Search This Blog

Monday, July 9, 2018

Innovation To Patient's Satisfaction In The Romanian Healthcare

Image result for patients satisfactionThe word is evolving since the 1980s with many influential forces. For instance, globalization, technology innovations or demographic changes have contributed to the economic, political and social transformation worldwide. Globalization represents a multi-faceted phenomenon today in the modern society that has an impact on the global healthcare system(Burcea, Toma and Papuc, 2014). This is considered an important topic in a health care system because it constitutes to the fact that some of its effects such as; disparities among the health infrastructure in different countries, the free movement of doctors, the increase rate of disease burden and the medical tourism have raised governmental difficulties all over the world (Azevedo and Johnson, 2011)

The healthcare service is a market that is confronted with many challenges and competition in the sense of the development of the private medical providers. Meanwhile, the patients have become increasingly more informed of the various options of treatment because of the availability of the medical information provided by many online platforms. This results in high expectations of patients towards their physicians to be able to provide the necessary information which is suitable to answer the questions of the patients. They as well expect politeness, empathy and attention from their doctors which brings them very close to the traditional meaning of consumer profile (Coțiu and Sabou, 2017).
Gradually, the healthcare system has become more of a complex political, social and economic environment in the recent globalized world. It undergoes pressures (for example; financial, demographic and technological) in order to deliver good quality services to the patients. As a consequence, the protection of patients’ rights has evolved within the key aspect of the agenda of the new global health (Ahoobim et al., 2012). The national public health organizations, health promotion agencies, health service providers, scientific research institutions and consumers association have put significant efforts to promote and support the patients’ rights protection around the world. In the last decades, researchers have conducted analysis on the rights of patients, their protection and its direct/indirect link with the healthcare quality and its improvement(Green et al., 2012).

There are studies that indicate the importance of customer expectations in the healthcare system. This is described as a means of desires to seek for the assistance from the doctor, demands or wants and preferences. Expectations from patients is important because it implies their involvement and creates the possibilities to better access of health services. Patients expectations from the Romanian healthcare providers are based on, firstly the model on active passivity which describes the physician-patient relationship in Romania. Within years of passivity, the Romanian system has moved to a more democratic approach. This is a new approach that focuses on the call for more client-centred orientation in the healthcare services. Therefore, the knowledge and awareness are expected to meet the needs of the patients. Secondly, patients measure their expectations based on their level of satisfaction with the healthcare services. This is mostly used as an indicator of the medical care outcome. Thirdly, the first step to prevent dissatisfied patients is through the knowledge of the patients’ needs, because this may result to discontinuity of care and cost ineffectiveness of the healthcare(Ionilã, Ana-Claudia, A-C Bara, WJA van den Heuvel, 200AD).

Patients satisfaction is an important part of the quality assessment of the healthcare system (Williams et al., 1995)

There are two dimensions used to improve the patient satisfaction:- The procedural dimension of the quality of the provided services such as the time spent at the waiting reception before getting the required medical attention, the condition of the accommodation provided according to the needs of the patient, and the doctor or physicians anticipated with the patient’s needs and, The personal dimension of the provided service quality-that is, the physical aspect of cleanness, maintenance of the facility, the attitude of the practitioner towards the patients, the demonstration of the body language between the physician and the patient and the voice tone used to address the patients (Agheorghiesei and Copoeru, 2013)

Over the past 10 years, there are many changes that occurred in the Romanian healthcare system.  These changes include the health insurance system, the role of the general practitioner, the position of hospitals and privatization. It is expected that the consumer satisfaction is related to the general healthcare system because of the significance of the role the primary care plays in the new healthcare reform as it has been shown in the transition of other countries(Bara et al., 2002).
The most used instrument in measuring patient satisfaction is a questionnaire survey which usually applied during the discharge moment of patients from hospitals.  Studies have suggested that the method of satisfaction measurement uses a broad and vague term that results in short, superficial, and affirmative answers without any true meaning. Several researchers have brought to attention the notion of “patient satisfaction”. Although this term is commonly used in evaluating and guiding the delivery of healthcare services, it is likely to be related to the quality of services rather than the quality of care provided. “According to Pomerantz, several changes have occurred within the recent years on the perception healthcare service users on quality care, and he suggested that an increase in the focus of patients’ needs and preferences may help better oriented medical care, compared to the adherence of the standard of care”. 

