ABSTRACT
Background:
Patient satisfaction is the subjective evaluation of a patient’s cognitive and emotional responses. This reflects their expectations regarding the ideal healthcare to be provided. This study aims to assess the satisfaction level of the attendees to the family medicine staff clinics at King Saud Medical City, Riyadh.
Materials and Methods:
A descriptive cross-sectional study recruited 378 participants. An adapted and piloted questionnaire was used to gather the data. The questionnaire enquires about the communication skills of the receptionist, the triage nurse, and the assigned physician. It included questions regarding the structure of the clinics.
Results:
Females represent the majority of about 255 (67.5%). About 2/3 of the respondents were within the age group of 18-34 years, 245 (64.8%). A high level of satisfaction was reported by the participants regarding the professionalism, kindness, interest of the staff member, and waiting time. Gender, marital status, and age group have no significant effect on the satisfaction level; the P value was uniformly more than 0.05.
Conclusion:
The result of this study identified high satisfaction responses regarding the communication skills of the receptionist, triage nurse, and physicians. The overall evaluation of the experience during staff clinic visits was satisfactory. Periodic evaluation of these attributes and other indicators that promote patient-centered care should be undertaken to improve the overall quality of care.
Keywords: Assessment, family medicine, clinics, KSMC
Introduction
This study was conducted because no previous study has been conducted in this setting. Internal and external audits were used to document patients’ views about the services received.[4]
Due to accessible information sources and increasing demand, the aspiration of the Saudi population, the country has witnessed a huge transformation.[1]
Patient satisfaction is a multi-dimensional process directed to provide an assessment of a patient’s experience.[12] Additionally, evidence-based care and guideline implementations have led to the restructuring of healthcare institutions.[3]
Previous studies have also concentrated on disease-oriented evidence (DOE) by emphasizing quantitative laboratory parameters.[7]
Objectives of this study
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1-
To assess the current services provided at family medicine staff clinics from the point of view of our patients.
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2-
To determine the overall satisfaction of the attendees to these clinics in terms of structure, process, and outcome.
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3-
To shed light on areas that deserve improvement and guide future quality improvement projects, and provide feedback to our healthcare providers and administrators.
Materials and Methods
Research design and setting
This study is an explorative, descriptive cross-sectional survey. It was conducted at the staff clinics of King Saud Medical City, Riyadh over a period of 2 months (February and March 2023). It was a quantitative, observational study to explore and assess the quality of healthcare. The clinics provide follow-up and walk-in services which include preventive curative and urgent care. The study was started after the approval of King Saud Medical City, Riyadh, Research and Innovation Center, and Institutional Review Board (IRB), and it was given the proposal IRB reference No.: H1RI-19-Oct22-02.
Study subjects
The population of this study consists of the attendees of the family medicine staff clinics during the study period. This includes King Saud Medical City employees, medical and non-medical, and their dependents. The sample size was 378 participants.
Data collection method and tool
The data collection tool was carried out by a questionnaire that had been prepared and adapted by the researchers (it was the modified patient satisfaction 18-item questionnaire). The questionnaire was piloted on 20 responders to evaluate its applicability. The questionnaire contains questions categorized into the following: personal data, communication with the clinic staff including the receptionist, triage nurse, and the assigned physician. The second part contains questions about the structure of the clinics including facilities and available equipment, waiting time, and appointment system. The investigators approached the participants in the waiting area. They were informed about the objectives of the study, the study investigators, and their affiliations. It was explained to them also that the questionnaire was anonymous. Receiving and responding to the questionnaire was considered consent to be included in the study. The questionnaire was available in both Arabic and English enabling the participants to select their preferred language.
The questionnaire was distributed manually by the researchers. The participants were requested to fill out the questionnaire on the same visit.
Results
The satisfaction status was rated into five levels based on the Likert scale. The total sample size was 378 in this study, out of which 255 were females (67%). Almost 2/3 of the respondents were aged between 18 and 34 years old, which was around 245 (64.8%). The age range was 18-75 years. About 189 (50%) of the respondents were married (48.7%). Most of the respondents about 291 (77%) had bachelor/diploma degrees. The main profession represented in our study sample was the nursing staff who were about 138 (36.5%). Table 1 shows the demographic data of the participants. Four, 4, 5, 2, and 17 respondents were inadvertently missed to indicate their gender, age, marital status, educational level, and job, respectively.
Table 1.
