1. Introduction
Developing nations are making every effort to entitle their citizens to receive fundamental healthcare because of limited consumer resources [
1]. Public hospitals play an essential role in providing health facilities or services for citizens who seek fundamental medical service, while the outpatient department (OPD) role is very effective [
2]. A world without basic health facilities would be a world of despair and suffering. Hypothetically speaking, if the world had a fundamental healthcare system that was universally recognized as providing low quality, that would only incur greater misery and suffering. In this hypothetical system, the cost of healthcare would further burden and intensify, increasing patient concern and worry. A healthcare unit is useless if it is inadequate to decrease patients’ distress. The healthcare sector of any country is a vital pillar for its overall progress, because it also influences all the other sectors, such as medical, moral, political, social, and business. Moreover, it has a number of economic implications [
3].
Healthcare is one of the major sustainable development goals (SDGs) of agenda 2030 of the United Nations Organization (UNO), which states that: “ensure healthy lives and promote well-being for all at all ages”, as well as its target to achieve universal health coverage, affordable medicine, accessibility, effective and safe quality, and access to quality essential healthcare for everyone [
4]. Even if you are wealthy, every aspect of life if is nullified without good health. The developed world is steadily building their health sectors by making revenue for their national economy by encouraging health tourism. Contrarily, the policy makers of developing countries, such as Pakistan, are helping the health sector of developed countries by seeking their services frequently at the expense of taxes being paid by their own citizens [
5], instead of forming their own healthcare system.
In emerging nations like Pakistan, healthcare problems receive more attention from researchers than from policy makers [
5], which is a matter of grave concern in Pakistan, because the current average cost of healthcare for the people of Pakistan is 66.5%, far greater than the world average of 18.147% [
6]. It is a regrettable situation that the number of dissatisfied patients receiving healthcare in Pakistan’s public hospitals has continuously increased [
7,
8]. Moreover, a large number of Pakistani citizens are in despair believing that the country’s healthcare sector is severely damaged by corruption [
9].
In accordance with these factual figures, it has become increasingly necessary to revise and assess the performance of feebly performing, less developed countries and to counterbalance their performance with that of their counterparts in the developed world. This is of the utmost importance, being a matter of life or death to the citizens of such countries. Javed and Ilyas [
5] stated that “despite this despondent situation of healthcare in Pakistan, where quality initiatives are relatively more visible in the manufacturing, education and agriculture sectors than in the healthcare sector, not many scientific studies have been done in this context.” In light of present situation, the perceived performance of public hospitals in Pakistan has been assessed by measuring the satisfaction of Pakistani patients from the public sector. To achieve this, we took into account their opinion concerning four areas of healthcare services; these include: Physical services (tangible and environmental), doctor–patient communication, pharmacy services, and laboratory services. Our study assessed patient satisfaction of those using OPD services in Pakistani hospitals. There is currently a significant gap in the existing literature regarding the evaluation of patient satisfaction with respect to doctor-patient communication, physical facilities, laboratory services and pharmacy services aspects. The current study is specifically useful for assessment of the Pakistani healthcare system, which is commonly associated with the lack of patient satisfaction and quality of service delivery.
Pakistan has a mixed health system that includes: Public, parastatal, private, civil society, philanthropic contributors, and donor agencies. In Pakistan, healthcare delivery to the public is systematized through four modes of preventive, promotive, curative, and rehabilitative services [
10]. According to the constitution of Pakistan, it is the responsibility of the state to provide fundamental health facilities to its citizens without any cost. However, after the implementation of the 18th amendment in the constitution of Pakistan, this duty was shifted from the central government to the provincial governments, who are assumed to devise provincial healthcare policies that affect around 200 million individuals in Pakistan [
11]. The public healthcare system of Pakistan is summarized in
Figure 1. Central and state governments have their own independent public healthcare setups [
12].
5. Discussion and Implications
This research was carried out to examine the service delivery of OPDs in southern Punjab hospitals, Pakistan, from the patients’ perspective. The present study sought to investigate how pharmacy services, laboratory services, doctor–patient communication, and physical facilities measured patient satisfaction alongside the quality of the hospital service. Our results confirmed that patient satisfaction was highly dependent on pharmacy services. such results are similar to those concluded from India, that pharmacy services have a significant impact on patient satisfaction [
67]. In a Pakistani context, the pharmacy staff are usually less qualified, a general lack of professionalism, a lack of knowledge regarding the rules and responsibilities of pharmacists and the execution of their duties are the key factors which impacted negatively on the quality of pharmacy services offered by public hospitals [
48]. These issues negatively impact on patient satisfaction. The information that pharmacists provide to patients is insufficient, which leads to a deficient interaction between the dispenser and the patient [
68]. It is for this reason that patients are highly concerned with finding a good private pharmacy service, rather than using a pharmacy service provided by public hospitals [
67].
For many years, technology has been used in healthcare practices, including in laboratory investigations or as a method to create new diagnostic tools, such as stethoscopes [
69]. As laboratory services are highly associated with patient satisfaction, the appropriate medical technology should be used as an aid for medical consultations. The use of technology facilitates a healthy consultation, but still patients are expecting in-depth laboratory investigations, which is consider as a central segment of the healthcare [
70]. Regarding to the laboratories used in public hospital services in Pakistan, patients face problems, such as non-hygienic environments, late and fake results, uncompetitive staff, and a significant communication gap [
7]. It is for these reasons that laboratory services directly impact on patient satisfaction. The prevalent issue is also highlighted and discussed in other part of the world such as Africa [
71].
The present study fills the current gap in the literature by evaluating patient satisfaction in regard to pharmacy services, laboratory services, doctor–patient communication, and physical facilities. Doctor–patient communication and physical facilities did not have a significant impact on patient satisfaction in Pakistan. The physical facilities in OPD had a very small impact on satisfaction, which is proved from previous findings in India [
72], South Korea [
73], and Iran [
74] where physical facilities had no significant relation with patient satisfaction.
For the sake of sustainability in the healthcare sector, governments should take serious steps to solve the issues in the healthcare sector, such as the creation of transparent policies, the provision of increased funding for physical infrastructure, and the involvement of all stakeholders in decision making. The healthcare administration should collaborate with the Provincial Health Department to digitize hospital records to decrease congestion and delays in laboratory services. Our findings will act as an important cue for healthcare administrators who could then be able to continuously maintain clean and attractive environments in hospital premises to retain the loyalty of patients. In order to maintain a better environment, vivid policy structures need to be created by the Government for uplifting the maintenance levels of their respective institutions.
Our findings highlighted that hospital management teams need to focus on a timely delivery of services, proper communication, and the employment of staff that willingly care for patients. As the population increases, the level of patient dissatisfaction also increases. In order to cope this issue, the numbers of doctors and pharmacy staff working in hospitals should be increased. The physical environment plays an important role in patients’ perceived satisfaction. Therefore, hospital administrators should improve facilities, such as the availability of clean drinking water, and hygienic conditions in wash rooms and sitting areas. The results from this study are associated with quality features provided by WHO 2006 framework, which recommends that health services should be sustainable.
These findings are helpful for healthcare organizations to improve their service delivery. Healthcare organizations should adopt a redesigned service delivery procedure by giving it a patient-centric orientation. This strategy may result in better patient care and higher returns of trust for the organizations. We expect that this study will play a significant role in the literature of the healthcare sector. Scholars will get benefit from these findings and, we hope, will conduct similar research involving more parameters to improve Pakistan’s healthcare system.