Leadership and Patient Satisfaction in a Tertiary Health
Care System
Owumi E. Bernard'
Omorogbe E. Christie"
Osamor E. Pauline"
IDepartment of Sociology
University of Ibadan; Ibadan
2Department of Nursing Science
School of Basic Medical Sciences
University of Benin, Beilin City
3Institute of Child Health
College of Medicine, University of Ibadan,
Ibadan .
E-mail: bowumi@yahoo.com.omorogbechristie@yahoo.com.
ejemenp@yahoo.com
Abstract
Patient satisfaction is one of the best indicators for measuring the success of the
services being provided in a health facility. This study investigates the leadership
factors that influenced patient satisfaction in the tertiary health care facility of the
University of Benin Teaching Hospital, Benin City;Nigeria. This hospital based cross-
sectional study was anchored on the social action theory, Talcott Parsons sick role
model and concept of bureaucracy. Using a multi-stage sampling technique, 420 in-
patients were randomly selected from five different units .(Medical, Surgical,
Pediatrics, Obstetrics, and Gynecology and Emergency) of the hospital. Data was
collected using semi-structured questionnaire and five in-depth interviews (IDls).
Quantitative data were analyzed at univariate and bivariate levels, using descriptive
statistics and Chi-square test while qualitative data were content analyzed. Findings
revealed that there were good knowledge and level of awareness of the services
available. Majority of the patients claimed that they were satisfied and rated the
satisfaction experiences as moderate satisfaction with the health care services of the
professional doctors and nurses in the hospital. Education (p<0.020) and income
(p<0.032) were found to be significant socio-economic factors influencing patient's
satisfaction. Answers doctors provided to patients' questions and prescribed drug
administration by nurses to the in-patients were derivable from the leadership factors
and thus influenced patient's satisfaction with the health care services. Results on
answers doctors provided to patients' question (p<0.001) and prescribed drug
administration by nurses to the in-patients (p<0.0073) were significant leadership
factors. Similarly, from the qualitative data, doctor 's communication and interaction
greatly influenced patient's satisfaction with leadership ethos of health care providers.
Management should organize stakeholder's forum comprising of doctors and nurses'
leaders from among the health care providers and in-patients with common health
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The Nigerian Journal of Sociology and Anthropology VoL13no. 1
conditions where subjective needs assessment of patients could be discussed within the
hospital.
Keywords: patient satisfaction, tertiary hospital, health care services
Background and Statement of the Problem
The primary goal of a tertiary hospital is to provide the best possible care to
patients. Professional health care leaders play significant roles in providing
health care services in health facilities that can bring about patient satisfaction.
Patients' satisfaction with health care services is regarded" as a subjective
feeling of contentment expressed by the patients themselves in which he/she
feels that their expectations concerning health care are met by the services
provided and received (Ware, Snyder and Wright, 1983). Despite the efforts of
the federal government at renovating the tertiary hospitals and employing
qualified doctors and nurses along with the purchase of modem equipment in
hospitals, (FMOH, 2004; Erah, 2009) patients' desires and expectations to
receive health care services in a way that gives them satisfaction with the
health care services provided by professional health care leaders have received
negligible attention. This is worrisome especially as there are indications that
services provided at these health facilities are generally perceived as being very
poor (Afolabi and Erhun, 2003). '
Tertiary hospitals in Nigeria perform various functions-that include health
care services for the sick, teaching, research and a range of activities with the
primary goal of improving health, general well being and social functioning of
sick persons seeking help and treatment in these health care facilities (Smith,
Sinclair, Raine and Reeves, 2010; Erinosho, 2005). IIiyasu, Abubakar,
Abubakar, Lawani and Gajida (2010) in their studies noted that patients face
several problems both as in-patients on the wards, as well as out-patients in the
different out-patient departments. Such problems include, long waiting time,
delay in attending to patients, long delays before getting results of
investigations, missing or misplaced patients case files, unavailability of drugs
and high cost of drugs. Other issues leading to patient's dissatisfaction with
health care services in the tertiary hospitals include overcrowding in the
admission wards, delays in consultations and lack of proper guidance from
health care workers (Skinvasion, 2000; Jawahar, 2007). .
Patients' satisfaction with the delivery of care by hospital personnel
(doctors and nurses) who are health care professional leaders is very important.
According to Cole (2005), leadership is the ability to influence a group towards
the achievement of goals. It is essentially a process in which one individual
influences the efforts of others towards the achievement. in a given
circumstances. Thus, it is a social process and a part of management involving
the achievement of defined objectives and goals. Robbinson (1988) defines
leadership as social process in which one person in a group harnesses the
knowledge, skill and motivation of the others in the achievement of the group's
goals.'
