Original Article

Promoting the development of tertiary hospitals through satisfaction surveys


Chuanji Guo, Jiakai Guo, Qiyong Guo*

Hospital Administrative Office of Shengjing Hospital, Shenyang 110004, Liaoning Province, China


Background: It has been reported that there is a positive correlation between job satisfaction and the productivity of staff members. Measuring satisfaction has been widely adopted as an indicator of the medical quality of hospitals. Methods: This was a 6-year satisfaction survey from 2014 to 2019 of 11,045 participants, which included outpatients (5609 participants), inpatients (3647 participants), hospital staff (1647 participants), and relevant social institutions (142 participants). The average score of each questionnaire was calculated for the last score. Results: The satisfaction scores of outpatients and inpatients gradually increased over the years. Inpatients rated their satisfaction higher than outpatients did. The salary and welfare scores for hospital staff were significantly lower than other indicators. The survey of relevant relevant social institutions showed a wave change trend. Conclusions: This study examined feedback on hospital experience and evaluated of the quality of medical administration via six years of hospital satisfaction surveys. The hospital administrative office used the feedback from the surveys to direct substantial administrative work, thereby improving the quality of hospital services and development through satisfaction surveys.


Keywords: Satisfaction surveys; Hospital development


Address for correspondence:

Qiyong Guo, E-mail: guoqy@sj-hospital.org

For reprints contact: reprints@sppub.org

Received 09 October 2021; Accepted 05 January 2022; Available online 25 July 2022



Hospital staff put a lot of effort into routine hospital work. It has been also reported that there is a positive correlation between job satisfaction and the productivity of professionals, including hospital staff.[1] Feedback from hospital staff is helpful for improving hospital services. The opinions of hospital relevant social institutions, such as cooperative and supervising departments, are also indispensable.[2] These are all important sources of information for screening problems and developing an effective plan of action for quality improvement in hospitals.[3] Measuring satisfaction has become the method of choice for obtaining views about medical services and has been adopted widely as an indicator of the medical quality of hospitals.[4,5]


In this study, to recognize the inadequacies and improve the service quality of tertiary hospitals, a third party (Minxin network work platform was founded on May 21, 2004, and was jointly created by The Liaoning Provincial Commission for Discipline Inspection, the Provincial Supervision Department, and the Provincial Government’s Office of Rectification of Ethics) was invited to design surveys to evaluate the satisfaction levels at a hospital for six years (2014–2019). The hospital was a tertiary hospital with up to 4.71 million outpatients in 2019 (Table 1). This was the first comprehensive hospital satisfaction survey that included outpatients, inpatients, hospital staff and relevant social institutions. In response to the survey results, the hospital administrative office recognized inadequacies and improved the quality of their services. The hospital gradually improved over the 6 years of the study with the guidance of the survey results.


Table 1: The Outpatients and Inpatients of the Hospital
2014 2015 2016 2017 2018 2019
Number of Outpatients 3,487,307 3,664,354 4,177,817 4,409,140 4,455,901 4,718,183
number of Inpatients 198,662 206,420 228,424 236,879 248,206 256,469


Study Design and Setting

This was a 6-year satisfaction survey of 11,045 participants from 2014 to 2019. The participants included four groups, outpatients, inpatients, hospital staff and relevant social institutions. The outpatients (5609 participants) were randomly selected from hospital clinic patients and emergency patients. The inpatients (3647 participants) included patients undergoing treatment and patients who have been discharged from the hospital. The hospital staff (1647 participants) were from Shenjing Hospital, mainly from three departments (administrative staff, medical staff and support staff). Relevant social institutions (142 participants) were from health administrative offices, referral health facilities, social labor security supervision departments and medical insurance departments.


The survey items were designed by a third party after an extensive review of the pertinent literature[6] and actual situation of hospital, such as the number of patients, The proportion of various types of employees and Relevant social institutions. Satisfaction score was from 0-point to 100-points, the higher the score, the higher the satisfaction. The average score of each Questionnaire was calculated for the last score. The Cronbach alpha coefficients of the surveys were over 0.7.


