Article

Research

Patient satisfaction with post-operative surgical

services and associated factors at Addis Ababa City
government tertiary hospitals’ surgical ward, cross-
sectional study, 2022

Ermias Algawork Kibru, Yidnekachew Girma Mogessie, Abel Alemayehu Regassa, Kirubel Tesfaye Hailu

Corresponding author: Ermias Algawork Kibru, Addis Ababa University, College of Health Science, Addis Ababa,
Ethiopia. ealgawork@gmail.com

Received: 18 Feb 2023 - Accepted: 06 Jul 2023 - Published: 30 Aug 2023

Keywords: Patient satisfaction, surgical ward services, information provision, post-operative complications

Copyright: Ermias Algawork Kibru et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article
distributed under the terms of the Creative Commons Attribution International 4.0 License
(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited.

Cite this article: Ermias Algawork Kibru et al. Patient satisfaction with post-operative surgical services and associated
factors at Addis Ababa City government tertiary hospitals’ surgical ward, cross-sectional study, 2022. Pan African
Medical Journal. 2023;45(189). 10.11604/pamj.2023.45.189.38416

Available online at: https://www.panafrican-med-journal.com//content/article/45/189/full

Patient satisfaction with post-operative surgical School of Public Health, Baltimore MD, USA, 3Johns
services and associated factors at Addis Ababa Hopkins Carey Business School Baltimore MD,
City government tertiary hospitals' surgical ward, USA, St Paul's Hospital Millennium Medical
cross-sectional study, 2022 College, Addis Ababa, Ethiopia, 5Jimma University,
Institute of Health, Faculty of Medical Science,
Ermias Algawork Kibru1,&, Yidnekachew Girma Jimma, Ethiopia
Mogessie2,3, Abel Alemayehu Regassa1, Kirubel
&
Tesfaye Hailu4 Corresponding author
Ermias Algawork Kibru, Addis Ababa University,
1
Addis Ababa University, College of Health Science, College of Health Science, Addis Ababa, Ethiopia
Addis Ababa, Ethiopia, 2Johns Hopkins Bloomberg
Article
Abstract patients' calls (r = 0.498, p = 0.000). Post-operative
patient satisfaction with surgical ward nursing
Introduction: patient satisfaction is an attitude service, physician service, hospital facilities, and
resulting from a person's general orientation the provision of information about post-op
towards the total experience of health care. The complications explain about 40.9 percent of the
study was done with the aim of evaluating post- variation in the overall patient satisfaction with
operative patient satisfaction level with the quality post-op care provided at the surgical ward. Patient
of service provided at the surgical wards; satisfaction with nursing service has more
determining how much factors related to significant effect with overall patient satisfaction
physicians, nursing, laboratory, and information than the other variables (β = 0.266, p =0.0002).
provision service influence satisfaction level; and Conclusion: post-operative patients at Addis
determining factors impacting patient satisfaction Ababa City Government Tertiary Hospitals
level. Methods: a hospital-based quantitative expressed a very high degree of satisfaction with
cross-sectional study design was conducted in six the care they received in the surgical wards. The
Addis Ababa City Government tertiary hospitals study also found that patients were generally less
from November 4th to December 13th, 2022. satisfied with the information they were given on
Patients who had major operations done at the drugs, side effects, and available treatment
government hospitals from November 21st to options. Another factor identified in the study that
December 5th, 2022, were included in the study caused unhappiness was the unavailability of some
population. A pre-tested, structured, and Amharic- pharmacy and laboratory services.
version questionnaire was used to interview
patients. A bivariate and multivariate logistic Introduction
regression model was used to identify the variables
that had an association with the dependent Patient satisfaction is multifaceted and a very
variable. P-values less than 0.05 were considered challenging outcome to define. It seems easy to
statistically significant. Results: a total of 287 understand but hard to define. Satisfaction is not a
patients participated in the research, providing a pre-existing phenomenon waiting to be measured,
response rate of 95%. Of the total participants, but rather a judgment people make reflecting
144 were males (50.8%) and 143 were females their experience under specific circumstances. A
(49.5%). The overall patient satisfaction level with simple and practical definition of satisfaction
surgical ward service is 96.2%. The level of patient would be the degree to which desired goals have
satisfaction with nursing services is 94.8%, with been achieved [1]. Patient satisfaction is important
physician's services it is 98.6%, with the facility it is as it will result in patient participation in health
92.3%, and with the provision of information about care and treatment affairs. Nowadays, patient
post-operative complications it is 69.7%. Those satisfaction in health centers is recognized as a key
who have above-first-degree educational status indicator reflecting the efficiency of the
are less satisfied (66.7%) than patients with other organization [2].
levels of educational status. Only the patients'
residency showed a small level of association Traditionally, consumer satisfaction has been
(r= 0.145, p=0.014) with overall patient afforded a high level of importance in commercial
satisfaction with surgical ward service among the and market research. Similarly, there has been a
demographic components. The two variables that growing interest in the measurement of patients'
are strongly correlated with patient satisfaction satisfaction in health care research. A number of
are the adequacy of the time ward nurses spent studies show that hospitals with more satisfied
with patients during evaluation and treatment (r = patients generally provide higher-quality care as
0.503, p = 0.000) and adequate nurses' response to measured by standard quality metrics [3]. A meta-
analysis of 15 studies done by Muluget H et al.

