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Research on Humanities and Social Sciences ISSN 2222-1719 (Paper ISSN 2222-2!"# ($nline %ol.#& No.

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Effects of Provider-Patient Relationship on the Rate of PatientS Recovery among Inpatients at Wa Regional Hospital
)illiam *ng+o1& Hannah *,o-inga2 1. .epartment o/ 0an+ing and 1inance& School o/ 0usiness and 2aw& 3ni4ersit- /or .e4elopment Studies& P. $. 0o5 3P) #"& )a 6ampus. 7mail8 angwillie9hotmail.com:wang+o9uds.edu.gh 2. Health *ssistants ;raining School& ;eshie Nungua& *ccra Abstract 7//ecti4e interpersonal relationship ,etween healthcare pro4ider and patient is an important element /or impro4ing patient satis/action. ;he primar- o,<ecti4e o/ this stud- is to e5amine the ps-chological impact o/ pro4ider-patients relationship on patient satis/action in the 3pper )est Regional Hospital. *n e5plorator=uantitati4e research method was adopted to e5plore the proposed concepts o/ the stud-. ;he targeted population included a cross section o/ '(( patients who were see+ing healthcare in the )a Regional hospital during the stud- period. ;he results o/ the stud- re4ealed that patients in the stud- had high le4els o/ satis/action with care gi4en which in/luenced their rate o/ reco4er-. It was also /ound that satis/action in/luenced patients> compliance with medical recommendations among others. ;here are more emphasis with regards to the le4el o/ patient satis/action with healthcare and medical care ser4ice as e4idenced ,- the greater num,er o/ empirical and theoretical pu,lications regarding satis/action in recent -ears& this emphasis is consistent with ,roader trend towards holding those who control and pro4ide essential ser4ices more accounta,le to their consumers in wa-s other than the ones that commonl- operate in the mar+et. Patient satis/action is there/ore important ,ecause it leads to a higher rate o/ patient retention and customer lo-alt-. ;hese also in/luence the rates o/ patient compliance with medical recommendation. Polic- ma+ers and hospital administrators should there/ore paattention to what their patients> need /rom their hospitals and do e4er-thing within their power to meet those needs. Key ords8 pro4ider-Patient Relationship& rate o/ reco4er-& inpatients& le4el o/ satis/action !ac"gro#nd ;here is this sa-ing in the ,usiness world that ?the customer is alwa-s right@. ;his means that customers ha4e a choice as to what the- want and there/ore will continue to use products and ser4ices as long as the- are con4inced o/ the =ualit- o/ such ser4ices. Healthcare pro/essionals ha4e a tas+ o/ pro4iding medical ser4ices to patients recei4ing treatment under their care. In other words& .octors& Nurses& Records o//icers& .ispensartechnicians& and other allied healthcare pro4iders pla- 4arious roles in pro4iding ser4ices to patients. ;here/ore the wa- and manner in which the- relate with patients greatl- contri,utes to patient satis/action with ser4ices rendered to them. 7//ecti4e interpersonal relationship ,etween healthcare pro4ider and patient is an important element /or impro4ing patient satis/action (*ndalee, and Simmonds& 1997 . *necdotall-& patient satis/action could translate into treatment compliance& reco4er- rate and health outcomes. Patients who understand the nature o/ their illness and its treatment and ,elie4e the pro4ider is concerned a,out their well,eing show greater satis/action with the care recei4ed and are more li+el- to compl- with treatment regimens. Se4eral studies conducted in de4eloped countries show strong positi4e health outcomes and impro4ed =ualit- o/ care associated with e//ecti4e interpersonal relationship. (Parson& 197' . ;he mind pla-s an important role in the well,eing o/ a person. *s de/ined ,- the )orld Health $rganiAation ()H$ in 19B!& ?Health is a state o/ complete ph-sical& mental and social well,eing and not merel- the a,sence o/ disease and illness@. 0eing satis/ied with treatment and care& gi4es an indi4idual a sense o/ well,eing and this can increase speed o/ reco4er- /rom ill health& since the outcome o/ treatment has ,een pro4en to ha4e ,oth ph-sical and ps-chological components. Healthcare is 4ital /or e4er- indi4idual in the treatment o/ ,oth ,iological and ps-chological disorders. Cust li+e an- other consumer o/ ser4ices& the greatest e5pectation o/ patients /rom healthcare pro4iders in alle4iating such su//erings is in part e5plained ,- the dimension o/ satis/action. .issatis/action certainl- results in dispute among ser4ice pro4iders and patients since patients are the primar- ,ene/iciaries o/ the ser4ices and care that hospitals pro4ide. Patient satis/action is de/ined ,- Pascoe (19!# as the patient>s reaction to salient aspects o/ the conte5t& process and results o/ their e5perience. Satis/action was also de/ined ,- Speeding D Rose (19!' as the ph-sician>s a,ilit- to communicate concern& warmth and interest in the patient as a whole person which e4o+es a positi4e response /rom the patient. 3nless the medical encounter is success/ul in relie4ing the patient>s emotional distress endangered ,- s-mptoms o/ illness and uncertainties o/ treatment& it ma- not pro4ide the /ull measure o/ satis/action to the patient. Patient satis/action measures the patients> opinion o/ the =ualit- o/ healthcare ser4ices pro4ided to them and their /amil- mem,ers:4isitors during their sta- in the hospital. ;here are man- important /actors that contri,ute

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Research on Humanities and Social Sciences ISSN 2222-1719 (Paper ISSN 2222-2!"# ($nline %ol.#& No.1'& 2(1#

