
==== Front
J Family Med Prim Care
J Family Med Prim Care
JFMPC
J Family Med Prim Care
Journal of Family Medicine and Primary Care
2249-4863
2278-7135
Wolters Kluwer - Medknow India

JFMPC-13-2868
10.4103/jfmpc.jfmpc_1428_23
Original Article
Assessment of the services provided at the family medicine staff clinics in King Saud Medical City, Riyadh
ELNasieh Abdulrahman M.
Almesned Mohammed
Alomran Yousef A.
Alhadlaq Razan K.
Alhazmi Akram N.
Alhuwaidi Faisal
Hazazi Yahya O.
Alawami Hawra M.
Derani Maria A.
Ahmed Amani A.
Department of Family Medicine, King Saud Medical City, Riyadh, Saudi Arabia
Address for correspondence: Dr. Abdulrahman M. ELNasieh, Department of Family Medicine, King Saud Medical City, Riyadh, Saudi Arabia. E-mail: Dr.Abdulrahman.Elnasieh@outlook.sa
8 2024
26 7 2024
13 8 28682872
29 8 2023
18 11 2023
28 11 2023
Copyright: © 2024 Journal of Family Medicine and Primary Care
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
ABSTRACT

Background:

Patient satisfaction is the subjective evaluation of a patient’s cognitive and emotional responses. This reflects their expectations regarding the ideal healthcare to be provided. This study aims to assess the satisfaction level of the attendees to the family medicine staff clinics at King Saud Medical City, Riyadh.

Materials and Methods:

A descriptive cross-sectional study recruited 378 participants. An adapted and piloted questionnaire was used to gather the data. The questionnaire enquires about the communication skills of the receptionist, the triage nurse, and the assigned physician. It included questions regarding the structure of the clinics.

Results:

Females represent the majority of about 255 (67.5%). About 2/3 of the respondents were within the age group of 18-34 years, 245 (64.8%). A high level of satisfaction was reported by the participants regarding the professionalism, kindness, interest of the staff member, and waiting time. Gender, marital status, and age group have no significant effect on the satisfaction level; the P value was uniformly more than 0.05.

Conclusion:

The result of this study identified high satisfaction responses regarding the communication skills of the receptionist, triage nurse, and physicians. The overall evaluation of the experience during staff clinic visits was satisfactory. Periodic evaluation of these attributes and other indicators that promote patient-centered care should be undertaken to improve the overall quality of care.

Assessment
family medicine
clinics
KSMC
==== Body
pmcIntroduction

This study was conducted because no previous study has been conducted in this setting. Internal and external audits were used to document patients’ views about the services received.[4]

Due to accessible information sources and increasing demand, the aspiration of the Saudi population, the country has witnessed a huge transformation.[1]

Patient satisfaction is a multi-dimensional process directed to provide an assessment of a patient’s experience.[12] Additionally, evidence-based care and guideline implementations have led to the restructuring of healthcare institutions.[3]

Previous studies have also concentrated on disease-oriented evidence (DOE) by emphasizing quantitative laboratory parameters.[7]

Objectives of this study

1- To assess the current services provided at family medicine staff clinics from the point of view of our patients.

2- To determine the overall satisfaction of the attendees to these clinics in terms of structure, process, and outcome.

3- To shed light on areas that deserve improvement and guide future quality improvement projects, and provide feedback to our healthcare providers and administrators.

Materials and Methods

Research design and setting

This study is an explorative, descriptive cross-sectional survey. It was conducted at the staff clinics of King Saud Medical City, Riyadh over a period of 2 months (February and March 2023). It was a quantitative, observational study to explore and assess the quality of healthcare. The clinics provide follow-up and walk-in services which include preventive curative and urgent care. The study was started after the approval of King Saud Medical City, Riyadh, Research and Innovation Center, and Institutional Review Board (IRB), and it was given the proposal IRB reference No.: H1RI-19-Oct22-02.

Study subjects

The population of this study consists of the attendees of the family medicine staff clinics during the study period. This includes King Saud Medical City employees, medical and non-medical, and their dependents. The sample size was 378 participants.

