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Survey on client satisfaction at Centre Pasteur Cameroon

Killa Claris1*, Kaiyen Afi Leslie2, TANGA Grace3

1Department of Laboratory, Bsc Biochemistry, HPD medical laboratory sciences, Msc Health sciences, Cameroon
2Department of Medical research, Bsc medical laboratory science, Msc Health sciences, United Kingdom
3Department of Quality assurance, Msc in quality assurance, Cameroon

*Corresponding author

*Killa Claris, Department of Laboratory, Bsc Biochemistry, HPD medical laboratory sciences, Msc Health
sciences, Cameroon

Abstract

Satisfaction is the client’s opinion which results from the gap between his/her perception of the product or service consumed and his/her expectations. The survey on client satisfaction occupies an important place in quality management. It is necessary for businesses to listen to their customers and to measure their rate of satisfaction. Thus they can enrich their loyalty and improve the effectiveness of their customer services.

The study is a prospective descriptive one which was conducted at Centre Pasteur Cameroon (CPC) during a 3 month period (October 2014 - January 2015). Questionnaires were distributed to clients who filled them and handed them back to the investigator. The exercise constituted in getting information concerning the different domains of the service in order to calculate the percentage satisfaction and equally identify areas for amelioration. The sample size was calculated using the Lorenz formula and we obtained 1067. The questionnaire was pre tested and analysed for loopholes and the final questionnaire was validated. The questionnaire administration proper began on the 6th of November 2014 and the questionnaires were administered every day except Sundays from 7:30 am to 4pm and on Saturdays from 8 am to 12 noon. Of the 1633 clients who were sensitized on the ‘Raison d´être’ of the survey, 1067 ended up filling the questionnaires making a survey participation of 65.3% and non participation of 34.7%. Of the total number of clients, 35.6% were very satisfied while 47.3% were satisfied giving a total satisfaction of 82.9% and dissatisfaction of 17.1% (12.7% mediocre and 4.4% poor). Sample collection scored the highest percentage satisfaction of 93.2% and waiting time lapse scored the lowest satisfaction of 60.5%. Of the 1067 clients, 27.9% gave suggestions for amelioration while 72.1% did not. As far as suggestions for amelioration is concerned, 31.8% of the clients suggested an amelioration of the courtesy of personnel and 0.1%, an amelioration of sample collection.

Come to the end of our survey on client satisfaction which had as objectives to inquire on the satisfaction of our clients, measure the percentage satisfaction of the different domains of the service and obtain comments ∕ suggestions for amelioration. We concluded that the clients are satisfied of our services but that much has to be done to maintain this level and why not go higher by ameliorating the areas recommended for amelioration and carrying out satisfaction surveys yearly in order to monitor our performance.

Key words: client satisfaction, survey, amelioration, dissatisfaction, performance, quality management.

Introduction

The importance of quality in the functioning of health care laboratories in developing countries has been universally recognized. Laboratories practicing the principles of quality assurance generate relevant, reliable and cost-effective results. Quality means meeting the standards. The standards are predetermined requirements for a particular substance or service. (Mayura et al., 2005). There are actually 4 references that are applicable to medical laboratories (ML):

  • Since 1994, the good practice and execution of analysis guide (GBEA) enumerates rules which if not respected will bring about the sanctioning of private as well as hospital laboratories. This has established a very high level of quality analysis and demands as far as the health profession is concerned (Dreux, 2008). The following are applicable to ML’s that have not yet been accredited.
  • The FN EN (French and European standard) ISO 15189, 2007 version « Laboratories for medical analysis» particular demands concerning quality and competence.
  • The FN EN ISO 22 870, 2006 version «demands concerning quality and competence for delocalised medical analysis», for ML’s carrying out delocalised medical analysis.
  • The certification manual, 2010 Version published in June 2009 deals with the follow up of medical analysis and is therefore applicable to ML’s within health settings. (Scheffknecht, 2012).

Quality management (QM)

This is the management activities and functions involved in the determination of quality policy and its implementation  using quality planning and quality assurance (including quality control). It ensures that an organization, product or service is consistent. It has four main components: quality planning, quality control, quality assurance and quality improvement (ISO 9004:2009). Quality management is focused not only on product and service quality, but also the means to achieve it. Quality management therefore uses quality assurance and control of processes as well as products to achieve more consistent quality.

