Assesment of Clients’… Fekadu A.

et al 1

ORIGINAL ARTICLE

ASSESSMENT OF CLIENTS’ SATISFACTION WITH

HEALTH SERVICE DELIVERIES AT JIMMA UNIVERSITY
SPECIALIZED HOSPITAL

FEKADU ASSEFA*1, Andualem Mosse2, Yohannes H/Michael1

ABSTRACT
BACKGROUND: Client satisfaction is considered as one of the desired outcomes of health care and it is
directly related with utilization of health services. Nonetheless, there is no adequate information on
users’ perception about the service provided in the hospital after the implementation of Business process
re-engineering reform. Hence, the objective of this study was to assess the perceived levels of clients’
satisfaction with health services rendered at Jimma University Specialized Hospital.
METHODS: A cross sectional study was conducted from March 1-8, 2010 on a sample of 422 service
users of the hospital using systematic random sampling technique. Data was collected using structured
questionnaire and analyzed by SPSS for windows version 16.0. Statistical tests were employed where
necessary at 0.05 level of significance.
RESULT: The questionnaire was administered to a total of 422 clients , of which, 51.7 % were male,
about 33.4% of the respondents were between the age group 25-34, 41.% of the clients were illiterates,
60% were from the rural areas and 57.8 % received the service free of charge. The findings of the study
showed that the overall client satisfaction level with the health services rendered at the hospital was 77%.
Satisfaction was reported to be highest (82.7%) with the way the doctors examined them and on the other
hand dissatisfaction was reported to be highest (46.9%) by respondents with the time spent to see
a doctor. Furthermore, satisfaction with the health care was found to have a significant association with
the age of the respondents (p=0.034) and educational level of the respondents (p=0.003).
CONCLUSION: This study showed higher clients’ satisfaction level in the University Specialized
Hospital when compared to previous studies in the same hospital as well as other similar studies in the
country. Lack of drugs and supplies, poor information provision, long waiting time, poor cleanliness,
lack of privacy and inadequate visiting hours, were found to be the major causes of dissatisfaction.
Therefore, the Hospital management should understand these weak service areas and plan for a better
service delivery.
KEYWORDS: Hospital, Outpatient Department, inpatient, satisfaction.

