INTRODUCTION

The quality of health care service is the extent of the clients’ perception of the service and how it exceeds their expectations.¹ Quality in healthcare service also refers to services that meet excellent standards and satisfies the needs of both clients and healthcare practitioners in a way that adds significant meaning to both parties.² Client’s satisfaction with quality of health care delivery is the degree to which the clients’ desired expectations, goals or preferences are met by the health care provider.³ Satisfaction and dissatisfaction of the client indicates the strengths and weaknesses of the health care service.⁴ The World Health Organization has identified six dimensions of health care quality as; effective, efficient, accessible, acceptable/patient-centred, equitable and safe.⁵

A study carried out at a hospital in India to evaluate patient satisfaction was done using primary data that was randomly sampled from 50 patients. Semi-structured questionnaire adapted from literature related to patient satisfaction from health care services was used, the questionnaire consisted of 5 points from the lowest to the highest scores indicating the level of satisfaction of patients responses ranging from 5=poor, 4=fair, 3=good, 2=very good, 1=excellent, those who chose 5 or 4 i.e. poor or fair were considered dissatisfied while those choosing either 3, 2 or 1 were considered satisfied with the services and quality of health care delivery. Patients were also asked for any specific inputs or complaints regarding their encounters in the Hospital and the survey had the following results; the overall rating for doctor-patient relationship had a 68% satisfaction, 70% were satisfied with basic facilities, 40% were satisfied with information and support services while 30% was dissatisfied with the general organisation of the facility. Overall, the rate of satisfaction of the health care delivery system was 64%.⁶ In conclusion, it was agreed that assessing the satisfaction of clients is a simple and cost-effective way to evaluate the quality of health care delivery.

The study aimed at identifying the perception of clients in the health care delivery system in FMC, Yenagoa. The objectives of the study were to identify positive/negative perception by clients in FMC, Yenagoa; to identify those basic infrastructures including personnel that can/cannot deliver quality health care in FMC, Yenagoa; to proffer solutions to the basic needs of clients in improving the health care delivery system in FMC, Yenagoa.

MATERIALS AND METHODS

The research was a primary research study, a cross-sectional survey using quantitative data collated over a period of 3 weeks. The simple random sampling method was used to ascertain the sample size of 300 persons to represent the general population of patients in FMC, Yenagoa.

A modified SERVQUAL questionnaire was adapted for the study. The SERVQUAL model will help the hospital to improve upon the gap identified in performing its services and consequently satisfy the patients. The SERVQUAL framework utilises six criteria in assessing service quality specifically; Reliability, responsiveness, assurance, tangibility, empathy and responsiveness. Reliability refers to the ability to perform promised service dependably and accurately. Assurance or security is the knowledge and courtesy of employees and their ability to inspire trust and confidence. Tangibility refers to the physical facilities, equipment and appearance of personnel. Empathy is caring, individualised attention provided to consumers. Responsiveness refers to the willingness to help consumers and provide prompt service. The questionnaire has six parts. Part 1 documented the socio-demographic characteristic of participants, Part 2 documented aspects of the process based on responsiveness, Part 3 documented the client’s perception of assurance, Part 4 documented aspects on tangibility, Part 5 documented empathy and Part 6 documented reliability based on the SERVQUAL tool¹.

The core of participants were clients attending in-patient and out-patient clinics as well as other clinics in FMC, Yenagoa.

DATA ANALYSIS

Data was analysed using SPSS (Statistical package for Social sciences). Analysis involved a combination of descriptive and inferential statistic tests. Descriptive analysis involved running frequency and percentage tests of all key variables. Inferential analysis also involved running tests of significant association and correlation, depending on the nature of the independent and dependent variables.

 RESULTS

A total of 300 patients were recruited for this study, majority of the respondents 226 (76.4%) were female while 70 (23.6%) were male. One hundred and ninety-seven (67.2%) of the respondents were from the South-South Geo-political zone of Nigeria, 20 (6.8%) of the respondents were from the South-West, 62 (21.2%) from the South-East, 3(1%) from the North-East, 10 (3.4%) from the North-Central and 1 (0.3%) from the North-West.

Two hundred and eighty (94.9%) of the respondents were Christians, 8 (2.7%) were Muslims, 3 (1.0%) were traditionalist, while other religions accounted for 4 (1.4%) of the respondents. One hundred and thirty-five (46.4%) had tertiary level of education, 111 (38.1%) had secondary level of education, 40 (13.7%) had Primary education while 5 (1.7%) had no education. Among the respondents interviewed, 154 (53.5%) were unemployed, 132 (45.8%) were employed. One hundred and forty-one (62.7%) earned between 0 – 49,000, 49 (21.8%) earned between 50,000 – 99,000, 27(12.0%) earned between 100,000 – 149,000, 2(0.9%) earned between 150,000 – 199,000, 2 (0.9%) earned between 200,000 – 249,000, 4 (1.8%) earned 250, 000 and above.