Data collection method and tool

The data collection tool was carried out by a questionnaire that had been prepared and adapted by the researchers (it was the modified patient satisfaction 18-item questionnaire). The questionnaire was piloted on 20 responders to evaluate its applicability. The questionnaire contains questions categorized into the following: personal data, communication with the clinic staff including the receptionist, triage nurse, and the assigned physician. The second part contains questions about the structure of the clinics including facilities and available equipment, waiting time, and appointment system. The investigators approached the participants in the waiting area. They were informed about the objectives of the study, the study investigators, and their affiliations. It was explained to them also that the questionnaire was anonymous. Receiving and responding to the questionnaire was considered consent to be included in the study. The questionnaire was available in both Arabic and English enabling the participants to select their preferred language.

The questionnaire was distributed manually by the researchers. The participants were requested to fill out the questionnaire on the same visit.

Results

The satisfaction status was rated into five levels based on the Likert scale. The total sample size was 378 in this study, out of which 255 were females (67%). Almost 2/3 of the respondents were aged between 18 and 34 years old, which was around 245 (64.8%). The age range was 18-75 years. About 189 (50%) of the respondents were married (48.7%). Most of the respondents about 291 (77%) had bachelor/diploma degrees. The main profession represented in our study sample was the nursing staff who were about 138 (36.5%). Table 1 shows the demographic data of the participants. Four, 4, 5, 2, and 17 respondents were inadvertently missed to indicate their gender, age, marital status, educational level, and job, respectively.

Table 1 Demographic details of the study participants

Characteristics	n	Percentage	
Gender			
 Male	119	31.5	
 Female	255	67.5	
 Not specified	4	1.1	
Age groups			
 18-34	245	64.8	
 35-54	113	29.9	
 55-75	15	4.2	
 Not specified	4	1.1	
Marital status			
 Married	189	50.0	
 Not married	184	48.7	
 Not specified	5	1.3	
Education			
 Postgraduate	52	13.8	
 Bachelor/Diploma degree	291	77	
 High school	27	7.1	
 Elementary school	5	1.3	
 Illiterate	1	0.3	
 Not specified	2	0.5	
Job			
 Administrative	48	12.7	
 Laboratory	8	2.1	
 Nursing	138	36.5	
 Pharmacy	3	0.8	
 Physician	33	8.7	
 Radiology	1	0.3	
 Others	130	34.4	
 Not specified	17	4.5	

The analysis of the variance (ANOVA) interpretation of the results showed that there was no significant effect of the gender, age group, marital status, educational level, and job of the participants on their satisfaction item assessment; the P value was uniformly more than 0.05.

The interpersonal relationship between the participants and the healthcare providers was rated the best. About 105 (27.8%) and 130 (34.4%) strongly agreed and agreed, respectively, that the professionalism of the receptionist was very high. The highest percentage of the number of participants confessed that the kindness, courtesy, and interest of the receptionist were very satisfactory. The detailed responses of the participants to the satisfaction variables with the receptionist are shown in Table 2.

Table 2 Participants’ responses to the satisfaction items with the receptionist

Questions	Strongly agree n (%)	Agree n (%)	Neutral n (%)	Disagree n (%)	Strongly disagree n (%)	
The professionalism of the receptionist is very high	105 (27.8)	130 (34.4)	74 (19.6)	45 (11.9)	24 (6.3)	
The kindness and courtesy of the receptionist are very high	105 (27.8)	111 (29.4)	95 (25.1)	41 (10.8)	26 (6.9)	
The interest of the receptionist in attending to the patient’s problems is very high	109 (28.8)	107 (28.3)	104 (27.5)	39 (10.3)	19 (5.0)	
The waiting time in the staff clinic before being registered is adequate	103 (27.2)	100 (26.5)	99 (26.2)	39 (10.3)	37 (9.8)	

Responses to the statements describing the satisfaction with the nursing staff at the triage rooms were, 116 (30.7) and 168 (44.4) strongly agreed and agreed, respectively, that the professionalism of the nurses was very high. A similar satisfactory response to the other attributes with the triage nurse was indicated. The detailed responses to the triage nurse encounters are shown in Table 3.

