Developing a Process - Oriented Feedback System for Assessing Customer Satisfaction at a Multi-Specialty Hospital in Pune City

Introduction

Customer satisfaction is a measure of how the organization’s total product or service performs with regard to a set of customer expectations and requirements.¹ Customers play an important role in spreading word of mouth about a product or service, sharing their satisfaction, and developing consumer loyalty to a brand, organization, or corporation that is beneficial to the company. Kotler defined customer satisfaction as, ‘A person’s feelings of pleasure or disappointment resulting from comparing a product’s perceived performance (or outcome) about his or her expectations’.² Customer satisfaction relies on good customer service. Customer service is the service a consumer receives before, during, and after they’ve purchased a good or service. Customer satisfaction is the key to the success of any business and is considered to be the most important factor for a product or a service. Quality of industry offerings of various services have to ensure customer satisfaction as this plays an important role in attracting and retaining the customer.³

Customer happiness is influenced by a variety of elements, but the three most important aspects in current customer satisfaction are customer understanding, service, and technology.^2,3 You can deliver good, consistent customer experiences and build true customer loyalty by using these characteristics. Customer satisfaction provides various benefits to an organization like ‘customer loyalty’, ‘improved reputation’, ‘employee satisfaction’, etc. The Consumer Satisfaction Index (CSI) is a versatile tool for determining customer satisfaction with a product, service, or company. It assists in finding the reasons for consumer satisfaction or dissatisfaction. Customer satisfaction statistics are among the most often gathered measures of market perceptions.^3,4 In an ideal world, a company would solicit feedback regularly to increase customer happiness. Customer dissatisfaction may lead to failure of even a big business; therefore, management must periodically assess consumers and the difficulties or roadblocks they are encountering with the system, workers, and management. There are also consequences for a business failing to provide good customer service. It may result in decrease in profit, bad reputation in the market, loss of market share, loss of competitive edge, low staff morale, and many more.

The present study was done at a multispecialty hospital in Pune city to evaluate the quality of services from the customer perspective. The primary objective of the study was to collect the process - oriented feedback from patients visiting the Out-patient Department (OPD) and to analyze the areas of development/improvement for the OPD of the hospital. The secondary objective was to analyze the reasons for low customer satisfaction and identifying the hurdles that should be sorted to achieve high customer satisfaction.

Methodology

The study was conducted during June-September 2021 at a 750-bed multi-speciality hospital in Pune city. The data collection was performed at four active OPDs wherein the patients were requested to fill the feedback form based on their experience at the hospital OPD. The feedback forms were collected from desks of four out of five OPD counters in the hospital. One of the OPD was non-functional as it was dedicated to industrial COVID-19 vaccination. The survey data collection included both primary and secondary data. Primary data was collected on the excel sheet from the feedback forms and secondary data was collected from various books, articles and research papers which were published in the past on the subject ‘Customer satisfaction’.

Prior to the present study, feedback from the customers was collected on the printout of feedback forms which were kept on the front desks of all four active OPDs at the hospital. The reception staff were requesting the customers to fill the feedback forms after consultation and billing. The old feedback forms used by the hospital were designed based on the designation of employee like- Physician, Nurses, Technician Staff, etc and was more person specific. During our study, a new feedback form was designed with a higher emphasis on the processes which are important for customer satisfaction which included- booking an appointment, waiting time, interaction with doctors, nursing and technicians, and quality of laboratory services. Hence, a process-oriented feedback form was designed instead of designation or person-oriented form. The ‘Likert Scale for Satisfaction Mapping’ developed by Rensis Likert in 1970 was used for the feedback and responses. It has been proven to be very useful for exploring social and psychological attitude of a patient.⁵ An open-ended question was also added at the end for collecting subjective responses in the questionnaire. The old feedback design was replaced by the implementation of the newly created feedback forms and the staff was instructed to collect the feedback on primary basis. The data analysis was done using MSExcel.

Also, the “Customer Satisfaction Score” was calculated. “Customer Satisfaction Score” is a simple statistic for measuring customer satisfaction (CSAT). On a scale of 1 to 5, this is a measure of how happy customers are with a product or service. The average is computed, and the average customer satisfaction is determined. CSAT is the assessment of customer service results. To have a good progress on overall customer satisfaction, the organization needs to be building a structural mapping between customer service and corresponding CSAT activities. This gives immense benefits. The employees know how exactly their work or procedures are rated by the customers.⁶ If the CSAT score is close to one, then your customers are satisfied and if it is close to zero, then customers are not satisfied.

The “Net Promoter Score” (NPS) is another technique to gauge customer happiness and loyalty. Satmetrix Systems, Inc., Brain & Company, and economic strategist Frederick F. Reichheld (“The One Number You Need to Grow,” Harvard Business Journal) devised this strategy.