Quality assurance (QA)

This is a way of preventing mistakes or defects in manufactured products and avoiding problems when delivering solutions or services to customers. ISO 9000 defines quality assurance as "A part of quality management focused on providing confidence that quality requirements will be fulfilled" (ISO 9000:2005). QA is applied to physical products in pre-production to verify that what will be made meets specifications and requirements. It is also applied to software in order to verify that features and functionality meet business objectives and equally refers to administrative and procedural activities implemented in a quality system so that requirements and goals for a product, service or activity will be fulfilled (ASQ, 2014). This is the systematic measurement, comparison with a standard, monitoring of processes and an associated feedback loop that confers error prevention (MASB, 2010). This can be contrasted with quality control, which is focused on process output. Two principles included in Quality Assurance are: "Fit for purpose", the product should be suitable for the intended purpose; and "Right first time", mistakes should be eliminated. QA includes management of the quality of raw materials, assemblies, products and components, services related to production,  management and inspection processes. Suitable quality is determined by product users, clients or customers. It is not related to cost and adjectives or descriptors such as "high" and "poor" are not applicable. For example, a low priced product may be viewed as having high quality because it is disposable, where as another may be viewed as having poor quality because it is not disposable. Often used interchangeably with quality control (QC), it is a wider concept that covers all policies and systematic activities implemented within a quality system. QA frameworks include:

Quality control (QC)

This is a process by which entities review the quality of all factors involved in production. ISO 9000 defines quality control as "A part of quality management focused on fulfilling quality requirements"(ISO 9000:2005). This approach makes emphasis on three aspects:

  • Elements such as controls, job management, defined and well managed processes, performance and integrity criteria and identification of records (Dennis, 2007).
  • Competence, such as knowledge, skills, experience, and qualifications.
  • Elements such as personnel, integrity, confidence, organizational culture, motivation, team spirit and quality relationships.

Customer focus

Customer focus is the first principle as far as the eight principles of quality management is concerned. Organisations depend on their customers and therefore should understand current and future customer needs, should meet customer requirements and strive to exceed customer expectations. The key benefits being:

  • Increased revenue and market obtained through flexible and fast responses to market opportunities.
  • Increased effectiveness in the use of the organization’s resources to enhance customer satisfaction.
  • Improved customer loyalty leading to repeat business. Applying the principle of customer focus typically leads to:
  • Researching and understanding customer needs and expectations.
  • Ensuring that the objectives of the organization are linked to customer needs and expectations.
  • Communicating customer needs and expectations throughout the organization.
  • Measuring customer satisfaction and acting on the results.
  • Systematically managing customer relationships.
  • Ensuring a balanced approach between satisfying customers and other interested parties such as owners, employees, suppliers, financiers, local communities and society as a whole. (ISO 9004:2009).

Research question and method

It is necessary to carry out surveys and organise interviews or panels in order to obtain information concerning the vision of clients on the services rendered by the laboratory. In this way, the laboratory can obtain information on the problem causing domains and have insight on the domains that are not covered by internal processes or that are not part of complains. The ISO (international organization for standardization) standards strongly insist on the importance of client satisfaction. Every laboratory having a quality management system whether accredited or not should have an eye on the satisfaction of their clients in order to know if it responds to their needs. (WHO (world health organisation), 2014).

It has been noticed that the clients who come to Centre Pasteur Cameroon (CPC) on a daily basis always complain about services rendered. Work is either too slow, or results are released late and so on and so forth, we then thought it necessary to carry out a client satisfaction survey in order to assess the level of satisfaction of the clients requesting the services of CPC so as to put forth corrective actions to ameliorate services and satisfy them better and equally to obtain comments / suggestions for amelioration from these clients in order to put in place better services so as to meet their needs. We assumed that clients should be satisfied to a certain degree if not they would not come to the Centre Pasteur laboratory at all. Our main research question therefore was centred on knowing to what level or degree the clients requesting the services of Centre Pasteur are satisfied. The study was conducted in Yaounde, the political capital of Cameroon at CPC more precisely at the quality service of the centre. Our choice was focused at CPC because it is a technical body of the MINPH (Ministry of public health) of Cameroon which carries out medical analysis, vaccinations, public health research and training of laboratory technicians and equally because it receives more patients (500) daily from far and wide as compared to any other laboratory in Cameroon. The overall workflow of the laboratory is partially computerized, that is, physicians order tests on preprinted paper ordering slips, and orders arrive in the laboratory after being registered in the computer system. Computer-printed results are taken by the patients or their care takers to the physician who ordered the tests. Urgent tests are labeled “urgent” on the request and processed first.