The most frequent aspect of satisfaction and dissatisfaction in the healthcare services is professionalism among the providers. Professionalism is an area that includes various sub-categories such as, advancement in medical knowledge, improved level of development in clinical competence, strong ethical morals and standards, sharing of honesty and respect as values, and showing empathy, courtesy and kind attitude towards the patients. In economically developed countries such as the Western European countries and USA, the medical orientation act changed from a “predominantly doctor-oriented approach to a patient-centred culture”. This cannot be expressed in Eastern Europe, which is influenced by corruption, informal payments and in need of a new reform 5, 20. Since the 1970s, Eastern European countries are slagging behind Western European countries in terms of healthcare quality because of its communist policy throughout the region. Romanian has the lowest level of patient satisfaction in Europe. Romania is faced with other challenges that are related to the lack of access to health services among the less privileged communities.  The general dissatisfaction and cynicism in Romania are owned by the country’s poor economic performance, which limits the freedom of the individual to explain a greater degree in behavioural and environmental factors(Popa et al., 2017).

INNOVATION FOR IMPROVING PATIENT SATISFACTION(Agency for Healthcare Research and Quality, 2014):

Implementing Staff Training:
It has been brought to attention that most hospital staff such as the physician or the healthcare organizers have expressed their concern to ask patients personal questions that include their race, ethnicity and language. They believe that it may offend the patient. In addition, most physicians may be time-sensitive towards the modern nature of clinical practice and want to ensure the effectiveness of asking questions. For data to be accurate and consistent, healthcare organizations are required to invest in clinical training among all staff levels (health professionals, administrative staff, hospitals and health plan leadership), which includes integrating the significance of the data for detecting and addressing health care needs. For instance, those assigned to the task of asking questions directly to the patients, enrollees can receive a front-line training on the importance of collecting the information, how to use the information and the means of collecting the data, and how to address the concerns of the patients, enrollees and other members.

The training exercise should be based on the context and the methods of collecting and utilizing the data. For example, health plan staff who do not have face-to-face communication with the enrollees can obtain the demographic information through telephone encounters. Therefore, there should a training for “telephone means of collecting data” because pre-registration by telephone can occur before hospital admission or ambulatory care appointments.  Before establishing a formal training session with the medical staff, an assessment should be conducted based on the practices and determine what is currently happening and identify the necessary changes. These changes will be clearly communicated among the staff members during the training session.

Sharing and Collecting of Data Across the Healthcare System:
The health system is a diverse set of a public and private entity that contribute to the collection of data including health surveys, administrative enrollment, billing records and medical records used by different medical departments such as the hospitals, CHCs, physicians and health plan management. The data collected on the patient’s race, language and ethnicity are extended to these entities suggesting that each can collaborate to obtain and sustain the patient’s medical record.  No one of the entities can individually gather the necessary information regarding the population of patients, neither can they collect the health data on an individual patient.  Therefore, it is important to increase the integration of data from other sources within and across the healthcare system.

Many observed three main issues with patient-reported measures, the feedback provided by the patients may not be conclusive because they acquire little or no formal medical training. “Critics hold that patient-reported measures that include patient satisfaction signify an aspect of happiness” as they consider the process to be subjective among patients, which can be influenced by other factors that is not related to health care. The patient’s experience measures could be confounded by aspects that may not be linked to the quality process of the health services.  For instance, it could be a case where the patient may rate their experiences that is based on their subjective assessment of their health status instead of the experience of the healthcare services provided to them. Finally, the experiences of patients may be reversed to the fulfilment of the actual desire of the patient. For example, “the receipt of a specific medication regardless of its benefit”. These problems may decrease the validity of the patient’s perception(LaVela and Gallan, 2014).

A significant factor that influences the satisfaction of patients is the medical services bounded by the medical personnel. Firstly, the level of information provided by the medical staff on the schemes of new treatment, the appearances of advanced medical equipment for diagnosis and investigation, and the medical process can generate a better result in customer satisfaction and, the behavior and attitude of the medical personnel is considered important because it can improve the communication between the doctors and the patients (Economics, Domain and Thesis, 2015).


 Agency for Healthcare Research and Quality (2014) Improving Data Collection across the Health Care System | Agency for Healthcare Research & Quality, U.S Department of Health and Human Services. Available at: (Accessed: 27 April 2018).

