Hospital Services Quality And Its Relation With Patient Trust And Satisfaction

Introduction:

Service quality is a multidimensional concept that includes how far the difference between reality and expectations of customers for the services they received or acquired. Indeed, it is the expected benefits and control over the level of excellence to meet customer desires. Thus the service quality of health care is an effort to fulfill the needs and desires of the customer as well as the accuracy of delivery according to customer expectations. (1)

Service quality is an important element of customer responses as in the case of pure service, such as health care, financial services and education. If the services received or perceived as expected, then the perceived service quality is good and satisfactory. Conversely, if the services received are lower than expected, the quality of service perceived as poor quality. The quality of health care is multidimensional which consists of health care service users, health care providers and financial health care. (2)

 Trust is one of the most important determinants of creat­ing and maintaining sustainable long-term relationships between the provider and the customer in the services sector. In the health service, the trust is meant to be the belief of the patient to the practitioner or the hospital based on the concept that the care provider seeks the best for the patient and will provide the suitable care and treatment for him/her. (3)

 Patient satisfaction is a feeling resulting from an evaluation process about what is received on what to expect including the purchase decision of the goods itself, as well as the needs and desires associated with the purchase. Customers have level of satisfaction and dissatisfaction after having or experiencing each service according to how far their expectation fulfilled or exceeded. Expectation is an internal standard used by customer to judge a quality of service experience (4). Dissatisfaction of customer with the service occurs due to the following causes: there is a gap between expectation and reality, poor service, bad behavior of personnel, unsupportive physical atmosphere and condition and too expensive cost. (5)

 Patient satisfaction with medical care is a multidimensional concept, with a dimension that corresponds to the major characteristics of providers and services. Within the health care hospital, patient satisfaction can be considered as an important component and measure of the quality of care. Patient satisfaction is a cumulative construct which embraces satisfaction with various hospital facilities such as technical, functional, interaction and atmosphere. Patient satisfaction plays an important role in the continuity of service utilization and positively influences the patient’s trust. (6)

The service quality means the fulfillment of the patient's expectations, and the ability of a service provider in satisfy­ing the patient's needs and expectations will result in the patient's positive perception towards the capabilities of the service provider. When the perception of service qual­ity is positive and the performance of the provider results in meeting patient's expectations, the patients will be satisfied and trust more in the provider's capabilities and competencies. In contrast, if the service provider's performance is accompanied by low quality and failure in satisfying the customer's expectations, the customer's trust in com­petencies and capabilities of the service provider will de­crease. In fact, when a customer trusts in an organiza­tion, he/she trusts to the quality of its goods and services. (7)

Significance of the study:

Hospitals provide the health services to the citizens in their daily life. This shows the importance of hospitals and their role in providing better health care services to the citizens. It has under gone many changes in technology as well as in terms needs and demands of patients. It identifies these needs and brings changes to satisfy patients. Trust is especially important in health care service organizations because it creates the environment in which patient disclosures and cooperates in treatment, desires of seeking care, making easier to adjust unhealthy behavior as well as minimize the chance of complaints, disputes and lawsuits.  For this purpose the researcher decided to study   hospital services quality and its relation with patient trust and satisfaction.

Aim of the study:

The aim of this study is to assess hospital services quality and its relation with patient trust and satisfaction at Mati Distract Hospital in Minia Governorate.

Research Question:

Is there is a relation between hospital services quality, patient trust and satisfaction?   

Subjects and Methods

 Research design:

Descriptive correlational research design was utilized in current study to achieve the aim of the study.

Setting:     

The study was conducted at Mati Hospital in Minia Governorate.

Subject:

Convenient sample of all available patients in a selected Hospital in Minia Governorate was  utilized in the current study, with total number (n= 100).

Tools of data collection:

Data for this study was collected by using the following tools

It divided into two parts, it include:-

1st part: -Socio- Demographic data sheet:

To get information about the patient it includes (Sex, Age, Educational status, Family status and Department)

2nd part: - tools.

