INVESTIGATING THE FACTORS THAT INFLUENCE CUSTOMERS

SATISFACTION IN HEALTH CARE SERVICES THE CASE OF PUBLIC

HEALTH CARE SERVICES ORGANIZATION IN HAWASSA

A THESIS PROPOSAL
SUBMITTED TO THE SCHOOL OF GRADUATE STUDIES OF GRAND
COLLEGE IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
AWARD OF THE DEGREE OF MASTER OF BUSINESS ADMINISTRATION
(MBA)

BY ASRAT SHIKA

ID NO:-077/2011

GRAND COLLEGE HAWASSA

MBA PROGRAM

JUN, 2020

HAWASSA ,ETHIOPIA

Proposal Page 1
 DECLARATION
I, ASRAT SHIKA, here by declared that this study entitled as “INVESTIGATING
THE FACTORS THAT INFLUENCE CUSTOMERS SATISFACTION IN HEALTH
CARE SERVICES THE CASE OF PUBLIC HEALTH CARE SERVICES
ORGANIZATION IN HAWASSA”, is my own work. i have
carried out the research work independently with the guidance and support of my
research advisor. this study had not been submitted to any degree/diploma in this or
any other institution. it is done in partial fulfillment of the requirements for the award
of the MASTER DEGREE OF BUSINESS ADMINISTRATION (MBA).

Name of student: ______________________________

signature: ____________________________________

place: ________________________________________

date: ________________________________________

Proposal Page 2
 CERTIFICATION
This is to certify that ASRAT SHIKA has carried out his research work on the topic
entitled “INVESTIGATING THE FACTORS THAT INFLUENCE CUSTOMERS
SATISFACTION IN HEALTH CARE SERVICES THE CASE OF PUBLIC
HEALTH CARE SERVICES ORGANIZATION IN HAWASSA””. this work is
original in nature and is suitable for submission to the award of MASTER DEGREE
OF BUSINESS ADMINISTRATION (MBA).

Name of advisor: ________________________

signature: ____________________________

place: ______________________________

date: ____________________________

BOARD OF EXAMINERS

Proposal Page 3
Internal examiner: _________________________

signature: _______________________________

date: ___________________________________

External examiner: ________________________

signature: _______________________________

date: ___________________________________

JUN, 2020

HAWASSA ,ETHIOPIA

ABSTRACT

Proposal Page 4
 The purpose of this research proposal was to INVESTIGATING THE FACTORS
THAT INFLUENCE CUSTOMERS SATISFACTION IN HEALTH CARE SERVICES
THE CASE OF PUBLIC HEALTH CARE SERVICES ORGANIZATION IN HAWASSA

This research is mainly investigating the current practice, challenges and opportunities
of the factors that influence customers satisfaction in health care services by focusing
on selected public health care services organization in hawassa.

Three sample public health care services organization were selected to strengthen the
findings of the study

. primary data is collected from 120 respondents using well-organized self-

administered questionnaire descriptive research approach has been applied to analyze
the data that are collected from the respondents. data for the analyses collected
through questionnaire and focus group discussions.

The study has used stratified random sampling technique to select from 13 public
health care services organization where 10 health center & 3 hospitals fond in
hawassa town. the study has established in investigating the factors that influence
customers satisfaction in health care services the case of public health care services
organization working around hawassa town,. moreover, there are many factors that
can predispose a population to increased or decreased utilization of health care
services. they include: (1) socio-economic status, (2) physician supply, (3) policies
and beliefs of a nation, (4) risk behaviors of a population, and (5) health status

keywords customers satisfaction and public health care services organization in

hawassa town

CHAPTER ONE

INTRODUCTION

Proposal Page 5
1.1. background of the study
INVESTIGATING THE FACTORS THAT INFLUENCE CUSTOMERS
SATISFACTION IN HEALTH CARE SERVICES THE CASE OF PUBLIC
HEALTH CARE SERVICES ORGANIZATION IN HAWASSA regarded as
engines to solve problems which influence customer satisfaction in public
health care services organization . there are many factors that can predispose a
population to increased or decreased
utilization of health care services. they include: (1) socio-economic status,
(2)physician supply, (3) policies and beliefs of a nation, (4) risk behaviors of a
population, and (5) health status of peoples. .
1.2. STATEMENT OF THE PROBLEM

