Assessment of Patient Satisfaction in IPD Settings of AVBRH and Designing Strategies for Providing Patient-centric Care

Background: Health industry is changing and growing at a very rapid phase. The patient is the most essential stakeholder in healthcare now. The Healthcare industry is a service industry where patient satisfaction are of paramount importance for the success of any organization. Healthcare is becoming more and more customer-centric. Patient satisfaction encompasses patients’ expectations, perception, and overall experience of healthcare services. Patient feedback helps a lot in improving services to patient satisfaction. This study aims to assess the satisfaction level and causes of dissatisfaction in ABVR Hospital and provide patient-centric healthcare. Methodology: This will be a descriptive cross-sectional study. Patient satisfaction survey questionnaires will be administered, and personal interviews will be conducted with 50 randomly selected patients admitted to AVBRH. The qualitative and quantitative data will be analysed using appropriate statistical tools. Results: Key reflections are expected about patient satisfaction level regarding healthcare services Study Protocol Seth et al.; JPRI, 33(60B): 3328-3334, 2021; Article no.JPRI.81026 3329 at AVBRH which can guide to frame patient-centric care policies. Conclusion: Patient perception and feedback should be considered for formulating quality improvement strategic decisions. Pas the end-user of service, patients can judge the organizational and environmental dimension, empathetic work culture, and clinical aspect.


INTRODUCTION
The health industry is changing and growing at a very rapid phase. Patient is the most essential stakeholder in healthcare now. The Healthcare industry is a service industry where patient is customers, and customer satisfaction are of paramount importance for the success of any organization. Healthcare is becoming more and more customer-centric (patient-centric) [1]. Now the patient is better informed and demands the best quality services. Patient-centered -care emphasizes customized care that is respectful and responsive to individual patient preferences and needs and which ensure patient participation in clinical decisions [1]. Therefore, patient feedback ensures good quality healthcare that resonates with patient needs. Patient satisfaction must be the ultimate goal of an organization.
Increased competition in the healthcare industry cause healthcare providers to enhance their quality of service, upgrade their technology and improve patient experience in healthcare [2]. Improving patient satisfaction in healthcare surely gain patient loyalty, help in creating a positive patient experience, and maintains a good reputation and goodwill.
Although patient perception and healthcare expectations can be subjective and can vary from time to time, still it can be used to assess the quality and efficiency of health care. As it reflects the customer and provider gap. It helps to identify the strength and weakness of different services provided. To enhance the quality of care and improve patient satisfaction [3].
It is the measure of administrative and managerial efficiency along with giving fair idea about clinical practice followed. It may also reflect coordination among various clinical, nonclinical, administrative, and support services in a healthcare setting. Patient satisfaction survey can be used as a tool for quality management in Healthcare.

Aim
To access patient satisfaction with the service provided in the hospital and inpatient ward in AVBRH.

Objectives
 To identify problems in inpatient ward causing dissatisfaction to patients. Provide suggestions to overcome the problems and improve patient satisfaction. For quality assessment in IPD ward.  To understand the strength and weakness of the hospital. Patient satisfaction will be accessed in each service area like registration, billing, physicians, nursing, dietary, housekeeping, pathology, and radiology etc.

METHODOLOGY
Descriptive Cross-sectional study conducted in two phases: first phase: patient satisfaction survey questionnaire. Second phase: patient interview. Random sampling will be used as a sampling technique.
Patient satisfaction survey questionnaire can be based on registration and admission process, billing nursing, quality of medical care, accommodation, dietary services, housekeeping, and overall hospital atmosphere. Patient will be asked survey questioner and interviewed while they are still hospitalized to reduce recall bias. It is also cost effective and quick method. As the setting of research is a rural hospital, most patients are uneducated telephone follow-up interview and mailing and receiving of questionnaire are not feasible.
Face to face interviews with patients about their experience in the IPD ward can provide rich qualitative data. In interview, openopenendedstions will be asked to patients related to their stay in the Inpatient ward. Patients will be encouraged to express their opinions and views freely and fairly. Before survey and interview, patients will be explained the purpose of the survey, and verbal consent will be obtained from patient. The questionnaire shall be read to the patients in simple language they can understand, and their response shall be noted. Patient confidentiality shall be maintained [2]. Sufficient time shall be given to each face-to-face interview, so that the patient point of view regarding hospitalization is noted. A sample of 50 patients was selected using systemic random sampling. By all means, patient wellbeing and comfort shall be maintained and considered during survey.

Study Design
Descriptive cross-sectional study.

Sample Collection
Random sampling technique.

Participants
Patient admitted in Inpatient ward of AVBRH.

Inclusion Criteria
Patient admitted to IPD ward for at least two days. Patient giving consent for survey and interview. Patient fit and comfortable to participate in survey and interview.

Exclusion Criteria
Patient admitted in emergency ward. Patient not giving consent. Patient critically ill.

Bias
To reduce recall bias survey shall be conducted while the patient is still admitted in the In-patient ward. Patient with severe pain, critically ill with life-threatening complications, chronic diseases, and prolonged hospitalization negatively impact patient satisfaction. Therefore, patient in emergency ward or other patient critically ill is excluded from survey [4].

Background of Study
AVBRH Acharya Vinoba Bhave Rural Hospital is a 1525 bedded multi-specialty teaching hospital in Sawangi Wardha which is attached to deemed university Datta Meghe Institute of Medical Science (DMIMS). Its motto is "cure with care" and it is certainly living up the same with its state of art facilities and highly qualified and dedicated work force. AVVBRH has 25 years of experience in healthcare sector. It provides much needed healthcare facilities to rural area of Wardha. AVBRH is empanelled with Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) launched by government of Maharashtra providing free quality critical care for low income families.

