Perceived quality of medical services at outpatient department of public hospitals in Dawro Zone, Southern Ethiopia

Quality of care is the extent to which health services are provided to individuals to increase the likelihood of desired health outcomes and are consistent with current professional knowledge [1]. Donabedian defined medical service quality as the application of medical science and technology in a manner that maximizes its benefit to health without correspondingly increasing the risk [2, 3]. The quality of health care has been described by six factors, namely efficiency, effectiveness, efficacy, optimality, legitimacy, and equity. The disparity between a customer's expectations of a service provider's performance and their evaluation of the services received determines the quality of care [4, 5]. It can be differentiated into observed and perceived quality from the provider's or user's perspective, and it can also be assessed from different perspectives such as client perception, service provider, and facility manager, although client perception in quality of service is assumed to be more important than providing feedback about service areas of strength and weakness that need to be improved [6, 7]. According to the 2016 Ethiopian demographic health survey (EDHS) report, in the last 20 years, there has been a huge success in health infrastructure construction and health workforce development for the expansion of primary and secondary health care units in Ethiopia. However, the wide disparity in equity and quality of health care delivery across the region and within the region in terms of quality and equity has been observed. There are a lot of efforts made by the FMOH (Federal Ministry of Health) of Ethiopia to improve the quality of healthcare services and better health outcomes [8]. Between 5.7 and 8.4 million deaths are attributed to poor-quality care each year in low- and middle-income countries (LMICs), and up to 15% of overall deaths are due to poor quality [4]. For instance, in sub-Saharan Africa (SSA), public health facilities lack basic facilities such as a physical environment (water supply and hygiene). Most of the time, public health facilities are bypassed for lack of diagnostic facilities, drugs, and qualified health personnel. [9]. In the last two decades, different initiatives and efforts have been made to improve the quality of health services. However, healthcare services in public health facilities still lack some sort of quality-related concerns. [10]. Thus, it is vital to investigate providing quality client service in Ethiopia. For instance, OPD service quality in eastern Ethiopia seems to be low and the service delivery of federal referral hospitals is also not satisfactory, thus leading the service consumers to frustration. In addition, in Arsi Negele hospital, payment for the service and a long waiting time for laboratory results hampered the service quality given to consumers. [11‐13]. Other studies from different parts of the country revealed that there are marked discrepancies in outpatient service quality and satisfaction. For instance, recent findings from different public hospitals like Jimma medical center, Adare General Hospital, and Yekatit 12 hospital were low in terms of quality and satisfaction [14‐16]. Findings from Dawro zone Mareka district indicated that most of the OPD services provisions in the health facilities such as laboratory, triage, and pharmacy services are poor in terms of quality, thus hampering the satisfaction of the service users [17]. According to the Dawro zone health department 2019/2020 annual report, the OPD visit per person per year is 0.4, which is very low concerning utilization to attain a national target of 2020 outpatient visits per person [18, 19]. According to researchers’ understanding, little is known about the current perceived quality of medical service at OPD in the study area. Therefore, the purpose of this study is to assess the perceived quality of medical services at the OPD of Dawro zone public hospitals.

The overall perceived quality of the present study is 51.15%. In this study, 35% of respondents rated the client's perceived quality as good. The finding was less than the studies done in Mexico, Nigeria (85.2%), and Tehran (57.5%) respectively [19, 24, 25]. Also, the finding was less than a study done in India Faridabad city which is (93.9%) [26]. The reason for this disparity could be a difference in setting in terms of economy, level of facilities, and quality of service provided [10]. Another reason could be the differences in way of measurement. For instance, the measurement for classification of client perceived quality in our study is based on the percentage mean score of total participants whereas other studies like Teheran and Nigeria used different categorical systems (i.e., Respondents were asked to rate their experience as good, average and poor) this could make a slight difference in the result. The other possible reason might be the difference in the study period.

The present study showed that the highest mean perception score was related to the tangibility dimension. The finding was similar to the study done at Woliata sodo referral hospital [27]. However, the finding was different from a study done in a federal police referral hospital, which found the highest mean perception score was related to the responsiveness dimension [19]. The finding was different from the study done in Bahrain, where the highest mean score in that study was related to the reliability dimension [28]. In addition, also Nepal’s study finding was different from our finding and the highest mean score was related to the assurance dimension [29].

The reason for this difference might be the number of human resources in the hospitals, and the differences between facility setting and professional composure. Another reason for the differences might be healthcare workers' attention and attitude toward their clients. In addition, the possible reason for this might be due to the health policy of the countries concerning client-centered service provision.

In our study, a long waiting time to be seen by a healthcare worker was one of the factors associated with a client’s perceived quality. Accordingly, as compared to study participants, those with a waiting time of less than one hour to be seen by a healthcare worker have an average increment of 0.729 (95% CI = 0.605, 0.853 p < 0.001) in client perceived quality than those who wait longer than one hour. Other studies also support this finding. According to a study conducted in Lagos, Nigeria, patients with short waiting time histories were 5.08 times more likely to be satisfied with the quality of care than those with long waiting times. [27]. This implies that long waiting time was associated with poor perceived quality. This long waiting time could be attributed to poor quality of care and a decrease in the number of clients.

Client-perceived quality was also an independent predictor of client perception. Accordingly, participants whose privacy was maintained had an average increase of 0.529 (95%CI: 0.412, 0.647 p < 0.001) in their client-perceived quality as compared to their counterparts. A study conducted in Iran found that clients whose privacy was not maintained rated service quality as lower than their counterparts [30]. This finding is supported by research from Nigeria's Ekiti state, where the provision of health care services with privacy resulted in a significant positive perception of service quality [31]. This implies that clients will be comfortable when medical staff maintains their privacy. Also, clients believe in emotional attachments, and maintaining privacy makes them satisfied with the service they have obtained [32].