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Enhancing Healthcare Quality in Saudi Arabia

Introduction

The past three decades have seen an increased improvement in terms of healthcare access in the Kingdom of Saudi Arabia. With this improved access, however, came a number of challenges for the various stakeholders in the healthcare industry. These challenges have brought about the need to improve the quality of medical and healthcare services, a need that has become rather so axiomatic. In order to ensure and promote better medical services and care for their patients and meet the standards for accreditation, Saudi Arabian hospitals and other health care centres have adopted different methods over the years. With the adoption of different methods aimed at improving quality comes the need to apply the same methods at all levels and sectors of healthcare in order to achieve the required quality, effectiveness and efficiency. It therefore goes without saying that the evaluation of patient satisfaction is a very crucial element that can be used to identify areas that need to be improved on, so as to deliver high quality health services in an optimal manner. As such, having quality as a priority and placing it higher on the agenda will go a long way in improving quality not only in hospitals in Saudi Arabia, but in any hospital anywhere. To achieve this, numerous monitoring and evaluation and improvement methods will have to be engaged.

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Quality of care is increasingly and continuously being recognized as important in health care. This study will look at the quality of services in health care centres from the perspective of the patients while considering the likely differences between satisfaction and experience of the patients. When it comes to healthcare, quality can be said to be the ability to fully meet the needs of those who are in need of the medical services, within the directives and limits defined by authorities (such as government), and at the lowest possible cost to the medical organization. For this reason, patient satisfaction will be looked at as the extent to which the experiences of the patient compare with their expectations, depending on the level to which the general healthcare needs and patient-specific medical needs are met. While a range of measures are used by doctors, health care givers, policy makers and patients themselves to evaluate the quality of service rendered in hospitals, patient experience is the most commonly used, even preferred. From these experiences, the resulting satisfaction becomes one of the key mechanisms or measures health care providers use to assess the quality as well as outcome of their services. If the health care services and quality offered to the patient do not meet the standards expected by the patient, patient dissatisfaction will occur. They will however, experience patient satisfaction when their experience of the services offered provides them with sufficient information on their condition and treatment, meet their needs or exceed their expectations. Similar studies conducted in various medical and health care centres across the United kingdom, Australia, the United States of America and Europe have reported high levels of satisfaction among patients whose needs and expectations were met and/or exceeded. It is important, maybe even necessary, to evaluate the difference- between patient satisfaction and dissatisfaction- because satisfaction will most likely result in maintaining the patient thus, their loyalty; while dissatisfaction may lead to unexpected behavior by the patient in future.

Besides being important by itself, patient satisfaction has also been termed as an indicator of quality care in most developed countries as it has been found to contribute to improvement of health care strategies, as well as their services and delivery. The various components of experiences that the study will evaluate to determine the extent to which they influence patient satisfaction include: patient-doctor interactions, convenience, administrative efficiency and health care centre environment, person-focused care and other global items, for the inpatients. For the outpatients, the study will also investigate additional components such as admission, room allocated, meals, nurses and care providers and discharge alongside the aforementioned ones. The aim of this proposal therefore, is to determine how the experiences of patients will impact on their satisfaction and consequently, their perception of the quality of health care and medical services in hospitals in the Kingdom of Saudi Arabia.

Literature review

To access medical care and services in the Kingdom of Saudi Arabia, patients can go through either if the two routes: they can use public health care centre services first before being referred to secondary care centres, or they can seek services at emergency department (commonly referred to as ED) while bypassing primary health care centres and later on seeking further secondary care at outpatient clinics. Alyasin and Douglas (2014) in their study found that 65% of Saudi Arabian patients’ visits to the emergency departments were for cases that weren’t urgent. However, when asked if they had regular public health care centres that they visited for their medical needs, 63% of the patients said they didn’t have a regular public health facility whereas 44% of them said that the emergency department worked just fine for them since they provided better care than the other health facilities (Alyasin and Douglas, 2014). They further state that these statistics raise concern over the effectiveness of Saudi Arabian public health centres.

This study will look at the quality of services in health care centres from the perspective of the patients while considering the likely differences between satisfaction and experience of the patients (Alyasin and Douglas, 2014). Patient satisfaction is a reflection of the patients’ experience as they seek medical services and it is closely linked to the outcomes of treatments, while also being used as a way of measuring the quality of health care services. Several previous studies conducted all over the world have proved the usefulness of patient experience and satisfaction, as well as the benefits that they offer. Whereas experience will focus on what the patient experiences (or does not experience) while interacting with care givers (Berkowitz, 2016), patient satisfaction will evaluate the patient’s overall perceptions of their experience(s) (Batbaatar et al., 2017).

