# Toward Better Clinical Governance: A Six Sigma Analysis of Patient Satisfaction Determinants in a Tertiary Care Government Hospital

## TL;DR

This study uses Six Sigma to identify factors affecting patient satisfaction in a government hospital, finding that clinical care is key while nonclinical areas need improvement.

## Contribution

Applies Six Sigma methodology to analyze patient satisfaction determinants in a public hospital setting.

## Key findings

- Clinical care by doctors and nursing staff was the primary factor in patient satisfaction.
- Facility-related issues like toilet cleanliness and pharmacy queues caused significant dissatisfaction.
- Elderly and poorly healthy patients showed lower satisfaction levels.

## Abstract

Background: The quality of hospital service and clinical governance depends heavily on patient satisfaction as an essential indicator. The identification of satisfaction determinants helps healthcare providers enhance their delivery methods, particularly in public hospitals with limited resources.

Objective: The research investigated patient satisfaction while applying Six Sigma principles to determine its essential determinants in a tertiary care government hospital.

Methods: A facility-based cross-sectional study took place from November 2023 to December 2024 by selecting 400 patients through random methods. The 19-item structured questionnaire assessed patient satisfaction in three domains that included service utilization, patient-provider interaction, and facility-related factors. A five-point Likert scale evaluated the general satisfaction of patients. The researchers used SPSS to analyze the data through factor analysis and bivariate regression to identify the predictors.

Results: The patient satisfaction level reached 80.4% in the study. The clinical care delivered by doctors and nursing staff proved to be the primary factor that satisfied patients. Facility-related amenities showed substantial gaps because patients expressed dissatisfaction with toilet cleanliness, waiting space availability, dietary services, and pharmacy queue lengths. The unclean state of toilets proved to be the primary cause of patient dissatisfaction because 40% of participants expressed their discontent. The study revealed that elderly patients together with those who reported poor health status demonstrated lower satisfaction levels. The analysis showed that service quality improvements directly resulted in increased patient satisfaction.

Conclusion: The overall satisfaction scores were positive, but nonclinical service domains require substantial improvement. The satisfaction levels could increase substantially through hospital hygiene improvements, outpatient procedure optimization, patient-provider communication enhancement, and technology-based queue management systems. The implementation of the Six Sigma methodology for regular monitoring enabled healthcare providers to develop evidence-based strategies that enhance clinical governance in government hospitals.