|Year : 2016 | Volume
| Issue : 4 | Page : 1048-1054
Patient satisfaction toward patient safety measures among Elobour family health centers
Omima M Aboelfath, Hala M Elmselhy Shahein, Nagwa N Hegazy, Shreen S Mohamed Salem MBBCh
Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
|Date of Submission||16-Mar-2015|
|Date of Acceptance||26-May-2015|
|Date of Web Publication||21-Mar-2017|
Shreen S Mohamed Salem
Shebin Elkom, 32511
Source of Support: None, Conflict of Interest: None
This study aimed to assess the patients' satisfaction towards safety measures in the family health centers in Elobour city to improve the family health cente's services utilization rate.
In recent years, countries have increasingly recognized the importance of improving patient safety. Estimates show that in developed countries as many as one in 10 patients was harmed while receiving hospital care.
Patients and methods
This is a descriptive and analytical cross-sectional study conducted in three family healthcare centers in Elobour city – Alhaialawal, Alshabab, and Almostakbal – during a period of 1 month (August 2014). All the 275 participants were selected by simple random sample from all the patients who attended the clinics during the period of the study from the selected settings. The researcher used an interviewing questionnaire sheet, a modification of Ware questionnaire, in addition to the checklist of accreditation tools of Ministry of Health and Population, to measure the quality of health services in the prementioned centers.
Most interviewees (97.2%) were totally satisfied with the overall quality of service at the centers. Moreover, 76.4.9% of them were satisfied with curative and healthcare services, 90.9% of patients were satisfied with safety and infection control measures, and 78.2 and 66.5% of patients were satisfied with facility services and dealing with the patient and patient rights, respectively.
This study demonstrates that 90.9% of patients were satisfied with the safety measures provided by healthcare workers in Elobour family health centers. However, a high percent of noneducated patients need more attention from healthcare workers toward educating patients about safety culture.
Keywords: family centers, patient safety, patient satisfaction, safety measures
|How to cite this article:|
Aboelfath OM, Elmselhy Shahein HM, Hegazy NN, Mohamed Salem SS. Patient satisfaction toward patient safety measures among Elobour family health centers. Menoufia Med J 2016;29:1048-54
|How to cite this URL:|
Aboelfath OM, Elmselhy Shahein HM, Hegazy NN, Mohamed Salem SS. Patient satisfaction toward patient safety measures among Elobour family health centers. Menoufia Med J [serial online] 2016 [cited 2020 Sep 19];29:1048-54. Available from: http://www.mmj.eg.net/text.asp?2016/29/4/1048/202488
| Introduction|| |
Satisfaction refers to a state of pleasure or contentment with an action, event, or services. It also refers to the promptness of the care given to patient, including issues like waiting time before consultation, duration of consultation, duration of time spent services, especially one that was previously desired , in addition to the 'efficiency' of the physicians, quick response to emergencies, quick dispensation of drugs, and fast and accurate laboratory tests .
The most recent works of Institute of Medicine to identify the components of quality care for the 21st century were centered on the conceptual components of quality rather than the measured indicators: quality care is safe, effective, patient centered, timely, efficient, and equitable. Thus, safety is the foundation on which all other aspects of quality care are built .
Satisfied patients are more likely to comply with prescribed treatment and advice from physicians. They are also more likely to return for additional care when necessary and may be more willing to pay for services, thereby increasing revenue . Patient satisfaction has long been considered an important component when measuring health outcomes and quality of care ,. The rising strength of consumerism in society highlights the central role patients' attitudes play in health planning and delivery ,. Furthermore, a satisfied patient is more likely to develop a deeper and longer lasting relationship with their medical provider, leading to improved compliance, continuity of care, and ultimately better health outcomes .
There are some expectations of patients. For example, they want a wider range of services to be easily available, and they seek to be listened to about their demands for healthcare. However, patient care teams are ignored .
Healthcare recipients in developing and newly developed nations are particularly sensitive to perceptions of the quality of their healthcare delivery systems when compared with those in advanced economies . It was reported that patient satisfaction is influenced by communication, cost, continuity of service and providers, physical environment of clinic, humanity, information, time spent on patient, technical quality, official procedures, physicians' sex, and nursing care . Medication errors pose a threat to patient safety and have been implicated in adverse outcome for patients including death.
Institute of Medicine reported that medication errors account for one of 131 outpatient deaths and one of 854 inpatient deaths .
All prescriptions should be written in ink or typed: prescriber information, patient information, date prescription issued, Rx symbol, medication information, dispensing directions for pharmacist, directions for use, refill, prescriber signature, and other information .
