Impact of Frontline Staff’ Behaviors and Waiting Time on Patients’ Behavior in the Outpatient Departments (OPDs): A Cross-Sectional Study of Tertiary Care Hospitals

Syeda Baseerat Fatima  Jafri; Mirza Kashif Baig

doi:10.52633/jemi.v5i4.347

Authors

Syeda Baseerat Fatima Jafri Dow Institute of Business and Health Management, Karachi, Pakistan. Author
Mirza Kashif Baig Assistant Professor, Institute of Business and Health Management, Dow University of Health Sciences, Karachi, Pakistan Author

DOI:

https://doi.org/10.52633/jemi.v5i4.347

Keywords:

Healthcare Management, Healthcare Strategy, Patient-Centric Care, Quality of Care, Frontline Employees, Healthcare Organizations

Abstract

Healthcare is a crucial service whereby frontline workers' behavior and waiting time play more critical roles in the quality of the service than other services. As patients are exposed to a more unstable psychological state, their behavioral dissonances may hinder the quality of care provided. Employee patterns for both employees and patients are critical aspects of healthcare leadership and management alike. However, frontline employee behavior and waiting time domains are missing in the emerging economies context, especially in Pakistan, where these fundamentals of patients’ resulting behaviors, remained unexplored. This study, therefore, investigated the impact of frontline employees and waiting time on the patients' behavior. A quantitative, cross-sectional approach was applied with deductive logic to conduct this study. A pre-validated structured questionnaire, adapted and cited from different sources, was administered among patients in five major, private tertiary care hospitals in Karachi, Pakistan through a non-probability judgmental sampling. The findings revealed a significant effect of both the behavior of employees and waiting time on the patients’ behavior. This study can be utilized at a wider level to adopt the need for further reforms in tertiary care setups in Pakistan at the rural level and policymakers may use the findings to train empathy and a patient-centric approach to the behavior of employees to counter unpleasant patient behavior and produce satisfaction leading to improved quality of care and to combat waiting time, patient dissatisfaction, patients complains and overcrowding challenges faced by tertiary hospitals in urban areas.

References

Aboukanda, E. K., & Latif, M. (2014a). The Effect of Patient Behaviour on Wait Times in Emergency Departments. International Journal of Business and Commerce, 3(6). www.ijbcnet.com

Aboukanda, E. K., & Latif, M. (2014b). The Effect of Patient Behaviour on Wait Times in Emergency Departments. International Journal of Business and Commerce, 3(6).

Aburayya, A., Alshurideh, M., Albqaeen, A., Alawadhi, D., & al A’yadeh, I. (2020a). An investigation of factors affecting patients' waiting time in primary health care centers: An assessment study in Dubai. Management Science Letters, 10(6), 1265–1276. https://www.doi.org/10.5267/j.msl.2019.11.031

Aburayya, A., Alshurideh, M., Albqaeen, A., Alawadhi, D., & al A’yadeh, I. (2020b). An investigation of factors affecting patients waiting time in primary health care centers: An assessment study in Dubai. Management Science Letters, 10(6), 1265–1276. https://www.doi.org/10.5267/j.msl.2019.11.031

Adamu, H., & Oche, M. (2013). Determinants of patient waiting time in the general outpatient department of a tertiary health institution in North Western Nigeria. Annals of Medical and Health Sciences Research, 3(4), 588. https://www.doi.org/10.4103/2141-9248.122123

Abdelmaged, M. A. M. (2021). Investigating the impact of omni-health integration on waiting time in healthcare centers. ResearchBerg Review of Science and Technology, 1(1), 41-49.

Alhelalat, J. A., Habiballah, M. A., & Twaissi, N. M. (2017). The impact of personal and functional aspects of restaurant employee service behaviour on customer satisfaction. International Journal of Hospitality Management, 66, 46–53. https://doi.org/10.1016/j.ijhm.2017.07.001

Alrajhi, K. N., Aljerian, N. A., Alazaz, R. N., Araier, L. B., Alqahtani, L. S., & Almushawwah, S. O. (2020). Effect of waiting time estimates on patients’ satisfaction in the emergency department in a tertiary care center. Saudi Medical Journal, 41(8), 883–886. https://www.doi.org/10.15537/SMJ.2020.8.25190

Alrasheedi, K. F., AL-Mohaithef, M., Edrees, H. H., & Chandramohan, S. (2019). The Association Between Wait Times and Patient Satisfaction: Findings from Primary Health Centers in the Kingdom of Saudi Arabia. Health Services Research and Managerial Epidemiology, 6. https://www.doi.org/10.1177/2333392819861246