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to the patient>s e5perience with ser4ice pro4ision in the hospital. *lso& it is important ,ecause it leads to a higher rate o/ patient retention and customer lo-alt- (Nelson and 2arson& 199# and in/luences the rates o/ patient compliance with ph-sician ad4ice (6alnan 19!!E Roter& Hall& and FatA 19!7 . Patients as customers are not homogeneous in what the- e5pect /rom care pro4iders (Reiden,ach and Sandi/er-Smallwood 199( & and that di//erent patient su,groups (e.g.& old 4ersus -oung and chronic 4ersus acute ma- place di//erent degrees o/ importance on the 4arious =ualit- dimensions that in turn in/luence patient satis/action (1letcher& 19!# . ;o cope with the emerging concern a,out cost containment and cost e//ecti4eness o/ healthcare inter4entions& pro4iders must learn how to e//ecti4el- satis/- the needs and desires o/ their patients. 6onse=uentl-& the culture is shi/ting /rom emphasiAing the e//icac- and e//ecti4eness o/ care outcomes to adapting ser4ices in response to patient needs (.ona,edian 199"E )illiams 199B . In this new culture& pro4iders and polic-ma+ers are increasingl- using patient satis/action measures to assess the per/ormance o/ healthcare organiAations (Hi,,ard and Cewett 199" . 74er-one o/ten has positi4e or negati4e word-o/-mouth upon 4isiting the hospital. 2ong waiting time& insensiti4it-& apparentl- /ault- diagnoses and treatments that ha4e no e//ect on patients in recent times causes patients dissatis/action. In Ghana& the issue o/ satis/actor- health ser4ices has alwa-s ,een a ma<or challenge. It is there/ore not surprising that man- organiAations which are into health thus go4ernmental& donors:partners as well as non-go4ernmental ha4e throughout these -ears made attempts to impro4e on patient satis/action in healthcare ser4ices. ;he s-stem has also e5perienced tremendous re/orms to tac+le pro,lems o/ rising costs o/ medical ser4ices& ine//iciencies in ser4ice pro4ision& poor =ualit- o/ care and ine=ualit- in ser4ice deli4er-. In 2(('& Ghana re/ormed its health sector /rom the traditional user /ee& commonl- called ?the cash and carr- s-stem@ to introduce the national health insurance scheme (NHIS . ;he scheme too+ ground /rom the success/ul e5ercise o/ the communit--,ased mutual health insurance. ;his was intended to impro4e patients> access to health care. Howe4er& since its implementation access to health care has ,een impro4ed with signi/icant compromise on =ualit-. Patients are sometimes met with un/riendl- and pro4ocati4e language /rom care pro4iders. 1rom this perspecti4e& poor communication is a hindrance to e//ecti4e pro4ider-patients relationship. $thers are lac+ o/ pri4ac- during the interaction encounter& time constraints due to hea4- patient loads or /amil- pressures& or /ear o/ lac+ o/ con/identialit- resulting in low reco4er- rate o/ patients& non-compliance to treatment& high re-admission rate. 1rom these issues a,o4e& it is imperati4e to /ocus on issues o/ patient satis/action with particular attention on the ps-chological impact o/ pro4ider patient-interaction& hence the need /or this stud-. $b%ectives of the St#dy ;he primar- o,<ecti4e o/ this stud- is to e5amine the ps-chological impact o/ pro4ider-patients relationship on patient satis/action in the 3pper )est Regional Hospital. Speci/icall-& the stud- see+sE ;o assess patients perception o/ pro4ider attitude ;o e5amine impact o/ pro4ider-patient relationship on patient satis/action ;o e5amine what constitute patients satis/action and dissatis/action. ;o e5amine the determinants o/ patient satis/action &HE$RE&I'A( )RA*EW$RK ;he Primar- Pro4ider ;heor- (*CHI& 2((# &proposed ,- *ragon is a generaliAe theor- o/ how the patientcenteredness o/ health care pro4iders a//ects outcomes li+e patient trust& satis/action& ratings o/ =ualit-& and other results. ;he theor- states that& disproportionate to an- other 4aria,le& patient satis/action is distinctl- and primaril- lin+ed to the ph-sician:pro4ider ,eha4iour and secondaril- to waiting time. ;he theor- holds that patient satis/action occurs at the ne5us o/ pro4ider power and patient e5pectations. Hore speci/icall-& patient satis/action is principall- the /unction o/ an underl-ing networ+ o/ interrelated satis/action constructs-satis/action with the primar- pro4ider& waiting /or the pro4ider& and satis/action with the pro4iderJs assistants. Hierarchicalllin+ed to patient-centered e5pectations o/ pro4ider 4alue& the ;heor- speci/ies that primar- pro4iders o//er the greatest clinical utilit- to patients. ;he ;heor- is operational ,- patient-centered measures e5clusi4el-& where onl- patients <udge the =ualit- o/ ser4ice. E*PIRI'A( (I&ERA&+RE ;he stud- o/ patient satis/action did not ,egin in earnest until the late 197(>s and earl- 19!(>s. ;his might ,e attri,uted to the commercialiAation o/ medicine& and ,- increasing interest in ?indi4idual e5perience@ among social scientists. Patient satis/action is there/ore important ,ecause it leads to a higher rate o/ patient retention and customer lo-alt- and in/luences the rates o/ patient compliance with ph-sician ad4ice (6alnan 19!!E Roter& Hall& and FatA 19!7 . * good deal o/ research has e5plored a 4ariet- o/ healthcare ser4ice =ualit- dimensions that ma- in/luence patient satis/action& such as continuit- o/ care& ph-sician e5pertise& the concern shown ,- the ph-sician and other medical sta//& and ph-sical /acilities (1letcher& 19!#E )are& .a4ies-*4er-& and Stewart 197! . *ccording to 2inder-PelA& (19!2 & 6omponents that constitute patient satis/action are 1(!