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about patient satisfaction with nursing care in Methods
Ethiopia estimated the pooled level of patient
satisfaction with nursing care in Ethiopia at 55.15% Study design and period: a hospital-based cross-
(95% CI: 47.35, 62.95). Based on the sectional study was conducted in six surgical wards
subgroup analysis, the estimated level of of Addis Ababa City Government Tertiary Hospitals
satisfaction in Addis Ababa was 54.24% (95% CI: from November 4th, 2018 to December 13 th, 2022.
46.84, 61.65) [4]. According to this study, patient
satisfaction was influenced by the patient's history Study setting: this study was conducted at six
of admission, residence, availability, and skill of Addis Ababa City government tertiary hospitals,
the assigned nurse, as well as the presence of the surgical wards of which were purposefully
other diseases [4]. chosen out of the tertiary-level government
hospitals found in Addis Ababa for reasons of
According to a cross-sectional study conducted at accessibility and less bureaucratic red tape. These
Jimma University Specialized Hospital by are Yekatit 12 Hospital and Medical College
Woldeyohanes TR et al., 61.9% of patients were (Yekatit 12), Zewditu Memorial Hospital (Zewditu),
overall satisfied with their in-patient care. The Menelik II Hospital, Tikur Anbessa Specialized
patients in medical wards were less satisfied than Hospital (TASH), St. Paul Millennium Medical
those in other departments. Patients with no College (SPMMC), and St. Peter Specialized
formal education and patients from rural areas Hospital (St. Peter), which are located in the
were more satisfied than their counterparts. Most nation's capital, Addis Ababa. These hospitals are
of the patients were dissatisfied with the nursing, among Ethiopia's largest referral and tertiary-level
pharmacy, and laboratory services, the level of hospitals.
health education given, and the communication
and information they received about their illness. Participants: the study population includes all
while others complain about the crowdedness of adult patients who had a major operation in one
rooms, privacy, confidentiality, and restricted of the six hospitals listed above between
visiting hours [5]. November 21st and December 5th. Based on
information obtained from each hospital, the
Abera RG et al. conducted a cross-sectional study average number of surgeries performed during the
at Tikur Anbessa Specialized Hospital and found data collection period is 250 in TASH and St. Paul
that 59.7% of patients were satisfied with the and 125 in the remaining hospitals.
clinical laboratory services provided. Patients were
highly dissatisfied with the location of the Inclusion and exclusion criteria
laboratory, latrine accessibility and availability,
latrine cleanliness and comfort, the waiting time Inclusion criteria: patients aged ≥18 years and
for specimen collection, and the whole availability who had major surgery, patients who have been
of requested tests [6]. This study aims to assess operated at least 2 days prior, patients who are
patient satisfaction level with post-operative voluntary to participate in the research
surgical services at Addis Ababa City Government
Tertiary Hospitals. It will assess the relationship Exclusion criteria: patients aged <18 years, patient
between patient satisfaction level with nursing whose post-op duration is less than 2 days,
services, physicians, facilities and information Patients with post-op duration of greater than 2
provision about post-operative complications. days but unconscious, Patients who are not
voluntary to participate in the research