Demographic details of the study participants
| Characteristics | n | Percentage |
|---|---|---|
| Gender | ||
| Male | 119 | 31.5 |
| Female | 255 | 67.5 |
| Not specified | 4 | 1.1 |
| Age groups | ||
| 18-34 | 245 | 64.8 |
| 35-54 | 113 | 29.9 |
| 55-75 | 15 | 4.2 |
| Not specified | 4 | 1.1 |
| Marital status | ||
| Married | 189 | 50.0 |
| Not married | 184 | 48.7 |
| Not specified | 5 | 1.3 |
| Education | ||
| Postgraduate | 52 | 13.8 |
| Bachelor/Diploma degree | 291 | 77 |
| High school | 27 | 7.1 |
| Elementary school | 5 | 1.3 |
| Illiterate | 1 | 0.3 |
| Not specified | 2 | 0.5 |
| Job | ||
| Administrative | 48 | 12.7 |
| Laboratory | 8 | 2.1 |
| Nursing | 138 | 36.5 |
| Pharmacy | 3 | 0.8 |
| Physician | 33 | 8.7 |
| Radiology | 1 | 0.3 |
| Others | 130 | 34.4 |
| Not specified | 17 | 4.5 |
The analysis of the variance (ANOVA) interpretation of the results showed that there was no significant effect of the gender, age group, marital status, educational level, and job of the participants on their satisfaction item assessment; the P value was uniformly more than 0.05.
The interpersonal relationship between the participants and the healthcare providers was rated the best. About 105 (27.8%) and 130 (34.4%) strongly agreed and agreed, respectively, that the professionalism of the receptionist was very high. The highest percentage of the number of participants confessed that the kindness, courtesy, and interest of the receptionist were very satisfactory. The detailed responses of the participants to the satisfaction variables with the receptionist are shown in Table 2.
Table 2.
Participants’ responses to the satisfaction items with the receptionist
| Questions | Strongly agree n (%) | Agree n (%) | Neutral n (%) | Disagree n (%) | Strongly disagree n (%) |
|---|---|---|---|---|---|
| The professionalism of the receptionist is very high | 105 (27.8) | 130 (34.4) | 74 (19.6) | 45 (11.9) | 24 (6.3) |
| The kindness and courtesy of the receptionist are very high | 105 (27.8) | 111 (29.4) | 95 (25.1) | 41 (10.8) | 26 (6.9) |
| The interest of the receptionist in attending to the patient’s problems is very high | 109 (28.8) | 107 (28.3) | 104 (27.5) | 39 (10.3) | 19 (5.0) |
| The waiting time in the staff clinic before being registered is adequate | 103 (27.2) | 100 (26.5) | 99 (26.2) | 39 (10.3) | 37 (9.8) |
Responses to the statements describing the satisfaction with the nursing staff at the triage rooms were, 116 (30.7) and 168 (44.4) strongly agreed and agreed, respectively, that the professionalism of the nurses was very high. A similar satisfactory response to the other attributes with the triage nurse was indicated. The detailed responses to the triage nurse encounters are shown in Table 3.
Table 3.
Participants’ responses to the satisfaction items with the triage nurse
| Questions | Strongly agree n (%) | Agree n (%) | Neutral n (%) | Disagree n (%) | Strongly disagree n (%) |
|---|---|---|---|---|---|
| The professionalism of the triage nurse is very high | 116 (30.7) | 168 (44.4) | 71 (18.8) | 14 (3.7) | 9 (2.4) |
| The kindness, confidence, and courtesy of the triage nurse are very high | 125 (33.1) | 145 (38.6) | 86 (22.8) | 10 (2.6) | 11 (2.9) |
| The concern of the triage nurse to understand the problems of the patient is very high | 128 (33.9) | 140 (37.0) | 81 (21.4) | 16 (4.2) | 13 (3.4) |
| The triage nurse explains in detail the procedure | 123 (32.5) | 131 (34.7) | 89 (23.5) | 22 (5.8) | 13 (3.4) |
| Communication with the triage nurse is very good | 117 (31.0) | 159 (42.1) | 77 (20.4) | 11 (2.9) | 14 (3.7) |
| The waiting time in the staff clinic before getting vital signs is adequate | 128 (33.9) | 126 (33.3) | 89 (23.5) | 17 (4.5) | 18 (4.8) |
Our survey reconfirmed that the professionalism of the assigned physician was very high. About 174 (46.0%) strongly agreed with this statement and 138 (36.5) agreed with the statement. The consultation dynamics with the physician were explored by the questions about the encounters and the result is shown in detail in Table 4.
