ASSESSMENT ON QUALITY OF HEALTHCARE SERVICES AND PATIENTS’ SATISFACTION IN UNIVERSITY TEACHING HOSPITAL IN NIGERIA

CHAPTER ONE INTRODUCTION 1.1 Background to the Study Healthcare quality has emerged as a pivotal concern within global health systems due to its significant implications for patient outcomes, institutional credibility, and overall trust in health delivery systems. High-quality healthcare is generally characterized by its responsiveness, safety, professional competence, environmental cleanliness, and the efficiency of provider–patient communication (Donabedian, 2021). In the context of low- and middle-income countries such as Nigeria, persistent challenges such as infrastructural deficits, workforce inadequacies, and suboptimal service coordination have led to concerns regarding the capacity of healthcare institutions to deliver services that meet patients’ expectations. These concerns are even more pronounced in university teaching hospitals, which are expected to set the benchmark for tertiary healthcare delivery and medical training. However, the observed decline in service quality has often translated into heightened levels of patient dissatisfaction, a trend that demands scholarly and policy attention. University teaching hospitals in Nigeria perform a dual function: delivering specialized health services and serving as training grounds for medical professionals. This dual mandate necessitates a high standard of care, reflective of international best practices. Despite these expectations, empirical studies and anecdotal reports point to recurring patient grievances in these facilities, such as prolonged waiting times, poor staff attitudes, inadequate drug supply, and weak provider–patient communication (Akinyemi & Arulogun, 2022). These issues not only affect patients' immediate experiences but also their long-term trust in public healthcare institutions. As patient satisfaction is increasingly recognized as a core metric for evaluating healthcare quality, it becomes imperative to explore the extent to which service delivery dimensions in teaching hospitals align with patients’ expectations and contribute to their overall satisfaction. According to Damian, Osarume & Philip (2023), patients’ satisfaction, which is widely regarded as a comprehensive measure of patients’ perceptions and experiences across the healthcare continuum is influenced by various factors including clinical outcomes, interpersonal relations, and physical infrastructure. With the quality of healthcare services, operationalized through indicators such as service accessibility, staff competence, communication effectiveness, safety practices, and environmental hygiene, Damine et al validated the significant relationship between these quality dimensions and patients’ satisfaction. Ogbonna et al. (2021) reported a strong positive correlation between patient-centered communication, availability of care, and overall patient satisfaction in tertiary hospitals across southern Nigeria. The implication is that improvements in healthcare quality are likely to yield commensurate gains in satisfaction levels. According to Oladele and Olatunji (2023), patient satisfaction is not only a reflection of service delivery but also a determinant of health-seeking behavior, compliance with treatment protocols, and public perceptions of health systems, patients who perceive high-quality care are more likely to revisit the facility, adhere to medical advice, and recommend the service to others, contributing to improved health outcomes and institutional efficiency. Conversely, dissatisfaction may lead to delays in seeking care, non-compliance with treatment, or reliance on alternative healthcare providers. As such, assessing the link between healthcare quality and satisfaction provides actionable insights for healthcare administrators, policymakers, and public health practitioners aiming to reform the tertiary health sector in Nigeria. While university teaching hospitals in Nigeria occupy a strategic position in national healthcare delivery and human resource development, the quality of services rendered in these facilities remains a subject of concern. There is a compelling need to empirically investigate how various components of healthcare quality affect patient satisfaction. This study is therefore designed to critically examine the relationship between healthcare service quality and patients’ satisfaction in selected university teaching hospitals in Nigeria, with the goal of informing strategic interventions that could enhance service delivery and restore public confidence in the healthcare system. 