Table 3 Participants’ responses to the satisfaction items with the triage nurse

Questions	Strongly agree n (%)	Agree n (%)	Neutral n (%)	Disagree n (%)	Strongly disagree n (%)	
The professionalism of the triage nurse is very high	116 (30.7)	168 (44.4)	71 (18.8)	14 (3.7)	9 (2.4)	
The kindness, confidence, and courtesy of the triage nurse are very high	125 (33.1)	145 (38.6)	86 (22.8)	10 (2.6)	11 (2.9)	
The concern of the triage nurse to understand the problems of the patient is very high	128 (33.9)	140 (37.0)	81 (21.4)	16 (4.2)	13 (3.4)	
The triage nurse explains in detail the procedure	123 (32.5)	131 (34.7)	89 (23.5)	22 (5.8)	13 (3.4)	
Communication with the triage nurse is very good	117 (31.0)	159 (42.1)	77 (20.4)	11 (2.9)	14 (3.7)	
The waiting time in the staff clinic before getting vital signs is adequate	128 (33.9)	126 (33.3)	89 (23.5)	17 (4.5)	18 (4.8)	

Our survey reconfirmed that the professionalism of the assigned physician was very high. About 174 (46.0%) strongly agreed with this statement and 138 (36.5) agreed with the statement. The consultation dynamics with the physician were explored by the questions about the encounters and the result is shown in detail in Table 4.

Table 4 Participants’ responses to the satisfaction items with the assigned physician

Questions	Strongly agree n (%)	Agree n (%)	Neutral n (%)	Disagree n (%)	Strongly disagree n (%)	
The professionalism of the physician is very high	174 (46.0)	138 (36.5)	46 (12.2)	6 (1.6)	14 (3.7)	
The kindness, confidence, and courtesy of the physician are very high	170 (45.0)	130 (34.4)	53 (14.0)	13 (3.4)	12 (3.2)	
The concern of the physician to understand the problems of the patient is very high	167 (44.2)	133 (35.2)	55 (14.6)	9 (2.4)	14 (3.7)	
Physicians explain in detail the diagnoses and treatment of a disease	163 (43.1)	141 (37.3)	51 (13.5)	10 (2.6)	13 (3.4)	
Individualized care of the physician to the problems of the patient is very good	165 (43.7)	134 (35.4)	61 (16.1)	6 (1.6)	12 (3.2)	
The holistic approach of the physician during the consultation is very good	167 (44.2)	133 (35.2)	58 (15.3)	7 (1.9)	13 (3.4)	
There is a good continuity of care and follow-up plan by the physician	160 (42.3)	132 (34.9)	63 (16.7)	9 (2.4)	14 (3.7)	
Communication with the physician is very good	154 (43.4)	135 (35.7)	54 (14.3)	15 (4.0)	10 (2.6)	
The waiting time in the staff clinic before entering a medical consultation clinic is adequate	138 (36.5)	114 (30.2)	71 (18.8)	30 (7.9)	25 (6.6)	
The time spent during consultation focusing on the care of each patient is adequate	150 (39.7)	126 (33.3)	72 (19.0)	13 (3.4)	17 (4.5)	

Regarding the structure and facilities of the clinic, 140 (37%) strongly agreed that the clinics were clean and well-equipped. About 138 (36.5%) strongly agreed that the clinic was very accessible. About 123 (32.5%) strongly agreed that there was clear signage to locate the clinic. About 154 (40.7%) strongly agreed that their privacy was maintained during their visit. About 141 (37.3%) strongly agreed that there were no interruptions during their consultation. About 124 (32.8%) strongly agreed that they were able to get urgent medical care while 109 (28.8%) strongly agreed that it was hard to get follow-up appointments.

Responding to the statement evaluating the experience during staff clinic visits, 112 (29.6%) strongly agreed that this was very satisfactory. About 133 (35.2%) agree that the experience was to be very highly rated.

