Patient satisfaction with the quality of outpatient care

Zurab Kikvidze

The Masters thesis submitted to the School of Business, Ilia State University, in accordance with
the requirements for the academic degree of a Master of Business Administration (Healthcare
Management)

Healthcare Policy and Management

Scientific Supervisor: Tengis Verulava, MD, PHD

Ilia State University

Tbilisi, 2015

Declaration

As an author of the present thesis, I declare that it is an original piece of work and does not
contain data from works either already published, or accepted for publication, or submitted for
defense by other authors, that are not referred to or quoted in accordance with the rules.
Zurab Kikvidze

03.03.2015

ii

Abstract

Patient satisfaction is one of the significant quality indicators attracting great attention in
developed countries. The 2009 recommendations of the World Health Organization mentioned
the quality indicator as a necessary component for the development of the quality of medical
care in our country.
The present research project was designed in order to establish how satisfied patients are
with outpatient care. The tenets of the research are based on the survey conducted protecting
the patients anonymity. The questionnaire was designed in order to identify patients views and
opinions about shortcomings and advantages of outpatient care. Study of patients opinions and
attitudes enabled us to discuss the occurring problems in outpatient care.
In the questionnaire, patient satisfaction is presented as a dependent variable. In addition,
the questionnaire reflects patients attitude to such aspects of outpatient care as registration
office, waiting, attitude of the medical staff, availability of various medical services, patients
expenses.
The results of the investigation demonstrated that pre-consultation waiting and patients
expenses are among negative aspects of satisfaction. The rest of the criteria were assessed
positively.

Key words: quality of medical care, patients satisfaction, outpatient service

iii

Acknowledgements

First of all, I thank my supervisor, Mr. Tengiz Verulava, Professor of Ilia State University, for
his interest in the theme in question and for his support in the process of my work on the thesis.
For three academic semesters, our academic cooperation conditioned my, as a masters degree
student, profound interest in healthcare management and in further research. I also owe thanks
to the Chapidze Clinic for their support in the implementation of research activities within the
framework of my masters thesis; I thank its administration as well. If not their permission and
the opportunity to survey 230 ambulatory patients, the present work would lack a rather
significant quantitative component of quality management. My sincere thanks go to my
interviewees whose responses enabled me to apply the methodology of quantitative research in
my work. I also express my gratitude of Ms. Marine Pataridze for her support in processing and
analyzing of statistical data. I believe that my experience during the process of working on my
masters thesis has been a rather effortful and best practice on my way toward my professional
growth and development as a researcher of healthcare management.

iv

Contents

Declaration

ii

Abstract

iii

Acknowledgements

iv

Contents

Tables

vi

Diagrams

viii

Introduction

Review of Scholarly Literature

Methodology

14

Results

16

Interpretation/Discussion of Results

27

Conclusion and Recommendations

31

Bibliography

33

Appendix

35

Appendix 1: General Statistics

35

Appendix 2: Patients Satisfaction Survey

37

Tables

Table 1. How would you rate satisfaction with the quality of medical care * Age

17

Table 2. How would you rate satisfaction with the quality of

medical care * Education

17

Table 3. How would you rate satisfaction with the quality of

medical care * Gender

17

Table 4. How did you learn about our clinic?

18

Table 5. Have you been to our clinic before?

18

Table 6. How did you arrange a visit?

18

Table 7. Did you have to wait owing to the staff being busy?

19

Table 8. Descriptive Statistics

21

Table 9. Is a waiting room comfortable and convenient?

22

Table 10. Do you like the building, comfort, conditions of the clinic?

22

Table 11. Are you satisfied with sanitary conditions, cleanness?

22

Table 12. Are you satisfied with your physicians attitude?

22

Table 13. Are you satisfied with your physicians professionalism?

23

Table 14. Do you trust your physician?

23

Table 15. Did your physician explained details of your disease in

an understandable way for you?

23

Table 16. Are you satisfied with nurses attitude?

23

Table 17. Have there been any facts of rude attitude to you on the
part of the medical staff of the clinic?

24

Table 18. In your opinion, does your physician always spend enough
time during a visit and does /she make you hurry?
vi

24

Table 19. How long did you stay at the consultation?

24

Table 20. In your opinion, are the procedures in various units of the clinic safe?

25

Table 21. How did you pay?

25

Table 22. How much (GEL) did you pay during your visit?

25

Table 23. In case of an availability of choice, would you apply?

26

Table 24. How would you rate satisfaction with the quality of medical care?

26

Table 25. Does the quality of received care correspond to the paid amount?

26

Table 26. General Statistics 1

35

Table 27. General Statistics 2

35

Table 28. General Statistics 3

36

Table 29. General Statistics 4

36

Table 30. General Statistics 5

36

vii

Diagrams

Diagram 1. Level of satisfaction with various aspects of received

medical services. 2007

Diagram 2.

Arrage a visit * Waiting

19

Diagram 3.

Payment * Waiting

20

Diagram 4.

Payment * Consultation time

21

viii

Introduction

The Georgian healthcare system has undergone a lot of changes. In 1921-1991, it was a part
of the Soviet healthcare which, in 1964, was integrated into the Semashko management model
considering centralized management. In that period, healthcare expenses were high, albeit not
adequate to the level of quality. Since 1995, clinics started being privatized. A new system of
healthcare financing, the so called social insurance, was implemented in Georgia, including
some elements of the Bismarck model. However, it was hard to talk about the quality of health
care and, moreover, about patient satisfaction as far as the amount allocated per capita was only
0.40$. In 2006-2010, the insurance sector developed and clinics were distributed to regions. As a
result, the structural organization of clinics became satisfactory and the process was improved.
However, saving of expenses for a patients treatment and thus increasing of gains cause high
dissatisfaction. In 2013, The Universal Healthcare Program was implemented within the
framework of which all citizens of Georgia were insured.
As it it seen, the healthcare system underwent a number of reforms; however, the quality of
healthcare has never been among the priorities. What does a patient need when s/he comes to a
clinic? It is a quality treatment. What is quality?
A quality healthcare is an optimum, professional provision of available and impartial services
with a view to available resources providing for acceptable services for customer and for their
satisfaction.
It was by means of patient satisfaction, as one of the criteria of healthcare quality, I
attempted to assess the quality of out-patient services in present-day Georgia. In order to
establish patient satisfaction, I conducted a quantitative survey within which the questionnaire
included the components by means of which I established patients common idea about the
aspects of out-patient services such as:
1

1. Clinical principle of performing of medical standards;

2. Sociological patient satisfaction with the quality and volume of medical care;
3. Legal implementation level of of legal rights of the insured;
4. Economic degree of adequateness of financial spending.
Besides, their objective and subjective attitudes should also be considered.
Patient satisfaction with out-patient service is one of the criteria to measure patients
attitudes, and, thus, recently it has been attracting more and more attention. Hence, medical
professionalism plays a great role in measuring of quality. For instance, A. Donabedyan stated
that the determination of value of the patient could be accomplished through achieving and
producing health and satisfaction, as defined for its individual members by a particular society
or subculture, as the ultimate validator of the quality of care.
There are several factors having facilitated research on patient satisfaction. Customers
become more and more sophisticated with various kinds of treatment providers pay more
attention to more wanted products of treatment. Despite of the interest in measuring of patient
satisfaction, the methodology is not standardized and the literature on the issue in point is very
comprehensive. I my research, I tried to describe the relation of patient satisfaction to the
quality of ambulatory services. The questionnaire is based upon on various studies of
determining of patient satisfaction. I summarized a number of basic criteria in order to measure
patient satisfaction and to associate goals to the quality of ambulatory services.

