|Year : 2020 | Volume
| Issue : 4 | Page : 267-271
Patient satisfaction with neurosurgical care at King Saud University Medical City
Nasser Almujaiwel1, Ghadeer Alsager1, Sarah Bin Abdulqader2, Safdar Malik3, Sherif Elwatidy3
1 College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
2 Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
3 Department of Neurosurgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
|Date of Submission||26-Mar-2019|
|Date of Decision||19-Apr-2020|
|Date of Acceptance||27-Apr-2020|
|Date of Web Publication||25-Jun-2020|
College of Medicine, King Saud University, King Saud University Medical City, P. O. Box 242069, Riyadh 11322
Source of Support: None, Conflict of Interest: None
Objectives: The objectives of this study were to determine the extent of patient satisfaction with the care provided by the neurosurgery team in our institution. Methods: This cross-sectional study was conducted at King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia. Adult postoperative neurosurgical patients, who had elective surgery between January 2018 and March 2019, were included. Data were collected over 3 weeks during May 2019 through telephonic interviews. Ninety-three patients were included (47 cranial and 46 spinal cases). Results: A total of 85 questionnaires were completed. Sixty-nine percent of patients who underwent spinal surgeries did not seek a second opinion from another specialist, whereas 81.4% of the patients with cranial pathologies did. The mean for patient satisfaction for the cranial cases was 88.4%. Cranial patients were least satisfied with the consultant's explanations of the procedure and most satisfied with how their privacy was respected. Spinal patients were least satisfied with the availability of the resident and most satisfied with the availability of the nursing staff. Overall, 91.8% of the patients indicated that they were satisfied with the service that they received. Conclusion: The majority of the patients were satisfied with the care provided by the neurosurgery team at KSUMC and with the results of the surgery. The majority of the patients who underwent spinal surgery did not seek a second opinion from another neurosurgeon, whereas the majority of the cranial patients sought a second opinion.
Keywords: Care, neurosurgery, satisfaction
|How to cite this article:|
Almujaiwel N, Alsager G, Abdulqader SB, Malik S, Elwatidy S. Patient satisfaction with neurosurgical care at King Saud University Medical City. J Nat Sci Med 2020;3:267-71
|How to cite this URL:|
Almujaiwel N, Alsager G, Abdulqader SB, Malik S, Elwatidy S. Patient satisfaction with neurosurgical care at King Saud University Medical City. J Nat Sci Med [serial online] 2020 [cited 2021 Jan 21];3:267-71. Available from: https://www.jnsmonline.org/text.asp?2020/3/4/267/287699
| Introduction|| |
Patient satisfaction has become an important factor when considering health-care quality, and it is thus important to assess patient satisfaction.,,, In the past, patients' feelings have not been viewed as a major indicator of quality of clinical practice as it has been assumed that patients lack the scientific and specialized knowledge required to assess clinical standards. Nevertheless, new research has confirmed that the degree of patient satisfaction is a predictor of treatment compliance and the likelihood of returning for treatment or changing health-care providers.,,
There is no specific definition of patient satisfaction; however, quality of health services received, patient expectations, and cost-effectiveness are contributing factors., Medical practice is progressing from being disease-centered into patient-centered care, with health research increasingly focusing on patient-reported outcomes.,, In order to provide the comprehensive services that patients deserve, it is important to not only evaluate clinical outcomes but to also consider patient feedback on services and care. There is always room for improvement in health care as no health-care system is without faults. Reviewing the current system to identify areas to improve on will thus lead to better clinical standards and improvement in patient care quality. Assessment of care is also important for medical providers as it makes them aware of how their services are perceived by patients and enables them to adequately react to and resolve any problems.,, When patients are formally asked about satisfaction, they tend to answer with satisfaction as they feel gratitude toward the health providers. However, patient satisfaction surveys using a scale from “very satisfied” to “very dissatisfied” have been shown to be valuable and highly reliable. There have been a number of Saudi Arabian studies addressing patient satisfaction in other specialties. A study at King Abdulaziz Medical City in Riyadh involving inpatients, outpatients, and emergency care patients concluded that there was a significant satisfaction with staff respecting them 87.4% and dissatisfied with physicians not explaining procedures 57.2% and not introducing themselves 59.1%. Another study was conducted in Jeddah primary health services, which found that communication skills were the most important patient satisfaction-determining factor. Another study of cancer patients in eight Riyadh hospitals showed that the lowest level of satisfaction on a five-point scale was attentive listening to patients' complaints, which received only 2.22 points. A research conducted in Albaha addressed the impact of service quality perception on patient satisfaction and to determine which dimension from 5 dimensions (tangible, reliability, responsive, assurance, and empathy) has the greatest impact on patient satisfaction. They found that empathy dimension is the greatest influence on patient satisfaction. The objective of this study was to evaluate patient satisfaction with the neurosurgical team at a prominent tertiary care center.