Discussion

Patient satisfaction is defined as the patient’s subjective evaluation of their cognitive and emotional reaction as a result of the interaction between their expectations regarding ideal healthcare services and their perceptions of the actual care.[89]

Our study participants have expressed a high level of satisfaction regarding the professionalism, kindness, courtesy, and waiting time at the reception, triage nurse room, and physician encounter. This level of satisfaction in our study reflects the improvement efforts undertaken by healthcare providers, healthcare authorities, and administrators in the setting of the study.[6] Looking at accessibility to our staff clinics, our study participants reported an acceptable satisfactory level. These results are comparable with the national, regional, and international studies, and they also reflect how our healthcare professionals utilize communication skills and the potential they possess to provide high-standard care.[10]

Local research conducted by Abrar H. Allafi et al. reported similar findings.[1]

The domains of consumer satisfaction are myriad. However, our study questionnaire sought to conceptualize the main parameters. A study done by Enock Mintah et al. conformed with our assessment tool.[5]

Whereas Tarig Ali M Alzaied and Abdurrahman Alshammari’s study results were in line with our study results.[14]

One of the earliest studies in Saudi Arabia by Muneera H. Al-Osimy concluded that the facilities in the three centers studied were inadequate,[10] in contrast to our respondents who were satisfied with the cleanliness and equipment availability; this reflects the efforts of the Saudi Ministry of Health to improve the healthcare services provided.[2]

Moreover, research by Riyadh A. Al Hilfi, Rajaa A. Mahmoud, and Nihad Q. Al Hamadi indicated weaknesses in some of the patient’s satisfactory dimensions including non-verbal cues of the communication process.[12] However, it provided evidence of having no significant difference in the chosen satisfactory dimensions between the healthcare centers providing family medicine services compared to those with no family medicine ones.[12] Whereas our participants were satisfied with their overall communication skills.[13]

While Nilofer Sultan Ali et al. study revealed some areas of improvement in family practice such as accessibility and reduction in waiting times,[11] whereas our study revealed that the scores of the waiting time to see the receptionist, triage nurse, and the physician were very adequate.

A study by Asif Iqbal Sandhu et al. reported discontent with the communication skills[4] aspect, this is in contrast to our study findings on this domain.

The participants survey for the dimensions of quality as shown in Table 5 about 38.4% of 145 are agree with the cleanness of clinic while 2.4 % of 9 are disagree, The equipment of clinic the also 38 .4 % agree the goodness of equipment while 2.6% are disagree, The accessibility of the clinic about 36 % are strongly agree while 32 are agree, The patient’s privacy is well maintained during the staff clinic visit 40% are strongly agree while 35 % are only agree, The patient’s privacy is well maintained during the staff clinic visit same percentage as mentioned previously , There is no interruption during medical consultation 33 % are strongly agree while 34.9 are agree.

Table 5 Evaluation of the structure, process, and outcome by the participant

Questions	Strongly agree n (%)	Agree n (%)	Neutral n (%)	Disagree n (%)	Strongly disagree n (%)	
The cleanliness of the clinic is very good	140 (37.0)	145 (38.4)	70 (18.5)	14 (3.7)	9 (2.4)	
The equipment of the clinic is very good	140 (37.0)	145 (38.4)	73 (19.3)	10 (2.6)	10 (2.6)	
The accessibility of the clinic is very good	138 (36.5)	122 (32.3)	71 (18.8)	30 (7.9)	17 (4.5)	
There is clear signage for the clinic	123 (32.5)	120 (31.7)	80 (21.2)	36 (9.5)	19 (5.0)	
The patient’s privacy is well maintained during the staff clinic visit	154 (40.7)	134 (35.4)	62 (16.4)	17 (4.5)	11 (2.9)	
There is no interruption during medical consultation	141 (37.3)	128 (33.9)	65 (17.2)	28 (7.4)	16 (4.2)	
I find it hard to get a follow-up appointment for medical care	109 (28.8)	74 (19.6)	90 (23.8)	72 (19.0)	33 (8.7)	
I can get urgent medical care whenever I need it during an acute presentation	124 (32.8)	104 (27.5)	96 (25.4)	26 (6.9)	28 (7.4)	
Overall assessment of my experience during staff clinic visits is very high	112 (29.6)	133 (35.2)	91 (24.1)	21 (5.6)	21 (5.6)	

I find it hard to get a follow-up appointment for medical care about 28 % are strongly agree and 19% are agree,

I can get urgent medical care whenever I need it during an acute presentation 32 % are agree and 27 % are gree

Overall assessment of my experience during staff clinic visits is very high 29% are strongly agree while 35 are only agree we can see from this result the most of participants are giving high preferences for the dimensions of quality in the clinic.

