Patient Satisfaction with Doctors’ Care in Bangladesh: A Case of Government Hospital

Research Article

J Fam Med. 2017; 4(6): 1132.

Patient Satisfaction with Doctors’ Care in Bangladesh: A Case of Government Hospital

Uddin MJ1*, Ashrafun L2 and Kubra TJ3

¹Professor & Head, Department of Sociology, Shahjalal University of Science & Technology, Sylhet, Bangladesh

²Professor, Department of Sociology, Shahjalal University of Science & Technology, Sylhet, Bangladesh

³Graduated in Sociology, Shahjalal University of Science & Technology, Sylhet, Bangladesh

*Corresponding author: Mohammad Jasim Uddin, Professor & Head, Department of Sociology, Shahjalal University of Science & Technology, Sylhet, Bangladesh

Received: October 30, 2017; Accepted: November 28, 2017; Published: December 05, 2017


Patient satisfaction with health care services is viewed as an important factor in explaining patients’ perceptions of quality health care. It is becoming increasingly important for determining the success of health care service and institutional survival, let alone prosperity. Although research on patient satisfaction regarding health care has become standard in many developed or developing country, in countries such as Bangladesh the importance of patient’s perspectives in assessing quality of health care is still relatively ignored. The aim of the present study is to assess patient satisfaction with doctors’ services at a government hospital in Bangladesh. Suitable Patients’ Satisfaction Indicators (PSI) in relation to doctors’ services within the hospital were developed from the existing literature related with quality studies. A survey was carried out and 104 responses were collected from the inpatients receiving medical treatment for gynaecology and obstetrics, and respiratory diseases at a divisional government medical college hospital in Bangladesh. The principal component analysis was performed to identify the key items affecting patient satisfaction levels with respect to doctors’ services. The result of the principal component analysis shows that there is a single factor (‘Doctors listen carefully to patients’ problems’) in the initial solution has eigenvalues greater than 1. It is accounted for almost 61% of the variability in the original variables.

Keywords: Health; Hospital; Patient; Satisfaction; Bangladesh


The development of health sector is one of the pinnacle goals of Millennium Development Goals (MDGs). Like all other UN nations, the government of Bangladesh has taken necessary step in conformity with acquire the MDGs. Following the Government footstep, different local, national and international NGOs are also working here for implementing MDGs and developing the health status of the people. Accordingly, Bangladesh has achieved noteworthy progresses in the health status of the population by achieving MDG 4 by reducing child death before the 2015 target, and rapidly improving on other key indicators such as maternal death, immunization coverage, and survival from some infectious diseases including malaria, tuberculosis, and diarrhoea [1]. The country has been working towards a fully digitalized health information system. In recognition of its endeavours, Bangladesh acquired the 2011 United Nations “Digital Health for Digital Development” award for outstanding contributions to the use of information and communications technology (ICT) for health and nutrition.

Over the 46 years after independence, the health system of Bangladesh has gone through a number of reforms and established an extensive health infrastructure in the public and private sectors. Bangladesh has a mixed health care system that includes government, private, nongovernmental organizations (NGOs) and donor agencies. The country has developed an institutional network for providing health care which has been operated through the following tiers: primary health care (Upazilla Health Complex, Union Sub Center & Community Clinics), secondary health care (District Hospitals), tertiary health care (Medical College Hospitals), and super specialized care (specialized institutions). Th e Government of Bangladesh (GOB) has taken initiatives to provide primary health care at the door step of grass root people through establishing Community Health Clinic (CHC) at the village level and Union Health and Family Welfare Centre (UHFWC) at the union level, specialized postgraduate hospitals are available only at the divisional level.

