Patients Perception on services related issues at Colonial War Memorial Hospital (CWMH) Clinical Laboratory

doi:10.21203/rs.3.rs-4714882/v1

Download PDF

Research Article

Patients Perception on services related issues at Colonial War Memorial Hospital (CWMH) Clinical Laboratory

https://doi.org/10.21203/rs.3.rs-4714882/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Introduction: Laboratory Services is an essential service that is part of the hospital system to aid physicians to come to a definite diagnosis for their patients. Being an essential service, it is very important that the laboratory service run in a manner that satisfies its customers. Thus, it is very important to take perceptions of patients who readily excess these services to get their point of view on issues they face while excessing laboratory services and how best the profession can work with the MoHMS to create avenues for improvements that would benefit the patients. No studies to date have been conducted in Fiji until now to gauge the issues that are faced by patients accessing laboratory services at government hospitals. Similar perception studies have been done on a large scale looking at the views of patients on the services provided by Nurses and Doctors thus this study aimed to explore the perceptions of patients on services provided by the largest laboratory department in Fiji that is the CWMH.

Materials and Method: Patients who attended the laboratory outpatient department of Colonial War Memorial Hospital (CWMH) in Suva, Fiji, during August and October of 2022 provided data for the study, which was qualitative in nature. The study included all patients who visited the CWMH laboratory outpatient department during the data collection period, regardless of gender or ethnicity, and who were older than 18. For this study, in-depth interviews with 20 participants were conducted until data saturation was reached. Face-to-face in-depth interviews were utilized to gather data utilizing a semi-structured open-ended questionnaire. To identify the themes and sub-themes for the findings, the data were transcribed and subjected to a thematic analysis procedure.

Results: Twenty patients in all were questioned, ten (or 50%) of them were men and ten (or 50%) were women. Unaware of change in location, lack of signage or other means to inform patients that staff is inside, privacy and confidentiality, waiting time, waiting area, and issues with occupational health services (OHS) are among the six themes that emerged from the data analysis. Although they encountered numerous obstacles in their attempts to receive the best care possible, the patients had high expectations. Users of the laboratory outpatient department began to have a bad opinion of it because of the department's shortcomings.

Conclusion: This study revealed that patients who visited the CWMH laboratory outpatient department more frequently than not had general dissatisfaction with the services they received. In order to improve the delivery of services and increase patient satisfaction, MoHMS and service providers must investigate the legitimate concerns that patients have expressed.

Patients perception

Clinical Laboratory

Quality of service

Service issues

A laboratory is a crucial component of medical diagnostic methods, it "helps contribute objective patient information to individual patient records (1). The medical laboratory has various sections that evaluate specimens collected in the outpatient section of the lab as well as those sent in by doctors for processing. Some of the most frequent areas of the clinical laboratory are Clinical Chemistry, Microbiology, Blood Bank, Hematology, Central Reception Area, Histology, Cytology, and Serology. The doctor may order tests on the patient's blood, serum, plasma, urine, stool, exudates, transudates, secretions, or other fluids (2).

It is essential to consider and include patient perspectives. According to a study, having a solid healthcare system can help with long-term care. However, when it is based on the incorporation of an action plan that includes the patients' opinions, experiences, and perceptions, it becomes more precise. Quality evaluation is often focused on technical issues, such as the procedure for administering therapy. Numerous elements affect patient satisfaction, which in turn affects how patients perceive services delivery (3).

Customer service is typically a word used in the commercial world; however, it has only recently become common in the medical field. As a result, numerous health-care initiatives have been launched to increase client satisfaction. Healthcare providers have discovered what businesses have long known: superior customer service sets one provider apart from another. Although it should be practiced at all levels, excellent customer service is challenging to uphold. It is imperative for staff to be polite and understanding towards patients (4).

Customer focus is increasingly important in the healthcare sector. The introduction of quality guidelines like ISO 15189 and ISO 17025 in clinical testing facilities, as well as the use of management tools like performance monitoring, have further emphasized how crucial client feedback is to enhancing laboratory services. It can be difficult for clinical laboratory management to understand and utilize the customer perspective. Conducting a customer satisfaction survey is a standard method for getting feedback from customers. The level of contentment can be rated in satisfaction surveys. Studies may not be sufficient to identify the root causes of unhappiness on their own, though. Additionally necessary are specific consumer clarifications. About 20% of the participants in the two categories of disagreement showed a significant level of unhappiness with the laboratory services (5).

A discrepancy between customer expectations and the service provided is the root cause of dissatisfaction. The caliber and competence of the staff, the availability of sufficient information for specimen collection and when and how to receive laboratory results, the turnaround time for results, the ease of use of ordered laboratory tests, the hygienic conditions of the laboratory room, its location, and the availability and accessibility of latrines are all factors that affect patient satisfaction with the services provided by clinical laboratories. In a survey conducted in Ethiopia, lengthy wait times were cited as a factor in people's decision to not use the same center or laboratory services again. Most respondents (82.4%) said it takes more than an hour to see results, and more than two-thirds (67%) said they've tried vein puncture at least once. Opening times and patient satisfaction with laboratory services provided by clinical laboratories were both related (6).

