Effect of waiting time on patients’ satisfaction in outpatient: An empirical investigation

doi:10.21203/rs.3.rs-2469793/v1

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Effect of waiting time on patients’ satisfaction in outpatient: An empirical investigation

https://doi.org/10.21203/rs.3.rs-2469793/v1

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Study objective

This study mainly aimed to identify the effect of waiting times on patient satisfaction.

Methods

A clever questionnaire was designed, and it contained two parts. The first part includes a series of short, standardized questions about expected waiting time (EWT), reasonable waiting time (RWT), limited waiting time (LWT), and basic personal information. This part of the questionnaire was filled in when the patient entered the waiting area. The second part includes perceived waiting time (PWT) and satisfaction evaluation, and this part was filled before patients entered the doctor’s office. The two questionnaires were summarized by the same number. The actual waiting time (AWT) was calculated based on the time difference between the registration time recorded by the experimenter and the time between entering the clinic. Linear regression was used to analyze the influence of waiting times on satisfaction. Before starting data collection, this study was approved by the hospital health ethics committee.

Results

A total of 323 questionnaires were collected, in which 292 (90.4%) were valid. EWT, LWT, RWT, and PWT had a significant effect on patient’s satisfaction (p = 0.006, p = 0.043, p = 0.009, p = 0.000), whereas AWT had no significant effect on satisfaction (p = 0.365). The difference between EWT and AWT had a significant effect on satisfaction (p = 0.000), while the difference between PWT and AWT had a significant effect on satisfaction (p = 0.000). Age, education background, gender, appointment, and hospital visit experience had no significant effect on patient satisfaction (p = 0.105, p = 0.443, p = 0.260, p = 0.352, p = 0.461).

Conclusions

The patient’s satisfaction of waiting time was not directly affected by the AWT, but by the subjective waiting times. And the difference between AWT and EWT has a significant impact on patient’s satisfaction. Meanwhile, the difference between AWT and PWT also has a significant impact on patient’s satisfaction. Therefore, service quality can be improved by hospital managers by focusing on the adjustment of patients’ subjective waiting time while reducing the objective waiting time.

subjective waiting time

objective waiting time

satisfaction score

The actual waiting time (AWT) is among the most important factors that affect patients’ satisfaction [1–3]. Researchers and managers aim to improve patient satisfaction by reducing AWT [4]. The methods for AWT reduction include appointment[5, 6], scheduling [7], and the use of artificial intelligence to arrange image examinations in advance [8, 9]. These measures have reduced the AWT of patients in outpatient [10], but patients still complain about the long waiting time [11]. In addition to the shortage of medical resources, the effect of AWT on patients’ satisfaction needs to be determined. Some studies show that AWT does not have a significant effect on patient satisfaction in orthopedic clinics [12]. Then, in the category of time factors, in addition to the AWT, the effect of other time factors on patients’ satisfaction needs to be determined. Furthermore, considering that AWT has no direct effect on satisfaction, its combined effect with other time factors on patients’ satisfaction needs to be determined. This study aimed to address the possibility of jointly improving patients’ satisfaction by improving the environment of other time elements while reducing the actual waiting time. Satisfaction is the subjective evaluation of patients, and it is affected by subjective factors. Some scholars have noticed that patient satisfaction is affected by AWT, as well as subjective factors such as expected waiting time (EWT) [13, 14] and perceived waiting time (PWT) [15, 16], etc.

Irrational individuals make decisions or evaluations that are not completely based on the current objective situation but are also based on reference points [17, 18]. In the value function model of prospect theory, if the actual situation is better than the reference point, it is regarded as obtained, and the individual tends to give a positive evaluation; by contrast, if the actual situation is worse than the reference point, it is regarded as a loss, and the individual tends to give a negative evaluation[19]. EWT is the reference point in the evaluation of waiting. If the AWT is far more than the EWT, then patients tend to give a negative evaluation; otherwise, they tend to give a positive evaluation of the waiting time [13]. PWT is another important subjective waiting time, which has attracted attention in the field of service [20], and affects the evaluation of medical service quality [21].

Some people who waited for an hour feel like as if they had waited for a century, while other people also have waited for an hour feel like they only waited for a few minutes. People’s subjective estimates of the AWT are sometimes longer than perceived and sometimes shorter than it [22]; to some extent, this condition is related to their limited waiting time (LWT). If patients have other arrangements on the day of treatment, the waiting time will have an LWT; when the AWT exceeds the patient’s LWT, patients become increasingly impatient, leading to obvious physical and mental discomfort [23]. The reasonable waiting time (RWT) is the evaluation of the rationality of the patient’s waiting time, and it does exist in the waiting process.