Review of Scholarly Literature

The chapter discusses the Georgian and international literature dealing with patient
satisfaction. Irrespective of the available scarce data in Georgia, I did my best to highlight all
information at hand. As for international data, it is true that these works were published quite
long ago and one may say that they are old in a way but that does not mean that they are
outdated,
First, do not harm (Primum non nocere).
According to the estimates of the World Health Organization (2009), elimination of
changeability of healthcare can save thousands of lives in Georgia. Improved quality of
healthcare causes improvement of clinical results, more safety for patients and their satisfaction.
In order to estimate this component, one of the obstacles is the lack of data about patients
safety. Data, necessary for such basic indicators of patients safety as post-surgery infections and
medical errors, are not delivered to the central healthcare information system. Information
about obstetrical injuries and peritonitis following a C-section has been available, however,
presumably non-reliable. In order to estimate patients safety, exacts measurements and
provision of such information are necessary.
There are factors beyond the healthcare system having a significant influence on it. Strength
of a healthcare system is the basic determiner of the populations health. Even in best healthcare
systems in the world, there are documented and commonly recognized quality-related
problems. Elimination of changeability of healthcare can save thousands of lives in Georgia.
Improved quality of healthcare causes improvement of clinical results, more safety for patients
and their satisfaction.
According to the results of the survey of provision of healthcare services and healthcare
spending in 2007, the level of patient satisfaction with regard to aspects of medical care is rather
high both in countryside and in town, which can be an outcome of adequate responses to
3

patients demands on the part of the healthcare system. With such categories as sufficient
explanation of the need of treatment, adequacy of the time spent by a physician with a patient,
cleanliness or thorough cleanliness in medical facilities, patients involvement in decisionmaking about treatment, the percentage is either up to or over 80%. The percentage, trusting
the service provided at their common clinics, is somewhat lower and is about 65%.
Diagram 1. Level of satisfaction with various aspects of received medical services. 2007

Tengiz Verulava tells about methods of payment in ambulatory medical institutions in his
paper where he assesses various methods. Satisfaction with quality is rendered in the capitation
method of medical care: it should be stated that, in terms of quality of medical care, satisfaction
of medical staff and population, the combination of performed work and the capitation method
was higher rated. These are outcomes of new methods of payment for medical care.
4

The Law of Georgia on Patients Rights includes many interesting articles to be associated
with the aspect of patient satisfaction. Of the general articles, I should note the ones about
Patient and Medical care, also about awareness and accept of service. Below there are some
of them:
Patient any person who uses, needs or intends to use the health care services, despite of
his/her health status;
Medical Service any intervention or procedure having diagnostic, therapeutic, prophylactic
or rehabilitative purpose and carried out by healthcare provider;
Every citizen of Georgia has the right to receive from any healthcare provider medical
service in accordance with the professional and service standards, acknowledged and established
in Georgia.
1. The patient shall have the right to receive from the healthcare provider comprehensive,
objective, timely and understandable information about:
a)

Available resources of healthcare services, the methods of accessing these services,

as well as the tariffs and methods of payment.

b)

The rights and responsibilities of the patient stipulated by legislation of Georgia

and bylaws of the medical institution.

c)

Proposed preventive, diagnostic, therapeutic and rehabilitation procedures patient

will be subjected, and potential risks and benefits of each procedure.

d)

Results of medical investigations.

e)

Alternatives to the proposed medical procedures and potential risks and benefits

of alternative procedures.
f)

Possible results of refusal to proposed medical procedures.

g)

Diagnosis, prognosis and ongoing treatment.

h)

The identity, status and professional experience of healthcare provider.

Satisfaction with health care can be interpreted most appropriately as a measure of the fit
between the preferences and expectations of the beneficiaries and the plan or delivery system in
which they participate. Satisfaction scores are not measures of health plan quality, nor can any
inference be made about the level of satisfaction that one enrollee would have experienced if
he/she had joined a different health plan (Newcomer, Preston, and Harrington, 1996).
Healeyet.al. state that a patients satisfaction with his or her care represents an evaluation, a
judgment on the care received. Therefore, satisfaction is an outcome of care and can be used to
assess how well the care process is working (Healy, Govoni, and Smolker, 1995).
Customer satisfaction is an outcome health managers want to improve, and therefore they
are looking for additional information to assist them in determining how to improve that
satisfaction (Healy, Govoni, and Smolker, 1995). In todays extremely competitive healthcare
market, patient satisfaction rates are one of the measures that are being used by health care
organizations to retain current customers and to attract potential customers. One of the
hallmarks of organizations committed to continuous quality improvement is a clear focus on
customer satisfaction. Routine analysis of data on customer satisfaction with health care is an
integral part of information systems focused on improving quality (Healy, Govoni, and Smolker,
1995). Health care organizations that are not committed to continuous quality improvement or
do not use patient satisfaction surveys, or fail to analyze the data from these surveys will
ultimately find themselves facing very troubled financial times. The use of a customer
satisfaction survey will therefore be a very useful instrument for gauging how satisfied
customers are with services at KACC. This tool will show how satisfied/dissatisfied patients are
with the services they currently receive at KACC. The survey will also identify the number of
beneficiaries using outside medical facilities for their care and point out why they are using
those facilities.
Patients have become more educated in the business of healthcare and are therefore
demanding better health services for their money. Bennett and Mandell report that consumer
6