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Leadership and Patient Satisfaction 147
In any organization, leadership is crucial,. as an act of influencing the
actions, behaviours, beliefs, and goals of one individual in a social system by
another actor with the willing cooperation of the one being influenced.
Leadership is an ongoing process in which its 'activities involve individuals
with an unequal distribution of power among leaders. The focus of leadership
is the accomplishment of goals as outcome. In the health industry, the
healthcare team is multidisciplinary with different health care professionals
having different goals and skills and also having different kinds of
relationships/interactions with patients and clients. The functional headship of
the teaching hospital when it comes to the actual individual patient
management, are the medical doctor and nurses who are officially designated
with this responsibility. According to Asuzu (2012) and Aina (2012), evidence
have shown that professional's interaction with their patients can substantially
influence patient satisfaction; for example, the importance of good
doctor/patient relationship is well documented in literature while poor
patient/doctor communication is a major reason for dissatisfaction with health
care service (Owumi,1989).
A survey conducted in Brazil showed that most respondents were satisfied
with delivery of care by health personnel. This might be due to the fact that the
respondents being of low literacy level might not want to .admit that they do
not understand the physician's medical jargon (Jaipaul and Rosenthal, 2003).
In a similar study conducted in Uganda in a tertiary institution, respondents
declared high levels of satisfaction (Kulkarni, Dasgupta, Deoke and Nayse,
2011). Studies in Nigeria also reported high levels of satisfaction with delivery
of care provided by doctors and nurses (Iliyasu et. aI., 2010; Ajayi, 2000;
Oyediran, 2005). These reported high satisfaction levels might be due to the
nature of healthcare in Nigeria where the physician is often perceived as doing
the patient a favour rather than as a service provider. On the contrary, a
satisfaction survey conducted in the -dental outpatient clinics of the Lagos
University Teaching Hospital, Nigeria', however reported that patients
expressed dissatisfaction with the practice of allowing unsupervised students to
attend to them (Adeniyi and Onajola, 2010). This was also the case in another
study that compared public and private institutions. Findings revealed that
study participants showed dissatisfaction in the aspects of physician
conduct/interaction with the patients (Messina, Scott, Ganey and Zipp, 2009).
In-patients' satisfaction is an increasingly important issue both in
evaluation and in the shaping of health care services for any nation. In the past,
patients have been viewed as passive recipients of health care services and
. voiceless, whereas patients' desire is to receive health care services and be
treated in a way that gives them satisfaction. Different health service research
reports have indicated however that those patients who are satisfied with health
care services from health facilities in the developing countries behaved
differently from those who are dissatisfied (Reeder, 1972; Wilson, 1980; Linn,
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The Nigerian Journal of Sociology and Anthropology Vol. 13no. 1
Linn, Stein, 1982; Freidman, 1979). Similarly Owumi (1989) noted that the
compatibility of patient's expectation and the physician's performance have
important 'implication for treatment outcome. Alliyu arid Oduwole (2005) in
their study of patients presenting with STls and other conditions in the teaching
hospital, revealed that patients have certain expectations about the facilities and
these expectations become the basis for satisfaction or dissatisfaction. Patients
also expect prompt attention which can compromise their satisfaction when
lacking.
This study therefore, investigated leadership activities in terms of major
interactions ·inhealth care service provision between the clients of the teaching
hospital (in-patients) who have various expectations and are also recipients of
health care services and the professional health providers (doctors and nurses),
whose duty it is to provide the desired health care services. A consideration of
leadership and patients' satisfaction is not only important to the leaders in the
health care industries in terms of addressing the expectations of patients but
also an important factor in the continued use of these services by the patients
(Dutton, 1978).
Previous studies show that not only do the users of health facilities want
full information about the nature of the ailment for which they are admitted;
they also want to know about their treatment, the drugs prescribed for them and
the administration of the prescribed drugs either by the doctors or the nurses
(Alliyu et. al., 2005). The concept of patients' satisfaction is complex and
multidimensional, patients' view of some core health care services provided by
professional health practitioners (doctors/nurses') in the University of Benin
Teaching Hospital Benin City, Nigeria was considered as an outcome measure
from the following perspectives:
1. Doctor's communication (clarity of communication between patient and
doctor)
---- receive intelligible answers to questions asked.
---- receive adequate information from doctors regarding treatment
regimen.
2. Patient/doctor relationship (interaction).
3 Nurses behaviour in providing nursing care services in terms of
---- administration of doctors' prescribed drugs
4. Obedience of patients to health advice and compliance.
The study was designed to address the following objectives, to assess the
knowledge of patients about the benefits of the use of health care services in
. the UBTH; determine the level of patients' satisfaction with the health care
rendered by teaching hospital core health professionals (doctors and nurses);
and assess the patients' willingness to obey/comply with professional advice in
order to continue with the use of the health care services.