Branquinho, M., Shakeel, N., Horsch, A., & Fonseca, A. (2022). Frontline health professionals’ perinatal depression literacy: A systematic review. In Midwifery (Vol. 111). Churchill Livingstone. https://www.doi.org/10.1016/j.midw.2022.103365

Castle, N. G., Brown, J., Hepner, K. A., & Hays, R. D. (2005). Review of the literature on survey instruments used to collect data on hospital patients’ perceptions of care. In Health Services Research (Vol. 40, Issue 6 II, pp. 1996–2017). https://www.doi.org/10.1111/j.1475-6773.2005.00475.x

Cheng, S. H., Yang, M. C., & Chiang, T. L. (2003). Patient satisfaction with and recommendation of a hospital: Effects of interpersonal and technical aspects of hospital care. International Journal for Quality in Health Care, 15(4), 345–355. https://www.doi.org/10.1093/intqhc/mzg045

Chu, H., Westbrook, R. A., Njue-Marendes, S., Giordano, T. P., & Dang, B. N. (2019). The psychology of the wait time experience - What clinics can do to manage the waiting experience for patients: A longitudinal, qualitative study. BMC Health Services Research, 19(1). https://www.doi.org/10.1186/s12913-019-4301-0

Dobrzykowski, D. D., McFadden, K. L., & Vonderembse, M. A. (2016). Examining pathways to safety and financial performance in hospitals: A study of lean in professional service operations. Journal of Operations Management, 42–43, 39–51. https://www.doi.org/10.1016/j.jom.2016.03.001

Epstein, A., Moucheraud, C., Sarma, H., Rahman, M., Tariqujjaman, M., Ahmed, T., Glenn, J., Bossert, T., & Kruk, M. E. (2019). Does health worker performance affect clients’ health behaviors? A multilevel analysis from Bangladesh. BMC Health Services Research, 19(1). https://www.doi.org/10.1186/s12913-019-4205-z

Fornell, C., & Larcker, D. F. (1981). Evaluating Structural Equation Models with Unobservable Variables and Measurement Error. In Source: Journal of Marketing Research (Vol. 18, Issue 1).

Gaakeer, M. I., Veugelers, R., Van Lieshout, J. M., Patka, P., & Huijsman, R. (2018). The emergency department landscape in the Netherlands: An exploration of characteristics and hypothesized relationships. International Journal of Emergency Medicine, 11(1). https://www.doi.org/10.1186/s12245-018-0196-5

Gifford, R., van der Vaart, T., Molleman, E., & van der Linden, M. C. (2022). Working together in emergency care? How professional boundaries influence integration efforts and operational performance. International Journal of Operations and Production Management, 42(13), 54–78. https://www.doi.org/10.1108/IJOPM-10-2021-0644

Goodman, J., & Newman, S. (n.d.). Understand Customer Behavior and Complaints Eight areas of quantifiable data can be integrated into quality assurance decisions.

Hair, J. F., Hult, G. T. M., Ringle, C. M., & Sarstedt, M. (2017). A Primer on Partial Least Squares Structural Equation Modeling (PLS-SEM). 2nd Edition. Sage Publications Inc.

Hair, Jr. F., Hult, G. T., Ringle, C. M., & Sarstedt, M. (2014). A Primer on Partial Least Squares Structural Equation Modeling (Pls-Sem). Sage Publications, Inc.

Harris, L. C., & Reynolds, K. L. (2003). The Consequences of Dysfunctional Customer Behavior. Journal of Service Research, 6(2), 144–161. https://www.doi.org/10.1177/1094670503257044

Hemmati, F., Mahmoudi, G., Dabbaghi, F., Fatehi, F., & Rezazadeh, E. (2018). The factors affecting the waiting time of outpatients in the emergency unit of selected teaching hospitals of Tehran. Electronic Journal of General Medicine, 15(4). https://www.doi.org/10.29333/ejgm/93135

Hernández, B., Jiménez, J., & Martín, M. J. (2010). Customer behavior in electronic commerce: The moderating effect of e-purchasing experience. Journal of Business Research, 63(9–10), 964–971. https://www.doi.org/10.1016/j.jbusres.2009.01.019

Hewett, D. G., Watson, B. M., Gallois, C., Ward, M., & Leggett, B. A. (2009). Intergroup communication between hospital doctors: Implications for quality of patient care. Social Science and Medicine, 69(12), 1732–1740. https://www.doi.org/10.1016/j.socscimed.2009.09.048

Hill, C. J., & Joonas, K. (2006). The impact of unacceptable wait time on health care patients’ attitudes and actions. Health Marketing Quarterly, 23(2), 69–87. https://www.doi.org/10.1300/J026v23n02_05

