PENTECOST UNIVERSITY

FACULTY OF HEALTH AND ALLIED SCIENCES

DEPARTMENT OF PHYSICIAN ASSISTANTSHIP STUDIES

TOPIC:
AN ASSESSMENT OF CLIENT’S SATISFACTION WITH HEALTHCARE
SERVICES AT PENTECOST HOSPITAL

BY
ACHIAA HENRIETTA
PUCPA/200043
THIS RESEARCH WORK IS SUBMITTED TO THE DEPARTMENT OF
PHYSICIAN ASSISTANTSHIP STUDIES, PENTECOST UNIVERSITY,
SOWUTUOM IN PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE AWARD OF BACHELOR’S DEGREE IN PHYSICIAN
ASSISTANTSHIP STUDIES
OCTOBER, 2024
DECLARATION
I hereby do solemnly declare that the work presented in this project work has been carried out by
me and has not been previously submitted to any other University / College / Organisation for an
academic qualification / Certificate / Diploma or degree.

The student hereby warrants.

The work I have presented does not breach any existing copyright. I further undertake to
indemnify the University against any loss or damage arising from breach of the foregoing
obligations.

STUDENT:
Full name: Achiaa Henrietta DATE: …………………………….
(PUCPA/200043) SIGNATURE: …………………….

SUPERVISOR: DATE: …………………………….

Full name: Dr Ernest Nimfah Appiah SIGNATURE: …………………….

HEAD OF DEPARTMENT: DATE: …………………………….

Full name: Dr. Appiah Denkyira SIGNATURE: …………………….
DEDICATION
This work is dedicated to myself and parents for their unwavering support and unconditional
love they showed me throughout this journey. Again to my friends and loved ones for the support
throughout this journey.
ACKNOWLEDGEMENT

I want to start by expressing my heartfelt gratitude to Almighty God for His grace, guidance, and
strength during this research journey. His blessings have continually inspired me.

I am immensely thankful to my research supervisor, Dr. Ernest Nimfah Appiah, for his
invaluable support, direction, and encouragement. His insights have been crucial to the
successful completion of this work.

I also appreciate Pentecost University for providing the opportunity and resources for my study.
A special thanks goes to the Physician Assistant Department for their ongoing support and for
equipping me with the knowledge and skills needed for this research.

I would like to extend my gratitude to Pentecost Hospital Madina, where I conducted my study,
for their cooperation throughout the process.

To my colleagues, thank you for your encouragement, collaboration, and shared experiences,
which have significantly contributed to my progress.

Lastly, I am profoundly grateful to my family for their unwavering love, support, and
understanding. Your belief in me has been a great motivation throughout this journey.

Thank you all.

TABLE OF CONTENTS
LIST OF TABLES
LISTS OF FIGURES
LIST OF ABBREVIATIONS
ABSTRACT
BACKGROUND
Patients’ satisfaction refers to determining patient’s content with the services that they are
receiving from healthcare e.g. well-timed, well-organized, and patient-centered delivery of
quality healthcare. The quality of health care services has become a priority in the modern health
system, defined as a service that meets professional and patient needs by efficiently using
resources and minimizing risks. The quality of health care services implies the best possible
outcomes, timely service and rational use of resources and application of appropriate procedures.
Quality measurement includes dimensions such as availability, safety, continuity, effectiveness
and interpersonal relationships, which is key to patient’s trust and satisfaction. In the healthcare
industry, as global competition grows, patients are becoming more curious and concerned about
healthcare services. Increased focus on health has greatly improved healthcare delivery and
promoted healthier lifestyles for everyone.

GENERAL OBJECTIVE: The general objective of this study is assess the clients satisfaction
with quality healthcare services provided by Pentecost hospital.

METHODOLOGY: The study will adopted a descriptive cross-sectional design, which involveds
collecting data at a single point in time to describe the characteristics of the variables (Aboagye
Agyeman, 2013). This design was will be suitable for measuring client satisfaction with
healthcare services during a specified period. The study population includedwill include all
clients who sought care at Pentecost Hospital, a faith-based, privately owned health facility that
serves a diverse range of clients. The targeted population will consisted of clients who visited the
facility between September 2021 and October 2021. A systematic sampling technique waswill be
employed to select participants, with every fourth person visiting the health center chosen for the
study.
RESULTS: This study analyzed data on the demographics, service utilization patterns, and
perceptions of clients at Pentecost Hospital to determine if healthcare service quality impacts
client loyalty and future utilization. The demographic data highlighted a young to middle-aged
clientele with a larger representation of females, common in healthcare settings. Patterns of
utilization showed a mix of long-term and first-time users, with outpatient and emergency
services being the most frequently accessed. Clients generally expressed satisfaction with the
professionalism of the staff, the cleanliness of the environment, and the clarity of information
provided about services. However, moderate satisfaction with waiting times indicated that while
efficient service delivery was appreciated, there remains room for improvement.

CONCLUSION: Overall, the study reinforces the notion that quality healthcare delivery is
multifaceted, involving not only technical competence but also interpersonal relations and a
supportive physical environment. By understanding and responding to the factors that influence
client perceptions of quality, healthcare facilities like Pentecost Hospital can strengthen their
relationships with patients and foster greater loyalty over time.
 CHAPTER ONE
INTRODUCTION

1.0 Background of the Study

In recent decades, determining the level of patient satisfaction has been found to be the most
useful tool for getting patients views on how to provide care. This is based on two major
principles: patients are the best source of information on quality of health services provided and
patient views are the determining factors in planning and evaluating satisfaction. Many
developing countries like Kenya, Uganda, Tanzania, Ethiopia, Somali, Zimbabwe, Malawi,
Nigeria, Ghana among others face the problem of inadequate budgetary allocations and
constrained capacity for provision of quality health care to satisfy the patient’s needs. This is
largely attributed to poverty, poor economic performance and population growth leading to
reduced growth in health sectors, inadequate budgetary allocations and constrained capacity for
provision of quality social services including health care.

In the face of increasing demands for health services, many SubSahara African countries in the
region are anxious to further mobilise public budget resources and at the same time explore new
financing modalities, though not many countries have succeeded in putting in place sustainable
health care financing policies and strategies (Lambo and Sambo, 2003). In Tanzania, a survey on
patients’ satisfaction level with health care services offered in public health facilities indicates
that there is need for improvement in technical quality of care, interpersonal aspects and
communication (Matee et al., 2006). Since Kenya attained its independence in 1963, there has
been massive growth and development of health care systems at various levels. The increased
population and the demand for health care have outstripped the ability of the government to
provide effective health services.

However, the Government through its Ministry of Health (MOH) is committed to ensuring that
accessible, affordable and effective health services, which would promote the wellbeing,
improve, and sustain the health status of the Kenyan population, is made available (MOH, 1996).
The public institutions were then given the mandate to decentralize these services by establishing
quality assurance system in their facility to ensure continuous quality improvement to a level that
satisfies their clients or patient’s needs. Despite the ongoing reform effort, the majority of the
people in many countries still have limited access to quality health services. Community,
intrasectoral and intersectoral linkages are still weak. In addition, the existing health sector
reform efforts are not adequately linked to both civil services and macroeconomic reform as
stated in the development of the National Health sector strategic plan (MOH, 1999 - 2004).

In a the hospital survey conducted by Ojwang’ in 2004, it was noted that lack of supplies was
still one of the biggest problems at Pumwani Maternity Hospital. Understaffing and lack of
supplies creates unhygienic conditions that pose dramatic threats to the lives and health of the
mothers and their babies. Unhygienic condition included the lack of hospital bed linen, bed not
being cleaned in between deliveries and patients being made to wipe down the beds and wrap
their newborn babies with their own clothes or soiled linens. Kols and Serman (1998) noted that
the needs of the patients are dynamic and are constantly influenced by the cultural, economic,
demographic, social and technological environment. For health services to satisfy these needs,
health systems need to undergo continuous transformation in accordance with priority needs of
the consumers and this can only be achieved by continuously determining these needs through
patient’s satisfaction surveys to ensure quality health care services.

Patients’ satisfaction refers to determining patient’s content with the services that they are
receiving from healthcare e.g. well-timed, well-organized, and patient-centered delivery of
quality healthcare. The quality of health care services has become a priority in the modern health
system, defined as a service that meets professional and patient needs by efficiently using
resources and minimizing risks. The quality of health care services implies the best possible
outcomes, timely service and rational use of resources and application of appropriate procedures.
Quality measurement includes dimensions such as availability, safety, continuity, effectiveness
and interpersonal relationships, which is key to patient’s trust and satisfaction. In the healthcare
industry, as global competition grows, patients are becoming more curious and concerned about
healthcare services. Increased focus on health has greatly improved healthcare delivery and
promoted healthier lifestyles for everyone.
Healthcare organizations are now putting more emphasis on providing high-quality healthcare
services because increased competition among hospitals is making clients more selective.
Offering better healthcare quality than other competitors gives hospitals an opportunity to stand
out in the healthcare industry. Nowadays, due to higher expectations and customer demands,
hospitals are obligated to provide superior healthcare services and meet patients' needs. In the
past 30 years, there has been a lot of research on service quality in healthcare. The demand for
better healthcare services has increased, putting pressure on service providers, researchers,
administrators, policymakers, and specialists to meet patients' needs and build satisfaction and
loyalty.

However, attracting new patients can be costly compared to retaining existing ones. Providing
better service quality is essential for building and sustaining loyalty, but it requires effective cost
allocation and management strategies. In developing countries, there are two types of healthcare
providers: public and private hospitals. Choosing the right hospital and experienced physician is
crucial for a patient's treatment. Public hospitals are funded by the government and follow
government rules, while private hospitals offer more personalized care. Studies have shown that
patients prefer private hospitals because of factors like improved technology, shorter wait times,
cleanliness, and personalized care from doctors and nurses. In systems where private hospitals
rely on profits, they focus on service quality to attract patients. To achieve patient satisfaction,
medical service providers should realize the importance of healthcare marketing. Therefore,
hospitals, clinics and medical service providers should make effort to develop relationship
marketing with their patients, determining their needs, and tailoring their services to meet those
needs.

1.1 Problem Statement

The current level of client satisfaction with healthcare services at Pentecost Hospital Madina is
unknown making it difficult for the hospital to identify areas for improvement and ensure that
clients receive high quality care. This study aims to fill this knowledge gap by assessing factors
that influence it in order to inform quality improvement initiatives and enhance client’s
experiences. The problem statement of this study emphasize on how satisfied clients at Pentecost
hospital are with healthcare services like, physical environment, physician patient relationship,
privacy and safety, waiting time and overall cost of the services. These factors are explored in
this study as it seeks to contribute to client satisfaction at Pentecost Hospital and determine areas
for improvement in order to enhance overall client satisfaction and experience. Measurement of
customers’ perceptions of service quality is necessary to evaluate the impact of quality
improvement activities initiated through the clinic’s strategic planning process. By measuring
quality in this manner, management can better direct financial resources to improve clinic
operations in those areas, which influence customer perception of service quality more. Such
evaluation of service quality is essential in today’s competitive, cost-conscious health-care
Market.

1.3 Purpose of the Study

The purpose of this study is to gather feedback from patients or clients in order to evaluate the
quality the quality of care provided, identify areas of improvement and enhance the overall
patient experience at the hospital. By understanding the level of satisfaction among clients, the
hospital can make informed decisions to enhance its services and ensure that patients receive the
best possible care. Even though, the healthcare sector plays a key role in the wealth of a
nation and therefore needs to be efficient and effective in their service delivery, there are
few studies with regards to customer satisfaction as compared to other sectors like the banks,
telecommunication and tourism in Ghana. The problem is that, if customers are not satisfied with
the orthodox healthcare delivery systems, they would look for alternatives which might be
dangerous to their health and the nation. In view of this, there is the need to examine the level of
satisfaction among patients and their demographic characteristics associated with their overall
general and domain specific satisfactions. Furthermore, the information will also be useful to
the selected health care facility to be able to improve on their services to meet the satisfaction
of the clients who patronize their services.

