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Health System Performance Assessment


 

APVVP - Patient Satisfaction Survey

 
 
Introduction
PSS December 2001
 
Objective
PSS June 2001
  Indices
PSS December 2000
  Satisfaction level
PSS June 2000
 
PSS June 1999

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Introduction to the survey

The patient satisfaction survey is the first of its kind for public hospitals in India. Measurement of patients satisfaction with services provided by the concerned hospital is important from two angles. Firstly, patients constitute the hospital's direct clientele. Thus overall satisfaction of the patient is an important aspect of the service itself, apart from other dimensions like technical quality of medical care, effectiveness clinical care etc. Secondly, patient's satisfaction provides an indirect measure of the other dimensions as well. The study obtains feedback from patients and, in case the patient could not be interviewed, the attendant. For the survey a modified version of the Patient Satisfaction Questionnaire-III originally developed by Ware and others (Hays, Davies and Ware, 1987) is used. In each hospital, patients are identified through stratified random sampling. Stratification is on the basis of sex and wards.

Objectives of the survey

  • To estimate the indices of patient satisfaction with APVVP hospitals;
  • Identify and report on the perceived strengths and weaknesses of the health care services provided to patients in Andhra Pradesh Vaidhya Vidhan Parishad Hospitals;
  • Provide Hospitals the information about their quality improvement initiatives with respect to services provided to the patients.
  • Present data to allow hospitals to measure their performance in the sphere of providing care to patients as compared to similar hospitals.
  • To build up evidence and information about the functioning of the hospitals and satisfaction level of the people with regard to " Care, Courtesy and Comfort of the patients".
  • To help the Andhra Pradesh Vaidya Vidhana Parishad management to take appropriate allocative and managerial decisions for utilization of public hospitals by people who need them most and to improve the quality of their services.
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Indices The Key indices in the questionnaire, used in this study are grouped into the following seven sub scales, as in case of PSQ-III

  1. Access - Availability - Convenience
  2. Communication
  3. Financial Aspects
  4. General Satisfaction
  5. Interpersonal Aspects
  6. Technical Quality
  7. Time spent With Doctor

Level of Patient Satisfaction in APVVP hospitals from 1999 June to 2001 December

Level of Satisfaction is computed by dividing the composite score of patient satisfaction over the maximum possible score. Level of satisfaction can range from 20% to 100%. Thus mid rating is of 60%.
A graph of composite scores (satisfaction level) of all the five patient satisfaction surveys. Clearly the level of overall patient satisfaction with APVVP hospitals has remained stagnant at about 70% over the past two and half years. Except for PSS2000Dec there is little growth in the satisfaction scores. The overall satisfaction level in PSS1999 was 70 percent which rose to 71 percent in PSS2000Jun. In PSS2000Dec the satisfaction level came down to 68 percent to again rise to 71 percent in PSS2001Jun and then remained constant in PSS2001dec. This is worrisome. One plausible interpretation is that the APVVP authorities may have not used the patient satisfaction surveys results to review the performance, analyse gaps and take remedial action.

                                                                                                                          TOPFindings from PSS December 2001
This is the fifth survey of patient satisfaction (PSS) in APVVP hospitals. Starting with the first survey in 1999 (Institute of Health Systems, 1999). A patient satisfaction survey (PSS Dec 2001) was conducted in 30 District, Area and Community Hospitals managed by the Andhra Pradesh Vaidya Vidhana Parishad (APVVP). The study refers to the period December 2001 to January 2002. A total of 1382 inpatients were interviewed, consisting of 30 - 50 inpatients per hospital. Most patients had already stayed for more than four days in the hospital and were included from all areas of hospital service such as Surgical, Medical, Maternity wards etc. Female and male patients of different ages are represented in the sample.

The level of patient satisfaction achieved by the APVVP hospitals in the fifth survey is 71%.

