|Year : 2017 | Volume
| Issue : 1 | Page : 26-30
Patients’ perception of quality of services of the haematology laboratory in Ahmadu Bello University Teaching Hospital Zaria, Northwest Nigeria
Sani Awwalu FMCPath (Haematology) 1, Abdulaziz Hassan1, Yawale Iliyasu2, Ismaila N Ibrahim1, Ibrahim U Kusfa1, Benjamin Augustine1
1 Department of Haematology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
2 Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
|Date of Web Publication||7-Jun-2017|
Department of Haematology, ABUTH, Zaria
Source of Support: None, Conflict of Interest: None
Background: To assess the patients’ perception of quality of services (PPQS) offered by the haematology laboratory of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. A cross-sectional descriptive study was conducted among 125 outpatients of the haematology laboratory in ABUTH, Zaria. A stratified sampling with subsequent systematic random sampling was utilized. This study was conducted in the haematology laboratory of ABUTH, Zaria, Nigeria from 25th April to 3rd August 2016.
Participants and Methods: Five-point Likert scales were used to rate 10 categories in addition to overall satisfaction. The most important service categories were also assessed. Percentage satisfaction and scores (on a scale of 1–5) were computed. Data were analyzed using the Statistical Package for the Social Sciences version 20.0 software. Data were presented using tables. Medians and interquartile ranges were used to summarize ordinal data. Mann–Whitney U or Kruskal–Wallis tests were used as applicable. The level of significance was set at P < 0.05.
Results: The mean age of participants was 32.04 ± 10.97 years, and females constituted 71 (56.79%). The service category with the highest satisfaction was cleanliness of phlebotomy area (85.60%) followed by information on how to receive results (80.00%). Staff courtesy had the highest satisfaction score (4.25) followed by ease of phlebotomy (3.97). The least was cleanliness of toilets (3.12). Privacy during phlebotomy, ease of phlebotomy and comfort of chairs were the most important categories, with respective scores/values of 26 (20.80%), 23 (18.40%) and 22 (17.60%). Overall satisfaction was 81.60% (score of 3.94). The distribution of overall satisfaction ratings did not differ across socio-economic groups.
Conclusion: The PPQS of the haematology laboratory of ABUTH, Zaria reveals a high level of overall satisfaction. Satisfaction with waiting time and cleanliness of toilets are low. All metrics should be considered as opportunities for improvement.
Keywords: Haematology laboratory, patient, quality of service
|How to cite this article:|
Awwalu S, Hassan A, Iliyasu Y, Ibrahim IN, Kusfa IU, Augustine B. Patients’ perception of quality of services of the haematology laboratory in Ahmadu Bello University Teaching Hospital Zaria, Northwest Nigeria. J Med Trop 2017;19:26-30
|How to cite this URL:|
Awwalu S, Hassan A, Iliyasu Y, Ibrahim IN, Kusfa IU, Augustine B. Patients’ perception of quality of services of the haematology laboratory in Ahmadu Bello University Teaching Hospital Zaria, Northwest Nigeria. J Med Trop [serial online] 2017 [cited 2021 Jun 15];19:26-30. Available from: https://www.jmedtropics.org/text.asp?2017/19/1/26/207589
| Introduction|| |
The haematology laboratory, similar to any other clinical laboratory, is a complex environment. It entails continuous interactions among men, materials and machines. All activities in the laboratory are geared towards satisfying a diverse range of clients which include physicians, patients, public health authorities among others. Pathologists are often saddled with both technical and managerial responsibilities in the laboratory. The assessment of client or customer satisfaction is an important tool in measuring the quality of services provided by a laboratory. Data generated from such studies can serve as quality indicators. The efficiency and effectiveness of the clinical laboratory depend on continuous quality improvement systems. However, there is a dearth of scientifically generated customer-associated quality indicator data in our laboratories. Thus, most often, laboratory managers make assumptions, though unsubstantiated, about customer perceptions.,, Additionally, customer satisfaction data are prerequisite inputs in the laboratory management review and planning process. Therefore, any laboratory that does not perform the periodic assessments of customer satisfaction has a significant flaw in its management review process.
