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EFFECTS OF WAITING TIME ON PATIENT
SATISFACTION: NIGERIAN HOSPITALS
EXPERIENCE
JOHN KOLADE OBAMIRO
Lagos State University, Nigeria
Received: June 21, 2013 Accepted: August 29, 2013 Online Published: October 10, 2013
Abstract
The time spent waiting for services at outpatient department couple with some factors of
quality care are major determinants of patient satisfaction. This study examines the
relationship between waiting time and patient satisfaction. Data was obtained through
structured questionnaire distributed to a randomly selected 240 outpatients of the selected
public and private health centres to ascertain their views as regards to waiting time and
evaluation of level of satisfaction with service delivery. Data obtained were analysed using
descriptive statistics. This study has shown that a good numbers of the patients were satisfied
with the service delivery despite experiencing long waiting time. Though, lengthy waiting line
is evident in the public hospital than the other private hospitals. But this does not affect
patient perception of quality care offered because long waiting time is a general occurrence
in Nigerian hospitals especially in publicly funded health centres. Efforts should be made by
hospital administrators and medical personnel to eliminate unnecessary delay in service
delivery and where unavoidable; the waiting time should be made productive. Also, emphasis
should be directed toward training of medical personnel on ways to create patient-oriented
services and deliver more efficient services.
Keywords: Waiting Time; Healthcare Centre; Medical Personnel; Service Delivery; Quality
care; Patient Satisfaction.
1. Introduction
Ma Managing waiting time in healthcare settings is a concept that has been receiving attention
among researchers, healthcare practitioners and administrators over the years (Anderson,
Camacho and Balkrishnan, 2007; Umar, Oche and Umar,2007; Senti and Lemire, 2011; Gup,
Ofoedu, Njoku, Odu, Ifedigbo and Iwuamanam, 2012). Waiting in line has become an integral
part of healthcare services and it is considered to be central to assessing patient satisfaction.
Yeddula (2012) is of the opinion that as patients experience a greater squeeze on their time,
short waits seem longer than even before. This queuing situation is worst in publicly funded
or highly busy hospitals and managing it has become a serious challenge.
Waiting lines occur where resources (doctors, nurses, beds, etc.) are limited and demand
for service exceeds supply. Patient waiting time can be described as the amount of time
patient spent before being served. In hospitals, patients can wait for minutes, hours, days or
months to receive services. Yeddula (2012) asserts that the amount of time patient wait during
clinic visit is a source of dissatisfaction with healthcare. Generally, patients are annoying or
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not interested in waiting for services, they want to receive immediate services on arrival. In
healthcare setting, waiting time can be described in two folds: waiting room wait time and
exam room wait time. Waiting room wait time is described as the time spent between
requesting the patient be seated in the waiting room and the time he/she was called to see the
medical personnel such as nurse, doctor, pharmacist, etc. This can occur in between different
services. Exam room wait time is described as the amount of time spent from the time the
patient was seated in an exam room and the time the physicians, nurses, pharmacists, etc.
spent with patients (Micheal, schaffer, Egan, Little and Pritchard, 2011).
Nowadays, medical service delivery is patient-centred in which patients have become
increasingly demanding, expecting high quality services at competitive price and delivered
promptly. The general queue discipline adopted in hospital is that patients are served
immediately on arrival on first come first serve or join a queue if the server is temporary
engaged (Brahma, 2012). The length of time a patient spent waiting to be served affects the
desired satisfaction and it’s central to patients’ evaluation of service delivery process. Afolabi
and Erhun, (2003) assert that a patient’s experience of waiting can radically influence his/her
perceptions of service quality. Several studies have documented that patients’ long waiting
times are barriers to actually obtaining quality services (Kurata, Nogawa, Philips, Hoffman
and Werblum 1992) which results to dissatisfaction with health care (Anderson, Barbara and
Fildman, 2008) and patient frustration. Afolabi and Erhun’s, (2003) and Prasanna, Bashith
and Sucharith’s (2009) revealed that excessive patient waiting time undermines system
efficiency, patient satisfaction and patronage which lead to the loss of some patients to
competitors. Unmanaged waiting lines in hospitals negatively affect the quality of care which
in turn adversely affects patient satisfaction. Increased waiting time results to patient
disappointment, frustration and decrease the patient's sense of control and lead to loss of
patronage on the part of the hospital patronage.
