|
In-Patient Satisfaction
in Belfast City Hospital 2000
3 Results
3.1 Respondent Profile
The tables below compare the
profile of the overall sample of patients who were sent
questionnaires with the profile of those who chose to take
part in the survey, that is, the actual respondents.
The tables show that, whilst
the gender profile of both groups is identical, there is
an under-representation of older people (aged 65 and over)
among the respondents (34% as opposed to 42%). In addition,
the breakdown by speciality shows that general surgery is
over-represented among the respondents, whereas gynaecology
is under-represented.
Gender
| Total sample |
n
|
%
|
Respondents |
n
|
%
|
| Male |
91
|
38
|
Male |
55
|
38
|
| Female |
149
|
62
|
Female |
89
|
62
|
| |
|
|
Missing |
5
|
---
|
Age
| Total sample |
n
|
%
|
Respondents |
n
|
%
|
| 18-35 |
25
|
10
|
18-35 |
18
|
13
|
| 35-65 |
114
|
48
|
35-65 |
76
|
53
|
| 65 and over |
101
|
42
|
65 and over |
49
|
34
|
| |
|
|
Missing |
6
|
---
|
Speciality
| Total sample |
n
|
%
|
Respondents |
n
|
%
|
| Breast surgery |
39
|
16
|
Breast surgery |
21
|
16
|
| Cardiology |
8
|
3
|
Cardiology |
4
|
3
|
| Ear, nose & throat |
20
|
8
|
Ear, nose & throat |
14
|
10
|
| General surgery |
39
|
16
|
General surgery |
34
|
26
|
| Gynaecology |
56
|
23
|
Gynaecology |
20
|
15
|
| Urology |
56
|
23
|
Urology |
31
|
24
|
| Vascular Surgery |
22
|
9
|
Vascular Surgery |
8
|
6
|
| |
|
|
Missing |
17
|
---
|
3.2 Out-Patient Experience
3.2.1 Referral by GP
45% of respondents (63) received
notification of the dates of their appointments with the
consultants less than one month after being referred by
their GP (figure 3.1). However, 32% (46) waited for between
one and three months; 9% (13) waited between four and six
months and 8% (11) waited over six months for appointments.
5% (7) were unsure how long they had waited.
Figure 3.1 Referral Time
The majority of respondents
(82%: 115) found the length of time they had to wait for
out-patients appointments either very satisfactory or satisfactory
(n = 141).
3.2.2 Contacting Belfast
City Hospital
Fifty-six respondents (38%
of total sample) contacted Belfast City Hospital about appointments
prior to receiving dates for their operations, but one of
these respondents did not specify who s/he spoke to at the
hospital. Of the remaining respondents, 73% (40) spoke to
consultants' secretaries and 9% (5) were put through to
the appointments office (table 3.1).
Table 3.1 Contacted re
appointment
| Contact |
%
|
| Consultant's Secretary |
73 (40)
|
| Appointments Office |
9 (5)
|
| Nurse or other |
6 (3)
|
| Unsure |
13 (7)
|
Ninety-five per cent (52)
of these respondents reported that the staff contacted were
very helpful or helpful (n=55).
3.2.3 Out-Patient Appointment
At their out-patient appointments,
78% of respondents (110) stated that they were seen by consultants
(n = 141).
Of those patients (n = 28)
who were not seen by consultants, 32% (9) saw a senior registrar,
18% (5) saw a registrar and 32% (9) saw a senior house officer
(figure 3.2). The majority of these patients (86%: 24) were
satisfied or very satisfied with seeing doctors other than
the consultants at their appointments, whereas only two
respondents were dissatisfied with whom they had seen. However,
it should be noted that 18% of patients (5) were unsure
which doctor they had seen at their appointments.
Figure 3.2 Doctor patients
saw instead of consultant
Seventy-five per cent of
respondents (99) were seen at their arranged appointment
times (n = 132). However, of those respondents who were
not seen at their specified appointment times, almost half
(16) waited over 30 minutes; a third (11) waited over 20
minutes and 15% (5) waited between 10 and 20 minutes (figure
3.3).
Figure 3.3 Waiting times
for appointment
Twelve respondents (36%)
were dissatisfied or very dissatisfied with the waiting
times for their appointments. Eleven of these respondents
waited over 30 minutes after their specified appointment
times and the twelfth person waited between 21 and 30 minutes.