Jung, H. M., Kim, M. J., Kim, J. H., Park, Y. S., Chung, H. S., Chung, S. P., & Lee, J. H. (2021). The effect of overcrowding in emergency departments on the admission rate according to the emergency triage level. PLoS ONE, 16(2 February). https://www.doi.org/10.1371/journal.pone.0247042

Kaur, M., Bashar, A., Singh, T., & Kumar, R. (2020). Cross-Sectional Study of Clients’ Satisfaction with Outpatient and Inpatient Services of Public Health Facilities of a North Indian State. Health Services Insights, 13. https://www.doi.org/10.1177/1178632920929969

Koszegi, B. (2003). Health anxiety and patient behavior. Journal of Health Economics, 22(6), 1073–1084. https://www.doi.org/10.1016/j.jhealeco.2003.06.002

Kreitz, T. M., Winters, B. S., & Pedowitz, D. I. (2016). The Influence of Wait Time on Patient Satisfaction in the Orthopedic Clinic. Journal of Patient Experience, 3(2), 39–42. https://www.doi.org/10.1177/2374373516652253

Kreuter, M. W., Chheda, S. G., & Bull, F. C. (2000). How Does Physician Advice Influence Patient Behavior? Evidence for a Priming Effect. In Arch Fam Med (Vol. 9).

Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., Adeyi, O., Barker, P., Daelmans, B., Doubova, S. V., English, M., Elorrio, E. G., Guanais, F., Gureje, O., Hirschhorn, L. R., Jiang, L., Kelley, E., Lemango, E. T., Liljestrand, J., … Pate, M. (2018). High-quality health systems in the Sustainable Development Goals era: time for a revolution. In The Lancet Global Health (Vol. 6, Issue 11, pp. e1196–e1252). Elsevier Ltd. https://www.doi.org/10.1016/S2214-109X(18)30386-3

Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., García-Saisó, S., & Salomon, J. A. (2018). Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. The Lancet, 392(10160), 2203–2212. https://www.doi.org/10.1016/S0140-6736(18)31668-4

Leigh, E., & Clark, D. M. (2018). Understanding Social Anxiety Disorder in Adolescents and Improving Treatment Outcomes: Applying the Cognitive Model of Clark and Wells (1995). In Clinical Child and Family Psychology Review (Vol. 21, Issue 3, pp. 388–414). Springer New York LLC. https://www.doi.org/10.1007/s10567-018-0258-5

McIntyre, D., & Chow, C. K. (2020). Waiting Time as an Indicator for Health Services Under Strain: A Narrative Review. In Inquiry (United States) (Vol. 57). SAGE Publications Inc. https://www.doi.org/10.1177/0046958020910305

McMullen, M., & Netland, P. A. (2013). Wait time as a driver of overall patient satisfaction in an ophthalmology clinic. Clinical Ophthalmology, 7, 1655–1660. https://www.doi.org/10.2147/OPTH.S49382

Mehra, P. (2016a). Outpatient clinic waiting time, provider communication styles and satisfaction with healthcare in India. International Journal of Health Care Quality Assurance, 29(7), 759–777. https://www.doi.org/10.1108/IJHCQA-02-2016-0017

Mehra, P. (2016b). Outpatient clinic waiting time, provider communication styles and satisfaction with healthcare in India. International Journal of Health Care Quality Assurance, 29(7), 759–777. https://www.doi.org/10.1108/IJHCQA-02-2016-0017

Miller, R., & Chalapati, N. (2015). Utilizing lean tools to improve value and reduce outpatient wait times in an Indian hospital. Leadership in Health Services, 28(1), 57–69. https://www.doi.org/10.1108/LHS-01-2014-0001

Nottingham, Q. J., Johnson, D. M., & Russell, R. S. (2018a). The effect of waiting time on patient perceptions of care quality. Quality Management Journal, 25(1), 32–45. https://www.doi.org/10.1080/10686967.2018.1404368

Nottingham, Q. J., Johnson, D. M., & Russell, R. S. (2018b). The effect of waiting time on patient perceptions of care quality. Quality Management Journal, 25(1), 32–45. https://www.doi.org/10.1080/10686967.2018.1404368

Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric Theory (3rd ed.). McGraw-Hill.

