CHAPTER ONE

GENERAL INTRODUCTION

1.1. Background to the study

Good health for the people in the country is important to the human development and improvement of their economies (Peprah, 2014). Health supply has been explained in the performance of the service deliveries that demand high consumer involvement within the consumption process. A nasty service delivery harms the client and to some extent could even result in the loss of life. For this reason, checking and assessing client satisfaction with health care is a necessary effort to improve the standard of the health system (Samson et al., 2015). One among the measures of health care service outcomes is by evaluating the effectiveness of service quality on Customer satisfaction. Commenting on the possible determinant factors for the customer’s satisfaction will have importance to policymakers to think about upon which to emphasize.

Customer satisfaction has been a subject of great interest to organizations and researchers alike. The principal objective of organizations is to maximize profits and to minimize cost. Profit maximization can be achieved through increase in sales with lesser costs. One of the factors that can help to increase sales is customer satisfaction, because satisfaction leads to customer loyalty recommendation and repeat purchase (Wilson, 2008). Customer satisfaction is the main concern of business sectors of today.

Patient satisfaction  is  a  complicated phenomenon  that  is  related  to  many  factors  such  as  patient  expectations,  service  quality, health  status  and  outcome,  and  health  system  characteristics (Gagliano, 2015).    It is critical to clearly understand the determinant of healthcare service quality evaluation, patient satisfaction and what encourage the patients to reuse a service of the healthcare sectors.

Customer satisfaction remains the most interesting subject for organizations as well as for the researchers at the same time.  Patient satisfaction has emerged as an increasingly important health outcome. Satisfaction  is  believed  to  be  an  attitudinal  response  to  value  judgments  that patients make  about  their  clinical  encounter (Ogunlade et al., 2017). The healthcare industry is a service-oriented sector that requires a high level of customer satisfaction to ensure quality care and positive health outcomes. Customer service is a critical component of healthcare delivery, as it directly impacts patient satisfaction, loyalty and ultimately, the reputation of healthcare providers. In recent years, the concern for service quality reached unprecedented level in many service industries throughout the country while looking kindly at the public health sector.  Service quality has been identified as the difference between the customers’ expectations of service and their perceptions of the service delivery (Kuo. & Tsai 2016).

The healthcare industry is a complex and dynamic sector that plays a critical role in ensuring the well-being and quality of life of individuals. The industry has experienced significant changes in recent years, driven by advances in technology, changing patient expectations and increasing competition (Andaleeb, 2001). As a result, healthcare providers are under pressure to deliver high-quality, patient-centered care while maintaining efficiency and cost-effectiveness.

Effective customer service in healthcare involves more than just providing medical treatment; it requires healthcare providers to be responsive to patients’ needs, communicate effectively and show empathy and compassion (Bourne, 2018).

Despite its importance, customer service in healthcare often falls short of patient expectations. Studies have shown that patients are increasingly dissatisfied with the quality of care they receive, citing long wait times, poor communication, and lack of empathy from healthcare staff as major concerns (Kotleret al., 2002)

The global healthcare landscape has undergone significant transformations in recent years, driven by factors such as technological advancements, shifting patient expectations, and evolving disease patterns (World Health Organization, 2019). The World Health Organization (WHO) has emphasized the importance of patient-centered care, quality and safety in healthcare delivery (WHO, 2016). The delivery of high-quality healthcare services is a critical concern globally, as it directly impacts patient satisfaction, health outcomes, and the overall effectiveness of healthcare systems. The World Health Organization (WHO) emphasized the importance of patient-centered care, which prioritizes the needs and preferences of patients (WHO, 2016).

In the United States, the Agency for Healthcare Research and Quality (AHRQ) has developed the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to measure patient satisfaction with healthcare services (AHRQ, 2020). Research has shown that service quality is a key driver of patient satisfaction in the US healthcare system (Sweeney et al., 2018). The US, the healthcare system is characterized by a strong emphasis on patient-centered care. Studies have shown that service quality delivery is a critical factor in determining out-patient satisfaction (Gagliano, 2015). The use of patient satisfaction surveys, such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), has become widespread in the US.

In Europe, the healthcare system is generally characterized by universal access and comprehensive coverage. Research has shown that service quality delivery is a key driver of out-patient satisfaction in European healthcare systems (Sofaer&Firminger, 2005). The use of patient satisfaction surveys, such as the European Health Consumer Index (EHCI), is becoming increasingly popular in Europe. The European Commission has emphasized the importance of patient-centered care and service quality in healthcare (European Commission, 2019). Research has shown that service quality is a critical determinant of patient satisfaction in European healthcare systems (Van der Scheeet al., 2018).