patient satisfaction has become an integral part of

INTRODUCTION hospital/clinic management strategies across the
Client satisfaction is the level of satisfaction that globe. Moreover, the quality assurance and
clients experience having used a service. It accreditation process in most countries requires
therefore reflects the gap between the expected that the satisfaction of clients be measured on a
service and the experience of the service, from regular basis (1).
the client’s point of view. Measuring client or
1
Department of health services management, College of Public Health and Medical Sciences, Jimma University
*
Corresponding author: E-mail: [email protected]
2
Department of Biomedical Sciences, College of public health and medical sciences, Jimma University, E-
mail:[email protected]
Asking patients what they think about the care and influences whether a person seeks medical advice,
treatment they have received is an important step complies with treatment and maintains a continuing
towards improving the quality of care, and ensure relationship with practitioners (3, 4). Donabadian,
local health services are meeting patients’ needs arguably the leading theorist in the area of quality
(2). It is an established fact that satisfaction assurance, has emphasized that Client satisfaction is
2 Ethiop J Health Sci. Vol. 21, No. 2 July 2011
of fundamental importance as a measure of the level of social services has been the major causes
quality of care because it gives information on the for a poor health status of the people (12, 13).
provider’s success at meeting those client values
and expectations, which are matters on which the Several studies conducted in Out Patient
client is the ultimate authority (5, 6). Departments of different hospitals in Ethiopia
In the prior years when hospitals were revealed client satisfaction level ranging from
symbols of humanitarian efforts for community 22.0% in Gondar to 57.1% in Jimma (14, 16, 17).
welfare, accountability for performance was of Long waiting hours during registration, visiting of
little concern. Today however, people are Doctors after registration, laboratory procedures
increasingly concerned about hospital’s and re-visiting of the Doctor for evaluation with
performance because: -1) Hospitals use an laboratory results failure to obtain prescribed
increasing proportion of scarce community medications from the hospitals’ pharmacies and
resources. 2) There are increasing questions about difficulty to locate different sections were the
quality and effectiveness. (9). Moreover, frequently faced problems affecting utilization
addressing those service aspects of healthcare that leading to dissatisfaction (15, 18).
consumers most readily appreciate, such as access, This study would have an important input
provider relationship, availability of information in assessing the level of clients’ satisfaction on
and opportunity for participation can influence outpatient as well as inpatient health care services,
health care quality outcomes (7,8). identify the factors affecting the clients’
A recent study from Bangladesh reported satisfaction, and provide a recommendation on an
that the most powerful predictor for client improved health service delivery that will be
satisfaction with health services was provider helpful to fill research knowledge gaps which
behavior, especially respect and politeness (9). ultimately contributes to enhance quality of patient
It is indicated that health care systems in most services in the hospital and improve the level of
developing countries suffer from serious clients' satisfaction.
deficiencies in financing, efficiency, equity and
quality and are poorly prepared to meet these
challenges (10). METHODS AND SUBJECTS
An in-depth study of the Iringa district of A cross sectional descriptive study was conducted
Tanzania, a poor rural area, showed that patients to assess the perceived levels of clients’
bypassed low quality facilities in favor of those satisfaction with health services rendered at Jimma
offering high quality consultation and University Specialized Hospital, which is located
prescriptions, staffed by more knowledgeable 350KM Southwest of Addis Ababa. JUSH is a
physicians and better stocked with basic supplies referral and teaching hospital running annual
(11). budget of Birr more than 20 million with bed
In Ethiopia the low level of socio-economic capacity of over 450 and total staff exceeding
development resulting in one of the low standard 550.It provides services for approximately 9000
of living, poor environmental conditions and low inpatient, 5000 accident and emergency cases and
80,000 outpatient attendants each year.
All clients visiting the hospital for health
services from March 1/2010 to March 8/2010
were the source population. Sample size(n) was
determined based on the assumption of 50%
satisfaction level, Expected margin of error (d) of
0.5 and with 95% confidence level (Zα/2) and
10% contingency for non-response. The study
population was selected using systematic random
sampling technique. According to the data
obtained from the Hospital the annual cases seen
at OPD is estimated to be 80000 excluding
accidents and emergencies and the annual
admission rate is 9000.Therefore the proportional Gynecology &Obstetrics wards. For Outpatient
sample size for inpatient was 40 and shared services the sample size was 382 and divided among
equally among Internal medicine, Surgery and OPDs of the above mentioned Departments. As a
 Assesment of Clients’… Fekadu A. et al 3
result, 422 clients were involved in the study.
The following Operational definitions were used
Questionnaire was administered to every 5th of
during the conduct of this study;
Outpatient clients who received treatment and
Patient waiting time: The interval between
completed their visit and similar exit interview
departure from the proceeding outpatient station
was administered to every other inpatient clients
and receiving service at the next outpatient station.
on their discharge date.
Outpatient station: The different part of
outpatient department, registration station,
Structured questionnaire was developed in
weighing station, examination room laboratory,
English and the interview was administered by
and dispensary etc...
medical interns who can speak Afan Oromo
Consultation time: The time spent discussing
fluently, after orientation training on purpose of
health matter with one’s physician.
the study and proper administration of questioners
Satisfaction: Attaining one’s need or desire.
was conducted for one day. The questionnaire was
Very satisfactory: Above one’s expectation.
designed to obtain information on socio
Satisfactory: Just one’s expectation.
demographic characteristics of respondents and
Dissatisfactory: Below one’s expectation.
their satisfaction level with the different
Very dissatisfactory: Fail to meet one’s
components of the Hospital’s services which
expectation usually leading to disappointment.
included the availability of drugs and supplies,
Assessment: Is the process by which the
information provision by the health workers,
characteristics and needs of clients, groups or
waiting time to get the services, courtesy and
situations are evaluated or determined so that they
respect of the health workers, and cleanliness of
can be addressed. The assessment forms the basis
waiting areas, toilets and wards of the hospital.
of a plan for service or actions.
Data consistency and completeness was
Service: any activity undertaken to meet the
checked throughout the data collection, data entry
social needs.
and analysis. Data were coded and entered into
Quality: User based quality is defined as “fitness
computer using SPSS version 16.0 software. In the
for use”, which means the consumer’s perception
analysis of client satisfaction the very satisfied and
of quality. It is also defined as meeting the desires
very dissatisfied were categorized to satisfied and
and expectations of customers”
dissatisfied groups because the numbers of the
respondents in the very satisfied and dissatisfied
RESULTS
were small. Frequency distribution, percentages
and Chi-square test were calculated for selected A total of 422 clients were enrolled in the study
variables to check associations at 5% level of and there was comparable gender distribution with
significance. Prior to this study an official letter slight male predominance (51.7%) and 33.4% of
from the college of public health and medical the clients were between the age group of 25-34
sciences was written to the Hospital to conduct the years. Considerable number of clients (41%) were
study and verbal consent from the Medical not able to read and write, while, 304 (72%) were
director, and Head nurses was secured. Informed married. Farmers account for 48.6% and 253
consent was also obtained from the clients after (60%) of the clients were from the rural areas. Out
explaining the purpose of the study. of the total respondents, 54.7% were revisiting and
91.0% came because of illnesses. 344 (81.5 %)
were clients themselves and the rest were close
family members and others. Nearly three fifth of
the clients (57.8%) received the services free of
charge. Concerning the ethnic composition of the
clients, 306 (72.9) of them were Oromo, and 273
(64.7%) were followers of Islam (Table 1).
Table- 1: Socio-demographic characteristics of respondents JUSH March, 2010(n=422)