satisfaction is an important factor in purchase decisions (Bennett and Mandell, 1969). Patient
satisfaction has been shown to affect subsequent buying behavior and word of mouth referrals
by customers (Peterson, 1988).
Although there are similarities in consumer satisfaction processes regarding goods and
services, the latter are more complex. Services are intangible and are therefore more difficult to
measure, whereas goods have a number of search properties that can be determined prior to
purchase and that serve as decision-making input (Nelson, 1974). Conversely, consumers find it
more difficult to assess the quality of services, which primarily involve properties that can be
determined only after the service has been purchased and consumed (Peyrot, Cooper, and
Schnapf, 1993). This is especially true for professional services such as healthcare. Health service
consumers may use nontechnical characteristics (such as the length of time waiting for a
procedure or the pain they experience) to evaluate quality (Peyrot, Cooper, and Schnapf, 1993).
In the study, Patient Attitude Towards Waiting in an Outpatient Clinic and its Applications
results show that patient waiting time in outpatient clinics is often the major reason for patients
complaints about their experiences of visiting outpatient clinics. Therefore, patient satisfaction
with waiting time plays a crucial role in the process of health quality assurance or quality
management (Huang, 1994).
Most of the current research on patient satisfaction related to health services focuses on the
hospital setting and in particular, on ones inpatient experience. Researchers have given little
attention to outpatient health services despite the fact that most health services are delivered on
an outpatient basis and that health care is increasingly being transferred to outpatient settings to
achieve cost containment objectives (Peyrot, Cooper, and schnapf, 1993).
Satisfaction with care is an important outcome which may determine if a person seeks
medical advice, follows a prescribed treatment, and maintains a continuing relationship with the
practitioner (Jones, Carnon, Wylie, and Hedley, 1993). Cleary and McNeil also show that higher
levels of patient satisfaction may lead to better patient compliance, better communication,
7

increased likelihood of return for care, and thus better patient outcomes (Cleary and McNeil,
1988). In the outpatient setting, it has been suggested that dissatisfaction with clinics leads to
non-attendance and losses to follow-ups (Jones, Camon, Wylie, and Hedley, 1993). John Ware
points out that whet her or not one believes the public is able to judge quality, it is important to
keep in mind that they do, whet her they are informed or not. The disenrollment rates for
California HMOs in the late 1970s and the 1980s demonstrates this fact. Plans with higher
ratings had lower disenrollment rates of approximately three percent, whereas those with lower
ratings often had disenrollment rates as high as thirty percent (Ware, 1995). These results are
especially important and relevant to the current situation at KACC.
The Joint Commission on Accreditation of Healthcare Organizations Manual on Standards
identifies a need for a systematic approach to patient care evaluation. The manual specifically
addresses gathering, assessing, and acting upon information related to patient satisfaction
surveys as a tool which could be used by hospitals to carry out those actions (Joint Commission
on Accreditation of Healthcare Organizations, 1993). Scoring standardized responses to
standardized questions is an efficient way to measure health status. Carefully constructed sets of
survey questions have greatly helped research efforts over the past ten years (Ware and
Sherbourne, 1992). Among the surveys most useful with diverse groups and treatments are
surveys that address general health concepts not specific to any age, disease, or treatment group
(Ware and Sherbourne, 1992).
In an environment of increasing cost containment, with or without managed competition,
payers such as the government and employers are likely to encourage or even require
beneficiaries to enroll in prepaid managed care programs priced lower than fee-for-service
indemnity insurance plans (Rubin, Gandek, Rogers, Kosinski, McHorney, and Ware, 1993). As
managed care continues to proliferate, the Military Health Services System and KACC will have
to continue to evolve with the changes. The Base Realignment and Closure Commissions
decision to close inpatient services at KACC has generated many problems for KACC, yet at the
8

same time it has spurned opportunities. Kimbrough is actively seeking to increase the amount of
workload performed in its Same Day Surgery Center. Currently, the same day surgery operation
is running at around 45% efficiency. This is reflective of four to ten surgical cases per day.
Kimbrough has an operating suite of four rooms, and there is adequate staff in the postanesthesia care unit and same day surgery ward to accommodate an increase in surgical
workload. Increasing the workload in the Same Day Surgery Center will be one way of
justifying the importance of keeping KACC open. It is vitally important for those patients who
use the Same Day Surgery Center to have a satisfying experience. Satisfied customers are the
best marketing tool available to an organization.
Cost containment efforts, advanced technology, and new anesthetic techniques have
generated increased growth and utilization of ambulatory surgery. This major shift toward
ambulatory surgery has encouraged greater competition among health care providers and
institutions. Increased competition between hospital-based and free standing ambulatory
surgery programs has created a greater focus on health care marketing and effective
management and has prompted renewed interest in consumer satisfaction (Pica-Furey, 1993).
One study conducted in 1985 showed that 69.3% of patients were dissatisfied with the
health care staff in ambulatory surgery settings. The patients complained that staff members
took too long to explain care or provided no information at all (Pica-Furey, 1993). A more
recent study conducted in 1992 found that 50% of ambulatory surgery patients believe they
were discharged too early. More than half of the patients report that they would have preferred
inpatient surgery (Pica-Furey, 1993). In several other studies, patients report high 10 degrees of
satisfaction with ambulatory surgery. Patients expressed satisfaction with the quality of nursing
care, patient teaching, and the convenience of care. Overall satisfaction with the
technical/professional, interpersonal/trusting, and educational components of ambulatory care
have been documented. Ambulatory surgery patients have reported more satisfaction than
inpatients with the educational aspects of their care (Pica-Furey, 1993).
9

Group practices are also measuring patient satisfaction as never before. Competition and
pressure from health plans and employers are the two main reasons (Terry, 1996). Employers are
demanding data on quality and patient satisfaction is the most easily accessible measure. In
addition, groups are doing large-scale, sophisticated surveys to get data they can use themselves
for quality improvement (Terry, 1996).
Managed care organizations are also conducting patient-satisfaction surveys. However, if
the managed care organizations share any of the results with medical groups, it is generally the
group-wide data only. Observers state that information is often gathered, from small samples
that it is meaning lesson the individual physician level (Terry, 1996). Never the less, the
National Committee for Quality Assurance (NCQA) requires health maintenance organizations
to deliver patient satisfaction data as a condition for accreditation (Terry, 1996).
La Puma and Schiedermayer define a health maintenance organization as an organized
system of healthcare that provides a defined, comprehensive set of services to a defined
population for a fixed, periodic per person or per family fee (La Puma and Schiedermayer, 1996).
The National Committee for Quality Assurance is an independent, not for profit
organization that provides information that enables purchasers and consumers of managed care
plans to distinguish among plans based on quality, therefore allowing them to make more
informed decisions (www.ncqa.org., 1996). The NCQA is governed by a Board of Directors that
includes employers, consumer and labor representatives, health plans, quality experts,
regulators, and representatives from organized medicine.
The NCQA is centered around two primary functions: accreditation of prepaid managed
care organizations and HMOs, and establishment of performance measures, which are known
as, Health Employer Data and Information Set (HEDIS). One of the performance measures
included in HEDIS is a patient satisfaction survey. The mission statement of NCQA is:
NCQA promotes improvements in the quality of patient care provided through managed
health plans. NCQAs primary function is to develop and apply oversight processes and measures
10

