الفهرس 
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Abstract
The assessment of clients’ satisfaction level, and the knowledge of what factors influence satisfaction are very important for health care managers as it influences health care results and health care institutions financial results (Raposo, 2009). Little is known about its importance as a tool for monitoring the right to health. Indeed clients’ satisfaction studies have proved of value as a health indicators and allowed the implementation of improvement strategies in the health sector based on the voice of clients”, thus becoming a potential right to health indicator Mpinga et al., 2010 One such management philosophy is Total Quality Management TQM), which has been forward as a mean of improving quality and effectiveness. TQM is based on the principal that a real quality improvement is founded upon understanding the process function and systems, their constant modification resulting from information Navipour et al., 2010). Total Quality Management (TQM) is relatively new in Egypt, where the environment and culture are different from other developed countries which have effectively applied TQM. The Egyptian government has given TQM top priority, yet there is not enough literature on the Egyptian experience with TQM (Salem, 2011 This study was conducted to determine the degree of clients’ satisfaction with utilization of health care services delivered in Menofiya hospitals after application of the Total Quality Management program Subjects A purposive sample of clients who hospitalized at the studied hospitals’ wards, general hospital and district hospitals (Surgical Medical - Obestatric – Orthopedic) wards and specialized hospitals Summary 111 males & females wards) and clients who used the health services at the hospitals’ out clinics department ( emergency & clinics The sample size was estimated by using statistical formula and according to the statistical formula the sample size was reached hospitalized clients and 100 out clinic clients o The general Menof hospital: - 72 clients (49 hospitalized – 23 outo The district hospitals 171 clients ( 151 hospitalized – 20 out 1. kwesna hospital: - 57 clients 2. Elbagoor hospital: - 57 clients . Tala hospital: - 57 cliento The specialized hospitals 107 clients ( 50 hospitalized – 57 out ) 1. Sadre Shebaen Elkoom hospital:- 53 clients 2. Ramad Shebaen Elkoom hospital: 54 clients The clients were selected according to the following criteria:- 1. Both sexes2. Age not less than 18 years 3. Hospitalized clients for at least 3 days All the clients from population who fulfill the sampling criteria agreed to be interviewed and included as subjects for the study. The technique was used as following The study used a multistage random system to select 6 of the ministry of health hospitals out of 17 hospitals in Menofyia The study design Summary 112 Descriptive design (analytical) was used to determined clients satisfaction from heath services Data Collection Instruments The questionnaires were designed by the Egyptian MOH. Two questionnaires were construed, one for in - clients and the other for out -clients using the interview method The main finding of the study revealed the following The results in the present study found that, there was no statistically significant association between gender, age, residence, marital status educational level, occupation and general clients’ satisfaction. According to the result of the present study it was found that clients were satisfied from care facilities provided by all the surveyed hospitals, admission process, room services (level of cleanliness, bath room’s conditions availability of beds and level of meals). The present study revealed that the majority clients were satisfied from the health care providers (doctors nurses and employees).Regarding the clients’ satisfaction with the hospital administration. This study finding revealed that, more than one half of the clients said that, the hospital rules are applied and respected About one quarter of the hospitalized clients in the present study were found to be un satisfied from the discharge process. High proportion of the studded clients were satisfied with the overall inpatient and out clinics hospital services. More than one half of out – clients mentioned that they spent a very long time to get the needed health services Conclusions Summary 113 There was no statistically significant association between the clients’ gender, age, residence, marital status, educational level occupation and general satisfaction Concerning the causes for choosing the hospital, near by the hospitals was the main cause.
High proportion of the surveyed clients were satisfied from care facilities provided by all the surveyed hospitals More than one third of the surveyed clients reported that, they bay medications from outside the hospitals Less than one quarter of the hospitalized clients were less satisfiedfrom the discharge process More than one half of out – clients mentioned that they spent a very long time to get the needed health services This better finding of the present study could be due to the ongoing changes because of the application of Total Quality Management program in the study area hospitals, where an improvement in the service delivery process and staff attitudinal change might have resulted Recommendations - Ministry of Health needs to Top management of the Ministry of Health should provide adequate resources to the implementation of Total Quality Management (financial resources, training for senior management/ staff level) at all health organizations.
Audit and assessment are the most powerful ways to support project of Total Quality Management continuity Summary114 Carry out clients’ satisfaction surveys routinely in all aspects of health care to enable the hospitals keep adequate stock of essential drugs and supplies 2 –The hospitals’ directors need to Make changes in management culture which are; employee participation, teamwork, system evaluation, and training &<development of staff Improve the out-clinics services’ quality & reduce the clients
waiting time by:-
Encouraging doctors to arrive at the clinic on-time and the
staff is available when the clinic opens to ensure that clients are
ready for their examinations Sufficient number of doctors, nurses and employee on duty by a well-planned schedule should in place Make extra clinics in the hospitals with insufficient number of clinics Appropriate distribution of clients among all the consultants Separate queues for old and new clients, as new clients need
more time for history and workup Make a clients’ path way at the clinics to safe clients’ time and efforts Make medical records with a unique identifier for each client evaluated and treated, to document the client’ course of illness treatments Make Master Patient Index Cared ( MPI) to each out-client it is a manual system , it can be computerized, it contain the clients’ important information, not the medical data, it is necessary to locate the clients’ medical records Sufficient computer facilities at the registration of clients’ data Make an electronic calling system to direct clients to the appropriate consultation room Repeat clients’ waiting time measurements and management information analyses on a regular basis The clients need to be hospitalized. A nurse takes care of the necessary arrangements with the inpatient department Facilitate the hospitalized clients’ discharge process by Receive pre-printed discharge instructions, including medications & food at home after discharge Anticipated discharge date and time is communicated to clients and client’s family with enough time Arrange physician follow-up after discharge.