Factors Influencing Patient Satisfaction in a Free Health Care System in The National Referral Hospital (NRH), Thimphu, Bhutan

Abstract

Apparent rise in patient dissatisfaction at The National Referral Hospital at Thimphu, Bhutan, warranted a study to find out levels and factors for dissatisfaction. A cross sectional hospital-based study was conducted involving 180 inpatients from all wards and cabins in January-February 2004. An interviewer administered questionnaire survey on patients, 5 key informants were interviewed and a short questionnaire survey of physicians were conducted. Mostly young, both genders reresented equally, 61.1% of study population was illiterate. 66.1% was poor with a monthly income below Ngultrum 5000 (agout US$ 110), 35% were farmers and though a referral hospital, 56% patients were self-admitted patients mainly for acute conditions (58.3%). Overall, there were 91.7% satisfied and 8.3% dissatisfied patients. Among wards, the cabin had the highest overall satisfaction at 66.7%, followed by EENT, surgical and maternity at 64.7%, 62.1% and 60.0% respectively. Wardwise differences were statistically significant (p=0.029). Age, ethnicity and duration of hospital stay had statistically significant association with accessibility (p=0.003, 0.041 and 0.014 respectively); referral status and admission history with comfort in ward (p=0.026 and 0.021 respectively).Gender, referral status and admission history had significant associations with waiting time (p=0.047, 0.009 and 0.007 respectively). Nurses' competence and ethnicity had significant associations with disease status and doctor patient relationship (p=0.046 and 0.045 respectively). Provider-related domains were more important for patient satisfaction than were hospital milieu-related domains (p<0.001). Free health care, kind and helpful staff, their competencies, good nursing and mursing and medical care, reputation of this apex hospital were some of the main factors for satisfaction. Visitor restrictions, long waiting time, inadequate communication between physicians and patients were some of the factors highlighted for dissatisfaction. Lack of adequate staff was identified as one of the main bottlenecks for the NRH in not being able to meet patients' expectations. Lack of staff also impeded physicians from practicing "Sservice with a Humane Face". Encouraging a good doctor-patient relationship, reviewing visitor restriction rules and hospital diet, and provision of a decent resting place for patient attendants/companions at night were some of the main recommendations worth considering.