Literature shows that waiting time is one of the key predictors of patient satisfaction
(Umar et al, 2011; Camacho, Anderson, Safrit, Jones and Hoffmann, 2006 Anderson,
Camacho and Balkrishnan, 2007; Karaca, Erbil and Ozmen, 2011; Yeddula, 2012) and it is
useful to evaluate system efficiency.
Waiting time reduces the efficiency of production time and adds to the indirect costs of
both the patients and hospitals. Lovelock (1996) as cited in Karaca, et al. (2011) posited that
American spent 37 billion hours per year waiting in emergency rooms. What is experienced in
some departments (such as Outpatient Department, Pharmacy, Diagnostic, Ante-natal, etc.,)
of the hospital is similar. The waiting time experience in developing country such Nigeria is
worst than what is obtainable in developed country. In fact, it has been assumed to be part of
health care delivery. The amount of time patients wasted waiting to receive medical service
can be productivity invested. Yeddula (2012) found that if the healthcare organizations can
improve patients’ perceptions of the time they spend waiting then patients will experience less
frustration and may feel more satisfied with the services and results to improvement in
hospital performance. Drain (2007) study reveals that reducing wait times can lead to
improved financial performance of the practice.
Patient satisfaction is a highly desirable outcome of care in the health centres, but it is
difficult to measure because it is a function of both clinical and non-clinical activities (Sodani,
Kumar, Srivastava and Sharma, 2008). Though, it centres on patient’s judgment on the
quality and goodness of care (Sixma, Spreeuwenberg and van der, 1998). So, healthcare
resources should be channeled towards the outcomes that are consistent with patient values
and preferences (Gup, Ofoedu, Njoku, Odu, Ifedigbo and Iwuamanam, 2012). Although,
patient satisfaction is acclaimed to be subjective judgment of the quality of medical service
(Merkouris, Andreadou, Athini, Hatzimbalasi, Rovithis, Papastavrou, 2013) but it has long
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been considered an important component in the assessment of health care quality
(Harutyunyan, Demirchyan, Thompsonand Petrosyan 2010; Yeddula, 2012). Also, despite
describing several methods of evaluating the quality of care (Hermida, Nicholas and
Blummenfeld, 1999) and no universal accepted of assessing quality of care (Gup, et al, 2012),
there is growing agreement that patient satisfaction survey will be the best to measure quality
of care (Press, 2006; Turnbull and Hembree 2006; Merkouris, 2013).
Patients are satisfied when their numerous expectations are met and dissatisfied when they
are not met. Bopp (1989) and Matulich and Finn (1989) reveal that patients expected free
flow of information from servers. They expected equality in treatment and be treated in a
caring, professional, and competent manner. They expected a reasonable and justifiable
waiting time. Each factor encounter enhances or detracts from a patient's appraisal of overall
service quality, hence patient satisfaction. In Senti and LeMire’ (2011) opinion, patient
satisfaction is a function of the degree of agreement between the patient;s preconceived
expectation and perceptions of the actual care. Furthermore, Jenkinson, Coulter, Bruster,
Richards and Chandola (2002) assert that patient satisfaction is an attribute of many factors
such as: quality of medical services provided, availability of medicine, behavior of doctors
and other health staff, cost of services, hospital infrastructure, physical comfort, emotional
support, and respect for patient preferences.
An important factor in assessing patient satisfaction is timely service delivery which can
be achieved with reasonable waiting time. In Mowen, Licata and Mcphail’s (1993) opinion,
there are four key attributes associated with patient satisfaction: trust, adequate
communication flow, behavior of the service providers and waiting time. This study focuses
more on the fourth attribute (waiting time) of Mowen et al’s (1993) study. This implies that in
this research, patient satisfaction was defined importantly as satisfaction with waiting room
wait time and exam room wait time, and other patient satisfaction indexes. Therefore, this
study wants to investigate the relationship between waiting time and patient satisfaction of
outpatients focusing on waiting experience and some satisfaction attributes. Although, few
researches have been done on relationship between waiting time and patient satisfaction, with
longer waiting times being associated with decreased patient satisfaction (Camacho,
Anderson, Safrit, Jones and Hoffmann, 2006), but the degree of the association between
waiting time and patient satisfaction varies across nations, hospitals and departments.
Most of these studies were conducted in developed nations and few that were conducted
in Nigeria focused mostly on Government funded University Teaching Hospitals.