EXPECTED OUTCOME/ RESULTS
Survey and face to face interview will provide data to access level of patient satisfaction and identify the problem and provide suggestions for rectification. It helps to enhance positive and patient centric care.

DISCUSSION
During the past few decades the hospital care system has shifted from provider-based system to patient (receiver)based system [3] . Patient expectation has changed greatly in the recent year and to keep up with their expectation and earn customer loyalty organization uses various strategies (2). Quality management and improvement is a continuous process. Timely patient feedback gives direction to the management to improve patient experience in healthcare and to gain competitive advantage.
Health industry in recent decade has changed too a great extend with many corporate hospitals coming up, increased competition and technological advances. Patient now are more aware and well informed; therefore, their expectation has increased [5]. Along with treatment patient wants quality services and good experience which has changed the healthcare scenario completely. Patient now have ability to choose the healthcare which suits their need and budget causing increased competition among healthcare organizations.
The reason for choosing particular healthcare by patient can be distance of healthcare, recommendation and referral, low cost, health schemes, insurance policy, hospital facility, amenities, specialization and technology, or even particular physicians preferences [3]. Strategies to gain new customer and retain old customers are made keeping patience preference in view.
Patients expectation from a healthcare facility are timely and adequate treatment along with empathy and emotional support, respect of privacy and consent, proper information regarding treatment and procedure, transparency in billing and cost, better communication between patient and staff, physical comfort and amenities, updated technology and equipment, sanitation and clean safe environment [6].
Patient satisfaction is the outcome of perceived needs of patient, patient expectations and actual patient experiences during hospitalization therefore it is a relative phenomenon [7].While Patient experience is the mix of both subjective and objective experiences of patient during the course of hospitalization and treatment. It can vary greatly from patient to patient. Still it can highlight the weakness in management of healthcare and allows rectification. Satisfied patient not only comply to treatment and appointment but also recommend it to others. Word-of-mouth Marketing helps to retain customers, attract new customers and also establishing good will.
Generally, physician's domain gains highest satisfaction score, nursing and pathology second [3]. Physicians interpersonal skill and good communication with patient positively affects patient well-being. When physicians gave sufficient time resolving patient quarries and providing information, patient anxiety is greatly reduced and help in creating a positive image of organization. Well informed and educated patient are more likely to adhere to treatment and followups [3].
Secondly, Nursing play a very important role in patient satisfaction as they are involved in every aspect of patient care. Compassion, good communication, prompt answering the call and attention provided by nurse goes a long way in patient satisfaction, good clinical outcome and creating a positive image of hospital [8].
Main domain for dissatisfaction is registration billing, dietary and housekeeping departments. Long waiting time, high hospital charges, lack of recovery, lack of communication and information about treatment, procedure and lack of sanitation, rude and unsympathetic behaviour of staff are some of the cause of dissatisfaction.
Even navigation in a big hospital can be frustrating for an uneducated, elderly or new patient. There must be proper flow between various services in the healthcare so patient can easily navigate their way and patient time is not wasted.
In recent years patients have an active part in their healthcare whereas earlier patients wanted to be just directed by their physicians. Therefore, communication and interaction with staff and physicians now have become an important part for patient's satisfaction. Interpersonal skill and behaviour of clinical, non-clinical, administrative, clerical, support and even housekeeping staff has a direct impact on patient satisfaction. Warm, polite, empathetic and compassionate staff help to ease patients and their relative anxiety and creating trust and positive outlook towards health care.
Patient has an altogether different outlook on hospital and services provided, they make judgement based on convivence, amenities, physical appearance, timely appointment, cost and courteous staff. As the user of the service they have first-hand experience to judge it. Also, as customers they have right to demand service that corresponds to their need and perception. 10. Creating a work culture which reflects quality, compassion and empathy [5].

Scope or Benefit
Patient satisfaction survey has proven to be quick, easy and cost-effective tool to access quality management or its efficiency. It also reduces bias. Patient satisfaction survey is widely used to access the quality of care provided. Firstly, as the service user they are the best judge to access aspects of care like accommodation, dietary, billing and registration time taken or interaction with health care provider. Secondly, healthcare has now become a service-oriented industry so feedback of patient is valuable for success of organization [4].
Patient needs and satisfaction fulfilment not only earn good name in market but also gain customer loyalty. And as a service user patient have to right to have part in decision making and factors affecting their needs. The survey is to access the patient's needs and expectation, give service user a voice. It cannot be used to judge clinical and technical quality but it represents humanitarian and empathetic care provided. The increasing competition in healthcare industry causes organization to get excellent patient feedback rating. It also highlights the importance of interpersonal, social, ethical and humanitarian aspect of service [9]. A number of related articles and studies were reviewed [10][11][12][13][14][15][16][17][18][19][20][21].

CONCLUSION
Many a times a gap between patient expectation and patient experience causes dissatisfaction, timely patient satisfaction survey helps to bridge the gap between patient expectation and that of service provider and management. Patient feedback can act as a driving force for improving organizational efficiency and work culture. It helps to strength theinter-disciplinary coordination and teamwork where administrative, clinical and other support services work in unison to provide patient centric services. It also helps to identify strength and weakness of different services provided and administrative efficiency.
Patient perception and feedback should be taken into account for formulating quality improvement strategic decision. Patient as the end user of service can judge the organizational and environmental dimension, empathetic work culture if not clinical aspect. While negative feedback indicates room for improvement likewise positive feedback gives a moral boost to thrive for excellence. Main aim of survey is to identify cause of dissatisfaction and enhance quality of service provided.

CONSENT
As per international standard or university standard, patients' written consent will be collected.

ETHICAL APPROVAL
As per international standard or university standard written ethical approval will becollected and preserved by the author(s).