FACTORS AFFECTING

PATIENT SATISFACTION
IN A HOSPITAL
Group - 4
Brief Introduction:
• Quality of care: This includes the technical
competence of the medical staff, the
effectiveness of the treatment, and the overall
quality of the medical services provided.
• Communication: Effective communication
between patients and healthcare providers is
essential for building trust and ensuring that
patients feel informed and involved in their
care. This includes clear explanations of
diagnoses, treatment options, and potential
risks and benefits.
• Empathy: Patients want to feel treated with
respect and dignity, and they appreciate
healthcare providers who show empathy
and understanding for their concerns. This
includes listening attentively to patients,
addressing their questions and concerns,
and involving them in decision-making.
• Hospital environment: The physical
environment of the hospital can also play a
role in patient satisfaction. This includes
factors such as cleanliness, comfort, noise
levels, and access to amenities.
 Data Sources: Literature review

• Waiting Time
Alarcon-Ruiz, C.A., Heredia, P. & Taype-Rondan, A. Association of waiting and consultation time with patient satisfaction: secondary-data analysis of a national survey in
Peruvian ambulatory care facilities. BMC Health Serv Res 19, 439 (2019). https://doi.org/10.1186/s12913-019-4288-6
• No. Of Beds
https://www.researchgate.net/publication/320265672_Does_Hospital_Size_Affect_Patient_Satisfaction
• Time Spent by Doctor
Alarcon-Ruiz, C. A., Heredia, P., & Taype-Rondan, A. (2019). Association of waiting and consultation time with patient satisfaction: Secondary-data analysis of a national
survey in Peruvian ambulatory care facilities. BMC Health Services Research, 19(1), Article 439. https://doi.org/10.1186/s12913-019-4288-6
• Cost of Treatment
Xesfingi, S., Vozikis, A. Patient satisfaction with the healthcare system: Assessing the impact of socio-economic and healthcare provision factors. BMC Health Serv Res 16, 94
(2016). https://doi.org/10.1186/s12913-016-1327-4
• Length of Stay
Karaca, A., & Durna, Z. (2019). Patient satisfaction with the quality of nursing care. Nursing open, 6(2), 535–545. https://doi.org/10.1002/nop2.237
• Number of Specialties
Sodani PR, Sharma K. A study on patient satisfaction at a multi super specialty hospital in Delhi. Hosp Top. 2014 Jan-Mar;92(1):1-6. doi: 10.1080/00185868.2014.875311.
PMID: 24621132.
Variables: Dependent and
Independent

DEPENDENT VARIABLE

• Patient Satisfaction

INDEPENDENT VARIABLE

• Wait Time in Minutes

• Number of Beds
• Time Spent by Doctors
• Cost of Treatment
• Length of Stay
• Number of Specialties
DESCRIPTIVE
STATISTICS

•The data set comprised of total 1000 entries.