Data source/measurement: the data was

collected using pretested, structured

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questionnaires, with samples selected using availability when needed Factors related to
simple random sampling. Primary data is used for postoperative management by hospital facility:
the purpose of data collection in this study. The Cleanliness of wards/beds, cleanliness of bathing
primary data is gathered using questionnaires room, cleanliness of toilet, adequacy of food and
from a randomly selected sample of individual water, quality of food, accessibility of pharmacy
post-operative patients found in surgical wards. A and laboratory, cost for medications and
pre-tested, structured, and Amharic-version investigation Factors related to information
questionnaire was used to interview patients 24 provision about postoperative complications and
hours after their operation and after they were treatment options: Pain, Post-operative nausea
fully awake. The questionnaire was pre-tested and and vomiting, sore throat, discomfort, depression,
verified to be valid in other research done in hunger, thirst, bleeding, re-operation, and death
Gondar. To ensure the quality of the data
collected, training was provided for the data Dependent variable: proportion of patients who
collectors, and the investigators directed and would say they were satisfied
monitored the whole data collection process for
consistency, completeness, and accuracy. Statistical analysis: the data obtained from the
questionnaire were collected, stored, and
Study size: sample size (n) is determined based on analyzed using Epi data version 2.9 and SPSS
the assumption of 55% prevalence, expected version 23.0 software. A P-value of <0.05 was
margin of error (d) 0.05 at 95% confidence interval considered statistically significant. Categorical data
(Z8/2). n becomes 380. After correction formula obtained were summarized using counts and
(Nadj= n/1 + n/N) is employed to adjust for the percentages while continuous variables were
total population of <10,000, the final sample size summarized using mean and median. Bivariate
has become 302. Then, the sample size is going to analysis with chi-square and Multivariate
be proportionally allocated to each hospital regressional analysis was done.
surgical ward. Systemic random sampling method
is going to be used to select study subjects from Bias: one potential source of bias in this cross-
the patients. sectional study could be selection bias. If the study
only involved patients who were willing to
Study variables participate and complete the survey, there could
be a selection bias towards patients who had more
Independent variables: socio-demographic positive experiences with surgical services.
variables: age, sex, address, educational Patients who have had negative experiences may
background, marital status, monthly income level, choose not to participate or complete the survey,
general health status (co-morbid diseases), leading to an overrepresentation of positive
frequency of hospital visit, frequency of operation responses.
Factors related to postoperative management by
nurses: skill, sympathy for patients, maintaining Efforts to address the potential source of bias: to
privacy, respect during communication, prompt address this potential source of bias, the
response to patient call, information about patient researchers could use a random sampling
health status or progress, clear information about technique to select participants for the study. By
the investigations, spending adequate time with randomly selecting participants from a larger pool
patient during treatment, adequate care at night of patients who have undergone surgery at the
Factors related to postoperative management by hospital, the study sample will be more
physicians: confidence in the skill of physicians, representative of the entire patient population.
showing a caring attitude, maintaining privacy, The researchers could also use incentives to
communicating in an understandable way, encourage participation from a broader range of

