The study aims to examine the factors that influence patients’ satisfaction during healthcare delivery at a selected district hospital.

A quantitative descriptive design was used. This design is suitable for the phenomenon under study as it allows the researcher to collect numerical data from many patients and describe their satisfaction levels accurately. This design seeks to identify factors – such as waiting time, communication, and staff attitude – that influence satisfaction. Using structured surveys, it ensures consistent, objective, and reliable data for clearly describing patient experiences. Moreover, it is a method that collects and analyses numerical data to describe the characteristics of a population or phenomenon under study, and has clearly defined research questions (Slater & Hasson 2024).

The study was conducted in Limpopo province, South Africa. The selected district hospital was also appropriate because it is a busy 122-bed facility that sees approximately 1200 outpatients monthly and admits around 400 inpatients in various wards per month, including medical, surgical, antenatal, and postnatal wards, and also provides operative and emergency care services. It has a large patient size and a diverse case mix, providing a rich environment for gathering reliable information on patient satisfaction.

The study population comprised all hospital patients, both outpatients and inpatients. Systematic random sampling was applied by calculating the sampling interval (k) using the formula: k = N.n.

In the formula, N is the population (number of patients in the ward, e.g. 35), and n is the targeted sample size (8) of the ward per day (Polit & Beck 2018:289). If the sampling interval (k) is 8, and the sampling started by randomly selecting the patient’s bed number 3, then applying the sampling interval, the third number was 11, followed by the number 19 (Polit & Beck 2018:748). A two-stage process was used: firstly, patients were stratified into inpatients and outpatients. Eight inpatients were to be selected daily for 20 days. Secondly, eight outpatients were to be randomly selected for 20 days. Therefore, the total number of both inpatients and outpatients was 160 each, totalling 320.

A multi-stage sampling method further divided groups into smaller units, enabling detailed examination of population structures (Okechi 2024).

The inclusion criteria were all inpatients who were admitted to the hospital, plus all outpatients who visited the hospital to seek healthcare. Furthermore, patients were older than 18 years to give voluntary consent to participate and were well-oriented and aware. Patients in the surgical and medical wards were given equal opportunities, but only those who could make informed decisions were allowed to participate.

All patients seen in the emergency room and operating room were excluded because of the emergency nature of the care they had to receive. Furthermore, all patients under 18 years of age and those who were mentally unstable were excluded.

A structured questionnaire was developed using the Donabedian model for quality care (2005) to measure patient satisfaction with healthcare. This questionnaire was developed with the assistance of a statistician and had 32 questions grouped into four sections. Section A covered demographic information, Section B assessed satisfaction with care received, Section C examined satisfaction with the quality of care provided, and Section D contained three open-ended questions for additional views and suggestions. The views and experiences of the respondents were considered. The tool was piloted with 16 randomly selected inpatients and 16 outpatients to assess feasibility and practicality. Therefore, 32 patients participated in the piloting process. During the pilot, the inpatients completed the questionnaire in a side room, while the outpatients used the pharmacy boardroom at their exit point. During actual data collection, the same tool that was piloted was used with minor amendments, and the data from the pilot study was not part of the main study, as there was a need for minor amendments to the data collection tool. The questionnaires were distributed to 320 respondents. Eight inpatients were to be selected daily for 20 days from a random starting point as per the total number of patients on that specific day during data collection. Furthermore, eight outpatients were to be randomly selected for 20 days so that each patient had an equal opportunity. Therefore, the total number of both inpatients and outpatients was 160 each, totalling 320, who were randomly selected. A total of 240 (n = 240) were outpatients, and 80 (n = 80) were inpatients. All respondents completed the questionnaires and returned them to the investigator. The study was carried out face-to-face in a side room and in a pharmacy boardroom.

Respondents who could not read and write were assisted in completing the questionnaire. The response rate was therefore 100%.

Data were analysed using statistical software, SAS 9.2, with descriptive statistics and Chi-square tests. The data were described using the Chi-square test (χ²) for the equal proportion technique.

The results were presented in tables, graphs, and bar charts. The responses for open-ended questionnaires were analysed by the researcher, using sentiment data analysis that assisted in grouping and categorising sentiment. The sentiment was confirmed by the statistician. The findings were presented in the report using bar charts.

Rigour was ensured through validity and reliability, with assistance from a statistician, to accurately assess patient care at the selected hospital (Polit & Beck 2021:690). For this study, face validity was established through pre-testing to confirm that the questions were relevant, clear, and easy to understand. Content validity was ensured by including sufficient content to measure the phenomenon under study, supported by Polit and Beck (2021:690). Additionally, the researcher ensured that the questions were formulated to elicit the variables that influence the care of the patient at the selected hospital. Adjustments to the questionnaires were made after pilot study discussions with the statistician. Reliability is the accuracy and consistency of information (Polit & Beck 2021:691), and this was achieved by ensuring that the information was obtained directly from the respondents.