Two hundred and fifty-four (85.2%) of the patients were given prompt attention, while 43 (14.4%) stated they were not given prompt attention by the health care providers. Two hundred and sixty-two (87.3%) stated that their needs were met while the needs of 34 (11.4%) were not met. Two hundred and nineteen (74.0%) of the respondents were comfortable with the attitude of the health care providers, while 38 (12.8%) were not comfortable with the attitude that they perceived from the health care providers. Thirty-nine (13.2%) of the respondents were indifferent to the attitude of the healthcare providers. One hundred and forty-three (48.5%) of the respondents stated that they waited for a long time to see the health care providers, while 150 (50.8%) of the respondents stated that they did not wait for long.

Thirty-five 35 (12.9%) of the patients waited less than 5 minutes, 76 (27.9%) waited between 10 to 20 minutes, 54 (19.9%) waited between 21-30 minutes 60 (22.1%) waited for more than 1 hour, 47 (17.3%) waited for more than 2 hours. Two hundred and sixty (90.3%) of the respondents stated that the health care providers were courteous and friendly, 23(8.0%) stated that health care providers were not courteous and friendly, while 3 (0.3%) of the respondents were indifferent to the attitude of the Health care providers. Two hundred and thirty-three (79.3%) of the respondents stated they were treated with respect and dignity during their hospital visit. Thirteen (4.4%) said they were not treated with respect, 48 (16.3%) of the respondents were not sure how they felt about how they were treated by the health care providers. Two hundred and fifty-four (86.4%) respondents stated that the health providers they came in contact seemed knowledgeable, 4 (1.4%) said the health care providers were not knowledgeable, 36 (12.2%) of the respondents were not sure if the health care providers were knowledgeable or not. Two hundred and forty-eight (83.9%) of the respondent said their conditions were thoroughly explained to them, 18 (6.2%) said their conditions were not thoroughly explained, while 9.9 (29%) of the respondent were not sure if their conditions were thoroughly explained.

Two hundred and twenty-two (76.3%) of the respondents agreed that the clinics were clean and well kept, 30 (10.3%) said the clinics were not clean and well kept, while 39 (13.4%) were not sure if the clinics were clean or well kept. Two hundred and three (69.5%) of the respondents agreed that the environment was comfortable, 50(17.1%) of respondents said the clinics were not while 38 (13.0%) of the respondents were not sure if the clinic environment was comfortable.

Two hundred and fifty-six (88.6%) of the respondents observed confidentiality when care was rendered, 32 (11.1%) said they did not observe any form of confidentiality or privacy, while 3 (0.3%) were not sure of confidentiality when care was rendered. One hundred and sixty-six (58%) of the respondents stated that the facilities in the clinics were well maintained, 53(17.7%) said the facilities were not well maintained, while 67 (23.4%) of the respondents were not sure if the facilities in the clinics are well maintained.

Two hundred and thirty-seven (81.7%) of the respondents stated that the health care providers acted understandingly toward their needs, 19 (6.6%) stated that the health care providers were not understanding towards their needs, while 34 (11.7%) were not sure if the health care providers acted understandingly towards their needs. Out of the patients recruited for this study, 206 (70.3%) stated that the health care providers offered assistance to them, 48 (16.4%) stated that they did not offer assistance to them while 39 (13.3%) said they were not sure if the health care providers offered any form of assistance. In regards to patient interest, 195 (67.0%) of the respondents stated that health care providers gave preference to their treatment, 39 (13.4%) said the healthcare providers did not give preference to their treatments, while 66 (19.6%) were not sure if the health care providers gave preferential interest to their treatment.

Two hundred and twenty-two (76.0%) of the respondents stated that healthcare providers treated individual patient as important, 30 (10.3%) stated that they were not treated as important, while 40 (13.7%) were not sure if the healthcare providers treated them as important or not.