This study was aimed at assessing the patients’ perception of quality of services offered by the haematology laboratory of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria.
| Participants and methods|| |
This was a cross-sectional descriptive study involving 125 outpatients at the haematology laboratory of ABUTH, Zaria, Nigeria from 25th April to 3rd August 2016. Since this will be the first of such studies in our centre, we utilized the following assumptions to arrive at the minimum sample size: proportion of satisfied patients, P = 0.50, Z = 1.96 and a precision (d) of 10% were set. This gave a minimum sample size of 96. However, after factoring in a 20% non-response rate, a minimum sample size of 115 was arrived at. Eventually, 125 participants were enrolled for this study. The records of outpatients of the haematology laboratory for the last 6 months of 2015 were used to determine stratified sampling by gender with proportional allocation. These revealed that 56.79% of the patients were females. Thereafter, systematic random sampling was used with every 4th male or 4th female interviewed daily until the sample size was achieved.
Questionnaires were initially pretested among 10 randomly selected patients, and appropriate revisions were made and subsequently interviewer-administered to the study participants. These assessed participants’ ages, gender, highest educational levels (none, primary, secondary and tertiary) and occupational status (unemployed, self employed and civil/public servants). A five-point Likert scale was utilized to assess the respondents’ satisfaction ratings with the quality of ten service categories. Participants responded as follows: 1–poor, 2–below average, 3–average, 4–good and 5–excellent. Overall satisfaction was also rated separately by the participants. Additionally, respondents indicated which service category they considered as the most important.
Data were collated and analyzed using the IBM Statistical Package for the Social Sciences version 20.0 software (IBM Corp., Armonk, NY, United States). These were presented as tables and charts and summarized as median and interquartile ranges (IQR). Spearman rank test was utilized to assess the correlations between age and satisfaction ratings. Mann–Whitney U tests were performed to determine gender differences in satisfaction ratings. Kruskal–Wallis tests were performed to evaluate the differences in satisfaction ratings across educational levels and occupational status. A P value of <0.05 was considered as significant.
The following formulae were used to calculate some satisfaction indices:
Ethical approval was obtained from the ABUTH Health Research Ethics Committee.
| Results|| |
The mean age of the participants was 32.04 ± 10.97 years with females constituting the majority with 71 of the 125 patients (56.80%). Most of the participants had secondary school education 57 (45.60%), whereas few 5 (4.00%) had none. The majority of the participants were unemployed 85 (68.00%).
Summary of satisfaction ratings
Staff courtesy had the highest medianIQR rating 5 (1), whereas waiting time for phlebotomy had the least 3 (1). The medianIQR rating for overall satisfaction was 4 (0) [Table 1].
Most important service category
Participants considered cleanliness of phlebotomy area 26 (20.80%), ease of phlebotomy 23 (18.40%) and comfort of chairs 22 (17.60%) as the three most important service categories. Availability of toilets was considered as the least important 1 (0.80%) [Table 2].
Derived satisfaction scores (on a scale of 1–5)
Staff courtesy had the highest derived satisfaction score (4.25), whereas cleanliness of toilets had the least (3.12). The overall satisfaction score for the haematology laboratory was 3.94 [Table 3].
Percentage of satisfied participants
Cleanliness of phlebotomy area had the highest satisfaction percentage (85.60%), whereas the least was for waiting time for phlebotomy (49.60%). The overall satisfaction percentage for the laboratory was 81.60% [Table 4].
Age and satisfaction ratings
There was a positive, weak and statistically significant correlation between the age of participants and satisfaction ratings for staff courtesy (ρ = 0.222, P = 0.01) on one hand and the age of participants and information on how to receive results (ρ = 0.205, P = 0.02) on the other.