As hospital-supervising government departments were included in the relevant social institutions group and the characteristics of government agents are confidential, the characteristics of this group were excluded.


Inclusion and Exclusion Criteria

Patients with serious physical or mental diseases, such as terminal diseases or psychosis that could make comprehension and completion of the survey difficult, were also excluded.


Data collection

All the data were collected by a third party. All participants were approached by independent, trained, third-party research assistants. The assistants explained the purpose of the study onsite when the participants agreed to participate in the study. The survey was done face to face.


From 2014 to 2019, the hospital’s outpatients increased from 3.48 million to 4.71 million and the inpatients increased from 190,000 to 256,000 (Table 1). The demographic characteristics of participants are summarized in Table 2A, 2B, and 2C. The number of participants in each group for every year is shown.


(Table 2A) For the outpatient survey, the proportion of women was nearly 2 times that of men. Most participants were less than 30 and 31–40 years old. Most of the respondents were local residents in Shenyang (above 80%). In the educational level, the proportion of College/Undergraduate or above is more than 50%. More than half people who participated in the survey had a monthly income greater than 2000 yuan. Regarding occupational composition, the highest proportion were employees of a business enterprise, followed by unemployed, students, retirees, and employees of government departments and institutions.


Table 2A: Characteristics of outpatients and emergency patients
Characteristic 2014 n = 888 2015 n = 920 2016 n = 920 2017 n = 923 2018 n = 923 2019 n = 1034
Age(years)
  <30 281 32% 316 34% 269 29% 245 27% 284 31% 327 32%
  31-40 306 33% 332 36% 338 37% 333 36% 344 33%
  41-50 540 61% 146 16% 147 16% 119 13% 129 14% 133 13%
  51-60 78 8% 79 9% 88 10% 82 9% 92 9%
  >60 67 8% 74 8% 68 7% 67 7% 61 7% 85 8%
  Refuse to answer 0 N/D 0 N/D 25 3% 66 7% 34 4% 53 5%
Sex
  Male 308 35% 367 40% 375 41% 308 33% 363 39% 385 37%
  Female 580 65% 553 60% 545 59% 615 67% 561 61% 647 63%
Residence
  Shenyang 742 84% 836 91% 794 86% 760 82% 756 82% 881 85%
  Liaoning 113 13% 65 7% 103 11% 105 11% 126 14% 109 11%
  Out of Liaoning 33 4% 19 2% 23 3% 58 6% 42 5% 44 4%
Education level
  Junior high school and below 132 15% 187 20% 155 17% 172 19% 153 17% 174 17%
  High school/technical school 194 22% 217 24% 191 21% 148 16% 194 21% 213 21%
  College/Undergraduate 520 59% 459 50% 459 50% 430 47% 485 53% 489 47%
  Postgraduate and above 42 5% 57 6% 54 6% 49 5% 46 5% 40 4%
  Refuse to answer 0 N/D 0 N/D 61 7% 124 13% 46 5% 118 11%
Monthly income（yuan）
  <1000 43 5% 74 8% 45 5% 43 5% 42 5% 47 5%
  1001-2000 123 14% 123 13% 76 8% 62 7% 66 7% 69 7%
  2001-3000 245 28% 237 26% 215 23% 147 16% 150 16% 138 13%
  3001-4500 216 24% 256 28% 186 20% 173 19% 202 22% 188 18%
  >4500 261 29% 230 25% 236 26% 288 31% 354 38% 339 33%
  Refuse to answer 0 N/D 0 N/D 162 18% 210 23% 110 12% 253 24%
Ocupation
  Employees of government department and institution 137 15% 151 16% 138 15% 126 14% 145 16% 126 12%
  Employees of business enterprise 251 28% 237 26% 205 22% 184 20% 204 22% 204 20%
  Farmers 45 5% 67 7% 58 6% 76 8% 70 8% 59 6%
  Unemployed, students, retirees 181 20% 226 25% 201 22% 191 21% 208 23% 247 24%
  Others 274 31% 239 26% 247 27% 219 24% 240 26% 273 26%
  Refuse to answer 0 N/D 0 N/D 71 8% 127 14% 57 6% 125 12%
N/D is no data.


