Caring for children: A model of healthcare service quality in Bangladesh

Abstract

Objective: This study assesses the links between service quality and patient satisfaction in the context of health services delivered to children in a developing country. With the growing importance of patients' voice in the healthcare environment, it is important to assess the factors that are best able to explain patient satisfaction to influence the art and science of patient care and health service delivery. Design: A field survey was conducted using a household surveyto assess the quality of services provided to children who had been to a hospital in the past 12 months. Participants: Caregivers who had accompanied an afflicted child to a hospital in Dhaka City. Main outcome measures: Patient satisfaction wasthe main outcome/ dependent variable as reflected in surrogate measures obtained from the children's accompanying caregivers. Results: A regression model was tested. The independent variables were nurse composite, doctor composite, tangibles, health inputs and facilitation payments. The model explained 67.4% of the variation in the dependent variable (R2). The behavior of nurses had the greatest impact on satisfaction (P < 0.001) as reflected in the standardized betas, followed by the behavior of doctors (P < 0.001). Facilitation payments had a negative effect on satisfaction (P < 0.01). Conclusions: Bringing about attitude change among doctors, nurses and support staff is vital for improving children's satisfaction with hospital care. Installing proper recruitment procedures, training, supervision, and reward systems are most likely to facilitate this change. But similar changes are also needed elsewhere: in the Ministry of Health and Family Welfare, other facilitating ministries, as well as the development partners to achieve enduring and positive effects. © The Author 2008. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.