When these respondents were asked what they thought would
be a reasonable waiting time, five of them said 16 to 20
minutes and four said 6 to 10 minutes, whereas only two
respondents said 11 to 15 minutes. The twelfth respondent
suggested that up to 45 minutes would be reasonable
Of the 16 respondents (49%)
who were kept waiting for over 30 minutes for their appointments,
most of them (14/16: 88%) were given explanations for the
delays. One respondent (6%) was unsure if an explanation
had been given.
3.3 Operation
3.3.1 Preparatory Information
The majority of the respondents
(92%: 126) felt they had been given enough information to
prepare them for their in-patient stays (n =137). The information
was obtained from a variety of sources but consultants provided
the information in almost a third of cases (table 3.2).
However, where respondents simply indicated that doctors
in general provided the information, this category may also
have included some consultants.
Table 3.2 Who Provided
Information
| Source of information |
%
|
Number
|
| Consultant |
31
|
32
|
| Doctor and nurse |
19
|
20
|
| Doctor |
14
|
14
|
| Hospital |
12
|
12
|
| Staff nurse |
8
|
8
|
| Information leaflet |
7
|
7
|
| Friends |
1
|
1
|
Eight patients commented
that they would have liked more information:
|
I would have liked more information on how long my
stay in hospital was going to be.
I would have liked more information on my operation.
I felt I was not given enough details.
|
3.3.2 Notice Given of
Operation
Over half of the patients
(51%: 66) were given up to one weeks notice of the dates
of their operations. Forty-one per cent of patients (53)
were given between 2 and 4 weeks notice and 9% of patients
(11) were given more than 4 weeks notice (figure 3.4).
Figure 3.4 Notice of operation
The majority of the respondents
(96%: 128) were satisfied or very satisfied with the extent
of the advance notice provided for their operations (n =
133).
3.3.3 Discussion on operation
Respondents discussed the
details of their operations with a range of professionals
(n = 132). Specifically, a third (46) of them discussed
their operations with a doctor and a surgeon. 18% of respondents
(25) discussed their operations with a doctor and an anaesthetist
and a similar proportion (19%: 26) also discussed their
operations with a nurse (as well as medical staff). 10%
of respondents (14) discussed their operations with a doctor
and a nurse. The remaining respondents discussed their operations
with medical and nursing staff generally.
The majority of respondents
(96%: 135) were very satisfied or satisfied with the information
they received prior to their operations (figure 3.5).
Figure 3.5 Satisfaction
with information received
3.4 Food
3.4.1 Choosing Food
Nearly all the respondents
(90%: 130) were given a choice of menu and the majority
(81%: 117) thought the choice of food was good or very good
(n = 145): The menus were well thought out and the cooking
and presentation was good also. The majority of respondents
(58%: 82) stated that they always got the food they requested
(figure 3.6). However, 3% of patients (4) got what they
ordered only in some instances. Figure 3.6 Obtained foods
requested
3.4.2 Quantity and Temperature
The majority of respondents
said the amount of food which they received was just about
right (table 3.3).
Table 3.3 Satisfaction
with quantity of meals
| Meal |
Less than Wanted
|
About right
|
Too Much
|
n
|
| Breakfast |
11% (16)
|
87% (124)
|
1% (2)
|
142
|
| Lunch |
10% (14)
|
87% (122)
|
4% (5)
|
141
|
| Evening meal |
14% (19)
|
84% (117)
|
3% (4)
|
140
|
Negative comments were made
by two people about the size of the meals provided:
|
It made no difference if you marked
'large' on menu.
For me the dinner was not substantial
as there were a few times where there was just a sandwich
for dinner.
|
The majority of respondents
(89%: 127) stated that the temperature of the food was just
right, whereas 9% (12) of them said it was too cold and
2% of patients (3) said it was too hot (n = 142):
| I found the soup to be warm but the
main meal was never hot. |
3.4.3 Satisfaction with
Time to Eat Meal
Eighty per cent of respondents
(114) felt they always had enough time to eat their meals
and the remainder reported that they usually had enough
time to eat their meals (n = 143).
3.4.4 Cleanliness of Crockery
and Cutlery
The majority of respondents
reported that the crockery and cutlery were always clean
(table 3.4).
Table 3.4 Cleanliness
of crockery and cutlery
| |
Always Clean
|
Sometimes Clean
|
Never
|
n
|
| Plates |
97% (140)
|
3% (4)
|
-
|
144
|
| Cutlery |
92% (127)
|
7% (10)
|
1% (1)
|
138
|
3.4.5 Quality of Food
When respondents were asked
to rate the quality of the food, 79% (112) stated that it
was good or very good, whereas 8% (11) said it was poor
or very poor (figure 3.7).