Furthermore, it is evident in Nigeria that patient and society comments negatively about
public hospitals operations ranging from long waiting time, unpleasant behaviours and
negligence of staff, incompetence and discontinuity of care. These negative experiences and
comments have resulted to poor public confidence in public hospitals and increased the
patronage of private hospitals. Despite the relevance of these negative comments especially
concerning waiting time management to practice outcomes and patient satisfaction, timeliness
of care has not been taken serious and among the least studied in Nigeria.
There is limited publication in the Western Nigerian on the relationship between prompt
service delivery and patient satisfaction in both public and private hospitals. It is against this
development that this study focuses on how efficient waiting time can improve quality of care
and patients satisfaction in the selected hospitals (i.e. both public and private).
2. Materials and Methods
A survey method was carried out at the outpatient units of the selected hospitals which
are located in Ogun State. Ogun State is a bounder state to Lagos; Nigeria’s biggest
commercial centre and former federal capital. Covenant University Health Centre is situated
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at the entrance of Covenant University, Ota, and it provides medical services to the students
and staff of the university. Also, it services the staff and families of Living faith Church, Ota,
Nigeria.
Covenant University is one of the leading private universities in Nigeria, with population
of over 7000 (staff and students). Medicare is one of the best private hospitals in Ota, Ado-
Odo-Ota, Local Government, Nigeria. It provides services for workers of numerous national
and multinational companies, and elite people of Sango-Ota. Ota General Hospital is a
publicly funded health centre that caters for both elite and low income earners of Ado-Odo-
Ota, Local Government. The selected hospitals serve as referral centres in Sango-Ota. Also,
by virtue of their locations in areas that accommodate many people working in Lagos, the
patients’ visits to these health centres are high.
Data were collected from patients who visited the outpatient units of these hospitals
through observation and well structured questionnaire. Owing to the constraint of fund being
a self sponsored paper, a sample of 240 patients (i.e. 80 patients per centre) was randomly
selected over the study period (i.e. three months). The questionnaire sought information
related to patient's demographic characteristics such as patient's age, sex, educational and
occupational levels. Information about patient’s waiting time obtained include; time spent
waiting to see server, length of queues, causes of long queues and rating of service delivery
on time performance. These questions were rated on a five-point Likert scale, 5(strongly
agree) to 1 (strongly disagree). Any ratings involving strongly disagree and disagree were
considered as disagreement overall, while rating involving agree and strongly agree was
considered as agreement overall for purposes of average ratings. The analysis ignored the
undecided responses in order to avoid the problem of central tendency and to gain more
effective screening power (Sin and Tse, 2002). Also, the survey asked patients to rate their
hospitals and medical personnel (especially the doctors and nurses) on several issues relating
to their satisfaction like respect for patient, level of doctors and nurses’ responsiveness,
professionalism in handling the patients, trust in services, doctor friendliness and
accommodating, quality of service to meet patient’s expectations, etc. For patient satisfaction
questions, respondents were asked to indicate their answers on a scale of 1 (poor) to 5
(excellent). For easily analysis, ratings involving good, satisfaction, very good and excellent
were good overall. Data were analyzed by SPSS.
The in-depth review of literature on waiting time and patient satisfaction confirmed the
sufficient validity. This means that the response was not due to chance but resulting to the
relationship tested. Clark and Watson’s (2007) opinion of measuring the internal consistency
of the research instrument using Cronbach Alpha Coefficient (1951) recommended at least
70% reliability level. This was used to test the reliability of questionnaires and it resulted to a
score of 0.87 (87%). Therefore the research instrument is reliable and accepted because the
score is higher than the recommended 70%.
3. Results and Discussion
Of the 240 questionnaires distributed, a total 200 questionnaires were retrieved but some
were partially filled and not suitable for research.. Overall, 85 copies of the questionnaires
were properly filled which formed the basis of analysis of this paper. This results to a
response rate of 35.42%, which falls within acceptance rate of similar past studies. Table 1
shows the patients’ social- demographic characteristics. The majority were female (65%),
dominated with patients of 18 to 24 ages (45%), involving more single (59%) than married
patient (41%). All the respondents are educated having at least SSCE/NCE/OND certificate
(25%); with 54% B.Sc, 15% M.Sc./MBA while few of the respondents (6%) hold other
certificates not captured in the study. This implies that the respondents are educated and
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understood the purpose and relevance of this study. However, this study did not evaluate the
influence of gender, age, marital status, and educational level on patient satisfaction similar to
the study conducted by Hall and Press (1996), believing that variables such as sex, age,
marital status, education, gender do not have a strong influence on patient satisfaction.
