Factors contributing towards patient’s choice of a hospital clinic from the patients’ and managers’ perspective
Keywords:
factors, choice, patient, military, clinicAbstract
Introduction: Given the competitive nature of the health market and the multiplicity of factors that may contribute towards patient’s choices of a hospital, patients' needs and preferences for a hospital must be considered in the planning and decision making of hospitals and health care organizations. This study aimed to identify the factors that contribute to patient’s choices of a clinic and the importance of each factor.
Methods: A mixed-method approach was used to collect quantitative and qualitative data in two phases. The study was conducted in a hospital clinic in 2014. Qualitative data were collected by face-to-face semi-structured interviews of a sample of 22 managers and heads of outpatient wards. The self-administered questionnaire designed for this study collected quantitative data from a stratified random sample of 381 patients referred to this clinic. The qualitative data were analyzed by a system of coding, while parametrical statistical analyses were conducted to analyze the quantitative data using the independent-samples t-test and ANOVA in SPSS software, version 21.0.
Results: The qualitative data indicated that there were 21 factors that may contribute to patient’s choices of a clinic, and these factors were classified into six categories, i.e., facilities and physical assets, physicians and employees, location and place, services, price, and promotion. Among the 16 questions studied in the quantitative questionnaire, the highest and lowest means were related to "appropriate clinic environment" (2.47 ± 0.58) and "advertising through TV and radio, the Internet, newspapers, etc." (1.77 ± 0.75), respectively. There were significant associations between "having experienced and responsive personnel, including physicians and employees" and the patient’s gender and frequency of referrals, between "belonging to the Armed Forces" and the patient’s age and frequency of referrals, between "advertising through TV and radio, the Internet, newspapers, etc." and shifts and frequency of referrals, between "inadequate facilities and poor quality of services provided in other health care organizations of the Armed Forces" and "adornment and good behavior of staff" and shifts (p < 0.05).
Conclusion: The most significant contributing factors to attract patients were the "physicians and employees," and “the clinic’s environment.” Therefore, it is essential for clinic managers and heads of outpatient wards to focus on and strengthen these two factors. Also, since the means of the factors were better in the morning shift, the employees should perform their duties properly and consistently in all shifts.
References
Sibbel R, Urban C. Agent-based modeling and simulation for hospital management. Cooperative agents.
: 183-99. doi: 10.1007/978-94-017-1177-7_11.
Jenkinson C, Burton JS, Cartwright J, Magee H, Hall I, Alcock C, et al. Patient attitudes to clinical trials:
development of a questionnaire and results from asthma and cancer patients. Health Expect. 2005; 8(3):
-52. doi: 10.1111/j.1369-7625.2005.00335.x
Merle V, Germain JM, Tavolacci MP, Brocard C, Chefson C, Cyvoct C, et al. Influence of infection control
report cards on patients' choice of hospital: pilot survey. J Hosp Infect. 2009; 71(3): 263-8. doi:
1016/j.jhin.2008.11.025. PMID: 19147258.
Torres EJ, Guo KL. Quality improvement techniques to improve patient satisfaction. Int J Health Care Qual
Assur Inc Leadersh Health Serv. 2004; 17(6): 334-8. doi: 10.1108/09526860410557589. PMID: 15552388.
Davis BA, Kiesel CK, McFarland J, Collard A, Coston K, Keeton A. Evaluating instruments for quality:
testing convergent validity of the consumer emergency care satisfaction scale. J nurs care qual. 2005; 20(4):
-8. doi: 10.1097/00001786-200510000-00013. PMID: 16177589.
Lee MA, Yom YH. A comparative study of patients’ and nurses’ perceptions of the quality of nursing
services, satisfaction and intent to revisit the hospital: A questionnaire survey. Int J Nurs Stud. 2007; 44(4):
-55. doi: 10.1016/j.ijnurstu.2006.03.006. PMID: 16687147.
Bjørngaard JH, Ruud T, Garratt A, Hatling T. Patients' experiences and clinicians' ratings of the quality of
outpatient teams in psychiatric care units in Norway. Psychiatr Serv. 2007; 58(8): 1102-7. doi:
1176/ps.2007.58.8.1102. PMID: 17664522.
Soufi G, Belayachi J, Himmich S, Ahid S, Soufi M, Zekraoui A, et al. Patient satisfaction in an acute
medicine department in Morocco. BMC health serv res. 2010; 10(1): 149. doi: 10.1186/1472-6963-10-149.