Olasehinde, N., Osakede, U. A., & Adedeji, A. A. (2023). Effect of user fees on healthcare accessibility and waiting time in Nigeria. International Journal of Health Governance. https://www.doi.org/10.1108/IJHG-07-2022-0062

Oluwole, E. O., Osibogun, O., Adegoke, O., Adejimi, A. A., Adewole, A. M., & Osibogun, A. (2019). Medication adherence and patient satisfaction among hypertensive patients attending outpatient clinic in Lagos University Teaching Hospital, Nigeria. The Nigerian Postgraduate Medical Journal, 26(2), 129–137. https://www.doi.org/10.4103/npmj.npmj_48_19

Pham Ngoc Tram, A., Nguyen Tien, D., Huynh Uyen, T., & Pham Ngoc, T. (2016). Antecedents and Consequences of Adaptive Behavior of Frontline Employees in The Health Care Service. Journal of Economics and Development, 38–53. https://www.doi.org/10.33301/2016.18.01.03

Prakash, B. (2010). Patient satisfaction. Journal of Cutaneous and Aesthetic Surgery, 3(3), 151. https://www.doi.org/10.4103/0974-2077.74491

Ren, W., Sun, L., Tarimo, C. S., Li, Q., & Wu, J. (2021). The situation and influencing factors of outpatient satisfaction in large hospitals: Evidence from Henan province, China. BMC Health Services Research, 21(1). https://www.doi.org/10.1186/s12913-021-06520-2

Sofaer, S., & Firminger, K. (2005). Patient perceptions of the quality of health services. In Annual Review of Public Health (Vol. 26, pp. 513–559). https://www.doi.org/10.1146/annurev.publhealth.25.050503.153958

Spee, P., Jarzabkowski, P., Smets, M., & Jarzabkowski PJarzabkowski, P. (2015). The Influence of Routine Interdependence and Skillful Accomplishment on the Coordination of Standardizing and Customizing.

Tasso, K., Behar-Horenstein, L. S., Aumiller, A., Gamble, K., Grimaudo, N., Guin, P., Mandell, T., & Ramey, B. (2002). Assessing patient satisfaction and quality of care through observation and interview. Hospital Topics, 80(3), 4–10. https://www.doi.org/10.1080/00185860209597996

Taylor, C., & Benger, J. R. (2004). Patient satisfaction in emergency medicine. In Emergency Medicine Journal (Vol. 21, Issue 5, pp. 528–532). https://www.doi.org/10.1136/emj.2002.003723

Taylor, S. E. (1979). Hospital Patient Behavior: Reactance, Helplessness, or Control? Journal of Social Issues, 35(1), 156–184. https://doi.org/10.1111/j.1540-4560.1979.tb00793.x

van der Ham, A., Van Raak, A., Ruwaard, D., & van Merode, F. (2022). Exploring changes in integration, differentiation, rules, coordination, and performance following the introduction of a hospital planning centre: a case study. Journal of Health Organization and Management, 36(9), 158–178. https://www.doi.org/10.1108/JHOM-10-2021-0375

van der Veen, D., Remeijer, C., Fogteloo, A. J., Heringhaus, C., & de Groot, B. (2018). Independent determinants of prolonged emergency department length of stay in a tertiary care centre: A prospective cohort study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1). https://www.doi.org/10.1186/s13049-018-0547-5

Wang, X., Chen, J., Burström, B., & Burström, K. (2019). Exploring pathways to outpatients’ satisfaction with health care in Chinese public hospitals in urban and rural areas using patient-reported experiences. International Journal of Equity in Health, 18(1). https://www.doi.org/10.1186/s12939-019-0932-3

Xie, W., Yang, X., Cao, X., & Liu, P. (2019). Effects of a comprehensive reservation service for non-emergency registration on appointment registration rate, patient waiting time, patient satisfaction, and outpatient volume in a tertiary hospital in China. BMC Health Services Research, 19(1). https://www.doi.org/10.1186/s12913-019-4652-6

Yan, L., Wolniewicz, R. H., & Dodier, R. (2004). 50 IEEE INTELLIGENT SYSTEMS Predicting Customer Behavior in Telecommunications. www.computer.org/intelligent

Yip, W., & Hsiao, W. (2014). Harnessing the privatization of China’s fragmented healthcare delivery. In The Lancet (Vol. 384, Issue 9945, pp. 805–818). Elsevier B.V. https://www.doi.org/10.1016/S0140-6736(14)61120-X

Yousef Shaheen, M. (n.d.). AI in Healthcare: medical and socio-economic benefits and challenges. https://www.doi.org/10.31219/osf.io/um38t

Zhang, M., Zhang, C., Sun, Q., Cai, Q., Yang, H., & Zhang, Y. (2014). Questionnaire survey about the use of an online appointment booking system in one large tertiary public hospital outpatient service center in China. In BMC Medical Informatics and Decision Making (Vol. 14, Issue 1). BioMed Central Ltd. https://www.doi.org/10.1186/1472-6947-14-49