Agheorghiesei, D.-T. and Copoeru, I. (2013) ‘Evaluating Patient Satisfaction – A Matter of Ethics in the Context of the Accreditation Process of the Romanian Hospitals’, Procedia -Social and Behavioral Sciences World Conference on Psychology and Sociology, 82, pp. 404–410. doi: 10.1016/j.sbspro.2013.06.283.

Ahoobim, O. et al. (2012) ‘Council on Foreign Relations The New Global Health Agenda’. Available at: (Accessed: 20 April 2018).

Azevedo, M. J. and Johnson, B. H. (2011) ‘The Impact of Globalization Determinants and the Health of the World’s Population’, INTECH. Available at: (Accessed: 20 April 2018).

Burcea, M., Toma, S.-G. and Papuc, R.-M. (2014) ‘PATIENTS’ SATISFACTION WITH THE HEALTH CARE SYSTEM IN THE AGE OF GLOBALIZATION: THE CASE OF ROMANIA* Marin BURCEA Sorin-George TOMA Răzvan-Mihail PAPUC’, Transylvanian Review of Administrative Sciences, Special Issue, pp. 5–20. Available at: (Accessed: 18 April 2018).

Coțiu, M. A. and Sabou, A. (2017) ‘Patient Satisfaction with Diabetes Care in Romania – An Importance-performance Analysis’, in. Springer, Cham, pp. 297–302. doi: 10.1007/978-3-319-52875-5_62.

Green, S. et al. (2012) ‘Aligning quality improvement to population health’, International Journal for Quality in Health Care, 24(5), pp. 441–442. doi: 10.1093/intqhc/mzs049.

Ionilã, Ana-Claudia, A C Bara, WJA van den Heuvel, J. M. (200AD) ‘The Romanian health care system in transition from the users’ perspective’, Ionilã, Ana-Claudia. Available at: (Accessed: 27 April 2018).

Williams, S. et al. (1995) ‘Patient expectations: What do primary care patients want from the GP and how far does meeting expectations affect patient satisfaction?’, Family Practice. Oxford University Press, 12(2), pp. 193–201. doi: 10.1093/fampra/12.2.193.

Bara, A. C. et al. (2002) ‘Users ’ satisfaction with the Romanian health care system : an evaluation of recent health care reforms’, European Journal of Public Health, 12(4), pp. 39–40.

Economics, F. O. F., Domain, M. and Thesis, D. (2015) ‘Doctoral School in Economics and Business Administration Study Regarding the Measurement of Consumer Satisfaction in Healthcare’.

LaVela, S. and Gallan, A. (2014) ‘Evaluation and Measurement of Patient Experience’, Patient Experience Journal, 1(1), pp. 28–36. Available at:

Popa, D. et al. (2017) ‘Patients’ perceptions of healthcare professionalism - A Romanian experience’, BMC Health Services Research, 17(1). doi: 10.1186/s12913-017-2412-z.

Monday, May 7, 2018

Bureaucracy Has A Contradictory position In The Administrative System of Nigeria; (Cons Of Establishing A Bureaucratic System In Nigeria):

Nigeria, an oil-rich West Africa country with 190million inhabitants, gained its political independence from the British in October 1st, 1960. As a heterogeneous ethnic country (composed of 250 ethnic groups), with a historical background on the traditional administrative, military, and democratic governance, has established traditional structures of politics and administration (Agba & Chukwurah, 2014)
Nigeria is categorized in thirty-six states and one federal capital territory, which are states of which existed only three at independence, reflecting the country’s tumultuous history and the difficulties of managing such a heterogeneous national entity at all governmental levels (Administrative structure of Nigeria, 2012-2015).

Bureaucracy as a means of Governance (Theory of Bureaucracy by Max Weber):
Bureaucracy as a state is assumed to propose development and good governance by providing fair actions for social provision in the third world (Weber, 2001)
Max Weber a German sociologist sought to understand the social, political and economic institutions of the present through contrasting them with established organizations from the past (Chand, Smriti, 2010).  He identified in bureaucracies a rational-legal authority in which legitimacy is seen as a categorized form of legal order. Example of his acknowledgements; exercised power assures the continued dominance over the ruled administrators  (Weber, 2001). Max Weber, defined bureaucracy as a system of government or institutions that has many complicated rules and ways of doing things (Merriam, 1828).