Research on Humanities and Social Sciences ISSN 2222-1719 (Paper ISSN 2222-2!"# ($nline %ol.#& No.1'& 2(1#

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accessi,ilit-:con4enience& a4aila,ilit- o/ resources& continuit- o/ care& e//icac-:outcomes o/ care& /inances& humanness& in/ormation gathering& in/ormation gi4ing& pleasantness o/ surroundings& and =ualit-:competence. Howe4er& the author /ound no theoretical /ormulation o/ patient satis/action and thus ,egan an independent theoretical wor+ ,- /ormulating a theor- ,ased on theories o/ <o, satis/action& as seemingl- little ethnographic wor+ on patient satis/action had ,een conducted ;he interaction ,etween patients and healthcare pro4iders is 4er- uni=ue. *mong other /eatures include an emotional intensit- ,ecause the healthcare pro4ider is gi4en access to the patients> ,od- and intimate details o/ the patients> li/e. .omatteo& (19!( /ound out that when ill& an emotional dependenc- can de4elop. Parson>s (19'1& 197' wor+ on the sic+ role added that& a patient is a willing passi4e recipient o/ care pro4ided ,- a +nowledgea,le health care pro4ider. ;he patients /reel- gi4e up their power to pro/essionals ,ecause the- ha4e specialiAed +nowledge that the patients do not ha4e and pro/essionals willingl- accept this power. In comparison with Parson>s sic+ role& Roth>s (19"#& 1972 studies o/ doctorKpatient relationships in tu,erculosis hospitals /ound that patients were less li+el- to remain passi4e and used negotiation and ,argaining to increase their interpersonal powerE ne4er& howe4er& to the point o/ attaining e=ualit-. Hewiston (199' and Cohnson and )e,, (199' also studied power dimensions in nurseKpatient interactions SitAia and )ood (1997 suggest that patient satis/action could ,e assessed ,- measuring 1 the degree to which patients ,elie4e that care possesses certain attri,utes and 2 the patient>s e4aluation o/ those attri,utes. ;hesuggest that satis/action is not a single concept ,ut made up o/ multiple determinants and that there e5ists three independent models o/ satis/action& each associated with one determinant. ;hus& there is the ?need /or the /amiliar&@ the ?goals o/ help-see+ing@ and the ?importance o/ emotional needs.@ 1urthermore& there is e4idence that there are two states o/ satis/action& sta,le ones related to health care generall- and d-namic ones related to speci/ic health care interactions. 6omponents o/ satis/action consist o/8 structural& technical and interpersonal aspects o/ care. 75pectations o/ patient are critical as the- /orm the ,asis /or the su,<ecti4e assessment o/ care in the rating o/ satis/action. ;here can ,e di//erent e5pectations /or di//erent aspects o/ care and patients with lower e5pectations tend to ,e more satis/ied. Satis/action should not ,e interpreted as a measure o/ =ualit- o/ care ,ut must ,e interpreted in the conte5t. ;he determinants o/ satis/action are e5pectations& patient characteristics& and ps-chosocial determinants. ;he structural aspects includes8 access& ph-sical setting& costs& con4enience& and treatment ,- nonclinical sta//:insurers. ;he technical aspects include +nowledge& competence:=ualit- o/ care& inter4entions& and outcomes. ;he interpersonal aspects includes8 communication& empath-& and education. Inui and 6arter (19!' stud- o/ pro4ider-patient communication& asserts that& e4en with the 4ast +nowledge a4aila,le on ,iological processes and disease mechanisms& communication ,etween health care pro4ider and patient is an e5tremelimportant aspect o/ health care. *ttempting to measure this& howe4er& re=uires interdisciplinar- acti4ities& since merel- measuring satis/action at the conclusion o/ an interaction cannot measure all the nuances o/ communication (,oth 4er,al and non-4er,al . ;he- descri,e methods o/ s-stematic anal-sis o/ these interactions& citing that man- o/ the methods ha4e generic similarities8 strategies utiliAed direct o,ser4ationE emphasis on speci/ic processes such as 4er,al communicationE multiple classi/ications to categoriAe encountersE and an approach to =uanti/- the e4ents. ;he authors also argue that it is important to understand pre-encounter state in order to place post-encounter measures into perspecti4e. ;his could include patient e5pectations o/ the encounter& degree o/ prior e5posure to the health care pro4ider& and demographic characteristics& all o/ which can ultimatele//ect how a patient interprets the encounter. ;he authors conclude that it is important to augment measures that categoriAe a speci/ic t-pe o/ interaction (4er,al communication is gi4en as an e5ample with measures o/ other t-pes o/ interaction& such as ,od- language. ;he- also point out that /or chronic diseases& addressing s-mptoms and pro4iding support rather than a ?cure@ is o/ten the goal& once again pointing to the importance o/ communicating e//ecti4el- with patients through the course o/ their treatment. In a stud- ,- 2inn (197' & on /actors associated with patient e4aluation o/ health 6are& he relates satis/action with health insurance co4erage& healthcare pro4ider& and ?new@ (at the time non-ph-sician health care pro4iders (e.g. ph-sician>s assistant and /ound out that there were high le4els o/ patient satis/action. Fane& Hacie<ews+i and 1inch. (1997 & also asserts that patient satis/action is not onl- important as an outcome o/ the patient>s e5perience with the health care encounter& ,ut as an important determinant o/ health-related outcomes. ;heargued that patients that had a more positi4e health care e5perience ma- ,e more li+el- to compl- with treatment or to +eep /ollow-up appointments that are a component o/ continued care. * +e- result was that ?patient satis/action indeed is related to the outcomes o/ care& ,ut that the relationship is stronger /or a,solute outcome than /or the relati4e ones@. ;his suggests that how a patient is /eeling when assessed is more important to patient satis/action than the degree o/ impro4ement in health status o4er time. H,P$&HESES * positi4e relationship e5ist ,etween patient satis/action and reco4er-