However, studies have shown that demographic variables except gender have profound
influence on satisfaction (Aragon and Gesell, 2003) while Soleimanpour, Gholipouri
Salarilak, Raoufi, Vahidi, Rouhi, Ghafouri, Soleimanpour’s, (2011) demonstrated that those
with higher education were less satisfied, but there was no significant relationship between
marital status, occupation, gender, work shift and satisfaction level..
Table 1 – Respondents’ Demographic Characteristics
Gender Male Female Total
Frequency 35 65 85
Percentage 35% 65% 100
Age group 18-24 25-29 30-34 35-39 40+
Frequency 45 16 18 5 5%
Percentage 45% 16% 18% 5% 15%
Educational Level SSCE/NCE/OND HND/HND M.Sc. Others
Frequency 25 54 6
Percentage 25% 54% 15% 6%
Source: Field Survey, 2012
Issues Relating to Waiting Time and Quality Service Delivery
Delivery of quality medical service is function of various components, of which waiting time
is very important factor; formed the focus of the section. Six issues relating to waiting time
and quality service delivery at the health centres were presented to the respondents to rank in
order of seriousness. Percentage of the responses was calculated as shown in table 2. The
findings reveal that forty percent (40%) of the respondents admitted that they experience
waiting time on visits while 27% describe the waiting time as normal and adequate. 52% of
patients considered the waiting time as long while the rest 32% were satisfied with the length
of the queue. Those that considered the waiting time as normal (27%) and satisfied with the
length of the queue (32%) may enjoy talking and watching television provided to reduce
boredom while waiting.
More than half, 44% of respondents claimed satisfactory when service delivery is
evaluated on time performance while 30% of patients were not satisfied with level of
promptness in service delivery. This finding is similar to Omidvari, Shahidzadeh, Montazeri
A, Azin, Harirchi ,Souri ‘s (2008) report in Tehran and Senti and LeMire’s 20011) in
Midwest that long waiting causes less satisfaction.
On the behavior of medical personnel towards the patients, 72.5% of the respondents rated
their actions as been friendly and accommodative (i.e customer oriented). This implies that
doctors carefully handled the patients, listen to their complaints and created an atmosphere of
care and trust. Customer oriented service is paramount for quality care because it allows time
for friendliness, listening; and respectful, professional care for every patient (Finch, 2005).
Previous studies (Senti and LeMire, 2011; Omidari, et al 2011; Gup, et al, 2012; Yeddula,
2012) supports this finding that customer oriented service environment enhances satisfaction.
Overall, majority of patient expressed satisfied with the service delivery in the health
centres despite some patients dissatisfied with long waiting. This finding is similar to the
outcomes of Soleimanpour (2011) and Gup, et al’s (2012). 62% of patients rated the service
delivery of these medical centres superior than other similar hospitals in the neigbourhood.
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Also 72% claimed their services are reliability. It means that majority of the respondents are
not first time visit and have been provided quality services which implies that they will be
willing to recommend the health centres to others.
Table 2 – Results on Issues Relating to Waiting Time and Quality Service Delivery
S/N Issues Agree (%) Disagree (%)
A1 Health centres waste time in service delivery
A2 Always long queues on visits
A3 Service delivery on time performance
A4 Medical personnel Behaviour -friendship and accommodation
A5 Superior service compared to other health care centres in the
neigbourhood
A6 Service reliable after several visits
40 27
52 32
44 30
72.5 16.5
62 28
72 17
Issues Relating to Hospitals, Doctors and Patient Satisfaction
Table 3 depicts that the entire medical personnel responsiveness to patients’ requests are
extremely satisfactory (89%). Also, a considerable number of patients (89%) rated the
medical personnel professionalism high in delivery their services. These responses confirmed
the evaluation of comparison of patient expectation with actual service delivery. Majority of
the respondents claimed that their expectations were met (80%). Meeting patients’
expectations resulted to satisfaction with service delivery. This finding is in agreement but
higher than Senti and Lemire’s (2012) report which indicated that when realistic expectations
are met overall satisfaction scores should improve. The respondents rated the system
approach to service delivery as good (87%), while 32 (16%) of them rated the overall
approach as excellent. Despite satisfactory responses, it amazing to know that more than half,
104(52%) of the respondents had experiences one disappointment or others in service delivery
of these health centres.