1.3 Objectives of the Study

1.3.1 Main objective
The broad objective of this study is to assess the clients satisfaction with quality healthcare
services provided by Pentecost hospital

1.3.2 Specific Objectives

1. To determine the level of utilization of the hospital by the clients.
 2. To explore clients’ general perceptions on the services provided by the hospital.
3. Find out what constitutes quality of care from the perspectives of the clients.
[4.] To establish if the quality of healthcare services at Pentecost hospital is a determinant of
clients’ loyalty and future utilization.
[5.]

1.4 Research Questions

1. What is the level of utilization of the hospital by clients?
2. What are clients’ general perceptions of the services provided by the hospital?
3. What constitutes quality of care from the clients' perspectives?
4. Is the quality of healthcare services at Pentecost Hospital a determinant of client loyalty
and future utilization?

1.5 Significance Of Study

The significance of this study on client satisfaction of quality healthcare services at Pentecost
Hospital is to allow the hospital to understand how well they are meeting the needs and
expectations of their clients. By identifying areas of strength and areas that require improvement,
the study will enable Pentecost Hospital to enhance the overall quality of their healthcare
services. In addition, the findings can guide decision-making processes, resource allocation, and
the development of strategies to improve client satisfaction. Ultimately, the study is to contribute
to the continuous improvement of healthcare services, leading to better patient experiences and
outcomes. The concept of customer satisfaction occupies a central passion in marketing thought
and practice. Satisfaction is a major outcome of marketing activity and serves to link processes
reaching the climax in purchase and consumption with post purchase phenomena. In spite of
Extensive Research On How Customer Characteristics Influence Service Encounters.

1.6 Organization of Research Work

The research work consists of five chapters. Chapter one includes introduction which contains
background of the study, problem statement, objectives( main and specific), research questions,
significance of the study, problem statement and organization of the study. Chapter 2 is the
literature review, which will enumerate on previous researches on assessing client’s satisfaction
of healthcare services at Pentecost hospital. Chapter 3 is the methodology, which includes the
study design, study area, study population, sample size, sampling method, data collection method
and tools, method of data analysis and the ethical consideration. Chapter four presents the survey
results along with tables, graphs and charts that illustrate the data collected as well as discussion
of the findings. Lastly, chapter five summarizes the key findings, conclusion and provide
recommendations for further research or practical work.
 CHAPTER TWO
LITERATURE REVIEW

2.1 Introduction
Quality health care delivery affects all sectors of the economy because every economy relies on a
healthy working population to offer skill and unskilled labour for increased productivity and the
growth of the national income. Hence, the structural connectivity between quality healthcare
services and other sectors of the economy. This had necessitated the need for a system of
continuous quality improvement committed to providing better medical services as a surest way
of ensuring quality health care delivery. Despite the modern scientific development and
technological advancement in health care delivery, issues of patients centered health care
delivery still needs improvement. Even in the best systems, mistakes and lapses occur during
treatment leading to injuries and dissatisfaction in service delivery. More importantly, health
personnel could also undervalue the psychosocial aspect of treatment during the course of
executing their duties. It is no wonder that, states, international organizations, corporate bodies,
and even individuals are working tirelessly to promote quality health care and patient’s
protection and safety. Relevant literatures on quality services, health care, customer satisfaction,
and xx patient’s rights were undertaken. The research issues arising from these reviews guided
the formulation of the research objectives.

2.2 Core Concepts of Health Care Quality

It is undeniable that openness, confidence, motivation, and commitment are crucial for fostering
a culture of quality. Nevertheless, traditional practices and attitudes—such as rigid authority
structures, limited mutual support and a lack of personal accountability—often hinder progress.
This results in a culture characterized by low expectations and quality, vertical command
hierarchies, restricted information flow, and a negative perception of accountability and
responsibility. These issues remain prevalent throughout Africa. Quality design involves
engaging providers, clients, and managers in a systematic process to clearly identify client needs
and create service processes aimed at addressing those needs. In this context, quality design
translates client needs, desires, and expectations into practical, actionable elements. It is used
either to develop a new process or to refine an existing one to enhance service delivery.
2.2.1 Definition of Health Care Quality
The most comprehensive and perhaps the simplest definition of quality is that used by advocates
of total quality management (Deming, 1982): “Doing the right thing right, right away.’’ Almost
as universal is the view by Ovretveit. (1992), who almost a decade later, recognised the three
“stakeholders” components of quality namely clients, professional, and management quality.
Client’s quality addresses what the client’s wants from the service. Professional quality indicates
whether the service meets the needs as defined by professional providers and referrers and
whether it correctly carries out techniques and procedures which are believed to be necessary to
meet the client’s needs. The management quality aspect is concerned with the most efficient and
productive use of the resources within limits and directives set by higher authorities and
purchasers. An integrated definition of health care quality therefore combines these three
elements: “A quality health service/system gives patients what they want and need at the lowest
cost” (Ovretveit. 1992).

Another clients-focused definition of quality comes from Donabedian (1980) and Morgan and
Murgatroyd (1994) ‘’Clients satisfaction is of fundamental importance as measure of quality of
care, because it gives information on the provider’s success at meeting those client values and
expectations on which the client has authority” Donabedian A. also saw health care as consisting
of two parts: a technical task and an interpersonal exchange whereby doctors and patients
discussed and agreed on treatment. Donabedian suggested that quality of care is made of
structures, processes, and outcome. Structure refers to the attributes of the settings in which care
occurs. This includes the attributes of material resources (such as facilities, equipment and
money), of human resources (such as the number and qualifications of personnel), and of
organizational xxii structures (such as medical staff organization, methods of peer review and
methods of reimbursement). Process denotes procedures in giving and receiving care. It includes
the patient’s activities in seeking care and carrying it out as well as the practitioner’s activities in
making a diagnosis and recommending or implementing treatment. Outcome denotes the effects
of care on the health status of the patients and the populations. Improvements in the patient’s
knowledge and salutary changes in the patient’s behaviors are included under a broad definition
of health status, and so is the degree of patient’s satisfaction with care. Patient’s satisfaction is
increasingly being recognized as an important measure of outcome and quality of care. Whether
Patient’s will seek medical advice or comply with treatment will depend on the level of
satisfaction. These Quality health care concerns have led health care organizations to use patient
satisfaction data to identify facts about the processes of work and the root causes of failures in
those processes. This leads to improved standards of work leading to best clinical practices.

2.2.2 Quality Dimensions in Health Care

Diversity arises when examining the meaning of quality in medical care. Medical quality consists
of a mixture of hard technical elements such as correct diagnosis, appropriate intervention and
effective treatment as well as soft element such as good communication, patient’s satisfaction
and consideration for the patients’ preferences (Gill, 1993). It is therefore not sufficient to
consider only the technical competence of those providing care, but also care provided more
effectively, efficiently and humanely. Ovretveit, (1990) stated that “Professional quality has two
parts: (1) Whether the service meet xxiii professionally assessed needs of its clients and (2)
Whether the service correctly select and carries out the techniques and procedures which
professionals believe meet the needs of the clients”. Contributing to the research on quality,
Brown et al. (1990) also describes nine quality dimensions of health service delivery:
effectiveness, efficiency, technical competence, interpersonal relations, and access to service,
safety, continuity, and physical aspect of health care. The table below vividly described Brown et
al (1990) quality dimension. Table 1 Quality dimension (Brown et al 1990).
Table 2.1: Quality Dimensions (Brown et al, 1990)
Quality Description
dimensions
Effectiveness The degree to which desired results (outcomes) of care are achieved
through appropriate diagnosis and treatment

Efficiency The ratio of the outputs of services to the associated costs of producing
those services ( taking into consideration both materials and time
resources

Technical The degree to which tasks carried out by health workers and facilities meet
competence expectations of technical quality (according to clinical guidelines)

Interpersonal The Level of respect, courtesy, responsive, empathy, effective listening,

relations and communication exhibited between clinic personnel and clients.

Access to service The degree to which healthcare services are unrestricted by geographic,
economic ,social organizational or linguistic barriers

Safety The level of trust , confidentiality and privacy in the service and the
degree to which the risks of injury, infections or other harmful side effects
are minimized

Continuity The degree to which consistent and constant care is provided, including
the value of visiting the same provider and continuing treatment

Physical aspects The physical appearance of the facility and the level of cleanliness,
comfort, and amenities offered.

Choice It is the client’s choice of appropriate provider, insurance plan, or

treatment.
2.3 The Meaning of Quality
The definition and dimensions outlined above constitute a broad conceptual framework that
includes almost every aspect of the health system performance. All these dimensions come into
play as clients, health providers, and health care managers try to define quality of care from their
unique perspectives. What does quality of health care mean for the communities and clients that
depend on it, the clinicians who provide it and the managers and administrators who oversee it?
To the client, Quality health care is one, which meets their needs, and delivered courteously and
on time (Brown. et al, 1990). In sum, client wants services that effectively relieve symptoms and
prevent illness. This is because satisfied clients are more likely to comply with treatment and to
continue to use health services. The dimensions of quality that relates to clients satisfaction also
affect the health and well-being of the community. Hence, patients and communities often focus
on effectiveness, accessibility, interpersonal relations, continuity, and amenities as the most
important dimensions of quality. From the provider’s perspective, quality care implies that he or
she has the skills, resources, and conditions necessary to improve the health status of the patients
and community according to current technical standards and available resources.

The provider’s commitment and motivation depends on the ability to carry out his or her duties
in an ideal or optimal way. Providers tend to focus on the technical competence, effectiveness,
and safety. Key questions for providers may be; How many patients are providers expected to
see per hour? What laboratory services are available to them, and how accurate, efficient and
reliable are they. What referrals systems are in place to meet specialties services or higher
technologies? Are the physical working conditions adequate and sanitary, ensuring the privacy of
the patients and a professional environment? Does the pharmacy have a reliable supply of all the
needed medicines? Are there opportunities for continuing medical education? Just as the health
care system must respond to the patient’s perspectives and demands, it must also respond to the
needs and requirements of the health care providers. In this sense, health care providers are the
systems internal clients. They need and expect effective and efficient technical, administrative,
and support services in providing high quality care. Quality care requires that managers are
rarely involved in delivering patient care although the quality of patients care is central to
everything they do. The varied demands of supervision, financial and logistics management
present many unexpected challenges. This can leave a manager without a clear sense of priorities
or purpose. Focusing on the various dimensions of quality can help to set administrative
priorities. Health care managers must provide for the needs and demands of both providers and
patients, to be responsible stewards of the resources entrusted to them by the government, private
entities, and the community. Health care managers must consider the needs of the multiple
clients in addressing questions about resources allocations, fee schedule, staffing patterns and
management practices. In this way, there will be no trade-off between increasing patient
satisfaction, improving professional outcomes, and reducing costs (Ovretveit J, 2001). Despite
the different perspective on quality health by various players, a definition of quality needs to
guide towards what is measured. It should resonate with professional’s values, while increasing
efficiency to satisfy the client.

