Satisfaction Rates Among Outpatients of Hospital

Satisfaction Rates Among Outpatients of Hospital Assessment of satisfaction among outpatient department (OPD) patients visiting tertiary level government hospital ABSTRACT Background Selection of an appropriate health care and measurement of its quality is very complex and elusive yet the tools of its measurement have been improving. It is easier to evaluate the patient’s satisfaction towards the service than to evaluate the quality of medical services that they receive. (1) Therefore, a research on patient satisfaction can be an important tool to measure of health system performance and improve the quality of services. (2,3). Satisfaction manifests itself in the distribution, access and utilization of health services. Objective: The main objective of this study is to measure the satisfaction of OPD (Outpatient Department) patients in tertiary care public health facility namely Guru Gobind Singh govt. Hospital, Jamnagar, Gujarat. Materials and Methods: Data were collected from a pre-tested pre-structured questionnaire from 322 patients who gave the verbal consent at the end of their O.P.D visit at tertiary health facility, Guru Gobind Singh Government Hospital, Jamnagar for days from to. The items in the questionnaire referred to particulars of the patients such as age, gender, education, occupation, income, family type etc.; perception of patients towards doctor , paramedical staff, basic amenities and quality of care. The responses were expressed in proportions. The data was tabulated on Microsoft Excel sheet and analyzed using EPI info. Results –Although majority of patients were satisfied with the availability of medicines; availability of information on illness, treatment and prevention; doctor’s patience, compassion and dedication but most of the patients were not satisfied with the behaviour of hospital personnel ;delay in reception of investigation reports ;unhygienic toilets and improper cleanliness of hospital; and lack of availability of drinking water . INTRODUCTION Quality care is the most important dimension of public health and it has emerged as an internationally important aspect in the health care services provision. This quality of care can be measured in terms of structure, process and outcome. Structure refers to the basic infrastructure and facility, process refers to the way the care is delivered and outcome refers to the end result. (4) While measuring health outcome and quality of patient care services, patient’s satisfaction is considered to be important component. Patients’ perceptions about health care systems and his satisfaction seem to have been largely ignored by health care managers in developing countries (12). The outcome of any disease is influenced not only by the appropriate diagnostic and treatment services but also the receipt of satisfactory care from service providers. A satisfied patient is more likely to develop a deeper and longer lasting relationship with their medical provider, leading to improve compliance, continuity of care and ultimately better health outcome. But it is difficult to measure the satisfaction and gauze responsiveness of health systems as not only the clinical but also the non-clinical outcomes of care do influence the patients’ satisfaction ,(5)such as: Quality of clinical services provided, availability of medicine, behavior of doctors and other health staff, cost of services, hospital infrastructure, physical comfort, emotional support, and respect for patient preferences.(6) Mismatch between patient expectation and the service received is related to decreased satisfaction.(7) Therefore, assessing patient perspectives gives them a voice, which can make public health services more responsive to people’s needs and expectations.(8,9) In the recent past, studies on patient satisfaction gained popularity and usefulness as it provides the chance to health care providers and mangers to improve the services in the public health facilities. Patients’ feedback is necessary to identify problems that need to be resolved in improving the health services. Even if they still do not use this information systematically to improve care delivery and services, this type of feedback triggers a real interest that can lead to a change in their culture and in their perception of patients. (10) OPD is the window to any health system and OPD care indicates the quality care of hospital reà ¯Ã‚ ¬Ã¢â‚¬Å¡ected by patient’s perception in terms of satisfaction to the services they are provided.