A 2016 online article titled “Where does the US rank internationally in patient satisfaction?” revealed the top ten countries that had scored the highest in the positive feedback ranking, in which Sweden occupied the first place with 92.37 percent of satisfied patients and the U.K. was number 10 with 81.6 percent [6]. The typical questions administered to patients included information on wait times, overall patient experience and the quality of communication in regard to patient concerns. The global average patient satisfaction level benchmark during March was 88.02 percent. At the same time, according to statista.com, one country on the Arabian Peninsula – Yemen – and nine other countries that are all located in Africa were reported as the worst in healthcare satisfaction in the whole world in 2013, some of which had as many as 80 percent of all patients unhappy with overall patient experience and the quality of communication in regards to patient concerns [6].
Therefore, as demonstrated by this ranking, the income level of a country is correlated with the level of satisfaction of patients which is an outcome of a quality healthcare system [6].
Despite the numerous advances that the Republic of Kazakhstan has made since the well-known collapse of the Soviet Union, the number of complaints of patients based on dissatisfaction with dental care in the Republic of Kazakhstan remains high and is steadily increasing [1, 2, 3, 4, 5]. According to “Trends in Health Systems in the Former Soviet Countries” issued by the European Observatory on Health Systems and Policies,” following the collapse of what is known to be the last communist economy of the 20th century, every single Soviet state experienced a drastic decline in the quality of healthcare [7]. Scarce finances, brain drain, the absence of any sort of stable authority, soaring numbers of unemployment, and many other hefty reasons contributed to the enormous growth of instability in every single sector, and medical care was not an exception. However, it has been almost thirty years since those dramatic events unfolded, and the recent changes in the healthcare system have been evolving towards a higher quality system. This system of care places the patients as the main decision-makers and puts their well-being and optimal health as an important goal to achieve [1]. The Dental Quality Outcomes Framework has set three indicators of quality such as clinical effectiveness, patient-centeredness, and safety [3]. The Institute of Medicine has set six aims for the quality health care system: safe, equitable, evidence-based, timely, efficient and patient-centered [2, 4]. Nevertheless, being respectful of the needs, preferences, and values of patients is a brief definition of patient-oriented care [3]. The development and need for quality have led to the widespread adoption of patient-centered care in medicine, management, politics and service sectors. The main reason is that healthcare providers are not able to provide full assistance without having communicative, collaborative patients. If patients share their state of wellbeing, dentists can accurately discern the health needs of the patient. Therefore, patient satisfaction is a commonly used indicator for measuring patient-centered care and health care quality. Research in health services has consistently demonstrated that patient-centered health care produces higher levels of satisfaction of patients, more preferable clinical outcomes and a boosted healthcare system [2, 4]. Thus, dental communication has maintained its importance [3].
The increase in the number of private dental clinics might have an impact on the healthcare system. According to BISAM (Business information, sociological and marketing research center) Central Asia, the researches, over 3 years, 40 percent of the population contacted dental centers more than once in cities as well as in villages in Kazakhstan [5]. The development of the dental market in Kazakhstan began in the 1990s with the wave of privatization when the country perceived its independence in 1991[5]. The transition of dental clinics away from state ownership led to the growth of private dentistry, as well as the introduction of innovative methods and technologies [8]. Since then, the dental care needs continue to remain high in the country. The dental sector is the largest segment of Kazakhstani private medicine and comprises approximately 60% of the private medicine in the country [8]. This shows a high demand for the dental services and its accessibility which leads to high competitiveness for the best quality which can be achieved through the professional development and continuing education of dental personnel [8]. Accumulating professional experience and introducing modern treatment technologies into practice are features of some dental clinics while other smaller clincis are not able to afford these innovations.
