Determinants of and levels of client satisfaction associated with waiting time at Nyakach district Hospital, Kenya

Abstract

Client satisfaction is influenced by the efficiency of services offered in health facilities. When services are offered promptly, clients are more likely to comply with prescribed treatment. Long waiting time has frequently been mentioned as one factor which may limit health service utilization by any given community. Studies carried out in developing countries show that clients spent 3-4 hours in outpatient departments before seeing the doctor. Studies have shown that long waiting time before medical intervention may result in unnecessary anxiety, worsening of the illness, permanent disability or death. As such, there is need for periodic assessment of determinants of waiting time and client’s satisfaction associated with it in different service delivery points and health facilities to guide efforts to reduce it. Nyakach District Hospital is a recently upgraded level 4 facility and is a referral hospital for the district leading to congestion of available resources. It is unclear whether this upgrading has created different determinants and clients satisfaction associated with waiting time. This study forms a basis for monitoring interventions aimed at reducing waiting time and hence improve client satisfaction with service delivery. In this hospital-based cross-sectional study, the determinants of actual waiting time and client’s satisfaction at key outpatient departments in Nyakach District Hospital were evaluated. Clients were selected through random sampling at the clinicians’ consultation room and followed to the laboratory, pharmacy, and cash office. A sample size of 359 clients was used for waiting time with random sampling. A structured questionnaire for waiting time measurement and patients’ satisfaction was used. Staff members were blinded during measurement of waiting time. A structured questionnaire was administered to 36 staff members purposively sampled at the key departments to identify determinants of waiting times. Regression analysis was used to identify determinants of waiting time while client’s satisfaction was based on a Likert Scale. This study revealed the mean waiting time at the hospital was 17, 24, 24 and 50 minutes at the cash office, laboratory, pharmacy and consultation room, respectively. Clients served at the hospital were mostly dissatisfied with the waiting times at the clinicians’ consultation room (41%), laboratory (37%) and pharmacy (50%) while those served at the pay-point were generally satisfied (31%). Results further revealed that relative to the Ministry of Medical Services (MOM’s) reference time, the service point (OR, 5.03, 95% CI; 3.21-7.34, p<0.001), having an emergency (OR, 2.05, 95% CI; 1.64-2.97, p=0.042), number of clients to serve (OR, 4.45, 95% CI; 2.33-5.42, p=0.024), number of staff attending to clients (OR, 5.39, 95% CI; 3.45-7.87, p<0.001), years of service of the staff and their experiences (OR, 5.97, 95% CI; 4.22-8.76, p<0.001), the staff’s training and competencies (OR, 6.01, 95% CI; 4.27-7.88, p<0.001), amount of workload (OR, 1.70, 95% CI; 1.21-2.00, p=0.047), employee’s attitude/morale (OR, 1.99, 95% CI; 1.21-2.03, p=0.047) significantly influenced the waiting time in this facility. Therefore, the hospital should increase efficiency at the various service points, including the emergency, increase the number of staff serving the clients, ensure they are adequately trained and be competent, reduce individual staff’s workload and find ways of motivating them in order to increase client’s satisfaction in this and other facilities.