Table 4.
Participants’ responses to the satisfaction items with the assigned physician
| Questions | Strongly agree n (%) | Agree n (%) | Neutral n (%) | Disagree n (%) | Strongly disagree n (%) |
|---|---|---|---|---|---|
| The professionalism of the physician is very high | 174 (46.0) | 138 (36.5) | 46 (12.2) | 6 (1.6) | 14 (3.7) |
| The kindness, confidence, and courtesy of the physician are very high | 170 (45.0) | 130 (34.4) | 53 (14.0) | 13 (3.4) | 12 (3.2) |
| The concern of the physician to understand the problems of the patient is very high | 167 (44.2) | 133 (35.2) | 55 (14.6) | 9 (2.4) | 14 (3.7) |
| Physicians explain in detail the diagnoses and treatment of a disease | 163 (43.1) | 141 (37.3) | 51 (13.5) | 10 (2.6) | 13 (3.4) |
| Individualized care of the physician to the problems of the patient is very good | 165 (43.7) | 134 (35.4) | 61 (16.1) | 6 (1.6) | 12 (3.2) |
| The holistic approach of the physician during the consultation is very good | 167 (44.2) | 133 (35.2) | 58 (15.3) | 7 (1.9) | 13 (3.4) |
| There is a good continuity of care and follow-up plan by the physician | 160 (42.3) | 132 (34.9) | 63 (16.7) | 9 (2.4) | 14 (3.7) |
| Communication with the physician is very good | 154 (43.4) | 135 (35.7) | 54 (14.3) | 15 (4.0) | 10 (2.6) |
| The waiting time in the staff clinic before entering a medical consultation clinic is adequate | 138 (36.5) | 114 (30.2) | 71 (18.8) | 30 (7.9) | 25 (6.6) |
| The time spent during consultation focusing on the care of each patient is adequate | 150 (39.7) | 126 (33.3) | 72 (19.0) | 13 (3.4) | 17 (4.5) |
Regarding the structure and facilities of the clinic, 140 (37%) strongly agreed that the clinics were clean and well-equipped. About 138 (36.5%) strongly agreed that the clinic was very accessible. About 123 (32.5%) strongly agreed that there was clear signage to locate the clinic. About 154 (40.7%) strongly agreed that their privacy was maintained during their visit. About 141 (37.3%) strongly agreed that there were no interruptions during their consultation. About 124 (32.8%) strongly agreed that they were able to get urgent medical care while 109 (28.8%) strongly agreed that it was hard to get follow-up appointments.
Responding to the statement evaluating the experience during staff clinic visits, 112 (29.6%) strongly agreed that this was very satisfactory. About 133 (35.2%) agree that the experience was to be very highly rated.
Discussion
Patient satisfaction is defined as the patient’s subjective evaluation of their cognitive and emotional reaction as a result of the interaction between their expectations regarding ideal healthcare services and their perceptions of the actual care.[8,9]
Our study participants have expressed a high level of satisfaction regarding the professionalism, kindness, courtesy, and waiting time at the reception, triage nurse room, and physician encounter. This level of satisfaction in our study reflects the improvement efforts undertaken by healthcare providers, healthcare authorities, and administrators in the setting of the study.[6] Looking at accessibility to our staff clinics, our study participants reported an acceptable satisfactory level. These results are comparable with the national, regional, and international studies, and they also reflect how our healthcare professionals utilize communication skills and the potential they possess to provide high-standard care.[10]
Local research conducted by Abrar H. Allafi et al. reported similar findings.[1]
The domains of consumer satisfaction are myriad. However, our study questionnaire sought to conceptualize the main parameters. A study done by Enock Mintah et al. conformed with our assessment tool.[5]
Whereas Tarig Ali M Alzaied and Abdurrahman Alshammari’s study results were in line with our study results.[14]
One of the earliest studies in Saudi Arabia by Muneera H. Al-Osimy concluded that the facilities in the three centers studied were inadequate,[10] in contrast to our respondents who were satisfied with the cleanliness and equipment availability; this reflects the efforts of the Saudi Ministry of Health to improve the healthcare services provided.[2]
Moreover, research by Riyadh A. Al Hilfi, Rajaa A. Mahmoud, and Nihad Q. Al Hamadi indicated weaknesses in some of the patient’s satisfactory dimensions including non-verbal cues of the communication process.[12] However, it provided evidence of having no significant difference in the chosen satisfactory dimensions between the healthcare centers providing family medicine services compared to those with no family medicine ones.[12] Whereas our participants were satisfied with their overall communication skills.[13]
While Nilofer Sultan Ali et al. study revealed some areas of improvement in family practice such as accessibility and reduction in waiting times,[11] whereas our study revealed that the scores of the waiting time to see the receptionist, triage nurse, and the physician were very adequate.