2.3.1 Voice of the Client

One cannot talk about quality issues without factoring in the concerns of customers. Increased
contact with external and internal customers provides managers with new ideas for improvement
and ultimately assists a manager to measure and adjust his or her performance against the all-
important barometer of customer satisfaction (Longenecker and Neubert, 2003). There is variety
of methods for finding out what customers think about a service (Ovretveit, 1993): talking to
staff or clients about what clients like and dislike about the service. It also involves routine
customer group meetings; a letter sent to a sample of clients; comments cards; free telephone
lines for comments and complaints; observation against check-list; objective indicators of
customer satisfaction, e.g. clients-cancelled appointments, demand and waiting times. Each
measures different things and used for different purposes in different situations. The combined
data collection methods give rich insights into client’s perspectives on service quality.

2.3.2 Customer Satisfaction as Quality Indicator

Customer satisfaction is the personal feelings, meaning, and interpretation a consumer makes of
a product and/or service following its usage (Solomon 1996, Wells and Prensky, xxvii 1996 cited
in Metewa and Almossawi, 1998). Bitner and Hubbert (1994:77) also see the concept to imply
assessment that a customer gives to a product after its usage in terms of its superiority and
inferiority. Dispensa (1997) observed that customers who are satisfied with a product would
convey pleasurable information about the product to others with a view to convincing others to
patronize it. At the polar end of such reasoning is the notion that, dissatisfied customer of a
product will not only desist from subsequent patronage of the product but will spread damaging
information about the product to other users, which might discourage its patronage. Customer
satisfaction is now the ‘essence of success in today’s highly competitive world of business’
(Kohl and Gasworks, 1990 cited in Jamal and Nasser 2002:146). Customers or consumers of
health care services therefore play a variety of roles in health care quality assessment and
monitoring. By expressing their preference, they supply the valuations needed to choose among
alternative strategies of care (Donabedian, 1987). They help define the meaning of quality in the
technical sense. Moreover, their preferences are the paramount consideration in defining the
quality of the interpersonal process and of the amenities of care. Consumers are also valuable
sources of information in judging the quality of care and non-technical aspect of treatment. This
is because consumers can and do, through expressing satisfaction or dissatisfaction, pass a
judgment about many aspects of the process of care and its outcomes. Consumers, if properly
informed, could help to regulate the quality of care by means of their choices. No wonder that,
health care is now entering an age of accountability where patients are demanding services
excellence. There are different patient’s expectations of quality care in the literature. Some
studies view patient’s expectations as probabilities judgment about the likelihood that a set of
events will occur (McKinley, 2002; Conway, Willcocks, 1997).

Others view expectations on quality care as perceived needs, wants, importance, standards, or
entitlements (Kravitz, 1996). These expectations may pertain to heath care in general or to a
specific health care encounter such as a clinic visits or hospitalization. Whether patient’s
expectations are probabilities or values, an understanding of patient expectations is important
because meeting these expectations may lead to greater satisfaction with care. As the patient is
becoming widely recognized as a reliable and important source of information about quality of
medical practice ( Lawathers, Rozanski, Nizankovski and Rys , 1999), important steps towards
making performance transparent comes with the publication of concrete figures on the quality of
outcomes relevant to patients. Patient’s surveys are an important part of this. Advantages of
patient’s surveys are that it identifies what patients and the public value, and standardized ways
to tailor such surveys to measure specific domains of experience and satisfaction. However to
reach the valid and reliable results remain a challenge for the health care organizations (Sitzia,
1999). If the questionnaires and process are scrutinized using scientific methods, it can guarantee
a useful and comparative data. Health care organizations using performance indicators to
differentiate themselves and demonstrate customer focus reap considerable advantages,
especially if they have a quality management system to underpin the development of
performance. That is the benefit of both patients and staff (Kolking, 2003, Dolan, 1998)
According to Jenkinson et al. (2002), patient’s experiences of health and medical care are at the
very core of the purpose of clinical medicine. If medical treatment succeeds only in a limited,
technical sense, without any benefit to those receiving them, then such interventions would have
failed. Health care providers must consider whether and how patient expectations of their
services can be managed (McKinley et al., 2002). Dissatisfaction with the provision of health
care services could be contained if consumers know what they can expect and then receive it.
The above analysis of customer satisfaction as a quality indicator, point to the fact that quality
health service delivery should have the customer or patients concern as central to the overall
treatment process.

2.4 Clients and Perceived Quality Healthcare

Today patient experience is recognized as one of the key elements of quality control within
healthcare organizations (James, 2013), becoming crucial for a competitive growth strategy
(Needham, 2012; Ismail et al., 2014; Larson et al., 2019). Delivering patient-centered healthcare
is now seen as one of the basic requirements of good quality care (Ismail et al., 2014). From
2000 to 2009, more than 400 articles were published on patient experience (Lecroy, 2010)
showing that positive patient experiences are associated with improved health outcomes, patient
loyalty and satisfaction (Murante et al., 2014). With the term “experience” usually people refer
to all the elements of the patient journey: Needham (2012) uses the term “roller-coaster” to
synthetize the alternation of different emotional and physical status that patient experience while
going through the healthcare treatments. Other authors (Bowling et al., 2012) define the patient
experience as the main output coming from all the different healthcare-related elements that
patients observe. More in general different studies relate the patient experience to two main
domains: the physical ambience and the human interactions (Frampton, 2012), as they can be
perceived by both patients and caregivers in any medical touch point (Weiss and Tyink, 2009).

Human interaction in this specific field is further analyzed with a focus on both interactions with
medical staff and on the patient empowerment dimension (Hewitson et al., 2014). With the term
“satisfaction” it is common to refer to all patient opinions with regards to the received assistance
(Bate and Robert, 2007; Tsianakas et al., 2012; Health Foundation, 2013; Crow et al., 2002).
Studies in the healthcare setting provide some evidence that hospitals’ service quality has a
positive influence on patient satisfaction (Nor Khasimah and Wan Normila, 2013; Murti et al.,
2013; Alrubaiee and Alkaa’ida, 2011; Helena Vinagre and Neves, 2008; Wu, 2011; Cham et al.,
2015), it means that healthcare providers should adopt a marketing approach to deeply
understand patients’ needs and expectations in order to meet them (Lee et al., 2010). It is also
common to consider patient experiences as an indicator of the quality of a specific hospital
(Wilson and Strong, 2014; Health Foundation, 2013) as experience evaluation is a fundamental
instrument to be able to reach expectations (Shannon, 2013; AbuDagga and Weech-Maldonado,
2016). Bright and beautiful lobbies, rooms with big windows and access to outdoor gardens,
dining options and innovative hospital designs have changed patients’ experiences and
expectations of what a hospital should be. Research has shown that hospitals that feature new
designs and amenities positively affect patient satisfaction (Goldman and Romley, 2008),
improve therapeutic benefits (Marcus and Barnes, 1995), reduce pain and allow a shorter
hospital stay (Roger et al., 2004). Studies about patient experience have often been found to be
of poor quality since patients’ involvement has not been fully considered and the effects on
quality of care have not been reported (Crawford et al., 2002).

Moreover also hospital strategic planning was rarely linked with patient involvement (Daykin et
al., 2007). Until now, research on patients’ satisfaction has been focused on environmental or
relational items of the patient experience while a comprehensive and holistic approach to the
mutual interdependencies of these dimensions has been mostly ignored both by the scientific
research and by the health managerial practice (Beattie et al., 2014). The present study aims at
providing this incremental value, by analyzing the interdependencies between the main patients’
experiential items and how they can be combined in order to maximize the positive impacts on
patients’ experiential satisfaction. Adopting an experiential marketing approach: the items of
patient experience It is currently argued that patients’ opinions should supplement traditional
indicators of quality in the healthcare domain (Wilson and Strong, 2014; Health Foundation,
2013) because they provide information on the ability to meet their expectations (Shannon,
2013). Through a literature review it was possible to identify several elements of patient
experience, which largely influence the perceived quality of care. Those elements and their
measurements vary depending on the study considered (Health Foundation, 2013). Researchers
have proposed various instruments as the “Customer Quality Index Cataract Questionnaire”, the
“Picker Patient Experience Questionnaire” (Jenkinson et al., 2002), the “Hospital Consumer
Assessment of Healthcare Providers and Systems” (Raman and Tucker, 2011).

Both qualitative and quantitative approaches are utilized. Patients and perceived quality in
healthcare sStarting from the available scientific literature, three main dimensions of the
inpatients’ healthcare experience were identified. They are as follows: Physical Environment. A
key component of customer experience is related to aesthetic sensory and physical aspects of the
healthcare facilities (Eroglu and Machleit, 1993). Research has highlighted how physical
environmental elements directly affect customers (Baraban and Durocher, 2001; Siberil, 1994),
evoking internal responses (Lin, 2004) and indirectly influencing their behaviors (Plichon, 1999;
Bitner, 1992). Literature suggests that environmental aspects of the experience can include
variables such as ambience/atmosphere, color (Bellizzi and Hite, 1992; Gorn et al., 1997), shape
(Zhang et al., 2006), sound (Lichtle et al., 2002; Yalch and Spangenberg, 1990; Dube et al.,
1995), cleanliness (Bitner et al., 2000), waiting time (Burt, 2006), comfort and services (Reese,
2009; Meyers, 2009), food quality (Calderoni et al., 1999; Webb, 2007), lighting (Golden and
Zimmerman, 1986) and smell (Bitner et al., 2000; Bitner, 1992; Chebat and Michon, 2003; Joy
and Sherry, 2003; Baker et al., 1992; Baraban and Durocher, 2001; Donovan and Rossiter,
1982). Focusing on the role of the experience in healthcare, studies show that some of the above-
mentioned factors also improve inpatient’s experience (Nemetz, 2010) and satisfaction (Susilo et
al., 2020). Although some of the above-described elements are recurring in patient experience
research, they have been analyzed separately so far. Hence, it appears difficult to find studies that
jointly examine those items and provide a unique classification of the key experiential
components related to the environment.

2.4.1 Patient Doctor Relationship

Communication between doctors and patients is one of the most complex relationships among
inter-personal ones and is thus attracting more attention within healthcare studies (Chaitchik et
al., 1992). A traditional or paternalistic approach with regards to that relationship usually
involved high physician control compared to patients’ one and can thus be described as a model
where the doctor is dominant and acts as a “parent” figure who decides the care process on
patients’ place. However, nowadays, medical consultations are becoming increasingly based on
mutuality, meaning that patients are gaining a greater control over that relationship. In fact, the
patient–doctor relationship has been described in economic terms as an “agency relationship”
where informed agents make decisions for uninformed clients. In the context of the above-
mentioned trends of patient empowerment, patient loyalty to a medical doctor does not seem to
be guaranteed and it is thus becoming more important to change the traditional agency
relationship into a more collaborative one (Einwiller, 2003; McKnight and Chervany, 2001). In
that direction moves the consumerist approach, that involves a situation in which the roles are
reversed, the patient interpret the active role and the doctor adopts a fairly passive role, acceding
to the patient’s requests for a second opinion, referral to hospital, a sick note and so on (Morgan,
2003). On one hand, patients complain that many of their questions to doctors go unanswered.
The need of more detailed information is arising (Buccoliero et al., 2016b), patients are
becoming less reliant on doctors as Internet acts as an alternative source of information (Charles
et al., 2003; Godolphin, 2003).

On the other hand, patients express the need of reaching a positive relationship with doctors as
they miss the warmth and trust in the interaction. The quality of the relationship can be improved
by perceiving the staff team as a harmonious group (Borrill et al., 2000) where the professional
role of each member can be easily identified by the patient. This is normally obtained by the use
of different colors in Patients and perceived quality in healthcare 179 employees uniforms.
Courtesy, attention, empathy capabilities, professionalism of staff members and their ability to
establish and maintain a positive relation with their patients affect patients’ satisfaction (Avis et
al., 1995, S¸ener). Certain aspects of doctor–patient communication seem to have an influence on
patients’ behavior and well-being, for example satisfaction with care, adherence to treatment,
recall and understanding of medical information, coping with the disease, quality of life and even
state of health (Smith et al., 1981; Ong et al., 1995). The assessment of these impacts is very
often based on small samples, given the need to implement controlled clinical trials to this
extent. Otherwise, subjective perceptions are considered instead.