1.2 Statement of the Problem Recently, despite significant investments in tertiary healthcare infrastructure and workforce in Nigeria, university teaching hospitals continue to record mixed outcomes in patients’ satisfaction. Reports from the Nigerian Ministry of Health (NMS,2020) and the World Health Organization (WHO, 2023) indicate that patients' grievances often border on prolonged waiting times, poor staff attitudes, lack of privacy, substandard amenities, and inefficient complaint resolution mechanisms. These concerns raise questions about the actual quality of healthcare services provided in university teaching hospitals and whether they meet the expectations and needs of patients. Studies by Egbon & Agbonifoh (2020) revealed that service quality dimensions such as assurance, empathy, reliability, tangibility and responsiveness) have a positive and significant relationship with patients' satisfaction. Thus recommended that healthcare providers should render services in a manner that instils confidence in patients by making them feel hospitable Although several studies have addressed aspects of service delivery in Nigerian health institutions, few have holistically examined the interconnection between quality service dimensions and patient satisfaction within the context of university teaching hospitals. The lack of empirical clarity in this regard poses a significant gap in evidence-based interventions. Without a comprehensive assessment of the factors influencing satisfaction, especially from the patients’ perspective, policy interventions risk being misdirected or ineffective. In this regard, this study, therefore, seeks to critically assess the quality of healthcare services in Nigerian university teaching hospitals and determine their influence on patients’ satisfaction with reference to Enugu State university teaching hospital. 1.3 Objectives of the Study The general objective of this study is to evaluate the quality of healthcare services and their effect on patients' satisfaction in Enugu State university teaching hospital.. The specific objectives are to: 1. Assess the level of patients’ satisfaction with the healthcare services received in Enugu State university teaching hospital.. 2. Examine the quality dimensions of healthcare services provided in Enugu State university teaching hospital.. 3. Investigate the relationship between the quality of healthcare services and patients’ satisfaction in Enugu State university teaching hospital.. 4. Identify the key challenges affecting the delivery of quality healthcare services in Enugu State university teaching hospital. 1.4 Research Questions 1. What is the level of patients’ satisfaction with the healthcare services provided in Enugu State university teaching hospital? 2. What are the quality dimensions of healthcare services offered in Enugu State university teaching hospital? 3. What relationship exists between the quality of healthcare services and patients’ satisfaction in Enugu State university teaching hospital? 4. What are the major challenges confronting the delivery of quality healthcare services in Enugu State University teaching hospital? 1.5 Research Hypotheses H₀₁: There is no significant relationship between quality of healthcare services and patients’ satisfaction in the university teaching hospital. H₀₂: Quality dimensions such as provider-patient communication and waiting time do not significantly influence patients’ satisfaction. 1.6 Significance of the Study This study is significant in several respects. Firstly, it provides empirical evidence on the relationship between healthcare quality and patient satisfaction, thereby contributing to existing literature on health systems in developing countries. Secondly, healthcare administrators and policymakers will find the findings useful in designing patient-centered interventions aimed at improving service delivery in teaching hospitals. Thirdly, the study can serve as a performance audit tool for health professionals, encouraging them to prioritize patient experiences in their service approach. Finally, the study lays a foundation for further research into institutional health service quality improvement strategies within the Nigerian healthcare landscape. 1.7 Scope of the Study This study is delimited to the assessment of healthcare service quality and patients’ satisfaction within a selected university teaching hospital in Nigeria. It focuses on adult in-patients and out-patients who have experienced medical care at the institution. The quality dimensions under investigation include timeliness of care, staff attitude, communication clarity, availability of medical resources, and cleanliness of the hospital environment. In geography, the study is limited to Enugu State university teaching hospital. 1.8 Operational Definition of Terms Quality of Healthcare Services: Refers to the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (WHO, 2023). Patient Satisfaction: A measure of the extent to which patients are content with the healthcare they receive, considering their expectations, experiences, and perceived service quality. Teaching Hospital: A tertiary healthcare institution affiliated with a university, involved in both providing care and training future health professionals. Healthcare Dimensions: Aspects of service quality such as communication, timeliness, infrastructure, empathy, and competence that influence the patient’s experience.