of performance for health plans. HEDIS is committed to providing information on managed care
quality to the public, consumers, purchasers, health plans, and other interested parties
(www.ncqa.org., 1996).
The National Committee for Quality Assurance was started in 1979by the Group Health
Association of America and the American Association of Foundations for Medical Care
(Kongstvedt, 1993). In 1988, the Robert Wood Johnson Foundation funded meetings where
NCQA began making inquiries to major purchasers. Specifically, they sought major purchasers
interest in the NCQA becoming an independent external review (Kongstvedt, 1993). In 1989, as
NCQA began to develop into an independent organization, the support of the managed care
industry was apparent as it gave matching grants to NCQA (Kongstvedt, 1993).
Health Employer Data and Information Set is rapidly becoming one of the most prominent
and popular measures of a health plans performance (Appleby, 1995). HEDIS is a set of
standardized performance measures designed to assure that purchasers and consumers have the
information they need to reliably compare the performance of managed health care plans. It is
sponsored, supported, and maintained by the National Committee for Quality Assurance.
HEDIS, in combination with information from NCQA's accreditation program, which is a
rigorous and expert evaluation of how managed care plans are organized and how they operate,
provides the most complete view of health plan quality available to guide choice among
competing health plans. HEDIS 3.0, which will be widely implemented across the country in
1997, will provide purchasers and consumers with an unprecedented ability both to evaluate the
quality of different health plans along a variety of important dimensions, and to make their plan
decisions based upon demonstrated value rather than simply on cost.
HEDIS 3.0 was developed by a broad-based committee, the Committee on Performance
Measurement (CPM), whose members were chosen to reflect the diversity of constituencies that
performance measurement must serve: purchasers, both private and public (Medicare and
Medicaid), consumers, organized labor, medical providers, public health officials, and health
11

plans. In addition, a number of other individuals were asked to serve on the CPM, to bring other
important perspectives, as well as additional expertise in the areas of quality management and
the science of measurement. The CPM and its related subcommittees were organized and staffed
by NCQA. The funding for the work came from a wide variety of public and private sources
(www.ncqa.org/hedis/30exsum.htm#what measures, 1996).
HEDIS 3.0 is the third HEDIS set released by NCQA. In contrast to earlier HEDIS versions,
HEDIS 3.0 is slightly different. HEDIS 3.0 is "outcomes," or results oriented. For the first time,
health plans will be expected to measure how well their patients are able to function in their
daily lives, in a way that will open a window on health plan success at improving functional
health. Also, for the first time, satisfaction results will be assessed with a single instrument,
providing the ability to capture and compare members' experiences across different health plans
(www.ncqa.org/hedis/3Oexsum.htm#whatis, 1996). All health care facilities have incentives to
try to improve all aspects of a patients encounter with that particular healthcare system. These
health plans have strong reasons to improve systems where failure in performance is associated
with dissatisfaction among patients, because patient dissatisfaction is known to correlate with
increased disenrollment (Zapka, Palmer, Hargraves, Nerenz, Frazier, and Warner, 1996).
As previously stated, one of the eight areas that HEDIS 3.0 measures is satisfaction with the
experience of care. These measures are intended to provide information about whether a health
plan can satisfy the diverse needs of its members. The desire for information in this area
recognizes that members tell us important things about the care they receive. It reflects the
opinion that encounters with the health plan should occur in a manner that is responsive to and
respectful of the preferences and interests of its members, and that its members' satisfaction is
the

most

revealing

summary

of

the

extent

to

which

this

is

so

(www.ncqa.org/hedis/30exsum.htm#whatmeasures, 1996).
The Annual Member Health Care Survey, version 1.0 is the result of a collaboration
between health plans, purchasers, technical experts, and the National Committee for Quality
12

Assurance. The primary purpose of the survey is to provide information to purchasers, plan
members, and potential plan members, and thereby to support more informed decisions about
health plan selection (NCQA, 1995). The questions comprising the survey were selected to assess
satisfaction with a variety of elements of health plan performance and provide insights into the
burden of illness in the population the plan serves (NCQA, 1995).
The importance of standardized information about enrollee satisfaction is increasingly clear.
Consumers have expressed great interest in an economical and reliable process for assessing
enrollee satisfaction. In addition, consumers are increasingly important audiences for this
information. In many respects, member satisfaction information is the most user friendly and
understand able of performance measures to a wide variety of individuals (NCQA, 1995). In
focus groups run by NCQA, consumers have stated that satisfaction information would be an
important factor for them in selecting a plan.
The Annual Member Health Care Survey, version 1.0, has four content areas. The first area
contains screening questions to confirm that the respondent is covered by the health plan, to
establish the length of their coverage, and to assess the members need for, as well as use of, in
plan and out-of-plan health services. The second area addresses satisfaction with care and plan
services and features. The last two areas address the respondents health and daily activities and
general socio demo graphic questions (NCQA, 1995). For the purpose of my study, I will only
address the first two content areas.

13

Methodology

The goal of the research was to establish the quality of ambulatory services for the sake of
which I applied patient satisfaction as one of the most significant indicators for establishing of
quality.
The quantitative component of the research envisaged a survey of patients who made use of
ambulatory services. Patients could participate in the survey voluntarily; their privacy was
reserved. In some cases, based on a patients desire, the questionnaire was filled in by the
interviewer.
The ambulatory department of the Chapidze Clinic was selected for the survey where
various kinds of consultations are provides (cardiology, cardiac surgery, interventional
cardiology,

rhythmology,

vascular

surgery,

endocrinology,

gastroenterology,

therapy,

neurology, allergology, and endocrinology).

The questionnaire consisted of 32 questions; of them, 30 questions were close-ended (in
some cases, to allow specifying of opinions) and 2 were open-ended. It was allowed to circle
more than one response. An average period of the survey was 10-15 minutes. The survey was
conducted between 02.02.2015 and 30.03.2015.
The questionnaire had patient satisfaction as a dependent variable and other factors in the
clinic influencing it such as registration, patients awareness, waiting, financial spending,
waiting room and sanitary conditions, medical staff, physician, process of treatment. The open
questions allowed specifically rendering of a patients attitude.
It was noteworthy to establish satisfaction of insured and self-pay patients with both waiting
and a physician and/or staff. Besides, it was interesting to see whether a consultation time was
different according to a patients status (insured or self-pay).

14

The questionnaire was complied in accordance with the international standards, and it
included all the necessary criteria for the assessment of the quality of patient satisfaction and
service.
The questionnaire reserved all ethic norms, and none of the questions dealt with a patients
personal life or business and political activities. Patients identities were not disclosed as far as
the survey was conducted based on privacy.
The above said allows me to consider the results of the survey as valid, on the one hand,
with respect to the accurateness of the components in the questions, and with respect to
removing all hindering factors for the respondents (for instance, the survey was conducted in
the waiting room and not in a physicians office because I assumed that it would influence
expected results).
The statistical data were process by means of IBMA SPSS Statistics 22 software. Descriptive
statistics, quantitative (mean) and percentage indicators (valid and cumulative) of value,
comparison of dependent and independent variations, standard deviation were applied for
recording of the data. Tables and diagrams were used as well.
A limitation of the research can be names the circumstance that I failed to come across a
research conducted in Georgia addressing establishment of satisfaction of ambulatory patients.
Hence, I was unable to compare my results with those of others, whereas it would allow me to
assess effectiveness of steps made for improving of the quality of service.

