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ScienceDirect Procedia Economics and Finance 32 (2015) 870 – 877

Emerging Markets Queries in Finance and Business

Patient Satisfaction in the Hospital's Emergency Units in Bucharest Celia Dana Be‫܈‬ciu Academy of Economic Studies, Bucharest, Romania

Abstract Nowadays health systems are centred to provide diagnosis and treatment and the focus is less placed on the relation between the doctor and the patient. Before scheduling a treatment process is very useful to know the causes that generates the aggravation of the health status and wich factors may increase the quality and the comfort of the healthcare units. Patient satisfaction must be one of the key objectives of modern healthcare systems and must be evaluated constantly. This study presents an analysis of the level of patient satisfaction felt in the emergency units of Bucharest, and highlights the factors that influence the relationship between a doctor and a patient, the level of communication and patient satisfaction. The necessary information was gathered in order to create a partial picture of the emergency medical services in Bucharest. The research method was quantitative and the research instrument was the questionnaire. The data processing was performed using the statistical analysis program, SPSS. The individuals who participated in the survey showed a fairly high rate of satisfaction regarding the medical services and said that they had confidence in their physician. The data collection and the analysis tool used allowed this paper to describe the relationship between the patient and physician, the characteristics of the environment in which it is established, the internal and external factors which influence the level of any patient satisfaction.

© 2015 Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license © 2015 Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). (http://creativecommons.org/licenses/by-nc-nd/4.0/). Selection and peer-review under responsibility of the Emerging Markets Queries in Finance and Business local Selection and peer-review under responsibility of Asociatia Grupul Roman de Cercetari in Finante Corporatiste

organization

Keywords: satisfaction, physician-patient relationship, communication, efficiency

1. Introduction On a current and general level, health systems provides care based on diagnosis and treatment and this characteristic is inherited over time from a philosophy which appeared on the early last century. It is

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2212-5671 © 2015 Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Selection and peer-review under responsibility of Asociatia Grupul Roman de Cercetari in Finante Corporatiste doi:10.1016/S2212-5671(15)01534-8

Celia Dana Beșciu / Procedia Economics and Finance 32 (2015) 870 – 877

necessary to be highlighted, the other factors that can enhance the quality and efficiency of the medical care and that's why literature and medical research studies complement those mentioned so far, trying to emphasize that it is important the relation between a physician and a patient, the dialogue taken place with the patient, knowing his private life situation, before determining a treatment plan. Even if in the last 20 years Romania has received consistent international support for health sector reform, including the improving of medical emergency medical services (Farcasu, 2010), Romania remain a country of emigration for medical staff and the funding of the health system is the lowest in Europe. (Vasile, ğâlea, 2013) In Romania there is a significant imbalance between different regions and 98 communities have not a doctor or a nurse and for one third of the territory and 30% of specialties are not covered. (Vlădescu, Olsavsky, 2009) Even if the emergency sector is a major component of the health system and emergency medical care is provided free, the evidence at the hospital are very few. (Ciutan, Nona, 2009) In developing countries as Romania, the access to basic services is still one of the most important barriers to health and is influenced with political decisions (Kruk, Freedman, 2008) and the patient satisfaction must remain one of the most important objectives of the public health system. If we refer to patient satisfaction this concept may include a number of elements as: low cost strategy to improve safety and quality in hospital (Boulding, Glickman, Manary, Schulman, Staelin, 2011), patients perceptions against professional skill and communication atitude of personnel, service quality and patient trust (Ching-Sheng, Su-Yueh, Yi-Ting, 2013) or waiting time for appointments, office waits, emergency care, availability of hospitals and other resources. (John, Ware, Mary, Snyder, Russel, Allyson, 1983). To ensure a good level of satisfaction, we need to monitor the quality of decision making and use health information technology that collect information from patients (Floyd, Flower, Carrie, Levin, Karen, 2011), but also a good level of satisfaction can mean high expectation on receiving timely and high quality of medical service. ( Bai, Bei, 2013) We can measure the level of quality and efficiency of the romanian management, by measuring the performance of the others involved systems in the absence of performance indicators (Nicolescu, Verboncu, Anghel, 2012) and the level of patient satisfaction can be a good indicator of health system performance. The performance of medical system is an important indicator of the level of economic development and a way to improve health outcomes is closing the gap between patient desires as a consumer and their medical needs. (Joel, Edward, 2012). The quality of medical services can refer to some factors as: external environment, perceptions of payment, commitments and promises and this factors can propose suggestions to improve the hospital patient satisfaction. (Miao, Lvlin , Sen, 2011) It is important to measure all time patient satisfaction because, nowadays is increasing in importance and is associated with increased market share, decreased malpractice claims, financial gains ((Eric, James, 2013), but also the efforts should be made to give more attention and more time to the patient. (Prahlad, Rajeev, Jayati, Laxman, 2010). It is important to investigate how the health conditions of the patients influence the way they combine the healthcare experiences ( Otani, Koichiro, Waterman, Brian Dunagan, Claiborne, 2012) and how in some cases patients correlates satisfaction with some factors as staff atitudes or provision of explanation. (Taylor, Benger, 2004). To ensure excellence of care services, hospitals and healthcare systems should invest in programs to determine how patients evaluate their experiences (Clarian Health Partners, 2002) and mentain a positive relationship between the interpersonal continuity of care and patient satisfaction (John, Waleed, 2004). Patient satisfaction should be accepted as an integral part of quality health. (Hjortdahl, Laerum, 1992) because quality outcomes and patient satisfaction with services are now a priority and the primary competitive edge in healthcare (Clarian Health Partners, 2002).