•79.3% of patients were satisfied, while 20.7%

were not satisfied. There is missing data for
one patient.
 Population Regression
Function (PRF)
The PRF is the theoretical relationship between the dependent variable and independent variables across the entire
population. It can be represented as:
Patient Satisfaction = β0 + β1 ⋅ Waiting Time + β2 ⋅ Number Of Beds + β3 ⋅ Time Spent By Doctor + β4 ⋅
Cost Of Treatment + β5 ⋅ Length Of Stay + β6 ⋅ Number Of Specialties + ε
• Logit Model: Pr(HI; = 1|x ) = G (B + β1 Waiting Time + β2 Number Of Beds + β3 Time Spent By Doctor
+ β4 Cost Of Treatment + β5 Length Of Stay + β6 Number Of Specialties+ Mi)
• Probit Model: Pr(HI₁ = 1|x ) = Φ (B + β1 Waiting Time + β2 Number Of Beds + β3 Time
Spent By Doctor + β4 Cost Of Treatment + β5 Length Of Stay + β6 Number Of Specialties+ Mi)
where:
• Patient Satisfaction is the dependent variable representing the level of satisfaction of patients.
• Waiting Time, Number of Beds, Time Spent By Doctor, Cost of Treatment, Length of Stay, Number of
Specialties are the independent variables.
• β0 is the intercept, β1 to β6 are the coefficients for each independent variable, and ε is the error term.
 Hypothesis
​ Cost of Treatment (x4)​
Waiting Time (x1)​ • H0: β4 = 0 (Cost of treatment has no effect on
• H0: β1 = 0 (Waiting time has no effect on patient patient satisfaction)​
satisfaction)​ • HA: β4 ≠ 0 (Cost of treatment affects patient
• HA: β1 ≠ 0 (Waiting time affects patient satisfaction)​ satisfaction)​
Number of Beds (x2)​ Length of Stay (x5)​
• H0: β2 = 0 (Number of beds has no effect on patient • H0: β5 = 0 (Length of stay has no effect on
satisfaction)​ patient satisfaction)​
• HA: β2 ≠ 0 (Number of beds affects patient • HA: β5 ≠ 0 (Length of stay affects patient
satisfaction)​ satisfaction)​
Time Spent by Doctor (x3)​ Number of Specialties (x6)​
• H0: β3 = 0 (Time spent by doctor has no effect on • H0: β6 = 0 (Number of specialties has no effect
patient satisfaction) on patient satisfaction)​
• HA: β6 ≠ 0 (Number of specialties affects
patient satisfaction)
Methodology Used

• Linear Probability Model (LPM): Initially, a simple linear regression approach (LPM) is utilized to provide a
preliminary understanding of how each factor might linearly impact patient satisfaction. This model is
straightforward and offers initial insights but is limited by its assumption of a linear probability model, which
can predict probabilities outside the [0,1] range and may exhibit heteroscedasticity.
• Logit Model: To address the limitations of the LPM, the logit model is applied. The logit model, using the
logistic function, ensures that predicted probabilities are bounded between 0 and 1. It models the log odds of the
probability that patient satisfaction is positive as a linear combination of the independent variables.
• Probit Model: Similarly, the probit model is employed, which assumes that the probability of patient
satisfaction follows a normal cumulative distribution function. This model is another way to ensure predicted
probabilities remain within a logical range and to check the robustness of the logit model findings.
 Justification for Methodology

• LPM to Logit/Probit Transition: The initial use of LPM followed by logit and probit models allows for a
comprehensive analysis that begins with a simple linear approach and progresses to more sophisticated models
that can accurately handle the bounded nature of the dependent variable (patient satisfaction). This
methodological progression ensures that the limitations of one model are addressed by the subsequent models.
 LPM MODEL
• x1 (Wait Time): A one-minute increase in wait time is associated with
a decrease of 0.00182 in the predicted probability of patient satisfaction. This coefficient
is statistically significant at the 1% level, indicated by the p-value of less than 2.2e-16.
• x2 (Number of Beds): A one-unit increase in the number of beds has a positive but
statistically insignificant effect on patient satisfaction (coefficient = 0.00008, p-value =
0.850).
• x3 (Time Spent by Doctors): A one-minute increase in the time spent by doctors with
patients is associated with a small increase of 0.00044 in the predicted probability of
patient satisfaction. This effect is also statistically significant at the 1% level (p-value =
8.50e-06).
• x4 (Cost of Treatment): A one-rupee increase in the cost of treatment is associated with
a decrease of 0.000098 in the predicted probability of patient satisfaction. This effect is
statistically significant at the 1% level (p-value < 2.2e-16).
• x5 (Length of Stay): A one-day increase in the length of stay is associated with
a decrease of 0.00986 in the predicted probability of patient satisfaction. This effect is
highly statistically significant (p-value < 2.2e-16).
• x6 (Number of Specialties): A one-unit increase in the number of specialties has
a positive and statistically significant effect on patient satisfaction (coefficient = 0.02159,
p-value < 2.2e-16).
• Residual Standard Error: This value (0.3269) represents the standard
deviation of the residuals from the regression line. It indicates the average
difference between the predicted and actual values of patient satisfaction.
• R-squared: This value (0.3537) represents the proportion of the variance in
patient satisfaction explained by the model. The adjusted R-squared (0.3498)
takes into account the number of independent variables and is slightly lower.
Interpretation:
• Based on the results, several factors appear to be statistically associated with
patient satisfaction in this healthcare setting:
• Wait time, cost of treatment, and length of stay: These factors have
negative associations with patient satisfaction, implying that longer wait
times, higher costs, and longer stays are associated with lower patient
satisfaction.
• Time spent by doctors and number of specialties: These factors have
positive associations with patient satisfaction, suggesting that more time
spent by doctors with patients and a greater number of specialties available
at the facility are associated with higher patient satisfaction.
 LPM MODEL: STARGAZER

