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

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Study Justification:
– Service quality assessments are important for identifying gaps in services and ensuring quality assurance.
– This study aims to assess the client perception of service quality at the outpatient clinics of Randle General Hospital in Lagos, Nigeria.
Highlights:
– A total of 400 respondents were interviewed.
– The highest mean score of 4.35 out of 5 was recorded in the assurance domain, while the lowest mean score of 4.00 was recorded in the responsiveness domain.
– Overall, the majority (80.8%) of respondents rated the overall service quality as good/very good.
– The assurance domain was found to be the most important predictor of the overall perceived service quality.
Recommendations:
– Implement measures to improve the responsiveness of services, particularly in reducing waiting times.
Key Role Players:
– Hospital management
– Staff members
– Research assistants
Cost Items for Planning Recommendations:
– Staff training on improving responsiveness
– Process improvement initiatives
– Technology upgrades for better service delivery
– Additional staff recruitment, if necessary
– Marketing and communication efforts to inform patients about improvements

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is fairly strong, but there are some areas for improvement. The study design is described as a descriptive cross-sectional study, which limits the ability to establish causality. Additionally, the sample size of 400 respondents is relatively small and may not be representative of the entire population. To improve the evidence, a larger sample size could be used to increase the generalizability of the findings. Additionally, a longitudinal study design could be considered to assess changes in client perception over time. Finally, the abstract could provide more information on the limitations of the study and potential sources of bias.

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.

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Based on the information provided, here are some potential innovations that could be used to improve access to maternal health:

1. Telemedicine: Implementing telemedicine services can allow pregnant women to access healthcare remotely, reducing the need for physical visits to the hospital. This can be particularly beneficial for women in remote areas or those with limited mobility.

2. Mobile clinics: Setting up mobile clinics that travel to different communities can improve access to maternal health services, especially for women who may have difficulty traveling to a hospital or clinic. These clinics can provide prenatal care, vaccinations, and other essential services.

3. Community health workers: Training and deploying community health workers who can provide basic maternal health services and education within their communities can help reach women who may not have easy access to healthcare facilities.

4. Digital health records: Implementing electronic health records can improve the efficiency and coordination of care for pregnant women. This can help healthcare providers access and share patient information more easily, leading to better continuity of care.

5. Health education programs: Developing and implementing health education programs that focus on maternal health can help raise awareness and empower women to take control of their own health. These programs can cover topics such as prenatal care, nutrition, and family planning.

6. Transportation services: Providing transportation services for pregnant women who have difficulty accessing healthcare facilities can help ensure they receive timely and appropriate care. This can include arranging for ambulances or partnering with local transportation providers.

7. Maternal health hotlines: Establishing hotlines or helplines specifically for maternal health can provide women with a direct line of communication to healthcare professionals who can answer their questions and provide guidance.

8. Collaborations with community organizations: Partnering with local community organizations, such as women’s groups or non-profit organizations, can help reach vulnerable populations and provide them with the necessary support and resources for maternal health.

It is important to note that the specific context and needs of the community should be taken into consideration when implementing these innovations.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health at Randle General Hospital in Lagos, Nigeria is to implement measures to improve the responsiveness of services, particularly by ensuring prompt delivery of services. This recommendation is based on the finding that the lowest mean score in client perception of service quality was in the responsiveness domain, indicating a need for improvement in this area. The study also highlighted the waiting time as a major deficiency in service quality.

To address this recommendation, the hospital management could consider the following actions:

1. Streamline processes: Identify bottlenecks in the service delivery process and implement measures to streamline them. This could involve improving coordination between different departments, optimizing scheduling and appointment systems, and ensuring efficient use of resources.

2. Increase staffing: Assess the current staffing levels and determine if additional healthcare professionals are needed to meet the demand for maternal health services. This could include hiring more doctors, nurses, and support staff to reduce waiting times and improve overall responsiveness.

3. Enhance training and communication: Provide training to healthcare providers on effective communication skills and customer service. This can help improve the overall experience for clients and ensure that their needs are met in a timely and respectful manner.

4. Implement technology solutions: Explore the use of technology to improve access and efficiency. This could include implementing electronic medical records systems to streamline documentation and reduce waiting times, as well as utilizing telemedicine or mobile health solutions to provide remote access to maternal health services.

5. Monitor and evaluate: Establish mechanisms to monitor and evaluate the effectiveness of the implemented measures. Regularly collect feedback from clients to assess their satisfaction and identify areas for further improvement.

By implementing these recommendations, Randle General Hospital can work towards improving access to maternal health services and enhancing the overall quality of care provided to pregnant women in Lagos, Nigeria.
AI Innovations Methodology
To improve access to maternal health, here are some potential recommendations:

1. Mobile clinics: Implementing mobile clinics that travel to remote areas or underserved communities can provide access to maternal health services for women who may not have easy access to healthcare facilities.

2. Telemedicine: Utilizing telemedicine technology can allow pregnant women to receive prenatal care and consultations remotely, reducing the need for travel and increasing access to healthcare professionals.

3. Community health workers: Training and deploying community health workers who can provide basic maternal health services, education, and referrals in their communities can help bridge the gap in access to healthcare.

4. Maternal health vouchers: Introducing maternal health vouchers that cover the cost of antenatal care, delivery, and postnatal care can help remove financial barriers and improve access for women who cannot afford these services.

5. Transportation support: Providing transportation support, such as vouchers or subsidies, can help pregnant women reach healthcare facilities for prenatal visits, delivery, and postnatal care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Identify the specific population that would benefit from the recommendations, such as pregnant women in underserved areas or low-income communities.

2. Collect baseline data: Gather data on the current access to maternal health services in the target population, including factors such as distance to healthcare facilities, utilization rates, and barriers to access.

3. Model the interventions: Use a simulation model to estimate the potential impact of each recommendation on improving access to maternal health. This could involve estimating the number of additional women who would be able to access services, reduction in travel time, or increase in utilization rates.

4. Input data and assumptions: Input relevant data and assumptions into the simulation model, such as the number of mobile clinics, the coverage area, the number of community health workers, or the cost of transportation support.

5. Run simulations: Run multiple simulations with different scenarios to assess the potential impact of each recommendation on improving access to maternal health. This could involve varying parameters such as the number of interventions implemented or the coverage area.

6. Analyze results: Analyze the results of the simulations to determine the potential impact of each recommendation on improving access to maternal health. This could include quantifying the increase in access, reduction in barriers, or improvement in healthcare utilization.

7. Validate findings: Validate the findings of the simulations by comparing them with real-world data or conducting pilot studies to assess the actual impact of implementing the recommendations.

By following these steps, policymakers and healthcare providers can gain insights into the potential impact of different interventions on improving access to maternal health and make informed decisions on which recommendations to prioritize and implement.

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