15

Results

The patient questionnaire, which was completed by ambulatory patients of the Chapidze
Clinic and which was aimed at establishing of patients satisfaction with medical services, was
finalized as a result of survey of 217 customers. 8 questionnaires were not considered valid as far
as only the first part was completed owing to the beginning of the consultation with a physician
due to which they ceased participating in the survey. Most of the tables provide standard
deviations in order to establish the dispersion of the data. Here are the results of the survey
arranged according to the following order:

General information (gender, age, education) - satisfaction

Patients awareness; Where did a patient received information from?

Wait times from registration to a physicians consultation

Satisfaction with registration

Satisfaction with structure of a clinic (comfort)

Satisfaction with a physician

Satisfaction with medical staff

Satisfaction with a process of treatment

Patients expenses

Assessment of general satisfaction

134 (61.8%) women and 83 (38.2%) men were surveyed. The educational status was
represented in the following way: secondary 72 (33.2%), higher 145 (66.8%), none 0 (0%).
The table below (1,2,3) represent patient satisfaction in accordance with gender, education,
and age. Satisfaction was assessed between 1 and 5. The tables were made up based on the mean
comparison analysis.

16

Table 1. How would you rate satisfaction with the quality of medical care * Age
How would you rate satisfaction with the quality of medical care
Age

Mean

Stand. Deviation

Sum %

20-30

4.5172

29

.50855

14.1%

31-40

5.0000

.00000

3.9%

41-50

4.6545

55

.67270

26.7%

51-60

4.8696

46

.34050

22.3%

61-65

4.0000

.00000

3.4%

65-70

5.0000

20

.00000

9.7%

71 and more

4.6829

41

.47112

19.9%

Sum

4.7136

206

.51372

100.0%

Table 2. How would you rate satisfaction with the quality of medical care * Education

How would you rate satisfaction with the quality of medical care
Education

Mean

Stand. Deviation

Sum %

Secondary

4.7222

72

.45105

33.2%

Higher

4.7310

145

.53040

66.8%

Sum

4.7281

217

.50442

100.0%

Table 3. How would you rate satisfaction with the quality of medical care * Gender
How would you rate satisfaction with the quality of medical care
Age

Mean

Stand. Deviation

Sum %

Female

4.7537

134

.43245

61.8%

Male

4.6867

83

.60340

38.2%

Sum

4.7281

217

.50442

100.0%

Tables 4 and 5 tell about a patients awareness of general information about the clinic, how
s/he learned about it and how s/he planned a visit. The results do not feature two items: print
media and internet. As it is seen, none of them has received any information from the said
17

media. As for the item Other, it was checked by the patients who has enjoyed the services of
the clinic for years. It was clear from their responses; they were able to write down them.

Table 4. How did you learn about our clinic?

Frequency

Valid %

Cumulative %

TV

27

12.4

12.4

12.4

Internet

83

38.2

38.2

50.7

Acquaintance

89

41.0

41.0

91.7

Other

18

8.3

8.3

100.0

217

100.0

100.0

Sum

Table 5. Have you been to our clinic before?

Frequency

Valid %

Cumulative %

Yes

203

93.5

93.5

93.5

No

14

6.5

6.5

100.0

217

100.0

100.0

Sum

The following table demonstrates how patients make appointments. It shows the tendency
that only 21% of the patients used to make an appointment for a visit. The received data will be
more comprehensively discussed in the respective chapter. The item Other was checked by
only 7 patients who wrote that their visit was primary.

Table 6. How did you arrange a visit?

Frequency

Valid %

Cumulative %

Phone

47

21.7

21.7

21.7

Acquaintance

32

14.7

14.7

36.4

Ambulance;

21

9.7

9.7

46.1

110

50.7

50.7

96.8

3.2

3.2

100.0

217

100.0

100.0

On there own;
Other
Sum

18

Table 7 presents the data about how patients consider that waiting is caused by the
personnels being busy.
Table 7. Did you have to wait owing to the staff being busy?

Frequency

Valid %

Cumulative %

Yes

48

22.1

22.1

22.1

No

121

55.8

55.8

77.9

Partially

27

12.4

12.4

90.3

Hard to answer

21

9.7

9.7

100.0

217

100.0

100.0

Sum

The next diagram shows patients wait times starting from being registered till a physicians
consultation. It compares a wait time and a type of appointment. According to the diagram, I
wanted to show lengths of wait times of appointed and non-appointed patients. It is seen that
most of patients without an appointment wait more than 30 minutes for a physicians
consultation; however, if we compare an individual wait time that is shorter than 30 minutes,
then the difference between wait times of appointed and non-appointed patients is only 10%.
Diagram 2. Appointment * Waiting

19

The diagrams below compare self-pay and insured patients wait times and durations of
consultations. Insured patients, taking into consideration their quantitative components and not
the temporal distribution of their wait times, have to wait longer than self-pay patients.
It should be noted that the data in the diagrams are presented in their percentage values and
a datum for each denominator along the X-axis is estimated as an integral one and the total of
their data is 100%.

Diagram 3. Payment * Waiting

20

Diagram 4. Payment * Consultation time

By means of the descriptive method, Table 8 represents patient satisfaction with registration.
It assumes both receiving of complete and exhaustive information and polite attitude.
Table 8. Descriptive Statistics
Mean

N
Did you receive complete and exhaustive information at

Stand. Deviation

217

1.1198

0.47573

217

1.0415

0.19985

the registration desk?

Did they speak to you politely at the registration desk?

Tables 9, 10, 11 demonstrate patients attitudes toward the interior, situation and sanitary
conditions in the clinic.
21

Table 9. Is a waiting room comfortable and convenient?

Frequency

Valid %

Cumulative %

Yes

166

76.5

76.5

76.5

No

2.8

2.8

79.3

38

17.5

17.5

96.8

3.2

3.2

100.0

217

100.0

100.0

Partially
Hard to answer
Sum

Table 10. Do you like the building, comfort, conditions of the clinic?

Frequency

Valid %

Cumulative %

Yes

177

81.6

81.6

81.6

No

13

6.0

6.0

87.6

Partially

27

12.4

12.4

100.0

217

100.0

100.0

Sum

Table 11. Are you satisfied with sanitary conditions, cleanness?

Frequency

Valid %

Cumulative %

Yes

183

84.3

84.3

84.3

No

14

6.5

6.5

90.8

Partially

20

9.2

9.2

100.0

217

100.0

100.0

Sum

Tables 12, 13, 14, 15 reflect satisfaction with a physician. Alongside with assessing a
physician, patients have an opportunity to refer to his/her name; the results are the following: of
the 217 interviewed patients, 162 referred to a physicians name. Totally, 11 physicians were
named. All of the patients, who referred to a physicians name, expressed satisfaction.

Table 12. Are you satisfied with your physicians attitude?

Frequency
Yes
Partially
Sum

Valid %

Cumulative %

197

90.8

90.8

90.8

20

9.2

9.2

100.0

217

100.0

100.0

22

Table 13. Are you satisfied with your physicians professionalism?