| Methods|| |
This cross-sectional study was conducted at King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia. KSUMC is an academic institution, treating various neurosurgical cases, general, trauma, spine, skull base, vascular, and pediatrics. The research was approved by the Institutional Review Board of the College of Medicine at King Saud University, Riyadh, Kingdom of Saudi Arabia. All postoperative neurosurgical patients who had surgery between January 2018 and March 2019 were considered. Emergency cases, patients younger than 18 years old, and patients operated in other hospitals or other departments were excluded. The study population consisted of 93 patients, of which 47 were cranial cases and 46 were spinal cases.
Data were collected over 3 weeks during May 2019 through telephonic interviews. Before the commencement of the survey, patients were assured of their anonymity and consent was obtained. Participants were informed of the purpose of the study that no incentives or rewards would be given for study participation and that they had the right to withdraw at any time with no obligation toward the study team.
The questionnaire was designed by us and tested for validity by doing a pilot study on a sample of 15 patients to ensure accuracy and proper language. There were no changes required on the questionnaire, and we included those 15 patients in our results. The questionnaire was translated into Arabic to ease patient understanding and was conducted and filled in by the interviewer. Approximately 4 min was required to fill in one survey. The questionnaire consisted of basic demographic information such as age, gender, and nationality as well as 13 questions pertaining to patient satisfaction. Age was categorized as “18–40,” “41–60,” “61–80,” and “above 80.” Patient satisfaction was rated according to a 5-point Likert scale. “Strongly agree” and “agree” categories were grouped together and “strongly disagree” and “disagree” were grouped together, leaving three categories for data analysis, namely “agree,” “neutral,” and “disagree.” The questions were selected intentionally to reflect the latent variables that they were designed to measure.
Microsoft Office Excel 2016 was used for data entry, and IBM IBM SPSS Statistics for Windows, version 21.0 (IBM Corp., Armonk, N.Y., USA) was used for statistical analysis. Chi-squared goodness-of-fit tests were conducted for the cranial and spinal cases separately as well as for both groups combined. P < 0.05 was considered statistically significant.
| Results|| |
A total of 85 questionnaires were completed out of 93 recruited patients (response rate: 91%). The respondents were almost equally distributed in terms of gender (51.8% of females and 48.2% of males). The highest percentage of patients was in the “18–40” age category (38.8%), followed by the “41–60” category (35.3%) and the “61–80” category (24.7%). Only one participant was older than 80 (1.2%). The majority of the respondents were Saudis (78.8%). Patient demographics are viewed in [Table 1].
|Table 1: Frequencies of patient demographics (age, gender, and nationality)|
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The results of the patient satisfaction survey are viewed in [Table 2]. Results of the Chi-squared test were significant for almost all aspects of patient satisfaction toward the care, indicating that the answers to the questions (namely “agree,” “neutral,” and “disagree”) were unevenly distributed. The only exception was for the question regarding nurse availability where all spinal case participants indicated “agree” and the test could not be performed.
|Table 2: Patient satisfaction toward the care provided by the neurosurgery team - the results of the Chi-square test|
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For the majority of the questions, the most common answer was agreement, which points toward patient satisfaction. There was only one instance for which the percentage of disagreeing patients was higher than the percentage of agreeing patients. Sixty-nine percent of spinal patients did not get a second opinion about their diagnosis. In contrast, 81.4% of the patients with cranial cases sought a second opinion regarding their diagnosis from another consultant.
The mean for patient satisfaction for the cranial cases was 88.4%. Cranial patients were least satisfied with the consultant's explanations of the procedure and its complications (79.1%) and most satisfied with how the whole team respected their privacy (97.7%). As for the spinal cases, patients were least satisfied with the availability of the resident when needed (59.5%) and notably, all patients were satisfied with the availability of the nursing staff (100%). When considering the cranial and spinal patients combined, it was observed that patients were most satisfied that the nursing staff treated them kindly, and with respect (92.9%), the nurses were available when needed (96.5%) and that their privacy was respected (94.1%). Overall, 91.8% of all the patients indicated that they were satisfied with the overall service that they received.