They also reported that marital status was an important correlate of patient satisfaction.[4] In our study, there were insignificant effects of marital status on respondents’ satisfaction assessment.

A study conducted by Waju Beyene, Challi Jira, and Morankar Sudhakar concluded that the interpersonal interactions were poor,[15] which was in contrast to our findings on this aspect.

A study conducted in Scotland by Jenkinson C. to assess patients’ experiences and satisfaction concluded that patient satisfaction scores present a limited and optimistic picture.[7] They recommended that detailed questions about specific aspects of patients’ experiences are likely to be more useful. This conforms with our recommendations.

Conclusions and Recommendations

Our participants’ assessment of the current services provided was found to be satisfactory.

The study findings also showed a high level of satisfaction regarding the structure, and the interaction process with the employees, and the overall assessment of their experience during the visits including the overall outcome was also satisfactory.

Future research on assessing the satisfaction of patients related to the provided services should include detailed questions about patients’ experiences and expectations, among the study recommendations the focus should be emphasized on the patient-oriented evidence that matters (POEM) which measures indicators that directly reflect patients’ experience and awareness of their illness. This includes mortality, morbidity, and the overall quality of life.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
==== Refs
1 Allafi AH Alqhatani JS Alruwayshid MS Alshuniefi AS Alarik EF Alreshidi F Patient satisfaction with services at the family medicine employee clinic in a tertiary hospital in Riyadh J Family Med Prim Care 2021 10 1754 58 34123924
2 Alshammari F Patient satisfaction in primary health care centers in Hail city, Saudi Arabia. Am J. Appl. Sci 2014 11 1234 40
3 Anna Rybarczyk-Szwajkowska and Michal Marczak, Quality assessment of healthcare services in patients and medical staff opinion Zdr publ 2011 121 110 6
4 Asif Iqbal S Patient satisfaction questionnaire: A tool towards improvement of health care services Esculapio Journal of SIMS 2019 15 206 9
5 Enock Mintah Ampaw et al. Assessment on health care service quality and patient satisfaction in Ghana http:www.emerald.com/insight/0368-492x.htm,2020
6 Farhan Barghoti Abu-Moghli F Khalaf I Patient satisfaction with health care services provided at the family medicine clinic at Jordan University hospital Medical and biological sciences, volume 32, No. 1 and 2 2005 52 64
7 Jenkinson C Coulter A Bruster S Richards N Chandola T Patients'experiences and satisfaction with health care: Results of a questionnaire study of specific aspects of care Qual Saf Health Care 2002 11 335 9 12468693
8 Johansson P Oléni M Fridlund B Patient satisfaction with nursing care in the context of health care: A literature study Scand J Caring Sci 2002 16 337 44 12445102
9 Larson LN Rovers JP MacKeigan LD Patient satisfaction with pharmaceutical care: Update of a validated instrument J Am Pharm Assoc (Wash) 2002 42 44 50 11833515
10 Ai-Osimy MH Evaluation of primary health care in Riyadh, Saudi Arabia J Family Community Med 1994 1 45 54 23008535
11 Ali NS Khuwaja AK Kausar S Nanji K Patients'evaluations of family practice care and attributes of a good family physician Qual Prim Care 2012 20 375 83 23114005
12 Riyadh A. Al Hilfi A Mahmoud Nihad Q. Al Hamadi Measuring the level of patients’ satisfaction for those attending primary health centers versus family medicine centers in Basrah governorate, the medical journal of Basrah University, volume 37, No. 2, 2019, 74-80
13 Sharifi T Hosseini SE Mohammadpour S Javan-Noughabi J Ebrahimipour H Hooshmand E Quality assessment of services provided by health centers in Mashhad, Iran: SERVQUAL versus HEALTHQUAL scales BMC Health Serv Res 2021 21 397 doi:10.1186/s12913-021-06405-4 33910551
14 Tariq Ali m Alzaied Abdulrahman Alshammari. An evaluation of primary health care centers (PHC) services:the views of users Health Science Journal 2016 10 2 15 1-8
15 Beyene W Jira C Sudhakar M Assessment of quality of health care in jimma zone, southwest ethiopia Ethiop J Health Sci 2011 21 (Suppl 1) 49 58 22435008