A study by Asif Iqbal Sandhu et al. reported discontent with the communication skills[4] aspect, this is in contrast to our study findings on this domain.
The participants survey for the dimensions of quality as shown in Table 5 about 38.4% of 145 are agree with the cleanness of clinic while 2.4 % of 9 are disagree, The equipment of clinic the also 38 .4 % agree the goodness of equipment while 2.6% are disagree, The accessibility of the clinic about 36 % are strongly agree while 32 are agree, The patient’s privacy is well maintained during the staff clinic visit 40% are strongly agree while 35 % are only agree, The patient’s privacy is well maintained during the staff clinic visit same percentage as mentioned previously , There is no interruption during medical consultation 33 % are strongly agree while 34.9 are agree.
Table 5.
Evaluation of the structure, process, and outcome by the participant
| Questions | Strongly agree n (%) | Agree n (%) | Neutral n (%) | Disagree n (%) | Strongly disagree n (%) |
|---|---|---|---|---|---|
| The cleanliness of the clinic is very good | 140 (37.0) | 145 (38.4) | 70 (18.5) | 14 (3.7) | 9 (2.4) |
| The equipment of the clinic is very good | 140 (37.0) | 145 (38.4) | 73 (19.3) | 10 (2.6) | 10 (2.6) |
| The accessibility of the clinic is very good | 138 (36.5) | 122 (32.3) | 71 (18.8) | 30 (7.9) | 17 (4.5) |
| There is clear signage for the clinic | 123 (32.5) | 120 (31.7) | 80 (21.2) | 36 (9.5) | 19 (5.0) |
| The patient’s privacy is well maintained during the staff clinic visit | 154 (40.7) | 134 (35.4) | 62 (16.4) | 17 (4.5) | 11 (2.9) |
| There is no interruption during medical consultation | 141 (37.3) | 128 (33.9) | 65 (17.2) | 28 (7.4) | 16 (4.2) |
| I find it hard to get a follow-up appointment for medical care | 109 (28.8) | 74 (19.6) | 90 (23.8) | 72 (19.0) | 33 (8.7) |
| I can get urgent medical care whenever I need it during an acute presentation | 124 (32.8) | 104 (27.5) | 96 (25.4) | 26 (6.9) | 28 (7.4) |
| Overall assessment of my experience during staff clinic visits is very high | 112 (29.6) | 133 (35.2) | 91 (24.1) | 21 (5.6) | 21 (5.6) |
I find it hard to get a follow-up appointment for medical care about 28 % are strongly agree and 19% are agree,
I can get urgent medical care whenever I need it during an acute presentation 32 % are agree and 27 % are gree
Overall assessment of my experience during staff clinic visits is very high 29% are strongly agree while 35 are only agree we can see from this result the most of participants are giving high preferences for the dimensions of quality in the clinic.
They also reported that marital status was an important correlate of patient satisfaction.[4] In our study, there were insignificant effects of marital status on respondents’ satisfaction assessment.
A study conducted by Waju Beyene, Challi Jira, and Morankar Sudhakar concluded that the interpersonal interactions were poor,[15] which was in contrast to our findings on this aspect.
A study conducted in Scotland by Jenkinson C. to assess patients’ experiences and satisfaction concluded that patient satisfaction scores present a limited and optimistic picture.[7] They recommended that detailed questions about specific aspects of patients’ experiences are likely to be more useful. This conforms with our recommendations.
Conclusions and Recommendations
Our participants’ assessment of the current services provided was found to be satisfactory.
The study findings also showed a high level of satisfaction regarding the structure, and the interaction process with the employees, and the overall assessment of their experience during the visits including the overall outcome was also satisfactory.
Future research on assessing the satisfaction of patients related to the provided services should include detailed questions about patients’ experiences and expectations, among the study recommendations the focus should be emphasized on the patient-oriented evidence that matters (POEM) which measures indicators that directly reflect patients’ experience and awareness of their illness. This includes mortality, morbidity, and the overall quality of life.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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