[Table 3] presents the results of a Chi-squared test for age, gender, and nationality in relation to patient satisfaction (question I am overall satisfied with the service). All of them were significant, and they closely follow the pattern described in the previous section. Overall, answers to the question were unevenly distributed for the age, gender, and nationality-based groups. The majority of the patients, regardless of their demographic characteristics, were satisfied, as shown by the very high percentages of “agree” answers.
|Table 3: Overall patient satisfaction toward the care provided by the neurosurgery team in relation to age, gender, and nationality - the results of the Chi-square test|
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| Discussion|| |
The primary objective of this study was to determine the overall satisfaction with the neurosurgical care in a single center by conducting surveys with postoperative patients. We found that a high percentage of patients agreed that they were overall satisfied with the care that they received 91.8%. Similarly, a study in a large hospital in London (NHS study) showed that initially, 76.7% of the neurosurgical patients were satisfied. Following implementation of measures for improvement, namely staff education, meetings, and posters, the satisfaction level increased to 90.6%. Another study conducted at the Pakistan Institute of Medical Sciences (PIMS) had similar findings, with the overall satisfaction index for neurosurgical patients being 94.9%. A study in Finland where they found a vast majority 93.8% of the patients reported high overall patient satisfaction with neurosurgery care, their theory behind the patients with low overall satisfaction may better reflect poor patient experience such as poor postoperative overall health status or the presence of severe postoperative symptoms.
In our study, we found that 85.9% of the patients were satisfied with the consultant's approach (with respect and kindness) and 82.4% of the patients were satisfied with the consultant's explanation of the diagnosis. This is consistent with a previous study from the National Hospital for Neurology and Neurosurgery in London (NHNN study), which found that 84% of the patients reported that they felt the neurosurgeon was friendly and approachable and 69% of the patients reported that their surgeons made every effort to inform them about their condition and the proposed treatment.
In our study, 72.9% of all the patients agreed that the residents were available when needed. However, when looking at the two patient groups separately, it is seen that only 59.5% of the spinal patients agreed that the residents were available when needed. In comparison, the NHS study reported that 82% of the patients were completely satisfied with the care provided by residents. Resident's role might be vague to the patient; a study about neurosurgery patients' feelings about the role of residents in their care found that the majority of the patients had very little to no knowledge about residents and their role. Most were unaware that the residents had obtained a medical degree.
Regarding the availability of the nursing staff, we found that 96.5% of all the patients and 100% of the spinal cases were satisfied compared to the NHS study where they found that the level of nursing satisfaction was 89.3%. Our study showed that 94.1% of the patients were satisfied with the privacy, which is comparable to the NHNN study in which 95% of the patients felt the privacy arrangements were very good or at least adequate. The NHNN study further reported that 76% of the patients felt enough time was spent discussing issues that were raised, whereas 87.1% of our patients were satisfied with the time spent on their care and treatment. Patient satisfaction with the outcome of the surgery was 85.9%. In the PIMS study, management was the lowest rated area with 86.97%. In regard to clinical outcomes, a systematic review about patient satisfaction in spine surgery found no consistent correlation between the achievement of the radiographic goal and the achievement of patient satisfaction. Questioning regarding getting a second opinion from another consultant about the diagnosis showed interesting results. We found that 81.4% of the cranial cases sought a second opinion as opposed to only 26.2% of the spinal cases. We propose that cranial patients were more likely to seek a second opinion in order to be certain of their diagnosis or due to surgeon preference. More research is, however, needed on the need for neurosurgical patients to seek a second opinion as no other studies are currently available. We investigated the relation between patient demographic data and overall satisfaction, and we found no significant difference between age, gender, and nationality. The previously mentioned spine surgery systematic review found that there was no significant difference in the satisfaction reported by different age groups and no sex-based differences in the satisfaction rates.
The main limitation that we encountered was during data collection. We had difficulty in reaching patients by telephone at a suitable time and had to phone repeatedly. Other limitations include that some of the resident physicians changed over the course of the study, the study was conducted in a single center, there may be recall bias, and the findings are not representative of all neurosurgery patients.
| Conclusion|| |
The majority of the patients were satisfied with the care provided by the neurosurgery team at KSUMC as well as with the results of the surgery. The majority of the patients who underwent spinal surgery did not seek a second opinion from another neurosurgeon, whereas the majority of cranial surgery patients did seek a second opinion.
