A POST OCCUPANCY EVALUATION OF PATIENTSʹ SATISFACTION WITH NIGER STATE GOVERNMENT HOSPITAL BUILDINGS

ABSTRACT

Patients in healthcare facilities are often fearful and uncertain about their health, safety and isolation from normal social relationships. This is due to the large, complex environment of a typical hospital which further contributes to the stressful situation. This research evaluated patientsʹ satisfaction of the Niger State Government hospital buildings using the Post Occupancy Evaluation approach as a prominent tool with a view to improving the building performance of the hospitals in Niger State. The objectives of this research are, to identify the relevance of the predominant services offered by the general hospitals to use of buildings, to assess the satisfaction of the patients with the general setting of the hospital buildings based on the sections and departments and to determine the factors influencing patients’ satisfaction in public hospital buildings. The research work focused on patients in three general hospitals in Niger State- Minna, Bida and Kontagora. A well-structured questionnaire was used to collect primary data from 150 respondents. Findings from the research showed that Clinical service is the predominant services offered by the general hospitals and efficiency is the major factor influencing patients‟ satisfaction of General Hospital buildings. It was also found that patients are satisfied with the illumination provided in all the departments in the hospital buildings. From the general Post Occupancy

Evaluation undertaken, the study therefore concluded that patients of the Niger State General hospitals are fairly satisfied with the characteristics of the facilities of all the Departments in the hospital buildings studied. Major recommendation from the study was that further studies should be undertaken to consider better means of improving cleanliness, aesthetics and comfortability of patients in the

General Hospitals Buildings.

TABLE OF CONTENTS

 

Title Page ………………………………………………………………………………………………………………. i

Declaration……………………………………………………………………………………………………………. ii

Certification …………………………………………………………………………………………………………. iii

Acknowledgement ………………………………………………………………………………………………… iv

Dedication …………………………………………………………………………………………………………….. v

Table of contents …………………………………………………………………………………………………… vi

List of tables ………………………………………………………………………………………………………. viii

List of figures ………………………………………………………………………………………………………… x Abstract ………………………………………………………………………………………………………………. xi

1.0   INTRODUCTION …………………………………………………………………………………………. 1

1.1   Background of the Study ………………………………………………………………………………… 1 1.2   Statement of the Research Problem …………………………………………………………………. 3

1.3Justification for the Study …………………………………………………………………………………. 4 1.4Research Questions ………………………………………………………………………………………….. 5 1.5Aim and Objectives ………………………………………………………………………………………….. 5

1.5.1 Aim ……………………………………………………………………………………………………………… 5

1.5.2 Objectives …………………………………………………………………………………………………….. 5

1.6 Scope of the Study …………………………………………………………………………………………… 6

2.0LITERATURE REVIEW …………………………………………………………………………………. 72.1Hospital Buildings and POE ……………………………………………………………………………… 7

2.2 Historical Development of Hospitals ……………………………………………………………….. 11

2.3Modern Hospitals …………………………………………………………………………………………… 122.4Classification of Hospital ………………………………………………………………………………… 132.5Functions and Social Responsibilities of Public Hospitals …………………………………… 14

2.5.1 Regular Medical Services………………………………………………………………………………………….. 15

2.5.2 Preventive Health Care, Health Education and Rehabilitation ………………………………………….. 15

2.5.3 Public Health Accidents ……………………………………………………………………………………………. 16

2.5.4 Other Government Missions ……………………………………………………………………………………… 16

2.6Hospital Design Coordination and Complexities ……………………………………………….. 17

2.6.1Hospital Building Form and Adaptations………………………………………………………………………. 18

2.6.2History of Building Evaluation …………………………………………………………………………………… 19

2.7Concept of Post Occupancy Evaluation…………………………………………………………….. 20

2.7.1Aim and Targets of POE ……………………………………………………………………………………………. 21

2.7.2Post Occupancy Evaluation Models …………………………………………………………………………….. 23

2.7.3The Post Occupancy Evaluation Phases and Steps ………………………………………………………….. 26

2.7.4Benefits and barriers to POE ………………………………………………………………………………………. 28

2.7.5Post Occupancy Evaluation Tools ……………………………………………………………………………….. 29

2.7.6 POE as a Facility Management Tool …………………………………………………………………………… 31

2.7.7POE in the Balance of Creativity and Utility in Building Design ………………………………………. 32

2.7.8Performance Criteria …………………………………………………………………………………………………. 33

2.8Patients’ Satisfaction ………………………………………………………………………………………. 34

2.8.1Factors Affecting Patient‟s Satisfaction ………………………………………………………………………… 36

2.8.2 Patients Satisfaction with Hospitals …………………………………………………………………………….. 38

2.8.3POE and Patient Satisfaction with Buildings …………………………………………………………………. 40

2.8.4POE and Building Performance ………………………………………………………………………………….. 42

3.0RESEARCH METHODOLOGY …………………………………………………………………….. 453.1Research Design …………………………………………………………………………………………….. 45