• Waiting Time (x1): Each additional unit increase in waiting time reduces
the probability of patient satisfaction by 0.2%, ceteris paribus.
• Number of Beds (x2): An additional bed is associated with a 0.01%
increase in the probability of patient satisfaction, all else being equal.
• Time Spent by Doctor (x3): For each extra minute the doctor spends with
a patient, the probability of patient satisfaction decreases by 0.4%, holding
other factors constant.
• Cost of Treatment (x4): Changes in the cost of treatment do not
significantly affect the probability of patient satisfaction.
• Length of Stay (x5): An additional day in the hospital is associated with a
1% decrease in patient satisfaction probability, ceteris paribus.
• Number of Specialties (x6): Each additional specialty available at the
hospital increases the probability of patient satisfaction by 2.2%, all else
equal.
 FITNESS OF LPM MODEL

Goodness of Fit Interpretation:

• R-squared (R²): An R² value of 0.354 suggests that 35.4% of the variability in patient satisfaction is explained by
the model. This value is moderate, indicating that while the model has explanatory power, there is still a significant
portion of variability not captured by the included variables.
• Adjusted R-squared: The adjusted R² of 0.350 is very close to the R², which indicates that the inclusion of
additional variables has not led to an overfitting of the model. This suggests that the model is generalizable and the
number of predictors is appropriate for the number of observations.
• F-Statistic: An F-statistic of 90.574 with a very low p-value indicates that the model provides a significantly better
fit than an intercept-only model. This tells us that the independent variables, as a group, are statistically significant
predictors of patient satisfaction.
 FITNESS OF LPM MODEL

•Density Plot Interpretation:​

The density plot for y1hat (the predicted patient satisfaction scores)
shows a distribution that is unimodal and roughly symmetric. This
suggests that the model's predictions are fairly normally distributed,
which is generally a good sign in a linear model context.​

The density plot for e1hat (the residuals of the model) exhibits a
bimodal distribution, which is a concern. Ideally, we would want the
residuals to be normally distributed, which would indicate that the
model is capturing all the systematic information, and what is left
(the residuals) is just random noise. The bimodal pattern could
indicate that there are two distinct groups in the dataset that the
model is not accounting for, or that the relationship between the
predictors and the outcome is not purely linear.​
 • Intercept: The baseline log odds of a patient being satisfied when all other