This is one of the first studies to investigate the extent of patient satisfaction towards neurosurgical care in Saudi Arabia. In order to enhance healthcare quality, further investigation is of paramount importance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Andaleeb SS. Service quality perceptions and patient satisfaction: A study of hospitals in a developing country. Soc Sci Med 2001;52:1359-70.
Aharony L, Strasser S. Patient satisfaction: What we know about and what we still need to explore. Med Care Rev 1993;50:49-79.
Hall JA, Dornan MC. What patients like about their medical care and how often they are asked: A meta-analysis of the satisfaction literature. Soc Sci Med 1988;27:935-9.
Naidu A. Factors affecting patient satisfaction and healthcare quality. Int J Health Care Qual Assur 2009;22:366-81.
Davies AR, Ware JE. Involving Consumers in Quality of Care Assessment do they Provide Valid Information? Paper No. P-7400. Santa Monica, CA: Rand Corporation; 1987.
Kincey J, Bradshaw P, Ley P. Patients' satisfaction and reported acceptance of advice in general practice. J R Coll Gen Pract 1975;25:558-66.
Roghmann K, Hengst A, Zastowny T. Satisfaction with medical care: Its measurement and relation to utilisation. Med Care 1979;17:461-77.
Weiss B, Senf J. Patient satisfaction survey instrument for use in health maintenance organisations. Med Care 1990;28:434-45.
Williams B. Patient satisfaction: A valid concept? Soc Sci Med 1994;38:509-16.
Crow R, Gage H, Hampson S, Hart J, Kimber A, Storey L, et al
. The measurement of satisfaction with healthcare: Implications for practice from a systematic review of the literature. Health Technol Assess 2002;6:1-244.
Epstein RM, Street RL Jr. The values and value of patient-centered care. Ann Fam Med 2011;9:100-3.
Tinetti ME, Naik AD, Dodson JA. Moving from disease-centered to patient goals-directed care for patients with multiple chronic conditions: Patient value-based care. JAMA Cardiol 2016;1:9-10.
van der Eijk M, Nijhuis FA, Faber MJ, Bloem BR. Moving from physician-centered care towards patient-centered care for Parkinson's disease patients. Parkinsonism Relat Disord 2013;19:923-7.
Ryland RK. The patients charter: The United Kingdom experience. J Adv Nurs 1996;23:1059-60.
Khan A, Naushad Chaudhry M, Khalid S, Nandi D. Improvement of patient satisfaction with the neurosurgery service at a large tertiary care, London-based hospital. BMJ Qual Improv Rep 2014;3. pii: u203956.w1881.
Meredith P, Gillham NR. NHS provision for the treatment of ankle fractures: A patient satisfaction study. J R Soc Med 1993;86:332-5.
Alaloola NA, Albedaiwi WA. Patient satisfaction in a Riyadh tertiary care centre. Int J Health Care Qual Assur 2008;21:630-7.
Al-Doghaither AH, Saeed AA. Consumers' satisfaction with primary health services in the city of Jeddah, Saudi Arabia. Saudi Med J 2000;21:447-54.
Ibrahim EM, Al-Saad R, Wishi AL, Khafaga YM, El Hussainy G, Nabhan A, et al
. Appraisal of communication skills and patients' satisfaction in cross-language encounters in oncology practice. J Cancer Educ 2002;17:216-21.
Alghamdi FS. The impact of service quality perception on patient satisfaction in government hospitals in Southern Saudi Arabia. Saudi Med J 2014;35:1271-3.
IBM SPSS Inc. SPSS Statistics for Windows. Vol. Version 21. Armonk, NY; 2012.
Saaiq M, Zaman KU. Pattern of satisfaction among neurosurgical inpatients. J Coll Physicians Surg Pak 2006;16:455-9.
Reponen E, Tuominen H, Hernesniemi J, Korja M. Patient Satisfaction and short-term outcome in elective cranial neurosurgery. Neurosurgery 2015;77:769-75.
Thorne L, Ellamushi H, Mtandari S, McEvoy AW, Powell M, Kitchen ND. Auditing patient experience and satisfaction with neurosurgical care: Results of a questionnaire survey. Br J Neurosurg 2002;16:243-55.
Knifed E, July J, Bernstein M. Neurosurgery patients' feelings about the role of residents in their care: A qualitative case study. J Neurosurg 2008;108:287-91.
Menendez JY, Omar NB, Chagoya G, Tabibian BE, Elsayed GA, Walters BC, et al
. Patient satisfaction in spine surgery: A systematic review of the literature. Asian Spine J 2019;13:1047-57.
[Table 1], [Table 2], [Table 3]