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Leadership and Patient Satisfaction 149
Theoretical Framework
This study is anchored on Talcott Parsons'sick role model, social action theory
and concept of bureaucracy, as the theoretical framework and effort was made
to triangulate the theories.
Parsons' Sick Role Model '
Sick role model was advanced by Talcott Parsons (1951) and emphasizes the
social dimension of illness {sick role) and social expectation. The main thrust
of the theory is on how social expectations and cultural beliefs and practices
surrounding sickness and illness management influence how the sick person;~
behaves within the social context in the therapeutic milieu. To Parson, being
sick confers a social role (sick role) with people who are sick acting in different
ways according to the culture of the society. Talcott Parsons' sick role model
explains patient/physician relationship and patient/nurse relationship during
illness management within the framework of social roles and expectations.
Talcott Parsons (1951) argues that illness is not purely a biological state but
has a social dimension to it.
Thus, the sick role describes the patterns of behaviour that the sick person
adopts in other to minimize the disruptive impacts on others. Parsons argues
that the patients and doctors, the patient and nurses are acting out roles in a
complementary but asymmetrical role relationship. The obligation oft the part
of the sick to get well involves a further obligation to seek technically
competent help usually from a physician (doctor) and the nurse. The sick ;'11'
person is also expected to co-operate with the physicians and nurses in the
process of trying to get well.
In applying the theory to the users of health care services and iri the role of ,;'1:
patients, the sick (patient) enters into a social relationship with the medical and
health professionals- the doctors and nurses. According to Parsons, patients,
doctor and nurses are acting out prescribed roles" The role of the sick person is
deemed to be undesirable; patients are expected to desire better health
condition, to voluntarily seek professional health advice and cooperate fully
with the doctor and other health care providers (Heps). The roles of the
patients/doctors are also characterized by rights and expectations. Doctors are
expected to use their skills and expertise for the benefits of their patients. In the
course of their duties they have the right to conduct physical examinations and
ask patients question about their physical health and personal circumstances.
A major expectation concerning the sick individual in our society
particularly in Nigeria is to seek health care services and advice and also co-
operate with the professionals. This behaviour is' predicated upon the
assumption made by Parson that being sick is an undesirable state and the sick
person desires a healthy state. By engaging in illness management, with the
behaviour of acceptance and co-operation in using the health care services,
he/she becomes involved with the role of the professional doctor/nurse in a
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The Nigerian Journal of Sociology and Anthropology VoL 13 no. 1
complementary but asymmetrical role relationship as one of obedience to
expected norms and medical directive thus and health care services become a
mechanism by which a social system seeks to control the illness of the sick
persons by returning them to the normal state of functioning as possible. Health
care services (Hospital Services) are oriented towards a supportive/creative
notion of patient welfare. .'
The sick or injured persons, following admission into the wards are
organized into various patient units, namely emergency, medical, surgery,
ophthalmic, haematology, neurology, orthopaedics, urology, paediatrics,
maternity/obstetrics and gynaecology and psychiatries. Thus, this organization
reflects themedical staff definition of their illnesses. Part of the orientation in
the wards includes giving information about visiting regulations and instruction
on type of food to eat. The visiting regulation does not only control when
patients are allowed to have visitors, but also who is allowed to visit and the
duration. In addition, the nurse supervises the diet/food served, decides the
general conduct and social life in the hospital.
Social Action Theory
Social action theory examines the cause and effect relationship in human
relationship within a specified' social context. It explains the subjective
meaning patients attach to social behaviour in the therapeutic milieu as they
receive health care services (Haralambos and Holborn, 2008; Olutayo and
Akanle, 2013). According to Enaikele (2013) social action is that which
individuals are acting with others in mind. For Weber it is only when the
subjective meaning behind an action is understood that an action could be
regarded as social. This implies that a patient will take health related action
such as acceptance of health related instructions in interactions with health
professionals who are also viewed as leaders (doctors), involvement in
undressing ~ for physical examination, acceptance' of drugs/treatment
administration and the serving of food in the context of present analysis, when
the patient understands the action of the health professionals by interpreting the
action provision of care services) and attaching meaning .
. Their interpretation, subjective meaning and understanding of action
produce a willingness to continue to use or discontinue with patronage at the
/ hospital as outcome of their subjective evaluation. The patient/care givers
ascribe meaning to the different activities of care provisions by the medical and
health care professionals which are oriented to bring about better health in the
patient's .life who is admitted into the hospital. This is the most consistent
individualized approach to understanding the intentions/motive of individual
actors (the in-patients) who are ill and receiving healthcare in a given social
context is releyant in explaining the subjective meanings attached to behaviour
that are associated with use of health care services among in-patients in the
tertiary hospital (with regards to satisfaction with healthcare services). It
provides an individualized approach to understanding the motives or intentions
of individual actors within the health institution. Applied to this study, the
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Leadership and Patient Satisfaction 151
theory provides a basis for understanding the subjective interpretation of the
outcome of interaction between the patients and health care professional
leaders within the therapeutic milieu.
