Patients’ satisfaction and quality of clinical laboratory services provision at public health facilities in northeast Ethiopia

  1. Daniel Dagne Abebe
  2. Minwuyelet Maru Temesgen
  3. Addisu Tesfie Abozin
  4. Abebe Eyasu Zeleke
  5. Seid Legesse Hassen
  6. Hailay Berhe Gebremichael

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Abstract

Patient satisfaction is a key element of quality measures that has increasingly become acknowledged as an important tool for service improvement. This study aimed to assess the level of patients’ satisfaction and associated factors with clinical laboratory services provided at public health facilities. A cross-sectional study was conducted from May-June 2019 among clients attending 24 health centers and 8 hospitals, northeast Ethiopia. A total of 502 patients were selected using systematic random sampling. Patient’s satisfaction towards multiple aspects of laboratory services was assessed using structured exit interview questionnaire, on a rating scale of 1 (very dissatisfied) to 5 points (very satisfied). We assessed test availability and laboratory practices using facility inventory, stepwise accreditation audit checklist and blinded slide rechecking. Data were entered and analyzed using EpiData ver3.1 and STATA ver14.1. Multivariable logistic regression analysis was used to determine the association of factors with overall satisfaction. Overall, majority of the respondents (73.5%) were found to be satisfied. Lowest mean ratings were obtained for waiting area (3.3), and information provided on specimen collection (3.5) and on how and when to receive results (3.7). Patients were more likely to be satisfied in health centers (75.2%) than in hospitals (68.6%) (AOR=1.9, 95%CI: 1.0-3.6, p =0.036). Patients’ timely receipt of results ( p =0.005) and laboratories’ accuracy of results ( p < 0.025) also showed significant positive associations with satisfaction. In conclusion, there were specific areas of deficiency that were driving dissatisfaction, particularly in the larger hospital laboratories. Therefore, more and balanced emphasis should be given to the patients’ experiences, alongside technical quality improvements, to reduce the disparities and enhance the overall quality of care.

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  1. PeerRef

    Peer review report

    Title: Patients’ satisfaction and quality of clinical laboratory services provision at public health facilities in northeast Ethiopia

    version: 1

    Reviewer: I wish for this review to remain anonymous. While certainly imperfect, I believe that well- conducted reviews anonymous are preferable to signed reviews and free of the bias that may affect reviewers in a relatively small field.

    General assessment

    The authors report on an ambitious study that sought to rigorously assess the level of patient satisfaction with a representative sample of laboratory service facilities in the Amhara region of Ethiopia. The relevance of this topic is clearly explained and the role of patient satisfaction in the assessment and life cycle of laboratory services is likely underappreciated – particularly in low-resource settings. The manuscript is reasonably well written but would benefit from some English-language copyediting, as well as editing for length as the manuscript contains several redundant passages.

    Overall, the assessment of customer satisfaction as a metric of lab quality is potentially important, and not easily captured by accreditation processes such as SLIPTA or ISO. As such this is a valuable endeavour that will stimulate the field in my view.

    In the present study, the authors directly address the fact that patients experience may not reflect the quality or safety of a diagnostic laboratory. They did so by conducting their own measures of laboratory quality assessment, with the aim of establishing whether patient satisfaction is associated with such measures.

    Given that this aspects is in my view the core of the study, it is important that the methods used for the quality assessments be better explained and expanded. It is laudable that the authors undertook what appears to be an external quality assurance audit of malaria and TB slides examined in the last 3 months. It is important to understand exactly who performed this examination and what their qualifications were. Moreover, other details on the methods are important such as whether the slides were re-stained at the time of the audit.

    Similarly, the section on facility assessment (line 177) suggests that the investigators performed a full SLIPTA audit on participating centres. This would require a huge amount of work from both auditors and the facilities in order to be a valid account. This should be described in much more detail. I was surprised to find few references detailing Ethiopian laboratory implementation or strengthening experiences (of which there are a few instructive published examples).

    Finally, the finding that satisfaction is most strongly associated with objective measures of quality – such as use of fresh gloves (pre-analytical quality), EQA results of microscopy (analytical quality) and TAT (post-analytical quality) is interesting and supports the idea that quality is not a compartmental issue, but rather a local culture that permeates all laboratory activities. This is a finding that deserves to be highlighted, even if it is unclear that patient satisfaction should be used as a surrogate for more direct measures of lab quality. The emphasis on the lack association with the SLIPTA score is overstated in my view because there wasn’t sufficient variation in these scores – i.e. they were all rather poor - to yield an association.