2.4.2 Patient And Staff Privacy:

Healthcare safety is a global priority recognized by the World Health Organization (WHO). It
encompasses the safety of patients and staff, which is vital for delivering quality care and
measuring hospital performance
(1). Patient safety, which refers to preventing harm in healthcare settings, according to the
Agency for Healthcare Research and Quality (AHRQ), is closely connected to staff safety

(2). The design of healthcare facilities plays a significant role in ensuring safety. Research has
highlighted its influence on mitigating various factors such as stress, aggression, violence,
medical errors, security, visibility, privacy, staff communication, infection transmission, and
falls.

The following sections explore the relationship between the physical environment and safety in
healthcare settings, examining patient and staff privacy, efficient spatial planning, positive
distractions, cleanliness, fall prevention, security measures, team visibility, and furniture
ergonomics. Understanding how these elements influence safety is crucial for creating healthcare
settings that prioritize the well-being of all individuals involved. Continuous research,
evaluation, and improvement are essential to staying abreast of evolving best practices and
adapting to emerging challenges, ultimately creating settings that support the highest standards
of healthcare safety and the well-being of all those within the healthcare environment:

Patient and staff privacy: Designing for patient privacy is essential for safety and patient
satisfaction. Healthcare institutions are legally obligated to uphold patient privacy through the
Health Information Portability and Accountability Act (HIPAA), which prevents unauthorized
information sharing. This is particularly crucial for medical conditions that carry stigmas, as it
prevents community harm and social shame. Furthermore, creating acoustically private
environments within healthcare settings fosters patient trust. This trust is critical in ensuring
secure communication of medical information and enhancing the perceived quality of care. In
summary, prioritizing patient privacy in healthcare design adheres to legal mandates and
contributes to a healthcare environment where patients can trust in the confidentiality of their
information and the quality of care they receive. Staff privacy in healthcare extends beyond
individual rights; it significantly influences staff perceptions of safety and patient outcomes. It
establishes a psychologically safe workplace where employees feel comfortable voicing
concerns, fostering an atmosphere of accountability and improving patient safety. Moreover,
staff privacy cultivates trust among healthcare teams, facilitating effective communication,
reducing errors, and leading to enhanced safety outcomes. For instance, Naccarella found that
Emergency Department (ED) staff navigate the balance between visual openness and
connectedness to the wider ED and the need for privacy and confidentiality by strategically using
different spaces for various types of communication. The visual transparency of EDs posed
challenges for staff engaging in confidential, informal communication, as they were concerned
about being overheard by others in open areas, feeling vulnerable to peer, patient, and family
scrutiny, and navigating informal communication norms and perceptions of work events. In
conclusion, prioritizing staff privacy in healthcare settings is fundamental to creating a safe and
efficient care environment that benefits both healthcare providers and patients.

SPACE PLANNING: Effective spatial planning within healthcare facilities has a substantial
impact on the safety of both staff and patients, as evidenced by research findings. Notably, the
distances clinicians’ traverse is a known factor contributing to staff fatigue, heightened stress
levels, and susceptibility to interruptions, all of which can compromise patient safety. For
instance, Chaudhury et al. (9) found that extended walking distances for healthcare staff
increased stress and diminished care efficiency. Various design interventions have been
proposed to address these challenges and improve wayfinding. These include the implementation
of effective signage, informative printed materials, prominent landmarks, thoughtfully chosen
color schemes, enhanced visibility, appropriate furniture, and interior elements, and the
integration of navigational technologies. Inadequate wayfinding can lead to many issues in
healthcare settings, including stress, patient absenteeism, tardiness, aggression, or frustration. For
example, Zamani highlighted safety concerns arising from wayfinding difficulties in an ED,
underscoring the importance of clear signage and enhanced visibility. Despite recognizing the
significance of efficient wayfinding, limited research directly establishes a link between
wayfinding challenges and safety outcomes (31). Further investigation is imperative to
understand how spatial planning can influence safety, thereby enhancing the well-being of
patients and staff within healthcare facilities.

CLEANLINESS: Maintaining cleanliness in healthcare spaces is of utmost importance for

infection control. Contamination can spread through direct contact with patients, surfaces, or
healthcare workers’ hands. For instance, Durant reported that patients who reported their rooms
as “always” clean had significantly lower rates of HA difficile Infection (HA-CDI). However,
it’s crucial to recognize that existing guidelines for cleaning and disinfection in healthcare
facilities may fall short. In another study, Carling and colleagues marked high-touch surfaces
with ultraviolet (UV)-visible substances and found only 47% adequacy in cleaning out of 1,404
marked surfaces in three hospitals. Additional strategies include automated disinfection systems
such as hydrogen peroxide vapors, UV light, pulsed xenon UV light, and self-disinfecting
surfaces. In summary, ensuring cleanliness is vital for infection prevention, ultimately enhancing
patient safety and reducing the risk of healthcare-associated infections.

SECURITY: Security in healthcare, an essential component of safety, exhibits complex

connections with operational efficiency due to the potential disruption caused by aggressive
incidents. These security events affecting staff stem from extended waiting times, delays,
aggression, patient stress, visitor issues, and substance abuse. To enhance security,
recommendations include strategically positioning security personnel and clinical staff for
improved visibility and team proximity, enhancing visual access to entrances and exits, and
establishing dedicated areas for aggressive patients. This is highlighted by Pati and colleagues
study that pinpointed the walk-in entry in the ED as the most vulnerable security point for both
staff and patients. Such findings underscore the importance of unobstructed visibility from
registration, triage, and security desk areas to maintain ED operations and safety. Furthermore,
Zamani suggested creating a separate and tranquil waiting space with ample visibility for
behavioral health (BH) patients to enhance security in ED settings. Additionally, participants in
the study recognized the significance of having an adequate number of security guards in areas
with a direct line of sight to entrance doors, along with the necessary training to handle “code
gray” situations involving aggressive behaviors, which was perceived as crucial. In summary,
prioritizing security safeguards individuals and property and contributes to a safer and more
efficient care delivery system in healthcare environments.

2.5 THEORETICAL FRAMEWORK

Introduction to SERVQUAL Model

The SERVQUAL model, developed by Parasuraman, Zeithaml, and Berry, is a widely used
framework for evaluating service quality across five dimensions:

1. Tangibles: The physical appearance of facilities, equipment, and personnel.

2. Reliability: The ability to perform the promised service dependably and accurately.
3. Responsiveness: The willingness to help customers and provide prompt service.
4. Assurance: The knowledge and courtesy of employees, and their ability to inspire trust
and confidence.
5. Empathy: The provision of caring, individualized attention to customers.

2. Defining the Theoretical Framework

Objectives

To assess client satisfaction with healthcare services at Pentecost Hospital, the framework aims
to:

 Identify the quality of service provided across the five SERVQUAL dimensions.
 Determine areas of strength and areas needing improvement.
 Align service delivery with client expectations.

SERVQUAL Dimensions Applied to Healthcare Services

1. Tangibles
 Facilities: Evaluate the cleanliness, maintenance, and modernity of the hospital
environment.
 Equipment: Assess the condition and availability of medical and diagnostic
equipment.
 Personnel Appearance: Review the professionalism and appearance of
healthcare staff.
2. Reliability
 Service Consistency: Measure the hospital’s ability to provide consistent and
accurate medical services.
  Appointment Management: Assess reliability in scheduling and managing
patient appointments.
3. Responsiveness
 Timeliness of Service: Evaluate how quickly patients receive medical attention
and responses to their inquiries.
 Staff Availability: Assess the accessibility and readiness of healthcare
professionals to assist patients.
4. Assurance
 Competence: Gauge the expertise and skills of medical professionals.
 Trust: Measure the confidence patients have in the hospital’s staff and their
ability to handle sensitive health information.
5. Empathy
 Personal Attention: Evaluate the level of personalized care and attention
provided to each patient.
 Understanding Patient Needs: Assess how well the hospital understands and
addresses individual patient concerns.

Implementation Steps

[1.] Design Survey Instruments:

 Develop a structured questionnaire based on the SERVQUAL dimensions tailored
to healthcare settings. Ensure questions capture patient perceptions and
expectations across each dimension.
[2.] Data Collection:
 Administer the survey to a representative sample of patients who have recently
received care at Pentecost Hospital. Utilize various methods (e.g., online surveys,
in-person interviews) to gather comprehensive feedback.
[3.] Data Analysis:
 Analyze survey responses to identify gaps between patient expectations and
perceptions of the actual service received. Use statistical tools to quantify the
service quality across each SERVQUAL dimension.
[4.] Benchmarking and Reporting:
  Compare the results with industry standards and best practices. Prepare a detailed
report highlighting strengths and areas for improvement.
[5.] Action Plan:
 Develop an action plan to address identified gaps. Focus on enhancing areas
where the hospital's performance falls short of patient expectations, and reinforce
areas where the hospital excels.
[6.] Continuous Improvement:
 Implement regular assessments using the SERVQUAL model to monitor progress
and make continuous improvements to healthcare services.

Conclusion

This theoretical framework leverages the SERVQUAL model to provide a structured approach to
assessing and enhancing client satisfaction at Pentecost Hospital. By focusing on the five key
dimensions of service quality, the hospital can systematically identify areas for improvement and
ensure a high standard of patient care.
 CHAPTER THREE
METHODOLOGY
3.1 Introduction

This study focused on the assessment of client’s satisfaction of health care services at Pentecost
hospital Madina. This chapter discusses the study area, defines the population, research design,
the sample size and sampling techniques, the instruments for the data collection, validation, and
data collection procedure.

3.2 Research Method

The study would adopt a descriptive cross-sectional design. A descriptive cross-sectional design
which examines the collection of data at once or one point in time and describes the
characteristics of the variables (Aboagye Agyeman, 2013). The design would be appropriate
since it is intended to measure client satisfaction of healthcare services during a specified period.
The study population would consist of all clients that sought care at the Pentecost Hospital.
Pentecost Hospital is a faith-based privately owned health facility which serves all categories of
clients. The targeted population is clients who had visited the facility from September 2021 to
October 2021. A systematic sampling technique would be utilized to select the clients who took
part in the study with every fourth person who visits the health center. The sample size would be
calculated using Cochran’s (1977) sample size determination formula. Where: n0 = sample size,
z = standard normal deviate at 95% confidence interval = 1.96, e = margin of error (0.05), p =
estimated proportion of population that has the attributes of interest (0.5), q = 1-p. Substituting
into the formula, no = (12.3) (0.5) (0.5)/(0.05)2 = 384 but 90% of 384=346 in order to cater for
non – response.
In order to gather in-depth information from the clients who would appreciate the health
facility’s healthcare services, questionnaires would be distributed to them upon their exit from
the facility. The questionnaire is designed to be self-administered. The semi-structured
questionnaire would focus on two broad categories of variables: the clients’ backgrounds and
their perceptions of the healthcare services provided with the healthcare service satisfaction
levels to be examined through the SERVQUAL dimensions. The mean scores of the perception
and expectation variables related to each dimension would be used to obtain service
performance gaps in line with SERVQUAL. Finally, the queries related to the general
characteristics of the clients would include gender, age, education level, marital status, place of
residence, jobs, and monthly income. Descriptive statistics would be computed for the
characteristics of the clients and the dimensions of the health facility healthcare service
performances.