Max Weber Concept of Bureaucracy
Max Weber concept of bureaucracy which emphasizes strict adherence to strict
rules and regulations governing organizational activities was also adopted.
Black and Gruen (2009) observed that the concept of bureaucracy is
summarizable in the following ideas; hierarchy, continuity, impersonality and
expertise.
Hierarchy- In the teaching hospital for example people engage in narrowly
defined tasks and work under rules. Among the doctors for example, power is
distributed according to defined area of competence in the discipline: Authority
and responsibility are clearly defined for each one, following the hierarchy.
Doctors work in hierarchies with other doctors while providing treatment and
health care to patients. In the provision of treatment, the Consultant is the most
senior in the hierarchy who gives instructions that should be followed, and next
in the hierarchy is the senior registrar which is closely followed bythe registrar
and house officer, who does the write up of prescription on paper and the
running around for the seniors in the profession.
Similarly, nursing leaders have their own hierarchy of leadership starting
Q
with the deputy director of nursing services. However in the administration of
the wards, the Ward Managers give directives to other nurses: Members of
different professional roles are oriented to different tasks. Thus the
administration of drugs prescribed by doctors to the patient is carried out by the
nurse on duty. This important leadership role of nurse is not done haphazardly
but follows laid down rules. Therefore the administration of drugs prescribed
by doctors to the patient by the nurse leader is an outcome of. complexity of
division of labour. The physician who is the medical expert in the field does
the prescription which can be at different levels. The drugs prescribed by
doctors are carefully looked at and then administered by the nurse in.a manner
that will be acceptable to the patient. The patient has his/her right to accept and
show compliance or reject. While this flow is significant, acceptance however
reflects assessment of leadership of the different professional leaders.
In Weber's view, bureaucracy is a consequence of increasing ,complexity
of division' of labour. It is in the light of Weber's approach to organizational
structure, that the tertiary hospital is seen as a tightly structured organization
that functions in accordance with strict bureaucratic rules and regulations.
The teaching hospital by its size and complexity. develops the characteristics of
bureaucracy. Thus, the teaching hospital houses in one place medical experts of
various specialties with a great deal of division of labour and' delegation of
authority between the various hierarchies of medical officers which spreads
from (l) the consultant through the senior registrar to the registrar and the
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The Nigerian Journal of~ociology and Anthropology VoL 13no. 1
house officer and the various functional units. Amongst this professional
group, there is a distinct 'and clear division of integrated activities which are
regarded as duties inherent in the office. These types of hierarchies that exist
can negatively or positively affect the interaction between the patients and the
health professionals (doctors/nurses) and invariably the outcome of health care
provided and received.
Methodology
Study Area
The study was carried out at the University of Benin Teaching Hospital
(UBTH) which is located on a large expanse of land (a ISO-acre site) in Benin
City, along the Benin-Lagos Highway in Edo State. It shares boundary with the
main campus of the University of Benin, Benin City to the West, to the east, its
other boundary is with the Federal Government Girls College road, Benin City.
The University of Benin (former Institute of Technology) was founded on
Sunday, 23 November, 1970. The University of Benin Teaching Hospital is an
integral part of the University of Benin which was established by law in the
Edict No.3 of 1975Midwestern State of Nigeria. Since 1973, the University of
Benin Teaching Hospital as a training institution provides effective practical
medical training for medical/dental undergraduate students of the University of
Benin, Benin City.
The structural organization of the hospital shows that in a simple form, the
departments are located and grouped into functional complex. They are made
up of the Consultant Outpatient clinic (COPD), the Physiotherapy Department,
the Special Investigation Unit, Ophthalmic Complex, Male medical ward AI,
Female medical ward A3, Male and Female stoke ward 5, Male Surgical ward
B4, Male Surgical Orthopaedic Ward B2, Gynaecological Ward A2, Renal
Unit, Intensive care Unit, Male and Female Neurological ward, Labour ward
and Paediatric ward P. New Accident ward 1, Emergency ward, Maternity
wards (Prof. T.B. Osagie Maternity ward) and Prof. P.N. Ajabor Maternity
ward. '
This study location was purposively selected because it is a Federal
Tertiary Teaching Hospital with highly qualified professional health team
members and state-of-the-art facilities provided by the federal government.
Study Design .
The study design was a hospital based cross-sectional design. The study
collected primary data using several research methods including a survey and
in-depth interviews (IDIs).