Ethical clearance to conduct this study was obtained from the University of Pretoria Faculty of Health Sciences Research Ethics Committee with the ethical approval number 406/2017 and the Provincial Department of Health Ethics Committee with ethical approval number 4/2/2. A letter was received from the CEO of the hospital who granted permission for the study to be conducted there. Informed consent was obtained before data collection. Respondents were assured of their rights to withdraw at any time should they feel like, the right to be protected from harm, the right to confidentiality, and privacy.

Respondents were male and female participants of various age groups and educational levels. All 320 respondents responded, comprising 160 inpatients and 160 outpatients. The response rate was therefore 100%. All questionnaires were completed appropriately and returned to the investigator.

Table 1 presents the respondents’ demographic characteristics, including age, gender, educational level, hospital visits, previous admissions, and wards of admission. A Chi-square test assessed the relationships between demographics and determinants of patient satisfaction. The sample included both male and female participants, of various age groups, and respondents with varying educational levels, including some with no formal education.

Table 2 presents the patient visit patterns. There was a highly significant difference (p < 0.001) between inpatients and outpatients. Eighty-four inpatients reported occasional visits, compared to 40 outpatients, while 59 outpatients visited monthly, versus 15 inpatients, mainly to collect scheduled chronic medication. Over 50 respondents in each group reported never being admitted. There was a significant association between outpatients (68%) agreeing that nurses sit and talk to patients and inpatients (49%) (p = 0.0065, χ² = 10.09). Similarly, inpatients showed higher disagreement (19%) with nurses explaining their condition compared to outpatients (6%) (p = 0.0018, χ² = 12.68). Inpatients also reported a higher disagreement (56%) regarding information on other available services compared to dissatisfaction with other factors.

Table 3 shows the relationship between patients’ categories (inpatients and outpatients) and communication, as well as how patients responded regarding communication. A significant relationship was found between outpatient agreement (68%) and inpatient agreement (49%) on how nurses sit and talk to patients (p = 0.0065, χ² = 10.09). Another significant relationship was observed between inpatient disagreement (19%) and outpatient disagreement (6%), concerning nurses explaining their condition, as well as the failure of healthcare providers to provide information on other services (p = 0.0018, χ² = 12.68).

Table 4 presents patients’ experience of care with the general service. The waiting time was strongly associated with inpatient responses (p < 0.001). Dissatisfaction with long waiting times to see a doctor was reported by 76% of inpatients compared to 24% of outpatients. Over half of the outpatients felt the wait was adequate, while only 16% of inpatients agreed. Overall, long waiting times were a key factor in dissatisfaction, with inpatients reporting the highest levels. Patients reported high satisfaction with cleanliness (p = 0.0459) and a clean environment (p = 0.0382), with nursing care scores above 80%. Most agreed on the positive quality of care, while only a few disagreed or remained neutral. The majority (90%) were pleased with the hospital’s care, and over 80% agreed the reception during admission was excellent, with friendly and helpful staff. Although agreement levels were high, the difference between patient categories was not statistically significant (p > 0.05). Most respondents (56%) expressed satisfaction with care from doctors, nurses, and other staff. Table 4 provides detailed scores on general care.

Figure 1 presents the association between patients’ category (inpatients, outpatients) and their satisfaction in the application of patients’ rights. Disagreement about nurses explaining patients’ rights did not differ significantly between inpatients and outpatients (p > 0.05), indicating rights were explained similarly to both groups. Although most respondents disagreed that their rights were explained, over 70% in both groups agreed they were treated equally and with dignity, showing no preference for either category (p > 0.05).

Figure 2 presents a summary of aspects that led to patient dissatisfaction. With reference to Figure 1, 34% respondents were dissatisfied with the service, citing dirty hospital linen and long Out Patient Department (OPD) waiting times. Several patients also noted the lack of drinking water in the OPD. Environmental hygiene ranked second (14%), with complaints about toilet conditions. Contact with staff received the lowest positive rating (7%). Infrastructure issues were mentioned by 5%, while food (3%) and staff attitude (5%) drew few complaints, which is encouraging. Staff shortages were not seen as a factor. Nearly 29% chose not to comment.

Figure 3 presents a summary of recommendations put forth by patients to improve patient satisfaction. Respondents suggested improvements in general service (23%), infrastructure (16%), environmental hygiene (13%), staffing (8%), waiting time (7%), and communication (6%). Others recommended maintaining high standards. Patients are a key source of feedback on hospital performance, as their expectations are shaped by personal experience or information from others. Patient satisfaction for the study was evaluated based on general service, infrastructure, environmental hygiene, waiting time, and staff availability.

The research was conducted in one province of the country, thus making it difficult to conclude that factors leading to patient dissatisfaction in healthcare facilities around the country are similar. The findings cannot, therefore, be projected to other hospitals in the country. Moreover, the exclusion of the emergency room may have been a limitation in terms of accessing a patient in the emergency room.

Further studies that focus on determining factors that lead to patient satisfaction in the country can be conducted. Monitoring and evaluation processes are to be emphasised and continuously implemented in healthcare facilities.