1-Service quality scale:

Service quality scale adopted from (Zineldin (2006) (8) & Parasuraman (1994) (9)) and necessary modification was made by the researcher. It includes 20 questions to measure service quality in the hospital. The question was ranked from (1) low to (3) high. With scoring system ranging from (20) to (33) low.  From (34) to (46) average. From (47) to (60) high.                           

 2- Patient trust scale

Patient trust scale adopted from (Hall et al (2002) (10) & Alrubaiee (2010) (11)) and necessary modification was made by the researcher. It includes 17 questions to measure patient trust. The questions were ranked from (1) low to (3) high. With scoring system:  From (17) to (28) disagree. From (29) to (39) neither. From (40) to (51) agree.                                                                           

3-Patient satisfaction scale:

Patient satisfaction scale adopted from (Grogan et al (1995) (12)). It includes 14 questions to measure the level of patient satisfaction. The questions ranked from (1) disagree to (2) agree. With scoring system includes:  From (14) to (21) dissatisfied (disagree).  From (22) to (28) satisfied (agree).

Validity:

The tool was tested for content validity by a jury of experts in the field of the study.

Reliability:     

Cronbach's alpha for reliability testing internal consistency was performed for assessment knowledge  ,attitude and resources toward needle stick injury it was (0.96, 0.71 and 0.68 ) respectively  .

Pilot study:

A pilot study was carried out on approximately (10 % ) of the study sample(10 patient) in a selecting  setting to evaluate  the validity and reliability of the study tool and to estimate the time needed for filling the tool  that ranged between 15 to 20 minute. As well as, identifying problems that may be encountered during actual data collection.

Study procedure:

An official letter of the study approved was obtained from Dean of Faculty of Nursing –Minia University to the manager of the hospital. This letter was including a brief explanation of the objective of the study. After receiving the initial acceptance from the ethical committee at the Faculty of Nursing, Minia University, the researcher initially introduced herself to all participants to explain the aim of the study and to obtain their permission. They were assured that the collected data would be absolutely confidential. Data were collected in the period from 1 May 2016 until 30 October 2016. The researcher collected the data at the morning at two days/week (Saturday and Monday) from 10 AM to 12 PM.

Ethical consideration:

A written initial approval obtained from the research ethical committee in the Faculty of Nursing, Dean of Nursing Faculty and agreement from Egypt academic for research center and technology. Participants in this study were voluntary and informed about the purpose, procedure of the study and the right to withdraw from the study at any time without any rational. Written consent was obtained from the subjects after reading all details. Confidentiality and anonymity of each subject were ensured through coding of all data and protecting the obtained data.

Statistical design:

Data entry and statistical analysis were done using a Statistical Package for Social Science (SPSS). Data were presented using descriptive statistics in the form of frequencies and percentages, mean and standard deviations. Probability (p-value) is the degree of significance, if it less than 0.05 was considered significance and correlation coefficient was done by using Spearman rank correlation.

Results:

Table (1): Frequency distribution of personal data among the studied patients (n=100):

Table (1) shows that, (58%) of the studied subjects were females, (42%) were males, (42%) had secondary education, (70%) were married and (46%) of them admitted at surgical department.

Figure (1): Frequency distribution of total score among service quality of the studied patient (n=100):

Figure (1) shows that 58% of patients evaluated the service quality as moderate service, 24% of them evaluated as low service and 18% of them evaluated as high service.

Figure (2): Frequency distribution of total score among patient trust of the studied patient (n=100):

Figure (2) illustrates that 57% of patients had a moderate trust, 24% had a low trust and 18% of them had a high trust.

Figure (3): Frequency distribution of patient satisfaction score of studied patients (n=100):

Figure (3) demonstrates that 52% of patients were dissatisfied while 48% of them were satisfied.

Table (2): Relation between personal characteristics with (hospital service quality, patient trust& patient satisfaction)

Table (2) shows the difference between demographic characteristics and (hospital service quality, patient trust& Patient satisfaction). It was noticed that a positive significant relation between age and patient satisfaction and level of education with service quality and patient trust.

Table (3): Correlation matrix between service quality, patient trust and patient satisfaction:

Table (3) shows that, there is a highly significant positive correlation between service quality, patient trust (p=0.0001*) and patient satisfaction (p=0.0001*).