Study Population
The Study population for the quantitative data comprised patients admitted into
the hospital wards in the five different units/departments which include;
Medical, Surgical, Obstetric and Gynaecological, Paediatric and Emergency
units.
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Leadership and Patient Satisfaction 153
Inclusion criteria were: 1. In-patients who have been admitted into the wards
for not less than forty-eight hours 2. In-patients, who are .conscious, well
oriented to time, place and person. 3. In-patients with good mental status. 4.
Patients who give their consent 5. Significant others/care givers who stood
proxy in the paediatric unit and under-age.
Exclusion Criteria
Patients who are unconscious, patients admitted into the wards that have, had
health care for less than forty-eight hours, and patients who refuse to give their
consent to participate in the study were excluded.
Sample Size
The sample size was calculated from the confidence interval for the population
mean using the formula below:
Sampling Methodology
A multi-stage sampling technique was adopted in the selection of samples from
the five different units/departments of the hospital. The first stage involved the
purposive selection of the 5 units/categories of the hospital units providing
medical care, surgical care including orthopaedics; neurosurgical and
ophthalmology, obstetric and gynaecological care and ante-natal care,
paediatrics care and emergency care. This was followed in the second stage, by
proportionate allocation of respondents in the different units (86, 86, 89, 87,
and 74, respectively to each unit). The final stage involved simple random
selection using balloting.
Data Collection
Some crucial steps were taken to ensure that reliable and relevant data were
collected. These included the selection and training of research assistants,
negotiating access to the respondents, the administration of the instrument and
the conduct of interviews and qualitative sessions. Four research assistants
were recruited and trained on the focus, objectives and various themes to be
addressed. The data collection was undertaken in six weeks. .
The structured questionnaire schedule contained both close and open-
ended questions, which were pre-coded -, The questionnaire was pre-tested
among 20 in-patients in a teaching hospital before the final copies were
produced, following the necessary exclusions and inclusions. In-depth
interviews (IDIs) were conducted among the patients/significant others by the
researcher and discussions were tape recorded along with note taking during
the interview sessions.
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The Nigerian Journal of Sociology and Anthropology VoL 13no. 1
Data Analysis
The pre-coded quantitative data were sorted and cleaned and analyzed with the
Statistical Package for Social Science (SPSS). Data analysis was carried out at
two levels: the univariate and bivariate levels in line with the objectives of the
study. At the univariate levels, descriptive analysis of data was done using
percentages and frequency distribution of variables while at the bivariate
levels, cross tabulations that identify important associations between variables
were done. Associations between the variables were defined by the chi-square
test that had probability values (P-values) ofless than 0.05.
Qualitative data analysis from the IDls involved translation and
transcription of tape recorded discussions and interviews. The data gathered
were read, coded and organized thematically to enable ease of comparison of
similarities and differences between various groups of respondents. Useful
quotes were thereafter used to elucidate and support quantitative data. The
resulting data were analyzed using manual content analysis. Information
gathered along with the insight generated was imported into the different
aspect~ of the study findings based on their relevance to the study discourse.
Ethical Consideration
In compliance with ethical standards on research work involving human
subjects, the researchers obtained the approval of all relevant authorities.
Ethical approval was obtained from the University oflbadan Institutional
Review Committee (UI/IRC) and the University of Benin Teaching Hospital
Ethical Committee. During the entire period of the field work, ethical
considerations were emphasized. The participation of the respondents was
i
( based on informed and voluntary consent. Confidentiality was assured and the
respondents were also assured that they were at liberty to withdraw from
participating at any time if they so desire at any time and will not be used
f, against them.
(,
~,
"( Results o
Socio-demographic characteristics
The socio-demographic profile of the respondents for the study revealed that
r 62% were females while the remaining 38.3% were males. This indicates thatthere were more females than males in the sample. This may be 'due to the fact
V
,., that women undertake caring responsibilities not only for themselves but for
other members of the family. This current study reveals a larger proportion of
female than the male respondents. This finding confirms the views of Erinosho
(2005) and Jegede (2013) that women do not only undertake more caring
responsibilities, not only for them but are saddled with the responsibilities of
caring for their spouses and other members of the family.
From the sample, the age of respondents ranged from 20 to 70 years and
above. More than half (70.0%) of the respondents were married. Regarding
professed religion, majority (96.0%) of the respondents were Christians, with
less than 2.0% who are Muslims, while the remaining about 3.0% belong to the
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Leadership and Patient Satisfaction 155
African Traditional religion. This is not surprising because the study area is
predominantly inhabited by, Christians. Majority of the respondents with
secondary education constituted the highest' cluster, representing 42.0% of the
total population. 0
In terms of ethnic composition, the majority of the respondents are Binis,
represented by 57.0% and followed by respondents from Yoruba (8%), Igbo
12.0%, Hausa 1.0%, while respondents from "other" ethnic groups constituted
22.0%. The occupational distribution shows that 44.0% of the respondents
were self employed, 20.5% had no jobs at all, only16.0% were civil servants,
9.0% said they are teachers, while 9.0% are full-time housewives. More than
half of the respondents 55.0% earn less than N20,000 monthly.