LOGIT MODEL •
variables are at zero is approximately 1.747.
Waiting Time (x1): The coefficient of -0.0232 suggests that with each
additional unit increase in waiting time, the log odds of patient satisfaction
decrease by this value. This indicates that longer waiting times are associated
with lower odds of patient satisfaction.
• Number of Beds (x2): The positive coefficient of 0.0024 implies that adding
more beds is associated with a slight increase in the log odds of patient
satisfaction.
• Time Spent by Doctor (x3): The coefficient of -0.0598 indicates that an
additional unit of time spent by a doctor with a patient (likely measured in
minutes) is associated with a decrease in the log odds of patient satisfaction.
• Cost of Treatment (x4): With a coefficient of -0.00003, as the cost of treatment
increases, the log odds of patient satisfaction decrease, although the impact
appears to be very small.
• Length of Stay (x5): The coefficient of -0.115 suggests that an additional day in
the hospital is associated with a significant decrease in the log odds of patient
satisfaction.
• Number of Specialties (x6): The coefficient of 0.259 indicates that having more
specialties available at the hospital significantly increases the log odds of patient
satisfaction.
• The statistical significance of all coefficients at the 0.001 level (indicated by
three asterisks) suggests strong evidence against the null hypothesis of no effect.
LOGIT MODEL:
STARGAZER • Waiting Time (x1): The coefficient of -0.022 (standard error: 0.002) is
statistically significant (indicated by three asterisks), suggesting that an increase
in waiting time is associated with a decrease in the log-odds of patient
satisfaction. Specifically, for each additional unit increase in waiting time, the
log-odds of being satisfied decreases by 0.022.
• Number of Beds (x2): With a coefficient of 0.001 (standard error: 0.0002), this
variable is also statistically significant, indicating that an increase in the number
of beds is associated with an increase in the log-odds of patient satisfaction. Each
additional bed increases the log-odds of satisfaction by 0.001.
• Time Spent by Doctor (x3): The coefficient of -0.060 (standard error: 0.008) is
statistically significant, showing that more time spent by doctors with patients is
associated with a decrease in the log-odds of patient satisfaction. Each additional
unit of time decreases the log-odds by 0.060.
• Cost of Treatment (x4): The coefficient of -0.00003 (standard error: 0.00000) is
significant, indicating a slight decrease in the log-odds of patient satisfaction with
each unit increase in the cost of treatment.
• Length of Stay (x5): With a coefficient of -0.115 (standard error: 0.010), this
variable shows a significant decrease in the log-odds of patient satisfaction for
each additional day of stay. Each additional day decreases the log-odds by 0.115.
• Number of Specialties (x6): The coefficient of 0.259 (standard error: 0.025) is
significant, suggesting that an increase in the number of specialties is associated
with an increase in the log-odds of patient satisfaction. Each additional specialty
increases the log-odds by 0.259.
• Log Likelihood: -272.759, a measure of the model fit. The closer this value is to
zero, the better the model fits the data.
• Akaike Information Criterion (AIC): 559.518, a measure used for model
comparison. Lower AIC values indicate a better fit to the data relative to other
models.
Marginal Effects at Means • The probability of patient satisfaction decreases by
(from logit model): 0.118% with each additional unit increase in
waiting time.
• The probability of patient satisfaction increases by
0.0048% for each additional bed available.
• The probability of patient satisfaction decreases by
3.710% for each additional minute the doctor
spends with a patient.
• The probability of patient satisfaction decreases by
0.317% for each unit increase in the cost of
treatment.
• The probability of patient satisfaction decreases by
0.609% for each additional day of the patient's
stay.
• The probability of patient satisfaction increases by
1.3687% for each additional specialty available at
the hospital.
 Odds Ratios (from logit model):​

• The odds of patient satisfaction are 0.9778 times lower for each
additional unit increase in waiting time.
• The odds of patient satisfaction are 1.0009 times higher for each
additional bed available.
• The odds of patient satisfaction are 0.9417 times lower for each
additional minute the doctor spends with a patient.
• The odds of patient satisfaction are approximately unchanged
(0.9997 times) for each unit increase in the cost of treatment.
• The odds of patient satisfaction are 0.8905 times lower for each
additional day of the patient's stay.
• The odds of patient satisfaction are 2.1955 times higher for each
additional specialty available at the hospital.
 Logit Model