Frequency

Yes

Cumulative %

190

87.6

90.5

90.5

20

9.2

9.5

100.0

3.2

217

100.0

Partially

Without answer
Sum

Valid %

Table 14. Do you trust your physician?

Frequency
Yes

Cumulative %

197

90.8

93.8

93.8

13

6.0

6.2

100.0

3.2

217

100.0

Partially

Without answer
Sum

Valid %

Table 15. Did your physician explained details of your disease in an understandable way for you?

Frequency

Valid %

Cumulative %

Yes

184

84.8

87.6

87.6

No

19

8.8

9.0

96.7

Partially

3.2

3.3

100.0

Hard to answer

3.2

217

100.0

Sum

As different from physicians, none of the patients were able to refer to a nurses name
notwithstanding high satisfaction with them (Table 16).
Attitude to staff is also noteworthy which is reflected in Table 17 where 12.4% speak about
rude attitude on the part of staff.
Table 16. Are you satisfied with nurses attitude?

Frequency

Valid %

Cumulative %

Yes

156

71.9

71.9

71.9

No

3.2

3.2

75.1

Partially

34

15.7

15.7

90.8

Hard to answer

20

9.2

9.2

100.0

217

100.0

100.0

Sum

23

Table 17. Have there been any facts of rude attitude to you on the part of the medical staff of the clinic?

Frequency

Valid %

Cumulative %

Yes

27

12.4

12.4

12.4

No

190

87.6

87.6

100.0

Sum

217

100.0

100.0

The following tables (18, 19, 20) will enable us to assess the process of treatment with
respect to patient satisfaction. They represent consultation time and a physicians attitude, also
reliability of various procedures.
Table 18. In your opinion, does your physician always spend enough time during a visit and does /she make
you hurry?

Frequency

Valid %

Cumulative %

Yes

92

42.4

42.4

42.4

No

97

44.7

44.7

87.1

3.2

3.2

90.3

21

9.7

9.7

100.0

217

100.0

100.0

Partially
Hard to answer
Sum

Table 19. How long did you stay at the consultation?

Frequency

Valid %

Cumulative %

Less than 10 min

21

9.7

10.0

10.0

11-20 min

88

40.6

41.9

51.9

21-30 min

70

32.3

33.3

85.2

31-40 min

25

11.5

11.9

97.1

41 and more

2.8

2.9

100.0

Without answer

3.2

217

100.0

Sum

24

Table 20. In your opinion, are the procedures in various units of the clinic safe?

Frequency

Valid %

Cumulative %

Yes

131

60.4

60.4

60.4

No

3.2

3.2

63.6

Partially

45

20.7

20.7

84.3

Hard to answer

34

15.7

15.7

100.0

217

100.0

100.0

Sum

Tables 21 and 22 demonstrate numbers of self-pay and insured patients and amount of paid
sums.

Table 21. How did you pay?

Frequency
Cash

Valid %

Cumulative %

169

77.9

77.9

77.9

Clearing (Card);

14

6.5

6.5

84.3

Insured

27

12.4

12.4

96.8

3.2

3.2

100.0

217

100.0

100.0

Other
Sum

Table 22. How much (GEL) did you pay during your visit?

Frequency
Less than 20

Valid %

Cumulative %

3.2

3.4

3.4

21-50

14

6.5

6.9

10.3

51-100

42

19.4

20.6

30.9

101-150

49

22.6

24.0

54.9

151-200

33

15.2

16.2

71.1

201-250

18

8.3

8.8

79.9

251-300

28

12.9

13.7

93.6

300 and more

13

6.0

6.4

100.0

Without answer

13

6.0

217

100.0

Sum

25

Tables 23 and 24 assess satisfaction in general; Table 25 represents correlations of amount

paid and quality. The data in Table 23 are a significant detail in patient satisfaction. Most of
them circled both items which is a very good indication of the fact a patient views a physician
and a clinic as a unitary organization providing health care. The table does not show the data
which were not circled. These responses are: In another institution and To another
physician; this is another indication of patients high satisfaction with available ambulatory
services.

Table 23. In case of an availability of choice, would you apply?

Frequency

Valid %

Cumulative %

Present Institution

54

24.9

24.9

24.9

Other Institution

61

28.1

28.1

53.0

Present Physician

102

47.0

47.0

100.0

Sum

217

100.0

100.0

Table 24. How would you rate satisfaction with the quality of medical care?

Frequency

Valid %

Cumulative %

2.8

2.8

2.8

47

21.7

21.7

24.4

164

75.6

75.6

100.0

Sum

217

100.0

100.0

Table 25. Does the quality of received care correspond to the paid amount?

Frequency

Valid %

Cumulative %

Yes

128

59.0

59.0

59.0

No

3.2

3.2

62.2

Partially

62

28.6

28.6

90.8

Hard To Answer

20

9.2

9.2

100.0

217

100.0

100.0

Sum

26

Interpretation/Discussion of Results

In designing the questionnaire I did my best to consider all the attributes allowing me to
study profoundly patient satisfaction as one of the significant indicators of quality. Judging from
the results of the survey, the bulk of the questionnaire was selected correctly; however, there
were misunderstandings in some instances. I was unable to interpret the results by way of
comparing them with previous ones as far as I failed to find such data. Irrespective of the
recommendations by international organizations, in Georgia quality was not assessed by means
of this indicator. I will present all the interesting details in a due sequence.
First of all, I will discuss satisfaction in relation with patients general data (gender, age,
education). Satisfaction was assessed with points from 1 to 5. As it is seen in Table 1, the lowest
point (4) was assigned by the age group 61-65; however, this does not imply that satisfaction is
inversely proportional to age. This is proved by the age group 66-70 whose mean evaluation was
the highest (5). The mean evaluation of other age groups is 4.5.
With respect to an educational status, Table 2 does not have the item No education because
such an datum was not reported. Other results are as follows: secondary education 33.2% -satisfaction 4.74, and higher education 66.8% -- satisfaction 4.7.
As for gender (Table 3), the data were distributed in the following way: women 61.8% -satisfaction 4.7, men 38.2% -- satisfaction 4.6.
The results about patients awareness are noteworthy. Judging from the data in Table 4, it
can be inferred that patients receive most of information from their relatives (38.2%) and
acquaintances (41%). As for information from TV (12.4%), it is available from programs on
medical topics (for instance, Health on Obieqtivi). I believe that it is a rather good index. If we
compare TV with print media, the situation is totally different, because none of the patients
circle this item. The item Other was circled by the patients (8.3%) who had enjoyed the
27