Table 1: Respondents assessment of satisfaction with Q doctor's
commumca. fIOnWiIth mi -pa tirents b)y sex
Doctor's communication with in-patients on illness type
Gender Low Moderate High satisfaction Total
satisfaction satisfaction
Male 5.0% 20.0% 13.6% 38.6%
Female 2.9% 31.4% 27.1% 61.4%
Total 7.9% 51.4% 40.7% 100%
Chi-square= 10.739, df=2, P-Value= 0.004
Table 2 is a cross tabulation of the outcome of interaction 'during illness
management with the professional health care leadership by sex which shows a
relationship at 0.005 significant level. Chi-square analysis showed that there is
a statistically significant difference between the levels of satisfaction with
doctor's communication with the team of doctors headed by the consultant on
ward rounds by sex. Table 2 also shows that 40.7 percent of the entire 420
respondents experienced high level of satisfaction with reference to doctors
communication with patients while 5.0 percent of the male reported their
satisfaction as low satisfaction as against 2.9 percent 'of the female respondents
who reported their experience of satisfaction as low satisfaction. The result
shows the statistically significant relationship. Those with less knowledge of
health care services are less likely to be satisfied.
Also" respondents with tertiary education are more likely to have
knowledge of health care services provided. This finding on low satisfaction
shows that the respondents know about doctors authority to lead. It can be
explained. as the respondents non-realization of their expectations concerning
doctors' communication and interaction during illness management. The
question that measured satisfaction with doctors' communication with the in-
patients was cross-tabulated by sex to see whether satisfaction with the
doctor's communication with the in-patients (an expectation of leadership oft
the doctor in the facility) was depended on their sex reveals that this depended
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The Nigerian Journal of Sociology and Anthropology VoL13no. 1
on their sex. What this means is that low level of.satisfaction with reference to
doctors' communication reflects the basis of the acceptance of authority to lead
by the health professionals ..
This fmding supports the views of Alliyu et. al. (2005) who observed that
~en differed significantly from women on knowledge of available health care
services and how health care professionals should provide health care services.
The low level of satisfaction with reference to doctors communication have
obvious implications for patients compliance prescribed drugs by doctors and
prescribed drugs administration by nurses. It is probable that the authorities to
lead in these areas are really not fully accepted and require "other categories"
of health care providers.
Another possible explanation for this differentials with satisfaction derived
may be in terms of expectations from the availability of the drugs in the
hospital, an experience of which considerations are not given to. Patients want
the drugs prescribed to be available in the hospital, as quality outside the
hospital cannot be guaranteed, particularly with the pluralistic nature of health
care delivery in Nigeria. The chi.•square values of both sexes Chi-square=
10.739, df =2, P-Value= 0.004 attest to the fact that the level of satisfaction is
statistically related to gender of respondents and reflects the overall pattern of
satisfaction with the doctors' communication about the type of illness. The
females were less satisfied with communication issues than the males.
Findings from the qualitative data revealed that the general perception of
the male respondents and interviews regarding level of satisfaction with
doctors' communication w,ere similar as emphasized by a male participant in
the IDI thus:
The doctors come in large numbers and gather round my bed, but
when they start to talk, they do not say anything to me about the
reason why I am on admission. Different doctors, one by one
take their turn to examine me and they only talk to Oga among
them. (IDI Male, February 2014)
Table 2: Respondents perception of physicians' responses to patients'
oues tlIons
Doctors responses to patients' questions
Low Moderate
Gender satisfaction satisfaction Hi~h satisfaction Total
Male 5.5% 19.5% 13.6% 38.6%
Female 3.8% 31.4% 26.2% 61.4%
Total 9.3% 51.0% 39.8% 100%
Chi-square= 8.247 df=2 P-Value= 0.01
In our quest to find out the, level of satisfaction of patients with the physician,
the respondents were asked to assess the responses of the doctors to the
questions requested from them, to provide answers. About 9.3 percent of the
respondents reported the satisfaction experiences achieved as low satisfaction
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Leadership and Patient Satisfaction 157
with answers provided by the doctors to the questions they asked. There was
also statistically significant difference between the levels of satisfaction with
, health care services with respect to physicians' responses to patients' questions
by sex (P< 0.05). What this means is that levels of satisfaction with health care
services with respect to physicians' responses to patients' ,questions is not
contingent on sex. About 3.8 percent of the female indicated low satisfaction
with the physicians' responses to patients' questions in the facility (Table 3).