• Ceteris paribus, on average, the log odds of

patient satisfaction:
• Decreases by 0.022 for each additional unit increase in
waiting time.
• Increases by 0.001 for each additional bed available in
the hospital.
• Decreases by 0.060 for each additional minute the
doctor spends with a patient.
• Decreases by 0.00003 for each unit increase in the cost
of treatment in NR.
• Decreases by 0.115 for each additional day of the
patient's stay.
• Increases by 0.259 for each additional specialty available
at the hospital.
• Wait time (x1): A one-minute increase in wait time is associated with
PROBIT
a decrease in the predicted probability of patient satisfaction. The
coefficient is negative (-0.0018) and statistically significant at the 1%
level (p-value < 2.2e-16).
MODEL
• Number of beds (x2): The coefficient for the number of beds
is positive but not statistically significant (p-value = 0.850). This
suggests that the number of beds may not have a strong impact on
patient satisfaction in this model.
• Time spent by doctors (x3): A one-minute increase in the time spent
by doctors with patients is associated with a small increase in the
predicted probability of patient satisfaction. The coefficient is positive
(0.0004) and statistically significant at the 1% level (p-value = 8.50e-
06).
• Cost of treatment (x4): A one-rupee increase in the cost of treatment is
associated with a decrease in the predicted probability of patient
satisfaction. The coefficient is negative (-0.0001) and statistically
significant at the 1% level (p-value < 2.2e-16).
• Length of stay (x5): A one-day increase in the length of stay is
associated with a decrease in the predicted probability of patient
satisfaction. The coefficient is negative (-0.0099) and statistically
significant at the 1% level (p-value < 2.2e-16).
• Number of specialties (x6): A one-unit increase in the number of
specialties has a positive and statistically significant effect on patient
satisfaction (coefficient = 0.0216, p-value < 2.2e-16).
 PROBIT MODEL: STARGAZER

Logit Model:
• Coefficients: The logit model coefficients are all statistically
significant (p < 0.01), indicating a meaningful relationship
between each predictor and the outcome variable when holding
other variables constant.
• Log Likelihood: The value of -272.759 indicates the fit of the
model; higher (less negative) values indicate a better fit.
• AIC: The AIC of 559.518 suggests the relative quality of the
logit model. When comparing multiple models, the one with the
lowest AIC is preferred.
PROBIT MODEL: STARGAZER

Probit Model:
• Coefficients: Similar to the logit model, all coefficients in the
probit model are statistically significant, with p-values less than
0.01. This indicates that each predictor variable has a significant
impact on the outcome variable.
• Log Likelihood: The log likelihood for the probit model is -
270.245, slightly higher than the logit model, indicating a better
fit.
• AIC: The AIC for the probit model is 554.490, which is lower
than that of the logit model, suggesting that the probit model may
be a better fit for this data.
 • The marginal effects reflect the percentage change in the

Marginal Effects at probability of y=1 (patient satisfaction being positive):​

• A one-unit increase in waiting time (x1) is associated with a
Means Interpretation: 0.13647% decrease in the probability of patient satisfaction.​
• Each additional bed available (x2) is associated with a
0.005170% increase in the probability of patient satisfaction.​
• Each additional minute the doctor spends with a patient (x3)
is associated with a 0.35882% decrease in the probability of
patient satisfaction.​
• Each unit increase in the cost of treatment (x4) is associated
with a negligible decrease (0.000155%) in the probability of
patient satisfaction.​
• Each additional day of the patient's stay (x5) is associated
with a 0.70712% decrease in the probability of patient
satisfaction.​
• Each additional specialty available at the hospital (x6) is
associated with a 1.58012% increase in the probability of
patient satisfaction.​
 Probit Model Coefficients and
Interpretations:​

Ceteris paribus, on average, the z score/probit index of patient

satisfaction:​
• Decreases by 0.013 for each additional unit increase in waiting
time (x1).​
• Increases by 0.001 for each additional bed available in the
hospital (x2).​
• Decreases by 0.033 for each additional minute the doctor
spends with a patient (x3).​
• Decreases very slightly (by 0.00001) for each unit increase in
the cost of treatment in INR (x4).​
• Decreases by 0.066 for each additional day of the patient's
stay (x5).​
• Increases by 0.147 for each additional specialty available at
the hospital (x6).
Logit And Probit Models

Logit Model: The McFadden Pseudo R-squared value is 0.465131. This suggests that the logit model explains approximately
46.5% of the variability in the dependent variable, relative to a null model with no predictors. It's a measure of improvement in
fit brought by the inclusion of independent variables.