clinics services for a long period of time. It became clear from their comments: I come here
from the very beginning, I knew it myself.
If we look at Table 5, showing that 14 patients (6.8%) of 217 are primary, then one of the
data (by an ambulance 21 (9.7%)) of Table 6 finding out how one got to a physician, may be
considered invalid. However, as I found it out, in that case they meant a primary visit. Despite
of the available service of appointments, only 21.7% made use of it. The bulk of the patients
(50.7%) preferred coming on their own to visit a physician. In Diagram 2, I related this datum
with waiting for consultation and received an interesting result. 40% of appointed patients wait
for less than 30 minutes, while 55% of those who wait between 30 and 60 minutes have come
one their own; as for the wait time exceeding one hour, most of the (65%) are patients who have
come on their own.
I also compared the data of waiting and duration of consultation with self-pay and insured
patients. Judging from the results, it is seen that most of the self-pay patients and none of the
insured ones had to wait for less than 30 minutes. Insured patients mostly occur within the time
span of 30-60 minutes.
Patients attitudes to registration were measured by means of descriptive statistics. For both
question, the number 1 corresponds to the response Yes referring to satisfaction. Standard
deviations are few; hence, dispersions are few, this demonstrating their reliability. In
establishing of patient satisfaction, registration is considered to be calling card of a clinic and
satisfaction with it is rather significant.
The situation in the clinic, a waiting room, comfort, and sanitary conditions were assessed
positively in 80% of cases. 12% were partially satisfied with the conditions; however, their open
responses to the question what changes they would make showed nothing, disregarding a single
instance about the absence of a paybox in the clinic. This claim can not be accepted as far as
there is a paybox in the lobby. The patient seemed to be upstairs at the moment.

28

The following four tables (12, 13, 14, 15) reflect patient satisfaction with a physician. Several
questions were used to establish various aspects of satisfaction. Table 12 represents satisfaction
with a physicians attitude rated as positive by the majority (90.8%), partially by 9.2%. the
percentages are rather valid and this is proved by the fact the response No does not occur at
all. The following tables reflect a physicians professionalism and reliability; in both cases, the
means positive evaluation was 88%. These results become more credible with a view to the data
from Table 15 telling how clearly a physician explains details of disease. This is a specific
question rendering a realistic situation of patient satisfaction with a physicians consultation. In
this case too, the positive evaluation is 84.8$. Alongside with assessing a physician, patients had
an opportunity to name them. The results are the following: of the 217 surveyed patients, 162
referred to names of their physicians. Totally, 11 physicians were named. All who referred to
physicians names expressed their satisfaction.
No distinct assessments were reported with nurses; the only difference was that their names
were not referred to. Despite of this, satisfaction is high 719%.
In Table 18, the responses Yes and No are almost equal; however, during processing these
results it was found out that they could not be considered valid as far as the question consisted
of two parts, and patients answered correspondingly Yes to the first part and No to the
second one. Hard to answer was checked by primary patients who had not yet taken a
physicians consultation.
Consultation length is represented in Table 19: 9.7% reported that they spent less than 10
minutes in the physicians office. This might be due to the patients who took on
electrocardiogram; however, quantitatively they are not few (21). The data for the consultation
lengths 11-20 minutes and 21-30 minutes are almost equal 32 minutes on the average. 11.5%
stayed with a physician for 31-40 minutes, while 2.8% spends more than 40 minutes;
quantitatively this is 6 patients. These data about consultation length could probably be
associated with the problem of wait time which was discussed above.
29

Table 20 tells about safety of procedures; 60.4% considers them safe. 3.2% (7 patients) did
not respond openly. 15.7% said that they had to answer, while apart said that they were
unaware of procedures in all the units.
Table 21 represents self-pay and insured patients: cash and non-cash payment 77.9% and
6.5% respectively; only insured 12.4%; Other was circled by 3.2%, implying co-payment.
The high number of cash-paying patients aroused interest in amounts paid. The values are rather
high (Table 22). Mean percentage was between 51-100 GEL. 8.3% reported that they paid 201250 GEL, and 12.9% said that they paid 251-300 GEL. With a view to the fact that outpatients
were concerned with, the number of patients, having paid more than 300 GEL, is considerable;
they are 6%.
In order to establish satisfaction, I asked patients to tell what they would do in case of
choice. The responses are the following: 24% and 28% checked the present institution and the
present physician, respectively, while the rest circled the both (47% -- present
institution/present physician). The questionnaire provided options Other institution and
Other physician but they were not circled.
In assessing general satisfaction, none of the patients rated it with points 1 and 2. The
percentages of other points are the following: 3 (2.8%), 4 (21.7%), 5 (75.6%).
Despite not very low expenses, in Table 25, 59% of the patients consider that amounts paid
by are adequate to received treatment; 28% believe that they are partially adequate, and 3.2%
think that they are inadequate.
In analyzing the open responses, it appeared that 40% of the patients rated services
positively, 28% did not state anything, and 31% expressed claims of which 15% was about long
wait times and 9% about high amounts.

30

Conclusion and Recommendations

Patient satisfaction is an unarguably complex issue, and it is very important to realistically

reflect and comprehend it. I did my best to design the questionnaire (see Appendix) with a view
to all the components being dealt with a patient during ambulatory services. They are:
registration, waiting room, waiting, attitude of the staff, attitude and professionalism of a
physician. High rating of these components do not always imply that they are the best what can
be offered to a patient. If we analyze well the responses to the open questions such as Judging
from the situation in the country, everything is the best, or Nothing, Almost nothing or
Nothing by now as the responses to the question What would you advice?, it can be stated
that the high ratings of satisfaction, reported by the patients, are not High at all but rather
Acceptable.
As different from reported satisfaction mentioned above, there were issues with which the
patients openly stated their dissatisfaction. They are: waiting and amount to be paid. Judging
from the available results (closed and open questions), waiting was more dissatisfying than
expenses. One of the ways to solve this problem can be appointment with a physician;
moreover, patients, having come on their own, have to wait longer than appointed ones. On the
other hand, with a view to the fact that only 21% enjoy the opportunity of appointments, and
20% of them have to wait for more than 30 minutes, considering patient, coming on their own,
who would use appointments, it can be stated that waiting times of appointed patients will
increase. Eventually, the number of patients waiting for more than an hour will decrease and
the number of those waiting for 30-60 minutes will increase.
One of the solutions of the problem of dissatisfaction with expenses is correction of prices
which is a purely economic issue, and another kind of research is necessary in order to study it.
31

As for expenses and patient satisfaction, it is necessary to raise patients awareness concerning
what kind of serves are available from various physicians as high class professionals, also about
the equipment complying with all the existing standards.
In the future, in order to better establish patient satisfaction it is necessary to include such
questions in the questionnaire to allow a patient to express a level of satisfaction in a more
specified way. These can be the question with the following response options: Bad,
Acceptable, Average, Good, Best.
For a more detailed study, it will be good to survey (dis)satisfaction with various units of an
ambulatory. It will be interesting to conduct such a survey in a polyclinic medical center and in
a clinic where the problem of waiting is deemed to minimum.
Finally, I believe that surveys of patients satisfaction, as one of the most significant indicators
of quality, should necessarily be conducted in all success-oriented clinics, to rate the said
indicator once a year and to plan goals and objectives in accordance to its results.