Table 3– Results on issues relating hospitals and doctors and patient satisfaction
Rank Issues Poor (%) Good (%)
B1 Level of medical personnel responsiveness to patients
B2 Personnel professionalism in handling patients
B3 Patient expectation with actual service delivery
B4 Health care system approach to delivering high quality services
B5 Past disappointment in service delivery
11
11
17
13
Yes (%)
48%
89
89
80
87
No (%)
52%
Perceived Causes of Long Queues
Table 4 reveals the observed causes for long waiting time in these health centres. These
factors are found in most Nigerian Hospitals, especially university and public funded health
centres. In Nigeria, University Hospitals and General (Government) Health Centres have the
high patient’s patronage. Reasons have been that University Hospitals are endowed with more
modern technologies and qualified personnel for effective and efficient medical service
delivery while General Hospitals is a place of visit for common man. Therefore, large number
of patients is received by these Health Centres on a daily basis. It was notice that few numbers
of Doctors serve a high population of patients at these hospitals. Though, this has been a
general trend in most standard hospital in Nigeria (Afolabi and Erhun, 2003; Thatcher, 2005;
Umar, et al, 2011).
Patients jumping queue through the help of some staff was high in General Hospital.
University Health Centre and Medicare have adopted the use of information technology in
their operations. This really helps in managing patient waiting time and facilitating patient
flow. But the situation is different in General Hospital that still relies on manual operations
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which results to long search of patient card, physical movement of card from one office to
another and patients wandering around from one unit to another.
Medical practitioners and health institute (Institute of Medicine) acknowledged that long
waiting time results to patient dissatisfaction and had therefore recommended that majority (
not less 90%) of patients should be served within 30 minutes of their scheduled appointment
time (O’ malley, Fletcher, Fletcher and Earp, 1993; Senti and Lemire, 2012 Gup, et al, 2012;
Yeddula, 2012). This recommendation is difficult to achieved in General Outpatient
Department of University Hospitals and Public Hospitals in developed countries talk less of
developing country like Nigeria who has a ratio of doctor to patient as one per 25,000 against
the World Health Organization (WHO) target of a doctor to 1000 patients (Latonte, Labonte,
Sander, Schrecker, 2004).
This overcrowding situation accounted for the reason while the some respondents claimed
that they had experienced disappointment with service delivery in time past. This is in
contrast with the satisfactory responses indicated by majority of respondents on issues relating
doctors, hospital and patients (see Table 3). Our findings revealed that despite the fact that
patients experience waiting time (see Table 2), high percentage of respondents are satisfied
with overall service delivery in these selected hospitals. This claim is consistent with the
findings of Afolabi and Erhun (2003); Camacho, et al, (2006); Prasanna, Bashith and
Sucharitha (2009) Senti and Lemire, (2012) Merkouris, et al (2013) but in contrast with Umar
et al’s (2011) findings where majority of patients were dissatisfied with service delivery
because of long waiting time.
The waiting time before seeing the nurse, doctor, pharmacist, etc., should be made
productive by organizing waiting process in line with patient’s perspective by; (i) medically
engage the patients by encouraging them to describe their previous medical experience and
providing relevant health education on important issues and not allowing them to watching
television, chatting, etc. (ii) equality treatment procedure; this reduces preferential treatment.
(iii) Increase interaction with patients by providing more adequate communication with them.
(iv) Medical personnel should be more friendly, caring, listen to patient’s complaints and
arrive in time and avoid unnecessary delay in service delivery.
Further research is required to examine other variables of patient satisfaction not
included in this study and the concept of patient perception of waiting time in relation to
patient satisfaction. This study was conducted at the moderate-sized hospitals in Sango-Ota,
Ogun State, Nigeria, and hence, the findings may not be generally applicable in other settings
not similar to these hospitals. However, despite these barriers, the study depicted how waiting
time is an important factor of quality service delivery and patient satisfaction in this setting.
Our findings agree with other studies in literature that revealed that there is relationship
between waiting time and patient satisfaction (Camacho, et al, 2006; Prasanna, et al, 2009;
Umar et al, 2011).