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Research on Humanities and Social Sciences ISSN 2222-1719 (Paper ISSN 2222-2!"# ($nline %ol.#& No.1'& 2(1#

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*ge& se5 and educational le4el o/ patient will positi4el- in/luence patient satis/action Satis/ied patients will ,e more li+el- to /ollow medical recommendations than unsatis/ied patients 6ommunication& in/rastructural and ps-chosocial /actors will impact positi4el- on patient satis/action

*E&H$-$($., *n e5plorator- =uantitati4e research method was adopted to e5plore the proposed concepts o/ the stud-. ;he targeted population included a cross section o/ the patients who were see+ing healthcare in the )a Regional hospital during the stud- period and consisted o/ ,oth outpatients and inpatients. * con4enience sampling design was adopted to o,tain participants /or the stud-. In all& 1(( participants in all consisting '( inpatients and '( outpatients were co4ered. ;he proportion o/ the sample o/ each group is considered using the sta//- patient ratio in the hospital. .ata was collected using a semi-structured inter4iew =uestionnaire. ;he measure was adapted /orm o/ Hc6los+e-:Hueller satis/action scale (199( & a #1 item multidimensional instrument& ' point 2i+ert scale with 6ron,ach>s alpha o/ (.!9. It was originall- de4eloped to ran+ rewards that nurse>s 4alue and that encourage them to remain in their <o,sE the Hc6los+e-:Hueller Satis/action Scale (HHSS is ,eing used e5tensi4el- in research and practice to measure nurse <o, satis/action. * pilot stud- was /irst conducted to chec+ the appropriateness o/ the =uestionnaire. *dministration o/ =uestionnaires was done under con/idential conditions. ;he =uestionnaire will comprise o/ /our sections8 Section *8 demographic in/ormation& Section 08 Patients satis/action as a result o/ the pro4ider-patient relationship& Section 68 Ps-chological impact o/ pro4iderpatient relationship& Section .8 Recommendation on a ,etter pro4ider-patient relationship. *ttaching a score o/ 1-' to a 2i+ert scale (/rom 14er- dissatis/ied- ' 4er- satis/ied will score the data. * mar+ o/ one(1 will ,e awarded /or e4er- LMes> answer i/ the =uestion is phrased to mean a positi4e relationship li+e ?.oes the healthcare pro4ider gi4e a good receptionN@ whilst a mar+ o/ Aero(( will ,e gi4en /or all LNo> answers in the same =uestion. Iuestions with three (# possi,le choices will ,e rated on a scale o/ %er- Good& Good& or Poor@ * mar+ o/ three (# or one (1 will ,e gi4en to e5treme choices. RES+(&S ;he stud- empiricall- e5amines the e//ects o/ pro4ider-patient relationship and the rate o/ patient>s reco4erspeci/icall- in4ol4ing inpatient o/ the medical unit o/ the upper west regional hospital. In the anal-sis& /i4e h-potheses were testedE the h-potheses are measured around the e5tent and the nature o/ patient satis/action as a result o/ pro4ider-patient relationship. Results o,tained are captured under /i4e headingsE the /irst part displa-ed results on satis/action and rate o/ reco4er-. ;he second part illustrated the /indings o,tained on education and how it in/luences satis/action. ;hirdl-& the stud- was also interested in /inding out how age in/luences satis/action. ;he /ourth loo+ed at Gender and Satis/action and /inall-& the stud- e5amine satis/action and compliance with medical recommendations. -emographic 'haracteristics .emographic data /or the entire sample (NO'(( . ;he sur4e- made a conscious e//ort to achie4e an e=ual gender representation. Howe4er& the inpatient response data result indicates that a,out #2P o/ the /i/t- respondents were males and rest o/ the "!P was /emales. ;his shows that ma<orit- o/ the patents on admission at the medical unit that were inter4iewed were /emales. ;he sur4e- de/ined si5 age groups. Moung people less than 2( -ears /ormed 1"P o/ sur4e- respondents& #2P and #"P were -oung adults ,etween the ages o/ 21-#( and #1-B( respecti4el-& BP and 2P were also older adults ,etween the ages o/ B1-'( and '1-"( respecti4el-& and onl- BP were aged a,o4e "( -ears. * ma<orit- o/ respondents had some /orm o/ /ormal education. 1" P o/ the respondents had uni4ersit- education and a,o4e& !P had Pol-technic education& BP with training college certi/icate& 1BP had some /orm o/ secondar- education& 1"P had a middle: CHS school lea4ing certi/icate. $nl- 7P had some primar- education and #!P o/ the respondents had no education at all. Hypothesis one/ Satisfaction and rate of recovery H-pothesis one stated that satis/ied patients are more li+el- to reco4er /aster than dissatis/ied patients. ;a,le one ,elow shows the /re=uencies o,ser4ed under the 4arious reco4er- and satis/action conditions. ;he chi-s=uare was then used to anal-Ae the data &able 0/ Satisfaction and rate of recovery 2e4el o/ Satis/action 2 d/ P Rate o/ Reco4er%er- Satis/ied Satis/ied Not Satis/ied %er- /ast 1ast Slow Source8 1ield Sur4e-& 2(1( 9( 1( 1( 1( 1#( 1'( ( 1( !( B #7.B9 (.((