Respondents who give a score of 5 are referred to as “promoters”. This customer group is very satisfied with a product. Those who choose a score of 4 are called “indifferent”, they are still undecided. Those customers who answer with a score of 0 to 3 are called “Detractors” - it is unlikely that they recommend a product to others. The Net Promoter Score is then calculated as follows:

Relative number of promoters = Number of promoters / number of all respondents * 100

Relative number of detractors = Number of detractors / Number of all respondents * 100

Net Promoter Score = Relative number of promoters - Relative number of detractors

The NPS varies between -100% and +100%. The more positive the NPS, the more satisfied customers an organization has.⁷

Results

The data collection was done on all the week days and was collected from a total sample size of 731 OPD patients on the overall satisfaction with the outpatient services. Sixty-eight (9.3%) respondents were aged less than 25 years, 479 (65.6%) respondents were in the age range of 25-49 years, 160 (21.9%) respondents were between 50-74 years and remaining 23 (3.2%) were more than 75 years of age. The overall experience was rated as ‘Very Good’ by 60% of the customers. Twenty three percent of the customers had evaluated their experience as ‘Good’, 1% rated as ‘Average’, another 1% rated as ‘Bad’, and was rated as ‘Very Bad’ by 1% of cases. This indicates that a large number of customers had a highly satisfying experience at the OPDs, whereas around 40% did not report an excellent experience. These 40% of the total respondents are those who had some issues, hurdles, and difficulties in the OPD processes.

The CSAT scores for the four active OPDs were calculated. Among all the OPD’s, highest CSAT score was reported in OPD 4, followed by OPD 5, 1 and 2 respectively. All the four OPDs reported high CSAT scores of more than 0.80, indicating satisfaction of the customers at all the four OPDs (Table 1).

As previously discussed, the NPS varies between -100% and +100%. The more positive the NPS, the more satisfied customers an organization has. In the analysis performed, all the four OPDs had positive Net Promoter Score and it was above 50%, which means most of the customers were satisfied by the service of the OPDs (Table 2).

The analysis of the subjective open-ended question revealed that for around 30% patients, these issues were related to: high waiting time in OPD, and pharmacy, queries on medication-related problems not being solved, radiology and pathology reports not being delivered on time. Some faced inconvenience at the OPD (10%) and were offended with the behavior of OPD staff, whereas around 15% reported negatively about the pricing of the hospital as it was overpriced according to them, etc. Many such incidences happened at the hospital which may have resulted in customer dissatisfaction including incidences like two to three hours of waiting time for patients, appointment scheduling on the wrong date, issues with medical certification from a physician, reminder call not been done about the canceled appointment, etc. When patients with such experiences were asked to fill the feedback form, they wrote the reasons in the open suggestions and suggested improvements in the respective departments.

There were few issues raised regarding the facility, lifts, conveyance parking, and floors such as lift not being available on time and the waiting time being too much for the same. Vehicle parking capacity of the hospital was lacking when industrial vaccination for COVID-19 was arranged in the hospital facility. Customers also had difficulty locating particular departments in the hospital. Issues like these also lead to customer dissatisfaction. The last column in the feedback included an open suggestion column which was added to receive the open suggestions, feedback, and complaints from the patients and the data we received included both positive and negative responses. The positive feedback was mostly about the doctors, the facility, the staff, the nurses, and the management. The negative feedback was related to the arrival time of doctors, appointment scheduling, Radiology, and other screening departments, parking system, lifts, the behavior of staff, etc.

This open suggestion column allowed the patients to share their perspective towards the hospital. There were issues raised and the facts appreciated by the customer of the hospital in this section of questionnaire. We received appreciable responses from the customers such as, “We like the service and we are glad to have visited the hospital”, and so many more. They additionally appreciated the quality, hygienic factors, consultant doctors and other medical staff, their disposition, willingness and courtesy towards the patients and attendants. All the conflicts which happened in the facility and the issues of the customers were conveyed to the higher management and the transmutations will be made accordingly. The open-ended question was availed to understand the customer mindset apart from the questionnaire. The feedback from the customers can be utilized by the management to identify ‘Areas of Improvement’ for the organization i.e. hospital and it is an additional valuable input for the future strategy and decision making.

