18th SOUTH PACIFIC NURSES FORUM 31 October to 4 November 2016 Honiara Solomon Islands

1. 18th SOUTH PACIFIC NURSES FORUM 31 October to 4 November 2016 Honiara Solomon Islands Towards Nursing Excellence for Universal (Pacific) Health Primary Author: Nelson A.Bilau Nbilau@nrh.gov.sb Advisor: Prof.Yang Ming, Taipei Medical University Published: International Journal for Quality in Health Care Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

2. Patient Satisfaction with Healthcare Quality at Solomon Islands National Referral Hospital(NRH) Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

3. Background National Referral Hospital(known as No:9) is one of the largest hospital in Solomon Islands. • Both Primary and Secondary Healthcare • Three Divisions: • medical division • nursing division • supporting services division • 28 departments • 332 beds • bed occupancy 82%/month • ALOS 7-10days • Human resource we have total of 1000 + officers & we are still recruiting Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

4. Introduction Definition: Patient satisfaction is a complex and difficult concept to measure. • Satisfaction of patients is an important and desired outcome measure of the quality of care Objective • is to identify particular healthcare dimensions that determine a patient's satisfaction or dissatisfaction with regards to healthcareprovided at the NRH. Statement of the problem • frequency of attacks from the public at large concerning the satisfaction of quality health care is creating fear, stress and anxiety among health workers, undermining confidence people have on health care providers Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

5. Methodology Conceptual frame work Patient Satisfaction Medical Care Treatment by doctor Treatment by nurse(N- Care) Information Age Wards Gender Locations Participation Environment Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

6. Hypothesis • Patients are satisfied with Medical Care services in the hospital • Patients are satisfied with Treatment by the Doctors • Patients are satisfied with Treatment by the Nurse (Nursing Care) • Patients are satisfied with Information given by Nurses and Doctors • Patients are satisfied with Participation regards to their care in the wards • Patients are satisfied with Physical Environment of the Hospital Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

7. Data Analysis & Result • SPSS (Scientific Psychological Statistical Software) • Descriptive Analysis (data process & analyses variants according to types of statistical products) • T/test & One Way Anova(Comparison of group means) • Pearson Correlation( Measure between two variables-given a value either positive or negative inclusively) • Multiple Regression Analysis( to predict the value of variables that used) Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

8. T/test and one-way ANOVA for Patient Satisfaction (n=252) Variables N Mean SD T/F P Scheffe Sex 2.8 0.005 Male 100 7.84 1.64 Female 152 8.38 1.37 Age[Range] 2.14 0.096 0-19yrs 65 8.2 1.37 20-30yrs 70 8.34 1.15 31-40yrs 63 8.33 1.09 >41yrs 63 7.76 2.14 Location 0.88 0.472 Rural health clinic 58 7.91 1.74 Area health center 23 8.17 1.37 Urban clinic 34 8.09 1.49 Provincial Hospital 62 8.15 1.64 Hospital OPD 75 8.4 1.21 *P<0.05; **P<0.01; *** P<0.001 Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

9. T/test and one-way ANOVA for Patient Satisfaction (n=252) (Cont’d) Variables N Mean SD T/F P Scheffe Education 8.38 <0.001 *** 1.Junior 69 7.58 1.79 (1) <(4) 2.Senior 63 7.94 1.51 (2) <(4) 3.Tertiary 66 8.55 0.96 4.No formal education 54 8.7 1.33 Wards 7.29 <0.001 *** 1. Medical ward 30 8.77 0.898 (1) <(2) 2.Surgical ward 55 7.00 1.96 (2) <(3) 3.Gynecology 30 8.57 1.19 (2) <(4) 4.Obstetric 32 8.88 0.707 (2) <(7) 5.Pediatric 33 8.33 1.56 6.Orthopedic 44 8.21 1.21 7.Tuberculosis 28 8.33 1.07 *P<0.05; **P<0.01; ***P<0.001 Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

10. Pearson Correlation (n=252) Variables Patient Satisfaction Medical care 0.593 *** Treatment by doctor 0.569 *** Treatment by nurse -0.638 *** Information -0.629 *** Participation -0.654 *** Environment 0.639 *** *: P-value <0.05; **: P-value <0.01; ***: P-value <0.001 Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

