Healthcare services have undergone a paradigm shift toward patient-centred care, making patient expectations and experiences pivotal factors in service evaluation and healthcare delivery. Patients no longer act as passive recipients of medical treatment; rather, they actively participate in their healthcare journey, expecting personalized treatment, transparent communication, and the ability to provide feedback1. As healthcare systems evolve, the gap between patient expectations and actual experiences continues to be a critical determinant of healthcare satisfaction and adherence to treatment2.

Effective communication between healthcare providers and patients is instrumental in fostering trust, improving adherence to medical recommendations, and enhancing overall patient satisfaction. Research suggests that when patients receive clear, empathetic communication from their physicians, they are more likely to engage with their treatment plans and report higher satisfaction levels3,4. Additionally, patient feedback mechanisms serve as a cornerstone for quality improvement, enabling healthcare institutions to identify gaps in service delivery and address patient concerns proactively5.

Patient expectations play a crucial role in shaping their healthcare experience. According to Jackson et al. (2018), patient satisfaction is significantly influenced by how well their expectations align with actual healthcare delivery1. Studies by Green et al. (2015) and Li et al. (2020) suggest that discrepancies between patient expectations and real-world experiences often result in dissatisfaction and decreased adherence to treatment plans2’6. Thompson and Garcia (2018) emphasized that cultural differences significantly impact patient expectations7. Their study found that patients from collectivist cultures often expect more holistic and family-involved healthcare, whereas patients from individualistic societies prioritize direct doctor-patient interactions. Similarly, Gupta et al. (2022) examined how globalized healthcare requires providers to accommodate culturally diverse expectations8.

Effective communication between healthcare providers and patients is a cornerstone of quality care. McCabe (2014) found that communication training for physicians leads to a 40% improvement in patient trust and adherence to medical recommendations3. In a meta-analysis, White et al. (2016) demonstrated that active listening and patient engagement strategies significantly enhance patient satisfaction9. Non-verbal communication also plays a critical role. Studies by Miller and Evans (2021) highlighted that body language, tone of voice, and facial expressions influence patient perceptions of care quality10. Additionally, their research demonstrated that physician empathy correlates positively with patient compliance and health outcomes10.

Patient feedback mechanisms provide critical insights for quality improvement11. Patel et al. (2021) examined how digital patient feedback platforms, including AI-driven sentiment analysis, have revolutionized service improvement strategies5. Martinez et al. (2019) explored the role of social media in patient feedback, noting that online reviews impact hospital reputations and patient choices12. Furthermore, studies by Liu et al. (2020) and Wong et al. (2023) highlighted the impact of real-time feedback systems in hospital settings6,13. Although use of digital platforms poses a significant challenge for special population groups like elderly and people with mental illnesses. On one hand where older patients face challenges like limited digital literacy, cognitive and sensory impairments, reliance on caregivers, and potential difficulties with technology14. A study conducted on general practitioners, revealed that there is a need for specific training for communication with psychiatrically ill patients15.

Although patient feedback is important in healthcare setting and it needs to be constantly updated in supervised manner. However, it has to ensure patient autonomy, protecting privacy & confidentiality, avoiding potential harm, and addressing power dynamics between patients & healthcare providers16.Their findings indicated that institutions actively responding to patient feedback experienced higher satisfaction rates and better patient outcomes11.

 In past many studies were performed on disease specific feedback but this study focuses on patient’s expectations in both outpatient and inpatient care. Cost and accessibility of healthcare can significantly impact patient’s perception to healthcare settings17. In year 2003, World health survey, reported that patients who seek treatment from private health care facility (high cost), reported lower level of satisfaction than those from public facilities18.

Primary Objectives: To assess the patient’s expectations in a healthcare setting.

Secondary Objective: To find possible gaps in doctor- patient communication. And To evaluate ‘overall patient feedback’ for improving healthcare facility.

Ethics: An informed consent in Hindi was administered to each adult participant duly signed by them or their thumb impression was taken.  

Study Design: Selection and description of participants- For our cross-sectional study design: was a hospital based (tertiary care centre), cross-sectional study.

Study Place: The present study has been carried out on patients visiting and admitted in tertiary care hospital of a private medical college i.e. NMCRC, Kanpur, UP.

