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Procedia Economics and Finance 32 (2015) 870 – 877

Emerging Markets Queries in Finance and Business

Patient Satisfaction in the Hospital's Emergency Units in

Bucharest
Celia Dana Be‫܈‬ciu
Academy of Economic Studies, Bucharest, Romania

Abstract

Nowadays health systems are centred to provide diagnosis and treatment and the focus is less placed on the relation
between the doctor and the patient. Before scheduling a treatment process is very useful to know the causes that generates
the aggravation of the health status and wich factors may increase the quality and the comfort of the healthcare units.
Patient satisfaction must be one of the key objectives of modern healthcare systems and must be evaluated constantly. This
study presents an analysis of the level of patient satisfaction felt in the emergency units of Bucharest, and highlights the
factors that influence the relationship between a doctor and a patient, the level of communication and patient satisfaction.
The necessary information was gathered in order to create a partial picture of the emergency medical services in Bucharest.
The research method was quantitative and the research instrument was the questionnaire. The data processing was
performed using the statistical analysis program, SPSS. The individuals who participated in the survey showed a fairly high
rate of satisfaction regarding the medical services and said that they had confidence in their physician. The data collection
and the analysis tool used allowed this paper to describe the relationship between the patient and physician, the
characteristics of the environment in which it is established, the internal and external factors which influence the level of
any patient satisfaction.

© 2015 Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
© 2015 Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/3.0/).
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Selection and peer-review under responsibility of the Emerging Markets Queries in Finance and Business local
Selection and peer-review under responsibility of Asociatia Grupul Roman de Cercetari in Finante Corporatiste
organization

Keywords: satisfaction, physician-patient relationship, communication, efficiency

1. Introduction

On a current and general level, health systems provides care based on diagnosis and treatment and this
characteristic is inherited over time from a philosophy which appeared on the early last century. It is

Tel.:
E-mail address: Ccelia_dana@yahoo.com.

2212-5671 © 2015 Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Selection and peer-review under responsibility of Asociatia Grupul Roman de Cercetari in Finante Corporatiste
doi:10.1016/S2212-5671(15)01534-8
 Celia Dana Beșciu / Procedia Economics and Finance 32 (2015) 870 – 877 871

necessary to be highlighted, the other factors that can enhance the quality and efficiency of the medical care
and that's why literature and medical research studies complement those mentioned so far, trying to emphasize
that it is important the relation between a physician and a patient, the dialogue taken place with the patient,
knowing his private life situation, before determining a treatment plan. Even if in the last 20 years Romania has
received consistent international support for health sector reform, including the improving of medical
emergency medical services (Farcasu, 2010), Romania remain a country of emigration for medical staff and the
funding of the health system is the lowest in Europe. (Vasile, ğâlea, 2013) In Romania there is a significant
imbalance between different regions and 98 communities have not a doctor or a nurse and for one third of the
territory and 30% of specialties are not covered. (Vlădescu, Olsavsky, 2009) Even if the emergency sector is a
major component of the health system and emergency medical care is provided free, the evidence at the
hospital are very few. (Ciutan, Nona, 2009) In developing countries as Romania, the access to basic services is
still one of the most important barriers to health and is influenced with political decisions (Kruk, Freedman,
2008) and the patient satisfaction must remain one of the most important objectives of the public health system.
If we refer to patient satisfaction this concept may include a number of elements as: low cost strategy to
improve safety and quality in hospital (Boulding, Glickman, Manary, Schulman, Staelin, 2011), patients
perceptions against professional skill and communication atitude of personnel, service quality and patient trust
(Ching-Sheng, Su-Yueh, Yi-Ting, 2013) or waiting time for appointments, office waits, emergency care,
availability of hospitals and other resources. (John, Ware, Mary, Snyder, Russel, Allyson, 1983). To ensure a
good level of satisfaction, we need to monitor the quality of decision making and use health information
technology that collect information from patients (Floyd, Flower, Carrie, Levin, Karen, 2011), but also a good
level of satisfaction can mean high expectation on receiving timely and high quality of medical service. ( Bai,
Bei, 2013) We can measure the level of quality and efficiency of the romanian management, by measuring the
performance of the others involved systems in the absence of performance indicators (Nicolescu, Verboncu,
Anghel, 2012) and the level of patient satisfaction can be a good indicator of health system performance. The
performance of medical system is an important indicator of the level of economic development and a way to
improve health outcomes is closing the gap between patient desires as a consumer and their medical needs.
(Joel, Edward, 2012). The quality of medical services can refer to some factors as: external environment,
perceptions of payment, commitments and promises and this factors can propose suggestions to improve the
hospital patient satisfaction. (Miao, Lvlin , Sen, 2011) It is important to measure all time patient satisfaction
because, nowadays is increasing in importance and is associated with increased market share, decreased
malpractice claims, financial gains ((Eric, James, 2013), but also the efforts should be made to give more
attention and more time to the patient. (Prahlad, Rajeev, Jayati, Laxman, 2010). It is important to investigate
how the health conditions of the patients influence the way they combine the healthcare experiences ( Otani,
Koichiro, Waterman, Brian Dunagan, Claiborne, 2012) and how in some cases patients correlates satisfaction
with some factors as staff atitudes or provision of explanation. (Taylor, Benger, 2004). To ensure excellence of
care services, hospitals and healthcare systems should invest in programs to determine how patients evaluate
their experiences (Clarian Health Partners, 2002) and mentain a positive relationship between the interpersonal
continuity of care and patient satisfaction (John, Waleed, 2004). Patient satisfaction should be accepted as an
integral part of quality health. (Hjortdahl, Laerum, 1992) because quality outcomes and patient satisfaction with
services are now a priority and the primary competitive edge in healthcare (Clarian Health Partners, 2002).