Figure 3.7 Quality of
food
| The food was served to the highest
of standards, I was very impressed. It ruined my perception
of hospital food! |
3.4.6 Special Dietary
Requirements
Sixteen per cent of respondents
(22) stated that they were on a special diet, for example,
a pureed, low-fat or diabetic diet (n = 140). The majority
of these individuals (91%: 20) always received their special
diets, whereas 9% (2) did not always receive their particular
dietary foods (n = 22):
| I am a diabetic and I felt that there
was not a great variety of foods for us. I had the vegetarian's
meal which was very good. |
3.4.7 Drinks Offered with
Meal
Almost three-quarters of
the patients (72%: 101) stated that they were always offered
drinks with their meals, whereas less than a fifth (19%:
27) were only sometimes offered drinks and 9% (12) were
never offered drinks (n = 140).
3.5 Nursing and Medical
Staff
3.5.1 Care from Nursing
Staff
Ninety per cent of respondents
(132) stated that they were told the names of the nurses
in charge of their care (n = 147).
The overall standard of nursing
care received was rated highly: 82% (120) rated it as very
good and 15% (22) rated it as good. Only one patient rated
the standard of nursing care received as very poor (figure
3.8).
Figure 3.8 Standard of
nursing care
The majority (89%: 132) of
respondents said that the nurses were very friendly and
10% (15) said they were quite friendly (n = 148):
| The nursing staff were efficient,
caring and friendly. They created a very pleasant atmosphere
in the ward and had considerable expertise in dealing
with cancer patients. |
The majority of respondents
felt the nurses spent enough time with patients generally,
whether in providing care, talking to them or teaching them
about their illnesses (table 3.5).
Table 3.5 Adequacy of
time spent by nurses with patients
| |
Yes
|
No
|
n
|
| Carrying out nursing care |
97% (141)
|
3% (4)
|
145
|
| Talking with patients |
92% (134)
|
8% (11)
|
145
|
| Teaching about condition |
91% (120)
|
9% (12)
|
132
|
| I have lost my baby and before my
operation I was very nervous and upset. The staff helped
me to come to terms with it and were always there for
me if I needed to talk. |
Of the 66 respondents (45%)
who had ever rang a call-bell to get attention from the
nursing staff, the majority (99%: 65) specified that a nurse
had always arrived within a couple of minutes. However,
two respondents (1%) said they had not been provided with
call-bells.
3.5.2 Information from
Nursing Staff
Eighty-eight per cent of respondents
(126) said the nurses gave them as much information as they
would have liked about their progress (n = 143).
The majority of respondents
(81%: 118) stated that the nurses always explained what
they were going to do before they carried out any nursing
procedures, whereas 15% (21) stated that this was usually
the case and 3% (5) said the nurses sometimes explained
the procedures in advance (figure 3.9).
Figure 3.9 Nurses explained
procedures
3.5.3 Care Plans
As regards care plans, almost
two-thirds of patients (63%: 90) did not know if care plans
had been drawn up for their nursing care (figure 3.10).
Figure 3.10 Knowledge of
care plan
Out of the 54 respondents
who were aware that care plans had been devised, less than
half of them (44%: 24) had been involved in contributing
to these plans for their nursing care. When the respondents
were asked if they would like to have been involved in writing
their nursing care plans, almost half (45%: 59) said they
preferred not to be involved, in contrast with around a
fifth of patients (21%: 27) who would like to have been
involved. The remainder of the respondents (44) were undecided
on this issue (n = 130).
3.5.4 Care from
Medical Staff
Ninety-five per cent of respondents
(120) were told the names of their consultants (n = 126).
There were slight differences between the specialities as
to whether or not the patients were told the consultants'
names (table 3.6).
Table 3.6 Knowledge of
consultants' names by speciality
| Speciality |
Yes
|
No
|
| Breast surgery |
95% (19)
|
5% (1)
|
| Cardiology |
100% (3)
|
-
|
| ENT |
100% (13)
|
-
|
| General surgery |
85% (28)
|
15% (5)
|
| Gynaecology |
100% (20)
|
-
|
| Urology |
100% (29)
|
-
|
| Vascular surgery |
100% (8)
|
-
|
| Overall |
95%
|
5%
|
The majority of the respondents
(95%: 139) said they saw their doctors often enough, with
only 5% (8) stating that they did not see them often enough
(n = 147).
However, one patient commented
that s/he would have preferred to have more continuity in
the medical staff:
| I would have preferred to have care
from the same doctor each day. Some visited and did
not seem to know much about my operation and had to
consult the file. |
The majority of respondents
(99%: 145) said the doctors were friendly or very friendly.