This study aimed to determine the effect of waiting time on patient satisfaction. First, this study specifically aimed to improve the understanding of the relationship between outpatient waiting times and patient satisfaction. The waiting time include both objective and subjective waiting time. Objective waiting time includes AWT, while subjective waiting times are mainly EWT, PWT, RWT, and LWT. Second, the effect of the interaction between objective and subjective waiting time on patient satisfaction was determined. Third, the study explored the correlation of AWT, EWT, PWT, RWT, and LWT. Finally, the influence of basic personal factors, such as gender and age, on the above waiting times was determined.

The innovation of this research includes three aspects. First, for factors of satisfaction, in addition to the AWT, the EWT, PWT, LWT, and RWT were included into the scope of the study according to the actual situation, making this study more consistent with the actual situation when discussing the time influencing factors of patient satisfaction. Second, this study focused on the effect of a single time factor on satisfaction, as well as the combined effects of various time factors on satisfaction. Finally, a smart questionnaire implementation process was designed, from which the patient’s subjective waiting time can be obtained.

Subjects and Experiment Design

A total of 323 questionnaires were collected, including 292 valid ones, with an effective ratio of 90.40%. Among them, 31 questionnaires were rejected because of the lack of logic or key data. For example, someone responded “0” to the question “How long did you think you had to wait for answering?”. Another example is that some patients make an appointment on site but fill in the appointment time, which is inconsistent with the actual situation. The patient’s subjective EWT, LWT, or RWT and other key data are missing and eliminated.

The interference of other factors other than waiting time on the satisfaction evaluation was minimized. The questionnaire was conducted in the optometry clinic of an ophthalmic hospital, because the physiological pain of patients coming here is very light. At the same time, the influence of doctor’s attitude on patient satisfaction was avoided by conducted the questionnaire in two parts. In the first stage, when patients hang up their numbers and enter the waiting area, patients generally have plenty of time. In this stage, first part of the questionnaire was given, and the process takes about 8 min, including the description of the research purpose and informed consent, EWT, RWT, and personal basic information research. When the patient completed this part of the questionnaire, the experimenter recorded the registration time of the patient on the back, wrote a number from 1 to 400, and distributed the same number to the patient. In the second stage, when the patient who was about to enter the clinic came to the door of the clinic, the experimenter gave the second part of the questionnaire. The questionnaire has two questions in total, one was how long he felt he had waited this time, and the other was how satisfied he was with the waiting time for this visit. For the evaluation of satisfaction, the patient was asked to choose a score from 0 to 100 randomly to represent their views on the time of the visit, in which 0 means very dissatisfied, and 100 means very satisfied. This part of the questionnaire can be completed in 1 minute. After the patient completed this part of the questionnaire, the experimenter filled in the number on the back of the questionnaire and recorded the time when the patient entered the clinic. The numbers of the two questionnaires are the same. Finally, a complete questionnaire was formed. The AWT of the patient is the difference between the time of entering the clinic and the time of registration.

Statistical analyses

Data analysis was carried out in IBM SPSS Statistics 22.0 software. Multiple linear regression was used for the analysis of factors that affect patient satisfaction. At p value less than 0.05, the factor has a significant impact on satisfaction. Considering that waiting times were non-normally distributed, two-sample Kolmogorov-Smirnov test and Kruskal–Wallis test were used to analyze is the presence of significant difference between basic characters and waiting times. If the p value is less than 0.05, a significant difference is considered between them. Some descriptive statistical methods were also used.

Ethics Statement and Informed Consent

The research was performed in accordance with the Declaration of Helsinki. The experimental has been approved by the Office of Research Ethics, Eye Hospital of Wenzhou Medical University (NO:2021-097-K-81-01). Informed consent was obtained from all study participants before the implementation of the questionnaire.

Baseline characteristics

In total, as is shown in Table 1, 219 (75%) subjects were women, 155 (53.0%) subjects were between 31 and 40 years old, and 71.8% of the subjects had college education or above. Among the 292 patients, 186 (75.6%) patients made an appointment, and 63.6% of the patients had hospital experience. Some basic information of a few patients is missing, but important information such as waiting times and satisfaction score is complete. Therefore, the data were retained during data analysis.