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;he calculated 6hi-S=uare 4alue re4ealed Q (B O #7.B9& p R (.('S ;he e5pectation was that patients who are more satis/ied with treatment are more li+el- to ha4e /aster rate o/ reco4er- /rom their illness. ;he result presented a,o4e suggests that the 6hi-s=uare 4alue is statisticallsigni/icant and this implies that the test support the h-pothesis that patients that are 4er- satis/ied with treatment at the hospital are more li+el- to reco4er /aster than their counterparts who are not satis/ied. Hypothesis t o/ (evel of Ed#cation and rate of recovery H-pothesis two predicted that educated patients would ,e more satis/ied than uneducated patients. ;he chis=uare was used to anal-Ae the data. &able 1/ (evel of Ed#cation and Satisfaction Satis/action 2 P 2e4el o/ 7ducation %er- Satis/ied Satis/ied Not Satis/ied d/ No education PrimarHiddle:CHS SHS ;raining 6ollege(N;6 or :;eacher training Pol-technic 3ni4ersit- and a,o4e Source8 1ield Sur4e-& 2(1( "( ( 2( 1( 1( ( 1(
2

1(( 1( "( '( ( B( B(

#( 1( ( 1( 1( ( #(

12

12."7

(.#9

1rom the ta,le a,o4e chi-s=uare results re4ealed Q (12 O 12."7& pT(.('S re<ecting the h-pothesis regarding this test that educated patients are more satis/ied than uneducated patients. ;he results in ta,le two a,o4e suggest that the 6hi-s=uare is statisticall- not signi/icant and there/ore do not support the h-pothesis. .espite this /act the that the 6hi-s=uared did not support the h-pothesis (calculated PO(.#9 T critical PO(.(' & it can ,e o,ser4ed /rom our /re=uencies in ta,le 2 a,o4e& that educated patients (primar- up to uni4ersit- education and a,o4e responded to ,e more satis/ied than their counterparts with no educational at all. Hypothesis &hree/ Age of Respondents and (evel of Satisfaction H-pothesis three also predicted that older patients would ,e more satis/ied than -ounger patients. *gain the chis=uare was used. &able 2/ Age and level of satisfaction 2e4el o/ Satis/action *ge o/ Respondent %er- Satis/ied 2ess than 2( 21-#( #1-B( B1-'( '1-"( "( and a,o4e Source8 1ield Sur4e-& 2(1( ( #( "( ( 1( 1( Satis/ied '( 11( !( 2( #( 1( Not Satis/ied #( 2( B( ( ( 1( d/

1( 9.2!9 (.'('

1rom the ta,le a,o4e& chi-s=uare results re4ealed Q (1( O 9.29& pT(.('S re<ecting the h-potheses that older patients are more satis/ied than -ounger patients. 1rom the discussion a,o4e& the chi-s=uared is statisticallinsigni/icant since the calculated pO(.'(' is greater than the critical pO(.('. $perationall-& older patients are de/ined as persons aged B1 -ears and a,o4e while -ounger patients are those aged B( -ears and ,elow at their last ,irthda-. 1ollowing the discussion& it can ,e seen that -ounger patients are more satis/ied with inpatient treatment than older patients at the )a regional hospital. Hypothesis fo#r/ .ender and Satisfaction ;he /ourth h-potheses suggest that male patients will ,e more satis/ied than /emale.

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&able 3/ .ender and Satisfaction 2e4el o/ Satis/action Gender Hale /emale %er- Satis/ied #( !( Satis/ied 11( 19(
2

Not Satis/ied 2( 7(

d/ 2

(.!1

(."7

Source8 1ield Sur4e-& 2(1(

;he chi-s=uare 4alue re4ealed Q (2 O (.!1& pT(.('S. ;he rule o/ thum, is that i/ the calculated P-4alue (PO(."7 is greater than the critical p-4alue (PO(.(' & then we re<ect the null h-pothesis and conclude that the chi-s=uare is statisticall- insigni/icant. ;he results suggest that /emale patients are more satis/ied with treatment at hospital than male patients. ;he possi,le reason that can ,e gi4en /or the re<ection o/ the null h-pothesis could ,e that the sampling did not get e=ual representation in gender. In general& it was o,ser4ed that /emale (27 were more satis/ied with treatment than their male (1B counterparts at the inpatient wards Hypothesis five/ Satisfaction and 'ompliance ith treatment H-pothesis stipulated that satis/ied patients will ,e more li+el- to /ollow medical recommendations than dissatis/ied patients. &able 4/ Satisfaction and 'ompliance ith treatment 2e4el o/ Satis/action 2 P 6ompliance rate %er- Satis/ied Satis/ied Not Satis/ied d/ Mes 1(( #(( ( 7( 2(
2