    Sub Scale wise scores were as follows:

Sub Scale / Aspect of Service Satisfaction Level
Access availability & Con. 71%
Communication 75%
Financial aspects 66%
General Satisfaction 72%
Interpersonal aspects 70%
Technical quality 72%
Time spent with doctor 73%
The overall level of satisfaction with services stood at 71%. There is no change in the overall satisfaction level when compared to the previous Surveys. Sub scale wise scores show low level of satisfaction about the financial aspects of care and interpersonal aspects. The highest level of satisfaction is 75% obtained by the communication sub scale.
Level of satisfaction in different areas of hospital service, for each hospital.

Hospital 

    PSS 2001 December

Aac Com Fin GS IPA TQ Twd All
DH Tandur   81 85 62 83 75 70 88 77
AH Vanasthalipuram  77 78 77 80 72 74 81 76
CHC Ghatkesar  78 79 74 79 71 72 83 76
AH Mancherial  74 77 71 78 73 81 64 75
CHC Huzurnagar  73 79 76 78 70 73 79 75
CHC Thiruvur 73 78 74 80 73 77 67 75
DH Ongole 74 78 65 81 70 77 81 75
AH Miryalaguda 74 78 72 78 70 75 78 74
AH Narsipatnam 76 69 66 79 68 75 79 74
CHC Avanigadda 69 78 72 81 70 77 81 74
DH Nizamabad 75 72 77 67 75 76 71 74
AH Khottagudem 73 78 68 75 68 76 78 73
AH Pulivendula 68 77 72 78 69 78 77 73
CHC Araku 73 78 67 77 68 74 79 73
CHC Palacole 78 81 61 81 73 59 81 73
CHC A.Jogipet 73 78 72 72 70 69 79 72
CHC Narsampet 71 73 66 76 70 72 76 72
CHC Dharmavaram 72 73 69 72 64 76 72 71
CHC Nirmal 72 70 60 70 75 74 72 71
AH Jangaon 71 71 62 74 69 71 72 70
DH Sangareddy 71 79 58 70 69 71 81 70
CHC Nandigama 75 76 58 60 69 78 64 69
CHC Rayachoti 71 81 63 56 66 79 76 69
AH Madanapally 69 72 62 65 71 67 58 67
CHC Kalwakurthi 59 73 62 67 70 70 71 67
DH Mahaboobnagar 72 69 58 65 66 76 55 67
CHC Chintalapudi 68 74 53 65 75 59 69 66
CHC Banaganepalli 59 65 66 60 68 60 56 63
AH Gadwal 62 62 61 61 63 64 59 62       

AH Bhainsa         

56 64 68 49 67 65 60 61
AAC=Access, Availability and Convenience; Com=Communication; GS=General Satisfaction; IPA=Interpersonal Aspects; TQ=Technical Quality; TWD=Time Spent with Doctor    
Among the 30 hospitals included in the study the highest level of composite satisfaction is 77% achieved by District Hospital Tandur. This hospital was independently visited by our staff twice i.e. in Mar 2001 and Feb 2002. In Mar 2001 it was observed that the new hospital was under construction, so it was functioning with an outpatient block only. There were no benches for patients to rest and patients expressed their dissatisfaction towards the hospital services. In Feb 2002 i.e. about a month after the patient satisfaction survey our independent field visit report, confirmed that the hospital's new building had started functioning. Even though it was not fully equipped, patients felt that the services in the hospital are better than before.

Other hospitals which came out with distinctly higher levels of patient satisfaction include the Area hospital (AH) Vanasthalipuram and Community Health Center (CHC) Ghatkesar (76%), followed by AH Mancherial, CHC Huzurnagar, CHC Thiruvur and DH Ongole(75%).

