Identification and analysis of critical factors influencing patient satisfaction for quality healthcare service delivery in Ghana using mixed methods.

Abstract

Purpose: Patient satisfaction is widely recognized as a key indicator of healthcare quality and system responsiveness, particularly in low- and middle-income countries pursuing Universal Health Coverage. In Ghana, despite expanded access through initiatives such as the National Health Insurance Scheme, challenges in service delivery persist. This study examined how administrative processes, clinical interactions and waiting times influence patient satisfaction and perceived quality of care. The findings seek to extend Donabedian's framework by positioning patient satisfaction as a mediating mechanism linking structural and process factors to quality outcomes. The study also examines the implications for interpersonal-centric care theories, suggesting that relational care must be supported by effective administrative and infrastructural systems, and proposes a context-specific, multidimensional model of patient satisfaction for Ghana's health system.

Design/methodology/approach: A mixed-methods approach was adopted, combining quantitative surveys with qualitative interviews. The study was carried out in both public and private facilities across Ghana's three ecological zones, capturing perspectives from both urban and rural settings. A total of 385 respondents participated, including 245 patients and 140 healthcare workers. Quantitative data were analyzed using multiple linear regression to identify predictors of satisfaction, while qualitative data were analyzed thematically to draw out key insights from patients and providers.

Findings: The results showed that the facility environment (ß = 0.553, p < 0.001) and access convenience (ß = 0.400, p < 0.001) were the strongest predictors of patient satisfaction. Waiting time negatively influenced satisfaction (ß = -0.215, p = 0.013), while administrative processes and staff attitudes also had significant effects. Qualitative findings reinforced these results, highlighting themes such as cleanliness, respectful communication, cost transparency and frustrations with delays. Interestingly, technical quality of care was not a significant predictor, pointing to a potential disconnect between professional standards and patient perceptions of quality.

Research limitations/implications: The study was conducted at selected health facilities in Ghana, and although it included diverse facility types (public, private and community-based), the findings may not fully capture the entire heterogeneity of Ghana's healthcare system. Differences across regions, facility levels and socioeconomic contexts could influence perceptions of satisfaction and quality.

Practical implications: The study highlights key strategies for improving patient satisfaction through targeted service quality improvements. Administrative efficiency emerged as the strongest predictor of satisfaction, underscoring the importance of streamlined workflows, transparent communication and staff training in customer service. Quality of care remains essential, with emphasis on clinical competence, compassionate care, continuous professional development and patient-centered models. Although waiting times showed a modest influence, patient experience during delays can be improved through queue management, triage systems and waiting-area amenities. Gender differences in satisfaction suggest the need for tailored services and feedback mechanisms. Overall, policymakers and managers should prioritize administrative efficiency, quality enhancement, patient experience during waiting periods and inclusive, demographic-responsive strategies.

Originality/value: This study provides an in-depth, evidence-based understanding of the multiple factors shaping patient satisfaction in Ghana. It emphasizes the need to address both operational inefficiencies and interpersonal care to improve patient experience. The findings contribute to ongoing health sector reforms aimed at strengthening administrative systems, enhancing staff-patient interactions and upgrading healthcare infrastructure, especially in resource-limited settings.