Table 4 – Perceived Causes of Long Queues
1. Large number of patients
2. Late arrival of Doctors
3. Fewer number of Doctor
4. Preferential treatment by medical personnel
5. Operations not computerized
6. Doctor waste time in seeing a patient
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4. Conclusions
As we move towards patient-centred service delivery where more emphasize is on
managing patients waiting time, time spent with the doctors, nurses, pharmacists, etc., and the
entire service delivery process.
Reduced waiting time, adequate health care, professionalism, responsiveness to patients,
friendly, adequate and purposive communication are among some important factors that
improve patient satisfaction. This study has shown that a good numbers of the patients were
satisfied with the service delivery despite experiencing long waiting time. Though, lengthy
waiting line is evident in public hospital than the other private hospitals as demonstrated in
the study. But this does not affect patient perception of quality care offered.
Part of the reasons may be because long waiting time is a general occurrence in Nigerian
hospitals especially publicly funded health centres. Efforts should be made by hospital
administrators and medical personnel to eliminate unnecessary delay in service delivery and
where unavoidable the waiting time should be made productive. Also, emphasis should be
directed toward training of medical personnel on how to design a productive waiting time
process and deliver timely services. This implies that hospitals that manage wait times
effectively and efficiently will experience significant improvement in patient satisfaction.
References
Afolabi, O. M. and Erhun, O. W. (2003). Patients’ Response to Waiting Time in an Out-
patient Pharmacy in Nigeria. Tropical Journal of Pharmaceutical Research, 2(2), 207-
214.
Anastasios, M., Angeliki. A., Evdokia, A., Maria, H., Michalis, R., Evridiki, P. (2013).
Assessment of Patient Satisfaction in Public Hospitals in Cyprus: A Descriptive Study.
Health Science Journal, 7(1), 28-40.
Anderson, R. T.,Camacho T. F.and Balkrishnan, R. (2007). Willing to Wait: The Influence of
Patient Wait Time on Satisfaction with Primary Care. BMC Health Services Research,
7(31), 1-5.
Anderson, R.,Barbara, and Feldman, A.(2008). What Patient Want: A Content Analysis of
Key Qualities that Influence patient Satisfaction. Journal of Medical Practice
Management
Aragon SJ, Gesell SB (2003) A patient satisfaction theory and its robustness across gender in
the emergency department: A multigroup structural equation modeling investigation.
American Journal of Medical Quality, 18,229-241.
Bopp, K. D. (1989). Value-added Ambulatory Encounters: A Conceptual Framework. Journal
Ambulatory Care Manage, 12 (2), 36–44.
Brahma, K. P. (2012). An Appraisal of Cost of Queuing in Health Sector: A Case Study of
IMS & Sum Hospital, Bhubaneswar. International Journal of Multidisciplinary
Research, 2(4), 209-218.
Camacho, F., Anderson, R. T., Safrit, A., Jones, A. S. and Hoffmann, P. (2006). The
Relationship Between Patient’s Perceived Waiting Time and Office-Based Practice
Satisfaction. NC Med Journal, 67(6), 409-413
Clark, L. A. and Watson, D. (1995). Constructing Validity: Basic Issues in Objective Scale
Development. Psychology Assessment, 7, 309-319
Cronbach, I. J. (1951). Coefficient Alpha and the Internal Structure of Tests. Psychometrical,
16, 297-334
Dansky, K. H. and Miles, J. (1998). Patient Satisfaction with Ambulatory HealthCare
Services: Waiting Time and Filling Time. Hospital Health Service Administration, 42
(2), 165-177.
125
Emergency department patient satisfaction survey in Imam Reza Hospital, Tabriz, Iran.
International Journal of Emergency Medicine, 4(2), 1-7.
Finch. L. (2005) Nurses’ Communication with Patients: Examining Relational
Communication Dimensions and relationship. International Journal of Human Caring,
9(4), 14-23.
Gup, I., Ofoedu, J. N., Njoku, P. U., Odu, F. U., Ifedigbo and Iwuamanam, K. D. (2012).
Evaluation of Patients’s Satisfaction with Quality of Care rovided at the National Health
Insurance Scheme Clinic of a Tertiary Hospital in South-Eastern Nigeria. Nigerian
Journal Clinical Practice, 15(4),469-474.
Hall, M.F. and Press, I. (1996) Keys to Patient Satisfaction in the Emergency Department:
Results of a Multiple Facility Study. Hospital Health Service Administration, 41(4), 515-
32.