  1. What is the percentage satisfaction of the clients requesting the services of Centre Pasteur Cameroon? We suggest 82.9 and this was obtained using a questionnaire. A well designed questionnaire containing open ended questions enabled the obtention of information or data which was then analysed.

What is the percentage satisfaction of the different domains or sections of Centre Pasteur? We suggest the following results for the different sections (professionalism of personnel (79.8%), respect of confidentiality(90.7%), comfort of the various departments(89.0%), waiting time lapse(60.5%), quality of reception by phone(88.4%), sample collection(93.2%), handling of emergency(82.7%), result release deadline(73.4%), entire service(88.7%),) Results obtained using a well-structured questionnaire. Of the 1633 clients contacted, 1067 ended up filling the questionnaires making a survey participation of 65.3% (1067 ∕ 1633) and non participation of 34.7%. Of the 1067 clients who filled the questionnaires, 533 were females and 534 were males giving a sex ratio (female/male) of 1 and a 50.0% (534 ∕ 1067) participation of both sexes. We noticed that the highest participation 19.1% (204 ∕ 1067) was observed among the 32− 37 age range and the lowest 0.3% (3 ∕ 1067) among the 80 − 85 age range. The clients had a mean age of 36.6 years ± 13.1 with the youngest client being 14 years and the oldest 85 years. Of the 1067 clients who participated in the study, 92.9% (991 ∕ 1067) were in active service and 7.1% (76 ∕ 1067) were retired. As far as profession is concerned those who participated the most were workers of the public sector 27.1% (289 ∕ 1067) followed by workers of the private sector 23.4% (250 ∕ 1067) , students 22.3% (238 ∕ 1067), house wives and jobless people 21.8% (233 ∕ 1067) , health personnel 4.8% (51 ∕ 1067) and finally the clergy 0.6% (6 ∕ 1067).

Result representation of the different domains of the reception

The results are given in frequencies and in percentages (Table I). Here respect of confidentiality scored the highest satisfaction of 90.7% (968 ∕ 1067) while the waiting time lapse scored the lowest with 60.5% (646 ∕ 1067)  Data was collected using a standard questionnaire constructed for the study and the data was registered in the EPI INFO 7.1.1.14 software. The SPSS software 0.9.3.1 enabled us to analyze the data. For quantitative data and for descriptive analyses we used the mean, median and standard deviation to describe socio demographic data. As far as qualitative data is concerned we used confidence intervals for uni varied analysis: Chi square to compare two variables in order to define the link of dependence. Graphics were plotted using Microsoft Office Excel 2007.

table 1 1

The different figures illustrating this table are found below

Professionalism of personnel

We observed a total satisfaction of 79.8% (851 ∕ 1067) and dissatisfaction of 20.2% (216 ∕ 1067) (figure 1) with a mean of 1.0 and standard deviation of 0.7

fig 1 6

Respect of confidentiality

At this level a total satisfaction of 90.7% (968 ∕ 1067) was observed and dissatisfaction of 9.3% (99 ∕ 1067) (Figure 2) with a mean of 0.7 and a standard deviation of 0.7

fig 2 3

Comfort of the various departments

As far as the comfort of the various departments is concerned a total satisfaction of 89.0% (950 ∕ 1067) and dissatisfaction of 11.0% (117 ∕ 1067) (Figure 3) was observed with a mean of 0.8 and a standard deviation of 0.6

fig 3 3

Waiting time lapse

There was a total satisfaction of 60.5% (646 ∕ 1067) and dissatisfaction of 39.5% (421 ∕ 1067) (Figure 4) with a mean of 1.4 and standard deviation of 0.9

fig 4 1

Quality of phone reception

A total satisfaction of 88.4% (943 ∕ 1067) and dissatisfaction of 11.6% (124 ∕ 1067) (Figure 5) was observed with a mean of 0.5 and a standard deviation of 0.8

fig 5 1

Result representation of the different domains of the collection bench

The results are given in frequencies and in percentages (Table II). Here sample collection scored the highest satisfaction of 93.2% (994 ∕ 1067) as compared to handling of emergency which scored the lowest with 82.7% (882∕1067).

