Analysis of patient satisfaction in in-patient department of paediatric care units

INTRODUCTION

Paediatrics focuses on the health of infants to young adults. It includes sub-specialties and must meet the unique needs of hospitalised children, addressing various challenges.^[1] Safe paediatric care environments paediatric intensive care units (PICUs), led by paediatric intensivists with multidisciplinary teams, maintain high staff-to-patient ratios and advanced equipment. Hospitals must be equipped and staffed for paediatric admissions and timely transfers.^[2] Globally, 2.7 million children are in institutional care due to conflict, discrimination or inadequate support. The United Nations International Children’s Emergency Fund (UNICEF) reports these children fare better in family-based care, as institutional care often leads to emotional, physical and social harm.^[3] Improving paediatric hospital systems highlights system reforms, including family feedback integration, diagnostic error prevention and paediatric care planning.^[4] The role of specialised paediatric hospitals, such as the Children’s Hospital Mumbai, exemplifies comprehensive paediatric care with 24/7 expert services, family-centred policies and specialised PICU facilities.^[5]

UNICEF’s Contribution to Newborn Health UNICEF partners with the Indian government and medical organisations to enhance neonatal survival through training, advocacy and infrastructure, aiming for single-digit neonatal mortality by 2030.^[6] Facility-Based Pediatric Care under Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH + A) India’s RMNCH + A strategy highlights referral systems and integrated services, with district hospitals serving as vital hubs for emergency and paediatric care.^[7]

Quality of paediatric care in low- and middle-income countries (LMICs) district hospitals in LMICs, while central to healthcare, often delivers substandard paediatric care, necessitating consistent assessment and support per the World Health Organization’s quality indicators.^[8] Health information technology (HIT) in paediatrics the AAP and federal initiatives support HIT to enhance paediatric care, yet most electronic health record systems focus on adults, lacking paediatric features. HIT must address specific needs such as growth tracking and immunisation records for improved safety.^[9]

The National Child Health Programmes in India, India’s NRHM Child Health Programme, combines interventions to reduce mortality and promote child health, including Special Newborn Care Units, Janani Shishu Suraksha Karyakram, Integrated Management of Neonatal and Childhood Illness, Social Awareness and Action to Neutralize Pneumonia Successfully and awareness campaigns.^[10] Continuum of care approach: The RMNCH + A framework highlights the interconnectedness of maternal, neonatal and adolescent health, promoting interventions for better child outcomes.^[11]

MATERIAL AND METHODS

RESULTS

The analysis of sociocultural and demographic characteristics reveals significant differences between caregivers utilising government and private hospital services for paediatric care in Raichur. Across both sectors, mothers were the primary caregivers, accounting for 98.5% in government hospitals and 97.5% in private hospitals, highlighting their central role in managing child health during hospitalisations. A majority of children admitted were under 5 years of age, with 81.5% in government and 79.5% in private hospitals, indicating a high vulnerability of this age group to illnesses requiring inpatient care. Gender distribution revealed a slight variation; in government hospitals, females (57.5%) were more frequently admitted, whereas in private hospitals, males (53%) were more frequently admitted. This difference might reflect underlying gender dynamics in healthcare-seeking behaviour. In terms of residence, a higher proportion of respondents were from urban areas in both settings, 55.5% in government hospitals and 59% in private hospitals, suggesting better access to health facilities in urban zones or greater utilisation of institutional care by urban families. The religious composition showed that Hindu and Muslim communities formed the majority, with Christians comprising a smaller proportion. The distribution was relatively balanced across both hospital types, reflecting the local demographic mix. When examining education levels, private hospital caregivers had a clear advantage in literacy. In private hospitals, 51% had completed 10^th or 12^th grade and 15% held graduate/postgraduate degrees. In contrast, 40.5% of caregivers in government hospitals were illiterate and only 4% had pursued higher education. This educational gap likely influences health literacy, decision-making and satisfaction with healthcare services. Regarding occupational status, government hospital caregivers were predominantly engaged in daily labour (47.5%) and agriculture (42%), indicating limited financial means. In contrast, private hospitals catered to a more economically secure population, with 30% employed in the private sector and 15.5% in government jobs. This occupational distribution reflects the financial capabilities required to access private healthcare services [Table 1].