HOW DOES SES (SOCIO-ECONOMIC STATUS) HAVE AN EFFECT ON HEALTH

CARE UTILIZATION?
The socio-economic status (SES) of a community is a composite measure based on
factors such as education, income, and demographic characteristics (sex, age, and
ethnicity). it is believed that SES has a significant influence on utilization behavior
because of its effect on aspects such as need, recognition, and response to symptoms;
knowledge of disease; motivation to get well; and access or choice of health services.
It is well documented that persons of lower SES experience a greater degree of
disease and mortality. Despite these facts, research has shown that clinic and hospital
use is not reflective of their circumstances -- especially among infants and children.
This disparity in use by young persons of lower SES can result in a disproportionate
amount of use when they are older.

Education and income usually result in higher use of health care, especially
preventive visits and clinic visits; however, educated persons experience less acute
disease. Research has shown that women have a slightly higher rate of utilization than
their male counterparts.

Proposal Page 6
Age is another significant aspect of SES. Although elderly persons use more health
services, it is not equally distributed among the whole population.

Research has shown how other factors, such as the presence of chronic disorders
(health status), risk behaviors (e.g., smoking),and access to care, also play an
important role in how and why the aged use health care. This is an excellent
illustration of the multi-factorial nature of health care utilization and the faults of a
shortsighted approach to health policy decisions.

CAN PHYSICIAN SUPPLY IMPACT ON HEALTH CARE UTILIZATION?

Physician supply is not as multifaceted as SES and a large part of the literature
illustrates that its relationships with health care utilization is straight forward.

An increase in the proportion of doctors available or access to doctors in a community

consistently results in an increase in health care utilization of all types. This indicates
that many patients will use or be encouraged to use services when the physician
services are made available.
HOW POLICY CHANGES AND NATIONAL VALUES CAN AFFECT HEALTH
CARE UTILIZATION?
Government policies and the values of a country can have a direct effect on health
care utilization. When a country wants to increase the use of health care by the
population it can create policies in order to do so.
The best example of this fact is the introduction of MEDICARE. Twenty years after
the introduction of the Medicare system in Canada a number of researchers
(Canadian and international) illustrated that health care systems like Canada’s provide
more access to health care for persons of lower SES.
RISK BEHAVIOR AND HEALTH CARE UTILIZATION

Policies, such as the enforcement of wearing seatbelts in vehicles, have also helped to
reduce the effects of risk behaviors that can have a significant impact on health

Proposal Page 7
utilization. Unfortunately, government efforts to reduce other risk behaviors such as
smoking and alcohol and drug abuse have not been as effective. Research has shown
that lifetime health costs of smokers are 47% higher despite the lower life expectancy
of smokers.

HEALTH STATUS AND HEALTH CARE UTILIZATION

Health status is the most important factor associated with increased health care
utilization. There is consistent evidence that shows that lower health status of a
population directly results in increased health care utilization of all types (i.e., clinic
visits, physician visits, and hospitalization). A recent trend analysis of hospital
utilization in Canada revealed that the characteristics of high users of hospital care are
those with multiple chronic conditions and elderly persons with multiple chronic
conditions and disabilities.
It is important to note that despite the enormous amount of literature on health care
utilization no distinction is made between necessary and excessive utilization rates.
Many authors argue that this is very difficult to measure and encourage policy makers
to determine what levels of utilization have positive, negative, or indifferent effects on
the health of the population.

1.3. RESEARCH QUESTIONS

a. What are the major factors that influence customers satisfaction in health care
services the case of public health care services organization?

Proposal Page 8
b. What are the possible solutions that can be applied to solve the problems?

c. Is the growth of health care services organization satisfactory or not?

1.4. OBJECTIVE OF THE STUDY

1.4.1. General objective

The main objective of the study was to investigating the factors that influence
customers satisfaction in health care services the case of public health care services
organization in hawassa.

