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Patient's Satisfaction from the Infrastructure Facilities of the Government

Hospitals in Saudi Arabia

Article · January 2014

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MAGNT Research Report (ISSN. 1444-8939) Vol.2 (6) PP: 531-539

Patient's Satisfaction from the Infrastructure Facilities of the Government Hospitals in

Saudi Arabia

Dr. Abdalelah Saifuddin Saaty1 and Dr. Zaid Ahmad Ansari2

1
Associate Professor in Health and Hospital Management
Dean, College of Business North Jeddah
King Abdulaziz University, Jeddah, Saudi Arabia
2
Assistant Professor in Marketing
Head, Department of Marketing, College of Business North Jeddah,
King Abdulaziz University, Jeddah, Saudi Arabia

Abstract: The paper investigated the satisfaction level of patients from the infrastructure facilities of the
government hospitals in Saudi Arabia with the aim of identifying potential areas of improvement to guide
the efforts of policymakers in right direction to enhance the satisfaction of patients from infrastructure
facilities of the government hospitals in Saudi Arabia.
Primary data is the main source of data for the study. The sample size of the study was 400 hundred
respondents, selected on convenience basis in the city of Jeddah. The researchers selected the variables in
hospital infrastructure by making personal visits and observing the systematic infrastructure facilities
needed by a patient and their family visiting a hospital. The researchers identified ten variables under
infrastructure facilities, which they consider important. The facilities were; Parking facilities, General
entrance, Emergency entrance, Waiting area, Seating area, Cleanliness and hygiene, Canteen, direction
Signboards, and use of Technology. Five point Likert scale measured the patient's satisfaction from these
ten infrastructure variables.
The results show that the patients are not satisfied with the infrastructure facilities of the government
hospitals in Saudi Arabia.

Keywords: Government Hospital, Infrastructure, Patient's satisfaction, Saudi Arabia