In Bangladesh, people of different social classes take treatment from different health providers like public, private & NGO-based hospitals for different reasons. Economic condition, health knowledge, socio-demographic determinants and cultural practices may influence people to choose the health care service providers [2-4]. Over the years the country has achieved impressive progress in enhancing primary health care services and health status of its population (WHO, 2015). Bangladesh has achieved exquisite improvement in childhood vaccination coverage, which is vital to reduce infant and child morbidity and mortality. Under the government’s Expanded Program for Immunization (EPI), children below one year of age receive immunization for six vaccine preventable diseases such as tuberculosis; diphtheria, pertussis, and tetanus (DPT); poliomyelitis; and measles. This EPI program takes in Bangladesh one step forward toward the attainment of MDGs. In 2010, the United Nations recognized Bangladesh for its outstanding progress towards MDG 4 (to reduce child mortality) and 5a (to reduce maternal mortality) in the face of many socio-economic hindrances. Between 1990 and 2011, under 5 mortality decreased from 151/1000 to 53/1000 live births (LBs). The infant mortality rate fell less rapidly from 87/1000 to 43/1000 LBs over the last 18 years. Between 1990 and 2010, maternal mortality in Bangladesh decreased from 574/100 000 to 194/100 000 LBs. The decline is associated with a reduced total fertility rate (from 5 births per woman in 1990, to 2 in 2011) and with increased skilled delivery attendance (from 5% in 1991 to 32% in 2011) (WHO, 2015)

The Constitution of the People’s Republic of Bangladesh (May 2004) set out the state’s obligation to make sure public health to all citizens. However, some challenges for the health system remain unmet and critical. Many sick people, in practice, have limited or no get entry to the health services at all and for many of the rest, the care they receive is insufficient and unsatisfactory. The National Health Service, established and administered for all, is allegedly being consumed by a selective group who are favoured by geography, social class, wealth or position. The under-served majority is largely rural however also includes the urban poor [17,8]. One study noticed that the overall public health care services have declined between 1999 and 2003, while the rate of utilisation of private health care facilities has increased for the same period [9]. Another study demonstrates that the overall utilisation rate for public health care services in Bangladesh is as low as 30 per cent [8,9]. Furthermore, the public health sector in Bangladesh is plagued by absenteeism, casual payments and perceptions of poor quality. Available evidence suggests that poor governance in the health sector is negatively influencing service delivery mechanism in Bangladesh, which, in turn, effects in low utilisation of public facilities. Non-availability of medication and commodities, discrimination against the poor, imposition of unofficial fees, lack of trained providers, weak referral, feedback and tracking systems, unfavourable opening hours and interdepartmental complications contribute to low use of public facilities in Bangladesh [10,11]. The present study aims to find out the determinants of patients’ satisfaction with physicians' services designed within a government hospital in Bangladesh.

Defining Patient Satisfaction

Measuring patients’ satisfaction is very important to evaluate the health care services provided by the health care institutes and to gauge patient outcomes. According to O’Connor et al. [12], “It’s the patient’s perspective that increasingly is being viewed as a meaningful indicator of health services quality and may, in fact, represent the most important perspective”. It gives researchers, health managers and professionals with valuable information for understanding patients’ experience, promoting patients’ compliance with treatment, identifying the weaknesses in services and evaluating health service performance [13-15]. Health care institutions in developing counties to a large extent seem to pay no attention to the importance of patients’ attitude regarding health services. Recent literature, however, puts emphasis on the importance of patient’s perspective in assessing quality of health care [15,16]. Since 1990s researchers, health professionals and policy-makers have given considerable attention to the patient perception of the quality of health services [17]. In these years, studies on patient satisfaction or consumer satisfaction have increased remarkably as shown by a PubMed search for “patient satisfaction” or “customer satisfaction”. Despite the enormous number of studies in Western countries over the past decade on patient satisfaction, an agreed definition of patient satisfaction with healthcare service is not yet achieved [18-20] owing to the multidimensional and subjective nature of the concept.

Client service is all about perceptions. No service can be tested before it is sold, it cannot be put away, returned or exchanged [21]. For all these reasons what is important most is customers' perception of their experience and interpretation of it [22]. Patient satisfaction is a complicated construct involving a number of factors, including providers’ perspective, the physician’s knowledge, clinical and communication skills, personal attributes, accessibility, convenience of location and surrounding area, patients’ socio-demographic characteristics, their expectations, needs or desires [15,23]. Patients’ satisfaction sometimes only reflects the providers’ perspective rather than the patients’ one [24]. On the other hand, when a patient has limited or lacking knowledge of opportunities, standards or low expectations of service quality, high satisfaction scores may be registered even though poor standards of care have been provided.