3.2 Population of the Study ………………………………………………………………………………….. 45

3.3Sampling Technique ……………………………………………………………………………………….. 463.4Sample Size ……………………………………………………………………………………………………. 473.5Questionnaire Design and Response …………………………………………………………………. 473.6Data Analysis Techniques ……………………………………………………………………………….. 47

3.8   Study Area ………………………………………………………………………………………………….. 49

4.0   DATA PRESENTATION, ANALYSIS AND DISCUSSION OF RESULTS ………. 514.1Data Presentation and Analysis ……………………………………………………………………….. 514.2Questionnaire Design and Response …………………………………………………………………. 51

4.3   Social Demographic Characteristics of Patients ……………………………………………… 51 4.4   Type of Predominant Services Offered by the General Hospitals ……………………… 55

5.0SUMMARY, CONCLUSION AND RECOMMENDATION ………………………………. 97

5.1 Summary of Findings …………………………………………………………………………………….. 97

5.2Conclusion …………………………………………………………………………………………………….. 985.3Recommendations ………………………………………………………………………………………….. 98 5.4Contributions to Knowledge ………………………………………. Error! Bookmark not defined.

REFERENCES …………………………………………………………………………………………………… 99

 

CHAPTER ONE

                                                                INTRODUCTION

                1.1                                           Background of the Study

Buildings can add substantial value to their clients, their occupiers, the economy and the environment. In spite of this, opportunities are regularly missed and value needlessly subtracted because people do not learn enough from the buildings they construct (Olagunjuet al., 2013). When undertaking a new project, to make the most of the potentialand to avoid common pitfalls, construction team need to obtain feedback from the previous projects and their performance in use and feed forward into the building project and into the procurement process (Bordass, Leaman and Eley, 2006).Feedback should also be obtained from the project itself, during the construction process and after it has been constructed. The feedback obtained is termed “post occupancy evaluation” (Khalil and Husin, 2009).

Buildings are required to provide a conducive and safe environment for various human activities. The ability of a hospital building to facilitate healing process is termed „therapeutic‟, which can be described as the overall environment both physical and non-physical created to aid the recovery process (Abbas and Ghazali, 2010; Dandajeh, 2011).Hospitals today have evolved as advanced centre for healthcare – diagnostics and research, recovery and preventive health facilities. Hospitals have a large ecological footprint. The wards buildings in hospitals form the largest component of any hospital setup. There are a number of factors such as privacy, comfortability, accessibility, design of the building, beyond good medical practices and safe environment that contribute to patient healing (Pritam and Mukta, 2012). The goal of every health institution is to provide patient care, produce medical and health manpower. In furtherance of this goal, staff and expertise based on the highest skill are motivated in an environment that is clean, conducive and patient friendly (Zubairu and Ayuba, 2012).

Patients in a healthcare facility are often fearful and uncertain about their health, their safety and their isolation from normal social relationships. The large, complex environment of a typical hospital further contributes to the stressful situation. While it is true that good patient care comes from dedicated individuals, it is equally true that the physical structures and hospital environment must be such that the safety and well-being of patients is protected (Shohet, 2003).

Patient‟s perceptions are gaining popularity to evaluate the quality of healthcare facilities delivered (Pritam and Mukta, 2012). The most known evaluation method for buildings is Post Occupancy Evaluation (Preiser, 2001). Post Occupancy Evaluation (POE) consists of a set of methods and techniques applied in thebuilt environment. It is the evaluation of the performance of buildings after occupancy. Its purpose is to evaluate performance from the perspective of specialists and from that of the environment‟s users, and then draw up a systematic diagnosis of the positive and negative functional aspects, as well as of the construction system, environmental comfort, cost/benefit relationships related to maintenance, and relationships between the built environment and human behaviour (Preiser, 2001). This diagnosis will serve as feedback for managing the quality of the construction process, as well as the use, management and maintenance of built environments. Importance of POEs has greatly increased in recent years, although it is a more typical activity in the USA and some

European countries than it is in most developing countries (Adewunmie. al., 2009). Post-occupancy evaluation (POE) is a platform for the systematic study of buildings once occupied, so as to identify building performance issues that will improve their current conditions and guide the design of future buildings. Various aspects of the occupied buildings‟ functioning and performance can be assessed in a POE and that is why Post Occupancy Evaluation is important in order to avoid repeated mistakes in building designs.