Probit Model: The McFadden Pseudo R-squared value is 0.4700604, indicating that the probit model explains about 47.0% of
the variability in the dependent variable compared to the null model. Like with the logit model, this is a relative measure.
Interpretation of Formal Tests for Heteroscedasticity
in Linear Regression Model (LPM)

Heteroscedasticity Interpretation- ​
The residual plot suggests that the linear
probability model may not be the best choice
for this particular dataset due to the presence
of heteroscedasticity and the bounded nature of
the dependent variable. The residuals indicate
that there are systematic variations in
patient satisfaction that are not being captured
by the model, especially for those observations
with mid-range fitted values.
Interpretation of Formal Tests for Heteroscedasticity
in Linear Regression Model (LPM)

1. Breusch-Pagan Test:
Interpretation:
Identical to the probit and logit models, the Breusch-Pagan test
statistic is highly significant (p-value < 0.001), strongly rejecting the
null hypothesis of homoscedasticity. This suggests potential
heteroscedasticity in the LPM.

2. White's Test:
Interpretation:
White's test statistic is highly significant (p-value = 0), also rejecting
the null hypothesis of homoscedasticity. This aligns with the
Breusch-Pagan test's conclusion.
 Interpretation of Formal Tests for
Heteroscedasticity in Logit Model

1. Breusch-Pagan Test:
•Test statistic (BP) : 286.02
•Degrees of freedom (df): 6
•p-value: < 2.2e-16
Interpretation: The Breusch-Pagan test statistic is highly significant (p-value < 0.001),
strongly rejecting the null hypothesis of homoscedasticity. This indicates potential
heteroscedasticity in the model.

2. White's Test:
•Test statistic: 2.21
•p-value: 0.331249
Interpretation: White's test statistic is not significant (p-value > 0.05), failing to reject the
null hypothesis of homoscedasticity. This suggests no evidence of heteroscedasticity.
 Formal tests for heteroscedasticity in Probit
model

1. Breusch-Pagan Test:
BP statistic: 286.02
p-value: < 2.2e-16
Interpretation: The Breusch-Pagan test statistic is highly significant with a p-
value close to zero. This strongly rejects the null hypothesis of
homoscedasticity, indicating the presence of heteroscedasticity in the probit
model.
2. White's Test:
Test statistic: 1.5
p-value: 0.471943
Interpretation: White's test statistic is not significant with a p-value greater
than 0.10. This fails to reject the null hypothesis of homoscedasticity.
 Multicollinearity

Interpretation:
•VIF values close to 1: Indicate little to no multicollinearity.
•VIF values between 1 and 5: Suggest moderate multicollinearity, which
may not be a significant concern but can affect the precision of
coefficient estimates.
•VIF values above 5: Indicate strong multicollinearity, which can lead to
unreliable and misleading coefficient estimates.

Analysis:
•LPM: All VIF values are very close to 1, suggesting minimal to no
multicollinearity concerns in the linear regression model.
•Logit and Probit: Some VIF values exceed 1,. This indicates potential
moderate multicollinearity among some independent variables in these
models.
 Conclusion:
• Patient satisfaction is a crucial aspect of healthcare, reflecting the quality of services provided and the overall patient
experience.
• Factors such as waiting time, time spent by doctors, length of stay, number of beds, number of specialties, and cost of
treatment significantly impact patient satisfaction.
• The methodology used, including the Linear Probability Model (LPM), Logit Model, and Probit Model, provides a
comprehensive analysis of how these factors influence patient satisfaction. The transition from LPM to more sophisticated
models like Logit and Probit ensures a thorough examination of the bounded nature of patient satisfaction.
• The study emphasizes the importance of understanding patient satisfaction as a guiding compass for healthcare providers
to enhance quality, public well-being, and patient empowerment.
• Insights from this study have implications for improving healthcare outcomes, community health, economic opportunities,
patient empowerment, and policy-driven compassion.
• The findings highlight the need for healthcare providers to focus on optimizing key factors that contribute to patient
satisfaction to enhance overall healthcare delivery.
Thank
you​
Group 4
• Bhumika Gupta
• Kripa Mehta
• Kriti Dubey
• Laxman Kavitkar
• Tanvi Chauhan