If the service falls short of the patients' expectations, they will be dissatisfied. In other words, if the service meets or exceeds the patients' expectations, they will be satisfied. Assessing patient satisfaction can aid in maintaining and improving service quality. As a useful framework for analyzing and anticipating client expectations, patient satisfaction assessment and knowledge are also crucial for providers to analyze their performance status. Additionally, to assess high-quality patient care operations, patient satisfaction capacity is rapidly being combined with hospital management activities. It also serves as a clear measure of an organization's capabilities and effectiveness in delivering services (7).

In addition, it's crucial to educate patients on crucial facts so they understand how long treatments will take. The staff is aware of his or her working environment since patient education makes sure that customers understand how long they are expected to wait. Only 45 out of 89 patients in an African study, or 50.6% of patients, knew when the results of their tests will be available. Despite 93.3 percent of laboratory staff stating that it is vital to inform patients of the testing turnaround time, just over half of patients (50.6 percent; 45 of 89 patients) stated they were aware when their test results would be available. Because of this, although laboratory staff are aware of the need to advise patients of testing turnaround times, this is rarely done on a regular basis. This was brought up by several workers in the lab, who cited the strain from an excessive workload as a key barrier to effective patient communication in several ways. A review conducted in Ghana found that patients are usually unaware of the intended laboratory analysis. Only 28.1% of patients said they were knowledgeable about the work they were carrying out in the lab. Only 15% of patients could correctly identify a few of the laboratory tests that were undergoing (8).

To ensure that the patient-staff connection is not jeopardized and to address the problem areas, which vary greatly by practice, individual staff attitudes, organizational factors, and patient characteristics, a collaborative approach is important. The long-term effects of the changes require a more quantitative evaluation (9).

This qualitative study aims to explore the patients’ perceptions services related issues at Colonial War Memorial Hospital (CWMH) Clinical Laboratory.

What are the perceptions of patients on the delivery of laboratory services at CWMH laboratory outpatient department and what are the possible problems and barriers while accessing services?

Study Setting, Study Design and Study Population (Inclusion and Exclusion Criteria)

The research utilized a qualitative methodology (10) of in-depth in-person interviews with twenty laboratory patients to investigate their perspectives regarding the services provided by the CWMH laboratory outpatient department in Suva, Fiji, between August 2022 and October 2022. In Suva, Fiji, at the CWMH Laboratory Outpatient Department, the suggested study was conducted. With more than 450 beds, this is Fiji's largest and primary referral hospital. With ten divisions and more than ninety employees, the CWMH Laboratory Department is also the biggest referral laboratory in Fiji.

This study covered every patient who came to the CWMH LOPD laboratory outpatient department between August 2022 and October 2022. Participants in the data collecting period (August 2022–October 2022) were all patients above the age of 18 who visited the CWMH laboratory outpatient department. They could belong to any ethnicity and be either gender. The study did not include any patient who declined to take part in the interview for private reasons. The purpose of the study was to gather patients' perceptions after they had accessed the service, the convenience sampling method was employed to choose the patients who would be interviewed. This would guarantee that the patients would provide an accurate and up-to-date opinion about what and how they perceived the service they received. Twenty patients in all were interviewed using the in-depth interview method.

Data Collection Tool

Data was collected using semi-structured, open-ended interview questions that were not adopted from any previous study but was built upon using ideas from past literature from various health cadres due to the limited research scope of the topic. In-depth interviews allowed participants to share their thoughts, ideas, and experiences in a way that may not have been possible in a scripted interview with closed-ended questions. (11)

In-person interviews allowed both the interviewer and the subject to ask questions and allowed the researchers to watch any nonverbal cues. The study used nine open-ended questions that were modified or added onto based on the participants responses. A section for demographic information was incorporated into the interview guide so that the specifics of the patients being questioned could be documented.

The questionnaire was developed in the English, I-taukei and Hindi language as the participants are commonly from these three backgrounds. All data collected was in the English language as all participants were well educated and confident to respond to the research questions in English.

Study Procedure and Data Collection

After receiving ethical permissions from Fiji National University's College Health Research & Ethics Committee (CHREC) - CHREC approval ID (091.22), permission was sought from the CWMH Medical Superintendent, the CWMH Laboratory Superintendent, and the corresponding department heads. The researcher approached the patients after they had used the laboratory services to invite them to take part in this study. The duration and direction of the in-depth interviews for this study were decided by the participants' responses. Although the in-depth interviews with patients and staff were scheduled to last 20 to 25 minutes, these questions and times just served as a guide or structure for the sessions. Over the course of two weeks, five to six patient interviews took place each day, giving the researcher time to think things through and adjust the questions as needed. Since the researcher was bilingual and could communicate with subjects who speak I-taukei or Hindi, there was no need for an interpreter.

The participants were notified that the interview would be recorded using a recording device by the researcher. Each participant in the in-depth interviews received an information sheet to read and kept for future reference if needed. Participants also filled out a written consent form prior to the commencement of the interview, giving the researcher permission to perform the interview. Before the interview commenced, demographic information such as age, gender, and ethnicity were collected. There was no need for translation because the staff are educated and speak English fluently. Each participant also received an information sheet for the in-depth interviews in the language of their choosing, which they read and preserved for future reference if necessary.