3.5.5 Time spent with Medical Staff Over three-quarters
of the respondents (76%: 110) felt the doctors always took
the time to answer any questions they had, whereas only
one respondent said this never happened (figure 3.11).
Figure 3.11 Doctors took
time to answer questions
3.5.6 Information from
Medical Staff
Eighty-nine per cent of respondents
(131) stated that the doctors gave them as much information
as they would have liked about their conditions. However,
one-eighth of the patients (17) said they had not been given
sufficient information about their conditions.
Table 3.7 gives a breakdown,
by speciality, of the adequacy of information given by doctors.
Between 3% and 25% of patients in each speciality did not
receive sufficient information about their conditions. In
particular, two vascular surgery patient and one cardiology
patient did not receive as much information as they wanted
about their conditions.
Table 3.7 Adequacy of
information given by doctors by speciality
| Speciality |
Dr gave as much
information as wanted
|
Dr did not give as much
information as wanted
|
| Urology |
97% (30)
|
3% (1)
|
| Breast Surgery |
95% (20)
|
5% (1)
|
| ENT |
93% (13)
|
7% (5)
|
| General Surgery |
85% (29)
|
15% (5)
|
| Gynaecology |
85% (17)
|
15% (3)
|
| Vascular Surgery |
75% (6)
|
25% (2)
|
| Cardiology |
75% (3)
|
25% (1)
|
| The consultants I felt were arrogant
when asked questions about when my operation may be.
I feel that consultants would need to explain a lot
more about how serious conditions are. |
Half of the respondents (66)
stated that they always understood the information they
received about their conditions from the doctors, whereas
6% (8) said they understood the information only on some
occasions (figure 3.12).
Figure 3.12 Understanding
of information received about conditions
As regards whether the doctors
provided explanations before they carried out any medical
procedures, the majority of patients (84%: 125) said this
was always the case and 13% (20) said the doctors had usually
given them explanations. Only one respondent said the doctors
had never provided any explanations about the medical procedures
they were about to carry out (n = 149):
| The doctors explained all procedures
in a professional manner and answered my questions adequately. |
When the respondents were
asked to rate the overall standard of care which they had
received from both the medical and the nursing staff, the
majority (98%: 145) stated that this had been good or very
good, whereas three respondents (2%) said the standard of
care which had been provided had been neither good nor poor
(n = 148).
3.5.7 Privacy
The majority of respondents
said they were given enough privacy when receiving information
from, or being examined by, the doctors or during ward rounds
(table 3.8). However, the adequacy of privacy available
during ward rounds was rated lower than that available during
discussions and examinations. Specifically, 10% (14) of
the patients said there was inadequate privacy during ward
rounds.
Table 3.8 Privacy (doctor-patient
interactions)
| |
Enough privacy
|
Not enough privacy
|
n
|
| Examination by doctor |
99% (144)
|
1% (2)
|
146
|
| Receiving information |
94% (135)
|
6% (9)
|
144
|
| During the ward round |
90% (131)
|
10% (14)
|
145
|
Table 3.9 shows the variation
in the adequacy of privacy during ward rounds by the type
of speciality. Whilst all the ENT and vascular surgery patients
said they had sufficient privacy, 10-25% of patients of
other specialities had insufficient privacy. In particular,
almost a fifth of the general surgery patients said they
did not have enough privacy during ward rounds.
Table 3.9 Adequacy of
privacy during ward rounds by speciality
| Speciality |
Enough privacy
|
Not enough privacy
|
| ENT |
100%
|
(13)
|
-
|
-
|
| Vascular Surgery |
100%
|
(7)
|
-
|
-
|
| Gynaecology |
90%
|
(18)
|
10%
|
(2)
|
| Urology |
90%
|
(28)
|
10%
|
(3)
|
| Breast Surgery |
86%
|
(18)
|
14%
|
(3)
|
| General Surgery |
84%
|
(27)
|
16%
|
(5)
|
| Cardiology |
75%
|
(3)
|
25%
|
(1)
|
3.6 Other Hospital Staff
149 respondents said other
professionals (physiotherapists, radiographers, dieticians
and social workers) were involved in their care. However,
there was probably some overlap in these responses in that
patients may have received services from more than one other
professional.
3.6.1 Physiotherapists
43 respondents received physiotherapy
services. Most of the respondents who received physiotherapy
(95%: 37) said the physiotherapists always explained what
they were going to do before they carried out any procedures
(n = 39). In addition, 93% of the relevant respondents (38)
said the care they received from the physiotherapists was
very good or good (n = 41).