1. Introduction from comparing product /service's perceived

Ministry of health in Saudi Arabia monitors the
healthcare system in the country. The healthcare
system of Saudi Arabia comprises of government
hospitals and private hospitals. The ministry is
continuously trying to enhance the healthcare
services in the Kingdom. The fast growing
population of Saudi Arabia and compulsory
health insurance is exerting high pressure on the
hospitals. Given the situation, the demand for
healthcare services is more than the supply in the
country, which puts the quality of services of the
hospitals under doubt. Thus in this study the
researchers investigated the satisfaction level of
patients from the services of government
hospitals. Customer satisfaction is individual’s
feeling of pleasure or disappointment that arises
(DOI: dx.doi.org/14.9831/1444-8939.2014/2-6/MAGNT.67)
performance or outcome with their expectations.
If the perceived performance falls short of
expectations, the customer is dissatisfied, and if
the performance matches the expectations, the
customer is satisfied. If the performance exceeds
expectations, the customer is highly satisfied or
delighted. In the following section, discusses in
brief the existing related literature.
2. Review Of Literature
Patients are like the customers of the company
using its products. Patient satisfaction is an
important indicator of quality of care for patients
(Ware et al., 1978; Donabedian, 1988). The
leading thinker in modern medical quality
assurance Avedis Donabedian 1980 said “it is
MAGNT Research Report (ISSN. 1444-8939)
useful to begin with the obvious by saying that
quality is a property that medical service can have
in varying degrees”. It follows that an assessment
of quality is a judgment whether a specified
instance of medical service has this property, and
if so, to what extent (Donabedian, 1980).
Zeithmal, et al., (2006), defined satisfaction as the
evaluation of customers for a service or product
whether it fulfill their needs and expectations.
Customer satisfaction is a feeling of pleasure or
disappointment resulting from comparing
product/service's perceived performance in
relation to his or her expectations. Thus,
satisfaction is a function of perceived
performance and expectations. If the performance
falls short of expectations, the customer is
dissatisfied. If the performance matches the
expectations, the customer is satisfied. If the
performance exceeds expectations, the customer
is highly satisfied or delighted. Tarantino (2004)
stressed on the fact that patients’ satisfaction is
truly measured based on two factors, their
expectations of the service and their perceptions
of the actual service they received. Thus if the
patients are satisfied it indicates their perception
to be good about service quality they received
from the hospital. Patient satisfaction is the most
important measure of the quality of medical
services because it gives information on the
provider’s success at meeting the patient's values
and expectations. The measurement of the
patients’ satisfaction is therefore important tool
for research, administration, and planning. Some
studies indicate that patient satisfaction is one of
the important indicators of the quality of care
provided by the emergency department at a
hospital (Hansagi et. al., 1992; Kurata et al.,
1992; Yamold et. al., 1998). Lewis et. al (1985)
claimed that service quality involves a
comparison of expectations with performance.
Gronross (1982) developed a model in which he
contends that clients compare the service they
expect with perceptions of the service they
receive in evaluating service quality.
Parasuraman et al (1988) defined service quality
as “global judgment, or attitude, relating to the
superiority of the service.” They linked the
concept of service quality to the concepts of
perceptions and expectations as follows: Service
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Vol.2 (6) PP: 531-539
quality is viewed as the degree and direction of
discrepancy between clients’ perceptions and
expectations” (Parasuraman et. al, 1988).
The study of (Aladham, 2004) shows a direct
relationship in all hospitals between service
procedures and patient satisfaction. It also shows
that patient's satisfaction is linked to the hospital
staff attitudes and values and have a direct impact
on all the activities of the hospital.
Rose Laub Coser (1956) conducted ‘standardized
interviews’ with 51 patients at a hospital. When
Coser asked “what is your idea of a good
doctor?” the answers given by the patients
seemed to classify them into two distinct groups.
A little more than half of the patients saw the
good doctor as one who provided kindness, love,
and security. He “talks nice, shows interest,
makes you feel good, so all knowing and all
powerful that you can rest secure in his safe-
keeping.” On the other hand, remaining patients
focused on the doctor’s scientific and
professional competence. Friedson (1969)
interviewed patients about their reasons for liking
and disliking certain doctors, and for continuing
to receive care from one but not from another.
Friedson concluded, “Patients assume that all
doctors possess a minimal competence” and they
are concerned only with degrees of competence.
The patients defined quality in terms of certain
behavior on the part of the physician, or attributes
of his care, which they felt denoted personal
interest or competence. Cartwright (1967)
interviewed patients to define the appreciated
qualities for doctors. Majority of the responses
showed the most appreciated qualities related to
the manner or personality of the doctor and the
way they looked after the patient.
Patients of Emergency and Accident Department
comprise a big proportion of people who refer to
a hospital (Lau 2000). The Emergency
Department of a hospital is a very critical unit
where a patient is struggling between life and
death, the emergency department requires high
coordination between human and material
elements (Jinn & Wen-Shan 2007). There are
many researches conducted in measuring the
patients satisfaction from emergency services of
MAGNT Research Report (ISSN. 1444-8939)
hospitals, namely; in Iran (Rezaee et.al. 2002;
Sarchami & Sheykhi, 1999; Zendehdel &
Baradarjalili, 1998), in USA (Boudreaux et. al.,
2003; Taylor & Benger 2004), in Australia
(Hordacre et. al., 2005), in Canada (Hutchison et.
al 2003), Spain (Miro et. al., 2003), in Britain
(Pickin et. al.2004; Richards et. al. 2002) and in
Pakistan (Qidwai et. al., 2005). The satisfaction
of patients from emergency services is critical as
the patients and their relatives struggling between
death and life.
The literature in the above section suggests
number of variables in hospitals considered for
measuring the patient's satisfaction namely;
doctors, emergency services, human resource et
al. The researchers in this study have taken
another area of hospital to measure the
satisfaction, which previously did not attract the
attention of the researchers. The researchers
studied the 'hospital infrastructure' for measuring
patient satisfaction, as it is the first element in the
hospital and patient interaction discussed more in
detail in the methodology section. The rest of the
paper presents the information in the following
order, research methodology, results, discussion,
conclusion, acknowledgement and references.
3. Research Methodology
3.1. Survey Instrument: The study draws result
on primary data. To obtain data from the users of
government hospital services the researchers used
self-administered close-ended questionnaires. To
maintain high reliability of the data and high
response rate from the respondents,
questionnaires translated into Arabic Language
were administered to the respondents, as most of
the respondents were Arabic speakers. The close-
ended questions translated into Arabic language
enabled the respondents to answer the questions
conveniently in short period and ensured highly
reliable data. Five point Likert Scale was used to
measure the intensity of the satisfaction of the
respondents. The grading used were 5 equal to
Highly Satisfied, 4 equal to Satisfied, 3 equal to
Somewhat Satisfied, 2 equal to Dissatisfied and 1
equal to Highly Dissatisfied.
The questionnaire comprised of two sections.
Section A comprised of respondents' profile such
as Nationality, and Educational qualification.
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Vol.2 (6) PP: 531-539
Section B was the focus of the study 'Hospital
Infrastructure', which comprised of ten variables
namely; Parking facilities, General entrance,
Emergency entrance, Waiting area, Seating place,
Cleanliness and hygiene, Canteen, Signboards,
and Technology.
3.2. Data Collection: Convenience sampling
methodology was used to identify the respondents
to administer the questionnaires. The respondents
were employees working in various companies
across the kingdom. The respondents were
presently pursuing bachelor degree in various
programs of College of Business Rabigh, King
Abdulaziz University through part time and
distance learning program. Researchers
personally administered the questionnaires to the
respondents during the counselling session
conducted prior to the final exam as well as
during the final exam.
Sample size: The sample size of the study was
400 respondents.
Research Hypothesis: The researchers tested ten
hypotheses from the results each representing one
variable in infrastructure.
H1: Patients were satisfied with the Parking
facilities.
H2: Patients were satisfied with the General
entrance.
H3: Patients were satisfied with the Emergency
entrance.
H4: Patients were satisfied with the Waiting area.
H5: Patients were satisfied with the Seating area.
H6: Patients were satisfied with the Washroom
facilities.
H7: Patients were satisfied with the Cleanliness
and hygiene.
H8: Patients were satisfied with the Canteen
facilities.
H9: Patients were satisfied with the direction
Signboards.
H10: Patients were satisfied with the use of
Technology.
MAGNT Research Report (ISSN. 1444-8939) Vol.2 (6) PP: 531-539