No ( Source8 1ield Sur4e-& 2(1(

9.27

(.(1(

1rom ta,le ' a,o4e& the chi-s=uare 4alue showed Q (2 O 9.27& pR(.('S. ;his implies that the chi-s=uare is statisticall- signi/icant at a 'P le4el o/ signi/icance. ;his is ,ecause the calculated p-4alue (PO(.(1( is less than the 'P signi/icance le4el. 1rom ta,le ' a,o4e& the results suggest that patients that were satis/ied (4er- satis/ied complied with treatment at the hospital. -IS'+SSI$5 ;he stud- in4estigates into the ps-chological impact o/ pro4ider-patient relationship on patient satis/action (a stud- in4ol4ing inpatients o/ the medical unit o/ the upper west regional hospital& )a . ;he /irst h-pothesis sought to in4estigate satis/action among patients with regard to pro4ider-patient relationship and the e//ect o/ such satis/action on the rate o/ reco4er-.It stipulated association ,etween le4el o/ satis/action and rate o/ reco4er-. Results o/ the data anal-sis supported this h-pothesis. Satis/ied patients were reported to ha4e a /aster rate o/ reco4er- than dissatis/ied patients. Patients /ound that their e5perience at the hospital was satis/actor-. In this situation& satis/action o/ patients pertained to their interaction with care pro4iders and the ward en4ironment. ;he le4el o/ patients> satis/action with the pro4ider-patients relationship was ,ased on pro4iders> attitude& competence and waiting time /or patient. ;his h-pothesis was supported ,- Coos (199( & which noted that the relationship ,etween patient and sta// predicts patient satis/action. ;his satis/action /urther has a signi/icant in/luence on 4arious treatment outcomes and reco4er-. 1rom a ps-chological point o/ 4iew there/ore& it is apparent /rom this present research /indings that cogniti4e /actors such as perception o/ patients is +e- to their responses to clinical or therapeutic procedures. *nother h-pothesis in this stud- predicted that males would ,e more satis/ied than /emales. ;his h-pothesis was not supported. ;he results suggested that /emale patients were more satis/ied with treatment at the unit than male patients. In general& it was o,ser4ed that /emale were more satis/ied with treatment than their male counterparts at the inpatient wards. 7arlier research in this area also /ound se5 di//erence in satis/action among hospital patients. In a stud- ,- Hard-& )est and Hill (199" & men were /ound to report signi/icantl- greater satis/action on the health scale than women. * possi,le e5planation /or this contrar- /inding could ,e that the sampling did not get e=ual representation in gender this present stud- used a smaller sample siAe. It was also h-pothesiAed in this wor+ that educated patients would ,e more satis/ied than their uneducated counterparts. ;he results re4ealed that the 6hi-s=uare 4alue was statisticall- not signi/icant and there/ore do not support the h-pothesis. .espite this /act that the 6hi-s=uare did not support the h-pothesis (calculated PO(.#9 T critical PO(.(' & it was o,ser4ed /rom the /re=uencies in ta,le 2& that educated patients (primar- up to uni4ersiteducation and a,o4e responded to ,e more satis/ied than their counterparts with no educational at all. ;his h-pothesis was ,ased on /indings o/ 2iu and )ang (2((7 & and 6haralam,os and .imitris (2((' . ;he- /ound 112

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PatientsJ le4el o/ education& among other /actors such as age& occupation& methods o/ pa-ment& and hospital wards as the main /actors in/luencing patient satis/action with nursing care. ;hus educated patients were satis/ied with care than uneducated patients and thus support the results o/ the data anal-Aed. 6alnan (19!! E Roter& Hall& and FatA (19!7 & in their studies /ound patient satis/action as important ,ecause it leads to a higher rate o/ patient retention and customer lo-alt- and also in/luences the rates o/ patient compliance with ph-sician ad4ice. 6omparati4e to this stud-& the data gathered on patient satis/action and compliance con/irmed the h-pothesis which stated that ?that satis/ied patients will ,e more li+el- to /ollow medical recommendations than dissatis/ied patients@. Practicall-& Patients who understand the nature o/ their illness and its treatment and ,elie4e the pro4ider is concerned a,out their well,eing show greater satis/action with the care recei4ed and are more li+el- to compl- with treatment regimens. S#mmary and concl#sion ;his stud- anal-Aed the ps-chological impact through an e5amination o/ pro4ider- patient relationship and patients> satis/action. ;he results o/ the stud- re4ealed that patients in the stud- had high le4els o/ satis/action with care gi4en which in/luenced their rate o/ reco4er-. It was also /ound that satis/action in/luenced patients> compliance with medical recommendations among others. ;here are more emphasis with regards to the le4el o/ patient satis/action with healthcare and medical care ser4ice as e4idenced ,- the greater num,er o/ empirical and theoretical pu,lications regarding satis/action in recent -ears& this emphasis is consistent with ,roader trend towards holding those who control and pro4ide essential ser4ices more accounta,le to their consumers in wa-s other than the ones that commonl- operate in the mar+et. Patient satis/action is there/ore important ,ecause it leads to a higher rate o/ patient retention and customer lo-alt-. ;hese also in/luence the rates o/ patient compliance with medical recommendation. Polic- ma+ers and hospital administrators should there/ore paattention to what their patients> need /rom their hospitals and do e4er-thing within their power to meet those needs. ;he results o/ this research could ,e used to de4elop policies that could lead to an impro4ement in patients> satis/action and there/ore ensure ,etter pro4ider-patient relationship in the upper west regional hospital& )a. Recommendation *lthough this stud- -ielded important results a,out pro4ider-patient relationship and patient satis/action& there is much more research to ,e done. $ne recommendation is to conduct a /urther research using a much larger& randomiAed sample and more standardiAed test to measure the le4el o/ patient satis/action. ;his will help to impro4e the li+elihood o/ achie4ing statisticall- signi/icant results that could ,e generaliAed to a larger and more di4erse population. ;here are man- other studies that could /urther patients> understanding satis/action. $ne would ,e to do a =ualitati4e stud- that e5amines which /actors are most important to patients> satis/action. 1urther stud- to determine the role o/ pro4ider-patient relationship in patients> satis/action would ,e 4alua,le to hospital administrators when de4eloping ,ene/its related to =ualit- o/ care and satis/action RE)ERE5'ES *ndalee,& S. S.& and Simmonds& P. 2. (1997 . Explaining User satisfaction with academic libraries: strategic implications& 6ollege and Research 2i,raries& 3S* *ragon& C. Stephen. (2((# . A Patient-Centered Theory of Satisfaction. *merican Cournal o/ Hedical Iualit1!8No. "E 22' - 22!. 6alnan& H. (19!! . 2a- e4aluation o/ medicine and medical practice8 report o/ a pilot stud-. nternational !o"rnal of #ealth Ser$ice. 1!(2 & #11-#22. .ona,edian& *. (19"" . U74aluating the Iualit- o/ Hedical 6are.U %ilban& %emorial '"nd ("arterly: #ealth and Society BB (# 8 1""-2(#. .imatteo& H and Roter& .. (19!( . Predicting Patient Satis/action /rom Ph-sicians Non-4er,al 6ommunication s+ills. %edical Care. 1!(B E #7"-#!7. 1letcher& R. H.& H. $JHalle-& C. *. 7arp& ;. *. 2ittleton& S. ). 1letcher& H. *. Greganti& R. *. .a4ison& and C. ;a-lor. (19!# . UPatientsJ Priorities /or Hedical 6are.)%edical Care 21 (2 8 2#B-B2. Hewiston *. (199' . Nurses> power in interactions with patients. !o"rnal of Ad$anced *"rsing 21& 7'K!2. Hi,,ard& C. H.& and C. C. Cewett. (199" . U)hat ;-pe o/ Iualit- In/ormation .o 6onsumers )ant in a Health 6are Report 6ard+) %edical ,esearch and ,e$iew '# (1 8 2!-B7 Inui& ;. and 6arter& ). (19!' . Pro,lems and Prospects /or Health Ser4ices Research on Pro4ider-Patient 6ommunication. %edical Care. 2#(' 8 '21-'#!. Cohnson H. D )e,, 6. (199' . ;he power struggle o/ social <udgment8 struggle and negotiation in the nursing process. *"rse Ed"cation Today. 1'& !#-!9. Fane& R.& Hacie<ews+i& H.& and 1inch& H. (1997 . ;he Relationship o/ Patient Satis/action with 6are and 6linical $utcomes. %edical Care. #1(7 8 71B-7#(. 2inder-PelA& S. (19!2 . ;oward a ;heor- o/ Patient Satis/action. Social Science and %edicine.1"& '77-'!2.