1.4.2. Specific objectives

In order to attain the- general objective the research put out to accomplish the
following specific objective.

i. To investigate major factors that influence customers satisfaction in health

care services the case of public health care services organization in hawassa
ii. To analyze there is relationship between customers satisfaction and public
health care services organization in hawassa
. iii. To provide predictive models for the future growth of public health care services
organization,

iv. To investigate whether the growth of public health care services organization is
satisfactory or not in hawassa town

1.5. Significance of the study

Findings from this study may help academicians for further study in the area by
providing a deeper understanding of the critical factors that affect the growth of
public health care services organization. In addition, the regional government uses the
findings of this study to overcome critical factors that affect the growth of public
health care services organization. Moreover, the findings of this study may help

(1) socio-economic status, (2) physician supply, (3) policies and beliefs of a nation,
(4) risk behaviors of a population, and (5) health status

Proposal Page 9
In consideration to areas where the strategies should be focused so as effectively
promote the growth of public health care services organization.

1.6 SCOPE OF THE STUDY

1.6.1 Geographical scope

This study will be carried out in hawassa town, the capital of sidama zone and the
southern nations, nationalities and peoples regional state in Ethiopia.

Hawassa town admiration is selected because it has many public health care services
organization found. It is also easier to access these public health care services
organization by the researcher because most of them are situated in the center of the
city like adare health care services organization.

Hawassa town have 8 sub towns namely (Meneharia sub town, Bahil aderash sub
town, Addis ketema sub town, Tabor sub town, Haik dar sub town, Misrak sub town,
Tula sub town and Mehal sub city).

1.7 ORGANIZATION OF THE STUDY

The research has been arranged into five chapters.

CHAPTER ONE presents the introduction part which consists of background,
problem statement, objectives of the research, significance, and scope of the study.
CHAPTER TWO presents the review of related literature. Both theoretical as well as
empirical literatures relevant to the study have been sufficiently reviewed.
CHAPTER THREE, on the other hand, states the research design and methodology
aspect of the study. While

Proposal Page 10
CHAPTER FOUR presents the analysis and discussion part, the last CHAPTER
presents summary of findings, conclusion and recommendations sections of the study.
1.9. LIMITATION OF THE STUDY
It is clear that preparing research paper will not be free from some limitation. The
following are the major limitation of this research paper.

 shortage of time;
 luck of adequate and consistent data;
 financial problems ( e.g. money );
 unwillingness of officials to give sufficient information;
 respondents carelessness to give quality information as
requested;
 shortage of internet facility;
 lack of recent publication in relation to the research title; and
 lack of past studies relevant to the research paper similar to
other research, this study had limitations.
 another problem encountered in the study has to do with the
representative’s of public health care services organization
unwillingness to cooperate due to covid-19. It is very
important to note that these limitations did not have any
significant interference with the outcome of the study because
of triangulation method of verifying the information.

CHAPTER TWO

LITERATURE REVIEW

2.1. chapter introduction

Proposal Page 11
This chapter reviews related literature under different sub topics relevant to the study
objectives.

HOW DOES SES (SOCIO-ECONOMIC STATUS) HAVE AN EFFECT ON HEALTH

CARE UTILIZATION?
The socio-economic status (SES) of a community is a composite measure based on
factors such as education, income, and demographic characteristics (sex, age, and
ethnicity). it is believed that SES has a significant influence on utilization behavior
because of its effect on aspects such as need, recognition, and response to symptoms;
knowledge of disease; motivation to get well; and access or choice of health services.
It is well documented that persons of lower SES experience a greater degree of
disease and mortality. Despite these facts, research has shown that clinic and hospital
use is not reflective of their circumstances -- especially among infants and children.
This disparity in use by young persons of lower SES can result in a disproportionate
amount of use when they are older.

Education and income usually result in higher use of health care, especially
preventive visits and clinic visits; however, educated persons experience less acute
disease. Research has shown that women have a slightly higher rate of utilization than
their male counterparts.

Age is another significant aspect of SES. Although elderly persons use more health
services, it is not equally distributed among the whole population.