Errors in prescribing are classified into three main types: errors of superscription, inscription, and subscription. Prescribing errors may have various detrimental consequences . Patient satisfaction is well recognized now because of influence of perceived quality over demand . The role of the health centers that provide health services needs to be addressed through the people's own experiences as it influences their satisfaction with the care, improves quality of services, and in turn its utilization .
| Patients and Methods|| |
A cross-sectional approach was adopted.
The study conducted in Elobour city, Kaliobia Governorate, Egypt. Elobour is a new city with a population of ˜250 000. A total of three family healthcare center clinics were involved in this study: Alhaialawal, Almostakbal, and Alshabab.
A random sample of patients attending Elobour family health centers over a 5-day period was asked to be included in the study. The study was conducted in the waiting room of the clinics. Only patients aged 18 years and older who were registered with the clinic (i.e., lived within the geographic zone the clinic served) and were themselves visiting the doctor were included. The investigators visited the clinic over a 5-day period in the morning sessions. Every 10th patient registering and seen by the doctor was invited to participate. A total of 310 participants were selected. Of them, 10 patients were excluded during the pilot study and 25 patients refused to participate; thus, the total number interviewed was 275. The response rate was 91.7%.
Tools of data collection
The data collection tools, developed by the Technical Support Office (2001)  in the Ministry of Health and Population, and a modification of patient satisfaction questionnaire originally developed by Ware et al.  were adopted and utilized in this study, it included:
The patient satisfaction questionnaire was used to measure patient satisfaction about the health services at the health centers. It includes two parts.
Part 1 included demographic data of the patients such as age, sex, occupation, marital status, number of children, and education level.
Part 2 included 28 questions about satisfaction of patient toward the utilization of safety measures by healthcare workers in these centers. In the questionnaire, each item was evaluated by assigning a score as follows: 2 for agree, 1 for disagree, and 0 for neutral. The four items measured in the questionnaire were curative and healthcare service, patient safety and infection control measures, facility services, and patient rights. Items were scored and calculated, with the patient being satisfied if the total score is 50% or more and not satisfied if the total score is less than 50%.
All participants were volunteers. An oral consent was taken from each participant in the study with an explanation of the purpose of the study to each of them. The consent form was developed according to the standard in quality improvement system in Ministry of Health and Population in Egypt, which is applied in all family centers and units. In addition, it was modified according to the international ethical guidelines for biochemical research involving human participants as prepared by the council for International Organization for Medical Science in collaboration with WHO .
A pilot study was done 1 week before the study to test the adequacy of the study tools ('questionnaire sheets' for content, language, and time consumption), availability of data, and feasibility of the research methods. The pilot study used 10 patients to check for applicability. Then, they were excluded from the total sample.
The data collected were tabulated and analyzed using statistical package for the social science software, version 11 (IBM, SPSS Statistics for Mac, Released 2011; IBM Corp., Armonk, New York, USA; SPSS Inc., Chicago, Illinois, USA)  on IBM compatible computer. Quantitative data were expressed as mean and SD. Qualitative data were expressed as number and percentage. The used level of significance was 5%.
| Results|| |
Most individuals in the studied group were female (>80%), with a mean age of 32.25 ± 10.98 years. There were high significant differences in individuals among the studied centers (P < 0.001) regarding educational level, occupation, and social level. Most studied patients were not working, except for those of Alshabab family health center, where 40% were working. In addition, most clients were married. Most participants were illiterate, except for those at Alshabab family health center, where 45.6% were highly educated. Moreover, 66.7% of patients in Alshabab had medium socioeconomic standards as shown in [Table 1].
Most patients were satisfied with all the health services provided in the family health centers: 76.4% were satisfied with curative services, 90% were satisfied with safety and infection control measures, and 78.2% were satisfied with facility services. There was a significant difference (P < 0.05) between the three centers regarding patient rights; the least satisfaction rate was in Alshabab family health center, with only 32.1% satisfied as shown in [Table 2]
|Table 2 Comparison of total patient satisfaction towards safety measures among Elobour family health centers|
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There were only 39, 51.1, and 37.6% of patients in Alhaialawal, Alshabab, Almostakbal family health centers, respectively, who agree about good recording; only 38, 36.6, and 29.4% of patients, respectively, who agree that physicians follow infection control measures like hand washing and wearing gloves in the clinic; and 79, 68.9, and 77.65% of patients, respectively, who agree that technician follow infection control measures. Moreover 70% of patients in Alhialawal, 45.6% in Alshabab, and 64.7% in Almostakbal agree that technicians explain prelaboratory preparation, with significant difference of P values less than 0.05, and 56, 34.4, and 49.4% of patients in Alhaialawal, Alshabab, Almostakbal family health centers, respectively, agree about availability of drugs in the three centers, with significant difference of P value less than 0.05, as shown in [Table 3].
