CHAPTER ONE: INTRODUCTION
1.1 Background Information
During the past few decades, there has been reawakening that health is fundamental human right and a worldwide social goal: that is satisfaction to basic human needs and to improve productivity of nations. However, it has been recognized that in both developed and developing countries, the satisfaction of public health expected has not yet been achieved. The concept of quality services in the healthcare system has been introduced in most developing countries. However, this is rapidly becoming a global issue. Currently, more and more countries are focusing their attention on healthcare quality because of the concern that healthcare is costly, and therefore needs to be dispensed appropriately and equitably with minimum variation (Berman, 2000). Client satisfaction is the level of satisfaction that clients experience having used a service. It therefore reflects the gap between the expected service and the experience of the service, from the client's point of view. Measuring client or patient satisfaction at the Out Patients Department (OPD) has become an integral part of hospital or clinic management strategies across the globe. Moreover, the quality assurance and accreditation process in most countries requires that the satisfaction of clients at the OPD be measured on a regular basis (Mathew & Beth, 2001). Asking patients what they think about the care and treatment they have received is an important step towards improving the quality of care, and ensure local health services are meeting patients' needs (Outpatient survey report, 2004/2005). It is an established fact that satisfaction at the OPD influences whether a person seeks medical advice, complies with treatment and maintains a continuing relationship with practitioners (Larsen & Rootman, 2000). Donabadian, the leading theorist in the area of quality assurance, has emphasized that Client satisfaction is of fundamental importance as a measure of the quality of care because it gives information on the provider's success at meeting those client values and expectations, which are matters on which the client is the ultimate authority. In the prior years when hospitals were symbols of humanitarian efforts for community welfare, accountability for performance was of little concern. Today however, people are increasingly concerned about hospital's performance because hospitals use an increasing proportion of scarce community resources. Questions on the effectiveness and efficiency of hospitals are on the increase. Moreover, addressing those service aspects of healthcare that consumers most readily appreciate, such as access, provider relationship, availability of information and opportunity for participation can influence health care quality outcomes. Expectations about quality of care are linked to perceptions of care, and when patient’s perceptions are positive their clinical experience and outcomes are more likely to be positive (Donabedian, 2003). An in-depth study in selected hospitals in eastern part of Africa, specifically in poor rural area, showed that patients bypassed low quality facilities in favor of those offering high quality consultation and prescriptions, staffed by more knowledgeable physicians and better stocked with basic supplies. In a related development a similar study carried out in Ethiopia showed that the low level of socio-economic development resulting in one of the low standard of living, poor environmental conditions and low level of social services has been the major causes for a poor health status of the people (James, 2000). Several studies conducted in Out Patient Departments of different hospitals in Ethiopia revealed client satisfaction level ranging from 22.0% in Gondar to 57.1% in Jimma. Long waiting hours during registration, visiting of Doctors after registration, laboratory procedures and re-visiting of the Doctor for evaluation with laboratory results failure to...
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