Comm Eye Health Vol. 15 No. 41 2002 pp 05 - 07. Published online 01 March 2002.

Patients’’ perspective: an important factor in assessing patient satisfaction

R Muralikrishnan MHM MSc , A K Sivakumar MHM

Lions Aravind Institute of Community Ophthalmology, 720 Kuruvikaran Salai, Gandhi Nagar, Madurai 625 020, Tamil Nadu, India

D D Murray McGavin MD FRCOphth


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Conventionally, the preparation of a patient satisfaction questionnaire is based on textbooks, one’s own perception and similar forms used at other hospitals. This process often reflects the providers’ perception of factors influencing satisfaction, perpetuating their shortcomings and not adequately dealing with necessary cultural and social variations.


Aravind Eye Care System in India, one of the highest volume eye care centres in the world, developed an innovative way of developing an in-patient satisfaction assessment tool. All the ‘suggestions and complaints’ of inpatients registered in a separate suggestion register during the year 1997 were scrutinised and grouped. To confirm that the groupings indeed reflected the patient’s expectations and concerns, another survey through interviews was conducted on 50 patients and 50 staff (ophthalmologists, nurses, administrative staff) with the objective of finding out the patients’ expectations, concerns and worries.


The 123 different complaints in the initial study and the results of the supplementary study were used to develop 12 different categories to assess patient satisfaction. These are:

  1. Medical care
  2. Nursing care
  3. Behaviour of staff
  4. Clear information
  5. Personal attention
  6. Responsiveness to complaints & care*
  7. Integrity*
  8. Physical facilities
  9. Supportive services
  10. Cleanliness & maintenance
  11. Waiting time
  12. Charges

* Derived from the supplementary study

Action(s) taken

In order to monitor patient satisfaction objectively, questions were developed in the broad categories, piloted and developed as a standard questionnaire to grade responses on different point scales. Some additional information, such as age, gender and treatment, was also included for better analysis. The questionnaire also used very clear and simple language and was worded to elicit thoughtful responses.

Consequence of action(s)

This process has helped to develop a standard questionnaire to measure patient satisfaction regularly in our hospital. The expectations are also understood as these change and are incorporated into the questionnaire from time to time. The results are presented to the hospital’s Quality Council and during meetings of heads of departments with a view to taking corrective actions. Individual audits are also undertaken on high patient dissatisfaction areas. The impact is that our patients are more satisfied (our regular survey results confirms this) and we experience an average workload increase of 15% every year. The success of our assessment and improvement of patient satisfaction is because we take into account the patients’ own views and perspectives.

We requested further information regarding the programme at Aravind Eye Hospital, specifically details of the Quality Council and the Questionnaire. These have kindly been sent to us and are included below.

Aravind Eye Hospital quality council

  • Dr P Namperumalsamy, Director Chair of the Council
  • Mr A K Sivakumar, Faculty-LAICO, Secretary
  • Dr G Venkataswamy, Chairman
  • Mr G Srinivasan, Secretary to Trust
  • Dr G Natchiar, Joint Director
  • Mr R D Thulasiraj, Executive Director
  • Dr M Srinivasan, Chief Medical Officer
  • Dr S Aravind, Administrator
  • Mr R Meenakshi Sundaram, Community Outreach Manager
  • Mr Ganesh Babu, EDP In-charge
  • Mrs R Alees Mary, Nursing Training Coordinator

Terms of reference

  1. Aravind Quality Council is a Management Committee, which will meet once a month, to direct, monitor, and support the Quality Management Programmes in Aravind Eye Hospital, Madurai.
  2. The Council will approve Department level Quality Objectives and Performance Standards as they are developed or amended.
  3. The Council will review and approve any major changes or re-organisation that is perceived as necessary for the quality improvement process.
  4. The Council will review and approve requests for additional support relating to quality improvement. Such requests may include the following:
  • Staffing
  • Staff developments
  • Equipment/instruments
  • Space
  • Re-organisation or re-structuring
  • The Council will review the impact of the various quality improvement measures.
  • The Council will approve the Quality Manual, which comprises Quality Principles and Quality Improvement Practice in Aravind Eye Hospital, Madurai.
  • The ultimate aim of the whole process is to ensure zero defects in the services and a high level of patient satisfaction

    Aravind Eye Hospital in-patient feedback form

    Aravind Eye Hospital is committed to giving high quality medical care and quality service. In order to assess our performance we would like you to take a few minutes to complete this questionnaire.

    a) Name:

    b) Age:

    c) Sex: Male / Female

    d) M.R. No.:

    e) Room No:

    Please answer all the questions by circling the number you feel to be appropriate. If you would like to add any comments or make suggestions, please use the box at the end.