|Table 3 Comparison among the studied family health centers regarding safety and infection control measure|
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There was a significance difference (P < 0.05) between patients in the studied centers regarding follow-up problems, as there were 55, 44.4, and 64.7% of patients in Alhaialawal, Alshabab, and Almostakbal family health centers, respectively, who disagree about the presence of follow-up for problems ([Table 4]).
|Table 4 Comparison between the studied family health centers regarding patient rights|
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| Discussion|| |
Patient safety refers to 'freedom from accidental injury', or 'avoiding injuries or harm to patients from care that is intended to help them'. Ensuring patient safety involves the establishment of operational systems and processes that minimize the likelihood of errors and maximizes the likelihood of intercepting them when they occur .
Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. In this definition, the term health services refer to a wide array of services that affect health, (In addition) applies to many types of healthcare practitioners (physicians, nurses, and various other health professionals) and to all settings of care .
The technical quality of care includes appropriateness of services provided and the skills with which appropriate care is performed. The ability of healthcare providers to meet expectations of patients is an important quality parameter .
In the study, 90.9% of patients were satisfied with safety and infection control measures, whereas 76.4, 78.2, and 66.5% of patients were satisfied with curative services, facility services, and patient rights, respectively, as shown in [Table 2]; this is in agreement with the findings by Momen  who reported that the indicators in reformed unit/centers are higher and applicable as the environmental safety, patient right, and infection control.
In the study, more than 80% were females with a mean age of 32.25 ± 10.98 years. Only 40% of attendants in Alshabab family health center were working.
In the study, 45.6% of the patients were highly educated, and 66.7% of patients had medium socioeconomic standard in Alshabab as shown in [Table 1]. This is in contrast to the result of Ofili and Ofovwe  in teaching hospital of Benin University, Nigeria; they observed the distribution of attendants of different outpatient clinics with different sociodemographic criteria. The mean age of the respondents was 36.2 ± 19.7 years. In addition, 40.4% of the respondents were male and 59.6% were female. Moreover, 18% patients had completed primary education only, 43% had completed secondary school, 20% had university degrees or other qualification from tertiary institutions, and 28% had no formal education.
Educational level difference affected the patient satisfaction with patient safety and infection control, as there were 90.9% who were satisfied with safety measures and infection control; 29.5% of them were from the Alshabab family health center whereas 34.5% of them were from the Alhaialawal, as shown in [Table 2]. This goes with the result of Babić-Banaszak et al.  who reported that less educated patients were generally more satisfied, as they are less demanding. It is possible that the more educated patients had higher expectations of the services, whereas the lower educated might appreciate getting any healthcare. However, Saeed et al.  reported that literate patients showed significantly higher mean satisfaction whereas students and illiterates showed the lowest satisfaction scores. Most patients were satisfied with the infection control measures in the laboratory, but they were dissatisfied with physician following infection control measures as shown in [Table 3]. Waterman et al.  surveyed 2078 patients discharged from hospitals and found that only 46% of respondents would feel very comfortable asking medical providers if they washed their hands, and only 5% reported that they had actually done so. Patients were satisfied with laboratory and pharmacy measures, as shown in [Table 3]. This is in agreement with the study findings by Ofilif and Ofovwe , in teaching hospital of Benin University, Nigeria; they observed that 73.2% of patients were satisfied with services rendered at the laboratories. An essential aspect of achieving a culture of safety is encouraging the reporting of errors and near misses. Reporting of incidents has to include both those causing harm to the patients (adverse events) and also those near misses that do not result in harm . In the study, 56, 46.7, and 53.3% of patients in Alhaialawal, Alshabab, and Almostakbal family health center, respectively, disagreed with the presence of good recording. There were high percent of disagreement among patients regarding listening to patients' problems, recording of problems, and follow-up of solutions to problems, as shown in [Table 4]. This is in agreement with Nabhan and Tawfik ; these investigators examined healthcare workers' attitudes toward patient safety regarding maternity care in Egypt. Managers, doctors, nurses, pharmacists, and technicians from 35 primary care centers were surveyed. Only 36% of participants viewed the safety climate positively. The authors concluded that the culture penalized staff for errors. There was suppressed error reporting, a lack of communication, and infrequent feedback.
| Conclusion|| |
The results of the present work showed that patients were satisfacted with the safety measures provided by healthcare workers in Elobour family health centers. However, there is a need for the presence of good recording, patient education on safety culture, and healthcare workers training on infection control measures.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hornsby AS, Crouther J. Oxford advanced learners dictionary
. Oxford, UK: Oxford University Press; 2000: 1042.