The age of participants and overall satisfaction ratings had very weak, positive and non-significant correlation (ρ = 0.081, P = 0.37).
Gender and satisfaction ratings
Although females consistently had lower satisfaction ratings than males in most service categories, there was no statistically significant difference between males and females in ratings for all service categories. Additionally, females had lower but non-significant ratings for overall satisfaction.
Education, occupation and satisfaction ratings
The distribution of satisfaction ratings did not vary significantly across educational levels and occupational status.
| Discussion|| |
The patient satisfaction with waiting time for phlebotomy 62 (49.60%) in this study was higher than the 28.8% reported by Iloh et al. in Umuahia, Nigeria. This is, however, lower than the findings of Iliyasu et al. in Kano, Nigeria where only 25.8% of the respondents felt there was a delay in attending to patients in the laboratory. These findings are, however, much lower than the 78.1% reported satisfaction among South Korean patients by Koh et al. The possible reasons for these variations may include differences in patient turnover, number of clinics run, number of doctors and laboratory staff. Additionally, the spacing of patient appointments may be contributory.
Satisfaction with ease of phlebotomy in this study is lower than the reports of Koh et al. (85.9%). This may be as a result of variations in competencies of phlebotomists, nature of veins of the patient population or even their pain thresholds. This study also revealed a comparable level of satisfaction with staff courtesy (76.80%) to that reported by Iloh et al. (74.4%). Both are, however, lower than the 82.1 and 93.1% reported by Koh et al. and Teklemariam et al. among Ethiopian patients, respectively. Staff courtesy may vary depending on the attitude of staff and pressure of work. The pressure of work may make the most amiable staff become less accommodating.
The high level of satisfaction with privacy in this study is mirrored by the additional finding that patients consider privacy to be the most important service category. Importantly, the level of satisfaction with privacy in this study is far less than the 89.2% reported by Mindaye and Taye among Ethiopian patients. The perception of importance of particular service areas can serve as additional guides to the management in prioritizing areas of intervention in addition to the considerations of satisfaction scores. It is, however, important to note that patients may consider certain areas less important because they spend less time in such areas.
This study has shown that gender, educational level and occupational status do not affect patient satisfaction with laboratory services. While this is in keeping with the findings of Teklemariam et al., Woldeyohanes et al. found an association between satisfaction and education but none with occupation. However, the latter study assessed patient satisfaction with hospital-wide services, the laboratory inclusive. Differences in the value systems of patients, cultural norms and response bias may be the possible reasons for these differences.
The overall satisfaction of 81.60% in this study is high. Although this is slightly higher than that reported by Ofili et al. (73.2%) in Benin-City, Nigeria, it is comparable to the 80.4% reported by Koh et al. Woldeyohanes et al. working in Ethiopia have reported a far lower satisfaction with the laboratory among patients (30.9%).
This study did not assess number of visits, ethnicity, utilization of insurance and respondents’ places of dwelling. This notwithstanding, this study has been able to generate data that can serve as initial key performance indicators for diverse patient-related service categories. Additional studies to assess physician satisfaction with the quality of haematology laboratory services will be important in further assessing customer service.
Satisfaction scores and percentage of satisfied patients are metrics computed in different ways. However, each can be utilized as an independent, actionable and measurable source for quality indicators; care must be taken to compare scores with scores and not with percentages. A satisfaction score or percentage, regardless of how high, is not an end in itself. This is because continuous improvement is the central dogma of laboratory quality. This concept is exemplified by Jegede et al. who despite recording an increase in satisfaction, from 59% in 2012 to 78% in 2013, noted that this still fell short of their ≥80% benchmark.
In conclusion, although there is a high level of overall satisfaction among patients, satisfaction with waiting time and cleanliness of toilets are low. All metrics should be considered as opportunities for improvement.