(11)This study was therefore undertaken at OPDs of tertiary level health facility in Jamnagar to measure patient satisfaction. The main objective of this paper is to know the desired level of services as perceived by the patients about various components of out-door patient department (OPD) services. In this study, the OPD is defined as the hospital’s department where patients received diagnoses and/or treatment but did not stay overnight. MATERIALS AND METHODS Study design: Institution based cross-sectional study. Study population: The present study was conducted among the patients attending the outpatient department (OPD) of Guru Gobind Singh government hospital, Jamnagar. Period of study: The period of survey was days from to. Sampling frame: The sampling frame consisted of the outpatient department (OPD) of Guru Gobind Singh government hospital, Jamnagar. . Sample size: fifty percent of the OPD patients. Sampling technique: random sampling technique. The sampling population was interviewed from the most frequented OPDs (Medicine, General surgery, Obstetrics and Gynecology, Paediatrics, Orthopedics, Otorhinolaryngology, Ophthalmology, Skin, Tuberculosis and Chest diseases) according to probability proportion to size based on the past years OPD attendance. Inclusion criteria: A new or referred patient attending the OPD of the respective health care facility who gave verbal consent, Exclusion criteria: Patients working in the health care facility and patients admitted (indoor patients) and follow-up patients attending the OPD of the respective health care facility, who didn’t gave verbal consent or gave incomplete information, were excluded from the study. Selection of patient: The patients attending the OPD of the respective health care facility were selected for the interview by systematic random sampling. Depending upon the previous attendance of the particular department and the time taken to complete the interview, a random number was chosen and every nth patient was selected for the interview. This process was continued till the required sample size was completed. Tools of data collection: Permission to conduct the study was taken from the superintendents of the concerned health care facility. All the patients were interviewed after they had consulted the doctor. Informed verbal consent was taken from all the participating patients before the start of the interview after telling them about the objective of the study and the approximate time that will be involved in the completion of the interview. The prescribing doctor was largely kept unaware of the procedure, except in unavoidable circumstances, to avoid the bias in their behaviour with the patient. A pre-tested pre-structured questionnaire was used to record information taking the key elements of socio-demographic characteristics and perception of the patients regarding quality of services available at the outpatient health care facility. Analysis Data was tabulated on Microsoft Excel sheet and analyzed using the software Epi Info version 6. OBSERVATIONS AND RESULTS:- Table 1-socio-demographic profile of the patients:- Among all the subjects interviewed during the data collection, 322 were included in the statistical analysis and the remaining were not included, because of incomplete information. A majority (56.21%) of the responders were male. The mean ages of the responders were years .About 40% of the responders were illiterate. About half (56%) belonged to a joint family. Nearly half of the study subjects belonged to the lower socioeconomic status category as per the Kuppuswamy classification. TABLE 2-PATIENTS’ PERCEPTION OF THE QUALITY OF SERVICES AVAILABLE (n =322) The results regarding each question are shown in Table 2. Most of the respondents were satisfied with the availability of medicines, also they were able to get the medicines easily. Most of the respondents agreed that complete information was provided to them on the illness, treatment, and the methods to avoid illness. Almost half (48%) of the patients were not satisfied with the politeness of the hospital personnel. More than half (61%) of the patients stated that hospital personnel were not helpful. 59 % patients said that the doctor did not give them adequate time while 60% of the patients said that the doctor has given enough time to listen completely to their complains. 57% of the patients were satisfied that the doctor has checked carefully and was readily answering their questions. Almost 50% of the patients were told that the doctor gave them adequate time and didn’t rushed. 42% patients couldn’t easily locate the place of investigation. 55% of the patients didn’t receive their reports in time. 57% of the patients were not satisfied with the cleanliness of the hospital. 69% of the patients were not satisfied with the toilet conditions. 