Time period: The period of study was from 16 Oct 2024 to 22 Oct 2024 i.e. 01 week. Subsequently the analysis of data was done.

Sample size: A purposive sampling was carried out. A sample of 451 patients was taken in a week’s time of which 337 patients consented from the outpatient department and 114 patients were from inpatient department.

Inclusion criteria: All above the age of 18 years Admitted patient and patient visiting outpatient department following acute management or stabilization who gave a written consent to participate in the study.

Exclusion criteria: 

1. Patients below the age of 18 years and those Patients who did not give consent. To participate in the study. 2. Patients with poor general medical condition - needing him/ her to stay in Intensive care unit (ICU) or suffering from acute conditions requiring close monitoring.

Data collection and technical information:

Following requisite permission from college authorities, Patients admitted for various illnesses and visiting out-patient department of the hospital during the study period, who gave consent to participate in the study. The present study was conducted in hospital on stable outpatient and inpatient. The complete study was conducted under guidance and direct supervision of Department of Psychiatry. Outpatients were requested to fill the questionnaire once they had visited the specialist doctor. Consenting patients were informed in detail about the study procedure and informed that they were free to refuse/ provide information at any point.

The predesigned proforma was used to collect information about demographic factors (like age, sex, occupation, education and socio-economic status) and a semi structured pretested questionnaire to gather information regarding patient’s expectations in a health care setting. The questions were based on items in questionnaires that were used in earlier studies of patient’s expectations and communication.

Statistics- Data was entered in SPSS version 27 software. Descriptive statistics were used to calculate frequency or sample prevalence of participants and its categories. Chi-square test was used to analyse Goodness of Fit for independent frequencies of participant’s Expectations associated with doctor’s Communication, experience and knowledge. The data was analyzed using appropriate statistical methods.

Table 1. Age distribution of participants

Table 2. Sex distribution of participants

Maximum number of patients were females visiting outpatient department of hospital. There were significantly greater number of patients between age groups of 18-45 years (n=284).

Table 3. Socio-economic Status of participants (as per modified Kuppuswamy Scale)

Socio economic status gives us an insight about the strata of population that is catered by the hospital. In current study maximum number of patients were from upper lower socio-economic class (n=266).

Table 4. Patient’s Expectations

In outpatient department more emphasis was on proper diagnosis and affordable cost of treatment. However Inpatient data advocated for additional clear and respectful communication from ward staff. As the patient enters the hospital the medical knowledge and experience of doctor, beside their way of communication, influences the trust of patients. Most of the patient denied any significant role of recommendation of others and online review for consulting doctor in a medical college offering subsidised treatment. A significant number of patients agreed for a fixed timeframe of seeing patient as 5-15 min, so that they can have less waiting period. It was alarming to know that even though the patient had trust on consultants but most of patients were unwilling to show themselves to junior doctor for their learning, even in a subsidized treatment centre. India is a global capital for healthcare tourism, and the expectations of patients regarding their health outcome from hospitals are high. Health industry has to comply with strict legal and health regulations. Cost of providing world-class healthcare facility is rising day by day. However, the present study revealed that only 13.75 % of patients were ready to pay more for priority services in the hospital.

Since COVID 19 pandemic, a serge was seen in online consultation platforms. In our study almost 24 % of outpatient and nearly 14 % of inpatient had same trust on online and offline consultation, but the results were statistically insignificant. In the era of Artificial Intelligence (AI), only 16.4% of patients were comfortable in discussing their issues with AI Chabot.  Approx 40 % of patient agreed to get evaluated only if there is a real human intervention after AI.

Table 5. Doctor-patient communication

Most of patient were satisfied with doctor’s communication skills, understanding the diagnosis/ medical terminology, clearing of doubts, discussing the investigations and information about possible duration of treatment. However nearly 35 % of patients reported that they were unaware about possible side effects of medications. 

Table 6. Feedback and patient satisfaction

Most of the patients reported their overall experience with healthcare service to be good/ excellent but around 7 % reported average to poor experience. 12.64 % were unsure about possible improvement from their feedback to hospital. Almost 1/4 of patients reported that they have been asked for feedback in hospital and only 18 % reported that they have submitted written feedback prior to current study. While most of the patients were satisfied from the hospital but around 4 % of patient reported unsatisfaction from the hospital.