                                                                                                                       TOPFindings from PSS June 2001 :

Patient Satisfaction Survey June 2001 was conducted in 30 District, Area and Community Hospitals managed by the Andhra Pradesh Vaidya Vidhana Parishad (APVVP). The study refers to the period July 2001 to August 2001. A total of 1422 inpatients were interviewed, consisting of 40 - 50 inpatients per hospital. Most patients had already stayed for more than four days in the hospital and were included from all areas of hospital service such as, surgical, medical and maternity wards etc. Female and male patients of different ages are represented in the sample. Most of the patients are from low socioeconomic background (72%), 64% are illiterate, 42% are daily wage laborers.

The level of patient satisfaction achieved by the APVVP hospitals in the fourth survey is 71%.

Sub Scale wise scores were as follows:

Sub Scale / Aspect of Service

Satisfaction Level

Communication

76%

Interpersonal aspects

74%

Access availability & Con.

73%

General satisfaction

72%

Technical quality

66%

Financial aspects

63%

Time spent with doctor

60%

The overall level of satisfaction with services stood at 71%. We see an increase in the overall satisfaction from 67% at the time of previous survey to 71% in the present one. Sub scale wise scores show low level of satisfaction about the time spent with doctor and financial aspects of care. The highest level of satisfaction is 76% obtained by the communication sub-scale. There has been substantial improvement in the level of communication with patients compared to previous surveys. It was 72% during the last two surveys and improved to 76% during this survey. There is marginal reduction in patient satisfaction about technical quality which had scored highest in the previous survey.
Hospitals which came out with distinctly higher levels of patient satisfaction include the Area hospital (AH) Tekkali (78%), Community hospital (CHC) Baruva (76%), AH Gudur and CHC Gooty (76% & 75% respectively) followed by CHC Sompeta, District hospital (DH) Ongole, CHC Satyaveedu and DH Mahaboobnagar (74% each). Area Hospital Tekkali stood first for the second time. In the previous survey AH Tekkali scored 70% where as this time it had improved 8 more points. We also find that there had been a slight improvement in all other hospitals in their satisfaction levels compared to previous surveys. This might be due to a gradual improvement among the hospitals of APVVP.

CHC Devarakonda recorded the lowest level of satisfaction (57%), AH Pulivendula (60%) followed by CHC Narsampet and CHC Yellareddy (65% each). This is because of poor interpersonal relationship between the patients and staff and inadequate supply of drugs. These problems were frequently reported by the respondents in concerned hospitals. In AH Pulivendula almost 32% of the respondents had commented on corrupt practices in the hospital.

The comparison with the previous survey (PSS00Dec) showed that the overall satisfaction increased marginally. The general satisfaction levels for APVVP hospitals has improved in all most all sub scale level except Technical quality (reduced from 74% to 66%).
 
Though the composite scores of patient satisfaction level is at 71%, it is also seen that 36% of the respondents made adverse comments. About 687 (48%) of the respondents offered specific comments. Nearly 8% of the respondents positively appreciated services provided by the hospital. Note that the number of patients giving positive remarks increased from 2% in the previous survey to 8% in the current one. Altogether 508 (36%) respondents had some adverse remarks in their statement.

Top concerns and adverse remarks : PSS June 2001

Parsed Adverse Remarks

Percentage

General facilities (Gen.)

17%

Medication and Supply of drugs (Drug)

16%

Dietary Services (Food)

14%

Toilet and cleanliness (Toil)

9%

Shortage of Staff (Staff)

9%

Interpersonal aspects (IPA)

7%

Water supply (Utilities)

7%

Miscellaneous (Miscns.)

7%

Corruption by hospital staff (Corp.)