PMID: 20525170.
Schulmeister L, Quiett K, Mayer K. Quality of life, quality of care, and patient satisfaction: perceptions of
patients undergoing outpatient autologous stem cell transplantation. Oncol Nurs Forum. 2005; 32(1): 57-67.
doi: 10.1188/05.ONF.57-67. PMID: 15660144.
Anell A. The monopolistic integrated model and health care reform: the Swedish experience. Health Policy.
; 37(1): 19-33. doi: 10.1016/0168-8510(96)00821-4. PMID: 10158941.
Øvretveit J. Informed choice? Health service quality and outcome information for patients. Health policy.
; 37(2): 75-90. doi: 10.1016/S0168-8510(96)90053-6. PMID: 10162644.
Vrangbaek K, Bech M. County level responses to the introduction of DRG rates for “extended choice”
hospital patients in Denmark. Health Policy. 2004; 67(1): 25-37. doi: 10.1016/S0168-8510(03)00085-X.
PMID: 14726005.
Zarei A, Arab M, Froushani AR, Rashidian A, Tabatabaei SMG. Service quality of private hospitals: The
Iranian Patients' perspective. BMC health serv res. 2012; 12(1): 31. doi: 10.1186/1472-6963-12-31.
van Empel IW, Dancet EA, Koolman XH, Nelen WL, Stolk EA, Sermeus W, et al. Physicians
underestimate the importance of patient-centredness to patients: a discrete choice experiment in fertility
care. Hum Reprod. 2011; 26(3): 584-93. doi: 10.1093/humrep/deq389. PMID: 21227936.
Hart M. Improving out-patient clinic waiting times: methodological and substantive issues. Int J Health
Care Qual Assur. 1995; 8(6): 14-22. doi: 10.1108/0952686951009881316. PMID: 10165401.
Dwight-Johnson M, Lagomasino IT, Aisenberg E, Hay J. Using conjoint analysis to assess depression
treatment preferences among low-income Latinos. Psychiatr Serv. 2004; 55(8): 934-6. doi:
1176/appi.ps.55.8.934.
Yaghoubi M, Agharahimi Z, Karimi S, Javadi M. Factors Affecting Patients' Preferences in Choosing a
Hospital Based on the Mix Marketing Components in Isfahan. Hakim. 2011; 14(2): 106-14.
York AS, McCarthy KA. Patient, staff and physician satisfaction: a new model, instrument and their
implications. Int J Health Care Qual Assur. 2011; 24(2): 178-91. doi: 10.1108/09526861111105121. PMID:
Mosadeghrad AM. Patient choice of a hospital: implications for health policy and management. Int J Health
Care Qual Assur. 2014; 27(2): 152-64. doi: 10.1108/IJHCQA-11-2012-0119. PMID: 24745140.
Pawlush GG. Health care marketing minicase. J Health Care Mark. 1981; 1(4): 49-52. PMID: 10254220.
Roh CY, Lee KH, Fottler MD. Determinants of hospital choice of rural hospital patients: the impact of
networks, service scopes, and market competition. J Med Syst. 2008; 32(4): 343-53. doi: 10.1007/s10916- 008-9139-7. PMID: 18619098.
Wisniewski M, Wisniewski H. Measuring service quality in a hospital colposcopy clinic. Int J Health Care
Qual Assur Inc Leadersh Health Serv. 2005; 18(2-3): 217-28. doi: 10.1108/09526860510594776. PMID:
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.
; 6(32): 1-244. doi: 10.3310/hta6320. PMID: 12925269.
Rahmqvist M. Patient satisfaction in relation to age, health status and other background factors: a model for
comparisons of care units. Int J Qual Health Care. 2001; 13(5): 385-90. doi: 10.1093/intqhc/13.5.385.
Danielsen K, Garratt AM, Bjertnaes OA, Pettersen KI. Patient experiences in relation to respondent and
health service delivery characteristics: a survey of 26,938 patients attending 62 hospitals throughout
Norway. Scand J Public Health. 2007; 35(1): 70-7. doi: 10.1080/14034940600858615. PMID: 17366090.
Campbell J, Ramsay J, Green J. Age, gender, socioeconomic, and ethnic differences in patients'
assessments of primary health care. Qual Health Care. 2001; 10(2): 90-5. doi: 10.1136/qhc.10.2.90.
PMCID: PMC1757978.
