Client perception of service quality at the outpatient clinics of a general hospital in Lagos, Nigeria

Introduction: service quality assessments have assumed increasing importance in the last two decades. They are useful in identifying gaps in services been provided with the ultimate aim of guaranteeing quality assurance. The objective of this study was to assess the client perception of service quality at the outpatient clinics of Randle General hospital, Lagos. Methods: a descriptive cross sectional study was conducted from March to May 2013. A multistage sampling technique was used to select respondents and data was collected with the aid of modified SERVQUAL questionnaires. The data was analysed with aid of EPI-INFO 2002 and statistical significance was set at a P value 0.05 for statistical significance. Results: total of 400 respondents were interviewed. The mean age was 40 years with a standard deviation of 15.2 yrs. The highest mean score of 4.35 out of a possible maximum of 5 was recorded in assurance domain while the lowest mean score of 4.00 was recorded in the responsiveness domain. The overall mean score of all the domains was 4.20 with standard deviation of 0.51. Overall majority (80.8%) of respondents rated the overall service quality as good/ very good. After linear regression, the assurance domain was the most important predictor of the overall perceived service quality (p< 0.001). Conclusion: the overall perceived service quality was good. The major deficiencies were in the responsiveness domain and especially the waiting time. The hospital management should implement measures to improve the responsiveness of services by ensuring prompt delivery of services. Lagos state is one of the 36 states in Nigeria. It is located in the South Western zone of the Nigeria. It is bounded on the North and the East by Ogun state in the West by Republic of Benin and on the south by the Atlantic ocean. It has a population of 17 million and has 20 local government areas LGA and 37 local council development area LCDA [25]. Surulere local government is one of the twenty local government areas. In Lagos State, Randle General Hospital is located at Number 66 Randle Avenue in Surulere local government area of Lagos state. Originally a health centre donated to the federal government of Nigeria by the united African company at independence in 1960, it was taken over by the Lagos state government in 1999 and was upgraded to a general hospital in 2001. It provides outpatient and inpatient services in the general outpatient clinics, medical, surgical, Paediatric accident and emergency clinics, dental, DOTS, and obstetric and gynaecological clinic and the relevant wards The maternal and child health services are provided at the Maternal and child care centre Gbaja which was moved out of the main hospital at Randle Avenue and commenced operation in 2011. The hospital has a staff strength of 405 and a bed capacity of 156. It has an X -ray department, pharmacy, laboratory and blood bank. There are 18 departments in the Hospital in 2011, there were a total of l06, 120 Outpatient visits reported in various clinics of the hospital Study design: descriptive cross sectional study to assess client perception of service quality at the outpatient clinics of Randle General Hospital Lagos. Study population: clients attending the outpatient clinics of the Randle general hospital Surulere. Sample size determination: sample size was calculated using the formula for descriptive studies [26]. N= (Z2 PQ)/d2; where N = minimum sample size; Z= Critical value corresponding to 95% confidence level= 1.96; P= Proportion with parameter (client satisfied with service = 50% assumption); Q= 1-p; D= precision So N= (1.96)2* 0.5* 0.5/ (0.05)2 N= 3.84 X 0.25/0.0025 N= 384 The minimum required sample size is 384. However a total sample size of 400 was used for the study A multi stage sampling method was used for the study. In stage one, five (5) outpatient clinics were selected from the various outpatient clinics. The selected clinics were the medical outpatient clinic, surgical outpatient clinic, general outpatient clinic, paediatric outpatient clinic and Obstetrics and Gynaecological clinics. In stage two, A systematic sampling method was used to select respondents in the selected clinics. The number of clients to be selected in each clinic was determined by proportionate allocation based on the statistics for the previous year. In each clinic, A sampling interval was calculated at each clinic based on the average clinic attendance. A modified SERVQUAL questionnaire was adapted for the study. The instrument has been validated for use in the health sector [27]. The SERVQUAL framework utilises five criteria in assessing service quality specifically Tangibles, Reliability, responsiveness, assurance and empathy [28]. Tangibles- refers to the physical facilities, equipment and appearance of personnel Reliability refers to the ability to perform promised service dependably and accurately Responsiveness refers to the willingness to help consumers and provide prompt service Assurance or security is the knowledge and courtesy of employees and their ability to inspire trust and confidence. Empathy- caring, individualised attention provided to consumers. The questionnaire had four sections. Section A documented the socio demographic characteristic of respondents, Section B documented some aspects of the process such as waiting time, consultation time while section C documented the client perception of various domain of service quality based on SERVQUAL tool. The instrument was pretested at General hospital Mushin and necessary corrections were effected. The instrument was administered by two (2) research assistants as exit interviews. The assistants were experienced research assistants with a minimum of Bachelor's degree in Social sciences and they were trained over a one day period through role plays and, demonstration to ensure that high quality data is collected. Data collection took place over a period of three weeks in April 2013. Each clinic was visited twice a week so as to get an appropriate representation of patients attending the clinics. On selected days in each clinic, the first patient was selected at random while subsequent patients were selected based on the calculated sampling interval. Selected patients were interviewed at the end of clinic consultation as exit interviews by the research assistants. The data collected was entered and analysed with EPI-INFO 2002 version 3...5...4. Windows Results were presented in tables and figures. The mean of the various domains of service quality was calculated. Linear regression was used to determine which domain of service quality was most important contributor to the overall client perception of service quality. Ethical approval was obtained from the health research ethics committee of the Lagos University teaching hospital. Permission for the study was obtained from the management of the hospital. Informed consent was obtained from the client attending the clinic. The confidentiality of information collected was secured by restricting access to the data collected to investigator and research assistants. Anonymity of the clients was ensured by not including the personal details of the clients in the instrument. Client were assured that their responses will not be used against them and it will not influence the care they will receive in the facility.