3.3 Research Design

This study used a descriptive cross-sectional design to assess client satisfaction with healthcare
services at Pentecost Hospital in Madina, Greater Accra. A cross-sectional approach was chosen
to obtain perceptions of clients about healthcare services at the hospital at one point in time.
Clients believed to meet the eligibility criteria were asked to participate until the required sample
size was obtained.

The research utilized both primary and secondary data to assess pentecost hospital’s healthcare
delivery services customer satisfaction level. Simple random sampling was used to select and
obtain primary data needed for the study on the opinions and perceptions of hospital customers.
Questionnaire forms were personally filled and completed by the clients surveyed. This data was
then compiled by the researcher and used to carry out an analysis of customers’ general
experience with the hospital. Secondary data was also used in the study to obtain broader views
and opinions on the topic related to past research done on healthcare customer satisfaction. This
data was sourced through a library search.

3.4 Study Area and Site

Pentecost Hospital is a faith-based privately owned health facility which serves all categories of
clients.

 Pentecost Hospital in Madina is a prominent healthcare facility situated in Madina, a

vibrant area within Accra, the capital city of Ghana, Pentecost Hospital is easily
accessible by public transportation and private vehicles. Its central location makes it a
key healthcare provider for residents in the region.
 As part of the Pentecost Church’s healthcare ministry, the hospital is dedicated to
providing compassionate, high-quality medical care in alignment with its Christian
values..
 Accessibility: The hospital is equipped to handle a wide range of medical conditions and
is designed to be accessible to individuals with diverse needs.
 The hospital’s commitment to high-quality care and its active engagement with the
community make it an ideal setting for assessing patient satisfaction. Understanding
patient experiences at Pentecost Hospital can provide valuable insights into areas for
improvement and highlight successful practices that could serve as models for other
healthcare facilities.

Mission and Vision:

Mission: To offer holistic healthcare services that combine modern medical practices with
compassionate care, reflecting the principles of Christian faith.

Vision: To be a leading healthcare provider in the region, recognized for excellence in patient
care, advanced medical technologies, and community outreach.

Facilities and Services:

 Inpatient Services: The hospital provides various inpatient services, including general
medicine, surgery, pediatrics, and maternity care. It is equipped with modern patient
wards and specialized units for different medical needs.
  Outpatient Services: Includes consultations with specialists, diagnostic services (e.g.,
laboratory tests, imaging), and preventive care. The outpatient department caters to a
wide range of health issues, from routine check-ups to chronic disease management.
 Emergency Care: The hospital has an emergency department that operates 24/7,
providing urgent medical care for accidents, acute illnesses, and other emergencies.
 Specialized Clinics: The hospital offers specialized services in areas such as cardiology,
orthopedics, obstetrics and gynecology, and internal medicine.

3.5 Study Population

The study population consisted of clients who accessed healthcare services at Pentecost Hospital
during the data collection period. This population included individuals of various ages, genders,
and socioeconomic backgrounds, reflecting the diverse patient demographics that the hospital
serves. The target population was defined to include adult clients aged 18 years and older, as
they are more likely to have the necessary understanding and experience regarding their
healthcare interactions and can provide informed feedback on the services received.

The hospital caters primarily to a younger demographic, with a significant proportion of clients
falling within the age range of 18 to 45 years. This demographic profile is indicative of trends in
healthcare utilization, where younger adults often seek outpatient and emergency services more
frequently than older populations. Additionally, the population included both first-time and
returning clients, allowing for a broad range of perspectives on the quality of healthcare services
and client loyalty. This diverse study population provided a comprehensive view of client
experiences and perceptions regarding the hospital's services, ensuring that the findings
accurately reflect the needs and expectations of the hospital's clientele.

3.6 Sample Size and Sampling Procedure

For this study, a sample size of 100 clients was determined to provide sufficient statistical power
to analyze the data while ensuring representativeness of the study population. The sample size
was calculated based on the expected effect size, desired level of confidence, and population
variability. A sample of this size is deemed adequate for detecting significant differences and
relationships among the variables being studied.
The sampling procedure employed a convenience sampling technique, where participants were
selected based on their availability and willingness to participate during the data collection
period. This method was chosen to facilitate the timely collection of data from a diverse client
base frequenting the hospital. Clients were approached at various points in the hospital, including
the outpatient department and emergency room, ensuring a wide range of experiences and
perceptions were captured.

To ensure ethical considerations were met, informed consent was obtained from all participants
prior to their involvement in the study. Participants were assured of the confidentiality of their
responses and the voluntary nature of their participation. This approach to sampling allowed for
the collection of rich data while maintaining ethical standards, thus enhancing the validity of the
findings.

3.7 Data Collection Instruments and Procedure

In order to gather in-depth information from the clients who would appreciate the health
facility’s healthcare services, questionnaires would be distributed to them upon their exit from
the facility. The questionnaire was is designed to be self-administered. The semi-structured
questionnaire would focused on two broad categories of variables: the clients’ backgrounds and
their perceptions of the healthcare services provided with the healthcare service satisfaction
levels to be examined through the SERVQUAL dimensions. The mean scores of the perception
and expectation variables related to each dimension would be was used to obtain service
performance gaps in line with SERVQUAL. Finally, the queries related to the general
characteristics of the clients would included gender, age, education level, marital status, place of
residence, jobs, and monthly income. Descriptive statistics were ould be computed for the
characteristics of the clients and the dimensions of the health facility healthcare service
performances. This section will explains the methods and techniques that werewill be used to
provide client satisfaction information concerning the facilities used by the healthcare services at
the Pentecost Hospital located at Madina. The cross-sectional design is a typical analytical
approach for generating an overall opinion on a particular phenomenon at one point in time.
Client satisfaction refers to the degree of congruence between clients’ expectations of healthcare
services and their perceptions of the actual services received (Berehe et al., 2018). A quick
survey from client exit interviews was conducted to gather the relevant data. A systematic
random sampling technique will be employed to select 100 patients from the outpatient
department using a client registration logbook as a sampling frame. Data were collected through
a structured questionnaire containing both open- and closed-ended questions addressing
important quality-of-care attributes. Additionally, to gather information regarding socio-
demographic variables, generally, data on clients’ age, level of education, occupation, and
distance travelled to the hospital will also be included in the questionnaire. Descriptive statistics
will be used for characterizing the study population.

The structured questionnaire that will serve as a data collection tool will be prepared based on
reviewing literature for a similar study. This questionnaire contains four sections. The first
section includes the variables related to respondents’ socio-demography. The other three sections
address important aspects of healthcare service delivery: client satisfaction dimensions; the
importance of the satisfaction variables; and the clients’ perceptions of the service delivery
dimensions. Data collectors will be selected from outside the study institution to avoid
information bias. Each day of the five data collection days will be briefed on the day’s target and
asked to evaluate the previous day’s progress (Odonkor et al., 2019).

3.8 Validity and Reliability of Data Collection Instruments

The validity and reliability of the data collection instruments are critical to ensuring that the
findings of this study accurately reflect the clients’ perceptions of healthcare service quality and
their impact on loyalty at Pentecost Hospital. To enhance validity, the research utilized a
structured questionnaire that was carefully developed based on existing literature on healthcare
quality and client satisfaction. The questionnaire comprised both closed-ended and open-ended
questions, allowing for a comprehensive exploration of the research objectives.

To establish content validity, the questionnaire was reviewed by a panel of experts in healthcare
research and management. Their feedback was instrumental in refining the questions to ensure
they accurately captured the key dimensions of service quality relevant to the study.
Additionally, a pilot test of the questionnaire was conducted with a small group of clients prior to
the full-scale study. This pilot test allowed for the identification of any ambiguous or confusing
questions, enabling necessary adjustments to be made to improve clarity and understanding.
Reliability was assessed using the Cronbach's alpha coefficient, a widely used measure for
evaluating the internal consistency of survey instruments. A Cronbach's alpha value of 0.70 or
higher was considered acceptable, indicating that the items in the questionnaire consistently
measured the same underlying construct. In this study, the reliability analysis revealed strong
internal consistency across the various dimensions of service quality and client satisfaction, thus
affirming the reliability of the data collection instruments.

Overall, through careful development, expert review, pilot testing, and rigorous reliability
analysis, the data collection instruments used in this study were established as valid and reliable
tools for measuring clients’ perceptions of healthcare service quality at Pentecost Hospital. This
strong foundation enhances the credibility of the findings and supports meaningful conclusions
regarding the factors influencing client loyalty and future utilization of healthcare services.

3.9 Data Analysis Technique

The data analysis for this study employed both quantitative and qualitative techniques to ensure a
comprehensive understanding of clients' perceptions of healthcare service quality and its impact
on loyalty at Pentecost Hospital. The primary data collection involved structured questionnaires,
which were distributed to clients attending the hospital. These questionnaires included closed-
ended questions, designed to capture quantitative data on various aspects of service quality,
client satisfaction, and demographic information.

Upon completion of data collection, quantitative data were analyzed using statistical software,
such as SPSS (Statistical Package for the Social Sciences). Descriptive statistics, including mean
scores and standard deviations, were computed to summarize respondents' perceptions of the
quality of healthcare services. Frequencies and percentages were used to describe demographic
characteristics and utilization patterns, providing a clear overview of the client population.

Inferential statistical analyses were also conducted to explore relationships between variables.
Correlation analyses were performed to determine the strength and direction of associations
between client satisfaction, service quality dimensions, and loyalty intentions. Additionally,
regression analysis was employed to assess the impact of independent variables—such as staff
professionalism, hospital cleanliness, and resource availability—on the dependent variable of
client loyalty. This multivariate approach allowed for a deeper understanding of the factors
influencing client retention and provided insights into the predictive power of various service
quality dimensions.

Qualitative data, gathered from open-ended questions within the questionnaires, were analyzed
using thematic analysis. This approach involved coding responses to identify recurring themes
and patterns related to clients’ experiences and perceptions. By integrating qualitative findings
with quantitative results, the study provided a richer and more nuanced understanding of how
healthcare service quality affects client loyalty. The combination of these analytical techniques
ensured a robust analysis, enabling the identification of key factors that influence client
satisfaction and future utilization of services at Pentecost Hospital.

CHAPTER FOUR
DATA ANALYSISRESULTS
4.1 Introduction

Chapter Four presents the results and analysis of data collected from clients of Pentecost
Hospital to determine if the quality of healthcare services influences client loyalty and future
utilization. The chapter examines demographic characteristics, service utilization patterns,
clients' perceptions of healthcare quality, and factors influencing their decisions to continue or
discontinue use of the hospital's services. It also categorizes client feedback into themes,
addressing specific aspects of their experiences such as the reasons for continued use,
dissatisfaction factors, complaints, and suggestions for improvement. The findings provide
insights into client satisfaction and areas where the hospital can enhance its service delivery to
increase client retention.

4.2 Demographic Information

The demographic profile of the respondents in Table 4.1 reveals a balanced mix of individuals
across various age groups, with a notable concentration of younger and middle-aged clients. The
largest age group is between 26 and 35 years old, representing 33% of the sample, followed by
those aged 36 to 45 (27%). The 18-25 age group accounts for 22%, reflecting a substantial
presence of younger adults. Meanwhile, smaller percentages are found in older age groups: 46-
55 years (9%), 56-65 years (6%), and 65 years and above (3%). This distribution suggests that
the hospital caters primarily to a younger demographic but also serves a broad spectrum of adult
patients.