2. Research Objectives

The general objective of this research work is to measure the level of patients satisfaction felt in their
relation with their Physician by observing the quality of medical services provided in establishments for the
872 Celia Dana Beșciu / Procedia Economics and Finance 32 (2015) 870 – 877

receipt of urgent causes. The first objective derived from the general objective, is to know the perception of
patients regarding the physician who treated their medical emergencies. The patients perception, will be
analyzed from the perspective of certain terms as: confidence in their physician, waiting time, relationship
established and the quality of medical services. The second objective of the paper is to propose several
measures to improve the efficiency of medical emergency services in order to increase the level of satisfaction,
if will be necessary.

3. Research hypothesis

The first hypothesis: To what extent the medical behaviour has visible effects on patients satisfaction, in
terms of his professional competence and his ethical dimension? I wanted to know if the resulting trust from
cooperation, triggers the patient's commitment toward physician instructions and ensure a good level of
satisfaction. The second hypothesis that I will test, will show to what extent the medical staff's attention, can
influence the satisfaction felt by the main beneficiaries of the medical system, the patients.

4. Research methodology

The research targeted group includes the patients who were found in the emergency units of the emergency
hospitals analyzed. The results of the study are mainly useful for hospitals managers, medical researchers,
economic agents involved and hospital administrators, in order to establish some strategies and actions plans
that increase the level of responsibility, security and safety. Observation Units chosen are represented by four
hospitals in Bucharest which offers emergency medical services namely: Emergency Hospital Saint John,
Emergency Hospital for children, Marie Curie, Emergency University Hospital of Bucharest's and Emergency
Hospital Bagdasar Arseni. The target group includes 88 randomly selected patients. The research method
chosen was quantitative method and the research instrument chosen was the questionnaire applied to patients in
Emergency Reception Units. This instrument, helped people to respond more easy and understand the
discussed problem. The questionnaire applied has contained a number of 10 questions with answers that were
varied: some questions had only one variant, others more versions and also other questions that offered the
possibility of free expression and interpretation. The questionnaire applied to patients it was structured in four
parts, as follows: The first part- introduction, part II- identify the relationship between physician and patient,
part III-shows how quickly emergency has been resolved and the fourth part contains general questions. The
questionnaire includes questions with a formulated answer and also free answer questions. The topics included
in the questionnaire shows the reasons they chose the emergency hospital, the reasons they chose the
physician, the collaboration between the doctor and the patients, the level of trust and confidence, the level of
attention and others. I offered them the possibility of granting certain values depending on the level of
satisfaction/dissatisfaction felt with respect to medical services. The last part of the questionnaire explores the
issue of the reform and which elements of the reform may contribute to increase the patient satisfaction. The
questionnaire applied to patients end with a question that check the extent to which the public health system in
Romania is influenced by policy makers who makes part of the current Government. I would like to mention
that before the process of collecting and analyzing the data I made out all the steps necessary to obtain official
approval from the National Association for the Protection of Patients Rights and from the manager of which
units have asked certain conditions to allow the application of questionnaires: eliminating the nominal elements
in the questionnaire, to prevent those people who stood in a difficult health condition or people who have
behavior problems.
 Celia Dana Beșciu / Procedia Economics and Finance 32 (2015) 870 – 877 873