3.6.2 Radiographers
71 respondents received radiography
services. 87% of the respondents (60) said the radiographers
always explained what they were going to do before they
carried out any procedures, whereas 4% (3) said they were
only sometimes provided with explanations. Five respondents
said that they usually received an explanation and one respondent
said the radiographers never explained what they were going
to do (n = 69). As regards the standard of care provided
by the radiographers generally, 97% of respondents (69)
said the care provided was very good or good, whereas the
remaining two respondents said the care was neither good
nor poor (n = 71).
3.6.3 Dieticians
Fifteen respondents received
dietetic services. Most of these respondents (13) were satisfied
with the amount of information provided by the dieticians,
whereas only one respondent said s/he had been given insufficient
information (n = 14). Most of the respondents (11) who were
seen by the dieticians said the care was either very good
or good, whereas only two respondents said the care received
was neither good nor poor (n = 13).
3.6.4 Social Workers
Twenty respondents were seen
by social workers. Most of these respondents (15) felt the
social workers had given them sufficient information, whereas
two respondents were dissatisfied with the amount of information
received. Three respondents did not specify whether they
were satisfied with the amount of information provided.
Most of the respondents (15) said the care received from
the social workers was either good or very good, whereas
three respondents said the care provided was neither good
nor poor (n = 18).
3.7 Satisfactory and Dissatisfactory
Aspects of Hospital Stay
When asked to comment on the
most satisfactory aspects of their hospital stays, the patients
generally specified the following:
- staff attitudes
- provision of information
|
The way the staff dealt with all the patients helped
to create a relaxed and friendly atmosphere. They
made me feel relaxed and confident that I was in good
hands.
I have to say the care I received from the nursing
staff was second to none, they were wonderful. The
doctor was very attentive and always had time to listen
to me, although I am sure he was quite busy; this
care and attention could not have been faulted.
The doctors explained all procedures in a professional
manner and answered my questions adequately.
|
However, comments provided
on the dissatisfactory aspects of hospital stays included
the following (the numbers of comments are provided in brackets):
- postponement of admission dates
(3)
- timing of meals (2)
- lack of clean bed linen (2)
- ward facilities (2) and visiting
arrangements (1)
- noise of hospital (4)
- lack of information prior to surgery
(4) and post operation (4)
- discharge planning (3)
- follow up communication with GPs
(2):
|
In the hospital I found there to be a lack of blanket
and bed cover. My night sheet was not changed after
blood was spilt on it.
The only complaint I would have is that it was 11.30-12
midnight before medication or supper was given at
night. By this time I was exhausted.
The ward was a bit sparse, i.e. no radios, few televisions
apart from day room. Visiting arrangements were poor
for people outside local area to conform to the hours
available to visit.
Although the doctors were always pleasant and polite
I felt that my post-operative care was left to the
nursing staff and I was discharged totally unprepared
for how I was to feel in the next 5-6 weeks. However
I have to make the point that the junior medical staff
did appear to be extremely overworked.
|
In addition, the comments
made regarding a lack of information provision prior to
surgery primarily related to a lack of information about
what to expect.
3.8 General Awareness of
Health & Social Services
Overall, the respondents
demonstrated little awareness of the Charter for Patients
and Clients or its implications for them as users of Health
and Social Services.
Just over half of the respondents
(59%: 82) stated that they had heard of the Charter (n =
138).
Out of 64 respondents, only
38% (24) were able to correctly state the length of time
that a patient should expect to have to wait, following
referral to hospital by a GP, before receiving a letter
specifying the date of her/his out-patient appointment (that
is, 2 weeks). Just over half of the respondents (51%: 34)
were able to state the maximum length of waiting time (30
minutes) that they should have to wait at an out-patients'
department after their designated appointment times (n =
67).
Over a third of patients (39%:
24) correctly stated that a GP should receive a report from
a hospital doctor one week following a patient's out-patient
appointment (n = 62).
Out of 68 respondents, just
over half (52%: 35) said that standards within the health
service had improved since the introduction of the Charter
for Patients and Clients, although only 4% (3) said that
standards had deteriorated since its inception. It would
appear that both interest in, and knowledge of, the Charter
for Patients and Clients and its implications was poor among
the respondents in this study, particularly as seventeen
per-cent of the respondents who had heard of the Charter
gave no opinion on whether they believed it had had an effect
on standards in the health service.
|