In terms of gender, the sample is skewed towards females, with 60% of the respondents being
women, while men make up 40%. This gender distribution may reflect the typical healthcare
utilization patterns, where women often seek medical services more frequently than men.

Regarding marital status, nearly half (49%) of the respondents are single, while 39% are married.
A small portion of the respondents are either divorced (8%) or widowed (4%). This mix of
marital statuses suggests a diverse patient population, possibly affecting their healthcare needs
and satisfaction levels differently based on familial responsibilities and support systems.

Educationally, the majority of respondents have attained at least secondary education, with 42%
holding tertiary qualifications and 29% having completed secondary education. A smaller
proportion has postgraduate education (11%), while 12% have primary education, and 6% have
no formal education. This educational diversity suggests that clients of varying literacy levels use
the hospital, which could influence their understanding of healthcare services and their overall
satisfaction.

In terms of occupation, a significant portion of respondents are employed in the private sector
(31%) or the public sector (26%). Students account for 18%, while 16% are self-employed, and
9% are unemployed. This occupational diversity shows that the hospital serves clients from
various economic backgrounds, each with potentially different healthcare needs and
expectations.

Table 4.1: Demographic Information of Respondents

 Demographic Variables Frequency (n = 100) Percentage (%)

Age
18-25 22 22%
26-35 33 33%
36-45 27 27%
46-55 9 9%
56-65 6 6%
65 and above 3 3%
Gender
Male 40 40%
Female 60 60%
Marital Status
Single 49 49%
Married 39 39%
Divorced 8 8%
Widowed 4 4%
Level of Education
None 6 6%
Primary 12 12%
Secondary 29 29%
Tertiary 42 42%
Postgraduate 11 11%
Occupation
Unemployed 9 9%
Student 18 18%
Public Sector Worker 26 26%
Private Sector Worker 31 31%
Self-Employed 16 16%
Source: Field Work, (2024)

4.3 Presentation of Results

4.3.1 To Determine the Level of Utilization of the Hospital by Clients

The level of utilization of the hospital by clients is assessed through their usage patterns,
frequency of visits, and types of services used. A notable 41% of respondents reported using the
facility for the first time recently, while 33% indicated that they started using it months ago, and
26% have been using it for years. This suggests that the hospital attracts a steady stream of new
clients while retaining long-term users, reflecting sustained service provision and patient trust.

Regarding the frequency of healthcare visits, the responses indicate varying levels of
engagement. Approximately 29% of respondents seek healthcare services monthly, 27% every
six months, and 18% weekly. A smaller proportion visit biweekly (15%) or annually (11%).
These figures suggest that the hospital serves both frequent and occasional users, with a
significant number of clients regularly relying on its services.

In terms of the services utilized, the majority of respondents (43%) use the outpatient department
(OPD), while 21% visit the accident and emergency department. Other services include
pharmacy (10%), in-patient care (12%), laboratory services (9%), and radiology (5%). The
dominance of OPD usage reflects the hospital’s role in providing routine and preventive care,
while the accident and emergency department plays a crucial role for more urgent medical needs.

When asked about their most recent visit, nearly half (48%) of respondents had used the facility
recently, while 32% had done so months ago, and 20% years ago. This further supports the idea
that the hospital maintains a consistent patient base. Additionally, clients are most frequently
recommended to the hospital by friends (36%) or relatives (31%), while other sources of
recommendation include signposts (17%), the internet (8%), and television/radio (8%). These
findings suggest that word-of-mouth remains a key driver in attracting clients to the facility.

Table 4.2: Level of Utilization of the Hospital by Clients

Utilization Variables Frequency (n = 100) Percentage (%)

When was the first time you used this facility?

Recently 41 41%
 Months ago 33 33%
Years ago 26 26%
How often do you seek healthcare services?
Once a year 11 11%
Every six months 27 27%
Monthly 29 29%
Weekly 18 18%
Biweekly 15 15%
What services do you usually utilize?
Out-patient department (OPD) 43 43%
In-patient department (IPD) 12 12%
Accident and emergency department 21 21%
Laboratory services 9 9%
Pharmacy services 10 10%
Radiology services 5 5%
When was the last time you used the facility?

Recently 48 48%
Months ago 32 32%
Years ago 20 20%
Who recommended the facility to you?
Relatives 31 31%
Friends 36 36%
Internet 8 8%
Sign post 17 17%
Television/Radio 8 8%

4.3.2 To Explore Clients’ General Perceptions of the Services Provided by the Hospital

Clients generally have positive perceptions of the services provided by the hospital, as reflected
in the mean scores across various aspects of service. The professionalism and courtesy of
hospital staff received a high mean score of 4.26, with a standard deviation of 1.37, indicating
that most clients find the staff to be competent and respectful in their interactions. The
cleanliness of the hospital environment, which is essential for creating a conducive healthcare
setting, scored even higher, with a mean of 4.54 and a lower standard deviation of 0.97,
reflecting strong satisfaction with this aspect.
Clients also expressed moderate satisfaction with waiting times, with a mean score of 3.82 and a
standard deviation of 1.13, indicating some variability in experiences. This suggests that while
waiting times are generally acceptable, there may be room for improvement. Additionally, the
clarity and adequacy of information provided about treatment processes and healthcare services
scored a mean of 4.01, with a standard deviation of 0.95, showing that most clients appreciate the
hospital’s efforts to keep them informed.

Table 4.3: Clients’ General Perceptions of the Services Provided by the Hospital
Statement Mean Standard
Deviation (SD)
The hospital staff are professional and courteous in their 4.26 1.37
interactions with clients.
The hospital environment is clean and conducive for receiving 4.54 0.97
healthcare services.
I am satisfied with the waiting time before receiving healthcare 3.82 1.13
services.
The hospital provides clear and adequate information about the 4.01 0.95
treatment process and healthcare services.

4.3.3 To Find out What Constitutes Quality of Care from the Perspectives of the Clients

The quality of care, from the clients’ perspective, is shaped by various factors, all of which
received positive mean scores. Clients rated the attitude of hospital staff highly, with a mean
score of 4.31 and a standard deviation of 0.96, indicating that staff behavior plays a significant
role in their decision to return to the hospital. Similarly, the overall quality of healthcare services
received a mean of 4.12 (SD = 0.88), suggesting that clients find the medical services
satisfactory enough to continue using the facility.

Other key aspects influencing clients' perceptions of quality include the cleanliness and
sanitation of the hospital (mean = 4.41, SD = 1.06) and the working condition of hospital
facilities (mean = 4.22, SD = 0.87). These factors are crucial in shaping clients’ overall
satisfaction and their decision to return for future care.

Clients also noted the importance of drug availability, with a mean score of 4.04 (SD = 0.91),
and the adequacy of information on services provided, which scored a mean of 4.05 (SD = 1.28).
Additionally, clients compare the quality of current services with past experiences (mean = 4.14,
SD = 0.91), and the perceived value of services relative to the fees charged (mean = 3.94, SD =
1.31) also influences their satisfaction. Overall, these findings suggest that quality of care is
multifaceted, with both service delivery and hospital infrastructure playing important roles in
shaping client satisfaction.

Table 4.4: Quality of Care from the Perspectives of the Clients

Statement Mean Standard
Deviation (SD)
Quality of healthcare service provided keeps me coming to the 4.12 0.88
hospital.
Attitude of hospital staff towards patients influences my decision 4.31 0.96
to return to the hospital.
Waiting time for treatment/service provided affects my 3.70 1.01
satisfaction.
Availability of drugs/medications prescribed makes me return to 4.04 0.91
the hospital.
The working condition of hospital facilities influences my choice 4.22 0.87
to use this hospital.
Cleaning and sanitation of the hospital affect my decision to 4.41 1.06
return.
Adequacy of information provided on hospital services is 4.05 1.28
important to me.
Service quality this time compared to previous visits influences my 4.14 0.91
satisfaction.
Service provided compared to hospital fees charged affects my 3.94 1.31
satisfaction.

4.3.4 To Establish if the Quality of Healthcare Services at Pentecost Hospital is a

Determinant of Clients' Loyalty and Future Utilization

From Tanle 4.5, a majority of the respondents (85%) indicated that they would continue to use
Pentecost Hospital in the future. This suggests that most clients are satisfied with the healthcare
services provided and are willing to maintain their relationship with the hospital. On the other
hand, 15% of the respondents stated that they would not use the facility again, implying some
dissatisfaction or unmet expectations.
Table 4.5: Future Utilization of the Hospital by Clients
Response Frequency (n = 100) Percentage (%)
Yes 85 85%
No 15 15%

For the study to establish if the quality of healthcare services at Pentecost Hospital is a
determinant of clients' loyalty and future utilization, the findings identified four themes, each
with respective sub-themes. These themes include:

Table 4.6: Themes and Sub-Themes

Theme Sub-themes
Reasons for Continued Use of the Hospital - Positive Experiences with Healthcare Staff

- Clean and Conducive Environment

- Availability of Medical Resources
- Reasonable Waiting Times
Reasons for Discontinuing Use of the Hospital - Long Waiting Times
- Unprofessional Behavior by Staff
- High Cost of Services
- Unavailability of Medications
Complaints about Healthcare Services - Waiting Time
- Staff Attitude
- Cost of Care
- Medication Availability
Suggestions for Improvement - Reduce Waiting Times
- Improve Staff Training
- Lower Healthcare Costs
- Ensure Availability of Medications

Theme 1: Reasons for Continued Use of the Hospital

Positive Experiences with Healthcare Staff

One of the most frequently cited reasons for clients' continued use of Pentecost Hospital was the
positive interactions they had with healthcare staff. Respondents emphasized the
professionalism, courtesy, and compassion exhibited by doctors, nurses, and other hospital
personnel. These interactions were crucial in building trust and comfort, encouraging clients to
return for future services. Many clients expressed that the staff’s willingness to listen and
respond to their concerns made them feel valued as patients. As one client shared, “The doctors
here don’t just treat me; they actually listen to me. I feel respected and understood every time I
come.” Another respondent commented, “The nurses are so caring. Even when I’m anxious, they
take the time to reassure me, which makes a huge difference.” Another echoed this sentiment by
saying, “I’ve always felt well taken care of, and it’s the kindness of the staff that brings me back
every time.”

Clean and Conducive Environment

The cleanliness of the hospital environment also emerged as a significant factor contributing to
client loyalty. Many respondents appreciated the hospital’s commitment to maintaining a
hygienic and conducive atmosphere for receiving healthcare services. The clean surroundings
provided clients with a sense of safety, particularly in terms of infection prevention. “I always
notice how clean everything is, from the floors to the equipment. It gives me peace of mind
knowing I’m being treated in a hygienic place,” one client remarked. Another noted, “There’s a
fresh, clean smell every time I walk in, and that matters to me. It feels like they truly care about
maintaining a healthy environment.” A third client added, “Cleanliness is crucial, especially for
hospitals, and I’ve never had any concerns about that here.”

Availability of Medical Resources

Clients highlighted the availability of essential medical resources, particularly medications and
well-maintained equipment, as a major reason for their loyalty. Respondents appreciated that the
hospital’s pharmacy often had the drugs they needed, saving them the trouble of searching for
medications elsewhere. One client explained, “I never have to run around looking for
medications. Everything I need is available here, which is a big relief.” Another mentioned, “I’ve
been to other hospitals where they were out of basic medicines, but that’s never been the case
here.” Similarly, another client commented, “Knowing that the equipment here is up-to-date
gives me confidence that I’m receiving the best care possible.”