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patients and increase response rates. Additionally, 70% of the patients reside in urban areas, while
the survey could be designed to include questions about 22% come from rural areas. Nearly half of
that capture both positive and negative the participants are half-time or full-time workers,
experiences, so that the researchers can gain a full while about 1/5th of the participants are
picture of patient satisfaction with the surgical unemployed (Table 1). The descriptive statistics
services. for the variables are presented in Table 2. The
average score from the 5-point Likert scale with 5
Ethical considerations: ethical clearance for the as "very satisfied" and 1 as "very dissatisfied" for
study was requested and obtained from Addis all the variables was computed to show the
Ababa University, College of Health Science, proportion of the respondents that were either
School of Public Health research ethical committee satisfied or dissatisfied with the items of the
with Institutional Review Board (IRB) number of variables. Where the mean for the variable is more
022/057/SPH. The objective of the study was than half of the 5-point Likert scale (i.e., 2.5), the
explained to every participant, and it was only respondents are satisfied, and where the mean for
after they gave their full informed consent that the the variable is less than half of the 5-point Likert
data was collected. No person was obliged to scale (i.e., 2.5), the respondents are dissatisfied.
participate without their consent. Moreover,
participants have been assured that no damage Outcome data
would be inflicted on them because of their
participation in this particular study by explaining The overall patient satisfaction level with surgical
to them the apparent purpose of the study which ward service is 96.2%. The level of patient
is for academic purposes. Any information satisfaction with nursing service is 94.8%; with
obtained is and will be kept confidential. physician service, it is 98.6%; with the facility, it is
92.3%; and with post-op complication information
Funding sources: this research did not receive any provision, it is 69.7%.
specific grant from funding agencies in the public,
commercial, or not-for-profit sectors. Main Results

Overall patient satisfaction was reported to be the

Results highest in Zewditu Memorial Hospital (100%) and
the lowest in TASH, with a satisfaction level of
Socio-demographic profile of the respondents
93.1%. Males are more satisfied with surgical ward
A total of 287 patients participated in the service than females (96.5% vs 95.8%). 96.6% and
research, providing a response rate of 95%. The 96.5% of patients who come from semi-urban and
data was collected from 6 Addis Ababa City urban areas respectively are satisfied with the
Governmental Tertiary Hospitals. Of the total overall service provision at the hospitals. 94.6% of
participants, 144 were males (50.8%) and 143 those from rural areas expressed overall
were females (49.2%). The mean age of the satisfaction. Those who have retired have a high
respondents is 40.42 ± 16.34 years. About 27.9% level of satisfaction with the surgical ward service
of the respondents have no formal education, (100%). Students are less satisfied than patients
while the rest of the respondents have attended at with other employment statuses with 89.5%
least primary level education. 40.8% of the expressing satisfaction. Those who have above-
respondents reported being in poor or very poor first-degree educational status are less satisfied
health status in the last 4 weeks before admission. (66.7%) than patients with other levels of
The mean period of waiting for surgery is 2.6 ± 6.3 educational status (Table 2). All components of the
months with a maximum waiting period of 6 years independent variables related to patient
and a minimum of 0 month - emergency. About satisfaction with nursing service, physicians,

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facilities, and information provision are satisfaction with the facility was 92.3%. The results
moderately correlated to overall patient indicated a high level of patient satisfaction that
satisfaction based on bivariate correlation analysis was also in line with the overall surgical ward
(Pearson correlation coefficient ‘r’ between 0.3 - postop patient satisfaction level. The results are
0.4, p between 0.0000 - 0.0002), except for two higher when compared to previous studies
variables. The two variables that are strongly done [6,11,15]. This could also be attributed to the
correlated with overall patient satisfaction are the hopeful attitude of the recovering postop patients.
adequacy of time ward nurses spent with patients The lowest satisfaction level was found with
during evaluation and treatment (r =0.503, p = regard to the provision of information about
0.000) and adequate nurses' response to a postop complications (69.7%). The level of
patient's call (r = 0.498, p = 0.000). On bivariate satisfaction found was lower when compared to
correlation analysis of the demographic findings in other studies [3,11]. The study also
information and overall patient satisfaction, no found males were slightly more satisfied with the
significant association was found between most of surgical ward service (96.5%) vs. females (95.8%).
the socio-demographic variables except for This result was in contrast with a study in Gondar,
residence. Patients' residency demonstrated a which found females more satisfied than males
small level of association (r = 0.145, p = 0.014) (93.6% vs. 88%) [8], and also with a study in TASH,
with overall patient satisfaction with surgical ward which found females more satisfied with services
service. As shown in Table 3 of the regression than males [9]. Patients with educational status
analysis, patient satisfaction with surgical ward above the first degree were found to be less
nursing service, physician service, facilities, and satisfied with the surgical ward service than others
the provision of post-op complication information (66.7%), which is also in line with another study in
explain about 40.9 percent of the variation in the Jimma that found satisfaction levels decreasing as
overall patient satisfaction with post-operative educational status increased [5]. The study found
care provided at the surgical ward. Patient patients from urban area are more satisfied than
satisfaction with nursing services has more those from rural area. This was in contrast to the
significant effect on overall patient satisfaction result found in the Jimma study, which stated that
than the other variables (β = 0.266, p =0.0002). patients in rural areas were more satisfied [5].

