Luận án TS y học: Patient’s satisfaction with health services at Kuta Blang health center in Bireuen district, Nanggroe Aceh Darussalam province, Indonesia

CHAPTER 1INTRODUCTION1.1 Rationale and justificationWith globalization has come an alarming increase in international statements and guidelines for developing about ethics, equity and health system reform. When it does not refer to specific places, times, people and condition, such thinking is of little interest international forum. All these trends in fact make the importance of the local of district health system more conspicuous. Within that system, health development is most effectively implemented through health centers, if health personal understand these to have responsibility both for maintenance of optimum health and for care of the sick in a given area population (1).Patient’s satisfaction is a component of health care quality and is increasingly being used to assess medical care in many countries in the world. Until recently, traditional assessments of medical care were done purely in terms of technical and physiological reports of outcomes. It is an established fact that satisfaction influences whether a person seeks medical advice, complies with treatment and maintains a continuing relationship with practitioners (2).Patient satisfaction has long been considered an important component when measuring health outcomes and quality of care. The rising strength of consumerism in society highlights the central role patient’s attitudes play in health planning and delivery. Further more, a satisfied patient is more likely to develop a deeper and longer lasting relationship with their medical providers, leading to improved compliance, continuity of care, and ultimately better outcomes (3). Medical care aims not only to improve health status but also to respond to patients need and wishes and to ensure their satisfaction with care. Likewise, conducting surveys to measure satisfaction with psychometrically validated questionnaires entails assessment of the quality of care organization and procedures. Patient judgment on medical care also contributes to medical outcome. In the case of ambulatory care, it has been clearly shown that satisfied patients are more likely to cooperate with treatment, to maintain a continuing relationship with a practitioner and thus enjoy a better medical prognosis. From a conceptual point of view, the construct of patient satisfaction as been defined by Isabell Gasquet Ware (4). As an "attempt to capture the personal evaluation of care that cannot be known by observing care directly" and to “Good” consider opinion of patients as a multidimensional subjective indicator of quality of care. The model most commonly, though implicitly, used in satisfaction work is the discrepancy model (degree of fulfilment of expectation is related to satisfaction level) giving to patient expectations a central role. This model, according to Sitzia “implies that concentrating upon areas of expressed dissatisfaction is more valuable than obtaining consistency of expressed satisfaction". In France, measuring satisfaction has been mandatory since 1996 and several questionnaires have been developed to evaluate inpatient care. Most existing outpatient satisfaction questionnaires have been developed to assess primary care practice, especially general practice. However, it could be hypothesized that content of questionnaires evaluating primary care physician may be different from that of questionnaires exploring hospital consultation with a specialist because of differences in patient expectations. So it could be assumed that dimensions that are very important in the case of primary care like human qualities of the physician and medical information could have a lesser importance in case of hospital consultation, while technical competency could have a more important place (5).The quality of health services can be measured by a community''''s level of satisfaction in terms of the health services received, both curative and preventive (6). The quality of health services is very much influenced by the quality of physical facilities, types of work force available, medicines, health instruments and other supportive facilities, services conferring process, and compensation received and the expectation of the consumer society. Hence the increase in physical quality and aforementioned factors are preconditions to be fulfilled. Afterwards, the process of services conferral is to be increased through increase in quality and professionalism of health resources as stated above. While the expectation of the consumer society is being adjusted through improvement in general education, health information, good communication between health providers and the public (7, 8).As the center for basic health services at the sub district level, each health center (community healthcare centers) generally has a doctor who is appointed as the head of the health center. However, the administrative duties of a health center head often reduce consultation time with patients. As a result, patients are mostly taken care of by nurses and midwives. This is a dilemma. On one hand, as a doctor assigned to a particular health center, he or she is required to contribute to the provision of health services, but on the other hand, the administrative duties of a health center head in fact interrupt their duties as a doctor (6).The health plan at provincial level emphasizes patient focused service improvement and organization development. The rate of patient satisfaction at 80% is the minimum goal for every hospital to achieve in Thailand (9). Indonesia health care delivery system consists of network of primary, secondary and tertiary facilities. An essential feature of health centers which operate at first level is the main contact among community. Based on vision of health Indonesia in 2010, 80% of health centers did not provide good quality of services (8).Health centers in Indonesia are designed to provide comprehensive, integrated health services; these include curative, promotive and preventive care, and community-based rehabilitation. There are also responsible for health development in their respective catchments area through community activities and innovative approaches. Depending on the population density, geographical area and local infrastructure, a health center catchments area is either a sub district or a Part of one. Each health center serves an average population of 30,000. They operate under the administrative authority of district administration and the district health office. The function of health center is expended through several subordinate units that include sub-center, posts for trained midwifes in village, and subordinate unit that integrated services unit (posyandu). This health center was linked to the “Village Community Resilience Body” (LKMD) to support village-based development activities (10).Patient’s satisfaction and its measurement are important as other clinical health measures and primary means of measuring the effectiveness of health care delivery as well as for policy analyst, health care managers, practitioners and users. Environment has forced health care organization to focus on Patient’s satisfaction as a way to gain and maintain market share. If you don’t know what your strengths and weakness are, you can’t compete effectively. Despite problem with establishing a tangible definition of “satisfaction” and difficulties with measurement, the concept continues to be widely used. In many instances when investigators claim to be measuring satisfaction, more general evaluation of health care services is being undertaken (11).Bireuen is the youngest district in NAD (Nanggroe Aceh Darussalam) by the rule UU No. 48 on October 1999, before it was apart of North Aceh. The total area is1.901,021 km2 consist of 17 sub district, and 581 villages. The total population is365.184 and until 2006, Bireuen district has 17 health centers, and 5 out of 17 health centers have beds for patients having serious illness. To provide services total of 142 staffs with one doctor, one nutritionist, one nurse secretary, one nurse for communicable disease ,one pharmacy assistance and for each village have one midwives and total of 40 for whole villages. The main programmes conducted in health center were focused on mother and chid health, immunization, nutrition, communicable diseases, health environment and health promotion and prevention. By National policy, a health center serves an average population of 30,000 (12, 13).Kuta Blang health center is one of the rural health centers in Bireuen sub district, which responsible for 40 villages with 20.006 populations and the average of patients visit were 60 patients per day. Health center provides free medical services to all the peoples in the village. There has been no study on patient satisfaction since the center was established; to improve quality of health care in this area the result of measuring patient’s satisfaction could be used for starting point to improve quality of services in Kuta Blang health center. A better understanding about factors relating to patient’s satisfaction can help policy and decision makers to implement programs adapted to patient’ need as perceived by patients for all health centers in Bireuen district. Therefore, this patient satisfaction study was conducted at Kuta Blang health canter, in Bireuen Aceh Province, Indonesia (12, 13).