Root cause analyses (RCAs) will be required to elucidate reasons for unsatisfactory metrics. These metrics and the findings of RCAs should serve as inputs in the laboratory management review process to institute, monitor and evaluate, immediate and long-term interventions. These interventions may include expansion and upgrading of facilities, recruitment of more phlebotomists and cleaners, training and retraining of phlebotomists, increased privacy of the phlebotomy process and utilization of Laboratory Information System. We also recommend a yearly appraisal of these set targets.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Customer Service. Laboratory Quality Management Systems Handbook: Version 1.1. Geneva: World Health Organization; 2012. p. 151-60.
Medical and Dental Council of Nigeria (MDCN). Job descriptions and qualifications of the various cadres of staff in the clinical (medical) laboratory. In: Regulation of Laboratory Medicine (Clinical Laboratory) Practice in Nigeria. 2nd ed. MDCN; 2012. p. 8-13.
Shahangian S, Snyder SR. Laboratory medicine quality indicators. A review of the literature. Am J Clin Pathol 2009;131:418-31.
Warade J. Outline of quality indicators in clinical laboratory. Int J Basic Appl Sci 2014;4:275-87.
Jones BA, Bekeris LG, Nakhleh RE, Walsh MK, Valenstein PN. Physician satisfaction with clinical laboratory services. A college of american pathologists Q-probes study of 138 institutions. Arch Pathol Lab Med 2009;133:38-43.
Adulkader NM, Garcia TB. Physician satisfaction with hospital clinical laboratory services in Aden Governorate, Yemen, 2009. East Mediterr Health J 2013;19:555-60.
Iloh GU, Ofoede JN, Njoku PU, Ifedigbo CV, Iwuamanam KD. Evaluation of patients’ satisfaction with quality of care provided at the national health insurance scheme clinic of a tertiary hospital in South-Eastern Nigeria. Niger J Clin Pract 2012;15:469-70. [Full text]
Iliyasu Z, Abubakar IS, Abubakar S, Lawan UM, Gajida AU. Patients’ satisfaction with services obtained from Aminu Kano Teaching Hospital, Kano, Northern Nigeria. Niger J Clin Pract 2010;13:371-8.
] [Full text]
Koh RY, Kim YS, Kim SI, Chang LC, Lee YE, Son CH et al.
Customer satisfaction survey with clinical laboratory and phlebotomy services at a tertiary care unit level. Ann Lab Med 2014;34:380-5.
Teklemariam Z, Mekonnen A, Kedir H, Kabew G. Clients and clinician satisfaction with laboratory services at selected government hospitals in eastern Ethiopia. BMC Res Notes 2013;6:15. Available from: http://www.biomedcentral.com/1756-0500/6/15
. [Last accessed on 2016 Nov 02].
Mindaye T, Taye B. Patients satisfaction with laboratory services at antiretroviral therapy clinics in public hospitals, Addis Ababa, Ethiopia. BMC Res Notes 2012;5:184. doi: 10.1186/1756-0500- 5-184.
Woldeyohanes RT, Woldehaimanot ET, Kerie WM, Mengistie AM, Yesuf AE. Perceived patient satisfaction with in-patient services at Jimma University Specialized Hospital, Southwest Ethiopia. BMC Res Notes 2015;8:285. doi: 10.1186/s13104-015- 1179-8.
Ofili AN, Ofovwe CE. Patients’ assessment of efficiency of services at a teaching hospital in a developing country. Ann Afr Med 2005;4:150-3.
Salinas M, Lopez-Garrigos M, Gutierrez M, Lugo J, Sirvent JV, Uris J. Achieving continuous improvement in laboratory organization through performance measurements: A seven year experience. Clin Chem Lab 2010;48:57-61.
Jegede FE, Mbah HA, Aminu M, Yakubu TN, Torpey K. Evaluation of laboratory performance with quality indicators in infectious disease hospital, Kano, Nigeria. Open J Clin Diagn 2015;5:1-9. doi: 10.4236/ojcd.2015.51001
[Table 1], [Table 2], [Table 3], [Table 4]