Although the industry has been developing steadily, the aggressive entry of private dental clinics into the market have revealed a poorly regulated health system. According to reports of Damu Research, the dental sector lacks the system of a unified plan for treating patients [5]. For instance, the sharp rise in the quantity of private clinics has led to poorly managed health systems and non-compliance with the general rules in some developing countries [9]. The poorly regulated healthcare system in the country, in turn, negatively affects the quality of the provided medical service in general. The provider-centeredness might be one of the factors affected by this phenomenon. Therefore, the vast increase in the number of private dental clinics has been determined as one of the variables of the level of patient-centeredness.
The requirements for the dentists and the level of dental care by the patients have greatly increased [8]. The medical sector, particularly, the dentistry sector in Kazakhstan, still retains the doctor-centered approach. Disorganized steps towards the patient-centered approach are one of the important reasons that keep a doctor-oriented approach in countries. The Soviet legacy had its consequences in terms of backward medicine in Kazakhstan [8]. The economic lag, which persisted during the Soviet period, continued and did not show the inclination to patient-centered care. The insufficient budget allocated to medicine, medical facility without quality have been noted as one of the indicators of the disorganization [10, 11]. We do not have any publicly available data and research studies about the nature of patients’ complaints about dental care. Occasionally, individual cases which resulted in negative consequences of dental care are published in the newspapers and web news. The Department of Medical Quality of the Republic of Kazakhstan keeps all data confidential, reviews each complaint before a final decision which is followed by punishing measures rather than reporting some statistics about the nature of complaints which could be used as measures for professional trainings to solve and reduce such dental issues.
Even though dentistry is a private sphere in the Kazakhstan and the government does not directly finance the purchase of facilities, it could affect the regulation of health systems and training of the dentists. Damu Research highlighted that there is a weak postgraduate training system in Kazakhstan, which demonstrates weak professional qualification and practical knowledge including dental communication leading to the failure of overall dental care including mistrust by patients and further negative consequences.
Effective verbal communication is necessary for successful dental treatment. According to Wener et al, oral health providers have to be good communicators able to meet the patients’ expectations [12]. The providers should show empathy and patients should feel valued. Thus, providers communicating their concerns efficiently, affect the better health results of patients. While investigating teaching communication skills, Levinson et al have identified that all medical schools have communication classes but only during the first and second years [13]. During the most important third and fourth years, the students do not have communication classes, otherwise, this class receives relatively low priority. There are some other barriers such as inadequately trained clinical faculty, the cost of resources and lack of the ability to balance the time spent on communicating and providing medical care [12–16]. It was revealed that the progress of students through their postgraduate education makes them patient-centered [14]. Further education makes dental graduates more aware of patient-oriented care. Testing extensive training programs to teach patient-centered communication skills has demonstrated progress in patient satisfaction [12].
These, in turn, were the potential indicators and associated variables of persisting paternalistic model of the doctor-patient relationship, doctor centeredness of dentistry in Kazakhstan, which might be the direct reason for the patient’s dissatisfaction with medical service. Furthermore, good doctor-patient interaction, the loyalty of doctors and patient education, which are factors for patient-centeredness might affect the overall performance of hospitals [15]. Therefore, a level of patient-centeredness might be a proxy variable for overall hospitals’ performance. In a previous pilot study, we have discussed that medical care is affected by the miscommunication between a health provider and a patient [17]. The objective of this study is, providing evidence-based research, to determine the degree of dental communication in Kazakhstan. Persisting doctor-orientedness in this field shows the conforming dentistry performance in Kazakhstan.
Through an investigation of patient-centredness of dentists and patients, we can examine the perceptions and expectations of dentists and patients and how these may be contributing to patient dissatisfaction. Our hypothesis was that the majority of dentists and patients are not patient-oriented whereas patients are likely to be patient-oriented.
RQ1: What are the orientations of dentists and patients towards patient-centered care in the dentist visit?
H1: Dentists in the private dental clinics in Nur-Sultan, Kazakhstan are primarily doctor-oriented rather than patient-oriented.
H2: Patients visiting these clinics will primarily report a patient-orientation rather than a doctor-orientation.