5. Descriptive statistics

The method of analysis and interpretation of the data obtained was carried out via computer statistical
analysis software called SPSS. There have been used a number of variants corresponding to questionnaire
responses. The variants of responses were coded with letter V for all variables tracked in the questionnaire and
the letter Q for all questions applied. Variable -V1 represents the hospital, variable-V2 represents the type of
the person, variable-V3 represents the person age, the variable level is V4 and V5 corresponds with the variable
occupations held by the person questioned. All the questions were encoded by the letter Q, affirmative
responses to the number 1, negative responses with the number 0 and none answered by the number 9 or
number of 99. There were situations when it was necessary to introduce coding variants. The necessary orders
have been applied to generate tables and graphs by selecting the case pursued by the analysis but also, were
generated certain frequencies of answers for certain questions addressed. The analysis of the information
obtained was held at the general level without any specific references to a particular unit observation.
According to data generated by the program SPSS most respondents were from Emergency University Hospital
of Bucharest's, followed by those of the Emergency Hospital Saint John. The average age of those surveyed
was placed in the range of 41-50 years old, with a level of education that was not superior, most of the
respondents were women employed without a major medical emergency. Of those questioned 44, 23% have
said they chose the hospital to treat because it is close to home and 28, 85% because doctors are trained (Table
1). For 56,78 % of patients, the most important aspect when they express their satisfaction level is represented
by the physician ability to solve the medical emergency as quick as possible followed by the doctor ability to
communicate with them, in percent of 25,42% (Table 2).

Tabel 1. The reason for choosing the Hospital

Choosing hospital: Choosing Choosing Choosing hospital:

close to home hospital: hospital: short recomandations made by
prepared waiting time relatives
medics
44.04% 2.88% 28.85% 24.04%

Table 2. Influence in collaboration with doctor

Collaboration with doctor: communication 26%

Collaboration with doctor: fast resolving 57%
Collaboration with doctor: explaining the problem 15%
Collaboration with doctor: personal problems 0.31%
Collaboration with doctor: previous results 1.69%


Most of the participants at the study stated in a percentage of 72% that they were satisfied with the
physician attention, and that means a positive aspect that shows a high level of satisfaction. 60.47% of
participants stated that they had trust in the physician who dealt with their emergency and 23, 26% of
respondents considered that physicians were attentive (Figure 1).Very few of participants mentioned that they
will need a closer future collaboration with the physician.
874 Celia Dana Beșciu / Procedia Economics and Finance 32 (2015) 870 – 877


Figure 1. Patient’s confidence in the physician

Table 3. The importance of the relationship with the doctor

Relation Relation with Relation with Relation with Relation with

with doctor: doctor: salary doctor: doctor: chances of doctor: the socio-
respect experience recovery professional
situation

19.7% 16.67% 27.27% 21.21% 15.15%

In terms of the relationship established between a physician and his patient, 27% of respondents are with the
opinion that the most important aspect is doctor’s experience in managing the patient (Table 3) and how close
is to them and how easy understand their medical problems. For patients, satisfaction is associated with
experienced doctors.
Most of the people polled appreciated a good level of promptness and 63.6% were satisfied with the doctor
attitude. The patients were not satisfied with the level of cleanliness.
Of those who participated in solving the questionnaire, 77, 3% indicated that they would revisit to treat in
the emergency hospital in which they found themselves at the time of questioning. This aspect reflected a good
level of satisfaction felt towards the services provided. (Table 4)