In the developing world such as Latin America, healthcare systems are characterized by a mix of public and private providers. Studies have shown that service quality delivery is a critical factor in determining out-patient satisfaction in Latin American healthcare systems (Vianet al., 2017). The use of patient satisfaction surveys, such as the Latin American Patient Satisfaction Survey (LAPSS), is becoming increasingly popular in Latin America.

In Asia, studies have highlighted the importance of service quality in healthcare, with a focus on cultural and linguistic diversity (Wong et al., 2017). In countries such as Japan and South Korea, healthcare providers are increasingly focusing on patient-centered care and service quality improvement (Kondo et al., 2018). Countries such as Japan, South Korea, and Singapore have invested heavily in healthcare infrastructure and technology. Studies have shown that service quality delivery is a critical factor in determining out-patient satisfaction in Asian healthcare systems (Kuoet al., 2016). The use of patient satisfaction surveys, such as the Asian Patient Satisfaction Survey (APSS), is becoming increasingly popular in Asia.

In the Caribbean, healthcare systems are often characterized by limited resources, inadequate infrastructure, and a shortage of skilled healthcare professionals. Despite these challenges, many Caribbean countries have made significant progress in improving healthcare outcomes and expanding access to services (Bourne et al., 2018). Research has emphasized the importance of service quality improvement in Caribbean healthcare systems (Samuels et al., 2019).

In Africa, healthcare systems face numerous challenges, including inadequate funding, insufficient infrastructure, and a shortage of skilled healthcare professionals. Research has shown that service quality delivery is a key driver of out-patient satisfaction in African healthcare systems (Ogunladeet al., 2017). The use of patient satisfaction surveys, such as the African Patient Satisfaction Survey (APSS), is becoming increasingly popular in Africa. The healthcare systems face significant challenges, including limited resources, infrastructure and skilled healthcare professionals (WHO, 2019). Research has highlighted the importance of service quality improvement in African healthcare systems, with a focus on patient-centered care and cultural sensitivity (Mills et al., 2019).

In Cameroon, the healthcare system faces challenges such as limited resources, inadequate infrastructure and a shortage of skilled healthcare professionals (Ministry of Public Health, 2019). Research has emphasized the importance of service quality improvement in Cameroonian healthcare systems, with a focus on patient-centered care and cultural sensitivity (Tih et al., 2018). The healthcare sector in Cameroon and particularly Bamenda regional hospital is not immune to these challenges. The sector has experienced significant growth in recent years, driven by an increasing demand for healthcare services. However, this growth has also led to increased pressure on healthcare providers to deliver high-quality care while managing increasing workloads and limited resources.

In recent years, there has been growing concern about the quality of healthcare services provided by public hospitals in Cameroon, including the Bamenda Regional Hospital. Patients have expressed dissatisfaction with various aspects of care, including long waiting times, poor communication with healthcare providers and inadequate attention to their needs or to patients in very precarious and complicated health challenges. These concerns have significant implications for patient satisfaction, health outcomes, and the overall reputation of the hospital, thus the study.

In Bamenda, the regional hospital serves as a major referral hospital for the Northwest Region of Cameroon. However, the hospital faces challenges such as limited resources, inadequate infrastructure and a shortage of skilled healthcare professionals (Bamenda Regional Hospital, 2020). Research from the Ministry of public Health (2006) has highlighted the need for service quality improvement in the Bamenda Regional Hospital, with a focus on patient-centered care and cultural sensitivity.

The Bamenda Regional Hospital, located in the North West Region of Cameroon, serves as a major healthcare provider for the local population. As a regional hospital, it provides specialized medical services, including outpatient care, to patients from surrounding districts. However, like many healthcare facilities in Cameroon, the Bamenda Regional Hospital faces challenges in delivering high-quality services, including inadequate infrastructure, shortage of skilled healthcare professionals, and limited financial resources.

While there is a growing body of research on service quality and patient satisfaction in healthcare, there is a need for more studies that focus on the specific context of developing countries, including Cameroon. This study aims to address this research gap by investigating the effectiveness of service quality delivery on out-patient satisfaction in the Bamenda Regional Hospital. The findings of this study will contribute to the existing body of knowledge on service quality and patient satisfaction and provide insights for healthcare policymakers and practitioners in Cameroon and other developing countries.

1.2. Statement of the research problem

The key argument in favour of public hospitals is that they treat citizens at lower prices as compared to private hospitals. It is for this reason that people rush there but the waiting time for public hospitals is a regular matter for debate. Waiting for  a  service is representing  the  first  direct  interaction  between  customer  and  service  delivery  process.  Despite the critical role that customer service plays in healthcare delivery, there is a significant gap in the literature on the effectiveness of customer service on customer satisfaction in out-patient of the Bamenda regional hospital. Specifically, there is a need for research that explores the relationship between customer service and customer satisfaction in healthcare units, and identifies the specific aspects of customer service that have the greatest impact on customer satisfaction.