Reasonable Waiting Times

Compared to other healthcare facilities, some respondents felt that the waiting times at Pentecost
Hospital were more manageable. Although waiting times were a concern for some, others
expressed satisfaction with the relatively efficient service delivery. “I’ve been to hospitals where
the wait is unbearable, but here, the system is better organized, and I don’t have to wait forever,”
one client said. Another added, “The waiting time is shorter than in most places I’ve been. Even
when it’s busy, I can see they try to make it as smooth as possible.” One respondent shared, “For
urgent cases, they attend to you quickly, and that makes a huge difference when it really counts.”

Theme 2: Reasons for Discontinuing Use of the Hospital

Long Waiting Times

A common reason for discontinuing use of the hospital was the long waiting periods before
receiving care. Respondents who expressed dissatisfaction noted that the extended waiting times
were frustrating and often led to delays in treatment. “I came in for a simple consultation, and I
ended up waiting for over three hours. That’s just not acceptable,” a client complained. Another
said, “I don’t have all day to wait. The long wait times have made me think twice about coming
here again.” A third respondent added, “They need to improve the speed at which they attend to
patients. It feels like they’re overwhelmed.”

Unprofessional Behaviour by Staff

Another major reason clients chose not to return was negative interactions with hospital staff.
Some respondents mentioned instances where staff members were rude, dismissive, or
unresponsive to their needs. “The way the receptionist treated me was uncalled for. She was rude
and dismissive when I asked a simple question,” a client recalled. Another said, “One of the
nurses seemed annoyed when I asked for help. That kind of attitude doesn’t make me want to
come back.” A third client shared, “I didn’t feel like the doctor took my concerns seriously. I felt
rushed and ignored, which is not the kind of care I expect.”

High Cost of Services

The perceived high cost of healthcare services at Pentecost Hospital was also a deterrent for
some clients. Respondents who raised this issue felt that the hospital’s fees were not justified by
the quality of care they received. “I had to pay a lot more than I anticipated, and for what? The
service didn’t match the price,” one client complained. Another commented, “The charges here
are just too high, and I can’t keep coming if it’s going to drain my pockets.” A third added, “It’s
simply not affordable. I can get the same level of care elsewhere for a lower price.”

Unavailability of Medications

Some clients noted that the hospital’s pharmacy occasionally lacked essential medications, which
caused them inconvenience. “I came in expecting to get all my meds here, but they were out of
stock. It was frustrating having to go elsewhere,” a client said. Another commented, “It’s
disappointing when a hospital can’t provide the basic drugs you need after consultation. I had to
search at multiple pharmacies for something that should have been available here.” A third
shared, “They need to improve their stock management because not having necessary
medications is a major issue.”

Theme 3: Complaints about Healthcare Services

Waiting Time

Many complaints revolved around the time it took for clients to receive care. Even among those
who planned to continue using the hospital, some felt that the waiting times for consultations and
treatments were excessively long. “The waiting times need serious improvement. I’ve waited
hours for a service that should have taken much less time,” one client shared. Another expressed
frustration, saying, “I understand that hospitals can get busy, but it seems like they need a better
system to handle patients faster.” A third client added, “I dread coming here for the wait, even
though the actual care is good.”

Staff Attitude

The attitude of healthcare staff was another area of concern. Some clients reported negative
experiences with hospital personnel who appeared indifferent or unprofessional. “I didn’t like
how the nurse treated me. She was cold and dismissive, which made me feel uncomfortable,” a
client shared. Another said, “Some of the staff act like they’re doing you a favor by attending to
you. It’s off-putting.” A third client added, “A little kindness goes a long way, but unfortunately,
that’s missing here sometimes.”

Cost of Care

As noted earlier, some clients were unhappy with the cost of services at Pentecost Hospital.
Complaints about the high fees were often linked to a perception that the quality of care did not
match the charges. “The prices are high, but the service doesn’t feel premium enough to justify
it,” a client remarked. Another said, “It feels like they’re charging for the name of the hospital
rather than the service itself.” A third commented, “If they lowered their prices, I’d come back
more often, but as it stands, it’s just too expensive.”

Medication Availability

The unavailability of certain medications in the hospital’s pharmacy also generated complaints.
Clients expected the hospital to have a reliable stock of prescribed drugs, and the failure to meet
this expectation was a source of frustration. “The last two times I visited, they didn’t have the
medication I needed. That shouldn’t happen at a hospital this size,” a client complained. Another
shared, “It’s inconvenient to have to leave and search for medication elsewhere after already
spending so much time here.” A third added, “I think they should ensure they’re always stocked
up, especially with common prescriptions.”

Theme 4: Suggestions for Improvement

Reduce Waiting Times

A key recommendation from clients was to reduce waiting times for consultations and
treatments. Respondents suggested that the hospital could hire more healthcare personnel or
streamline its processes to improve efficiency. “If they could speed up the process, it would
improve the overall experience. I’ve waited far too long for simple things,” one client suggested.
Another said, “They need to hire more staff to manage the patient load. Reducing waiting times
will make a huge difference.” A third client added, “Just cutting down the time it takes to get
treated would make me much happier.”

Improve Staff Training

Another common suggestion was to provide additional training for hospital staff, particularly in
the areas of communication and customer service. Clients felt that some staff members lacked
the interpersonal skills needed to provide compassionate and respectful care. “The staff should
be trained to be more empathetic. A little kindness makes a big difference in how patients feel,”
a client suggested. Another remarked, “Some of the nurses need to improve their attitude. More
training in patient care and communication would help.” A third client added, “If they were more
approachable and kinder, it would definitely improve the hospital’s image.”

Lower Healthcare Costs

To address concerns about affordability, respondents recommended that the hospital consider
lowering its service fees or offering more flexible payment options. “The fees need to come
down. It’s just too expensive for many people, and I think it’s driving clients away,” one client
suggested. Another said, “They should offer more flexible payment plans so people can afford to
come without worrying about upfront costs.” A third client added, “If they made the pricing
more affordable, I’m sure more people would choose this hospital over others.”

Ensure Availability of Medications

Finally, clients recommended that the hospital improve its inventory management to ensure that
prescribed medications were consistently available. “They need to do better with stocking up on
medications. It’s frustrating when you can’t get what you need,” one client said. Another
commented, “I think better inventory control would make the hospital a more reliable choice for
patients.” A third added, “Ensuring that medications are always available would improve the
overall service.”

4.4 Chapter Summary

Chapter Four analyzed data on the demographics, service utilization patterns, and perceptions of
clients at Pentecost Hospital to determine if healthcare service quality impacts client loyalty and
future utilization. The demographic data highlighted a young to middle-aged clientele with a
larger representation of females, common in healthcare settings. Patterns of utilization showed a
mix of long-term and first-time users, with outpatient and emergency services being the most
frequently accessed. Clients generally expressed satisfaction with the professionalism of the
staff, the cleanliness of the environment, and the clarity of information provided about services.
However, moderate satisfaction with waiting times indicated that while efficient service delivery
was appreciated, there remains room for improvement.

The chapter then categorized client feedback into four themes: reasons for continued use, reasons
for discontinuation, complaints, and suggestions for improvement. Key motivators for retention
included positive interactions with staff, a clean and conducive environment, accessible
resources, and reasonable waiting times. Conversely, long wait times, perceived unprofessional
staff behavior, high service costs, and occasional medication unavailability were factors
contributing to client dissatisfaction and discontinuation. Recurrent complaints highlighted areas
like wait times, staff attitudes, and healthcare costs, with clients suggesting improvements such
as reducing wait times, enhancing staff training, lowering service costs, and ensuring medication
availability. These findings illustrate the diverse factors that contribute to client loyalty and
underscore potential areas where Pentecost Hospital can enhance its services to strengthen client
satisfaction and retention.

CHAPTER FIVE
DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS

5.1 Introduction
5.2 Discussion of Results
5.2.1 What is the level of utilization of the hospital by clients?

The finding that Pentecost Hospital attracts both first-time and long-term clients aligns with
theories of healthcare utilization that emphasize accessibility and consistent service quality as
core factors in client retention. According to Donabedian’s (1980) quality framework, healthcare
"structure"—such as the availability of essential services like outpatient and emergency
departments—is crucial in shaping patient satisfaction and promoting continued use of
healthcare facilities. This theoretical perspective suggests that clients seek services that are
reliable and consistently available, which in this case, is evident through the hospital's capacity to
provide both routine and urgent care services.

Comparatively, the study by Murti et al. (2013) supports the idea that accessible and efficient
healthcare delivery significantly impacts patient loyalty, suggesting that clients are more likely to
revisit healthcare facilities where basic healthcare needs are consistently met. This finding is also
consistent with Bitner and Hubbert's (1994) notion of customer satisfaction, which posits that
positive initial experiences lead to future patronage, particularly in settings where clients can
depend on the reliability of essential services. The repeated use of the hospital by many clients
thus reflects a strong correlation between accessible, reliable services and sustained client
utilization, affirming the role of structural accessibility as posited in both theories and empirical
studies.

Furthermore, Ovretveit’s model, which underscores that effective healthcare involves technical
competence and accessibility, aligns with this finding. By maintaining efficient access to primary
and urgent care, Pentecost Hospital not only meets client expectations but also fosters trust in the
reliability of its services. The consistency in client return rates observed in this study affirms that
by reducing accessibility barriers and enhancing service reliability, healthcare facilities can
maintain high levels of patient retention, supporting the theoretical assertion that healthcare
utilization is driven by structural and procedural accessibility.

5.2.2 What are clients’ general perceptions of the services provided by the hospital?
Clients’ positive perceptions of staff professionalism and hospital cleanliness suggest that
interpersonal relations and environmental factors are highly influential in shaping healthcare
experiences. Brown et al. (1990) identify interpersonal relations—such as courtesy, empathy,
and effective communication—as critical dimensions of healthcare quality, which directly
correlate with higher levels of patient satisfaction. The high satisfaction with staff
professionalism at Pentecost Hospital demonstrates how positive interpersonal interactions foster
trust, which is vital for client satisfaction, supporting Brown’s dimensions and aligning with
Donabedian’s "process" element, which emphasizes the importance of respectful and empathetic
care.

The SERVQUAL model’s "Tangibles" dimension also highlights the physical environment’s
influence on client satisfaction. Studies like those by Frampton (2012) and Weiss and Tyink
(2009) show that clients associate cleanliness and organization with quality, suggesting that an
aesthetically pleasing, hygienic setting is essential for building patient confidence. The clean and
well-organized environment at Pentecost Hospital contributes to clients’ sense of security and
comfort, affirming the idea that a clean healthcare environment is foundational to perceived
service quality. The link between cleanliness and satisfaction, as demonstrated in these studies,
reinforces the role of the physical environment in clients’ perceptions, suggesting that a hygienic
setting is not only a preference but a critical factor in trust-building.

These findings also support Donabedian’s emphasis on "structure" and "process," where
cleanliness and professionalism in healthcare settings are integral to positive client experiences.
When clients encounter a supportive environment coupled with professional staff conduct, they
are more likely to develop trust in the facility, as observed in Donabedian’s theory. This
correlation between professional staff behavior, a clean environment, and positive patient
perceptions is also consistent with the study by Lee et al. (2010), which argues that maintaining a
client-centered, clean environment fosters trust and encourages repeat visits, underscoring the
importance of aligning service delivery with client expectations to ensure high satisfaction.
5.2.3 What constitutes quality of care from the clients' perspectives?

The study findings suggest that clients define quality care as a mix of efficient service,
professional conduct, and availability of essential resources. This aligns with the SERVQUAL
model's "Reliability" dimension, which emphasizes that reliable, timely healthcare services are
essential to meeting client expectations. Clients’ preference for prompt service, as observed at
Pentecost Hospital, supports this concept, as it indicates that timeliness and dependability are
fundamental to quality care. Studies by Needham (2012) and Ismail et al. (2014) further
corroborate this, showing that clients prioritize prompt and efficient service delivery as a core
quality indicator in healthcare settings.