Table 4. You may call on the services of this hospital?
Frequency Percentage Valid Percentage Cumulative
percentage
Not responded 20 22,7 22,7 22,7
Valid Yes, replied 68 77,3 77,3 100,0
Total 88 100,0 100,0

 Celia Dana Beșciu / Procedia Economics and Finance 32 (2015) 870 – 877 875

Another aspect that has been pursued and debated through question number eight in the questionnaire was
related to the importance of the reform in the public health system in Romania and which element of the reform
has a great impact on the level of satisfaction patients. Even if the most respondents said that they had limited
knowledge about the content of the reform and its importance they tried to resolve the questionnaire topic.

Patient satisfaction: co-payment system 3.98%

Patient satisfaction: private practice within public hospitals 4.09%

Patient satisfaction: medical staff without budgetary status 10.96%

Patient satisfaction: development of emergency structures 16%

Patient satisfaction: collaboration with IBM 7.56%

Patient satisfaction: reducing bureaucracy 6.22%

Patient satisfaction: professionalization of management 14.09%

Patient satisfaction: reorganization of the health insurance houses 14.14%

Patient satisfaction: increasing funding 16.48%

Patient satisfaction: implementation of the European Directive 6.48%


Table 5 .The importance of the reform for the patient'sƐĂƚŝƐĨĂĐƚŝŽŶ

From the analysis carried out on the graph generated by the computer program SPSS, I found that 16, 48%
of citizens consider particularly important to increase the funding to emergency system followed by the variant
linked to the development of emergency structures and health personnel training in percentage of 16%. At the
opposite, the patients gave a low importance to the private co-payment system, private offices inside public
hospitals and the implementation of the European directive on movements of patients (Table 5). Most
respondents have stated that the value of payments are insignificant and doesn't really help the public health
system in Romania and private offices must be separated from the public. They mentioned the preference to
treat inside the country only if the medical system allows this and give them the necessary treatment. The last
question of the questionnaire aimed the influence established between the public health system in Romania and
the system of political governance. For the last question, most of the respondents agreed that there is evident
relation between the two aspects mentioned and considered that the policy makers can influence the level of
satisfaction and can improve the quality of medical system with correct strategies applied. (Table 6)

Table 6. Is public health system influenced by political actors?

Yes, I agree I don’t know

78% 22%
Conclusion
I can clarify that I managed to capture issues that were not addressed in the questionnaire and I have
summarized this:
• Old equipment in the emergency units;
• Insufficient beds and baths service;
• Insufficient space for treating patients;
• Unfinished repairs in the emergency hospitals;
• Outside green spaces with weeds;
• Sheer number of attendants for only one patient;
• The lack of cleanliness.
876 Celia Dana Beșciu / Procedia Economics and Finance 32 (2015) 870 – 877

General conclusion

Patient satisfaction remain an important element of the medical system performance and should be
evaluated constantly. The quality of medical services affect directly the level of patient satisfaction and is not
influenced only by the level of economic development. In the present study, the level of patient satisfaction is
correlated with experienced doctors, the physician ability to resolve as quick as possible their medical
emergencies and emergency hospitals close to home. Only one hypothesis has been confirmed, because patients
involved in the study said that their satisfaction is not influenced only by the doctor attention and the level of
communication. Study participants expressed in general a good level of satisfaction but did not have the
courage to express directly disagreement for fear of not being treated appropriately. It is necessary to enhance
controls and to be implemented continuous monitoring systems to increase the patient satisfaction.

Acknowledgements

This work was co financed from the European Social Fund through Sectoral Operational Programme
Human Resources Development 2007-2013, project number POSDRU/159/1.5/S/134197 „Performance and
excellence in doctoral and postdoctoral research in Romanian economics science domain”

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