Table 2B: Characteristics of inpatients
Characteristic 2014 n = 509 2015 n = 615 2016 n = 641 2017 n = 600 2018 n = 597 2019 n = 685
Age(years)
  <30 80 16% 141 23% 140 22% 99 17% 95 16% 97 14%
  31-40 160 26% 147 23% 202 34% 137 23% 149 22%
  41-50 335 66% 114 19% 95 15% 100 17% 93 16% 104 15%
  51-60 105 17% 72 11% 85 14% 92 15% 125 18%
  >60 94 18% 95 15% 62 10% 66 11% 119 20% 161 24%
  Refuse to answer 0 N/D 0 N/D 125 20% 48 8% 61 10% 49 7%
Sex
  Male 222 44% 267 43% 275 43% 254 42% 246 41% 305 45%
  Female 277 54% 348 57% 366 57% 346 58% 351 59% 380 55%
Residence
  Shenyang 400 79% 445 72% 411 64% 334 56% 448 75% 452 66%
  Liaoning 80 16% 149 24% 189 29% 236 39% 131 22% 201 29%
  Out of Liaoning 29 6% 21 3% 41 6% 30 5% 18 3% 32 5%
Education level
  Junior high school and below 125 25% 243 40% 162 25% 129 22% 127 21% 207 30%
  High school/technical school 173 34% 160 26% 75 12% 101 17% 101 17% 134 20%
  College/Undergraduate 198 39% 189 31% 187 29% 176 29% 199 33% 223 33%
  Postgraduate and above 13 3% 23 4% 21 3% 13 2% 12 2% 20 3%
  Refuse to answer 0 N/D 0 N/D 196 31% 181 30% 158 26% 101 15%
Monthly income (yuan)
  <1000 39 8% 56 9% 36 6% 27 5% 22 4% 38 6%
  1001-2000 70 14% 87 14% 42 7% 37 6% 30 5% 48 7%
  2001-3000 179 35% 153 25% 68 11% 77 13% 50 8% 101 15%
  3001-4500 134 26% 152 25% 68 11% 66 11% 93 16% 95 14%
  >4500 87 17% 169 27% 89 14% 110 18% 140 23% 184 27%
  Refuse to answer 0 N/D 0 N/D 338 53% 283 47% 262 44% 219 32%
Ocupation
  Employees of government department and institution 66 13% 87 14% 75 12% 52 9% 48 8% 97 14%
  Employees of business enterprise 102 20% 91 15% 84 13% 69 12% 96 16% 71 10%
  Farmers 48 9% 63 10% 52 8% 56 9% 48 8% 94 14%
  Unemployed, students, retirees 109 21% 179 29% 131 20% 95 16% 141 24% 171 25%
  Others 184 36% 195 32% 106 17% 151 25% 99 17% 164 24%
  Refuse to answer 0 N/D 0 N/D 193 30% 177 30% 165 28% 88 13%
N/D is no data.


Table 2C: Characteristics of hospital staffs
Characteristic 2014 n = 244 2015 n = 278 2016 n = 245 2017 n = 255 2018 n = 247 2019 n = 378
Age(years)
  <30 67 27% 117 42% 95 39% 71 28% 69 28% 95 25%
  31-40 110 40% 112 46% 128 50% 128 52% 199 53%
  41-50 177 73% 34 12% 23 9% 32 13% 33 13% 54 14%
  51-60 17 6% 15 6% 19 7% 17 7% 27 7%
  >60 0 N/D 0 N/D 0 0% 5 2% 0 0% 3 1%
Sex
  Male 44 18% 49 18% 36 15% 45 18% 53 21% 90 24%
  Female 200 82% 229 82% 209 85% 210 82% 194 79% 287 76%
Education level
  Junior high school and below N/D N/D N/D N/D 4 2% 7 3% 2 1% 10 3%
  High school/technical school N/D N/D N/D N/D 161 66% 156 61% 169 68% 264 70%
  College/Undergraduate N/D N/D N/D N/D 54 22% 55 22% 43 17% 66 17%
  Postgraduate and above N/D N/D N/D N/D 26 11% 37 15% 33 13% 38 10%
Answered by
  Administrative staff 24 10% 22 8% 12 5% 23 9% 16 6% 8 2%
  Medical staff 186 76% 190 68% 190 78% 182 71% 164 66% 279 74%
  Supporting staff 34 14% 66 24% 43 18% 50 20% 67 27% 73 19%
N/D is the data missing due to the fine-tuning of the annual questionnaire.