The Bamenda Regional Hospital, a major healthcare provider in the North West Region of Cameroon, faces significant challenges in delivering high-quality services to its out-patients. Despite its importance as a referral center for patients from surrounding districts, the hospital’s out-patient department struggles with inadequate infrastructure, insufficient staffing and inefficient processes, ultimately affecting the quality of care provided to patients.

The current state of service quality delivery in the out-patient department of the Bamenda Regional Hospital is shrouded in uncertainty. There is a lack of comprehensive data on the department’s service quality delivery, making it difficult to identify areas for improvement and implement effective strategies to enhance patient satisfaction. The department’s service quality delivery seems to be influenced by various factors, including the competence and attitude of healthcare staff, the availability and accessibility of medical equipment and supplies and the physical environment of the department.

The lack of understanding of the current state of service quality delivery in the out-patient department of the Bamenda Regional Hospital has significant implications for patient care and satisfaction. Patients may experience long waiting times, poor communication with healthcare staff and inadequate care, ultimately leading to decreased patient satisfaction and negative health outcomes. The hospital’s reputation appears to suffer, leading to a decline in patient trust and loyalty. The Bamenda Regional Hospital, strives to deliver high-quality services to its out-patients. However, the relationship between service quality delivery and out-patient satisfaction in the hospital’s out-patient department remains unclear.

From the above problems it is imperative to assess the effectiveness of service quality delivery in the out-patient department of the Bamenda Regional Hospital. This ongoing research aims to provide a comprehensive understanding of the department’s service quality delivery, identifying areas of strength and weakness and informing strategies to improve patient satisfaction and healthcare outcomes.

Out-patient satisfaction is a critical indicator of healthcare quality, reflecting patients’ perceptions of the care they receive. Service quality delivery, encompassing various dimensions such as tangibles, reliability, responsiveness, assurance, and empathy, plays a pivotal role in shaping out-patient satisfaction. Nonetheless, the extent to which service quality delivery influences out-patient satisfaction in the Bamenda Regional Hospital’s out-patient department is not well understood. Several factors contribute to this knowledge gap. Firstly, the hospital’s out-patient department faces challenges in delivering high-quality services, including inadequate infrastructure, insufficient staffing and inefficient processes. These challenges may negatively impact service quality delivery and, subsequently, out-patient satisfaction.

Another problem affecting the relationship between service quality delivery and out-patient satisfaction may be influenced by various moderating factors, such as patient demographics, disease severity and healthcare staff characteristics. The lack of understanding of the relationship between service quality delivery and out-patient satisfaction in the Bamenda Regional Hospital’s out-patient department has significant implications for patient care and satisfaction. Patients may experience decreased satisfaction with the care they receive, leading to negative health outcomes, decreased patient loyalty and a decline in the hospital’s reputation.

Despite efforts to improve service quality delivery, the hospital’s out-patient department continues to receive complaints from patients regarding long waiting times, poor communication with healthcare staff, and inadequate care. These complaints suggest that the hospital’s service quality delivery may not be meeting the needs and expectations of its out-patients, leading to decreased patient satisfaction.

Therefore, it is essential to identify the factors that influence the effectiveness of service quality delivery on out-patient satisfaction in the Bamenda Regional Hospital. This study aims to provide a comprehensive understanding of these factors, including their interrelationships and impact on out-patient satisfaction, and inform strategies to enhance patient satisfaction and healthcare outcomes.

1.3. Research Questions

1.3.1. Main Question

How effective is service quality delivery and out patient’s satisfaction in the Bamenda regional hospital?

1.3.2. Specific Questions

Specifically the study aim at answering the following research questions

1. What is the current state of service quality delivery in the out-patient department of the Bamenda Regional Hospital?
2. In what ways do service delivery practices affects out-patient satisfaction in the Bamenda Regional Hospital?
3. What factors influence the effectiveness of service quality delivery and out-patient satisfaction in the Bamenda Regional Hospital?

1.4. Research Objectives

1.4.1. Main Objective

The main objectives of this study was to investigate the effectiveness of service quality delivery on out patient’s satisfaction in the Bamenda regional hospital

1.4.2. Specific Objectives

More specifically this research seeks to:

1. To evaluate the current state of service quality delivery in the out-patient department of the Bamenda Regional Hospital.
2. To examine the ways in which service delivery practices affects out-patient satisfaction in the Bamenda Regional Hospital.
3. To identify the factors that influences the effectiveness of service quality delivery and out-patient satisfaction in the Bamenda Regional Hospital.