus E, Boller GW. An experimental assessment of SERVQUAL scale. J Bus Res 1992;24:253–68.

Cronin JJ, Taylor SA. Measuring service quality: A re-examination and extension. Journal of Marketing 1992;56:55–68.

Carman JM. Consumer’s perceptions of service quality: An assessment of the SERVQUAL dimensions. J Retailing 1990;66:33–55.

Furrer O, Shaw-Ching Liu B, Sudhharsan D: The relationship between culture and service quality perceptions: Basis for cross-cultural market segmentation and resource allocation. J Serv Res 2000;2(4):371–81.

Fitzpatrick R: Satisfaction with health care. In The Experience of Illness, Ed R. Fitzpatrick, pp.154–75. Tavistock, London.

Williams B, Coyle J, Healy D. The meaning of patient satisfaction: an explanation of high reported levels. Soc Sci Med 1998;47(9):1351–9.

Hair JF, Black WC, Babin BJ, Anderson RE: Multivariate Data Analysis. 7th. edition. New Jersey: Prentice Hall; 2009.

Nunnally JC. Psychometric theory (2nd ed.). New York: McGraw-Hill; 1978.

Phillips D. Medical professional dominance and client dissatisfaction. Soc Sci Med 1996;42(10):1419–25.

Thomason J, Edwards K: Using indicators to assess quality of hospital services in Papua New Guinea. Int J Health Plan Manage 1991;6:309–24.

Pakistan Social And Living Standards Measurement Survey (PSLM) 2010;11. Available at: http://www.statpak.gov.pk/ fbs/sites/default/files/pslm/publications/pslm_prov2010-11/ household_perception.pdf (Accessed October 27, 2013)

Bakar C, Akgün HS, Al Assaf A. The role of expectations in patients’ hospital assessments: A Turkish university hospital example. Int J Health Care Qual Assur 2008;21(5):503–16.

Zarei A, Arab M, Froushani AR, Rashidian A, Ghazi Tabatabaei SM: Service quality of private hospitals: The Iranian Patients’ perspective. BMC Health Serv Res 2012;12:31.

Yesilada F, Direktr E: Health care service quality: A comparison of public and private hospitals. Afr J Bus Manag 2010;4:962–71.

Lin DJ, Li YH, Pai JY, Sheu IC, Glen R, Chou MJ, et al.Chronic kidney-disease screening service quality: questionnaire survey research evidence from Taichung City. BMC Health Serv Res 2009;9:239.

Padma P, Rajendran C, Prakash SL. Service quality and its impact on customer satisfaction in Indian hospitals: Perspectives of patients and their attendants. Benchmarking, 2010;17:807–41.

Rose RC, Uli J, Abdul M, Ng KL. Hospital service quality: a managerial challenge. Int J Health Care Qual Assur Inc Leadersh Health Serv 2004;17(2-3):146–59.

Lim PC, Tang NK. A study of patients’ expectations and satisfaction in Singapore hospitals. Int J Health Care Qual Assur Inc Leadersh Health Serv 2000;13:290–9.

Butt MM, de Run EC. Private healthcare quality: applying a SERVQUAL model. Int J Health Care Qual Assur 2010;23:658–7.

Published

2014-12-01