Research has shown how other factors, such as the presence of chronic disorders
(health status), risk behaviors (e.g., smoking),and access to care, also play an
important role in how and why the aged use health care. This is an excellent
illustration of the multi-factorial nature of health care utilization and the faults of a
shortsighted approach to health policy decisions.

Proposal Page 12
CAN PHYSICIAN SUPPLY IMPACT ON HEALTH CARE UTILIZATION?
Physician supply is not as multifaceted as SES and a large part of the literature
illustrates that its relationships with health care utilization is straight forward.

An increase in the proportion of doctors available or access to doctors in a community

consistently results in an increase in health care utilization of all types. This indicates
that many patients will use or be encouraged to use services when the physician
services are made available.
HOW POLICY CHANGES AND NATIONAL VALUES CAN AFFECT HEALTH
CARE UTILIZATION?
Government policies and the values of a country can have a direct effect on health
care utilization. When a country wants to increase the use of health care by the
population it can create policies in order to do so.
The best example of this fact is the introduction of MEDICARE. Twenty years after
the introduction of the Medicare system in Canada a number of researchers
(Canadian and international) illustrated that health care systems like Canada’s provide
more access to health care for persons of lower SES.
RISK BEHAVIOR AND HEALTH CARE UTILIZATION

Policies, such as the enforcement of wearing seatbelts in vehicles, have also helped to
reduce the effects of risk behaviors that can have a significant impact on health
utilization. Unfortunately, government efforts to reduce other risk behaviors such as
smoking and alcohol and drug abuse have not been as effective. Research has shown
that lifetime health costs of smokers are 47% higher despite the lower life expectancy
of smokers.

HEALTH STATUS AND HEALTH CARE UTILIZATION

Health status is the most important factor associated with increased health care
utilization. There is consistent evidence that shows that lower health status of a

Proposal Page 13
population directly results in increased health care utilization of all types (i.e., clinic
visits, physician visits, and hospitalization). A recent trend analysis of hospital
utilization in Canada revealed that the characteristics of high users of hospital care are
those with multiple chronic conditions and elderly persons with multiple chronic
conditions and disabilities.
It is important to note that despite the enormous amount of literature on health care
utilization no distinction is made between necessary and excessive utilization rates.
Many authors argue that this is very difficult to measure and encourage policy makers
to determine what levels of utilization have positive, negative, or indifferent effects on
the health of the population.

CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Introduction

Proposal Page 14
This chapter will discus to express the procedural structure used in attaining the
declared purpose of the survey and also it clarifies the study hypotheses assumed.

The main points discussed in this section were study plan, type and basis of
information, population explanation, sample size, nature of sampling, sampling
methods and explanation of the alternative information gathering tools, and technique
of facts evaluate.

3.2 Description of study area

Hawassa is an active city in sidama zone and south ethiopia at the heart of the rift
valley and is located at the eastern shore of lake hawassa & 275 km south of addis
ababa.it lies at an elevation of 1680 masl and has a plain topography. hawassa city
administration urban area is divided in 8 sub cities. it is the head quarter of the sidama
zone administration as well as the capital of the southern nations, nationalities and
peoples region. Over 56 various nations, nationalities and peoples made their home
with their own traditions, languages, dress, dance, and culture. The town has been
named after the lake that stands next to it. Hawassa city is attaining a continuous
growth; and daily attracting tourists and has opened its doors wide to investors. It is an
attractive town that you can come in any of your interest and do what you wish. It is
founded on 1959.

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Proposal Page 16
3.3. Target populations

The study has conducted in three out of 13 public health care service organization
found in hawassa town. The target population for this study is such as patient &
people caring patient, service provider like Dr., Nurses, HO, Midwifery.. & Official of
health organization.

.3. Source of data

The main sources of data for this study is primary data which is first hand data and is
directly collected from the respondents sampled from the target population by using
stratified random sampling techniques and through the well organized and
administered questionnaires to gather necessary information some secondary sources
of data were used for this study.

3.4. Sampling design and techniques

The sampling technique is simple random sampling (SRS) to select the representatives
from target population (frame). In this case the units in the populations are numbered
from 1 to N. A series of a random number between 1 to N is then drawn by means of
lottery method. At any draw, the process used must give an equal chance of selection
at any number in the population but not already drawn.