2. Research Objectives The general objective of this research work is to measure the level of patients satisfaction felt in their relation with their Physician by observing the quality of medical services provided in establishments for the

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receipt of urgent causes. The first objective derived from the general objective, is to know the perception of patients regarding the physician who treated their medical emergencies. The patients perception, will be analyzed from the perspective of certain terms as: confidence in their physician, waiting time, relationship established and the quality of medical services. The second objective of the paper is to propose several measures to improve the efficiency of medical emergency services in order to increase the level of satisfaction, if will be necessary. 3. Research hypothesis The first hypothesis: To what extent the medical behaviour has visible effects on patients satisfaction, in terms of his professional competence and his ethical dimension? I wanted to know if the resulting trust from cooperation, triggers the patient's commitment toward physician instructions and ensure a good level of satisfaction. The second hypothesis that I will test, will show to what extent the medical staff's attention, can influence the satisfaction felt by the main beneficiaries of the medical system, the patients. 4. Research methodology The research targeted group includes the patients who were found in the emergency units of the emergency hospitals analyzed. The results of the study are mainly useful for hospitals managers, medical researchers, economic agents involved and hospital administrators, in order to establish some strategies and actions plans that increase the level of responsibility, security and safety. Observation Units chosen are represented by four hospitals in Bucharest which offers emergency medical services namely: Emergency Hospital Saint John, Emergency Hospital for children, Marie Curie, Emergency University Hospital of Bucharest's and Emergency Hospital Bagdasar Arseni. The target group includes 88 randomly selected patients. The research method chosen was quantitative method and the research instrument chosen was the questionnaire applied to patients in Emergency Reception Units. This instrument, helped people to respond more easy and understand the discussed problem. The questionnaire applied has contained a number of 10 questions with answers that were varied: some questions had only one variant, others more versions and also other questions that offered the possibility of free expression and interpretation. The questionnaire applied to patients it was structured in four parts, as follows: The first part- introduction, part II- identify the relationship between physician and patient, part III-shows how quickly emergency has been resolved and the fourth part contains general questions. The questionnaire includes questions with a formulated answer and also free answer questions. The topics included in the questionnaire shows the reasons they chose the emergency hospital, the reasons they chose the physician, the collaboration between the doctor and the patients, the level of trust and confidence, the level of attention and others. I offered them the possibility of granting certain values depending on the level of satisfaction/dissatisfaction felt with respect to medical services. The last part of the questionnaire explores the issue of the reform and which elements of the reform may contribute to increase the patient satisfaction. The questionnaire applied to patients end with a question that check the extent to which the public health system in Romania is influenced by policy makers who makes part of the current Government. I would like to mention that before the process of collecting and analyzing the data I made out all the steps necessary to obtain official approval from the National Association for the Protection of Patients Rights and from the manager of which units have asked certain conditions to allow the application of questionnaires: eliminating the nominal elements in the questionnaire, to prevent those people who stood in a difficult health condition or people who have behavior problems.