Discussion The study found no significant association

between socio-demographic information like age,
The study found that the overall patient gender, educational status, marital status, and
satisfaction level with the surgical ward's post- working status with overall patient satisfaction
operative care as 96.2%. The result is closer to with surgical ward post-operative care. Different
satisfaction levels found in some studies [7-11] studies support no significant association, whereas
which were greater than 90% but higher when others found some association between some of
compared to most studies done in Ethiopia and the socio-demographic variables and patient
worldwide [3,5,12,13]. This could be due to the satisfaction level [7,9,13,16]. Literature appears
fact that the study was conducted on recent post- mixed on the importance of patients' demographic
op patients who have seen some improvement and social factors in determining satisfaction.
from their previous health condition, leading them Nevertheless, the literature does shed some light
to rate the service with a positive attitude, as on how particular demographic factors affect
shown in some studies [14]. patient satisfaction. This study found a significant
association between residence and overall patient
The study found that the level of surgical ward satisfaction. The study found no significant
patient satisfaction with nursing service was association between the frequency of surgeries
94.8%, physician service was 98.6%, and and waiting period of surgery with post-op surgical

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ward patient satisfaction level. This result is in Limitations: while the study on post-operative
contrast to another study in eastern Ethiopia, care provides valuable insights into the recovery
which found a negative association between the process, the small sample size and narrow focus of
length of the waiting period for outpatient services the study limit its generalizability and do not
and satisfaction level [13]. This may be due to the provide a comprehensive understanding of the
participants of the study, being post-op patients, entire surgical care experience. Therefore, future
who give more significance to their surgery studies should include larger sample sizes and
completion than the waiting period they spent. explore the full range of experiences involved in
surgical care, including pre-operative preparation,
The study shows patient satisfaction with the surgical procedure itself, and the post-
physicians, nurses, facilities, and information operative recovery period. This would provide a
provision contributes about 40.9% of the variance more holistic view of the factors that influence
in overall patient satisfaction with surgical ward patients' overall satisfaction with their surgical
services. The components of those services show a care and help to identify areas for improvement in
significant association with overall patient the delivery of healthcare services.
satisfaction. In our study, the major areas of
patient dissatisfaction in post-operative patient Generalisability: of the findings from this cross-
management are: by nurses, the provision of sectional study on patient satisfaction with post-
information about the importance of investigation operative surgical services at tertiary hospitals in
(12.5%), the provision of information about side Addis Ababa may be limited to similar contexts.
effects of medications (13.2%); by physicians, the The study was conducted in government tertiary
availability of the responsible physician when hospitals in a specific geographic location, and the
needed; by facilities, the cleanliness of the latrines results may not be applicable to different cultural
(17.8%), the adequacy and quality of food and or socio-economic settings. The sample size may
water (15%), the accessibility of pharmacy and also have implications for the study's
laboratory facilities (22%), and the fairness of generalizability, and results may not be
medication and investigation costs (16.4%). These representative of all patients undergoing surgical
dissatisfaction levels are similar to other studies procedures in the country or region. However, the
conducted in Gondar [14]. But the results are study's use of validated instruments and
lower than a similar study in Jimma [5]. structured interviews enhances the credibility and
transferability of the findings, and the results
When compared to the other factors, this study provide valuable insights into the factors
found a high level of patient dissatisfaction with influencing patient satisfaction with post-
the provision of information about post-operative operative surgical services in similar settings.
complications. The results show patient
dissatisfaction with the provision of information Conclusion
about the risk of reoperation and death after
operation (38%), the risk of depression and The study revealed a high level of patient
treatment options after operation (36.6%), the risk satisfaction in Addis Ababa City Government
of hunger and thirst after operation (36.5%), the Tertiary Hospitals' surgical ward. The study found
risk of discomfort and relieving methods after a relatively lower level of patient satisfaction with
operation (35.2%), the risk of bleeding and the provision of information about medications,
treatment options after operation (33.8%), and complications, and treatment options. The study
the risk of sore throat and treatment options after also found some level of patient dissatisfaction
operation (31.4%). The results were significantly with the availability of pharmacy and laboratory
higher than similar results in other studies [3,11]. facilities in the hospitals.

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Table 1: socio-demographic characteristics of the respondents
Variables Category N N%
Sex Male 144 50.20%
Female 143 49.80%
Educational Background No formal education 80 27.90%
Primary(1-8) 82 28.60%
Secondary(9-12) 57 19.90%
Below college diploma 11 3.80%
College diploma 30 10.50%
First Degree 24 8.40%
Above First Degree 3 1.00%
Marital Status Single 68 23.70%
Married 203 70.70%
Divorced/Separated 6 2.10%
Widowed 10 3.50%
General Health Condition in Last 4 weeks Very Good 30 10.50%
Good 62 21.60%
Fair 78 27.20%
Poor 87 30.30%
Very Poor 30 10.50%
Residence Urban 202 70.40%
Semi Urban 29 10.10%
Rural 56 19.50%
Working Status Retired 18 6.30%
Unemployed 59 20.60%
Full time Student 19 6.60%
Home Maker 50 17.40%
Full time / Part time Worker 141 49.10%
Data Collection Site St Paul 74 25.80%
St Peter 35 12.20%
Menelik II 33 11.50%
Yekatit 23 37 12.90%
Zewditu 36 12.50%
TASH 72 25.10%

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Table 2: patient satisfaction level with socio-demographic information
overall patient satisfaction Level
Dissatisfied Satisfied
N N% N N%
Data collection site St Paul 2 2.70% 72 97.30%
St Peter 2 5.70% 33 94.30%
Menelik II 1 3.00% 32 97.00%
Yekatit 23 1 2.70% 36 97.30%
Zewditu 0 0.00% 36 100.00%
TASH 5 6.90% 67 93.10%
Gender Male 5 3.50% 139 96.50%
Female 6 4.20% 137 95.80%
Marital status Single 4 5.90% 64 94.10%
Married 7 3.40% 196 96.60%
Divorced/Separated 0 0.00% 6 100.00%
Widowed 0 0.00% 10 100.00%
Residence Urban 7 3.50% 195 96.50%
Semi Urban 1 3.40% 28 96.60%
Rural 3 5.40% 53 94.60%
General health condition in Last 4 weeks Very Good 0 0.00% 30 100.00%
Good 2 3.20% 60 96.80%
Fair 4 5.10% 74 94.90%
Poor 3 3.40% 84 96.60%
Very Poor 2 6.70% 28 93.30%
Working status Retired 0 0.00% 18 100.00%
Unemployed 1 1.70% 58 98.30%
Full time Student 2 10.50% 17 89.50%
Home Maker 1 2.00% 49 98.00%
Full time / Part time Worker 7 5.00% 134 95.00%
Educational background No formal education 3 3.80% 77 96.20%
Primary(1-8) 5 6.10% 77 93.90%
Secondary(9-12) 1 1.80% 56 98.20%
Below college diploma 0 0.00% 11 100.00%
College diploma 1 3.30% 29 96.70%
First Degree 0 0.00% 24 100.00%
Above First Degree 1 33.30% 2 66.70%

Table 3: regression analysis tables

Model Summary
Model R R Square Adjusted R Square Std. Error of the Estimate
1 .640a .409 .401 .66701
Predictors: (constant), patient satisfaction with facility, patient satisfaction with physicians service, patient
satisfaction with post-op complication information provision, patient satisfaction with nursing service
dependent variable: overall patient satisfaction level

Ermias Algawork Kibru et al. PAMJ - 45(189). 30 Aug 2023. - Page numbers not for citation purposes. 11