5%

Linen and laundry (Lin)

4%

Diagnostic services (Dgf)

4%

Utilities

1%

Major areas of patient concern, at the time of this survey, were general facilities, supply of drugs, food supply, toilet and cleanliness, staff shortage, water supply, interpersonal aspects, etc. Functioning of general facilities like fans, bulbs, generator, ambulance, etc. appears to have deteriorated. Drug supply position continues to be severe. Problems about supply of food were also expressed by the patients. Shortage of staff, poor maintenance of toilets, lack of respect for feelings of the patients, were also expressed. Drug supply and shortage of staff were also among the top concerns at the time of the previous surveys. For some areas frequency of adverse comments have increased. These are, general facilities (up from 8% to 17%) and supply of food (up from 6% to 14%), where as in supply of drugs it has reduced (down from 26% to 16%). The reduction could have been due to real improvements in this aspect of service or a result of greater dissatisfaction with other aspects of service adversely commented in this survey.
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Findings from PSS 2000 December :

This is the third patient satisfaction survey conducted in APVVP hospitals. The patient satisfaction survey (PSS 2000 December) was conducted in 25 District and Area Hospitals managed by the Andhra Pradesh Vaidya Vidhana Parishad (APVVP). The study refers to the period December 2000 to January 2001. A total of 1075 inpatients were interviewed, consisting of 30- 50 inpatients per hospital. Most patients had already stayed for more than four days in the hospital and were included from all areas of hospital service such as, surgical, medical and maternity wards etc. Female and male patients of different ages are represented in the sample.

The level of patient satisfaction achieved by the APVVP hospitals in the third survey is 67%.

 Sub Scale wise scores were as follows

Sub Scale / Aspect of Service

Satisfaction Level

Technical quality

74%

Communication

72%

General satisfaction

70%

Interpersonal aspects

70%

Access availability & conv.

69%

Financial aspects

57%

Time spent with doctor

50%

There is a marginal decrease in the overall level of satisfaction from 69% at the time of previous survey (PSS 2000 June) to 67% in the present one. The general satisfaction levels for APVVP hospitals has improved, but, in the other sub scales the satisfaction level either remained unchanged or reduced. In case of time spent with doctor, the satisfaction decreased to a very low 50% and level of satisfaction in respect of financial aspects of care reduced from 63% to 57%.
Hospitals which came out with distinctly higher levels of patient satisfaction include the Area hospital (AH) Tekkali (70%), District hospital (DH) Eluru, DH KingKoti and DH Jangaon (69% each) followed by DH Rajahmundry, AH Kuppam and DH Nellore (68%). The Area Hospital Tekkali and DH Eluru are rated as the best managed hospitals in APVVP in the current survey. District Hospital Adilabad, judged the best hospital during the last survey, slipped to 10th position in the current survey. Likewise, AH Madanapally that stood second in PSS 2000 June moved to a low 18th position.
DH Nalgonda recorded the lowest level of satisfaction (60%) and slipped thirteen places as compared to PSS 2000 June. A shift of more than 5% in the level of satisfaction was evident in the District Hospitals at Nalgonda, Vizianagaram, Chittoor and AH Madanapally. Corresponding to this shift they recorded a very low level of satisfaction as compared to the previous surveys of patient satisfaction.
Patient's Adverse remarks and Concerns
About 452 (42%) of the respondents offered specific comments. Less than 2% of the respondents positively appreciated services provided by the hospital. Note that the number of patients giving positive remarks reduced from 6% in the previous survey to only 2% in the current one. Altogether 430 (40%) respondents had some adverse remarks in their statement.

Top concerns and adverse remarks : PSS December 2000

Parsed Adverse Remarks

Percentage

Linen and laundry (Lin)

26%

Shortage of Staff (Staff)

10%

Corruption by hospital staff (Corp.)  

10%

Medication and Supply of drugs (Drug) 9%

Interpersonal aspects (IPA)

8%

General facilities (Gen.)