    Decision

    Verified with reservations: The content is scientifically sound but has shortcomings that could be improved by further studies and/or minor revisions.

  2. PeerRef

    Peer review report

    Reviewer: Samuel Mayeden Institution: Ghana Health Service email: csmayeden@gmail.com

    Section 1 – Serious concerns

    • Do you have any serious concerns about the manuscript such as fraud, plagiarism, unethical or unsafe practices? No
    • Have authors’ provided the necessary ethics approval (from authors’ institution or an ethics committee)? Yes

    Section 2 – Language quality

    • How would you rate the English language quality? High quality

    Section 3 – validity and reproducibility

    • Does the work cite relevant and sufficient literature? Yes
    • Is the study design appropriate and are the methods used valid? Yes
    • Are the methods documented and analysis provided so that the study can be replicated? Yes
    • Is the source data that underlies the result available so that the study can be replicated? Yes
    • Is the statistical analysis and its interpretation appropriate? Yes
    • Is quality of the figures and tables satisfactory? Yes
    • Are the conclusions adequately supported by the results? Yes
    • Are there any objective errors or fundamental flaws that make the research invalid? No

    Section 4 – Suggestions

    • Do you have any other feedback or comments for the Author?

    • Line 35, 36 and 37: Authors should be consistent in using odds ratios and/or p values to indicate associations.

    • Line 37 (Conclusion): Should align with objectives and results stated in abstract

    • 42: Keywords should emerge from the text of the abstract. Kindly review the keywords to align with the body of the abstract

    • Introduction: Has no concrete global, regional or local level statistics on the subject. It will be good to indicate some statistics of existing work to appropriately conceptualize your work.

    • The introduction is too long. It will be good to keep it within 2 pages

    • Line 73: It helps to move citation to the end of the sentence

    • Line 132: Indicate from which department(s) of the health facilities the participants were recruited

    • Methods: Needs lots of clarification. Authors have to indicate the process of sampling more clearly

    • What influenced the selection of the 32 facilities out of the 252

    • You indicated 15 clients from health centres and 22 clients from hospitals. Are these the authors’ assumptions? Was this calculated from the facility registers? If so what amount of data from which period was used to make the estimates

    • Line 154: Did each facility have a sampling frame? What was k?

    • Line 172: Which department were patient exiting from. Was it outpatients or laboratory only cases, or inpatients as well.

    • Line 174: Was scale adapted or developed by authors

    • Line 183-185: how many slides were reviewed. Why did you choose only malaria and TB.

    • Line 196: Is the score decided by researchers or it has been adopted or adapted

    • Line 205: Reference star grading system

    • Line 256: state p value as p<0.001

    Section 5 – Decision

    Verified manuscript: The content is scientifically sound, only minor amendments (if any) are suggested.

  3. PeerRef

    SciScore rigor report

    Sciscore is an AI platform that assesses the rigor of the methods used in the manuscript. SciScore assists expert referees by finding and presenting information scattered throughout a manuscript in a simple format.

    Not required = Field is not applicable to this study

    Not detected = Field is applicable to this study, but not included.

    Ethics

    IRB: 234 Ethical clearance was obtained from the regional Ethical Review Board of Amhara

    Consent: The general aim and purpose of the study was described to each 239 eligible patient and all voluntary participants gave verbal informed consent prior to 240 enrolment.

    Inclusion and Exclusion Criteria

    Those 135 patients who were critically ill and unable to respond and those not voluntary to 136 participate were excluded.

    Attrition

    Those 135 patients who were critically ill and unable to respond and those not voluntary to 136 participate were excluded .

    Sex as a biological variable

    Sex Male Female Age group 18-24 25-44 ≥45

    Subject Demographics

    Age: 130 All adult patients ( aged ≥18 years ) who were using clinical laboratory services at 131 public health facilities of east Amhara , northeast Ethiopia were source population.

    Randomization

    132 Study population and eligibility criteria 133 Adult patients who received general laboratory services at the randomly selected 134 government health facilities during the study period were study population .

    Blinding

    not detected.

    Power Analysis

    not detected.

    Replication

    not required.

    Data Information

    Availability: It is made available under a CC-BY-NC-ND 4.0 International license .

    Identifiers: preprint doi: https:// doi.org/10.1101/2022.01.25.22269238; this version posted January 25 , 2022 . https://doi.org/10.1101/2022.01.25.22269238

  4. Version published to 10.1101/2022.01.25.22269238v1 on medRxiv