table 2 2

The different figures illustrating this table are found below

Sample collection

A good representation of 93.2% total satisfaction (47.2% very satisfactory and 46.0% satisfactory) and dissatisfaction of 6.8% being 5.6% mediocre and 1.2% (Figure 6) poor with a mean of 0.6 and standard deviation of 0.6

fig 6

Handling of emergency

There was a total satisfaction of 82.7% (60.0% very satisfactory and 22.7% satisfactory) and dissatisfaction of 17.3% (12.4% mediocre and 4.9% poor) (Figure 7) with a mean of 0.6 and standard deviation of 0.9

fig 7

Result representation of the different domains of the result withdrawal bench

The results are given in frequencies and in percentages (Table III). There was a percentage satisfaction of 88.7% (946 ∕ 1067) for the entire service as compared to result release deadline which scored a 73.4% (783 ∕ 1067) satisfaction.

table 3 2

The different figures illustrating this table are found below

Result release deadline

We had a total satisfaction of 73.4% (25.4% very satisfactory and 48.0% satisfactory) and dissatisfaction of 26.6% (18.5% mediocre and 8.1% poor) (Figure 8) with a mean of 1.1 and standard deviation of 0.9

fig 8

The entire service

A total satisfaction of 88.7% (12.6% very satisfactory and 76.1% satisfactory) and dissatisfaction of 11.3% (9.9% mediocre and 1.4% poor) (Figure 9) was observed with a mean of 1.0 and standard deviation of 0.5

fig 9

Representation of the distribution of the results of the different departments of the service

There was a 93.2% (994 ∕ 1067) satisfaction for the realization of sample collection which was the highest score as compared to the waiting time lapse which scored a 60.5% (646 ∕ 1067) satisfaction(the lowest score) (Table IV)

table 4 1

The different figures illustrating this table are found below

General results

Sample collection scored the highest percentage of satisfaction being 93.2% (994 ∕ 1067) and waiting time lapse scored the lowest satisfaction of 60.5% ( 646 ∕ 1067) (Figure 10 ).

fig 10

From the results below we see that 35.6% of the clients were very satisfied, 47.3% satisfied which gives a total satisfaction of 82.9% (885 ∕ 1067) and dissatisfaction 12.6% mediocre and 4.4% poor giving a total dissatisfaction of 17.1% ( 182 ∕ 1067) (Figure 11)

fig 11

From the results below we see that there was a satisfaction of 82.9% and dissatisfaction of 17.1%. (Figure 12 )

fig 12

This figure shows the satisfaction perceived of the different criteria of the service summed up to 100.0%. (Figure 13)

fig 13

This figure shows the dissatisfaction perceived of the different criteria of the service summed up to 100.0%. (Figure 14)

fig 14

A view of those who gave and did not give suggestions/comments for amelioration.

From the table we see that 72.1% of our clients did not give suggestions for amelioration whereas 27.9% did .(Table V)

table 5

Distribution of comments/suggestions for amelioration

From the table we see that of those who gave suggestions, the highest 31.8 % (340 ∕ 1067) suggested on the amelioration of the courtesy of personnel and the lowest 0.1 % (2 ∕ 1067) on the realization of sample collection (Table VI)

table 6

The figure illustrating this table is found below. From the figure the suggestions concerning the amelioration of the courtesy of personnel was 31.8% (highest score) and that for sample collection 0.1% (lowest score) (Figure 15)

fig 15

Conclusions and recommendations

Our study focused on evaluating the satisfaction of the clients requesting the services of Centre Pasteur Cameroon and measuring the satisfaction of the different criteria of the service.

We involved 1067 clients in the study. This sample size was higher than that used in a similar study carried out at the ´Atoutbio´ laboratory in 2012 with 240 clients, ´La Villa´ laboratory in 2014 with 51 clients, ´Le Phenix´ laboratory in 2010 with 540 clients, ´Le Labo´ laboratory in 2014 with 71 clients, ´CERES´ laboratory in 2013 with 240 clients, MSPHL in 2012 with 142 clients and a similar study carried out by Zelalem et al in 2012 at the Gondar university hospital in Ethiopia with a sample size of 196 clients, in 2010 at the Dil Chora, Jugal, Hiwot Fana and Bisidimo hospital laboratories with 429 clients and by T.A and E.K in 2009 at a specialized hospital laboratory in Egypt with 107 clients. This difference can be explained by the fact that this was the very first time a survey was being carried out at Centre Pasteur so we considered our prevalence to be 50% during the determination of our sample size.