Santillan D. Uses of satisfaction data: report on improving patient care. Soc Sci Med 2000; 12
Committee on the Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century
. Washington, DC: National Academy Press; 2001.
Ofili AN, Ofovwe CE. Patients assessment of efficiency of services at teaching hospital in a developing country.
Benin, Nigeria: Annuals of African Medicine; 2005. 4
Donabedian A. Evaluating the quality medical care. Milbank Memo Fund Q 1966; 44
Ware JE Jr, Davies-Avery A, Stewart AL. The measurement and meaning of patient satisfaction. Health Med Care Serv Rev 1978; 1
Baker R. Development of a questionnaire to assess patients' satisfaction with consultations in general practice. Br J Gen Pact 1990; 40
Williams SJ, Calhan M. Key determinants of consumer satisfaction with general practice. Fame Pact 1991; 8
Larsen DE, Rootman I. Physician role performance and patient satisfaction. Sock Sic Med 1976; 10
Fitzpatrick R. Surveys of patient satisfaction. II. Designing. QRB Quall Rev Bull 1989; 15
Sitzia J, Wood N. Patient satisfaction: a review of issues and concepts a questionnaire and conducting a survey. Br Med J 1991; 302
Haddad S, Fournier P, Putin L. Measuring lay people's perceptions of the quality of primary health care services in developing countries. Validation of a 20-item scale. Into J Quall Health Care 1998; 10
Leaped LL, Berwick DM. Five years after to err is human: what have we learned? JAMA 2005; 293
Taghreed M, Mohammad M, Mohamed F, Shimla M. Prescription errors in family practice in Menoufia governorate. Menoufia Med J 2014; 27
McLean D. Outcome and cost of family physicians' Care: pilot study of three diagnoses – related groups in elderly inpatients. J Am Board Fam Pract 1993; 6
Gilson L, Alilio M, Heggenhougen K. Community satisfaction with primary health care services: an evaluation undertaken in the Morogoro region of Tanzania. Soc Sci Med 1994; 39
Ware JE, Snyder MK, Wright WR. Vole I, part B: Results Regarding Scales Constructed from the Patient Satisfaction Questionnaire and Measures of other Health Care Perceptions. 1976 (NTIS Publication No. PB 288-329). Springfield, VA: National Technical Information Service (NTIS).
The Council for International Organizations of Medical Sciences (CIOMS) and World Health Organization. In 1991 International Guidelines for Ethical Review of Epidemiological Studies; and, in 1993, International Ethical Guidelines for Biomedical Research Involving Human Subjects.
SPSS Inc. SPSS for Windows Release 11.0.0, standard edition
. Chicago, IL: SPSS Inc.; 2001.
Institute of Medicine (US) Committee on the National Quality Report on Health Care Delivery. Envisioning the National Health Care Quality Report
. Washington, DC: Institute of Medicine; 2001.
Measuring the Quality of Health Care. A statement of the National Roundtable on Healthcare Quality Division of Health Care Services
. Washington, D.C. USA: National Academy Press; 1999.
Winkel P, Zhang NF. Statistical development of quality in medicine
. Hoboken, NJ: John Wiley and Sons Inc.; 2007.
Babić Banaszak A, Kovacic L, Mastilica M, Babic S, Ivankovic D, Budak A. Croatian health survey – patient's satisfaction with medical service in primary health care in Croatia. Collegium Antropologicum 2001; 25
Saeed AA, Mohammed BA, Magzoub ME, Al-Doghaither AH. Satisfaction and correlates of patients' satisfaction with physicians' services in primary health care centers. Saudi Med J 2001; 22
Waterman AD, Gallagher TH, Garbutt J. Hospitalized patients' attitudes about and participation in error prevention. J Gen Intern Med 2006; 21
Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system.
Washington, DC: National Academy Press; 2000.
Nabhan A, Tawfik AMS. Understanding and attitudes towards patient safety concepts in obstetrics. Int J Gynaecol Obstet 2007; 98
[Table 1], [Table 2], [Table 3], [Table 4]