4. Results Table 1 shows the result, the high value of .838

indicated high reliability of the data.
4.1. Reliability of data: Cronbach alpha test
measured the reliability of the collected data.

Table 1: Reliability Test

Infrastructure Facilities Reliability value

Hospital Infrastructure .838

Parking Facilities
General entrance
Emergency entrance
Waiting area
Sitting place
Washroom facilities
Cleanliness and hygiene
Canteen
Direction sign boards
Technology

4.2. Profile analysis of the respondents: The
profile of the respondents measured on three
variables namely their nationality, educational
qualification, and type of treatment received by
a patient. The results showed that majority of the
respondents were Saudi nationals approximately
85.5%, and 14.5% were non-Saudi nationals
working in Saudi Arabia. On educational front
55.8% were less than bachelor degree, 38.5%
were bachelor degree holders, 4.5% had
completed graduation, and 1.3% had Ph.D.
degrees. The third variable in profile analysis
considered the type of treatment received;
approximately 40.3% had been outpatient,
20.5% were inpatient, and 39.3% used both the
services as outpatient as well as inpatient.

Table 2: Profile of government hospital users

Users N %
Nationality
Saudi 342 85.5
Non Saudi 58 14.5
Total 400 100.0
Educational Qualification
Less than bachelor degree 223 55.7
Undergraduate 154 38.5
Graduation 18 4.5
Ph.D. 5 1.3
Total 400 100.0
Type of treatment received
Out patient 161 40.2
In patient 82 20.5
Both 157 39.3
Total 400 100.0

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MAGNT Research Report (ISSN. 1444-8939) Vol.2 (6) PP: 531-539