In the inpatient survey, the proportion of women was still higher than men. Most participants were 31–40 years old, followed by 41–50 years old, then 51–60 years old, and less than 30 years old. Compared with the outpatient survey, residents from other cities increased, but local residents still accounted a much high proportion. The majority of the participants had a monthly income between 2000 yuan and 4500 yuan.


Table 2C shows that most hospital employees participating in the survey were under 40 years old and the proportion of female participants was much larger than that of male participants. Most had a college/undergraduate level of education and were medical staff.


The items and results of the satisfaction surveys in each group are shown in Table 3A, 3B, 3C, and 3D. The satisfaction scores of outpatients and inpatients gradually increased. The outpatient and inpatient surveys included six parts: quality, price, image, expectation, satisfaction, and loyalty (Table 3A, Table 3B). The satisfaction of inpatients over the years was higher than that of outpatients.


Table 3A: Satisfaction of outpatients
Primary indicators Secondary indicators 2014 2015 2016 2017 2018 2019
Quality 77.18 77.81 81.31 79.91 82.77 83.01
Medical service 77.50 78.12 81.47 80.18 83.02 83.25
Ancillary services 76.56 77.01 80.92 79.23 82.14 82.40
Medical environment 77.32 79.48 82.02 80.63 82.21 83.11
Price 77.14 77.35 81.85 80.20 81.49 83.23
Clear cost list 77.14 77.35 81.85 80.20 81.49 83.23
Image 77.48 77.70 78.80 76.57 79.74 80.49
Public recognition 82.93 83.81 84.31 83.29 85.95 86.44
Public welfare 75.25 78.58 78.21 76.08 79.70 79.85
Pay attention to patients 72.45 75.80 84.31 83.22 77.90 78.84
Expectation 76.56 76.80 78.31 76.94 79.33 78.58
Current acceptance 78.94 78.60 79.74 79.24 81.06 81.04
Gap with the ideal 73.00 74.99 76.87 74.65 77.60 76.11
Satisfaction 76.49 76.36 78.14 79.83 82.04 81.68
Overall impression 76.19 76.09 77.88 80.71 82.74 82.89
Compare with peers 76.94 76.91 78.64 78.13 80.69 79.34
loyalty 79.55 80.41 81.31 80.26 82.71 82.42
Come again 79.44 80.28 80.9 80.00 82.32 83.11
Confidence for the future 79.73 80.53 81.72 80.53 83.10 81.72
Overall satisfaction 77.38 77.67 80.24 79.18 81.67 81.96