Celia Dana Beșciu / Procedia Economics and Finance 32 (2015) 870 – 877

5. Descriptive statistics The method of analysis and interpretation of the data obtained was carried out via computer statistical analysis software called SPSS. There have been used a number of variants corresponding to questionnaire responses. The variants of responses were coded with letter V for all variables tracked in the questionnaire and the letter Q for all questions applied. Variable -V1 represents the hospital, variable-V2 represents the type of the person, variable-V3 represents the person age, the variable level is V4 and V5 corresponds with the variable occupations held by the person questioned. All the questions were encoded by the letter Q, affirmative responses to the number 1, negative responses with the number 0 and none answered by the number 9 or number of 99. There were situations when it was necessary to introduce coding variants. The necessary orders have been applied to generate tables and graphs by selecting the case pursued by the analysis but also, were generated certain frequencies of answers for certain questions addressed. The analysis of the information obtained was held at the general level without any specific references to a particular unit observation. According to data generated by the program SPSS most respondents were from Emergency University Hospital of Bucharest's, followed by those of the Emergency Hospital Saint John. The average age of those surveyed was placed in the range of 41-50 years old, with a level of education that was not superior, most of the respondents were women employed without a major medical emergency. Of those questioned 44, 23% have said they chose the hospital to treat because it is close to home and 28, 85% because doctors are trained (Table 1). For 56,78 % of patients, the most important aspect when they express their satisfaction level is represented by the physician ability to solve the medical emergency as quick as possible followed by the doctor ability to communicate with them, in percent of 25,42% (Table 2).

Tabel 1. The reason for choosing the Hospital Choosing hospital: close to home

44.04%

Choosing hospital: prepared medics 2.88%

Choosing hospital: short waiting time

Choosing hospital: recomandations made by relatives

28.85%

24.04%

 Table 2. Influence in collaboration with doctor Collaboration with doctor: communication

26%

Collaboration with doctor: fast resolving

57%

Collaboration with doctor: explaining the problem

15%

Collaboration with doctor: personal problems

0.31%

Collaboration with doctor: previous results

1.69%

  Most of the participants at the study stated in a percentage of 72% that they were satisfied with the physician attention, and that means a positive aspect that shows a high level of satisfaction. 60.47% of participants stated that they had trust in the physician who dealt with their emergency and 23, 26% of respondents considered that physicians were attentive (Figure 1).Very few of participants mentioned that they will need a closer future collaboration with the physician.

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Figure 1. Patient’s confidence in the physician Table 3. The importance of the relationship with the doctor Relation with doctor: respect

Relation with doctor: salary

Relation with doctor: experience

Relation with doctor: chances of recovery

Relation with doctor: the socioprofessional situation

19.7%

16.67%

27.27%

21.21%

15.15%

In terms of the relationship established between a physician and his patient, 27% of respondents are with the opinion that the most important aspect is doctor’s experience in managing the patient (Table 3) and how close is to them and how easy understand their medical problems. For patients, satisfaction is associated with experienced doctors. Most of the people polled appreciated a good level of promptness and 63.6% were satisfied with the doctor attitude. The patients were not satisfied with the level of cleanliness. Of those who participated in solving the questionnaire, 77, 3% indicated that they would revisit to treat in the emergency hospital in which they found themselves at the time of questioning. This aspect reflected a good level of satisfaction felt towards the services provided. (Table 4)  Table 4. You may call on the services of this hospital?