59% of the patients stated that drinking water wasn’t available in the hospital. TABLE – 3: QUALITY OF CARE Overall 66.45% respondents termed the hospital services as satisfactory, 62.11% were satisfied with the treatment given, but 52.48% stated that the services provided were not worth the money spent, and 40.99% replied that they would not like to visit the facility again in future. [Table 3]. DISCUSSION In our current study, patients were satisfied with the ease of availability of the required medicines while in a study done by Sivalenka (13) medicine supply was an area of concern. Most of patients were satisfied with the information provided to them about illness, its treatment and prevention. Patients were not very satisfied with the behaviour of the hospital personnel .lack of monitoring of staff, due to very high patient load, could be the reason for this. It was observed during the study that the ultimate satisfaction of the patient is their rapport with the doctor. A patient forgets the pain he faces to reach the doctor if the doctor sees him with patience and compassion. In our study, most of the patients were satisfied with the behaviour of the doctor, which was similar to the result of study by Kumar et al (14). More than half of the patients were not satisfied due to the delay in reporting time of the investigations thereby increasing their waiting time which is similar to other studies (17-18). Some of the responder cited inability to locate the departments as a constraint. Lack of proper sign boards leads to difficulty in locating the departments. A good number of patients were not satisfied with the cleanliness of the hospital. Also most of them were not satisfied with the condition of the toilets. As compared with private sector, government hospitals lack in general cleanliness and hygienic toilets, thereby leading to severe patient aversion and dissatisfaction, which needs to be improved .similar findings have been observed in some other studies (13-16) As observed in our study, Overall level of satisfaction of patients towards government tertiary care health facility is low, although patients appeared to be satisfied with the doctors, which seems to be a strong reason of their still existing faith in the tertiary care government hospital. Thus we need to improve the rest of the factors so as to keep up to the expectations of the patients ,thereby try to fulfill the basic need of patient- which is readily available ,easily accessible, and satisfactory health services for all. CONCLUSIONS Efforts should be made to reduce the patient load at the tertiary level facilities so that doctors and other staff can give more attention and time to the patients. The findings of the present study can be utilized to improve the services at public health facilities of the state resulting in the more satisfaction of patients availing such public health facilities. REFERENCES (1)Study on Patient Satisfaction in the Government Allopathic Health Facilities of Lucknow District, India, Ranjeeta Kumari et al Indian Journal of Community Medicine / Vol 34 / Issue 1 / January 2009 (2) White B. Measuring patient satisfaction: how to do it and why to bother. Family Practice management [serial online] January 1999; [9 screens]. Available from: http://www.aafp.org/ fpm/990100fm/40.html. (3) How satisfied are your patients? Family Practice Management April 1998; [2 screen]. Available from: http://www.aafp.org/ fpm/980400fm/fpstats.html (4) Measuring patient satisfaction: A Cross sectional study to improve quality of care at a tertiary care hospital. – by Andrabi Syed Arshad et.al. Healthline ISSN2229-337X Volume 3 Issue 1 January-June 2012 (5) Agrawal D. Health sector reforms: Relevance in India. Indian J Community Med 2006;31:220-2. (6) Jenkinson C, Coulter A, Bruster S, Richards N, Chandola T. Patients’ experiences and satisfaction with health care: Results of a questionnaire study of specific aspects of care. Qual Saf Health Care 2002;11:335-9. (7)McKinley RK, Roberts C. Patient satisfaction with out of hours primary medical care. Qual Health Care 2001;10:23-8. (8)World Health Organization. The World Health Report 2000-Health Systems: Improving Performance. Geneva: WHO, 2000. (9) Rao KD, Peters DH, Bandeen-Roche K. Towards patient-centered health services in India- a scale to measure patient perceptions of quality. Int J Qual Health Care 2006;18:414-21. (10) 6. Boyer L, Francois P, Doutre E, Weil G, Labarere J. Perception and use of the results of patient satisfaction surveys by care providers in a French teaching hospital. Int J Qual Health Care 2006;18:359-64. (11) Assessment of Client’s Perception in Terms of Satisfaction and Service Utilization in the Central Government Health Scheme Dispensary at Kolkata, D Haldar, AP Sarkar, S Bisoi1, P Mondal2Indian Journal of Community Medicine, Vol. 33, Issue 2, April 2008 (12) Measuring Patient Satisfaction: A Case Study to Improve Quality of Care at Public Health Facilities. Prahlad Rai Sodani. Indian Journal of Community Medicine / Vol 35 / Issue 1 / January 2010 (13) Sivalenka S. Patient satisfaction surveys in public hospitals in India. Available from: http://www.rand.org. [Last accessed on 2011 Feb 16] (14) Kumari R, Idris MZ, Bhushan V, Khanna A, Agarwal M, Singh SK. Study