If the health care services and quality offered to the patient do not meet the standards expected by the patient, patient dissatisfaction will occur. When their experience of the services offered provide the patients with sufficient information on their condition and treatment, meet their needs or exceed their expectations there will be patient satisfaction (Senitan et al.,2018). Previous studies have shown that patients that record high satisfaction levels were more likely to have their treatment benefit them. In this way, patient satisfaction brings about the aspect of success of treatment among other benefits such as: adherence to the health care procedure and plan by patients, improved medical results, reduced medical costs and expenses as a result of lesser visits to doctors, reduced hospitalization and minimization of the frequency with which untoward medical outcomes occur. A number of recent studies have shown that patient satisfaction also leads to the patients complying with health advice and follow ups (Kumah, 2019). It is therefore expected that this study will post similar results, in the case of the Kingdom of Saudi Arabia.

Objectives

The purpose of this study will be to evaluate the overall satisfaction of patients who have received health care services in health centres in the Kingdom of Saudi Arabia. To do this, the study will focus on the experiences of the patients as they seek health care and medical services, the factors that affect the patient experience and the perception of the patients with regard to the quality of service they receive.

Factors affecting patient satisfaction

According to (Alberto et al., 2014), various factors that have been found to relate to patient satisfaction include the patient’s age, their conditions, needs, past experiences, personal backgrounds, personality and expectations.

Under patient-doctor interactions component, we can look at aspects like communication and respect during the health service, the care provider’s courtesy or friendliness, the doctor listening to the patient, the doctor explaining to the patient their condition and course of action or medication, the doctor answering the patient’s questions and concerns or worries, inclusion of the patient in decision making by the doctor, advising the patient on the avoidance of future problems, giving the patient detailed instructions for their care at home and satisfaction of the treatment, and the patient’s confidence in the doctor. All these go along to satisfy the patient’s need for information. Previous studies have shown that the more information patients get from their health providers, the more satisfied they are likely to be. Patients also rank this provision of information by their health care providers higher compared to other factors that contribute to patient satisfaction.

For the component of access and convenience, we focus on factors like: ease of getting the hospital on phone and scheduling an appointment, the convenience of the medical facility’s or office location, provision of convenient parking, office hours, information about any delays and the amount of time waited before seeing the doctor. A recent study had hypothesized that the amount of time a patient spent (whether scheduling an appointment or waiting for service) greatly contributed to overall patient satisfaction.

The quality time component will look at how long the patients waited before they saw the doctor, if the doctor spent sufficient time with the patients, and if the doctor addressed the patient’s concerns.

The person-focused care component will address factors including patient’s personal issues, facility’s and staff’s focus on patient safety, sensitivity to patient’s needs.

Under administrative efficiency and environment, factors that will come into play include; waiting time, comfort of the waiting area, availability of medication, level of service provided by the care giver, cleanliness levels of the facilities, availability of up-to-date facilities and recommendations given. The other global items will take into account the patient’s overall assessment of the care they got in the course of their treatment, how satisfied they were by the care they got from the doctors, if they will go back to the same facility or doctor and if they could recommend them to others.

Significance of the study

The findings of this study will prove valuable to managers of private health care facilities and centres as it will provide them with guidance on ways to improve the quality of their health services, and as a result, patient satisfaction as a measure or indicator of their quality (Al-Abri & Al-Balushi, 2014).

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Methodology

For the purposes of ethics, the researcher will first have to get an ethical approval from the ethical committee of the University of Hail to undertake this study. The proposal will use an analytical cross-sectional study of patients who will have given their consent and agreed to participate. The cross-sectional study is crucial in that it will enable the researcher to conduct an unbiased evaluation of the impact of quality of care and patient experiences on their satisfaction (as perceived by the patients). Because patients are the only best viable source of data leading to information on their experiences while in pursuit of quick, stress free and quality medical care, we will recruit 200 patients who had received treatment in various health care facilities in the Kingdom of Saudi Arabia to participate in this study.

The study will employ the use of conventional sampling or random sampling technique to acquire the 200 participants, 100 outpatient and 100 inpatient. A self-administered questionnaire will be the most effective and efficient tool for collecting the needed information. Two sets of questionnaires, one for outpatient and the other for inpatient, will be used. The questionnaires will be in either English or Arabic, and will take less than 15 minutes to complete. The questionnaires will be developed in a manner such that it is able to evaluate patient satisfaction on various matters such as the availability, convenience as well as accessibility of medical care and services; their perceptions of behavior of medical service providers, patient provider interactions, care providers’ competence, communication and respect, quality time, tests and treatments, personal care, privacy and safety during service, cleanliness of service areas, type of hospital or health care centre, facilities or amenities that they deemed important to them among others.