3.5. Method of data collection

The method of data collection would be determined by the following factors.

Objective of the study, Nature information and operational possibility cost. There are
different methods of data collection. Among them administrated and direct
investigations are the appropriate for this study. Based on the origin of data, statistical
data can be classified as primary and secondary data. Among them, this research
project would be conducted by using primary source of data; this would be collected
information from respondents through some specific questionnaires.

3.6. Sample size determination

Determining the sample size is very important issue for the precision of the survey.
For this study would use stratified sampling is used with proportion allocation to
determine the population size of the organization. Determining the sample size is the
key step on the overall statistical processes. An appropriate sample size means of

Proposal Page 17
gaining high precision, accuracy and confidence with minimum cost. There is a
sample determination formula, with much better margin error,

i.e.0.05. (Godden (2004); (aczel, amir, sounderpandin and jayavel 2006)) accordingly:
¿
no=(za /2 ¿ 2 d 2 ¿ pq

where

(z=0.5, p=0.5, q=0.5, d=9%)=118. if no<5%, no=n but, )

118
❑no
n = =0.078>5 % (0.005)
1511

so use
no 118 118
n= n= =109.4 ≈109
1+ no 1+ 118 1.078
n 1511

3.7. Variables included in the study

The response variable in this study is current people using public health care
organization & service provider working there.

3.8. Method of statistical data analysis

3.8.1. Descriptive statistics

Descriptive statistics consist of the collection, organization, summarization and

presentation of data in some meaning full, from such charts, graphs or table. since
variable under study is quantitate variable, the bar graph is appropriate for the study.

3.8.2. Inferential statistics

In this way a set of methods will use to generalize from sample to population by
performing hypothesis testing, determining the relationship among estimate variables
and making prediction by data inferential methods such as chi-square, multiple linear
regression and hypothesis testing. Multiple linear regression analysis multiple linear
regressions are a direct extension of simple linear regression. It is statistical technique
that uses several explanatory variables to predict the outcome of a response variable

Proposal Page 18
(current capital). The goal of multiple linear regressions (MLR) is to model the
relationship between the explanatory and response variables. Regression models a
mathematical equation provides prediction of values of dependent variable based on
the known values of two or more independent variables. A particular form of
regression model depends up on the nature of the problem under study and the type of
data variables. Consider the problem of regression when study variable depends on
more than one explanatory or independent variables, called as multiple linear
regression models. This model generalizes the simple linear regression in two ways.

It allows the mean function e (y) to depend on more than one explanatory variable and
to have shapes other than straight lines, although it does not allow for arbitrary shapes.
The linear model: let y denotes the dependent (or study) variable that is linearly
related to k independent (or explanatory) variables

x1, x2, …, xk through the parameters β1, β2, …, βk and

we write

y = β0 + β1x1 + β2x2 +... + βkxk + ε

this is called as the multiple linear regression models. the parameters β1, β2, …, βk
are the regression coefficients associated with x1, x2, …, xk respectively and ε is the
random error component reflecting the difference between the observed and fitted
linear relationship. there can be various reasons for such difference, e.g., joint effect of
those variables not included in the model, random factors which cannot be accounted
in the model etc. note that the jth regression coefficient βj represents the expected
change in y per unit change in jth independent variable x j.

assuming (ε) =0.

assumptions

i. For any specific value of the independent variable, the values of the y
variable are normally distributed. (this is called the normality assumption)
ii. There is a linear relationship between the dependent variable and the
independent variables. (this is called the linearity assumption.)
iii. The independent variables are not correlated. (this is called the non muliti
co linearity.)
iv. The values for the y variables are independent. (this is called the
independence assumption.)