Comparative analysis of service availability between government and private hospitals reveals distinct differences in patient admission patterns and healthcare delivery focus, despite both sectors being equally equipped in terms of essential infrastructure. All government hospital respondents were treated in government-run facilities, whereas all private hospital respondents were treated exclusively in private institutions, ensuring sectoral clarity in responses. A significant difference was observed in the duration of hospital stay. In private hospitals, 74.5% of patients were discharged within 1–3 days, reflecting efficient patient management and possibly less severe admissions. In contrast, 59% of government hospital patients stayed for 4–7 days, suggesting more complex or delayed care pathways. Regarding the purpose of admission, 75% of private hospital admissions were for acute illnesses, while government hospitals handled a higher share of chronic conditions (51%) and surgeries (14.5%). This indicates that government hospitals are more involved in the long-term management of paediatric conditions, possibly due to affordability and accessibility. Insurance coverage was slightly higher in government hospitals (49%) than in private hospitals (42%), likely due to better awareness or access to public health (PH) schemes among government hospital users. In terms of basic and critical care infrastructure, both government and private hospitals reported 100% availability of portable water, baby warmers, Ambu bags, oxygen support and paediatric defibrillators. Government hospitals showed 99.5% availability of paediatric ventilators, slightly lower than the 100% in private hospitals. This reflects substantial investment in core paediatric care infrastructure across both sectors. Overall, while both hospital types are similarly equipped, private hospitals demonstrate shorter stays and focus on acute care, whereas government hospitals manage more chronic and surgical cases, often for longer durations. These insights help clarify the differing roles of both hospital types in Raichur’s paediatric healthcare system [Table 2].

The analysis of patient satisfaction across four critical service domains, namely, reception response, duration of waiting for consultation, response on hospital entry and quality of care provided by doctors, reveals a notable divergence in perceived service quality between government and private hospitals. The data clearly indicate that government hospitals are lagging in terms of patient satisfaction, with a consistently high proportion of respondents expressing dissatisfaction across all indicators. Specifically, in the domain of reception response, 60.5% of patients attending government hospitals reported being either dissatisfied or very dissatisfied. These findings highlight the significant shortcomings in the initial patient interaction, potentially due to understaffing, inadequate training, or overcrowding. Similarly, waiting time for consultation was a major concern, with 56.5% of government hospital respondents indicating dissatisfaction. This could reflect inefficiencies in queue management, limited availability of consulting physicians, or systemic delays in processing patients. A surprising finding was observed in the initial response upon entering the hospital, where 55.5% of patients reported negative experiences, suggesting potential issues with orientation, triage services, or immediate staff assistance. Moreover, when assessing the quality of care provided by doctors, 54% of respondents in government settings reported dissatisfaction, suggesting problems such as limited consultation time, poor communication, or perceived lack of attentiveness from medical professionals. In stark contrast, private hospitals demonstrated markedly higher levels of patient satisfaction across all four areas. Approximately 74–75% of patients in private settings expressed satisfaction with services received, highlighting the effectiveness of private institutions in maintaining patient-centred care standards. The proportion of dissatisfied or very dissatisfied respondents in private hospitals remained minimal, typically under 14% for each service area. These favourable outcomes in private hospitals could be attributed to better infrastructure, streamlined administrative processes, shorter waiting times and a higher doctor-to-patient ratio. In addition, private sector healthcare staff may be more responsive and motivated due to performance-linked accountability systems and a stronger focus on patient experience [Table 3].