4.3. Patient’s satisfaction levels with Hospital dissatisfaction category (highly dissatisfied +
infrastructure dissatisfied). The results in table 3 and table 4
shows that number of patients satisfied with the
Satisfaction of patients is an important measure
parking facilities are only 62 or 15.5%. The
of the service quality of the hospitals. The
patient’s satisfaction level from other
satisfaction levels of the patients from the
infrastructure facilities were also low. The
infrastructure of the government hospitals in
satisfaction levels were as follows; general
Saudi Arabia measured patients' satisfaction
entrance 30.8%, from emergency entrance
from ten variables. The list is suggestive not
30.3%, from the waiting area inside the hospital
exhaustive. In future researches, number of
23.3%, seating area and arrangements 23.8%,
variables may increase. The results in table 3
from the washroom facilities 24.5, from
and table 4 showed the patients’ satisfaction
cleanliness and hygiene 34.3%, from canteen
level from the hospital infrastructure. Table 3,
22%, from direction and signboards 45%, and
presented the results in number of respondents in
from technology 26.3% (table 3 and 4). The
the category of highly satisfied, satisfied,
results suggested that very less percentage of
somewhat satisfied, dissatisfied, and highly
patients were satisfied with the infrastructure
dissatisfied. However, table 4 presented the
facilities of the government hospitals in Saudi
result in cumulative percentage of respondents
Arabia.
in satisfaction category (together highly satisfied
+ satisfied) somewhat satisfied and

Table 3: Patient’s satisfaction on hospital infrastructure

Number of patients reporting
Infrastructure Highly Satisfied Somewhat Dissatisfied Highly
Facilities N satisfied satisfied dissatisfied
Parking facilities 400 31 31 99 72 167
General entrance 400 58 65 123 82 72
Emergency entrance 400 47 74 119 72 88
Waiting area 400 33 60 97 75 135
Seating place 400 41 54 104 79 122
Washroom facilities 400 43 55 73 70 159
Cleanliness and hygiene 400 53 84 99 89 75
Canteen 400 37 51 98 85 129
Signboards 400 79 101 101 57 62
Technology 400 47 58 96 66 133

Table 4: Patient’ satisfaction on hospital infrastructure

Somewhat Dissatisfied
Satisfied Satisfied
Infrastructure Facilities % % %
Parking facilities 15.5 24.7 59.7
General entrance 30.8 38.7 38.5
Emergency entrance 30.3 29.7 40.0

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MAGNT Research Report (ISSN. 1444-8939) Vol.2 (6) PP: 531-539

Waiting area 23.3 24.2 52.5

Seating place 23.8 26.0 50.2
Washroom facilities 24.5 18.2 57.2
Cleanliness and hygiene 34.3 24.7 41.0
Canteen 22.0 24.5 53.5
Signboards 45.0 25.2 29.7
Technology 26.3 24.0 49.7

patients and mean value above 3 indicated the

4.4. Analysis of Patient’s Satisfaction across
Outpatients and Inpatients
To find out the whether there was any difference
between the satisfaction level of outpatients and
inpatients, the researchers conducted ANOVA
analysis. The results of the ANOVA analysis
presented in table 5 showed that there is no
significant difference between the satisfaction
levels of the outpatients and inpatients. The
mean values for most of the variables in both the
groups were less than 3. A mean value of less
than 3 indicated the dissatisfaction of the
satisfaction of the patients. From ten variables in
the list of infrastructure only direction
Signboards is the item for which the mean value
was above 3 which is again a better situation
compared to others but the mean value of 3
shows a somewhat satisfaction only. For other
nine variables, the patients were dissatisfied.
However, the results shown are not statistically
significant. Thus, the outpatients as well as
inpatients both are not satisfied with
infrastructure facilities of the government
hospitals in Saudi Arabia.