Application of Bureaucracy in Nigeria:
The concept of Bureaucracy:
In Nigeria, the other term used for bureaucracy is Civil Service” or “Public Service”. It is a part and parcel of the executive charged with the responsibility of developing and implementing policies and programs of the government. That is to say, while it is the duty of the political parties to determine and direct the focus of policies, the bureaucracy Is the administrative machinery through which the objectives are determined (Adegoroye, G., 2015).
Weberian and Marxian believed the state was the outcome of the rise of property system, classes and class antagonisms. With the collection of historical materials, Marxian concluded that the state was an instrument of exploitation (Marxian & Weberian). The realization of rational goals and objectives are maximized through the bureaucratic qualities of formalism and impersonality in the application of rules and regulations in the operation and management of organizations (Adegoroye, G., 2015).

Bureaucracy and Efficiency in Nigeria Public Enterprise (Case study):
The purpose of bureaucracy in this study is to successfully implement the actions of an institution of any size (seldom associate with several large entities; examples; government, corporations and NGOs). To achieve its purpose and goals, the bureaucracy is tasked to determine how to achieve its aim with the greatest possible efficiency and at the least cost of any resources. Therefore, the study aimed at finding out to what extent in which bureaucratic efficiency have undermined the smooth effective and efficient operation of Nigeria Public Administration (BUREAUCRACY AND EFFICIENCY IN NIGERIAN PUBLIC ENTERPRISE; Power holidings, 2016).

Another case study: Bureaucracy and Efficiency in Nigeria Public Enterprise, Power Holding.

The aim of the study Is to ascertain the compact of bureaucracy towards achieving organizational systems. The invention of western bureaucracy in the past centuries helped solve the problem for leaders of governing human systems that grew bigger and more intense in each year (BUREAUCRACY AND EFFICIENCY IN NIGERIAN PUBLIC ENTERPRISE; Power holidings, 2016). The two case studies were based on the following characteristics:
1.       Bureaucrats are obliged to be personally free and subjective to authority with the respect to the impersonal duties of their offices.
2.       Bureaucrats are categorized in an organized defined hierarchy of offices.
3.       They accept and maintain their appointments (BUREAUCRACY AND EFFICIENCY IN NIGERIAN PUBLIC ENTERPRISE; Power holidings, 2016).

Advantages of Bureaucracy in Nigeria Public Services:
Structural, administrative attitudes and behaviours and political and economic are thematic formats of civil services. According to Nnoli (1980), Adebay (2001), and Yusufu (1992), theoretically, positions are supposed to be filled on the basis of merit. However, political, family, ethnic and religious factors are significant considerations in achieving bureaucratic appointments. Hence, the personnel regulations, qualifications, organizational structure and work environment play an important purpose in diminishing the administrative capacity in the public bureaucracy (Adebayo, A; Nnoli(1980), & Yusufu(1992), 2001).

Failure of Bureaucracy in Nigeria:
From the above case studies, the totality of government offices and bureaus constitute the permanent government of a state. That is to say, those persons and functions that continue irrespective of changes in political leadership. In Nigeria, bureaucracy is known as the 4th branch of government, despite the fact it was technically under the control of the executive branch, it sometimes seemed to function as if it had its own will, power and legal authority (Thomson, 2008).
If bureaucracy has the advantages mentioned above accompanied by the following:
1.       Clearly stated expectations
2.       Promotes equality in treatment
3.       Policies are strict
4.       Division of labour ETC. (Navajocode, 2015).