    Excellent = 1 Good = 2 Average = 3 Poor = 4 Don’t know = 5

    1. Your opinion about doctor(s) and medical care:

    Doctors’ Competence

    1 2 3 4 5

    Doctors’ Attitude and Behaviour

    1 2 3 4 5

    Listen to my problems

    Adequate Inadequate

    Time spent by the doctor: explanation about my health and treatment

    Adequate Inadequate

    Explanation about any specific procedure / treatment

    Adequate Inadequate

    Daily visit

    Adequate Inadequate

    Privacy while examining

    Adequate Inadequate

    2. Your opinion about nurses and nursing care:

    Smiling face / polite / friendly

    1 2 3 4 5

    Attitude and behaviour

    1 2 3 4 5

    Promptness in meeting the needs

    1 2 3 4 5

    Explanation of the process of treatment & progress

    1 2 3 4 5

    Provision of psychological support/reinforcement

    1 2 3 4 5

    Enquiries about food/night rest/discomfort/etc.

    1 2 3 4 5

    Provision of health education

    1 2 3 4 5

    Medication/treatment in time

    1 2 3 4 5

    3. How would you rate the charges and costs of services at Aravind?

    High Reasonable Low Don’t know

    4. How would you rate the attitude and behaviour of ward co-ordinators?

    1 2 3 4 5

    5. How responsive were all staff to your needs?

    1 2 3 4 5

    6. How do you rate the level of communication and information you received at Aravind?

    1 2 3 4 5

    7. How do you rate the general cleanliness of the ward?

    1 2 3 4 5

    8. How do you rate the catering / food service at Aravind?

    1 2 3 4 5

    9. How would you rate the facilities at Aravind (refreshments, pharmacy, etc)?

    1 2 3 4 5

    10. How would you rate the general facilities in the wards (space, furniture, etc.)?

    1 2 3 4 5

    11. List the areas where you experienced long waiting times:

    12. Would you recommend Aravind to friends and /relatives?

    Strongly Hesitantly Will Not Don’t Know

    13. Overall, how would you rate the services offered at Aravind?

    1 2 3 4 5

    14. Please add any further comments or suggestions you would like to make.


    Patients’ feedback: follow-up actions

    Suggestions and grievances / Actions taken

    Behaviour of Staff

    • Rude behaviour of certain doctors and nurses.
      Action taken: Concerned staff writes apology letter to the patient (decision by Joint Director and the Nursing Superintendent)

    Clear Information

    • Appoint a person in the ward who can speak different languages.
      Action taken: Appointed an in-patient counsellor fluent in 5 languages (Tamil, English, Malayalam, Hindi and Telugu)
    • Nurses do not provide sufficient information to patients about the various procedures.
      Action taken: This was addressed in the Quality Service Workshop for Nurses
    • Place information boards indicating the length of stay, operation charge, etc.
      Action taken: Information boards are now placed in front of the counselling department

    Personal Attention and Care

    • Receptionists guiding the patients to the clinics walk very fast leaving the patient behind.
      Action taken: This was addressed in the Quality Service Workshop

    Physical Facilities

    • Provide hot water for the patients
      Action taken: Hot water is now provided to the rooms, but needs improvement

    Supportive Services

    • Complaints about quality and quantity of food
      Action taken: Did a quality audit on catering; a member of the management team checks the quality and quantity randomly every day before serving
    • Open a separate telephone booth for local calls
      Action taken: A separate local call booth established near the cycle stand

    Cleanliness and Maintenance

    • Toilets near room no.10 smell badly
      Action taken: Frequency of cleaning the toilets has been increased

    Waiting Time

    • Explanation should be given to the patients about the long waiting time in the Laser room
      Action taken: Sisters are asked to provide an explanation when a patient is made to wait in the Laser room


    • Provide instruction about the fees to be paid at ‘old card’ registration provide information about the consulting fees
      Action taken: Boards displayed in the ‘new card’ & ‘old card’ registration counters


    • Take some action against the monkey menace
      Action taken: The monkeys have been caught and taken away