                1.2                                           Statement of the Research Problem

POE thoroughly appraises a particular environment to have a better understanding of the impact of a constructed or renovated facility on its occupants and environment, thus it analyses how it facilitates or inhibits health or daily activities of the occupants (Khalil &Husin, 2009). Therefore, the continuous and rekindled interest in natural condition within the hospital environment has increased the research efforts in documenting the advantages of nature for lessening stress, improving occupants‟ mood, and increasing healthcare satisfaction (Sherman, Varni, Ulrich &Malcarne, 2005). Sherman et al. (2005) argued that these efforts become necessary as a result of paradigmatic change in the subjective sphere of health outcome such as healthcare satisfaction and well-being, which are becoming gradually significant in health and hospital culture. This according to Sullivan (2003) has resulted in hospitals striving not only to cure physical conditions, but also to improve quality of life of healthcare seekers and hospital goers.

However, most of the studies on POE of hospital buildings have mostly been conducted in developed countries such as in USA and other European countries with little or no research in the developing world context such as Nigeria. A few number of studies on POE in Nigeria centred on public and residential buildings (Zubairu and Ayuba, 2012; Olagunjuet al., 2013). Meanwhile, previous studies have established that hospital environment replete with stressors and poor quality air can increase the rates of Sick Building Syndrome of occupants as well as high state of mental fatigue

(Kaplan & Kaplan, 1983; Rdesinski, 2009). Working and living in buildings can have unanticipated adverse health effects. Based on this assertion, early researchers (such as Kaplan & Kaplan, 1983; Sherman et al., 2005) have concluded that exposure to a curative natural environment would be relaxing, less stressful, and therefore, increase patient‟s satisfaction and psychological well-being. In spite of this huge benefits, it remains unknown the impact of hospital buildings in improving or increasing users‟ satisfaction as well as their well-being especially in the Northern part of Nigeria.

In the sphere of buildings however, construction professionals such as architects and engineers rarely carry out evaluation of completed buildings or even receive useful feedback about the performance of completed building projects (Olagunjuet al., 2013). Generally, the Maintenance departments actually have no framework in place for evaluating the performance of the building and the satisfaction of the users, thus creating a huge backlog of maintenance issues overtime (Olagunjuet al., 2013).The large, complex environment of a typical hospital further contributes to the stressful situation.As a result of this, patients in a healthcare facility are often fearful and uncertain about their health, safety and isolation from normal social relationships. This leads to the fact that presently in Nigeria, in order to address this problem, this research undertooka post occupancy evaluation of patient‟s satisfaction with selected Government Hospital buildings in Niger State.

                1.3                                           Justification for the Study

Previous studies have established that hospital environment replete with stressors, poor quality air; can increase the rates of Sick Building Syndrome of occupants as well as high state of mental fatigue (Kaplan & Kaplan, 1983; Rdesinski, 2009). British Council of Offices (2007) opined that with the evaluation of new and existing buildings, certain discoveries would come up; such as whether the building is satisfying the users and also problems associated with the buildings would surface.

However, large gaps still exist in knowledge in post occupancy evaluation of hospital building performance in providing safety, security, conduciveness, health recovery and prevention, especially in the Northern part of Nigeria. This necessitated this research to carry out a post occupancy evaluation of patient‟s satisfaction with Government Hospital buildings in Niger State. The outcome of this study will help future projects in meeting the need and aspiration of the patient. The outcome of the study will be a lesson learned for future projects to help in designing that meets the satisfaction of patients and construction methodology.

                1.4                                           Research Questions

To investigate this, the research asks the following questions:

1. What are thepredominant types of services provided in general hospitals? ii. What arethe factors influencing patientsʹ satisfaction with hospital buildings? iii.     What is the level of satisfaction of patientsʹ with the hospital buildings?

                1.5                                            Aim and Objectives

             1.5.1 Aim

The aim of this research is to carry out a Post Occupancy Evaluation of patients‟ satisfaction of the Niger State Government hospital buildings with view to ascertaining areas requiring improvements in design and contribution of future hospital developments..

1.5.2 Objectives

To achieve this aim, the following specific objectives were considered:

1. To identify the predominant types of services provided by the general hospital buildings.
2. To determinethe factors influencing patientsʹ satisfaction with hospital buildings based on sections and departments.

• To assessthe level of satisfaction of patientsʹ with the hospital buildings.

                1.6                               Scope of the Study

This research coveredthe General Hospital buildings in three major towns in Niger State (Minna, Bida and Kontagora). Hence, the questionnaires distributed were within the aforesaid jurisdiction.

 

A POST OCCUPANCY EVALUATION OF PATIENTSʹ SATISFACTION WITH NIGER STATE GOVERNMENT HOSPITAL BUILDINGS

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