Table 4 presents a comparative analysis of patient satisfaction across four key service areas: cleanliness and hygiene, availability of healthcare professionals and coworkers, accessibility of speciality care and emergency referral services and the behaviour of hospital personnel, including timeliness of services in government and private hospitals. The data clearly demonstrate that private hospitals consistently outperform government hospitals in all measured aspects of service delivery. In terms of cleanliness and hygiene, government hospitals received poor ratings, with 55.5% of patients reporting dissatisfaction. This highlights serious lapses in sanitation and infection control, which are fundamental to quality healthcare. Conversely, private hospitals reported 77% satisfaction in this area, reflecting better maintenance standards and greater attention to patient comfort and safety. The availability of healthcare professionals and support staff was also found to be inadequate in government hospitals, with over 61% of respondents expressing dissatisfaction. This points to possible issues such as staff shortages, high patient load and inefficiencies in deployment. In contrast, private hospitals demonstrated far better outcomes, with 77% of patients satisfied with staff availability, indicating more effective human resource management. Speciality care and emergency services also revealed major gaps in the public sector, where 61.5% of patients were dissatisfied. This may be due to delays in accessing specialised treatment, lack of emergency preparedness or inefficient referral systems. Private hospitals, however, had 77% satisfaction in this domain, suggesting they are better equipped and more responsive during critical health situations. Regarding the behaviour of hospital personnel and the time taken to deliver services, 52% of government hospital patients reported negative experiences. Issues such as delayed attention, lack of empathy and poor communication may have contributed to this dissatisfaction. On the other hand, 77% of private hospital patients were satisfied, indicating a higher standard of professionalism and patient-centric service. In summary, the interpretation highlights a substantial disparity in patient satisfaction between public and private healthcare institutions. Private hospitals consistently deliver higher quality services across multiple dimensions, while government hospitals continue to struggle with structural and operational challenges. These findings underscore the urgent need for systemic improvements in the public healthcare sector. Enhancing staff availability, improving infrastructure, investing in cleanliness and emergency care systems and training healthcare workers in communication and responsiveness are critical steps towards bridging this gap. Strengthening public hospital performance is essential for equitable healthcare access and improved health outcomes across all population groups [Table 4].

The independent t-test revealed significant differences in caregiver satisfaction between government and private hospitals. Private hospitals showed higher satisfaction in reception response and shorter waiting times for consultation. The initial response on entry was also better in private settings. Doctor’s care quality and nursing staff competence were rated superior. Responsiveness to children’s needs was greater in private hospitals. Staff were found to be kinder and more attentive. Cleanliness and hygiene standards were higher. Room and ward environments were more satisfactory. Test-related communication was timelier. Discharge procedures were clearer. Admission and discharge were also smoother in private hospitals [Table 5].

The independent t-test analysis revealed significantly higher satisfaction scores in private hospitals across several key service areas. Access to doctors was easier and more efficient in private settings. Paediatric supplies were more readily available, enhancing treatment quality. Waiting areas in private hospitals were more comfortable and child-friendly. The overall paediatric care experience was rated higher by caregivers. More respondents indicated willingness to recommend private hospitals. Cleanliness and hygiene continued to be superior. The availability of healthcare staff was better in private settings. Speciality and emergency services were more accessible. Staff behaviour and timeliness were more satisfactory. Infrastructure and basic facilities were better maintained. Pharmacy and diagnostics services, as well as signage and navigation, were more reliable and organised in private hospitals [Table 5].

