In the public eyes, hospitals will continue to be the ‘face’ of the health system, and upon it the public assess the quality of services provided [19]. There is an emerging consensus that the patient experience is a fundamental aspect of provider quality [20]. Measurement of patient experience is thus regarded as an important aspect of evaluation of health services; and it provides an opportunity to improve care, meet patients’ expectations, enhance strategic decision making, effectively manage and monitor health care performance [21]. The present study evaluated how outpatients of two different socioeconomic group (educational and employment status) and it rate their experience in respect to various domain of care at the Teaching hospitals in Southeast Nigeria. The study is an attempt to know how Patient experience can serve as metric for health industry competition and differentiation, since it reflects quality of care from the patient’s perspective [21]. The limitations of this study include its inability to capture all the domains of patient care in the hospitals. It was restricted to measures of outpatient or ambulatory healthcare services. Thus, the findings cannot be generalized to include that of admitted patients.
In this study 408 outpatients participated. The majority were within active age range of 18–65 years of age; 28.2% were unemployed and this is comparable to the prevailing unemployment rate in the general population of Nigeria as at the time of the study. Two-fifth (40%) of the respondents had tertiary or university education, while very few (13.2%) were without formal education. PE was measured using domains such as waiting time, environment of the OPDs, quality of doctor’s care, quality of care from nurses/other medical staff and responsiveness of care.
Waiting time, here, is defined as the length of time from when the patient enters the OPD to the time the patient actually leaves. And it is believed that reducing waiting time and making sure that patient receive the appropriate care timely will have a significant impact on quality of care [22]. UNTH had the shortest waiting time; patients spent less time waiting for services from doctor or other care giver. It is evident from previous studies that increased waiting time also affect the overall treatment provided by physician and other care givers [23]. In UK the national standard or accepted waiting time is 30 minutes [24]. In Nigeria, previous studies show that the majority of outpatients wait as long as 80–180 minutes or more in the OPDs, and the commonest reason for this long waiting time is the large number of patients as against few health workers [17, 25]. A study in India obtained average waiting time outside the various OPDs of only 12 minutes and 98.52% of patients were very satisfied with it [13]. In the present work, the actual length of time were not ascertained. However, only a mere 44.4% of male patients and 39.3% of female patients were satisfied with the waiting time. The findings show that very educated patients, unlike the illiterate ones, are less satisfied with waiting time. Impact or effect of educational status was also noted for quality of care by the nurses/other health workers. Larger proportion of poorly educated outpatients rated this class of care higher. On the other hand, educational status was not significantly associated with patients’ rating for OPD environment, doctors’ care and responsiveness of care. This differs from the findings of Zalmanovitch and Vashdi (2014) who reported that a lower level of education predicates greater responsiveness of care for primary and preventive healthcare than higher level of educational status [26].
The mean overall patient experience rating in this study was 74.31 ± 0.33%. This score, though, higher than that of similar study in a Federal Medical Centre in Southeast Nigeria (where average satisfaction score of outpatients respondents was 66.8%) is slightly below 83.0% obtained in a hospital of similar status (Aminu Kano teaching hospital) in Northern Nigeria [27, 28]. The study showed that employment status, and not level of educational, had direct significant association with patients’ rating for overall quality of care. Higher proportion of employed and retired outpatients rated the quality of care from the hospitals high. This, to some extent, is at variance with the findings of Arpey, et al (2017) who in their recent study observed that patients’ SES had no impact in the way they are viewed or treated by their physicians [29]. However, our findings agreed with that of Myers, et al (2006) and Bernheim, et al (2008) who found that physicians as a group perceive and treat low SES patients differently from those of higher SES [30, 31]. Maharlouei, et al (2017) had also reported on how the overall patient experience was associated with different SES [32].