Background characteristics No (%)

Sex Male 218(51.7)
Female 204(48.3)
Age (in years) 15-24 67(15.9)
25-34 141(33.4)
35-44 135(32.0)
45+ 79(18.7)
Marital Status single 80(19.0)
married 304(72.0)
widowed 14(3.3)
divorced 24(5.7)
Educational Status Illiterate(cannot read or write) 173(41.0)
1-6 112(26.5)
7-12 89(21.1)
Diploma &above 48(11.4)
Occupational status Farmer 205(48.6)
Merchant 78(18.5)
Government employ 48(11.4)
No occupation 15(3.6)
Student 49(11.6)
Others© 27(6.4)
Address Rural 253(60.0)
Urban 169(40.0)
Payment status Free 244(57.8)
Paying 178(42.2)
Reason for visit Illness 384(91.0)
Family planning 30(7.1)
Others α 8(1.9)
Frequency of visit New visit 191(45.3)
Repeat visit 231(54.7)
Religion Muslim 273(64.7)
Orthodox 105(24.9)
Protestant 43(10.2)
Others 1(0.2)
Ethnicity Oromo 306(72.9)
Amhara 69(16.4)
Keffa 20(5.3)
Dawro 15(3.5)
othersβ 10(2.4)
©=housewife, employee in private sector, no occupation
α= immunization, injection, dressing
β= Gurage, Yem, Welaita, Silte, Agnuak. Etc
 Assessment of Clients’… Fekadu A. et al 105

Among the Outpatient clients, the way the doctor laboratory orders 178(51.74%) got all the ordered
examined the clients was the aspect where procedures and of the 247 radiology requests
satisfaction was rated highest 349 (91.36%) and 184(74.50%) were able to get the requested
satisfaction was rated lowest (53.1%) with the procedure in the Hospital. While, 88.2 % of the
time spent to see a doctor. Out of 40 admitted total clients got a prescription paper for drugs and
patients included in the study 22 (55%) were supplies, only 33.3%, got all the prescribed drugs.
satisfied with the food service of the hospital and Over one third (37.0%) of the respondents
contrary to this, 24 (60%) were dissatisfied with reported dissatisfaction with the overall waiting
the visiting hours of the hospital. Nearly two fifth time to get the hospital services, while 23.5% of
of the respondents (39%) responded they were not the clients were dissatisfied with the lack of drugs
satisfied with the information provision about the and supplies in the hospital (Table 2).
hospital services and the flow. Out of 344
Table- 2 Level of satisfaction of clients with
the different components of health care
services JUSH, March, 2010(n=422).

Characteristics V. sat Sat.

(%) (%)
Information provision by health workers 12.2 51.7
Time spent to see a Dr 5.9 47.2
Courtesy and respect 11.8 64
Privacy 13.7 41.9
Access to latrines 10.7 58.5
Cleanliness of latrines 7.8 58.8
Cleanness of wards 15.0 30.0
Cleanness of bedding 5.0 42.5
Queue process to see a Doctor 6.9 48.6
The way the Doctor examined 28.0 54.7
Confidentiality 8.1 53.8
Availability of drugs 19.0 36.0
Food 5.0 50.0
Overall waiting time 3.1 44.5
Visiting hours 2.5 37.5
Way questions &queries dealt by staff 5.0 37.5
Overall level of satisfaction 6.2 70.9
v.sat = very
satisfied sat =
satisfied neut =
neutral dissat =
dissatisfied
v.dissat = very
dissatisfied

There was (p=0.002),

statistically
significant
association between
client’s satisfaction
and their age
(p=0.034), their
educational status
(p=0.003),
occupational status of
the respondents,
106 Ethiop J Health Sci. Vol. 21, No. 2 July 2011
address of the
respondents
(p=0.000),
payment scheme
of the respondents
(p=0.000) and
waiting time to see
a doctor (p=0.000)
(Tables 3, 4, 5).
Table-3 Comparison of overall level of clients’ satisfaction with health services rendered at Jimma
University Specialized Hospital by selected socio – demographic characteristics, March 2010.