The duration of the in-depth interviews was anticipated to be roughly 20 minutes; however, the participant's responses dictated the direction and duration of the interview, with the questions and timeframes serving merely as a guide or structure. The interviews were accurately recorded on audio so that it could be played again for analysis with the consent of the participants. There were no outside distractions during the interviews with the patients and lab personnel.

Data Management and Analysis

The interviews were transcribed verbatim by the researcher. To ensure that the study was conducted with rigor and to preserve quality, the supervisors checked the transcriptions of all the voice recordings that the researcher had transcribed. Since all the participants' words were recorded, the transcript would capture any coughs made by them during the interview. The purpose of this was to determine whether the participant was reluctant to answer that question. To verify that comparable information was captured, the interview notes from the researchers were compared.

The transcripts were examined using topic analysis by the researcher. A qualitative data analysis technique called thematic analysis is used to examine a group of texts, including transcripts from interviews. The researcher carefully examines the data in a thematic analysis to find recurrent themes, ideas, and meaning patterns. (12). Thematic analysis is an effective method for comparing the perspectives of different research participants and revealing surprising results. Additionally, because thematic analysis necessitates the researcher to use a well-structured approach to data processing, culminating in a concise and well-organized final report, it is useful for creating a summary of important components of a large data set (12). This study followed Braun and Clarke's (2006) description of the six steps of topic analysis in their journal article, "Using thematic Analysis in Psychology."(11).

Study rigor

A study's rigor or trustworthiness is defined as the level of confidence in the data, interpretation, and methods employed to guarantee the study's quality (13). According to Cypress (14), rigor is the ability to build confidence in a research study's conclusions. The Lincoln and Guba tactics of believability, transferability, dependability, and conformability were used in this study to incorporate trustworthiness (15).

When it comes to the study's credibility, a thorough background that explains the significance of the research and the approvals that were received from the relevant agencies are supplied for reference. To establish transferability, this study included background data to set the scene for the investigation and a comprehensive description of the phenomenon under investigation, allowing for comparisons with other relevant studies. To enable this study to be replicated, a thorough methodological description was provided to address reliability. Conformability was guaranteed because there was no investigator bias because the primary researcher is not employed by the CWM Hospital Laboratory department and is not involved in any laboratory-related activities related to the department. Additionally, a detailed methodological description was given so that the integrity of the research findings could be examined.

Ethical considerations

Ethics approval

was granted from the College Health Research Ethics Committee (CHREC) of Fiji National University (FNU) with ID#0091.22 followed by facility approval from the Medical Superintendent and Laboratory Superintendent of CWMH. All participants were offered consent forms and were interviewed once they had given their written consent.

3.1 Characteristics of participants

In the study 20 patients were interviewed, of which 10 (50%) were males and 10 (50%) were females. Most of the participants in the study were of Fijians of Indian Origin 10 participants (50%), followed by 6, I-Taukei participants (30%) and 4 Fijians of Other Origin participants (20%). There were no illiterate participants in this study, furthermore the open-ended questions for this study has been attached as a supplementary file.

Table 1

Patient’s demographic characteristics (n = 20)
Pseudonym	Age	Gender	Ethnicity
Participant 1	54	F	Fijian of Indian Origin
Participant 2	54	M	Fijian of Indian Origin
Participant 3	25	M	I-Taukei
Participant 4	63	F	Fijian of Indian Origin
Participant 5	30	M	I-Taukei
Participant 6	57	F	Fijian of Indian Origin
Participant 7	25	M	Others
Participant 8	67	F	Fijian of Indian Origin
Participant 9	65	M	Fijian of Indian Origin
Participant 10	24	F	Others
Participant 11	74	M	Fijian of Indian Origin
Participant 12	56	F	Others
Participant 13	33	M	Fijian of Indian Origin
Participant 14	28	F	Fijian of Indian Origin
Participant 15	36	M	I-Taukei
Participant 16	30	M	I-Taukei
Participant 17	27	F	Fijian of Indian Origin
Participant 18	43	F	I-Taukei
Participant 19	35	F	Others
Participant 20	59	F	I-Taukei

Table 2

Themes and codes identified.
Themes	Codes	Quotation Example
Waiting Time & No Signage	Department relocated, change in location, No sign to saying staff is inside, Long waiting time	“I didn’t know that the department had been relocated”, “I was not aware on where the department was’ “there was no sign to let me know that there was a staff waiting inside” “sometimes we have wait for a long time”, “The waiting time increase where there are more patients”, “Waiting time needs to improve as sick patients can’t wait to long”
Privacy & confidentiality	Treatment room exposed, No privacy, staff compromising patient privacy	“it is invasion of privacy for the two patients being served in the room”
Occupational Health and Safety (OHS) Issues	Dull waiting area, not appealing, needs a fan or AC, need for bigger waiting area, Identification of hazards and risk, compliance to policy	“Maybe the seats and sitting arrangement can be increased”, “it was very hot and suffocating…it needs fans or air conditioning” “the room also needs better ventilation”, “the room was too small”, “I felt suffocated in the room”

Themes Identified

The thematic analysis of the interview found 3 themes emerging from the main theme of perception of clinical laboratory services. The three main themes identified include: Waiting Time & No Signage, Privacy and Confidentiality, and Occupational Health and Safety (OHS) Issues.

Theme 1: Waiting Time & No Signage

A few patients were unaware of the change in location of the Laboratory Outpatient Department, as it has just been relocated to a new location recently. A patient also raised her concern on how there is no signage of system to make aware of the patients that a staff in waiting inside to serve them. As the curtains are down and when no one arrived at the department was also outside waiting. While most of the patients described that the waiting time before being served as long and dissatisfying. Ten out of the twenty patients that were interviewed raised the issue of waiting time.

P2, Indian, Male said that:

Today the waiting time was not an issue because there were less patients, however sometimes we have wait for a long time…Sometimes I see some people served first and they do not follow the number sequence. When a particular number is called but they serve call in someone else and serve them as they know them and serve them first and that is wrong.

P7, Others, Male stated:

“The waiting time depends on the day, as some days are good and we don’t have to wait long, whereas some days bad and we have to wait longer. It also depends on the number staff there”.

P9, Indian, Male added on:

“The waiting time increase where there are more patients, sometimes we need to wait for 30 minutes or more”.

P12, Others, Female said:

“Waiting has improved but sometimes we have to wait too long to be seen by the staff”.

P14, Indian, Female mentioned:

“I had to wait a little longer than usual today as the staff had gone out for lunch”.

P16, I-Taukei, Male stated:

“I was not happy to wait long, and I wanted a faster service”.

“When I came, I went to the other side, and I didn’t know that the department had been relocated to this place and I was not happy about this”.

P17, Indian, Female stated:

“The waiting was not an issue today but mostly it is…waiting time can be improved by expending the department size and by recruiting more laboratory staff to provide a faster service”.

P18, I-Taukei, Female stated:

When I came to the department today…when I looked around no one was there and when I was you coming (Interviewer)…I realized that maybe there is a staff to me. As the curtain was down and there was no sign to let me know that there was a staff waiting inside” inside the room to attend to me. As the curtain was down and there was no sign to let me know that there was a staff waiting inside

“Waiting time needs to improve as patients coming in from other health centers need to wait longer as sometimes their details are missing on the forms…if arrangements can be made for patients from other health centers to be seen on a booking basis to ensure patients do not have wait longer”.

P19, I-Taukei, Female mentioned:

“I was not aware of where the department was, and I am glad that the security helped me to get here”.

“Waiting time needs to improve as sick patients can’t wait to long”.

P20, I-Taukei, Female added on:

“I was surprised, and I wasn’t aware of the change in location, and it took a while to look for the place, until a staff told me it’s here”.

“Waiting time needs to be improved, as when there are more patients, we need to have more staff here to see the patients. As today they started calling 2 patients at a time first and then it went down to 1 at a time. But they need to call 3 or 4 at a time to provide a faster service as old people can’t wait too long”.

On the contrary P1, Indian, Male said:

“Waiting time was ok for me and there was no delay as I was seen immediately”.

P3, I-Taukei, Male stated:

“The numbers kept flowing so I didn’t have to wait too long”.

P4, Indian, Female mentioned:

“I did not have to wait long…I was happy the waiting time and service”.

P5, I-Taukei, Male also said:

“Whenever I come for my bloods, I don’t have to wait long as I am seen on time”.

P12, Others, Female stated:

“My experience today was very good, and the staff were very cooperative. I did/t have to wait too long, but prior to the pandemic I had to wait too long but not now”.

Theme 2: Privacy and Confidentiality

A patient raised concern on the privacy and confidentiality of the patients who are being served. As there are two patients called at one point of time and severed by two staff at a particular time and only two patients should only be called in and not more.

P1, Indian, Male suggested:

“My number was 40, 39 was being seen and 41 came and stood there, that I think needs to be avoided. If two patients are being seen at once on the two stations, then no one else should come and wait in the room while they are being served. As it is invasion of privacy for the two patients being served in the room”.

Theme 3: Occupational Health Services (OHS) Issues

A few patients raised concerns about the waiting area, as they were not happy with the area and suggested improving it. Five of the twenty patients raised issues regarding the waiting area, as they asked to increase the sitting capacity, a friendlier environment and to improve the ventilation in the waiting area. While majority of the patients raised concerns about the state of the bleeding room in the department and suggested to improve it to ensure that patients are satisfied with the environment of the room.

P1, Indian, Male suggested:

“The room is a little small and needs to be bigger, the room also needs better ventilation”.

P2, Indian, Male added on:

“The room is small as two patients are seen at once, if the room is bigger, it will be much more comfortable for us”.

P3, I-Taukei, Male also said:

“Only the room was too small, other than that is was clean and neat”.

P6, Indian, Female also stated:

“The room is a little small and the room has no ventilation and that I felt suffocated in the room. If they change that patient will feel more comfortable in the room”.

One thing which I would like to say is that depending on age, some young patients will be able to wait longer and those who are older cannot wait too long or sit too long. So, if provisions can be made to be sick and elderly patients first as they cannot wait too long

P10, Others, Female mentioned:

Maybe the seats and sitting arrangement can be increased, as people were standing and waiting…so if the number of seats and benches can be increased.

“The room is a little small as staff call in 3 patients at time and the room needs more ventilation and maybe they can put in another fan or air conditioning as sometimes it gets too hot.”

P11, Indian, Male added on:

“If more benches or chairs can be placed in the waiting area when there are more patients”.

If I tell you, the bleeding room should have air condition usually but there is a big fan there and the room is small and its needs to bigger.

P13, Indian, Male said:

Maybe a better space and a friendlier environment can be made, as the current area is not very customer friendly as it is an open space, and it needs to be isolated. If drinking water provisions can be made for patients, as sometimes patients get thirsty and need water while waiting.

It’s very hot when there are a lot of patients and there are ventilation issues. As it is a small room and less space to mauver around.

P15, I-Taukei, Male mentioned:

“If a cooler room with air conditioning can be used as it was hot in the room”.

P16, I-Taukei, Male added on:

“The room needs air conditioning, and it is very hot in the room”.

P17, Indian, Female stated:

When I came to the waiting area of the department it was very hot and suffocating…it needs fans or air conditioning”. On the Contrary P6, a 57-year-old Indian, Female mentioned: “The waiting area was nice, and the seating arrangement was also good for me

When I came to the department it was very hot and suffocating. Also, if a bigger room to be given with better ventilation and air conditioning.

On the contrary P4, Indian, Female said:

“I am happy with the room size and the location of the department”.

P5, I-Taukei, Male also stated:

“I was very happy with the service of the department, and I would rate the service as 10 for today, as I didn’t have to wait long and was seen quickly”.

In the findings of this research the participants identified that being unaware of change in location, no signage or system to let patients know staff is inside, privacy and confidentiality, waiting time, waiting area and Occupational Health and Safety (OHS) Issues as those factors which affect them in terms of the laboratory services provided at the CWMH, Laboratory Outpatient department.

Since the laboratory department is an essential part of the health services, it must run smoothly to provide services to its clients. Even if laboratory-related services have improved somewhat in the last year, there are still a lot of areas that need to be improved. The growing demand for services offered by the private sector puts pressure on the public sector to meet the established standards. A study done in India found that patients are becoming more aware of what they need and what is available in terms of medical care, which puts public health systems under increasing pressure from the private sector. In the past, India did not face any direct pressure to improve quality. The Indian health sector is undergoing significant changes, thus there is a lot of potential to apply quality ideals to healthcare (16). Hospitals that prioritize their patients' requirements have been able to grow their market share and capacity utilization, per a second study done in Bangladesh.

Furthermore, research indicates that dissatisfied customers are more inclined to lodge complaints or request assistance from companies to prevent cognitive dissonance and negative customer experiences. Dissatisfaction can, in fact, have detrimental effects. Patients who are unhappy are less likely to follow treatment plans, miss follow-up appointments, and, in the worst cases, resort to negative word-of-mouth, which can persuade others to seek medical attention elsewhere often abroad (17). It also goes without saying that the patient is the main beneficiary of a functioning healthcare system. Since they are the system's customers, patients are at the center of the health care delivery system. Since health, particularly the treatment or cure of illness, is of universal importance, it is imperative that high-quality services be provided in response to medical advancements and the purpose of the caring professions to strive for clinical excellence (16).

When analyzing the service-related issues, two more important variables need to be considered. The length of time patients must wait and maintaining their secrecy and privacy are these two things. The results of the research also raised these two issues. A survey carried out in Iran indicates that one of the rights of patients is confidentiality and privacy protection. Confidentiality is the primary attribute that fosters confidence in the doctor-patient relationship. Even while the law treats confidentiality as absolute outside of legal settings, breaches of confidence happen periodically and are not always unethical despite efforts to maintain secrecy. Iran lacks a specific ethical guideline that specifies exactly how patient confidentiality should be handled in a medical setting. To protect the privacy of any medical information, the scope of the problem needs to be ascertained (18).

Even though they can vary between countries, within a nation, and between medical facilities in the same region, long patient wait times have also been reported in both industrialized and developing nations. Patients' propensity to return to the clinic is negatively impacted by long wait times, which will drastically reduce the utilization of medical services. Waiting times are a major source of patient unhappiness and suffering in hospitals. A recommendation from the American Institute of Medicine states that patients should be seen within 30 minutes after arriving at a hospital. Long wait times are a losing tactic since they waste hospital clients' time, staff members' frustration, and patients' precious time. In many health care systems around the world, access to medical treatments is regularly delayed. To stop the common practice of extended patient, wait times in public hospitals, much more work needs to be done (19). Receiving medical treatments is sometimes delayed in various healthcare systems. Much more work needs to be done to eradicate the widespread practice of long patient wait times in public hospitals (20).

Similarly, a study highlighted that In Malaysia, the average wait time for an outpatient hospital stay is between one and two hours. The waiting experience, which is influenced by various factors like the waiting area's cleanliness and appeal, can also influence patient satisfaction. The availability of entertainment, such as television, health information, and reading materials, may increase the anticipation of waiting. It's also essential that the staff members are kind and friendly to improve the waiting experience. A lack of staff, outdated equipment, and a high patient volume can all contribute to lengthy wait times. Extended wait times in clinics might be caused by a laborious and time-consuming registration or work process that involves needless test repetition (21).

Moreover, according to study published by the College of American Pathologists, patients are permitted to protest if they endure prolonged wait periods during phlebotomy. Phlebotomists are essentially the face of the laboratory, therefore having excellent people skills is crucial. Although phlebotomy should be a quick and simple procedure, it can become arduous due to complicated sign-in processes and poor communication between phlebotomy professionals and patients. Excessive wait times paired with inconsiderate care might cause patients to lose faith in the operation, making for an unpleasant overall experience. To reduce wait times and improve the patient’s experience, several efficiency-boosting techniques were implemented. The phlebotomy room was rearranged to maximize patient flow, an innovative self-sign-in station was established to streamline the registration procedure, and a digital whiteboard was erected to show the patient sequence and convey anticipated wait times. The whiteboard improved the phlebotomy staff's efficiency and responsibility in addition to providing insights for the patients (22).

In Addition, Quality infrastructure (QI) is a system of initiatives, establishments, institutions (both public and private), activities, and people. It is made up of the procedures, rules, and laws required to maintain and raise the standard of operations, services, and goods as well as their safety and environmental integrity. Its worldwide recognition is essential for the smooth operation of the local market and for building its reputation in domestic and foreign markets. Quality of life (QI) is critical to the advancement and preservation of social and environmental well-being, as well as economic success. Market observation, metrology, standardization, accreditation, and conformance evaluation are all necessary. Laboratory operations provide conformity assessment in addition to certification and inspection. Because laboratories are able to show how well products and services conform to legal requirements as well as market norms, they are vital to the quality assurance system. Laboratory data and information are essential for transparent and trustworthy decision-making, especially when it comes to activities related to inspection and certification, as they help guarantee that products and services meet the triple bottom line of social, environmental, and financial considerations (23).

For the Laboratory Infrastructure to be developed or strengthened, vision and insight are needed. It is necessary to strike a balance between the expected benefits in both the short and long term and the projected investment amount. This usually means making difficult decisions, especially in many developing countries where resources are occasionally scarce. Should the emphasis be on constructing physical infrastructure like highways, bridges, and hospitals? How much weight should be placed on the sustainability, safety, and quality of products and services? Due to innate quality issues, capital-intensive infrastructure projects may not succeed, resulting in unnecessary expenses and possibly putting lives in jeopardy. It is imperative to have a detailed analysis, one that considers a country's requirement for laboratory capacity in addition to its strategic planning and policy goals. It is essential to have a thorough grasp of the laboratory services provided and their ability to meet regulatory and market criteria before making any more investment decisions. It is equally important to comprehend the initial and ongoing investment consequences about fulfilling specific needs and realizing potential advantages. These specifics offer a far more thorough analysis that helps decide whether to increase laboratory capacity investments (23).

The absence of any preventable harm to a patient during any stage of medical therapy is one of the most significant global health concerns. In wealthy countries, injuries occur to one in ten people undergoing medical care, according to reports. However, this number is noticeably higher in emerging countries than in developed ones. There are numerous potential causes of medical errors. The primary sources of avoidable errors include hospital equipment and supplies, staff involvement, and the complexity of medical care. An American study claims that the IOM report provides four step methods for improved safety. I. Because there isn't a single government agency tasked with advancing and commercializing safety solutions, the healthcare sector lags other higher-risk industries by at least ten years in terms of fundamental safety issues. Because of this, a national leadership conference should be held to raise awareness of patient safety. II. Error reporting systems ought to be established nationally. Encouraging healthcare providers to use these optional reporting channels is crucial. Healthcare facilities will be encouraged to implement internal safety protocols by recognizing errors and learning from them. III. Regulatory and related processes, such as licensing, certification, or accreditation, should specify the minimal performance criteria for healthcare workers to raise expectations for breakthroughs in patient safety. IV. To improve patient treatment's dependability and safety, healthcare facilities need to establish a "culture of safety" (24).

As a matter of fact, important OHS considerations that are essential to consider when providing services were found in two studies that focused on Ethiopia. These include the cleanliness of the location where blood is drawn, the coziness of the chairs, the convenience of access to and use of the latrines, and the comfort and cleanliness of the waiting room. The survey found that most participants (95.6%) were satisfied with the quality of service, with high points going to the blood drawing room's cleanliness and the comfort of the chairs (88.1%). Nonetheless, most patrons voiced dissatisfaction with the comfort and cleanliness of the latrines (63.5%) as well as their accessibility and availability (64.5%) (25). The second study found that between 25% and 50% of participants expressed dissatisfaction with various aspects of the laboratory, such as the cleanliness of the bathrooms. Based on their inability to locate the lab, cashier office, or restroom, 19%, 22%, and 21% of respondents, respectively, indicated displeasure with the laboratory.

Comparatively other studies also indicated that waiting areas lacked chairs and were dirty, and that laboratory patrons had low satisfaction ratings with the accessibility and cleanliness of the restrooms (25). Every healthcare facility that provides services ought to guarantee that the patient-friendly workplaces in each department are safe and clean. OHS in the laboratory department is essential for customer satisfaction because no patient would want to get care in an unclean and unsafe environment (2). Patients expressed dissatisfaction about several reasons, including job overload, lack of attention to activities outside the testing laboratory, and other issues that were comparable to those found in a study by Teklemariam et al. It was also observed that the cleanliness and location of the restroom, as well as how difficult it was to locate the latrine to turn in specimens like feces and urine, were crucial factors in determining patient satisfaction in the laboratory (26).

Study limitations

The major limitation of the study was participant recruitment, as many participants were resistant and reluctant to take part in the study as there hadn’t been any study conducted in the laboratory department.

The patient overall dissatisfaction with the quality of care is indicated by the study's findings. When a patient goes to a government facility, such as the CWMH Laboratory Outpatient Department, they anticipate getting the best care available. However, several problems, such as those with infrastructure and service accessibility, go against this expectation and bolster patients' unfavorable opinions of the Ministry and the laboratory staff. One issue that the patients brought up was the shared waiting room for patients. There must be more airflow in this stifling room. To guarantee that services are rendered without adversely affecting patient wait times, the laboratory outpatient section also requires more personnel on duty and more spacious seating arrangements during clinic hours. Despite having facilities for sick, disabled, and elderly patients, the department was also criticized for being inhospitable to the elderly and disabled communities.

The equipment breaking down and the shortage of reagents were two further factors that affected the patients. The patients were against the idea of being sent to the private laboratories because of the exorbitant cost, which was a big factor. Although the CWMH laboratory outpatient department was thought to be operating effectively overall, there is still potential for development in terms of staffing levels, quality of care, and patient-centeredness. The waiting area and bleeding area also require improved lighting and ventilation.

CHREC- College Health Research Ethics Committee
CMNHS- College of Medicine Nursing and Health Science
CWMH- Colonial War Memorial Hospital
FNU- Fiji National University
ISO- International Organization for Standardization
LOPD- Laboratory Outpatient Department
MHMS- Ministry of Health and Medical Services
OHS- Occupational Health and Safety
QI- Quality Infrastructure
QI- Quality of life
WHO SSA- World Health Organization Special Service Agreement
WHO- World Health Organization

Acknowledgements

The authors would like to gratefully acknowledge Dr. Javin Kumar for his support and assistance during the data collection period. Also, our gratitude is extended to Ms. Anjini Naicker and Mrs. Bharti Ben Sharma for their moral support during the preparation of this manuscript.

Authors’ contributions

JS and RDN comprehended the study. JS undertook data collection and analysis. All the authors discussed and contributed to decided final themes. JS supported study methodology. RDN and LT supervised the project. JS wrote the main manuscript text and was reviewed and edited by RDN. All authors have read and approved the manuscript.

Funding

Not Applicable.

Availability of data and materials

The data that supports the findings of this study are available on request from the corresponding author.

Ethics approval and consent to participate.

Ethical approval for this study was obtained from the College Health Research Ethics Committee (CHREC) of Fiji National University (FNU). Permission was obtained from the Laboratory Superintendent and Head of departments of the CWMH Laboratory department and Medical Superintendent of CWM hospital. All participants were given an informed consent form to sign before conducting the interview. The participants were informed about the purpose of the study and assured that their identities would be kept anonymous, and the participant’s responses and any other information would be kept confidential and protected. All methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

Not Applicable.

Declaration of competing interests

The authors declare that they have no competing interests.

Author details

¹ Medical Laboratory Scientist (WHO SSA), World Health Organization, Nadi, Fiji

² School of Public Health and Primary Care, Fiji National University, Suva, Fiji.

Hamid GA. (PDF) Clinical Laboratory Guide for Medical Students [Internet]. ResearchGate. 2012. https://www.researchgate.net/publication/263842348_Clinical_Laboratory_Guide_for_Medical_Students.
Sharma J, Nair R, Mohammadnezhad M, Singh S. Patients’ Perceptions on Facilitators and Barriers of Utilization of Clinical Laboratory Services: Suggestions for Pacific Nations [Internet]. Pacific Journal of Medical Sciences. Pacific Journal of Medical Sciences; 2021. https://www.pacjmedsci.com/Full%20journal%20PJMS%20Vol%2021%20No%202%20March%202021-1.pdf#page=45.
Sajid MS, Baig MK. Quality of health care: an absolute necessity for public satisfaction, International Journal of Health Care Quality Assurance, Vol. 20 No. 6, pp. 545–548; 2007. https://doi.org/10.1108/09526860710819477.
Anderson V. Customer Service and Its Importance in the Clinical Laboratory [Ebook]. LABMEDICINE. 2008. https://academic.oup.com/labmed/article/39/4/197/2504686.
Oja P, Kouri T, Pakarinen A. From customer satisfaction survey to corrective actions in laboratory services in a university hospital [Ebook]. International Journal for Quality in Health Care. 2006. https://academic.oup.com/intqhc/article/18/6/422/1803370.
Alelign A, Belay Y. Patient satisfaction with clinical laboratory services and associated factors among adult patients attending outpatient departments at Debre Markos referral hospital, Northwest Ethiopia [Ebook]. Biomed Central. 2019. https://doi.org/10.1186/s13104-019-4558-8.
Geberu D, Biks G, Gebremedhin T, Mekonnen T. Factors of patient satisfaction in adult outpatient departments of private wing and regular services in public hospitals of Addis Ababa, Ethiopia: a comparative crosssectional study [Ebook]. BMC Health Services Research. 2019. https://doi.org/10.1186/s12913-019-4685-x.
Adu P. A cross-case analyses of laboratory professionals-patients interaction for patients accessing laboratory services at University of Cape Coast hospital and Ewim Polyclinic in the Cape Coast Metropolis, Ghana [Ebook]. BMC Health Services Research. 2021. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06560-8.
Litchfield I, Bentham L, Lilford R, McManus R, Hill A, Greenfield S. Adaption, implementation and evaluation of collaborative service improvements in the testing and result communication process in primary care from patient and staff perspectives: a qualitative study [Ebook]. BMC Health Services Research. 2017. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2566-8.
Wyse S. What is the difference between qualitative research and quantitative research? [Online]. 2021. http://www.snapsurveys.com/blog/what-is-the-difference-between-qualitative-research-and-quantitative-research/.
Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77–101. ISSN 1478 – 0887.
Nowell L, Norris J, White D, Moules N. Thematic Analysis. Int J Qual Methods. 2017;16(1):160940691773384.
Maher C, Hadfeld M, Hutchings M, de Eyto A. Ensuring Rigor in Qualitative Data Analysis. Int J Qual Methods. 2018;17.
Cypress B. Rigor or Reliability and Validity in Qualitative Research. Dimens Crit Care Nurs. 2017;36(4):253–63.
Lincoln YS, Guba EG. Naturalistic Inquiry. Newbury Park, CA: Sage; 1985.
Duggirala M, Rajendran C, Anantharaman R. Patient-perceived dimensions of total quality service in healthcare. Benchmarking: Int J. 2008;15(5):560–83. 10.1108/14635770810903150.
Andaleeb S, Siddiqui N, Khandakar S. Patient satisfaction with health services in Bangladesh. Health Policy Plann. 2007;22(4):263–73. 10.1093/heapol/czm017.
Noroozi M, Zahedi L, Bathaei F, Salari P. (2018). Challenges of Confidentiality in Clinical Settings: Compilation of an Ethical Guideline [Ebook]. Iranian Journal of Public Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6077627/.
Biya M, Gezahagn M, Birhanu B, Yitbarek K, Getachew N, Beyene W. Waiting time and its associated factors in patients presenting to outpatient departments at Public Hospitals of Jimma Zone, Southwest Ethiopia. BMC Health Serv Res. 2022;22(1). 10.1186/s12913-022-07502-8.
Sun J, Lin Q, Zhao P, Zhang Q, Xu K, Chen H, et al. Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital-an interrupted time series study. BMC Public Health. 2017;17(1). 10.1186/s12889-017-4667-z.
Ahmad B, Khairatul K, Farnaza A. (2017). An assessment of patient waiting and consultation time in a primary healthcare clinic [Ebook]. Malays Fam Physician. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5420318/.
Le V, Wagar E, Phipps R, Del Guidice R, Le H, Middleton L. (2019). Improving Patient Experience of Wait Times and Courtesy Through Electronic Sign-in and Notification in the Phlebotomy Clinic. Archives Of Pathology &Amp Laboratory Medicine, 144(6), 769–775. 10.5858/arpa.2019-0139-oa.
United Nations Industrial Development Organization. (2021). LABORATORY POLICY: A GUIDE TO DEVELOPMENT AND IMPLEMENTATION [Ebook]. Retrieved from https://www.unido.org/sites/default/files/files/202104/LP_publication_22042021_FINAL.pdf.
Serteser M, Coskun A, Inal T, Unsal I. How ISO-15189 laboratory accreditation assures patient safety? / Kako ISO-15189 akreditacija laboratorija osigurava bezbednost pacijenta? J Med Biochem. 2012;31(4):271–80. 10.2478/v10011-012-0017-y.
Hailu H, Desale A, Yalew A, Asrat H, Kebede S, Dejene D, et al. Patients’ satisfaction with clinical Laboratory Services in Public Hospitals in Ethiopia. BMC Health Serv Res. 2020;20(1). 10.1186/s12913-019-4880-9.
Teklemariam Z, Mekonnen A, Kedir H, Kabew G. Clients and clinician satisfaction with laboratory services at selected government hospitals in eastern Ethiopia. BMC Res Notes. 2013;6(1). 10.1186/1756-0500-6-15.

No competing interests reported.

Download PDF

Editorial decision: Revision requested
16 Jul, 2024
Editor assigned by journal
10 Jul, 2024
Submission checks completed at journal
10 Jul, 2024
First submitted to journal
09 Jul, 2024

You are reading this latest preprint version

Patients Perception on services related issues at Colonial War Memorial Hospital (CWMH) Clinical Laboratory

Status:

Version 1

Abstract

Introduction

Aim and research question

Methodology

Study Setting, Study Design and Study Population (Inclusion and Exclusion Criteria)

Data Collection Tool

Study Procedure and Data Collection

Data Management and Analysis

Study rigor

Ethical considerations

Results

3.1 Characteristics of participants

Themes Identified

Theme 1: Waiting Time & No Signage

Theme 2: Privacy and Confidentiality

Theme 3: Occupational Health Services (OHS) Issues

Discussion

Study limitations

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1