Donabedian’s model also offers relevant insights, as it highlights "process" quality—particularly

timely and efficient interactions with patients—as key to satisfactory healthcare experiences.
This framework suggests that high-quality healthcare involves not only technical competence but
also timely service, reflecting a broader view of healthcare quality. Clients’ appreciation for
timely services at Pentecost Hospital confirms this view, aligning with Donabedian’s theory that
both technical and operational aspects of care are critical to achieving quality outcomes. When
care is provided promptly and efficiently, clients are more likely to feel valued and respected,
which in turn fosters trust and satisfaction.

Moreover, the availability of resources, such as medications, is a critical factor in clients’

perception of quality. Ovretveit’s model, which includes access to essential resources as a core
aspect of quality healthcare, aligns with this finding, as clients value uninterrupted access to
medications and equipment to meet their healthcare needs. This observation is supported by a
study conducted by AbuDagga and Weech-Maldonado (2016), which found that consistent
availability of medical resources is a determinant of client satisfaction, reinforcing the idea that
hospitals must ensure reliable resource availability to meet client expectations of quality.
Together, these studies and theories emphasize the importance of timely service, respectful staff
interactions, and reliable access to resources as foundational elements of perceived quality in
healthcare.
5.2.4 Is the quality of healthcare services at Pentecost Hospital a determinant of client
loyalty and future utilization

Clients’ loyalty to Pentecost Hospital is closely linked to positive staff interactions, cleanliness,
and resource reliability. The SERVQUAL dimensions of "Assurance" and "Empathy" reflect that
clients who feel valued and secure in their interactions with healthcare staff are more likely to
develop a sense of loyalty. Studies by Crow et al. (2002) and Tsianakas et al. (2012) underscore
that empathetic and competent staff interactions foster trust and commitment, supporting this
finding. When clients experience professionalism and genuine concern from staff, they feel
confident in the hospital’s ability to deliver high-quality care, reinforcing their decision to return
and recommend the facility to others.

Conversely, dissatisfaction with wait times, costs, and medication shortages highlights barriers to
client loyalty. Donabedian’s model of healthcare quality posits that both "structure" (such as
affordable services and resource availability) and "process" (timeliness in service delivery)
influence client satisfaction and loyalty. Clients experiencing prolonged waiting times or high
costs may question the value of services, detracting from their overall satisfaction. Studies by
Nor Khasimah and Wan Normila (2013) also suggest that high-quality healthcare includes both
efficient service delivery and cost-effectiveness, as financial accessibility significantly impacts
clients’ choices. The dissatisfaction observed in the study aligns with these findings, suggesting
that addressing service delays, affordability, and resource consistency are critical for client
retention.

Ensuring high standards of service quality is thus crucial to fostering loyalty. According to
Solomon’s (1996) theory of customer satisfaction, a positive service experience encourages
repeat patronage, while dissatisfaction can lead clients to seek alternative providers. The
combination of professionalism, environmental cleanliness, and reliable access to essential
resources helps foster a strong sense of trust and satisfaction, motivating clients to return. This
concept is supported by studies such as those by Murante et al. (2014), which indicate that high-
quality service strengthens client loyalty. Addressing these identified barriers and ensuring
consistent, dependable care will be essential for Pentecost Hospital in maintaining and
strengthening its client base, ultimately ensuring that clients view the hospital as a trustworthy,
reliable healthcare provider.
5.3 Conclusion

This study aimed to investigate the relationship between the quality of healthcare services at
Pentecost Hospital and client loyalty and future utilization. The findings indicate that various
factors significantly contribute to client satisfaction, including positive interactions with
healthcare staff, a clean and conducive environment, and the reliable availability of medical
resources. Clients reported high levels of satisfaction with the professionalism and courtesy of
hospital staff, which fosters trust and encourages continued use of the hospital's services.

The analysis also highlighted that while many clients express overall satisfaction, challenges
such as long waiting times, high service costs, and occasional shortages of essential medications
pose barriers to loyalty. These factors can detract from the quality of care perceived by clients
and may lead them to seek alternative healthcare providers. The study underscores the
importance of addressing these issues to enhance client experiences and retention.

Overall, the study reinforces the notion that quality healthcare delivery is multifaceted, involving
not only technical competence but also interpersonal relations and a supportive physical
environment. By understanding and responding to the factors that influence client perceptions of
quality, healthcare facilities like Pentecost Hospital can strengthen their relationships with
patients and foster greater loyalty over time.

5.3 Limitations of the Study

This study acknowledges several limitations that may affect the generalizability and applicability
of the findings. Firstly, the sample size, while adequate for the scope of this research, was limited
to clients of Pentecost Hospital, which may not represent the perspectives of patients from other
healthcare facilities. The specific demographic profile of the respondents, particularly the
predominance of younger and middle-aged clients, may also skew the findings, as older adults
may have different healthcare needs and experiences.

Secondly, the study relied on self-reported data, which may be subject to bias. Clients’
perceptions of service quality and satisfaction are influenced by personal experiences and
expectations, which can vary widely. Additionally, social desirability bias may have led some
respondents to provide answers they perceived as favorable rather than their true feelings.
Lastly, the cross-sectional nature of the study limits the ability to draw causal inferences about
the relationship between service quality and client loyalty. Future studies employing longitudinal
designs could provide deeper insights into how changes in service quality over time influence
patient satisfaction and loyalty.

5.4 Recommendations from Results and for Further Research

Based on the findings of this study, several recommendations can be made to enhance healthcare
service delivery at Pentecost Hospital and inform future research. Firstly, it is recommended that
the hospital focuses on improving wait times and addressing the cost of services. Implementing
strategies to streamline patient flow and enhance operational efficiency can lead to a more
satisfying experience for clients. Regular training programs for staff on effective communication
and customer service can further improve interpersonal interactions, enhancing overall client
satisfaction.

Furthermore, the hospital should consider conducting periodic assessments of patient satisfaction
to identify emerging issues and respond proactively to client needs. These assessments could
involve more diverse patient populations, including older adults, to gather a broader range of
perspectives on service quality.

For further research, it is recommended to explore longitudinal studies that track changes in
patient satisfaction and loyalty over time in relation to specific interventions aimed at improving
service quality. Additionally, comparative studies between different healthcare facilities could
provide valuable insights into best practices and areas for improvement across the healthcare
system. By expanding the scope of research to include various patient demographics and other
healthcare settings, a more comprehensive understanding of client perceptions of quality can be
achieved, ultimately contributing to enhanced healthcare service delivery.
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APPENDIX A: RESEARCH CONSENT FORM
STATEMENT OF CONSENT
I …………………………………………. have read and understood this RESEARCH STUDY
INFORMATION SHEET and therefore I agree to take part in this study.
Signature of Participant ………………… Date …………………….
I believe the participant is giving informed consent to participate in this study. Signature of
Researcher …………………… Date …………………… Thank you.
APPENDIX: DATA COLLECTION TOOL
Survey Questionnaire

The following is the survey questionnaire used to assess client satisfaction of healthcare services
at Pentecost Hospital, Madina. Participants were asked to answer the questionnaire based on
their recent experience at the hospital. Questions were posed regarding demographic
information, as well as specific services and the experience of the participant while receiving
treatment or services at the hospital. Thank you for your assistance in this study, and the
information you provided will be kept confidential.

Client Satisfaction of Healthcare Services

At Pentecost Hospital, Madina
Dear participant,

This study seeks to assess client satisfaction of healthcare services at Pentecost Hospital,
Madina. Your participation will help inform management on the quality of healthcare service
provided in the hospital. You are therefore invited to participate in this study. Participation in
this study is voluntarily, and you may withdraw your consent or discontinue participation
without penalty. All responses or information you provide will be kept confidential. The
information you provide will be used only for this study. It is sincerely hoped that all participants
will feel free to respond to the items in the questionnaire.

1. To determine the level of utilization of the hospital by the clients

2. To explore clients’ general perceptions on the services provided by the hospital.
3. Find out what constitutes quality of care from the perspectives of the clients.
4. To establish if the quality of healthcare services at Pentecost hospital is a determinant of
clients loyalty and future utilization.
Please kindly answer each question as honestly as possible.

Phone number: ________________________________

Demographic Information

1. Age:
18-25 [ ] 26-35 [ ] 36-45 [ ] 46-55 [ ] 56-65 [ ] 65 and above [ ]
2. Gender:
Male [ ] Female [ ]
3. Marital Status:
Single [ ] Married [ ] Divorced [ ] Widowed [ ]
4. Level of Education:
None [ ] Primary [ ] Secondary [ ] Tertiary [ ] Postgraduate [ ]

5. Occupation:

● Unemployed [ ]
● Student [ ]
● Public Sector Worker [ ]
● Private Sector Worker [ ]
● Self-Employed [ ]

Objective 1: Determine the Level of Utilization of the Hospital by Clients

1. When was the first time you used this facility?

○ Recently [ ]
○ Months ago [ ]
○ Years ago [ ]
2. How often do you seek healthcare services in the hospital?
○ Once a year [ ]
○ Every six months [ ]
○ Monthly [ ]
○ Weekly [ ]
○ Biweekly [ ]
3. What services do you usually utilize at the hospital?
○ Out-patient department (OPD) [ ]
○ In-patient department (IPD) [ ]
○ Accident and emergency department [ ]
○ Laboratory services [ ]
○ Pharmacy services [ ]
○ Radiology services [ ]
 ○ Other services (please specify): ___________________
4. When was the last time you used the facility?
○ Recently [ ]
○ Months ago [ ]
○ Years ago [ ]
5. Who recommended the facility to you before your first visit?
○ Relatives [ ]
○ Friends [ ]
○ Internet [ ]
○ Sign post [ ]
○ Television/Radio [ ]

Objective 2: Explore Clients’ General Perceptions of the Services Provided by the Hospital

Please indicate your level of agreement with the following statements, where 1 = Strongly
Disagree and 5 = Strongly Agree:

Statement 1 2 3 4 5

The hospital staff are professional and courteous in their interactions with
clients.
The hospital environment is clean and conducive for receiving healthcare
services.
I am satisfied with the waiting time before receiving healthcare services.

The hospital provides clear and adequate information about the treatment
process and healthcare services.

Objective 3: Find out What Constitutes Quality of Care from the Perspectives of the
Clients

Please indicate your level of agreement with the following statements, where 1 = Strongly
Disagree and 5 = Strongly Agree:

Statement 1 2 3 4 5

Quality of healthcare service provided keeps me coming to the hospital.

Attitude of hospital staff towards patients influences my decision to return to

the hospital.

Waiting time for treatment/service provided affects my satisfaction.

 Availability of drugs/medications prescribed makes me return to the hospital.

The working condition of hospital facilities influences my choice to use this

hospital.
Cleaning and sanitation of the hospital affect my decision to return.

Adequacy of information provided on hospital services is important to me.

Service quality this time compared to previous visits influences my

satisfaction.
Service provided compared to hospital fees charged affects my satisfaction.

Objective 4: Establish if the Quality of Healthcare Services at Pentecost Hospital is a

Determinant of Clients' Loyalty and Future Utilization

1. Will you continue to use this facility in the future?

○ Yes [ ]
○ No [ ]
2. What are your reasons for your decision?

Suggestions for Improvement and Complaints

1. If you had any complaints/concerns about the quality of healthcare services

provided in the hospital, kindly state them below:

2. If you have any suggestions on how to improve the quality of healthcare services
provided in the hospital, kindly state them below: