Evaluation of impact of COVID-19 precautionary measures and quality of services on the patient satisfaction in outpatient private clinics

Abstract

The general satisfaction of patients and population about healthcare services is an indicator measurement that provides a meaningful perception of population opinion about performance of healthcare system. To study the impact of COVID-19 precautionary procedures and quality of healthcare services on patients’ overall satisfaction in the Jordanian outpatient private clinics. Quantitative observational cross-sectional study was carried out targeting patients who received medical care in private clinics in Irbid/Jordan. Linear Regression was employed to perform the data analysis. A random sample of 400 respondents participated in a questionnaire. Results revealed that COVID-19 precautionary procedures and quality of healthcare services had an impact on overall patient satisfaction. The level of patient satisfaction was high across all domains examined. That means that all the producers and policies put in place during the pandemic were beneficial to patients. It is recommended that these precautions be maintained until the COVID-19 pandemic has passed. Patient satisfaction measurements give managers a more responsive system of health care delivery in response to patient wants and desires.

IMPACT statement

The paper investigates the impact of COVID-19 precautionary measures and service quality on patient satisfaction in outpatient private clinics. It examines how measures such as mask mandates, social distancing, and hygiene protocols affect patient perceptions of care. Additionally, it assesses the role of service quality factors like wait times, communication with healthcare staff, and overall patient satisfaction. The study employs quantitative methods to gather data, such as surveys and statistical analysis of patient feedback. Results provide insights into how healthcare providers can maintain or improve patient satisfaction amidst pandemic-related changes.

Keywords:

• COVID-19 precautionary procedures
• quality of services
• overall Patient’s satisfaction
• private clinics
• and Jordan

REVIEWING EDITOR:

• Huifen (Helen) Cai, Middlesex University Business School, United Kingdom

SUBJECTS:

• Health and Safety
• Health & Development
• Middle Eastern Cultural Studies
• Health & Society
• Health Conditions
• Public Health Policy and Practice

Introduction

Patient satisfaction is a multidimensional concept that reflects a patient’s experiences in the healthcare system when seeking medical care (Algudairi et al., 2018). Patient satisfaction is a critical element in the healthcare system, which provides significant metrics to measure different items such as technical, provision of services, and structural of quality. The satisfaction has become the main concern for different developing and developed countries and is used as a tool to measure the performance of the healthcare system, which has been defined as an essential part of term of service quality (Stepurko et al., 2016).

The focus on patient satisfaction leads to an increase in the importance of different issues related to the healthcare system which include patient-centered care, efficient providing of healthcare services, and improvements interventions. In addition, patient satisfaction has found to have a strong relationship with the performance of hospitals, clinics, and healthcare providers in delivering the healthcare services effectively and efficiently (Boudreaux & O’Hea, 2004; Kane et al., 1997).

During the outbreak of COVID-19, it is becoming the main concern for the healthcare system worldwide. Identifying criteria to evaluate patient satisfaction during this period has gained valuable importance due to its effect on patient’s treatment and health. Amin et al. (2020) studied the effects of COVID 19 on psychological well-being in Pakistan. He established the criteria that related to the psychological effect of COVID-19 and found people’s awareness of these criteria helps to reduce the negative psychological impact of this pandemic.

According to Shirazi et al. (2020), they suggested using Fuzzy the Analytic Hierarchy Process (AHP) and The Preference Ranking Organization Method for Enrichment Evaluation (PROMETHEE) approaches for improving the quality of services and increasing patient satisfaction during an outbreak like COVID 19. These scholars studied 8 hospitals that applying 10 criteria (Tangibility, Reliability, Responsiveness, Assurances, Empathy, Professionalism, Admission, Agility, Resilience, Updating) to evaluate patient satisfaction during the period of COVID-19 and resulted that some of these hospitals succeeded in achieving high-quality service delivery and increasing patient satisfaction during the Coronavirus pandemic (Shirazi et al., 2020).

Recently, the need for high-quality healthcare services has increased and has become a major interest for both the public and private sectors (Amin et al., 2013). As a result, patients are willing to pay more for hospitals that provide a high-quality service (Bamfo & Dogbe, 2017). Patients are the main and essential capital for the healthcare organization and maintain its sustainability and satisfying their patients, the healthcare services should be meet a high level of quality in each level of process (Alhashem et al., 2011; Arasli et al., 2008).

At the beginning of the COVID-19 outbreak, the Jordanian government has applied the recommendations and precautionary procedures provided by the WHO. Different strategies and regulations have taken to reduce the spread of COVID-19 at the local and international levels in Jordan. This crisis forced Jordan to close all industries and sectors, which the number of people infected was increasing from outside and inside the country and as result, quarantine imposed.

In the recent period, the increase of COVID-19 patients led to raising pressure on hospitals, especially the public sector. Therefore, clinics closed, and all medical services stopped in the public hospitals and transferred exclusively to treat Corona patients. Consequently, the demand for private clinics increases by patients, and many issues emerged through this period; different unstructured interviews conducting and revealed that there were several complaints raised regarding services provided by private clinics. Besides, the private health sector in Jordan is one of the sectors that suffer from a lack of interest in studying issues related to service provision, health performance, and patients. So, the main objective of this paper is to examine the impact of COVID-19 precautionary procedures and quality of services on patient satisfaction in outpatient private clinics. Thus, we hypothesize:

H1:

There is a relationship between COVID-19 precautionary procedures and the patient satisfaction in Jordanian privet clinics.

H2:

There is a relationship between the quality of services and patient satisfaction in Jordanian privet clinics.

Method

Study population

The population of this research included people from Jordan who sought medical care at private clinics located in Irbid.

Sample type

Convenience sampling was used as the distribution approach for this non-probability sample.

Study design

The present study used a quantitative approach to conduct correlational cross-sectional research, specifically employing a cross-sectional survey approach. A total of 400 patients who sought medical care at privately owned clinics participated in a self-administered survey aimed at assessing levels of patient satisfaction.

Data collection

A survey using a self-administered (in-person) questionnaire employing a Likert scale format was provided to a sample of 400 individuals from Jordan who were 18 years of age or older.

Scale and measures

The survey instrument had five distinct components. The first portion covers demographic data, including variables such as age, gender, income, educational attainment, nationality, resident status, and clinic type. The subsequent parts provided details about the independent variables, including theCOVID-19 precautionary procedures, and healthcare services quality, in the second, third, and fourth sections, respectively. The fourth section of the study included details pertaining to the dependent variable, namely patient satisfaction.

Validity and reliability

The questionnaire was created and approved following a review of several appropriate publications. Examining the questionnaire’s validity and dependability through expert validation testing and piloting.

Data analysis

Statistical analysis strategy

The statistical program SPSS 22.0 was used for the purpose of running the analysis, encompassing descriptive statistics, Cronbach’s alpha, and the examination of connections between variables.

Ethical consideration

The researcher obtained approval from the Institutional Review Board of Jordan University of Science and Technology (JUST) in May 2021 to proceed with the study. Confidentiality and privacy are emphasized at every stage of the data collection and processing procedures.

Results analysis

Reliability test

A Cronbach Alpha generated for each dimension to assess internal consistency and ensure the questionnaire’s reliability. Cronbach Alpha in this study ranged from 0.890 to 0.999, as indicated in Table 1, all alpha values are clearly high, indicating that the items are highly associated and thus consistent for each measure of variable.

Table 1. Cornbrash’s Alpha for study ‘dimensions.

Variable	Cronbach’s Alpha
COVID-19 precautionary- procedures	.894
Quality services	.934
Overall patient’ satisfaction	.951

Validity test: correlation method

Table 2 presents the strength of the relationships among the variables under investigation. Significant positive correlations were observed between the epidemic precautionary procedures and patient satisfaction (r = 0.555**, p = 0.000), the quality of services and patient satisfaction (r = 0.615**, p = 0.000), as well as epidemic precautionary procedures and the quality of services (r = 0.597**, p = 0.000). The findings demonstrate that the correlations observed were consistently low, suggesting that the presence of multi-collinearity is not a concern within the scope of this research.

Table 2. Pearson Correlation.

Correlations
		COVID-19 precautionary- procedures	Quality services	Overall patient’ satisfaction
COVID-19 precautionary- procedures	Pearson Correlation	1
Quality services	Pearson Correlation	.597**	1
Overall patient’ satisfaction	Pearson Correlation	.555**	.615**	1

**. Correlation is significant at the 0.01 level (2-tailed).

Table 3 demonstrates the socio-demographics of the participants. 400 participants filled out the questionnaire, In terms of age, 169 (42.3%) of the respondents were between the ages of 18 and 28. The sample consisted of 296 females and 104 males (76% and 26%, respectively). More than Two-thirds of the respondents (68.3%) of the population had an average monthly income of less than 500 JD. While most of the respondents (57.3%) hold a bachelor’s degree, and above three quarter of them (78.5%) had resident in Irbid. Furthermore, the percentage of patients seeking medical care at specialist clinics was higher (54.5%) in comparison to other types of clinics.

Table 3. Demographic Characteristics.

Variable			Frequency	Percent %
Age (years)		18-28	169	42.3
		29-39	145	36.3
		40-50	71	17.8
		51-60	10	2.5
		61-70	3	.8
		71-80	2	.5
		Total	400	100.0
Gender		Male	104	26.0
		Female	296	74.0
		Total	400	100.0
Income (JD)		<500	273	68.3
		500-1000	89	22.3
		1000-1500	13	3.3
		<1500	5	1.3
		Missing	20	5.0
		Total	400	100.0
Education	Secondary school		98	24.5
	Bachelor		229	57.3
	Master		25	6.3
	PhD		4	1.0
	Diploma		38	9.5
	Missing		6	1.5
	Total		400	100.0
Nationality		Jordanian	371	92.8
		non Jordanian	29	7.3
		Total	400	100.0
Residency		Irbid	314	78.5
		Amman	51	12.8
		Ajloun	23	5.8
		Jerash	1	.3
		Almafaq	11	2.8
		Total	400	100.0
Clinic type		GP	76	19.0
		Specialization	218	54.5
		Dental	104	26.0
		Missing	2	.5
		Total	400	100.0

Descriptive analysis of variables

Based on the Table 4, the average and standard deviation for each of the predictor variables are as follows: COVID-19 precautionary procedures (μ = 4.078, SD =.957) with high degree, Quality services (μ = 3.850, SD =.982) with high degree and Overall patients’ satisfaction (μ = 4.186, SD =.735) with very high degree.

Table 4. Descriptive Statistics.

No	Dimensions	Mean	Std. Deviation	Classification	Rank
1	COVID-19 precautionary procedures	4.078	.957	High	2
2	Quality services	3.850	.982	High	3
3	Overall patients’ satisfaction	4.186	.735	Very high	1

Descriptive analysis of COVID-19 precautionary - procedures (CPP-19)

As presented in Table 5, the mean score for those indicators ranged from 3.86 to 4.24, reflecting the agreement level toward these items. For example, most of the responses revealed that CPP-19/2 (facemask wearing) was a common feature of COVID-19 precautionary-procedures variable. The SD is used to see the amount dispersion of the mean’s data; the values of SD were ranged between 1.048 - 1.328.

Table 5. Mean and SD of CPP-19 (Reviewer 1).

Item	Item code	Statement	Mean	Std. Deviation
CPP-19 (COVID-19 Precautionary Procedures)	CPP-19/1	Namely proper hand washing (i.e. use solid or liquid soap to wash hands)	4.11	1.143
	CPP-19/2	Face mask wearing	4.24	1.048
	CPP-19/3	Social distancing (i.e. keep a one-meter distance from others	3.86	1.328
	CPP-19/4	Avoiding touching one’s eyes, nose, and mouth	3.95	1.106
	CPP-19/5	Carrying hand sanitizer when going out (herein after carrying hand sanitizer).	4.22	1.069
Average			4.076	1.138

Descriptive analysis of quality service (QS)

As presented in Table 6, the mean score for those indicators ranged from 3.82 to 3.89, reflecting the agreement level toward these items. For example, most of the responses revealed that QS1 (Has an excellent overall service) was a common feature of quality services variable. The SD is used to see the amount dispersion of the mean’s data; the values of SD were ranged between 1.048-1.109.

Table 6. Mean and SD of QS.

Item	Item code	Statement	Mean	Std. Deviation
QS (Quality Services)	QS1	Has an excellent overall service	3.89	1.068
	QS2	Has a service of very high quality?	3.85	1.048
	QS3	Provides a high standard of service	3.84	1.072
	QS4	Delivers superior service in every way.	3.82	1.109
Average			3.85	1.074

Descriptive analysis of overall patient satisfaction (OPtS)

As presented in Table 7, the mean score for those indicators ranged from 4.05 to 4.28, reflecting the agreement level toward these items. For example, most of the responses revealed that OPtS5 (My doctor shows respect to what I have to say) was a common feature of overall patient’s satisfaction variable. The SD used to see the amount dispersion of the mean’s data; the values of SD ranged between. 792-.959.

Table 7. Mean and SD of OPtS.

Item	Item code	Statement	Mean	Std. Deviation
OPtS (Overall Patient Satisfaction)	OPtS1	I am satisfied that my doctor has been taking care of me.	4.24	.811
	OPtS2	My doctor explains the reason(s) for any medical test.	4.20	.845
	OPtS3	My doctor explains things in a way that is easy for me to understand.	4.21	.837
	OPtS4	I am confident of my doctor’s knowledge and skills.	4.27	.792
	OPtS5	My doctor shows respect to what I have to say.	4.28	.819
	OPtS6	My doctor listens carefully to me.	4.26	.861
	OPtS7	My doctor really cares about me as a person.	4.20	.958
	OPtS8	My doctor encourages me to talk about all my health concerns	4.06	.959
	OPtS9	My doctor spends enough time with me.	4.09	.951
	OPtS10	I would like my doctor to be present in any medical emergency situation	4.05	.955
Average			4.186	.886

Regression analysis

To answer the first hypothesis, the below model in Table 8 shows a significant positive effect of COVID-19 Precautionary Procedures on Patient Satisfaction. Overall, a high level of COVID-19 precautionary measures was associated with higher patient satisfaction (β = .555, p= <0.001).

Table 8. COVID-19 Precautionary Procedures Coefficient Analysis.

Model		Unstandardized Coefficients		Standardized Coefficients		t	Sig
		B	Std. Error	Beta
1	(Constant)	2.451	.134			18.276	.000
	COV_19	.426	.032		.555	13.295	.000

Dependent Variable: OPtS.

R²=.308.

According to the second hypothesis, Table 9 also shows a significant positive effect of Quality of healthcare services on Patient Satisfaction. So, Quality Services were positively correlated with patient satisfaction (β =.615, p= <0.001), which means that existence of high level of quality services resulted in improved patient satisfaction.

Table 9. Quality Services Coefficient Analysis.

Model		Unstandardized Coefficients		Standardized Coefficients	t	Sig
		B	Std. Error	Beta
1	(Constant)	2.415	.117		20.568	.000
	QS	.460	.030	.615	15.565	.000

a. Dependent Variable: OPtS.

b. R²=.378.

Discussion

Findings from this research indicate that COVID-19 precautionary procedures and healthcare service quality positively influenced patient satisfaction. As like the prior studies, that revealed when patients maintained and observed a social distancing in different places in the health care facilities such as the registration place, waiting area, laboratory, or pharmacy, as precautionary procedures of COVID-19, were significantly associated with patient satisfaction (Ahmed et al., 2018; The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team, 2020). Therefore, when patients become aware of existing prevention policies, and they can obtain one of them in the healthcare facilities where they are treated that lead to becoming satisfied. For example, when patients get sanitizer and alcohol for hand cleaning at the entrance of the healthcare facility, which considered as control and prevention protocol of COVID-19 infection was found positively associated with patient satisfaction (Berkowitz, 2016; Deriba et al., 2020).

Similarly, with Gómez-Carmona et al. (2021), who approved that there was a statistical relationship between COVID-19 prevention protocol and patient satisfaction, the results of the study revealed that when there is confidence in the safety procedures established for protection against COVID-19, the greater the patient’s satisfaction with the health facility. In addition, the research of Guenzi et al. (2009) showed that when patients trust the health services provided, this will foster their commitment to treatment, or any other practices taken by the healthcare organization. Consequently, a higher level of patient satisfaction will be achieved.

As mentioned before, patient satisfaction is the most important factor to evaluate the quality of healthcare services provided (Amin & Nasharuddin, 2013; Gupta & Rokade, 2016; Jandavath & Byram, 2016). Health care service quality and patient satisfaction are positively related to each other, indicating that patients are satisfied due to health service quality. The results are consistent with previous studies, such as Al-Damen (2017), which demonstrated that service quality has a statistically significant impact on overall patient satisfaction. Also, similar to the present results and consistent with the result noted by Diab (2012), correlations and multiple regression approaches exhibited that there is a significant statistical relationship between service quality and patient satisfaction.

According to Belaid et al. (2015), they conducted a study in a public hospital in the city of Becher to evaluate the effect of health service quality on patient satisfaction, and the results showed that there was a relationship between service quality and patient satisfaction. From another point of view, Cronin and Taylor (1992) also discovered a strong causal relationship between public service quality and patient satisfaction. Also, Al-Zamil et al. (2012) evaluated the impact of health service quality on patient satisfaction in private and public Jordanian hospitals, their results indicated that the quality of health care had an impact on patient satisfaction. The current results are comparable to the literature that has demonstrated the relationship between health care service quality and patient satisfaction, indicating a direct relationship that expresses; the higher the perceived quality of healthcare service, the more salient is patient satisfaction (Bakan et al., 2014; Leisen Pollack, 2008).

According to Rao et al. (2006), in the state of Uttar Pradesh, India’s most populous state, they assessed inpatients and outpatients who visited primary health centers, community health centers, district hospitals, and female district hospitals, the results of patients’ perceptions of service quality found that there was a statistically significant relationship with patient satisfaction. A similar relationship was found by Kumari et al. (2009), who conducted a study in outpatient clinics that identified doctors’ behavior as a dimension of quality care and found this dimension highly correlated with patient satisfaction. In addition, Zaim et al. (2010) indicated that service quality in hospitals is considered an important principle to measure patient satisfaction in Turkey, which confirmed that the dimensions of quality were significant to patient satisfaction. Additionally, according to Alrubaiee and Alkaa’ida (2011) and Ramez (2012) studies, patient satisfaction had a high and positive association with patient perceptions of quality healthcare.

In general, previous work showed that patient satisfaction and health service quality should be combined to ensure the sustainability and stability of a health care organisation (Anirban, 2011). Furthermore, achieving a high level of quality aids in meeting patients’s needs and standardising health care facilities (Badri et al., 2008). So, there is a need to identify the basic standards and principles of service quality to attain a high level of patient satisfaction, which is considered a pre-requisite for long-term survival in a competitive environment (Komashie et al., 2007). However, the current research has limitations that should be considered when interpreting the results. Firstly, as a case study, this study was limited to private clinics in Irbid, limiting the generalisation of the findings. Second, this study was conceived from the standpoint of the patient. In future works, we suggest using a systematic observation methodology. It should also target a broader range of outpatient practice types, resulting in a larger sample size of patients and staff. Given how important patient interactions with staff members are, greater research is needed into the relationship between employee communication patterns and their impact on patient relationships.

Since Jordan’s private healthcare sector is expanding in a competitive healthcare market, managers must stand out as a signal to improve the perceived quality of healthcare services. This study is valuable to healthcare providers because it provides a tool for measuring patient satisfaction that can aid in the provision and management of healthcare services, as well as in increasing and sustaining service quality.

Conclusion

Given these results, we conducted a study to examine the beneficial impact of implementing COVID-19 preventive measures on patient satisfaction. Consequently, it was shown that patients generally experience satisfaction while receiving care from private clinics that strictly follow the COVID-19 preventative control plan. Similarly, when patients are provided with treatments of exceptional quality, they are more likely to experience higher levels of satisfaction. Hence, evaluating patient satisfaction with healthcare services has the potential to enhance the overall effectiveness of the healthcare system. This research reinforces the idea that patient satisfaction should not be regarded as an isolated characteristic. The importance of measuring patient satisfaction and understanding the correlation between numerous factors should not be overlooked.

Acknowledgment

The authors are grateful to Jordan University of Science and Technology (JUST) for the approval and facilitating the task of performing this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Main Naser Alolayyan

Main Naser Alolayyan PhD, is a management professional and an academic in the field of healthcare operational flexibility management, healthcare quality management with a focus on the health services and hospital management research. His research works have appeared in journals such as Total Quality Management and Business Excellence, International Journal of Organizational Analysis, The Asian Journal on Quality and International Journal of Productivity and Quality Management. His primary research interests include total quality issues, operational flexibility, organizational performance measurement, service quality and service management. He is currently working as Associate Professor and The chairman of the health management and policy department in Jordan University of Science and Technology, Faculty of Medicine

Haneen Mahyoub AlFaraj

Haneen Alfaraj is a promising new researcher who brings fresh perspectives and enthusiasm to the field of healthcare management. With a background reflecting a blend of academic excellence and practical experience, my research interests span various areas, including healthcare management, organizational behavior, and public health. My approach to research involve innovative methodologies, a commitment to rigorous analysis, and a focus on addressing real-world challenges. As a newcomer, I am seeking to make meaningful contributions to my filed, establishing as a valuable voice and contributing to the advancement of knowledge in my chosen domain. Haneen Al-Faraj, with a Bachelor’s in Healthcare Management and Policy and a Master’s in Healthcare Management and Quality, is a researcher with interests span healthcare management, education programs, and health policies researches. Currently, I am working as full-time lecturer at the health management and policy department in Jordan University of Science and Technology, Faculty of Medicine