Characteristics Satisfied Dissatisfied p-value

N0 (%) No (%)
sex Male 161(82.1)) 35(17.90) 0.451
Female 164(85.00)) 29(15.00)
Age in years 15 – 24 39(70.90) 16(29.10)
25 – 34 111(85.4) 19(14.50) 0.034
35 – 44 107((83.60) 21(16.70)
45+ 68(89.50) 8(10.50)
Educational status Illiterate 154(90.60) 16(9.40)
1–6 84(82.40) 18(17.60)
7 – 12 58(72.50) 22(27.50) 0.003
Diploma &above 29(78.40) 8(21.60)
Address Urban 109(73.20) 40(26.80.)
Rural 216(90.00) 24(10.00) 0.000
Payment status Paying 113(69.30) 50(30.70)
Free 212(93.80) 14(6.20) 0.000
Occupation Farmer 180(90.00) 20(10.00)
Merchant 51(71.80) 20(28.20)
Governmental 34(75.60) 11(24.40)
employee 0.002
student 28(75.70) 9(24.30)
Others 20(83.30) 4(16.70)
Status of respondents Patients 258(80.60) 62(19.40)
FP and 18(100) 0(0.00)
Vaccination users 0.003
Family members 49(96.10) 2(3.90)

Table- 4: Clients’ satisfaction on availability of drugs by selected sociodemographic characteristics, 2010.

Characteristics Satisfied Dissatisfied p-value

N0 (%) N0 (%)
Sex Male 115(67.30) 56(32.70)
Female 118(73.30) 43(26.70) 0.229
Age in years 15 – 24 31(67.40) 15(32.60)
25 – 34 70(65.40) 37(34.60)
35 – 44 80(74.80) 27(25.20) 0.467
45+ 52(72.20) 20(27.80)
Educational Illiterate 113(76.90) 34(23.10)
status 1–6 60(74.10) 21(25.90)
7 – 12 38(56.70) 29(43.30) .009
Diploma &above 22(59.50) 15(40.10)
Address Urban 75(61.00) 48(39.00)
Rural 158(75.60) 51(24.40) 0.005
Payment status Paying 76(52.80) 68(47.20)
Free 157(83.50) 31(16.50) 0.000
Frequency of New 108(78.80) 29(21.20)
visit Repeat 125(64.10) 70(35.90) 0.004
rendered at JUSH was 77.0 %. and this is higher
than reports from other studies conducted in Jimma
DISCUSSION
Hospital and in a Mozambique Hospital which
This study has revealed that the overall showed 57.1% and 55% , respectively (19, 20).
satisfaction level of the clients with the services
 This level of satisfaction is also higher when
The study has revealed that lack of drugs and
compared to studies conducted in the hospitals of
supplies in the hospital pharmacies was the major
the Amhara region which showed satisfaction
problem, where about 70% of the clients with
level of 22.0% to 50% (15, 16). Likewise, a
prescription paper for drugs did not get some or
report from Tigray zonal hospitals revealed
all of the ordered drugs from the Hospital’s
satisfaction level of 43.60% (17). The
Pharmacy. This finding is similar with that of the
difference might be attributed to the fact that this
study conducted in Jimma hospital earlier, where
study was conducted in a specialized teaching
63.7% of the clients lacked drugs from the
hospital where there are relatively adequate
hospital’s pharmacies. It is also a comparable
number of health professionals and better
finding with that of study in Tigray Zonal
diagnostic facilities. In addition, study time and
hospitals which reported about 61% of those
design might have also contributed. The present
clients with prescription paper for drugs did not
study was facility based and that of Gondar was a
get the ordered drugs from the hospital
community based. Thus, this study should be
pharmacies (17). However, our finding is higher
interpreted with caution as it may tend to
than that of the study conducted in the hospitals
exaggerate social desirability bias and subjected
of the Amhara region where about 1/3 rd of the
to Hawthorne effect (courtesy bias).
clients did not get the prescribed drugs (16).
Failure to obtain the prescribed drugs from
the hospital’s pharmacy is in line with a report
from a study conducted in Manica, Mozambique
where it was found to be the most complaint
associated with lower satisfaction (20). Another
study conducted in South Africa also revealed
that access to drugs was one of the most
suggested priorities for improvement of public
health services (21).