Harutyunyan, T., Demirchyan, A., Thompsonand, E. M. and Petrosyan, V. (2010). Patient
satisfaction with primary care in Armenia: Good rating of bad services?. Health Services
Management Research, 23 (1), 12-19.
Hermida, J., Nicholas, D. D. and Blummenfeld, S. N. (1999). Comparative Validity of Three
Methods for Assessment of the Quality of Primary Health Care. International Journal of
Qualterly Health Care, 11 (5), 429-933.
Karaca, A. M.,Erbil, B. and Ozmen, M. M. (2011). Waiting in the Emergency Room: Patient
and Attendant Satisfaction and Perception. European Journal of Surgical Sciences, 2(1),
1-4.
Kurata, J., Nogawa, A., Philips, D., Hoffman, S.,and Werblum, M.(1992). Patient and
Provider Satisfaction with Medical Care. Journal of Fam. Prac., 5(1), 429-442.
Latonte, R. N., Labonte, R., Sanders, D. Schrecker, T. (2004). Brain Drain, Fatal
Indifference: The GB, Africa and Global Health. IDRC, Illustrated Edition.
Matulich E. and Finn, D. W. (1989). Determinant Criteria in Patient Satisfaction Surveys.
Journal Ambulatory Care Manage, 12 (3), 45–51.
Merkouris, Andreadou, Athini, Hatzimbalasi, Rovithis, Papastavrou (2013). Assessment of
Patient Satisfaction in Public Hospitals in Cyprus: A Descriptive Study. Health Science
Journal, 7(2), 28-40.
Mowen, J. C.,Licata J. W.and Mcphail, J. (1993). Waiting in the Emergency Room: How to
Improve Patient Satisfaction. Journal of Health Care Marketing, 13, 26-33.
O’Malley, M., Fletcher, S., Fletcher, R. and Earp, J. (1993). Measuring Patient Waiting Time
in a Practice Setting: A Comparison of Methods. Journal of Ambulatory Care
Management, 6,20-27
Omidvari S, Shahidzadeh A, Montazeri A, Azin SA, Harirchi AM, Souri H: (2008).Patient
satisfaction survey in the hospitals of Tehran University of medical Sciences, Tehran,
Iran. Paiesh, Health Sciences Journal of Jehad Daneshgahi , 2,141-152, (Persian).
Prasanna, K. S., Bashith, M. A. and Sucharitha, S.(2009). Consumer Satisfaction about
Hospital Services: A Study from the Outpatient Department of a Private Medical College
Hospital at Mangalore. Indian Journal of Community Med, 34(2),156-159.
Press Graney Associates (2009).Emergency Department pulse report.
Fologixsys.com/Resources/Emergency Department pulse report.
Press, I. (2006). Patient Satisfaction: Understanding and Managing the Experience of Care,
2nd Edition. Michigan: Health Administration Press.
Senti, J. and Lemire, S. (2011). Patient Satisfaction with Birthing Centre Nursing Care and
Factociation With Likelihood to Recommend Institution. Journal of Nursing Care
Quarterly, 26(2), 178-185.
126
Sin, L. and Tse, A. (2002). Profiling Internet Shoppers in Hong Kong: Demographic,
Psychographic, Attitudinal and Experiential Factors. Journal of International Consumer
Marketing, 5(1),7-2.
Sixma, H. J., Spreeuwenberg, P. M., van der pasch, M. A. (1998). Patient Satisfaction with
the General Practitioner: A Two-level Analysis. Journal of Medical care, 35(11), 58-68.
Soleimanpour, Gholipouri, Salarilak, Raoufi, Vahidi, Rouhi, Ghafouri, Soleimanpour
(2011). Emergency Department Patient Satisfaction Survey in Imam Reza Hospital,
Tabriz, Iran. International Journal of Emergency Medicine 4(2), 1-7.
Turnbull, J. E., and Hembree, W. E. (1996). Consumer Information, Patient Satisfaction
Surveys, and Public Reports. Am. Journal of medical Quarterly, 11(1), 42-47.
Umar, I., Oche M. O.and Umar, A. S. (2007). Patient Waiting Time in a Tertiary Health
Institution in Northern Nigeria. Journal of Public Health and Epidemiology, 3(2), 78-82.
Yeddula R. V. (2012). Healthcare Quality: Waiting Room Issues. M. Sc. dissertation,
University of Nebraska – Lincoln.