8%
Diagnostic services (Dgf) 5%
Dietary Services (Food) 6%
Toilet and cleanliness (Toil) 6%
Miscellaneous (Miscns.) 6%
Water supply (Utilities) 4%
Utilities 3%
 
Evidently major areas of patient concern, at the time of this survey, were supply of drugs, linen, shortage of staff, corruption, general facilities etc. Drug supply position appears to be deteriorating. Corruption was reported to be prevalent at all levels of the hospital staff including doctors, nurses and other supporting staff. The availability and cleanliness of linen is also a major concern expressed by the patients. Lack of utilities like water supply, fans, lights etc., poor maintenance of toilets, lack of respect for feelings of the patients, were also expressed. Corruption, linen, drug supply and water were also among the top concerns at the time of the previous surveys. For some areas the frequency of adverse comments have reduced. These are, toilet and cleanliness (down from 9% to 6%), electrical accessories (down from 10% to 3%). The reduction could have been due to real improvements in these aspects of service or a result of greater dissatisfaction with other aspects of service adversely commented in this survey.
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Findings from PSS 2000 June : Survey Overview

This is the second survey of patient satisfaction (PSS) in APVVP hospitals. The patient satisfaction survey (PSSJune,2000) was conducted in 32 District and Area Hospitals managed by the Andhra Pradesh Vaidya Vidhana Parishad (APVVP). The study refers to the period June 2000 to August 2000. A total of 1466 inpatients were interviewed, consisting of 30- 50 inpatients per hospital. Most patients had already stayed for more than two days in the hospital and were included from all areas of hospital service such as, surgical, medical and maternity wards etc. Female and male patients of different ages are equitably represented in the sample. Majority of the patients surveyed are illiterate and from low socioeconomic class.

The level of patient satisfaction achieved by the APVVP hospitals in the second round of survey is 69%.

Sub Scale wise scores were as follows:

Sub Scale / Aspect of Service

Satisfaction Level

Access availability & Con.

73%

Communication

72%

Financial aspects

63%

General satisfaction

73%

Interpersonal aspects

70%

Technical quality

63%

Time spent with doctor

60%

There is a marginal increase in the overall level of satisfaction from 65% at the time of previous survey (PSS June 1999) to 69% in the present one. Sub scale wise scores show low level of satisfaction about the time spent with doctor and technical quality of care as perceived by the respondents. There was no change in level of satisfaction for these two sub scales from the last years survey (PSS June 1999). The highest level of satisfaction is 73% obtained by the general satisfaction sub-scale. There has been substantial improvement in the level of general satisfaction by patients compared to last year. It was 45% during the PSS June 1999 and improved to 73% during this survey. There is marginal reduction in patient satisfaction about financial aspects and communication.

Hospitals which came out with distinctly higher levels of patient satisfaction include the District hospital (DH) Adilabad (74%), Area hospital (AH) Madanapalli (73%), followed by AH Hindupur (72%).

The DH Adilabad and AH Madanapalli are rated as the best managed hospitals in APVVP in the current survey. District Hospital Adilabad, judged the best hospital during this survey, showed an improvement from the previous survey in all areas except in 'time spent with doctor', which remained constant. District Hospital King Koti which was the best managed hospital last year slipped down to sixth position with the level of satisfaction at 71%.

Hospitals in Medak district do not seem to be doing well with the Area Hospital Siddipet and Area Hospital Medak being rated low with the level of satisfaction at 61%. The District Hospital Sangareddy also was not doing very well and occupied 25th position with the level of satisfaction at 66%.

The comparison of two years of survey showed that overall satisfaction improved marginally. The general satisfaction levels for APVVP hospitals has improved, but, in the other sub scales the satisfaction level either remained unchanged or did not show much change.

Patient's Adverse remarks and Concerns

About 683 (47%) of the respondents offered specific comments. About 6% of respondents positively appreciated services provided by the hospital. About 36% patients made adverse remarks, while another 2% made some mixed statements. Altogether 556 (38%) respondents had some adverse remarks in their statement.

Top concerns and adverse remarks : PSS June 2000

Parsed Adverse Remarks

Percentage

Linen and laundry (Lin)

17%

Corruption by hospital staff (Corp.)