Discussion

Customer satisfaction is influenced by a variety of variables. Friendly workers, courteous employees, competent employees, helpful employees, billing correctness, billing timeliness, competitive pricing, service quality, good value, billing clarity, and rapid service are among these criteria. ² Perception is also widely inconsistent. Two different customers can consume the same good or service and have radically different perceptions about its quality. The difference may result from varying powers of perception.⁸

The presence of an attendant is seen as more of an institutional norm than a personal convenience in many Indian hospitals. The goal of this paper is to look into the moderators and mediators in the context of healthcare service quality in hospitals, as seen through the eyes of patients and their attendants.⁸ Researchers from the developed world investigated a wide range of influencing factors, from physician’s empathy and hospital infrastructure to courtesy of the paramedical staff and hospital image, while emphasizing the importance of customer (patient) satisfaction in fostering efficient delivery of healthcare services. Different business models and service quality variations exist in developing-world hospitals, necessitating contextspecific analysis. Patients are always accompanied by attendants in the Indian healthcare system, who perform a variety of tasks, including facilitating the execution of physicians’ recommendations. To collect the perspectives of patients and attendants, the present study used a questionnaire-survey technique. The study revealed that attendants play an indispensable role in the Indian context. Attendants provide physical and mental support to patients, which results in patient’s satisfaction with the hospital services.⁹

According to the research conducted at a Private Medical College Hospital in Mangalore, the availability of services and clinical care was found to be satisfactory. 81% of the respondents found the communication by the doctor good, 97% of the respondents were satisfied with the explanation of the disease by the doctor. The average time required for consulting the doctor was between 20.9 - 46.5 minutes. However, when it came to the time spent at the drugstore, it was too high creating dissatisfaction. In 97 percent of the cases, the investigative cost was considerably moderate or high.⁹ In comparison with the study performed at the Medical College Hospital in Mangalore, the results of our study were as follows - 60% of consumers evaluated their encounters as ‘Very Good’. Customers rated their experiences as ‘Good’ in 23% of the cases, as ‘Average’ in 1% of the cases, ‘Bad’ in 1% of the cases, and ‘Very Bad’ in 1% of the cases. The major issues and complaints were concerns with the waiting time, facility, and the radiology department. The feedback on doctors and supporting medical staff was good and the pharmacy was even rated excellent. The areas of development suggested by the customers and attendants were the diagnostic services and the facility management.

Customer satisfaction may also vary depending on various factors like consultant doctor, department, management, communication, quality of service delivered, etc. In the hospital, CSI for the specific number of doctors was low. The delivery timing of reports from the radiology department was reported to be always late as compared to the pathology department. There were always complaints about lifts and parking facilities. It shows there is always room for improvement in few departments and facilities.

Customer satisfaction constitutes the most reliable market information and helps an organization to evaluate its current position against competitors and accordingly can design strategies and future plans.

Customer satisfaction measurement may help business organizations to understand customer behavior, and particularly to identify and analyze customer expectations, needs, and desires. Another application of customer satisfaction measurement program is revealing the potential difference in the service quality perceptions between the customer and the management of the business organization.¹⁰

Understanding the customer’s expectations is of paramount importance to provide him/her a good quality of service. Customer satisfaction research plays a major role in establishing the expectations of a customer. The foundation of good customer service is a good understanding of customer expectations. An organization that does not perform any research on customer satisfaction will not be able to understand their requirements and satisfy them and eventually cannot grow their business. In today’s world, any business growth in the organization is directly proportional to the customer satisfaction and loyalty. Understanding customer satisfaction has become imperative for any organization. Customer satisfaction research must focus on service issues and bring up the customers’ expectation realistically like what satisfies the customer most and of the service delivery. The customer expects a predictable behavior from the service provider and for this consistency of service, delivery is very important.¹¹

Limitations of the study

Customer Satisfaction Index is not always a reflection of the firm’s or its offerings’ overall value or quality. CSI score is a good gauge of how satisfied customers are with the products and services offered by a company, but is not always a reflection of the firm’s or its offerings’ overall value or quality. For the aggregate of issues that customer satisfaction is advised to address, there are better measurements available (which includes loyalty, customer profitability, customer likeability, and wordof-mouth potential).

Suggestions

Though the multi-speciality hospital in Pune provided quality services, it still has areas of improvements like every other organization. From the findings and analysis of research, we would like to present few suggestions such as, waiting time as this was one of the highlighted issues in most of the feedback provided. The hospital management need to work on the appointment scheduling and on the prompt timings of consultant doctors. There are few other issues related to lift system and availability of lifts as waiting time for the lifts was reported to be more. Administration departments also received few complaints and parking issues were reported many a times with customers and even employees facing problems with the availability of parking areas because of mismanaged rows in parking. Management needs to look into these issues and we believe these issues can be solved with the help and cooperation of employees.

Conclusion

After analyzing various aspects of customer satisfaction, we concluded that hospital provided quality medical service to the customers, along with quality hospitality in the region. Customers i.e., patients appreciated the service provided by the firm. Still, there are certain areas for improvement which could be the reasons behind the customer dissatisfaction in the hospital. Further, process-oriented feedback form is recommended for feedback analysis regarding customer satisfaction. Such issues were conveyed to the management which helped in strategy making and establishing better quality compliance in the hospital.

Conflict of Interest

None