CIET in Pakistan, PO Box 13018, Karachi 75350, Pakistan.
BMC Health Serv Res. 2011 Dec 21;11 Suppl 2(Suppl 2):S10. doi: 10.1186/1472-6963-11-S2-S10.
The Bangladesh government implemented a pilot Hospital Improvement Initiative (HII) in five hospitals in Sylhet division between 1998 and 2003. This included management and behaviour change training for staff, waste disposal and procurement, and referral arrangements. Two linked cross-sectional surveys in 2000 and 2003 assessed the impact of the HII, assessing both patients' experience and satisfaction and public views and use of the hospitals.
In each survey we asked 300 consecutive outpatients and a stratified random sample of 300 inpatients in the five hospitals about waiting and consultation time, use of an agent for admission, and satisfaction with privacy, cleanliness, and staff behaviour. The field teams observed cleanliness and privacy arrangements, and visited a sample of households in communities near the hospitals to ask about their opinions and use of the hospital services. Analysis examined changes over time in patients' experience and views. Multivariate analysis took account of other variables potentially associated with the outcomes. Survey managers discussed the survey findings with gender stratified focus groups in each sample community.
Compared with 2000, an outpatient in three of the hospitals in 2003 was more likely to be seen within 10 minutes and for at least five minutes by the doctor, but outpatients were less likely to report receiving all the prescribed medicines from the hospital. In 2003, inpatients were more likely to have secured admission without using an agent. Although patients' satisfaction with several aspects of care improved, most changes were not statistically significant. Households in 2003 were significantly more likely to rate the hospitals as good than in 2000. Use of the hospitals did not change, except that more households used the medical college hospital for inpatient care in 2003. Focus groups confirmed criticisms of services and suggested improvements.
Improvements in some aspects of patients' experience may have been due to the programme, but the decreased availability of medicines in government facilities across the country over the period also occurred in these hospitals. Monitoring patients' experience and satisfaction as well as public views and use of hospital services is feasible and useful for assessing service interventions.
孟加拉国政府于 1998 年至 2003 年在锡尔赫特地区的五家医院实施了一项医院改进倡议（HII）试点计划。该计划包括对员工进行管理和行为改变培训、废物处理和采购以及转诊安排。2000 年和 2003 年进行了两次关联的横断面调查，评估了 HII 的影响，评估了患者的体验和满意度以及公众对医院的看法和使用情况。
在每次调查中，我们询问了五家医院的 300 名连续门诊患者和 300 名住院患者，了解他们的等待和咨询时间、入院代理的使用情况以及对隐私、清洁和员工行为的满意度。现场小组观察了清洁度和隐私安排，并访问了医院附近社区的样本家庭，询问他们对医院服务的意见和使用情况。分析检查了患者体验和观点随时间的变化。多变量分析考虑了与结果相关的其他变量。调查管理人员与每个样本社区的性别分层焦点小组讨论了调查结果。
与 2000 年相比，2003 年三家医院的门诊患者更有可能在 10 分钟内由医生看诊至少五分钟，但门诊患者报告从医院获得所有规定药物的可能性较小。2003 年，住院患者更有可能在不使用代理的情况下获得入院许可。尽管患者对某些方面的护理满意度有所提高，但大多数变化并不具有统计学意义。2003 年，家庭对医院的评价明显好于 2000 年。除了 2003 年更多家庭选择医学院附属医院进行住院治疗外，医院的使用情况没有变化。焦点小组证实了对服务的批评，并提出了改进建议。
患者体验某些方面的改善可能是由于该计划，但在此期间，全国政府医疗机构的药品供应减少也发生在这些医院。监测患者的体验和满意度以及公众对医院服务的看法和使用情况是可行的，对于评估服务干预措施也很有用。