Table 3B: Satisfaction of inpatients
Primary indicators Secondary indicators 2014 2015 2016 2017 2018 2019
Quality 81.16 82.43 85.27 86.05 85.88 88.29
medical service 81.96 82.52 85.87 86.93 85.91 89.19
Ancillary services 79.55 82.21 83.87 84.02 85.79 86.18
Medical environment 81.56 84.49 86.45 88.04 86.73 90.10
Value 80.00 80.72 82.34 86.08 82.74 86.60
Clear cost list 80.00 80.72 82.34 86.08 82.74 86.60
Hospital image 82.30 82.70 82.61 84.81 84.20 86.68
Public recognition 85.11 85.20 85.98 88.75 86.25 89.49
Public welfare 80.71 82.53 82.89 84.80 83.75 86.80
Pay attention to patients 80.16 81.99 81.55 83.64 83.68 85.81
Expectation 80.75 80.52 80.20 82.99 82.94 84.23
Current acceptance 82.51 81.47 82.06 83.19 83.14 85.34
Gap with the ideal 78.11 79.57 78.34 82.80 82.74 83.12
Satisfaction 81.21 81.78 84.33 86.36 84.11 86.62
Overall impression 80.15 81.68 85.48 87.30 84.09 86.90
Compare with peers 82.79 81.99 81.99 84.50 84.15 86.04
Loyalty 82.07 82.93 83.07 84.17 84.11 86.16
Choose this hospital again 82.32 82.55 83.52 84.62 84.41 86.16
Confidence for the future 81.69 83.31 82.63 83.72 83.81 86.22
Overall satisfaction 83.56 85.43 84.42 86.92 84.42 81.96


Table 3C: Satisfaction of hospital staff
2014 2015 2016 2017 2018 2019
Working enviro nment 80.02 83.21 82.73 83.10 83.10 87.62
Working environment 86.39 86.33 84.81 85.73 85.99 90.63
Resource provision 84.18 82.67 83.95 83.61 83.81 88.68
Convenience of office equipment 82.79 84.39 82.40 83.29 82.02 87.67
Waste of office supplies 65.57 77.32 76.48 79.76 81.62 83.49
Cooperates 85.16 85.36 86.00 87.22 86.23 89.47
Work arrangements 84.54 85.62 84.32 84.33 84.99 86.71
Job suitability 86.89 87.87 85.84 87.37 87.85 90.58
Personal value 82.70 83.09 81.21 83.45 82.83 87.35
Challenging work 76.89 79.21 77.84 77.56 79.03 82.60
Responsibilities and rights 87.05 89.41 88.50 87.22 89.31 90.74
Intensity of work 80.41 81.73 82.42 78.12 78.06 73.76
Importance of work 88.93 90.84 89.05 90.00 90.36 91.64
Work-extended learning 86.07 87.20 85.34 86.61 87.45 89.31
Salary and Welfare 70.84 71.30 71.77 74.77 74.77 78.48
Compatibility of salary with work 67.79 68.55 70.90 72.94 71.58 78.36
Incentive effect of salary system 71.15 71.19 71.59 75.84 73.68 79.37
Satisfaction with benefits 81.15 79.28 78.20 81.26 81.86 83.33
Salary and benefits level 64.67 66.19 66.38 69.02 68.74 72.86
Career Development 84.30 79.47 79.43 81.27 81.27 84.86
Training satisfaction 82.43 81.52 82.11 85.36 82.38 86.20
Work development space 83.03 83.10 83.18 82.20 82.83 86.83
Work recognized 78.44 81.75 78.37 81.18 81.38 84.66
Job promotion system 73.93 71.51 71.47 75.51 73.85 80.53
Hospital management 86.50 84.19 83.27 84.50 84.50 87.93
Cultural Construction 87.79 88.01 86.01 87.29 87.29 89.63
Activities 84.18 85.76 83.52 85.25 85.67 88.20
Activity effect 82.95 83.47 82.92 84.86 84.70 87.88
Rules and regulations 85.57 84.42 N/D N/D N/D N/D
Clear process 84.51 84.03 83.35 83.78 83.81 87.67
Rewards and punishments 80.93 80.51 81.12 82.90 82.51 85.93
System execution 84.92 N/D 83.18 83.76 84.45 87.09
Management services 83.28 83.16 83.26 81.09 84.70 88.60
Trust in the hospital 81.83 84.64 83.16 85.36 85.36 88.33
Sense of belonging 91.07 89.31 88.10 89.10 89.64 91.96
Recognition of positions 78.85 77.39 74.72 81.25 79.68 83.76
The hospital fulfills its promise 86.64 84.06 83.20 85.02 85.10 88.04
Leaders care about employees 85.66 87.05 84.40 86.67 85.75 91.43
Employee pride 89.02 88.48 87.33 87.45 88.10 90.00
Dedication of employees 86.15 81.52 81.22 82.69 83.40 84.81
Overall employee satisfaction 81.83 80.11 79.60 81.09 81.00 84.48
N/D is no data.