In this study, 236 (80.3%) of the respondents stated that required service were carried out  at their very first visit, 43 (14.6%) of the respondents stated that the required service was not rendered to them on their first visit, while 15 (5.1%) were not sure if the required services was rendered to them on their first visit. Two hundred and fifty-two (85.7%) of the respondents stated that the health care providers (doctors and nurses) are professional and competent, 7 (2.4%) stated that the health care providers were not professional and competent, while 35 (11.9%) were not sure if the doctors and nurses were professional and competent. Two hundred and twenty-six (77.9%) of the respondents stated that the other health care providers were professionals and competent, 11 (3.8%) of the respondents stated that the other health care providers were not professional and competent, while 53 (18.3%) were not sure if the other healthcare providers were professional and competent.

DISCUSSION

This study assessed the perception of clients concerning quality healthcare delivery in Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria. The assessment was carried out, using the five SERVQUAL dimensions of Reliability, Responsiveness, Assurance, Tangibles, Empathy and Reliability, otherwise known as RATER.

Responsiveness

Prompt attention has been shown to be a key dimension in surveys of client perception with health services.^{7, 8} This study showed that majority of the clients (85.2%) were given prompt attention which was similar to research done by Syed in 2012,⁸ where 88.2% of the client needs were met by the healthcare providers. Seventy-four percent of the respondents in this study were comfortable with the health care providers’ attitude.  According to Turkson in 2009,⁹ poor attitude was perceived by respondents during a Focal Group Discussion (FGD) in Rural Ghana. On the other hand, a study conducted by Ariba et al in 2007,¹⁰ in a Nigerian teaching hospital, found that 38.8% of the respondents (38.8%) were displeased with the overall quality and attitude of the health care providers.

Waiting time has being a major challenge while visiting the outpatient clinics or hospitals in general. The percentage of clients that waited less than 5 minutes was 12.9%. Majority of patients/clients in this study, 27.9% waited between 10 to 20 minutes, 19.9% waited between 21 to 30 minutes, 22.1% between 1 to less than 2 hours, 17.3% of the patients waited more than 2 hours. In comparism, this is an improvement to a research done by Babatunde et al in 2015¹¹ in a Lagos State Hospital where 1.2% of the patients waited for less than 30 minutes, while majority, 52.7% of the clients waited for more than 3 hours.

In another study carried out by Turkson in 2009,⁹ 52.2% waited for less than 1 hour, while 47.8% waited for more than 1 hour. In this case, majority of the clients, 83.4% found the waiting time reasonable.

Assurance

In respect to this study, 90.3% of the clients commended the health care providers as knowledgeable, friendly and courteous. A lower percentage 79.3% of the patients stated that they were treated with dignity and respect which is similar to a research carried out in a Lagos State Hospital by Babatunde, where 56.2% of the respondents agreed that they were treated with dignity and respect.¹¹ The respondents in a study on client perception of the quality of primary health care services in Afghanistan stated that staff were courteous and respectful during the course of health care delivery.¹²  In our study, 83.9% of the respondents stated that their conditions were explained clearly to them. This was higher than that in a similar study in Lagos where 51.7% of the respondents had their conditions explained to them in the study carried out.¹¹

Tangibility

This study showed that 76.3% of our clients felt the hospital was clean and well-kept with a comfortable environment in relation to a similar study where 56.8% of the clients felt the hospital was clean⁹ which in comparison to the work of Peter in 2008; revealed client perception of the quality of primary care services in Afghanistan, in term of cleanliness as 48.5%.¹²

Empathy

It was noted that 81.7% of the healthcare providers acted understandingly toward the needs of the patient, 70.3% of the healthcare providers offered assistance to patients while 76.0% of the healthcare providers treated individual patients as important.

Reliability

In the aspect of reliability, 85.7% of the doctors and nurses were professional and competent while 77.9% of other health care providers rendering services were professional and competent this was similar to a study done at the Lagos General Hospital,¹¹ where 61.5% of the healthcare providers were professional and competent.

The results of this study will be shared with FMC, Yenagoa community, other Government hospitals, and will be circulated globally to assist in the improvement of policies that will ensure delivery of quality health care.

Information obtained from the study could be used to design interventions that will be aimed at improving the overall quality of health care delivery in FMC, Yenagoa.

CONCLUSION

Assessing satisfaction of patients is a simple and cost-effective way for evaluation of health delivery services in clinics and hospitals.

ACKNOWLEDGEMENT

The authors appreciate the patients that participated in this research, and all the staff of the hospital that played roles in making this research possible.

 SOURCE OF FUNDING

The research was funded by the authors.

 CONFLIT OF INTEREST

The authors declare that there are no conflicts of interest.

 CONSENT

Written informed consent was obtained from every patient that participated in the research.

ETHICAL APPROVAL

The research work was examined and approved by the hospital research and ethics committee.