The findings show that the patients are in a better position to indicate
physicians' professional authority as they are also better placed. to assess
physicians' response to patients' questions, hence the reporting of their
satisfaction experiences. Furthermore, the physicians who are able to meet with
the expectations of the patients in terms of responses to patients' questions earn
the patients respect which gives the indication of whether physicians have
professional authority which patients look out for or not. This invariably
reflects in the reporting of levels of their satisfaction achieved. This-supports
the findings by IIiyasu et. al. (2010) that physician's failure in meeting patient
expectation is associated with low satisfaction.
Finding was supported with interviews from the IDIs with participants. A
female participant reported thus:
It is going to three weeks that I have been' on admission, and
both the doctors and nurses are trying. In fact I feel better. The
doctors and nurses are trying for me every time. Many doctors
come to see me. When I ask them questions about my health;
they use big, big grammar. I do not know when and what the
doctor is suppose to use to explain to me about my health
condition. (IDI Female, February, 2014)
In order to 'document the 'level of satisfaction of patients regarding
communication by health care provider leadership, respondents' were asked
how satisfied they were with different communications by these health care
leaders with in-patients. Half (51.0 percent) of the respondents reported
experiencing moderate satisfaction, while 40 percent claimed they had high
satisfaction, while only 9. 3 percent experienced low satisfaction With doctors
providing answers to patient's questions during the period of hospitalization on
wards. More (26. 2 percent) females reported high satisfaction than males (13.6
percent) with doctors' answers provided to patients' questions. Appropriate
communication of health issues have been revealed to influence satisfaction
obtained by users of alternative medicine in a study conducted in Okpe local
government area of Delta State (Owumi, 1989).
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The Nigerian Journal of Sociology and Anthropology VoL 13 no. 1
Table 3: Respondents satisfaction with the leadership health care service
and sex
Prescribed drug administration by nurse to
the in-patients
. Low Moderate High
Gender satisfaction satisfaction satisfaction Total
Male 2.4% 0 18.3% 17.9% 38.6%
Female 3.1% 31.2% 27.1% 61.4%
Total 7.9% 51.4% 45.0% 100%
Chi-square=.544 df=2 P-Value= .0073
Table 3 shows respondents' satisfaction with nurses' administration of
prescribed drugs to patients being leadership activity. Respondents were asked
to rate how satisfied they were with administration of drugs by nurses to in-
patients. Findings .revealed that slightly above half 51.4 percent of the
respondents were moderately satisfied, while 45 percent reported experiencing
high satisfaction with prescribed drug administration by the nurses to the in-
patients while only 8 percent reported low satisfaction with drug administration
by nurses to the in-patients.
Table 4 also shows the distribution of the patients by how they reported
their experience of satisfaction with service provision with respect to
prescribed drug administration by the nurse as a leader to the in-patients. Table
4 shows that 31.2 percent of the females relative to 18.3 percent males reported
satisfaction that is rated as moderate satisfaction level with the prescribed drug
administration by the nurse to. them. While 27.1 percent of the female relative
to 17.9 percent male reported satisfaction experience that is expressed as high
satisfaction. The fact that the chi-square value (p< 0.0073) is significant, attest
to the fact that this is statistically related to level of satisfaction with the sex
having .the doctors prescribed drugs administered by the nurse to the
respondents. This may also be explained by the fact that the expectation of
what to benefit from the health care activity of the nurse is greatly valued by
the different sexes. Although this is a weak association, however it calls for
attention considering-the fact that the feeling of satisfaction is closely linked
with identified expectations from specified health care services and health care
providers.
Discussion
In examining the knowledge and awareness of the participants about the health
care services, the findings from the study showed that there is a relatively high
level of knowledge and awareness of the health care services that the health
care professional leaders in the teaching hospital render. Over 80% claimed to
have knowledge of the health care services that professional leaders in the
teaching hospital are supposed to render. This buttresses the findings of Iliyasu
et. al. (2010) in a study of in-patients and expected roles and duties of
professional leaders conducted in a teaching hospital in the Northern Nigeria
UNIVERSITY OF IBADAN LIBRARY
Leadership and Patient Satisfaction 159
that most of the in-patient users of the tertiary hospital in Nigeria are well
educated as majority have knowledge of the health care services provided by
the professional health care leaders in teaching hospital.
This current study reveals a larger proportion of females than the male
respondents in the sample. This differentials in the sex proportion may have
been due to the fact that women undertake both complex ana major family
responsibilities of childrearing and in fact family reproduction which entails
the responsibility of being saddled with caring activities not only for their
spouses during illness management but for their own children as some other
studies have found (Erinosho, 2005; Jegede, 20l3). Another possible
explanation for this gender differentials with satisfaction derived may be in
terms of expectations from the clinical ward experience of events and
emotional problems which considerations are not given to. The implication on
emotional health is devastating on marital status.