11. Multiple Regression analysis for Patient Satisfaction (n=252) B S.E β Model1: (Constant) 1.756 0.202 0.000 Quality factors Medical Care 0.063 0.027 0.244* Treatment by Doctor 0.05 0.033 0.161* Treatment by Nurse - 0.01 0.031 - 0.020 Information -0 002 0.030 -0.009 Participation -0.008 0.034 -0.033 Environment 0.060 0.024 0.260* Sex Male __ __ __ Female 0.04 0.05 0.042 Age[Range] 0-19yrs __ __ __ 20-30yrs 0.052 0.093 0.057 31-40yrs 0.051 0.094 0.053 >41yrs -0.216 0.089 -0.227* Location Rural health clinic __ __ __ Area health center -0.103 0.093 -0.072 Urban clinic -0.077 0.086 -0.064 Provincial Hospital -0.096 0.072 -0.101 Hospital OPD -0.051 0.071 -0.057 Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

12. Multiple Regression analysis for Patient Satisfaction (Cont’d) B S.E β Model1: (Constant) 1.756 0.202 0.000 Education Junior __ __ __ Senior -0.057 0.068 -0.06 Tertiary 0.003 0.072 0.003 No formal education -0.029 0.074 -0.029 Wards Medical ward __ __ __ Surgical ward -0.043 0.096 -0.043* Gynecology 0.085 0.102 0.067 Obstetric -0.096 0.099 -0.078 Pediatric -0.126 0.139 -0.103 Orthopedic 0.064 0.094 0.059 Tuberculosis 0.098 0.101 0.075 R Square =0.537; Adjusted R Square=0.489; *: P-value <0.05; **: P-value <0.01; ***: P-value <0.001 Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

13. Result Summary • Medical Care: patients are satisfied, support research hypothesis • Treatment by the Doctor: patients are satisfied, hypothesis is accepted. • Treatment by the Nurse: patients are NOT satisfied, we reject our hypothesis. • Information: patient are NOT satisfied, our hypothesis is rejected. • Participation: patients NOT satisfied, the hypothesis is rejected. • Environment: very satisfied, which our study hypothesis is accepted. Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

14. Conclusion • Measuring patient satisfaction has become increasingly popular, but really a challenge. • The challenge is, very difficult to evaluate the patient satisfaction in such a • hospital with inadequate diagnostics devices • Half of our quality factors are controversial to the initial study hypothesis term as important and essential. • Health care managers, and administrators should consider our negative findings as a bench mark for improvement . • Patient’s satisfactions in hospital, apparently needed further consideration and concerted efforts. • to improve the quality of healthcare, nurses & Drs. should take special care to ensure the quality of their interactions with patients. Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

15. Conclusion (Cont’d) Weakness • Majority of patients are not educated • Luck of patient preference for healthcare facilities • Luck of competition in the healthcare market which undermine pt preference • Strength. • It provide the avenue and opportunity for better health care services at the hospital wards • It motivates the healthcare providers for positive change in the health care arenas • Identify areas nurses or health workers to improve on Limitation Financial constraints Time constraint hospital ward busy schedule Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

16. Recommendation • Training for nurses & doctors for effective communication (information). • Involvement (Participation) of patients are crucial aspect for patient satisfaction. • All wards should be equipped with all necessary machines for good caring procedures & all nurses should do nursing care plan • Nurse staff should pay attention on the caring units, especially, (Surgery ward). Need good post operative nursing care etc. • We recommend health care staff (nurses & doctor) take time to explain things to low educated patients or illiterate patients. • Interpersonal manner should be equal to every patients, particularly, elderly patients. • We recommend for further deeper study in application to others factors that attributed to quality health care patient satisfaction. • We also recommend that concerted efforts and working in partnership should be the art of service in the hospital wards. Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

17. Reference • Aiken LH, Clarke SP, Sloane DM, (2002). Hospital staffing, organization and quality of care: cross national findings. Nurses outlook. International Journal for Quality in Health Care. (50) pp. 187- 94.  • Alzi M.H, Neal R.D, (2003). The association between satisfactions with services provided in primary care outcomes in the Type II Diabetes Mellitus Med. (20), pp.486-490. • Cheng SH, Yang MC, Chiang TL, (2003). Patient satisfaction with and recommendation of as hospital: effects of interpersonal and technical aspects of hospital care. International Journal for Quality in Health Care, (15) pp. 345-355.  • Clarke SP [2004]. International collaborations in nursing research: the experience of the international hospital outcomes study. Applied nurses’ researches. International Journal for Quality in Health Care. (54) pp.416- 24.  • Coyle Joanne, (2010). Exploring the meaning of dissatisfaction with health care. The importance of personal identity threat. doi. 10.1111/1467-9566.t01-1-00144.  Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

18. Thank you for listening Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

19. Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

20. Result Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

21. Location & Education Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

22. Hospital Wards Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau

23. Total Patient Satisfaction(percentages) Patient Satisfaction with healthcare quality at NRH,by Nelson A.Bilau