The questionnaires will also be drafted with a 3-point response scale which ranges from 1 (disagree) to 3 (agree). 2 will represent ‘uncertain’. A mixture of statements and questions, both positive and negative, was set so as to do away with the aspect of a standard way of answering. This will require that the correspondents carefully read through each item before they respond. In order to have only relevant questions, a subset of respondents could be used to pilot test the questionnaires, after which questions deemed to be irrelevant to the study are dropped.

The questionnaire will be administered privately, with the researcher close by to offer guidance. Once all duly completed and the necessary data collected, version 21.0 of the SPSS will be used to analyze the data. The data for categorical and quantitative variables will described through the use of descriptive statistics and will be presented in percentage and frequency forms. Pearson’s chi-square test will then be employed to analyze how the categorical variables’ distributions compare. To be considered significant, a variable will have to show a p-value that is 0.05 or less. Data for continuous variables will be presented as mean and standard deviation. Mean satisfaction percentages will be used as a way of estimating the general ranking of patients’ personal satisfaction ‘disciplines’ (components).

References

Al-Abri, R. and Al-Balushi, A., 2014. Patient satisfaction survey as a tool towards quality improvement. Oman medical journal, 29(1), p.3.

Alberto Sánchez, C., Javier Prado-Galbarro, F., García-Pérez, S. and Sarría Santamera, A., 2014. Factors associated with patient satisfaction with primary care in Europe: results from the EUprimecare project. Quality in primary care, 22(3).

Al-Eisa, E.S., Al-Hoqail, H., Al-Rushud, A.S., Al-Harthi, A., Al-Mass, B., Al-Harbi, B.M., Al-Azzaz, S., Alghadir, A.H. and Iqbal, Z.A., 2016. Awareness, perceptions and beliefs about physiotherapy held by physicians working in Saudi Arabia: a cross-sectional study. Journal of physical therapy science, 28(12), pp.3435-3439.

Aljuaid, M., Mannan, F., Chaudhry, Z., Rawaf, S. and Majeed, A., 2016. Quality of care in university hospitals in Saudi Arabia: a systematic review. BMJ open, 6(2), p.e008988.

Almutairi, K.M., 2015. Culture and language differences as a barrier to provision of quality care by the health workforce in Saudi Arabia. Saudi medical journal, 36(4), p.425.

Alyasin, A. and Douglas, C., 2014. Reasons for non-urgent presentations to the emergency department in Saudi Arabia. International emergency nursing, 22(4), pp.220-225.

Batbaatar, E., Dorjdagva, J., Luvsannyam, A., Savino, M.M. and Amenta, P., 2017. Determinants of patient satisfaction: a systematic review. Perspectives in public health, 137(2), pp.89-101.

Berkowitz, B., 2016. The patient experience and patient satisfaction: measurement of a complex dynamic. The Online Journal of Issues in Nursing, 21(1).

Bleustein, C., Rothschild, D.B., Valen, A., Valatis, E., Schweitzer, L. and Jones, R., 2014. Wait times, patient satisfaction scores, and the perception of care. The American journal of managed care, 20(5), pp.393-400.

Freitas, J.S.D., Silva, A.E.B.D.C., Minamisava, R., Bezerra, A.L.Q. and Sousa, M.R.G.D., 2014. Quality of nursing care and satisfaction of patients attended at a teaching hospital. Revista latino-americana de enfermagem, 22(3), pp.454-460.

Kumah, E., 2019. Patient experience and satisfaction with a healthcare system: connecting the dots. International Journal of Healthcare Management, 12(3), pp.173-179.

Ministry of Health. Patient Experience Measurement Program. 2018. Retrieved from: https://www.moh.gov.sa/en/Ministry/pxmp/Pages/default.aspx. Accessed November 14, 2018.

Ministry of Health. Statistical Book-1436 MOH. Riyadh, Kingdom of Saudi Arabia: Ministry of Health; 2016.

Pérez-Stable, E.J. and El-Toukhy, S., 2018. Communicating with diverse patients: How patient and clinician factors affect disparities. Patient education and counseling, 101(12), pp.2186-2194.

Saudi Arabia Launches Healthcare Privatisation Programme. Int Med Travel J. 2018.

Senitan, M., Alhaiti, A.H. and Gillespie, J., 2018. Patient satisfaction and experience of primary care in Saudi Arabia: a systematic review. International Journal for Quality in Health Care, 30(10), pp.751-759.

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