Quintana JM, González N, Bilbao A, Aizpuru F, Escobar A, Esteban C, et al. Predictors of patient
satisfaction with hospital health care. BMC health serv res. 2006; 6(1): 102. doi: 10.1186/1472-6963-6-102.
PMCID: PMC1579213.
Habtom GK, Ruys P. The choice of a health care provider in Eritrea. Health policy. 2007; 80(1): 202-17.
doi: 10.1016/j.healthpol.2006.02.012. PMID: 16647156.
Lux MP, Fasching P, Schrauder M, Löhberg C, Thiel F, Bani M, et al. The era of centers: the influence of
establishing specialized centers on patients’ choice of hospital. Arch gynecol obstet. 2011; 283(3): 559-68.
doi: 10.1007/s00404-010-1398-0. PMID: 20180128.
Adams EK, Wright GE. Hospital choice of Medicare beneficiaries in a rural market: why not the closest? J
Rural Health. 1991; 7(2): 134-52. doi: 10.1111/j.1475-6773.2004.00324.x. PMID: 10116774.
Luft HS, Garnick DW, Mark DH, Peltzman DJ, Phibbs CS, Lichtenberg E, et al. Does quality influence
choice of hospital? JAMA. 1990; 263(21): 2899-906. doi: 10.1097/00006254-199010000-00015. PMID:
Goldsteen RL, Falcone DJ, Broyles RW, Goldsteen K, Reilly BJ. Local factors affecting the tendency to
bypass local hospitals for inpatient mental health care: an exploratory analysis. J Rural Health. 1994; 10(2):
-96. doi: 10.1111/j.1748-0361.1994.tb00215.x. PMID: 10134717.
Phibbs CS, Mark DH, Luft HS, Peltzman-Rennie DJ, Garnick DW, Lichtenberg E, et al. Choice of hospital
for delivery: a comparison of high-risk and low-risk women. Health serv res. 1993; 28(2): 201. PMID:
, PMCID: PMC1069930.
Tezak B, Chan A. Nurturing the seeds of learning: a professional development initiative for hospital-based
nurse educators. J Nurses Staff Dev. 2005; 21(3): 110-4.
Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000; 23(4): 334-40. doi:
1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G. PMID: 10940958.
Cueto M. The origins of primary health care and selective primary health care. Am J Public Health. 2004;
(11): 1864-74. doi: 10.2105/AJPH.94.11.1864. PMCID: PMC1448553.
Barekatain, M, Maracy MR, Hassannejad R, Hosseini R. Factors associated with readmission of patients at
a university hospital psychiatric ward in iran. Psychiatry journal. 2013; 1-5. doi: 10.1155/2013/685625.
Douglas CH, Douglas MR. Patient-centred improvements in health-care built environments: perspectives
and design indicators. Health Expect. 2005; 8(3): 264-76. doi: 10.1111/j.1369-7625.2005.00336.x. PMID:
Akinci F, Esatoglu AE, Tengilimoglu D, Parsons A. Hospital choice factors: a case study in Turkey. Health
Mark Q. 2004; 22(1): 3-19. doi: 10.1300/J026v22n01_02.
Gotlieb JB. Understanding the effects of nurses, patients' hospital rooms, and patients' perception of control
on the perceived quality of a hospital. Health Mark Q. 2000; 18(1-2): 1-14. doi: 10.1300/J026v18n01_01.
Woodside AG, Nielsen RL, Walters F, Muller GD. Preference segmentation of health care services: the
old-fashioneds, value conscious, affluents and professional want-it-alls. J Health Care Mark. 1988; 8(2):
-24. PMID: 10287901.
Miller L, May D. Patient choice in the NHS: how critical are facilities services in influencing patient
choice? Facilities. 2006; 24(9/10): 354-64. doi: 10.1108/02632770610677637.
Baldwin E, Shaw C. Buildings. Patient choice. Pick and mix. Health serv j. 2005; 115(5940): 38. PMID:
Green J, McDowall Z, Potts HW. Does Choose & Book fail to deliver the expected choice to patients? A
survey of patients' experience of outpatient appointment booking. BMC Med Inform Decis Mak. 2008;
(1): 36. doi: 10.1186/1472-6947-8-36. PMID: 18673533, PMCID: PMC2529277.
Sepehri A, Simpson W, Sarma S. The influence of health insurance on hospital admission and length of
stay--the case of Vietnam. Soc Sci Med. 2006; 63(7): 1757-70. doi:10.1016/j.socscimed.2006.04.029.
PMID: 16766108.
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