Question: Why bureaucracy not suitable for the governance of political parties in Nigeria?
Bureaucracy and Problems of Inefficiency in Nigeria’s Civil Service, Case Study in Enugu State Nigeria:
Although bureaucracy implies an institution categorized by rules, process, impersonal relations, elaborate and fairly rigid hierarchy of authority, responsibility and relation with the aim of control and coordination within the large demand of organization among the bureaucracy principles; in developing nations, such as Nigeria, bureaucracy has been linked if insignificant red-tape and inefficiency. Administration helps in the control of achieved public goals, and the achievement of these goals rely on proper supervision which enhances administrative efficiency that involves competing for successful large and complicated task that no individual could accomplish alone. Therefore, the bureaucracy has created several doubts among the population whether it is actually suitable for institutions like the civil service (Chudi-Oji, 2013). The confronting problem in Nigeria is the inability of the service to perform efficiently. Moreover, the Nigerian’s public administration environment show signs of inefficiency and poverty, this has interfered with the development (Chudi-Oji, 2013).
This inefficiency leads to lack of vacancies for circumstantial issues. Bureaucracy has no provides no room for the emergency crisis. In other words, there are lack of equipped resources among the bureaucratic companies and institutions to tackle unexpected problems such as market shift and natural disasters. Due to the fact that there’s a decrease in the economy in Nigeria within the past two years, the biggest problem is the amount of time it takes to get any form of goals accomplished (Navajocode, 2015).
Bureaucracy leads to situations where workers are estranged or disassociated from the from the society. Division of labour has enhanced the performance of complex bureaucracies. Hence leading to trained incapacity (Chudi-Oji, 2013). According to Schaefer (2002-06) believed that adherence to rules is quite in order but had an argument that it overshadows the large goals of an institution which becomes dysfunctional (Schaefer, 2010). As it is an inconsistency with democratic governance, Onah (2005), has described bureaucracy as an antithesis of democracy (Onah, 2005).  Obi and Chukwuemeka (2006:112) made an observation on the inefficiency of civil service. They are discredited to the democratic government in Nigeria; caused by the strict adherence to the bureaucratic rules by the civil service thus, making poor implementation of policy and Methuselah age; all because of due procedure, while the populace which consumes the outputs in jeopardous state (Obi, E.A; and Chukwuemeka, J.N, 2006).

Evidence has shown that the performance of the public service in virtually all categories of government and in extra-ministerial departments in Nigeria remained very abysmal, hence the present state of underdevelopment (Thomson, 2008).
It is recommended that if the civil service is to Abbey by the results of good governance in Nigeria, far-reaching are significantly necessary. Promotion and recruitment of civil servants should be comprised of the merit system. This is due to enrollment of federal character principle of recruitment and other spoils system techniques with sacrificed efficiency and effectiveness. Rules and regulations should be flexible and pragmatic since they are the sine qua non-for systematic and orderly government. To assure this system, it is relevant that they are designed to serve colonial policies and revised interest to meet the 21st-century demands (BUREAUCRACY AND EFFICIENCY IN NIGERIAN PUBLIC ENTERPRISE; Power holdings, 2016).


1.       Adebayo, A; Nnoli(1980), & Yusufu(1992). (2001). Principles and Practice of Public Administration. Ibadan, Nigeria . Retrieved from
3.       Administrative structure of Nigeria. (2012-2015). Lagos State, Nigeria. Retrieved from
4.       Agba, M. S., & Chukwurah, D. C. (2014, January 1). Politics and Administrative Responsibility in Nigeria: An Assessment of Legislative. Journal of Good Governance and Sustainable Development in Africa, 2. Retrieved from Website: ISSN: 2346-724X (Print) ISSN: 2354-158X (Online
5.       BUREAUCRACY AND EFFICIENCY IN NIGERIAN PUBLIC ENTERPRISE; Power holidings. (2016). project in Nigeria, 97. Retrieved from
6.       Chand, Smriti. (2010). Weber’s Bureaucracy: Definition, Features, Benefits, Disadvantages and Problems. Retrieved from
7.       Chudi-Oji, C. (2013, June 12). Bureaucracy And Problems Of Inefficiency In Nigeria’s Civil Service: A Case Study Of Enugu State Civil Service. Doublegist. Retrieved from
8.       Marxian, & Weberian. (n.d.). Weberian Theory of State – Explained! Political Science Note. Retrieved from
9.       Merriam, W. (1828). bureaucracy. Retrieved from
10.    Navajocode. (2015, June 15). Advantages and disadvantages of bureaucracy. Retrieved from
11.    Obi, E.A; and Chukwuemeka, J.N. (2006). Development Administration theory and Application . Onitsha .
12.    Onah, R. (2005). Public Administration.
13.    Schaefer. (2010, September 19). The Dilemma of the Bureaucratic Cog. Schaefer's blog. Retrieved from
14.    Thomson, G. (2008). Bureaucratization of Government. International Encyclopledia of Social Science. Retrieved from
15.    Weber, M. (2001). Max Weber's Theory of Bureaucracy. Retrieved from