Association Between Minimum Service Standards and Patient Satisfaction in Outpatient Departments of Nepal’s Government Hospitals

Abstract

Background: Nepal’s Minimum Service Standards (MSS) tool assesses structural readiness of government hospitals but its relationship to patient satisfaction is unknown. We evaluated how well MSS scores correspond to outpatient satisfaction and patient reported gaps in the quality of services.
Methods: A cross-sectional mixed-methods study utilized 839 patient satisfaction surveys conducted from July 2021 to May 2024 across 57 government hospitals, then linked responses to retrospective hospital-level MSS scores. Overall satisfaction was modeled with an ordinal mixed-effects logistic regression with hospital-level random intercepts. For qualitative insights, six hospitals were purposely sampled for six focus group discussions with OPD staff and six interviews with hospital leaders. Transcripts underwent thematic content analysis, and quantitative and qualitative findings were triangulated.
Results: Each 1% rise in OPD MSS score increased satisfaction odds by 3% (OR?1.03, 95?%?CI?1.02–1.05; p?<?0.001), with variable effects below a 50?% MSS threshold. Key gaps in privacy, human resources, and patient counseling were identified across hospitals, regardless of their MSS score, highlighting areas where the MSS tool does not fully correlate to patient experience. Less frequently reported problems (privacy, staff behaviour, and counselling) had the greatest effect on patient satisfaction, whereas more frequently cited problems (cleanliness, waiting times, cost, and medicine availability) had smaller effects. Qualitative findings revealed that hospitals with higher MSS scores had better management systems, stronger leadership, and improved team support, contributing to a more conducive working environment.
Conclusions: The MSS tool effectively reflects readiness in tangible aspects like cleanliness and equipment but fails to reflect gaps in privacy, human resources, and medicine availability. Addressing these misalignments is crucial to ensure that the MSS tool effectively addresses quality of care.
Keywords: MSS, OPD, patient satisfaction, quality, readiness.