Table 1

Patient demography across survey participants.
Basic information		n (%)
Gender	Male	73 (25)
	Female	219 (75)
Age (years old)	Under 20 years old	46 (15.7)
	21–30 years old	18 (6.1)
	31–40 years old	155 (53.0)
	41 years old and above	69 (23.6)
Educational level	High school or below	81 (27.7)
	Diploma or undergraduate	189 (64.7)
	Postgraduate	21 (7.1)
Hospital visit history	yes	221 (75.6)
	no	61 (20.8)
Appointment	yes	186 (63.6)
	no	103 (35.2)

Differences in waiting times

Significant differences were observed in the waiting times between the subjects with and without appointments. The EWT was significantly different between patients with or without appointment (20.0[10.0, 30.0] vs. 30.0[20.0, 60.0], p = 0.000, z = 2.311). Significant differences were also found in PWT (10.0[10.0, 30.0] vs. 30.0[10.0, 90.0], p = 0.000, z = 2.698), LWT (30.0[20.0, 60.0] vs. 45.0[30.0, 60.0], p = 0.000, z = 2.355), and RWT (20.0[10.0, 30.0] vs. 30.0[15.0, 30.0], p = 0.000, z = 2.310). For AWT, a difference was observed (25.0[13.0, 52.5] vs. 147.0[64.0, 415.0], p = 0.000, z = 5.175). At the same time, AWT was significantly different at different education levels (64.0[21.5, 291.0] vs. 41.0[15.25, 88.3] vs. 25.0[15.0, 43.5], p = 0.002, χ² = 12.605). However, significant differences in the waiting times were not found in other factors.

Factors influencing patient satisfaction

The factors affecting patient satisfaction were explored using the patient satisfaction score as the dependent variable and personal basic characteristics factors and waiting times as independent variables for linear regression.

Table 2

Analysis of factors affecting satisfaction
Independent variable	B	Standard error	t value	p
The constant	88.362	5.176	17.070	.000^***
Age	1.303	0.801	1.628	.105
Educational level	1.085	1.413	.768	.443
Gender	1.804	1.597	1.129	.260
Appointment	1.817	1.949	.932	.352
Hospital visit history	-1.282	1.739	− .738	.461
Perceived waiting time	− .168	.022	-7.759	.000^***
Actual waiting time	− .006	.006	− .925	.356
Expected waiting time	.084	.031	2.757	.006^***
Reasonable waiting time	− .159	.061	-2.621	.009^***
Limited waiting time	.058	0.028	2.031	.043^**
^adependent variable: satisfaction score

^bR square = 0.313, adjusted R square = 0.288, F = 12.381, P = 0.000.

^{c *p<0.1, **p<0.05, ***p<0.01}

Table 2 shows that EWT and LMT have significant impact on satisfaction (p = .006, p = .043), and they are positively correlated with satisfaction (B > 0, B > 0). For every minute of EWT increase, patient satisfaction increases by 0.08 points. For each minute of LWT increase, patient satisfaction increases by 0.06 points. PWT and RWT also have a significant impact on satisfaction (p = 0.000, p = 0.009), but they were negatively correlated with patient satisfaction (B < 0, B < 0). With a 1 min increase in PWT, patient satisfaction decreases by 0.17 points. With a 1 min increase in RWT, patient satisfaction decreases by 0.16 points. However, AWT has no significant effect on satisfaction (p = 0.365). Age, education background, gender, appointment, and hospital visit experience have no significant effect on patient satisfaction (p = 0.105, p = 0.443, p = 0.260, p = 0.352, p = 0.461).

AWT has a significant effect on satisfaction through expectation and perception

The influence of AWT on satisfaction was not significant. The effect of the gap between subjective waiting time and AWT on satisfaction was studied. The difference between EWT and AWT and between PWT and AWT has a significant effect on satisfaction (both p = 0.000). However, the difference between RWT and AWT (p = 0.557) and between LWT and AWT (p = 0.079) has no significant effect on satisfaction.

In addition to the objective waiting time, patients’ subjective waiting time also play an important role in the evaluation of medical service quality[24]. The effect of subjective factors such as EWT, PWT, RWT, and LWT on patient satisfaction also needs to be determined.