DISCUSSION

There is a complex dynamic relation between health care services and patient’s expectations, which aids in developing trust. Communication is an important pillar in health care briefing and significantly impact health outcome. Patients are the end utilizer of services provided by health care facility and it will act as insightful guide, as to what is working and what is not. Therefore, an effective feedback mechanism should exist in all healthcare facility to constructively utilize patient’s points to better health outcome.

A study conducted by Gupta R et al.(2017) concluded that majority 67 % of patient expected consultation between 5 to 15 min, which was also found in our study (82.19%)19. Study by Dcunha S et al (2018), reported 68 % of patient agreed to presence of doctor, nurse and others (student’s/ PG’s), beside patient during consultation. However, in current study nearly 70 % patient refused to consult to a junior doctor prior to specialist consultation, an insignificant 13 % of these cited lack of time for such consultations20.

Yathindra C et al. in 2024 reported more than 95 % (both strongly agree and agree combined) of patients were explained clearly about treatment plan and they were satisfied with overall care by treating doctors, similar results were revealed in our study (more than 96 % - both very satisfied and satisfied combined)21. However, in our study it was revealed that significant number of patient (28.94 %) after consulting from doctor did report issue regarding inadequate knowledge about potential side effects of medicines. Sebastian NM et al. (2016), reported that 80 % of patients were not informed about side effects of medicines22. This might be an potential gap in treatment goal. Studies done in India, have revealed significantly higher patient satisfaction (more than 95%) with treating doctor. In most of studies patients reported that they were told about how to take medication and duration of treatment19,22.

Another study by Dcunha S et al (2018), reported 69 % of doctors cleared the patient’s doubts/queries which was comparable to our study (75.96%)20. Similar results were found in study conducted by Sebastian NM et al. (2016), where 65.7 % of patients reported that their doubts were cleared by treating doctor22.

In a study conducted by Sebastian NM et al. (2016), nearly 62.9% reported overall satisfaction with consulting doctors which was comparable to our study (67.65%)22. Yathindra C et al. (2024) reported good satisfaction and overall quality of care in more than 93 % (both excellent and satisfactory combined) of patient21. Similar results were found in our study for overall experience (> 93 % in excellent and good combined) and satisfaction (94% satisfied and somewhat satisfied combined). More than 90 % of patient said that they would recommend this hospital to others. 

The findings suggest that effective communication and clear expectations significantly impact patient satisfaction.

Understanding patient expectations, fostering effective communication, and leveraging patient feedback are crucial for improving healthcare experiences. In an RCT conducted by Moira A concluded that health outcome can be improved if patient feel that they have active participation and their problems have been adequately discussed23. Further, the author suggested that patients should be encouraged to ask questions, provided with clear information in both verbal and written format23. Every medical echelon must now align to patient centric medical care with clear communication and frequent feedbacks for improving health outcome.

In our study most of patients expressed satisfaction with their physician but this study revealed that patients were unwilling to be seen by junior doctor or Artificial intelligence (AI) Chabot/ online consultation and desired time for consultation to be 5 to 15 min. A significant number patients were satisfied with hospital/ doctors but an improvement is required in communicating side effects of medicine was found.

Recommendations – Use of AI technology - As healthcare systems increasingly integrate technology, future research should focus on optimizing AI-driven patient feedback mechanisms. Choudhury and Mahajan (2023) discussed the potential of machine learning algorithms in analysing patient sentiments and predicting dissatisfaction trends24. Barker and Long (2020) reviewed the transition from paper-based surveys to digital platforms, advocating for more inclusive and accessible feedback collection methods25.

Regular training of physicians - Henderson and Blackwell (2019) emphasized the importance of ongoing physician training in communication skills, suggesting that continuous education can significantly improve patient satisfaction26. Yamamoto and Suzuki (2022) further explored how active listening techniques can reduce patient anxiety, leading to better health outcomes27.

Conflict of Interest

There is no conflict of interest in design, conduct and analysis of this research study

Acknowledgements

It is desirable to mention the gratitude toward administrative officials and owner able persons of NMCRC to give a permission to conduct this study. We are grateful to our hospital staff for smooth conduct of data collection. And who accurately managed with the provided time-span.

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