Table- 5 Comparison of client satisfaction with the overall waiting time to get the outpatient services by
selected socio – demographic characteristics at JUSH March, 2010.

Characteristics Satisfied Dissatisfied p-value

No (%) No (%)
Walking time (hrs) < 1 hour 47(73.30) 18(27.70)
1 – 2hour 108(86.40) 17(13.60)
2 – 6 hours 90(94.7) 5(5.30) 0.000
> 6 hours 80(76.9) 24(23.1)
Time to see Drs (hrs) < 1 hr 70(95.90) 3(4.100
1 – 2 hours 189(91.70) 17(8.30) 0.000
> 2 hours 66(60.00) 44(40.00)
< 1 hr 129(92.10) 11(7.90)
Giving lab 1 – 2 hours 80(80) 20(20) 0.000
specimen(hrs) > 2 hours 50(62.5) 30(37.5)

Waiting time to see the < 1 hr 71(91.00) 7(9.00)

Dr after receiving the 1 – 2 hours 147(91.90) 13(8.10) 0.000
lab result > 2 hours 49(53.8) 42(46.2)
As it has been indicated in the resulted, services (7).
dissatisfaction because of lack of drugs in the Twenty percent of the clients in the present
Hospital’s pharmacies was statistically significant study were dissatisfied with the provision of
with payment status (p=0.000), Where about 39% information about the hospital services and their
of the clients from urban areas and about 47% of health problems. This is quite a low dissatisfaction
the paying clients were dissatisfied because of it. rate when compared to the study conducted in
Many studies have also indicated that patients Tigray zonal hospitals with 46.7% dissatisfaction
equate availability of drugs with high quality rate (17).The reason for the big difference could be
due to the difference in the number and type of This better finding could partially be due to the
health care providers in those mentioned service ongoing changes in the study area hospital
delivery places and the variety of activities they because of the newly introduced reform, where an
run in their respective areas. improvement in the service delivery process and
A study conducted in South Africa staff attitudinal change might have resulted.
revealed lack of communication and relevant Analysis of overall satisfaction by socio-
messages to patients were identified as an demographic characteristics showed that
important issue impacting on quality thus educational status, and age were associated with
affecting client satisfaction (21). Highest satisfaction, where respondents who are illiterate,
satisfaction rate (82.7%) in this study may be and the older age group were more satisfied as
attributed the way the doctor examined the compared to those who have tertiary education
clients. This high result could be expected in the (diploma and above) and the younger age groups
study area hospital as it is a teaching center so respectively. This is in agreement with the study
that health professionals at different level are in Jimma Hospital in which satisfaction score was
expected to demonstrate the standard way of directly related to the age but had an in inverse
patient examination. In contrary the lack of relation to educational status, high education
respect and courtesy were among the major associated with low satisfaction score. It is also
reasons for dissatisfaction in Gondar study (15). similar with a study conducted in Trinidad and
In a study conducted in South Africa, the Tobago which showed the percentage of satisfied
comments made about the poor quality of the clients decreased with increased educational
relationships with the practitioner included: lack status, but increased with increasing age (22).
of empathy, mistreatment, lack of respect and The reason could be due to high expectation by
lack of communication (21). those who are more educated than the illiterate
As to this study, 37.2% of the clients were (could be true for those who came from rural and
dissatisfied by the overall waiting time to get the for farmers) and confidence in medical care
services. This is higher than the finding reported system and satisfaction in life in general by the
earlier in Jimma hospital which showed 20.4% of older age groups.
the clients have reported long waiting time In conclusion, the hospital management
(19).This higher dissatisfaction rate with waiting needs to understand the extent of the problem
time could be attributed to the increased number with drugs and supplies and plan to look for
of clients. However, the dissatisfaction rate with different mechanisms to keep adequate stock of
waiting time to receive the services in the study essential drugs and supplies, fulfill human
area is lower compared to the waiting time in the resource and standard medical equipment,
study in Tigray Zonal hospitals where 43.2% establish an information desk at a convenient
dissatisfaction rate was reported (17). corner of the hospitals which would particularly
be helpful for the majority of the clients who are
illiterates, and avoid long waiting time and lack
of privacy.

ACKNOWLEDGEMENTS

The authors are grateful to the student research

project of Jimma University for its support. We
would like to acknowledge the study participants
for their genuine participation and information.
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