DISCUSSION

The study highlights notable differences in paediatric inpatient care experiences between government and private hospitals in Raichur. Mothers were the primary caregivers (98.5%), reaffirming their central role in child health, consistent with findings from Nguyen et al.^[14] Children under five formed the majority of admissions, reflecting early childhood vulnerability. Interestingly, female children were admitted more to government hospitals, differing from Dos Santos and Coelho,^[15] who reported a higher risk for adverse outcomes among males, possibly reflecting local gender-based healthcare-seeking behaviours. Caregivers in government hospitals were often illiterate (40.5%) and economically vulnerable, working mainly as daily labourers or in agriculture. This demographic profile highlights the need for simplified communication in public settings to enhance care comprehension and satisfaction. Essential paediatric infrastructure, such as baby warmers, oxygen and defibrillators, was nearly 100% available in both settings, aligning with Baliga et al.,^[16] who emphasised infrastructure adequacy as a contributor to satisfaction in PPP hospitals. However, prolonged wait times (59% waited over an hour) and limited insurance coverage (51%) emerged as key issues, similar to concerns raised in PH-model hospitals by Baliga et al.^[16] Regression analysis revealed that perceived service quality was a significant predictor of both satisfaction (â = 0.427, t = 8.810) and loyalty (â = 0.275, t = 4.420), in line with communication gaps remained a concern. Over 50% of caregivers were dissatisfied with signage and discharge clarity, an issue also emphasised by Nguyen et al.,^[14] where longer hospital stays and unclear communication reduced satisfaction, even in technically advanced settings. Nonetheless, 40% were satisfied with communication about tests and procedures, mirroring findings by Baliga et al.,^[16] who highlighted communication clarity as a strength in PH settings. Clinicians who received high satisfaction scores consistently demonstrated empathetic communication behaviours, acknowledging delays, asking open-ended questions and showing non-medical kindness similar to the high-performing group in Finefrock et al.^[17] Structured communication training could help bridge this gap in government settings. Private hospitals showed notably high satisfaction 60% for reception, 62.5% for staff responsiveness and 66.5% for attentiveness. These patterns mirror Baliga et al.,^[16] where PPP hospitals performed better due to efficient service delivery and staff behaviour. Although hygiene training raised staff compliance to 100%, use of alcohol-based hand rubs remained at 66% and most hygiene criteria fell below 74%. These results echo global findings and align with Dos Santos and Coelho,^[15] who reported a 12.5% rate of paediatric adverse drug reactions (ADRs), highlighting the risk of poor hygiene and medication safety. Finally, patient satisfaction was significantly influenced by age, but not by gender, suggesting equitable care. This trend is consistent with Nguyen et al.,^[14] where parents of younger children reported higher satisfaction. The current study’s findings around adverse events and hygiene practices align with Dos Santos and Coelho,^[15] who reported a 12.5% incidence of ADRs among hospitalised children in Fortaleza, Brazil, underscoring the critical need for stringent monitoring and hygiene practices in paediatric wards. Similarly, Wells et al.^[18] compared care provided by paediatric residents and private community paediatricians, finding comparable quality, though patient satisfaction often leaned towards community-based providers, suggesting that relational and communication factors influence satisfaction beyond technical competence alone. When evaluating the public versus private hospital satisfaction differential, studies like Kumar and Anand^[19] in Puducherry and Begum et al.^[20] Bangladesh also reported that private hospitals tend to yield higher satisfaction levels due to shorter wait times, better communication and more responsive service delivery. These results closely mirror findings from the present study in Raichur, particularly regarding wait time dissatisfaction in government hospitals and communication challenges. Katira et al.^[21] emphasised that service quality dimensions such as responsiveness and empathy were significantly associated with satisfaction in private multi-speciality hospitals in Indore. This supports our findings where private hospital caregivers reported high satisfaction with reception services (60%) and staff attentiveness (66.5%). Meanwhile, Visagie and Schneider^[22] highlighted how even alternative pharmaceutical service models, such as postal pharmacies, influenced satisfaction levels, reinforcing the broader point that delivery models matter significantly in perceived quality. Internationally, patient satisfaction studies from Africa echo similar themes. In Northern Nigeria, Iliyasu et al.^[23] identified key dissatisfaction areas in government tertiary facilities, including staff behaviour and discharge instructions issues, mirrored in the Raichur government hospitals. Similarly, in Northern Malawi, Mbwili-Muleya et al.^[24] used a triangulated approach to assess satisfaction and identified communication and wait time as critical determinants, consistent with our local findings. Finally, Mushtaq et al.^[25] reported dissatisfaction with public hospital services in Khyber Pakhtunkhwa, Pakistan, despite ongoing reforms, illustrating that systemic service gaps—particularly those involving patient-provider communication and waiting time remain persistent challenges across public healthcare systems in South Asia. These comparisons reinforce the broader regional pattern that, while infrastructure might be available, satisfaction hinges greatly on interpersonal quality, clarity and speed of services delivered.

CONCLUSION

This study assessed and compared caregiver satisfaction in paediatric inpatient departments of government and private hospitals in Raichur. Despite government hospitals having adequate paediatric infrastructure, such as ventilators and baby warmers, caregivers reported lower satisfaction due to long wait times, poor communication and unhygienic conditions. Private hospitals, by contrast, offered cleaner environments, better staff responsiveness and more efficient administrative processes, resulting in significantly higher satisfaction scores. The key differentiator was not infrastructure alone, but the overall quality of service delivery, particularly in communication, staff behaviour and hygiene. Caregivers in private hospitals felt respected, informed and engaged in their child’s care, while those in government hospitals often faced unclear instructions and a lack of empathy. Cleanliness also played a vital role in caregiver comfort and trust in the facility. Moreover, delays in admission, discharge, and medication access added to dissatisfaction in government hospitals, whereas private hospitals offered smoother, more organised care transitions. This suggests that human-centred care, including timely updates, polite interaction and supportive environments, greatly enhances caregiver experiences. In conclusion, while both sectors contribute to paediatric healthcare, the study underscores a pressing need for reforms in government hospitals to improve communication, cleanliness and service responsiveness. Focusing on these areas can bridge the satisfaction gap and build greater trust in PH services.