Not responded Valid Yes, replied Total



Frequency

Percentage

Valid Percentage

20 68 88

22,7 77,3 100,0

22,7 77,3 100,0

Cumulative percentage 22,7 100,0

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Celia Dana Beșciu / Procedia Economics and Finance 32 (2015) 870 – 877

Another aspect that has been pursued and debated through question number eight in the questionnaire was related to the importance of the reform in the public health system in Romania and which element of the reform has a great impact on the level of satisfaction patients. Even if the most respondents said that they had limited knowledge about the content of the reform and its importance they tried to resolve the questionnaire topic. Patient satisfaction: co-payment system

3.98%

Patient satisfaction: private practice within public hospitals

4.09%

Patient satisfaction: medical staff without budgetary status

10.96%

Patient satisfaction: development of emergency structures

16%

Patient satisfaction: collaboration with IBM

7.56%

Patient satisfaction: reducing bureaucracy

6.22%

Patient satisfaction: professionalization of management

14.09%

Patient satisfaction: reorganization of the health insurance houses

14.14%

Patient satisfaction: increasing funding

16.48%

Patient satisfaction: implementation of the European Directive

6.48%

 Table 5 .The importance of the reform for the patient'sƐĂƚŝƐĨĂĐƚŝŽŶ

From the analysis carried out on the graph generated by the computer program SPSS, I found that 16, 48% of citizens consider particularly important to increase the funding to emergency system followed by the variant linked to the development of emergency structures and health personnel training in percentage of 16%. At the opposite, the patients gave a low importance to the private co-payment system, private offices inside public hospitals and the implementation of the European directive on movements of patients (Table 5). Most respondents have stated that the value of payments are insignificant and doesn't really help the public health system in Romania and private offices must be separated from the public. They mentioned the preference to treat inside the country only if the medical system allows this and give them the necessary treatment. The last question of the questionnaire aimed the influence established between the public health system in Romania and the system of political governance. For the last question, most of the respondents agreed that there is evident relation between the two aspects mentioned and considered that the policy makers can influence the level of satisfaction and can improve the quality of medical system with correct strategies applied. (Table 6) Table 6. Is public health system influenced by political actors? Yes, I agree 78%

I don’t know 22%

Conclusion I can clarify that I managed to capture issues that were not addressed in the questionnaire and I have summarized this: • Old equipment in the emergency units; • Insufficient beds and baths service; • Insufficient space for treating patients; • Unfinished repairs in the emergency hospitals; • Outside green spaces with weeds; • Sheer number of attendants for only one patient; • The lack of cleanliness.