15%

Dietary Services (Food)

13%

Medication and Supply of drugs (Drug)

10%

Diagnostic services (Dgf)

10%

Toilet and cleanliness (Toil)

9%

Water supply (Utilities)

9%

Interpersonal aspects (IPA)

5%

General facilities (Gen.)

5%

Miscellaneous (Misc.)

5%

Shortage of Staff (Staff)

1%

Utilities

1%

Major areas of patient concern, at the time of this survey, were linen, corruption, food supply, functioning of electrical accessories like fans, lights etc., water, supply of drugs and toilet maintenance. Corruption was reported to be prevalent at all levels of the hospital staff including doctors, nurses and other supporting staff. About food, the primary complaint was against the quality of milk. Lack of utilities like water supply, fans, lights etc., poor maintenance of toilet, lack of respect for feelings of the patients, was also expressed. Corruption, and utilities were also among the top concerns at the time of the previous year survey (PSSJun1999). For some areas the frequency of adverse comments have reduced. These are, toilet and cleanliness (down from 17% to 9%), communication and interpersonal skills (down from 12% to 5%). The reduction could have been due to real improvements in these aspects of service or a result of greater dissatisfaction with other aspects of service adversely commented in this survey.
                                                                                                                       TOPFindings from PSS June 1999 - Survey an Overview
A patient satisfaction survey (PSS June 1999) was conducted in 25 District or Area Hospitals managed by the Andhra Pradesh Vaidya Vidhana Parishad (APVVP). The study refers to the period May 1999 to July 1999. A total of 1179 inpatients were interviewed, including attendants of 237 patients, at a rate of about 40-50 patients per hospital. Most patients had already stayed for more than three days in the hospital and were drawn from all areas of hospital service such as surgical, medical and maternity wards etc. Female and male patients of different ages are equitably represented in the sample. Majority of patients were poor and illiterate.

Overall patient satisfaction level in APVVP hospitals was about 65%.

Sub Scale wise scores were as follows

Sub Scale / Aspect of Service

Satisfaction Level

Access availability & Con.

73%

Communication

76%

Financial aspects

67%

General satisfaction

45%

Interpersonal aspects

72%

Technical quality

63%

Time spent with doctor

60%

Hospitals which came out with distinctly higher levels of patient satisfaction include the district hospitals at Kingkoti Hyderabad (composite satisfaction 69%), Rajahmundry (composite satisfaction 69%), Srikakulam (composite satisfaction 68%) and Area hospitals at Chirala (composite satisfaction 67%), Hindupur (composite satisfaction 67%). The area hospital at Gudivada happened to be the worst managed one with the lowest level of patient satisfaction (composite satisfaction 55%). The District Hospitals at Karimnagar, Khammam and Eluru all appear to be poorly managed. The level of patient satisfaction was only 61% of what could be achieved.

Patient's Adverse remarks and Concerns

When respondents were requested to give their suggestions through the open ended Question, Altogether 432 (37%) of the 1179 respondents made special remarks. About 92% of the respondents offered adverse comments. This gives a clear indication of the very high proportion of dissatisfied and frustrated clientele.

Top concerns and adverse remarks : PSS June 1999

Parsed Adverse Remarks Percentage
Corruption by hospital staff (Corp.) 20%
Water supply (Utilities) 17%
Toilet and cleanliness (Toil) 17%
Interpersonal aspects (IPA) 12%
Medication and Supply of drugs (Drug) 9%
Dietary Services (Food) 8%
Linen and laundry (Lin) 5%
Shortage of Staff (Staff) 2%
Diagnostic services (Dgf) 2%
Miscellaneous (Miscns.) 8%
Corruption by all levels of hospital staff including doctors, nurses, and other supporting staff, lack of utilities, poor maintenance of toilets and very poor general cleanliness, very poor communication, interpersonal skills and lack of respect for feelings of the patient were evidently top concerns in the minds of patients.

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Updated on 13/05/2002 by Srinivasan Kallam & Sreenivasulu

  

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