32

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Appendix
Appendix 1
Table 26. General Statistics 1
Did you receive
How much

complete and

Did they speak

Is a waiting

How did you

(GEL) did you

exhaustive

to you politely at

room

pay?

pay during your

information at

the registration

comfortable and

visit?

the registration

desk?

convenient?

desk?
Valid

217

204

217

217

217

13

Mode

1.00

4.00

1.00

1.00

1.00

Range

3.00

7.00

2.00

1.00

3.00

Minimum

1.00

1.00

1.00

1.00

1.00

Maximum

4.00

8.00

3.00

2.00

4.00

Without answer

Table 27. General Statistics 2

Are you satisfied

Are you

In your opinion,

How long did

Did you have to

with your

satisfied with

does your

you stay at the

wait owing to

physicians

nurses

physician always

consultation?

the staff being

attitude?

attitude?

spend enough

busy?

time during a visit

and does /she
make you hurry?
Valid

217

217

217

210

217

Mode

1.00

2.00

2.00

2.00

Range

3.00

3.00

4.00

3.00

Minimum

1.00

1.00

1.00

1.00

Maximum

4.00

4.00

5.00

4.00

Without answer

35

Table 28. General Statistics

Are you

Do you

Did your physician

Have there been any

Do you like the

satisfied with

trust your

explained details of

facts of rude attitude

building,

your physicians

physician?

your disease in an

to you on the part of

comfort,

understandable way

the medical staff of

conditions of the

for you?

the clinic?

clinic?

professionalism?

Valid

210

210

210

217

217

Mode

1.00

1.00

2.00

1.00

Range

2.00

3.00

1.00

2.00

Minimum

1.00

1.00

1.00

1.00

Maximum

3.00

4.00

2.00

3.00

Without answer

Table 28. General Statistics 4

Are you satisfied

In case of an

Are you

Do you think that

In your opinion,

with sanitary

availability of

satisfied

there are not

are the procedures

conditions,

choice, would you

with the

specialists that you

in various units of

cleanness?

apply?

time of a

want in this clinic?

the clinic safe?

visit?
Valid

217

217

217

217

217

Mode

5.00

1.00

2.00

1.00

Range

4.00

3.00

2.00

3.00

Minimum

1.00

1.00

1.00

1.00

Maximum

5.00

4.00

3.00

4.00

Without answer

Table 28. General Statistics 5

Valid

Based on the above said, how

Does the quality of received

would you rate satisfaction with

care correspond to the paid

the quality of medical care?

amount?

Gender

Age

Education

217

217

217

206

217

11

Mode

1.00

1.00

4.00

2.00

Range

3.00

1.00

6.00

1.00

Minimum

1.00

1.00

2.00

1.00

Maximum

4.00

2.00

8.00

2.00

Without answer

36

Appendix 2
Questionnaire to establish indicators of outpatient satisfaction with the quality of medical
care

Name of office ______________________________

The questionnaire is aimed at studying of your views and opinions about shortcoming
and advantages of our clinic. It will allow us to discuss existing problems in our services and to
improve them. The questionnaire is anonymous and privacy of provided information is guaranteed.
We hope that you will find time to complete the questionnaire amd your sincere
responses will help us improve the quality of our services.

1. How did you learn about our clinic?

a) TV;
b) Internet;
c) Print Media;
d) Relative;
e) Acquaintance;
f) Other (to be written down) _______________

2. Have you been to oujr clinic before?

a) yes

b) no

3. How did you arrage a visit?

a) Phone;
b) Acquaintance;
c) Ambulance;
d) On there own;
e) Other (to be written down) ________________
37

4. How did you pay?

a) Cash;
b) Clearing (Card);
c) Insured;
d) Other (to be written down)

________________

5. How much (GEL) did you pay during your visit?

a) Up to 20 b) 21-50 c) 51-100 d) 101-150 e) 151-200 f) 201-250
g) 251-300 h) 300 and more

6. Did you receive complete and exhaustive information at the registration desk?
a) Yes b) No c) Partially d) Hard to answer

7. Did they speak to you politely at the registration desk?

a) Yes b) No c) Partially d) Hard to answer

8. How long did you have to wait for a consultation?

a) Less than 30 b) 30-60 min c) 1 hour and more

10. Is a waiting room comfortable and convinient?

a) Yes b) No c) Partially d) Hard to answer

11. Are you satisfied with your physicians attitude?

a) Yes b) No c) Partially d) Hard to answer
9.1. Physicians full name----------------------------------------------------------------------------

12. Are you satisfied with nurses attitude?

a) Yes b) No c) Partially d) Hard to answer
38

10.1. Nurses full name---------------------------------------------------------------------------

13. In your opinion, does your physician salways pend enough time during a visit and does
/she make you hurry?

a) Yes b) No c) Partially d) Hard to answer

14. How long did you stay at the consultation?

a) Less than 10min b) 11-20min c) 21-30min d) 31-40min e) 41min and more

15. Did you have to wait owing to the staff being busy?
a) Yes b) No c) Partially d) Hard to answer

16. Are you satisfied with your physicians professionalism?

a) Yes b) No c) Partially d) Hard to answer

17. Do you trust your physician?

a) Yes b) No c) Partially d) Hard to answer

18. Did your physician explained details of your disease in an understandable way for you?
a) Yes b) No c) Partially d) Hard to answer

19. Have there been any facts of rude attitude to you on the part of the medical staff of the
clinic?
1. Yes (Physician, Nurse) to be written down __________________

20. Do you like the building, comfort, conditions of the clinic?

a) Yes b) No c) Partially d) Hard to answer
21. Are you satisfied with sanitary conditions, cleanness?
a) Yes b) No c) Partially d) Hard to answer
39

2. No

22. In case of an availability of choice, would you apply:

a) Present Institution
b) Other Institution
c) Present Physician
d) Other Physician

23. Are you satisfied with the time of a visit?

a) Yes b) No c) Partially d) Hard to answer

24. Do you think that there are not specialists that you want in this clinic?
a) Yes (to be written down) ---------------------------------------------------------------------------------b) No
c) Hard to answer

25. In your opinion, are the procedures in various units of the clinic safe?
) Yes
) No (to be written down)

--------------------------------------------------------------------

c) Partially
d) Hard to answer

26. Based on the above said, how would you rate satisfaction with the quality of medical
care? Lowest point 1, highest 5.
1

26a. Does the quality of received care correspond to the paid amount?
a) Yes

b) No c) Partially d) Hard to answer

40

27. What do and dont you like most of all?

________________________________________________________

28. What would you advise in order to improve services?

_________________________________________________________________
_

29. Gender: Female;

Male;

30. Age:
a) Up to 19;
b) 20 30;
c) 31 - 40;
d) 41 50;
e) 51 - 60
f) 61 - 65
g) 65 70
h) 71 and more

31. Education:
a) Secondary
b) Higher
c) No education

Thank you for cooperation.

41