11#

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2inn& 2. (197' . 1actors *ssociated with Patient 74aluation o/ Health 6are. #ealth and Society. %ilban& %emorial '"nd ("arterly #ealth and Society. B& '#1-'B!. Nelson& 7.6. D 2arson& 6.& (199# . PatientsJ good and ,ad surprises8 how do the- relateto o4erall patient satis/action+ ("arterly ,e$iew -"lletin. #& !9. Parson ;. (19'1 . The Social System. ;he 1ree Press& Glencoe. Parson ;. (197' . ;he sic+ role and the role o/ the ph-sician reconsidered. %illban& %emorial '"nd ("arterly.#ealth and Society. '#& 2'7K27!. Pascoe& G. 6. (19!# . UPatient Satis/action in Primar- Health 6are8 * 2iterature Re4iew and *nal-sis.) E$al"ation and Program Planning " (#:B 8 1!'-97. Roter& .. 2.& C. *. Hall& and N. R. FatA. (19!7 . URelations ,etween Ph-sicians& 0eha4iors and *nalogue PatientsJ Satis/action& Recall& and Impressions.U %edical Care 2' (' 8 B#7-'1. Roth C. (19"# . Timetables. 0o,,s-Herrill& Indianapolis. Roth C. (1972 . Some contingencies o/ the moral e4aluation and control o/ clientele. *merican !o"rnal of Sociology. 77&!#9K!'". SitAia& C. and )ood& N. (1997 . Patient Satis/action8 * Re4iew o/ Issues and 6oncepts. Social Science and %edicine/ B'8 1!29-1!B#. Speeding& 7. C. D Rose .. N. (199' . 0uilding an e//ecti4e .octor-Patient Relationship /rom Patient Satis/action to Patient Participation. Social Science and %edicine. 21(2 E ""7-"97 )are& C. 7.& .a4ies-*4er-& *.& D Stewart& *. 2. (197! . ;he measurement and meaning o/ patient satis/action. #ealth and %edical Care Ser$ices ,e$iew 1& 1-1'. )illiams& 0. (199B . Patient Satis/action8 * %alid 6oncept+ Social Science and %edicine. #!8'(9-'1". )illiams& 0.& 6o-le& C.& and Heal-& .. (199! . ;he Heaning o/ Patient Satis/action8 *n 75planation o/ High Reported 2e4els. Social Science 0 %edicine. B7(9 8 1#'1-1#'9. Appendi6 Age of Respondent 2ess than 2( 21-#( #1-B( B1-'( '1-"( *,o4e "( &otal .ender Hale 1emale &otal *arital Stat#s Harried Single )idowed .i4orced &otal Ed#cational level No education PrimarHiddle:Cunior High School Senior High School ;raining 6ollege (N;6 :;eacher training Pol-technic 3ni4ersit- and a,o4e &otal

)re7#ency !( 1"( 17( 2( B( #( 488

Percentage 1" #2 #B B ! " 088

1"( #B( 488 #1( 1"( #( ( 488

#2 "! 088 "2 #2 " ( 088

19( 2( !( 7( 2( B( !( 488

#! B 1" 1B B ! 1" 088

11B

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09 (evel of satisfaction and rate of recovery 'hi-S7#are &ests %alue Pearson 6hi-S=uare 2i+elihood Ratio 2inear-,--2inear *ssociation N o/ %alid 6ases 9.2!9 12.17' #.'#( '((
a

d/ 1( 1( 1

*s-mp. Sig. (2-sided .484 .27B .("(

a. 1" cells (!!.9P ha4e e5pected count less than '. ;he minimum e5pected count is .#". Symmetric *eas#res %alue *s-mp. Std. 7rrora Inter4al ,- Inter4al $rdinal ,- $rdinal N o/ %alid 6ases PearsonJs R Spearman 6orrelation -.2"! -.2"B '(( .1(! .117 *ppro5. ;, -1.9#1 -1.!99 *ppro5. Sig. .('9c .("Bc