The survey of hospital staff consisted of six parts: working environment, work arrangements, salary and welfare, career development, hospital management and trust in the hospital (Table 3C). The salary and welfare scores are significantly lower than other indicators. All the indicator’s scores were low in 2016 and steadily increased after 2017. Of the indicators, work arrangements, trust in the hospital, hospital management and working environment are above the average score. Career development decreased significantly in 2015 (Figure 1).


Figure 1
Figure 1: Satisfaction of hospital staffs.


The survey of relevant social institutions contained 14 parts, shown in Table 3D. All indicators have the same wave change trend of declining in 2015, 2016, 2018 and rising in 2017, 2019 (Table 3D).


Table 3D: Satisfaction of coherent unit staff
2014 2015 2016 2017 2018 2019
Hospital management 99.33 94.67 92.00 100.00 94.00 96.00
Medical service 95.33 93.33 91.33 98.00 92.67 96.00
Techinique level 96.00 92.67 90.67 98.67 93.33 96.67
Medical equipment 97.33 94.67 92.67 97.33 92.00 96.67
Service attitude 92.67 89.33 90.00 94.00 89.33 96.00
Medical ethics 93.33 87.33 90.00 94.00 91.33 97.33
Accept supervision 94.00 90.00 92.00 98.67 92.67 96.67
Cooperation 94.67 89.33 91.33 99.33 94.00 98.00
Regional development contribution 96.00 88.00 93.33 99.33 89.33 94.67
Rank in the same industry 96.00 92.67 89.33 96.67 88.67 92.67
Social Responsibility 93.33 90.00 88.67 98.00 90.67 98.67
Integrity 93.33 92.00 90.00 98.00 92.67 98.00
Overall evaluation 94.00 92.67 92.00 98.67 93.33 97.33
Overall satisfaction 95.02 91.70 91.03 97.74 92.00 96.51


This study examined feedback about hospital experience and evaluated the quality of medical administration via 6-year hospital satisfaction surveys. These surveys included patients, hospital staff and coherent units. This was the first time a satisfaction survey of a large hospital in China simultaneously included patients, hospital staff and relevant social institutions. The relevant social institutions included insurance and hospital-supervising government departments. As these units are in contact with multiple types of hospitals, their responses were indicative of where the hospital in this study stood in relation to the medical society in China. Properly considering the opinions of the participants on the various administrative aspects of the hospital would result in improvement. The hospital administrative office used the feedback from the surveys to re-organize the administrative work. It provided confirmation that satisfaction surveys improve the medical service and development of big hospitals.[7]


All the survey results were discussed in hospital administrative office meetings and improvement plans were proposed by every staff member. Thereafter, solutions were decided on by the administrative office. For example, the complaints from patients about their hospital bills could be solved by improving communication with patients and by encouraging patients to attend a resident hospital instead of a big hospital for their first visit (which was called “two-way referral”), because resident hospitals are cheaper. The hospital staff increased communication with patients and each treatment plan was checked by senior doctors to prevent and reduce medical disputes. Patient satisfaction increased gradually after these improvements. The distribution of awards for hard-working staff was implemented and hospital benefits were improved in order to increase the satisfaction of hospital staff.[8,9] To achieve long-term development, the hospital set up themes for targeted improvement every year: 2014 was the “Medical Professional Literacy Promotion Theme Year,” 2015 was the “Hospital Culture Promotion Theme Year,” 2016 was the “Employee Care Theme Year,” 2017 was the “Hospital Safety Theme Year,” 2018 was the “Hospital Improvement Service Theme Year,” and 2019 was the “High-quality Development Theme Year.”


As above, satisfaction surveys were used to evaluate hospital service and find inadequacies. Solutions for the inadequacies were found and hospital quality increased.


Source of Funding

This research was funded by Hospital administrative expenses.


Conflict of Interest

None declared.


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