Proposal Page 19
3.9. Parameter estimation of the model

The model parameter is estimated by using least square estimation method. This is
given as β=(xx)-1xy. The model of least square estimation is used to estimate
regression coefficient in multiple linear regression model. There is a response variable
and more than one explanatory variables.Variables of (xi) assume the model has e (ε)
=0, var (ε) =σ and ∑(ε) are uncorrelated random variables.

where, y= nx1 vector of observation

x= nxp invertible matrix

β= px1 vector of regression coefficients that was estimated from the data.

the model

y = β0 + β1x1 + β2x2 +... + βkxk + ε

where: the model also can be expressed as in matrix form y= x+ε

least square estimator (lse) of β for the multiple linear regression model yi= x+β
=(xx)-1x’y assuming(x’x)-1x’ is invertible or non singular matrix β =minimize sse or
sum square of error.

4. RESULTS AND DISCUSSION

The main objective of this study is investigating the factors that influence customers
satisfaction in health care services the case of public health care services
organization in hawassa the data were collected on the respondents of the factor and
their activities. The sample size determined for this study was 3 public heath service
provider from hawassa town, the analysis was based on the information, and the data
obtained from 120 respondents

Proposal Page 20
4.1. Descriptive analysis about study variables

This technique is mostly employed for describing the characteristics of the sample and
the major study variables are displayed in the form of frequency description,
percentage, cross tabulation and diagrammatic representation such as bar chart.

4.2. INFERENTIAL ANALYSES

Inferential statistics is statistical method that deals with inferring or drawing

conclusions about population based on data obtained from limited number of
observations that came from the population. Inferential statistics consist of estimation
and hypothesis testing.

4.3. MODEL ADEQUACY CHECKING

This model is used to check whether the major or standard assumptions of multiple
linear regression analysis are meeting. This is made through the following.

RESIDUAL ANALYSIS: - analysis of residual is an effective way to discover several

type of model adequacy. It is a measure of variability that was left unexplained by the
regression model. Thus any departures from the assumptions on the errors should
show up in the residuals. Its analysis is effective through plotting. histogram, normal
probability plot and scatter plot.

Proposal Page 21
 CHAPTER FOUR

TIME SCHEDULE AND BUDGET BREAKDOWN

4.1 TIME SCHEDULE

 

 
s.n
activities
o  

Month  
augus septembe october
June july t r nov.
1 proposal defense
2 literature review
3 data collection
data clearing &
4 entering
5 data analysis
6 interpretation
writing &printing the
7 thesis
8 final submission

Proposal Page 22
4.2 BUDGET BREAK DAWN

no. item measurement quantity unit cost total cost

1 flash disc Pcs 1 500 500.00

2 toner cartridge Pcs 1 2,100 2,100.00
3 duplicating paper Pkt 3 115 345.00
4 clipboard Pcs 5 40 200.00
5 square paper Pcs 1 40 40.00
6 note book Pcs 5 15 75.00
7 pen(ball point) Pcs 15 3 45.00
8 pencil Pcs 10 1 10.00
9 staples Pkt 1 8 8.00
10 erasers Pcs 5 10 50.00
11 internet cost Hr 500
12 data collectors Days 5 200*5 5,000.00
13 focus group discussion Days 2 2500 5,000.00
Total 13,945.00

REFERENCES

Anderson ,j. g. (1973). health services utilization: framework and review. health
services research,

Proposal Page 23
 8(3)184-99.

Barer, m. l., evans, r. g., & labelle, r. j. (1988). fee controls as cost control: tales
from the frozen
north.milbankquarterly,66(1),1-64.

Hershey, j. c., luft, h. s., & gianaris, j. m. (1975). making sense out of utilization
data. medical care,
13(10),838-54.

Hodgson, t. a. (1992). cigarette smoking and lifetime medical expenditures.

milbank quarterly, 70(1),
81-125.

Hulka, b. s., & wheat, j. r. (1985). patterns of utilization. the patient perspective.
medical care, 23(5),438-60.

Johansen, h., nair, c., & bond, j. (1994). who goes to the hospital? an investigation
of high users of
hospitaldays.healthreports,6(2),253-77.

Muller, c. (1986). review of twenty years of research on medical care utilization.

health services
research,21(2pt1),129-44.

Rice, d. p., hodgson, t. a., sinsheimer, p., browner, w., & kopstein, a. n. (1986). the
economic costsof the health effects of smoking, 1984. milbank quarterly, 64(4),
489-547.

Proposal Page 24