a. Not assuming the null h-pothesis. ,. 3sing the as-mptotic standard error assuming the null h-pothesis. c. 0ased on normal appro5imation. Age of respondents and level of satisfaction 'hi-S7#are &ests %alue Pearson 6hi-S=uare 2i+elihood Ratio 2inear-,--2inear *ssociation N o/ %alid 6ases #7.B92 #B.7(# 2'.('9 '((
a

d/ B B 1

*s-mp. Sig. (2-sided .((( .((( .(((

a. ' cells (''."P ha4e e5pected count less than '. ;he minimum e5pected count is 1.!B. Symmetric *eas#res %alue *s-mp. Std. 7rrora Inter4al ,- Inter4al $rdinal ,- $rdinal N o/ %alid 6ases PearsonJs R Spearman 6orrelation ."7! ."'1 '(( .(!# .(9" *ppro5. ;, ".#22 '.!!( *ppro5. Sig. .(((c .(((c

a. Not assuming the null h-pothesis. ,. 3sing the as-mptotic standard error assuming the null h-pothesis. c. 0ased on normal appro5imation. .ender and Satisfaction 'hi-S7#are &ests %alue Pearson 6hi-S=uare 2i+elihood Ratio 2inear-,--2inear *ssociation N o/ %alid 6ases 11."B1 1(.2(" #.9'2 '((
a

d/ B B 1

*s-mp. Sig. (2-sided .(2( .(#7 .(B7

a. ' cells (''."P ha4e e5pected count less than '. ;he minimum e5pected count is .'B.

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Symmetric *eas#res %alue *s-mp. Std. 7rrora Inter4al ,- Inter4al $rdinal ,- $rdinal N o/ %alid 6ases PearsonJs R Spearman 6orrelation -.2!B -.1B7 '(( .1B1 .1'1 *ppro5. ;, -2.('2 -1.(2! *ppro5. Sig. .(B"c .#(9c

a. Not assuming the null h-pothesis. ,. 3sing the as-mptotic standard error assuming the null h-pothesis. c. 0ased on normal appro5imation. Ed#cation and level of satisfaction 'hi-S7#are &ests %alue Pearson 6hi-S=uare 2i+elihood Ratio 2inear-,--2inear *ssociation N o/ %alid 6ases 12.""B 1'.!(# 1.!(2 '((
a

d/ 12 12 1

*s-mp. Sig. (2-sided .#9B .2(( .179

a. 2( cells (9'.2P ha4e e5pected count less than '. ;he minimum e5pected count is .#". Symmetric *eas#res %alue *s-mp. Std. 7rrora Inter4al ,- Inter4al $rdinal ,- $rdinal N o/ %alid 6ases PearsonJs R Spearman 6orrelation .192 .191 '(( .1B2 .1BB *ppro5. ;, 1.#'B 1.#B' *ppro5. Sig. .1!2c .1!'c

a. Not assuming the null h-pothesis. ,. 3sing the as-mptotic standard error assuming the null h-pothesis. c. 0ased on normal appro5imation. (evel of Satisfaction and compliance ith treatment 'hi-S7#are &ests %alue Pearson 6hi-S=uare 2i+elihood Ratio 2inear-,--2inear *ssociation N o/ %alid 6ases 9.2"7 7.177 '.B91 B9(
a

./ 2 2 1

*s-mp. Sig. (2-sided .(1( .(2! .(19

a. # cells ('(.(P ha4e e5pected count less than '. ;he minimum e5pected count is .#7. 'ol#mn1 Inter4al ,- Inter4al $rdinal ,- $rdinal PearsonJs R Spearman 6orrelation 'ol#mn2 %alue (.##! (.##' 'ol#mn3 *s-mp. Std. 7rrora (.111 (.112 'ol#mn4 *ppro5. ;, 2.B"B 2.BB2 'ol#mn: *ppro5. Sig. .(17c .(1!c

a. Not assuming the null h-pothesis. ,. 3sing the as-mptotic standard error assuming the null h-pothesis. c. 0ased on normal appro5imation.

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*N$%* A5$;A how do -ou assess -our le4el o/ satis/action with treatment at the hospital Sum o/ S=uares 0etween Groups )ithin Groups ;otal 1(.("( 9.!'! 19.91! ./ 2( B"( B!( Hean S=uare '.(#( .21B 1 2#.B71 Sig. .(((

A5$;A did -ou conpl- with the instructions gi4en to -ou ,- the pro4ider (nurse& doctor Sum o/ S=uares 0etween Groups )ithin Groups ;otal A5$;A Gender Sum o/ S=uares 0etween Groups )ithin Groups ;otal .2'( 1(.1'! 1(.B(! ./ 2( B"( B!( Hean S=uare .12' .221 1 .'"" Sig. .'72 .(2' 1.!92 1.917 ./ 2( B'( B7( Hean S=uare .(12 .(B2 1 .297 Sig. .7BB

-eterminants of patients satisfaction A5$;Ab Hodel 1 Regression Residual ;otal Sum o/ S=uares 1(.1BB 9.77' 19.91! ./ '( B#( B!( Hean S=uare 2.(29 .227 1 !.92' Sig. .(((a

a. Predictors8 (6onstant & how do -ou assess -our rate o/ reco4er- at the hospital& Gender& highest le4el o/ educational attainment& marital status& *ge o/ respondent ,. .ependent %aria,le8 how do -ou assess -our le4el o/ satis/action with treatment at the hospital

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