In the present study, the patient’s subjective and objective waiting time that may affect patient satisfaction were investigated immediately in the hospital environment. Almost all studies on patient waiting time and satisfaction have concluded that the longer the AWT is, the lower the patient's satisfaction is [25–29]. However, some exceptions were observed. In orthopedic rehabilitation clinics, the AWT of patients has no significant impact on satisfaction [12], while in the present study, AWT does not directly affect satisfaction; however, through the role of EWT and PWT, it has a significant impact on satisfaction, and an answer was obtained from the prospect theory. The prospect theory holds that the individual’s evaluation and decision-making depend on the reference point. When the actual situation is above the reference point, a gain is considered and vice versa [17–19]. In the hospital treatment experience, two patients who waited for one hour but have different EWT of (e.g., 30 min vs. 90 min) would give different evaluations to the same waiting experience, because when the AWT was longer than the EWT. They would feel lost and tend to give a negative evaluation. Otherwise, they would have a sense of gain and tend to give a positive evaluation. Therefore, although AWT has no significant effect on satisfaction, the effect of AWT on satisfaction is revealed through subjective factors such as expectation and perception. Therefore, reducing patient waiting time and meeting patient expectations can significantly improve outpatient satisfaction [30].

Another finding of this study is consistent with the previous research that the EWT and PWT have an impact on satisfaction [13–16]. In addition to EWT and PWT, patient RWT and LWT also affect the satisfaction. This finding was obtained, because almost every patient tolerates some degree of wait time; when the AWT sufficiently exceeds patient norms, they would feel uncomfortable [29].

A significant difference was observed between the subjective and objective waiting time of the patients who did and did not make an appointment. The appointment can significantly reduce AWT. Considering the limited medical resource, the appointment registration aims to confirm that the patient will see a doctor, but it is very rare for the patients who make an on-site registration to have the opportunity to see a doctor. Therefore, the expectation and perception of the waiting time will be adjusted accordingly.

Limitations

The data used were obtained from a single hospital. Therefore, we are not sure whether the same research results can be obtained in other hospitals. Generally, when the hospital is committed to improving patient satisfaction, it can properly focus on how to adjust the patient’s subjective waiting time, such as adjusting the patient’s EWT through timely information release and optimizing the waiting area environment to reduce patients’ PWT. These measures can also improve patient satisfaction.

In addition, other factors, such as the visiting environment, may affect the patient satisfaction score but cannot be included in the analysis of this study. Previous studies have shown that the visiting environment affect the patient satisfaction. Like all surveys, an inherent reaction bias is present. The physical discomfort of patients with eye diseases is different from that of other patients. Therefore, the subjects of this study may not represent the experience of the whole patient group.

This study identified that the subjective waiting time directly affect patient’s satisfaction in outpatient rather than the objective waiting time. When evaluated with EWT and PWT, the AWT has a significant effect on satisfaction. Therefore, when efforts to reduce AWT have limited effect on improving patient satisfaction, we can try to shift part of our attention to subjective waiting time. Subjective waiting time is a feasible goal and a reliable direction for practical management and scientific research.

AWT: actual waiting time; EWT: expected waiting time; PWT: perceived waiting time; LWT: limited waiting time; RWT: rational waiting time.

Ethics approval and consent to participate

The experimental has been approved by the Office of Research Ethics, Eye Hospital of Wenzhou Medical University (NO:2021-097-K-81-01). Informed consent was obtained from all study participants before the implementation of the questionnaire.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

This work was supported by National Social Science Foundation of China (grant number 20BGL115. The funding body was not responsible for the study design, collection, analysis, and interpretation of data, or manuscript writing.

Authors’ contributions

All authors contributed to the design of this study. The data was prepared by WM-M. Statistical analysis was performed by JJ-Z and SF-Z. The first draft of the manuscript was prepared by ZH and MZ. WL reviewed and edited the manuscript. All authors read and approved the final version of the manuscript submitted for publication.

Acknowledgments

The authors thank Zhenjie-Guo for for her help in conducting experiments. We also thank the chief editor and anonymous reviewers for their valuable comments.

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No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Effect of waiting time on patients’ satisfaction in outpatient: An empirical investigation

Status:

Version 1

Abstract

Study objective

Methods

Results

Conclusions

Background

Methods

Subjects and Experiment Design

Statistical analyses

Ethics Statement and Informed Consent

Results

Baseline characteristics

Differences in waiting times

Factors influencing patient satisfaction

AWT has a significant effect on satisfaction through expectation and perception

Discussion

Limitations

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1