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General conclusion Patient satisfaction remain an important element of the medical system performance and should be evaluated constantly. The quality of medical services affect directly the level of patient satisfaction and is not influenced only by the level of economic development. In the present study, the level of patient satisfaction is correlated with experienced doctors, the physician ability to resolve as quick as possible their medical emergencies and emergency hospitals close to home. Only one hypothesis has been confirmed, because patients involved in the study said that their satisfaction is not influenced only by the doctor attention and the level of communication. Study participants expressed in general a good level of satisfaction but did not have the courage to express directly disagreement for fear of not being treated appropriately. It is necessary to enhance controls and to be implemented continuous monitoring systems to increase the patient satisfaction. Acknowledgements This work was co financed from the European Social Fund through Sectoral Operational Programme Human Resources Development 2007-2013, project number POSDRU/159/1.5/S/134197 „Performance and excellence in doctoral and postdoctoral research in Romanian economics science domain” References Farcasu, D. O. 2010. International projects on emergency health servicies in Romania reflected in the population opinion, a comparasion between years 2006 and 2009, University of Medicine and Pharmacy Victor Babes Timisoara, Department of Public Health, Center for Health Policies and Services, Bucharest, p. 325 Tilea, B., Vasile V., Tilea I. 2013. Labour force mobility and employment crisis in health care sector in Romania, Institute of National Economy, Romanian Journal of Economics,Vol.36, Bucuresti, p.21-42 Vladescu, C., Olsavsky, V. 2009. Migratia asistentelor medicale in cazul Romaniei, Journal Management in Health 4/2009, Managementul Resurselor Umane, p.14-18. Ciutan, M., Nona, D. 2009. Distributia teritoriala si utilizarea spitaleleor de urgenta in Romania, anul 2007, Journal Management in Health 1/2009, Cercetare, Management in sanatate, p.28-35 Nicolescu, O., Verboncu I. & Nicolescu C. & Anghel F. 2011. Romanian Management Status and Performance in the European Environment, Review of International Comparative Management, Vol. 12, Issues 4, Bucharest University of Economic Studies, 629 Margaret, E., K., Lynn & P., Freedman 2008. Assessing health system performance in developing countries: A review of the literature, USA, p.263-276 Boulding, W., Glickman, SW., Manary, MP., Schulman, KA., Staelin, R., 2011. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States, The Fuqua School of Business, Duke University, Durham, NC, USA.,The American Journal of Managed Care, 17(1), p.41 Ching-Sheng, C., Su-Yueh C. & Yi-Ting, L., 2013. Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters, BMC Health Services Research, p.1 avaible at http://www.biomedcentral.com/1472-6963/13/22 Floyd, J., Fowler Jr., Carrie A. Levin, Karen R. Sepucha 2011. Informing And Involving Patients To Improve The Quality Of Medical Decisions, Health Aff (Millwood), 2011, Apr;30(4), p.699 Bai, Bei, 2013 Factors associated with patient satisfaction in emergency department in mainland China, Hong Kong and Taiwan : a systematic review, Postgraduate Thesis, The University of Hong Kong Libraries, University of Hong Kong, p.2 Joel, M., K. & Edward U., B. 2012. Patient Satisfaction and Patient-Centered CareNecessary but Not Equal, The Journal of American Medical Association, vol. 308, no.2, p.139 Miao, S., Lvlin, Z., Sen, W. ,2011. Measures to enhance the hospital patient satisfaction based on perceived service quality, 2nd International Conference on Artificial Intelligence, Management Science and Electronic Commerce (AIMSEC), p.4667 Eric, D., S., James, O., S., 2013. Patient Satisfaction: Implications and Predictors of Success, The Journal of Bone& Joint Surgery, Vol.95, No.10, p.1 Prahlad, R., S., Rajeev, K., K., Jayati, S., Laxman, S., 2010. Measuring Patient Satisfaction: A Case Study to Improve Quality of Care at Public Health Facilities, Indian Journal of Community Medicine, 35(1), p.52. Otani, Koichiro, Waterman, BrianDunagan, W. Claiborne, 2012 Patient satisfaction: how patient health conditions influence their satisfaction, Journal of Healthcare Management, Vol.57, Issue 4, p.1 C Taylor, C., Benger, J., R., 2004. Patient satisfaction in emergency medicine, Emergency Medical Journal, 2004, no.21, p.528 John, W., S., Waleed, A., 2004. Interpersonal Continuity of Care and Patient Satisfaction: A Critical Review, Annals of Family Medicine, vol.2, nr.5, p.445

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Clarian Health Partners, 2002. Patient satisfaction measurement: current issues and implications, Europe PubMed Central, 6(3), 125 Hjortdahl, P., Laerum, E., 1992. Continuity of care in general practice: effect on patient satisfaction, British Medical Journal, 304(6837), p.1287 John, E., Ware. Jr., Mary, K., Snyder, W., Russell Wright, Allyson R.., D., 1983. Defining and measuring patient satisfaction with medical care, Evaluation and Program Planning, vol.6, issue 3-4, p.247

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