on patient satisfaction in the government allopathic health facilities of Lucknow district, India. Indian J Comm Med 2009;34:35à ¢Ã¢â€š ¬Ã¢â‚¬Ëœ42 (15) Peerasak L, Surasak B, Pattanawadi U. Patient satisfaction on health service at the family medicine learning centers. Chiang Mai Med Bull 2004;43:67à ¢Ã¢â€š ¬Ã¢â‚¬Ëœ76. (16) Bhattacharya A, Prema Menon P, Vipin Koushal V, Rao KL. Study of patient satisfaction hospital in a tertiary referral hospital. J Acad Hosp Adm 2003;15:29à ¢Ã¢â€š ¬Ã¢â‚¬Ëœ31 (17) Measuring patient satisfaction a case study to improve quality of care at public health facilities / Ind jcom. Med Vol 35 issi 1 jan 2010, 52-56. Prahlad Rai Sudani et.al. (18)Patient satisfaction with out of hours primary medical care. Quality in health care,2001;10:23-28 R K McKinley, C Roberts.

Heroes And Villains :: essays research papers

Is a hero a person who wears tights and a cape and goes around saving the world? And is a villain a person who schemes evil plots against the hero? Even though heroes and villains might be seen differently through the eyes of individual people, we all know that not all heroes and villains are recognized for their actions. A hero can be somebody as big as Superman or someone like your mother and a villain can be somebody like Charles Manson or a fictional character such as DR Evil from Austin Powers. There are many different types of people in the world and sometimes you are at the right place at the right time and do something good or you can make wrong decisions and do something that is very bad. The hero and villain I will discuss with you, my audience, is Michael Jordan and Jeffery Dahmer. Two very well known people. Michael Jordan is an idol to not only me but to many other people of many different ages. He was an exceptional basketball player leading the Chicago Bulls to six NBA championships and along the way; he was MVP of the league numerous times. He is the best player in my opinion to ever play the game. However, He is not only a good basketball player he is also a good businessman. He was a representative of ballpark hotdogs, Gatorade, and Nike just to name a few. He was always looking for opportunities to make money as any good businessman does. Even now, he is the co-owner of the Washington Wizards. Yet this is not why I look up to him, I look up to this man because he is a hard worker. He put many hours of work into his game everyday, working out to get better even on game days unlike almost everybody in the league. He was always trying to improve. He also was always a good showman. You will never see him in an interview or in a picture with something bad to say or with out a smile on his face. He knew many younger kids looked up to him and he made an effort not to disappoint anyone, always having a good positive mental attitude. He is just an all around exceptional person. The villain I will discuss with you is Jeffery Dahmer. He was a very sick and twisted person.

Answers Pressure Ulcer

There are two main layers which make up the anatomy of the skin, the epidermis and the dermis. When pressure is applied to the skin the blood supply is cut off and the tissue becomes damaged. 2. There are three main types of force that cause damage to the skin through pressure. These are: . Direct Pressure 2. Shear or shearing force Friction or friction force 3. 3. How long does it take for pressure ulcers to start forming? It is different for each person, some are more susceptible than others.Previously people thought that pressure ulcers started forming after two hours, but this is now known to be inaccurate. 4. What risk factors make service users more susceptible to pressure ulcers? Give 4 examples. 1 . Age 2. Being under or overweight Moisture on the skin 4. Reduced mobility 5. Circulatory problems Lack of sensation 6. 7. Previous history of pressure damage 5. What areas on the body are common sites for pressure ulcer development? Give 5 examples. 1. Scalp 2. Shoulder blades 3. Elbows 4. Sacrum 5. Heels 6. Ears 7. Hips 8. An keels Answers (6-10) 6.Describe the method you would use to check skin for pressure damage. First look at all the areas which are common sites for pressure ulcer development for redness. If you find redness on the skin, feel the area with your hands to check for heat and press the area with your fingers to check for damage of the blood vessels. 7. How would you tell the difference between simple reddening of the skin and actual pressure damage? When you press the reddened areas, healthy skin will go white under your fingers and then return to its normal color, but damaged skin will stay red, which shows that the blood vessels are damaged. . In some cases people have had to have amputations and even died as a consequence of their pressure ulcer. True or false? True 9. What can you do to help prevent pressure ulcer development in service users? Give 3 examples.