As regards in-patients' satisfaction with health care services provided by
the doctors and nurses, the results showed that majority oftlie female and male
patients claimed and reported in-patients' satisfaction as moderate and low
satisfaction respectively with professional leadership health care services
received at the health facility. This has implications for follow-up treatment
and compliance with take home prescribed drugs and also advice from doctors
relating to continuity with the use of health care services. This finding agrees
with the previous studies by Owumi (1989) that compliance with prescribed
treatment and advice from doctors is dependent on patients' satisfaction and
they are also more unlikely to return for additional care when necessary, more
willing to recommend the facility to others (Sun, Adams, Oravs, Rucker,
Brennan and Burtin, 2009).
With respect to getting their prescribed drugs administered to them by the
nurse .is much expected and the proportion of the respondents (49.5 percent)
who rated the health care services received as moderate satisfaction with
respect to getting their prescribed drugs administered to them by' the nurse is
much expected from the category of professional health care leaders in an
institution that has been in existence for over forty years. However close to 50
percent of the males and 40 percent of the females claimed and rated the
satisfaction with having the prescribed drugs administered by the nurse as low
satisfaction. The reason for this may be the belief in cultural values attached to
the provision of western medication when the need to change care provider
arises. Slightly more than half (50.2 percent) rated the services received as
moderate satisfaction with doctors communication about the illness condition.
Overall, the males are more satisfied than females in the sample with
respect to in-patients' subjective level of satisfaction with the professional
health care leaders activities following the use of the tertiary health care facility
of the University of Benin Teaching Hospital, were rated by the majority as
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The Nigerian Journal of Sociology and Anthropology VoL 13no. 1
moderate satisfaction. This also has an implication for the future use of the
health care institution by the public in general.
This study argues that the critical role of leadership activities of core
professional health care providers in enhancing' patients' satisfaction with
healthcare services during illness management cannot be overemphasized. For
the most part, it concretizes the extent of the social interactions in the doctor-
patient in the therapeutic milieu. This supports the views of Erinosho (2005) on
the roles and, importance of socio-cultural factors in the ways in which illness
management is interpreted i~ relation to gender.
Conclusion
The study has provided data that reveals link between the different ratings of
patient s.atisfaction with the expectations from -the leadership of professional
health care providers (doctors and nurses) activities that stem from the self-
rated assessment in the University of Benin. Leadership and patient satisfaction
was investigated by examining in-patients knowledge of the benefits to be
derived from the health care activities of the doctors and nurses and in-patient
satisfaction with professional health care activities of the doctors and nurses.
It is evident that the achievement and attainment of satisfaction rated as
moderate satisfaction by the respondents reflects the overall pattern of
satisfaction with having the doctors' prescribed drugs administered by nurses
to them. This feeling and behaviour may not be unconnected with the
commitment to duty. This research drew insight from the views of in-patients
who are recipients of health care services in order to have a clear understanding
1.,•.. '1.1U· of the factors that contribute to in-patients' satisfaction with leadershipl
W activities of-core health care providers.
~.. Findings from this study have also shown that not all of the respondents
using the health care services of the teaching hospital have their expectations
~, realized from the health care services rendered and received. It is pertinent to
I note that the desire of the in-patients and significant others concerningcommunication and interaction have significant implications for appropriateintervention by the core professional health care leaders.
I
il'!4 Recommendations
In order to enhance the therapeutic interactive processes between the
professional health care practitioners who are leaders in the health care system
and the people (as patients) who are the recipients of the different health care
services, the following recommendations are suggested:
.(1) Assessment of patient satisfaction profile with different health care
service activities in the different departments of the hospital should be
initiated and this must be on a continuous basis so that necessary change
that can lead to improvement in the health care service delivery can be
made.
(2) Very importantly, specific policies that aim at abolishing the existing
ambiguities and gaps in the roles of the leaders as professional health care
UNIVERSITY OF IBADAN LIBRARY
Leadership and Patient Satisfaction 161
providers, especially bringing to the fore those which relate to the rights
of the patients to treatment during hospitalization particularly disclosure
and communication of health information should be made.
(3) Relevant supervisory authorities such as medical monitory/audit and
nursing monitory/audit should be put in place to monitor the performance
of medical doctors and nurses, in the achievement of set goals, and also to
help relieve the associated stress ' that patients go through during
hospitalization. 0
(4) The role and place of research cannot be underrated. There is great need
for a survey to be conducted at the national level on leadership factor that
will improve outcome of health care received from the perspective of the
patients and their subjective expectations in the hospital, to enable the
Federal Ministry of Health formulate policies that will address the social
complaints of different manifestations in the therapeutic milieu.
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