Avedis Donabedian, the leading thinker in modern medical quality assurance, states that “it is useful to begin with the obvious by saying that quality is a property that medical service can have in varying degrees.” It follows that an assessment of quality is a judgment whether a specified instance of medical service has this property, and if so, to what extent [25]. Grogan and colleagues developed a 46-item questionnaire to measure patient satisfaction with specific aspects (e.g. access, nurses, appointments, facilities) of general practitioner services in England [26]. Following American Customer Satisfaction Index (ACSI), Ali and Ahmed [27] identified 27 items to measure patients’ satisfaction in private hospital of India. Hojat and associates [28] adapted 25 items from the Adult Primary Care Questionnaire developed by the Consumer Assessment of Healthcare Provider and Systems (CAHPS) for measuring overall patient satisfaction with primary care physician. Following the existing literature we have developed 10 items to measure patients’ satisfaction with doctors’ services in government hospital of Bangladesh. In this study, patient’s satisfaction with doctors’ services is defined as the patient’s opinion of the services received from physicians and is acknowledged as an outcome indicator of the quality of doctors’ services.

Materials and Methods

The data of the study was collected by using structured questionnaires from the inpatients receiving medical treatment for gynaecology and obstetrics, and respiratory diseases at a divisional government medical college hospital in Bangladesh. The work was performed on a sample unit of 104 inpatients on the basis of convenient random sampling techniques. The study was carried out during 15th November to 25th November 2016. The patients were selected on the following criteria: (1) age 18 years and above at the time of admission in the hospital; (2) spent at least two more days as inpatients. The survey instrument was mostly adapted from existing relationship quality studies. A total of 10 items in relation to doctor services were developed by the researchers from the existing literature in Bangladesh and elsewhere of the world. With regard to patient satisfaction, respondents were asked to record their level of satisfaction with respect to doctors’ services. Patient satisfaction in relation to doctors’ services are measured by asking the respondents to rate on a 5- point Likert scale ranging from “Strongly Disagree = 1” to “Strongly Agree = 5”. Total satisfaction score was calculated from the sum of all 10 items. The possible score rage is 10-50. A higher score indicates a greater satisfaction with health care services. However, an item such as “I would recommend this hospital to my family and friends” is included due to its direct relevance to patients’ satisfaction with doctors’ services in the hospital. We hypothesized that if patients were satisfied with doctors’ services within the hospital they would recommend the hospital to their family members and friends.

Reliability was measured by the Cronbach's alpha. Detailed information regarding their socio-demographic characteristics, income, diseases, and the number of days in the hospital was collected based on a questionnaire designed to capture all relevant data on patients. Interviewers were instructed to take oral consent from each participant just before carrying out the interview. To ensure privacy and confidentiality, no other persons (e.g. doctors, nurses, and staff) were present except the participant and the interviewer at the time of interview. The respondents were assured that information provided by them will be solely used for research purposes and the confidentiality of their responses will be strictly maintained at all times and the personal information provided by them will never be shared with any outside organisations or persons.

Findings and Analysis

Descriptive analysis

Table 1 shows that the greatest number of respondents belong to the age group of 32-38 years i.e. 34.6 %. While the smallest number of the respondents are from age group of 46 and above years i.e. 8.7%. About 42 of the respondents are male and 58% of the respondents are female. On categorizing the patients by their marital status, it is shown that 60% of respondents are married and 40% of respondents are unmarried. With regard to education, it is found that around 68% of the patients are either illiterate or educated up to primary level. Occupation status of the patients shows that the housewife category accounts for the largest category (41%), which is followed by service holder (20%) and business (15.4%). The table further shows that 45% of respondents have a monthly income of TK 5000-10000.