Pronoun Exercise Recasting a Paragraph With Pronouns

This exercise will give you practice in using the different forms of personal pronouns, possessive pronouns, and possessive determiners. Instructions Rewrite the following paragraph, substituting an appropriate pronoun for each italicized word or group of words. For example, the first sentence might be rewritten in this way: The fortune teller moved her dry, shriveled hands over the glass ball that she had bought at a dollar store a long time ago. When youre done, compare the sentences in your new paragraph with those in the revised paragraph on page two. The Fortune Teller The fortune teller moved the fortune tellers dry, shriveled hands over the glass ball that the fortune teller had bought at a dollar store a long time ago. The fortune teller could hear the laughter and the occasional shouts of the children as the children ran outside from ride to ride and from tent to tent. The children never came in to see the fortune teller. Instead it was always the face of a laid-off dock worker or a romantic teenager that peered through the entrance way of the fortune tellers tent. The unemployed dock workers wanted to hear about winning lottery tickets and new job opportunities. The teenagers were eager to hear stories about far away places and dark, mysterious strangers. And so the fortune teller always told the dock workers and the teenagers what the dock workers and the teenagers wanted to hear. The fortune teller liked giving the dock workers and the teenagers something to dream about. The fortune teller tried to fill the minds of the dock workers and the teenagers with great expectations. Just then, a young man appeared in the entrance way. The young man was nervous, and the smile of the young man was timid. The young man shuffled into the dark tent, the young mans head full of dreams and yet, at the same time, innocently empty. The fortune teller took the trembling hands of the young man into the fortune tellers own hands, and peered at the revealing lines etched on the palms of the young man. Then, slowly, in the cracked, ancient voice of the fortune teller, the fortune teller began to speak of new job opportunities, far away places, and dark, mysterious strangers. When you have completed this  exercise, compare the sentences in your new paragraph with those in the revised paragraph below. The fortune teller moved  her  dry, shriveled hands over the glass ball that  she  had bought at a dollar store a long time ago.  She  could hear the laughter and the occasional shouts of the children as  they  ran outside from ride to ride and from tent to tent.  They  never came in to see  her. Instead it was always the face of a laid-off dock worker or a romantic teenager that peered through the entrance way of  her  tent. The unemployed dock workers wanted to hear about winning lottery tickets and new job opportunities. The teenagers were eager to hear stories about far away places and dark, mysterious strangers. And so the fortune teller always told  them  what  they  wanted to hear.  She  liked giving  them  something to dream about.  She  tried to fill  their  minds with great expectations. Just then, a young man appeared in the entrance way.  He  was nervous, and  his  smile was timid.  He  shuffled into the dark t ent,  his  head full of dreams and yet, at the same time, innocently empty. The fortune teller took  his  trembling hands into  her  own hands and peered at the revealing lines etched on  his  palms. Then, slowly, in  her  cracked, ancient voice,  she  began to speak of new job opportunities, far away places, and dark, mysterious strangers. Next For additional practice in using pronouns effectively, see the following Editing Exercise: Correcting Errors in Pronoun ReferenceSentence Completion Exercise: Personal Pronouns and Possessive DeterminersUsing the Different Forms of Pronouns