Table 5: ANNOVA - Satisfaction on hospital infrastructure across patient types

Type of Treatment Out Patient In patient F df Sig.
N Mean Std. N Mean Std.
Deviation Deviation
Parking facilities 161 2.25 1.315 239 2.19 1.252 .228 1 .633
General entrance 161 2.93 1.297 239 2.86 1.284 .234 1 .629
Emergency entrance 161 2.82 1.313 239 2.79 1.287 .063 1 .802
Waiting area 161 2.47 1.318 239 2.44 1.311 .060 1 .807
Seating place 161 2.60 1.371 239 2.49 1.289 .626 1 .429
Washroom facilities 161 2.43 1.435 239 2.35 1.376 .292 1 .589
Cleanliness and hygiene 161 2.99 1.297 239 2.80 1.307 2.147 1 .144
Canteen 161 2.49 1.275 239 2.43 1.329 .201 1 .655
Signboards 161 3.34 1.250 239 3.10 1.377 3.014 1 .083
Technology 161 2.57 1.354 239 2.54 1.404 .065 1 .800

5. Discussions scale where 5 equals to highly satisfied and 1

The main objective of the current research was
to find out the patients satisfaction from the
infrastructure facilities of the government
hospitals in Saudi Arabia. To measure the
satisfaction from infrastructure the researchers
studied ten infrastructure variables. Patient’s
satisfaction on various aspects of hospital
infrastructure had been measured on five-point
(DOI: dx.doi.org/14.9831/1444-8939.2014/2-6/MAGNT.67)
equals to highly dissatisfied. Therefore, the
hypothesized test value for categorizing the
patients into satisfied and dissatisfied category
had been 3. One Sample t Test analyzed the
patient’s satisfaction on hospital infrastructure,
where a mean of a single variable differs from a
specified constant value.
MAGNT Research Report (ISSN. 1444-8939) Vol.2 (6) PP: 531-539

The results in table 6 show that the mean values
for nine items from ten items are less than 3.
Ranging from parking facilities where the mean
value is 2.22 significant at 95% confidence
level, for Washroom facilities mean value 2.38
significant at 95% confidence level, Waiting
area 2.45 significant at 95% confidence level,
followed by Canteen 2.46, Seating place 2.52,
Technology 2.55, Emergency entrance 2.80,
Cleanliness and hygiene 2.88, General entrance
2.89, direction Signboards 3.20. Based on the
results nine hypothesis namely H1, H2, H3, H4,
H5, H6, H7, H8, H10, are rejected as the mean
value for these variables are less than 3, which
indicated that the patients were not satisfied with
the services of the government hospitals in Saudi
Arabia. The only variable which has mean value
above 3 is 'direction Signboards represented by
H9. For this variable, also the mean value is just
more than 3 that is '3.20' which indicated that the
patients were somewhat satisfied. The results are
statistically significant at '0.01' level for all the
variables except for Cleanliness and hygiene,
and General entrance.

Table – 6: One sample t test – Patients' satisfaction on hospital infrastructure

Parameters N Mean Std. t df Sig.

Deviation (2-
tailed)
Parking facilities 400 2.22 1.276 -12.261** 399 .000
Washroom facilities 400 2.38 1.399 -8.830** 399 .000
Waiting area 400 2.45 1.312 -8.344** 399 .000
Canteen 400 2.46 1.307 -8.342** 399 .000
Seating area 400 2.53 1.322 -7.071** 399 .000
Technology 400 2.55 1.383 -6.508** 399 .000
Emergency entrance 400 2.80 1.296 -3.087** 399 .002
Cleanliness and hygiene 400 2.88 1.305 -1.878 399 .061
General entrance 400 2.89 1.288 -1.747 399 .081
Signboards 400 3.20 1.331 2.930** 399 .004
**significant at 0.01 level, * significant at 0.05 improvement. Besides, this can be basis for
level future researches as well.

6. Conclusion Acknowledgement
Thus from the results and discussion it can be This project was funded by the Deanship of
concluded that the infrastructure of the Scientific Research (DSR) King Abdulaziz
government hospitals in Saudi Arabia needs an University, Jeddah, under grant no.
enhancement to meet the patients expectations. (91/849/1433). The authors, therefore,
The basic facilities such as the parking, acknowledge with thanks DSR technical and
washroom, lobby, refreshment, sitting financial support.
arrangement, technology, cleanliness and et al.,
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