We obtained a percentage participation of 65.3%. This percentage participation is close to that observed by a similar study carried out at ‘Le Phenix’ laboratory in France in 2010 with a percentage participation of 63.0%, higher than that observed by the study carried out at the ´Iodolabo´ laboratory in 2013 having a percentage participation of 42.0% and lower than that observed at the Gondar university hospital in Ethiopia which had a response rate of 96.1%. This percentage participation we had was higher than the average and is rather interesting  taking into consideration the fact that this was the first time this type of study was being carried out at Centre Pasteur, we believe that with time, as they get used to, the percentage participation will increase. There were a few reasons of non participation in the study amongst which tiredness, anger, ill state, no interest, haste, low morals, collection for someone else and first time.

We had a total satisfaction of 82.9%. This result is inferior to that obtained from a similar study carried out at ´Atoutbio´ laboratory in France in June 2012 with a 99.0% satisfaction, ´CERES´ laboratory (98.0% satisfaction in 2013), ´Iodolabo´ laboratory (100, 0% satisfaction in 2013), ´La Villa´ laboratory (98.0% satisfaction in 2014), ´Le Phenix´ laboratory (94.0% satisfaction in 2010), Gondar university hospital in Ethiopia (Zelalem et al, 2012) 51.3%. The explanation for the results we obtained is that there is a high work load as compared to the personnel at the reception, thus making it almost impossible for everyone to be received as they would have loved to.

As far as sex is concerned there was a 50.0% participation of both sexes. This close observation between both sexes was due to the fact that the clients were selected at random, so there would be no bias. This percentage is similar to that observed by a similar study carried out at the Gondar university hospital in Ethiopia in which 50.7% were men and 49.2% were women.

The age range 20-43 with mean age 36.62 participated most in our study with a percentage of 69.5%. This is different from that obtained by ´La Villa´ laboratory in which those who participated the most were the >65 age range with a percentage participation of 50.0%. The observation in our case is due to the fact that this age range constitutes the very active population (sexually, habit wise (alcohol, cigarettes etc)) and so being more exposed to illnesses (CDC, 2014).

We observed a participation of 92.9% among the active as compared to 7.1% among the retired. Reason being that in our towns already there is a higher percentage of the active than of the retired. Most retired people settle in their home towns (villages) and equally because the life expectancy in Cameroon is 54.71 years (CIA World Factbook, 2013).

Participation according to profession was as follows: workers of the public sector 27.1%, private sector 23.4%, students 22.3%, house wives and the jobless 21.8%, health personnel 4.8%, the clergy 0.6%. This result is not statistically significant and explains to us that illness does not respect profession, anybody can get sick anytime.

There was a percentage satisfaction of 79.8% as concerns the professionalism of personnel. This is higher than that observed at the specialized hospital laboratory in Egypt carried out by TA and EK Mohammad in 2009 with 76.9% satisfaction, but lower than that observed by (Kelvin et al, 2012) at the Missouri state public health laboratory with a satisfaction of 98.0%, (Bruce et al, 2009) on ‘physician satisfaction with clinical laboratory services’ giving 89.9% satisfaction and ´La Villa´ laboratory with 100.0% satisfaction. The result we obtained is due to the fact that personnel are pressurized by the work load and so cannot be perfectly efficient.

We observed a percentage satisfaction of 90.7% as concerns the respect of confidentiality which is similar to that recorded at ´La Villa´ laboratory with a percentage satisfaction of 91.0%. This is due to the fact that there is privacy as each client gets into the counter and collection room and closes the door behind them where their conversation is not to the hearing of everyone.

We observed a percentage satisfaction of 89.0% as far as the comfort of the various departments is concerned which is close to 91.0% satisfaction observed at ´La Villa´ laboratory in 2014. This result can be explained by the fact that there is a spacious room where everyone can sit and be comfortable.

The lowest percentage satisfaction was observed for the waiting time lapse with 60.5% which is low as compared to a 77% satisfaction observed at ´Le labo´ laboratory in 2014. This is indicating that there is a long time in waiting to pay at the counters, to be attended to and to collect results. This is equally because there are many people (Centre Pasteur receiving approximately 500 people daily). Some coming for vaccines, some for analysis, others for one inquiry or the other and for result retrieval). The normal procedure is that patients are distributed numbers according to arrival, they then wait at the reception to be summoned to the counters to pay for their services, when this is done, they then wait in front of the collection bench for their specimen to be collected after which they are given the date to come collect their results .This is actually a long procedure which under normal circumstances takes a long time and becomes worse in relation to the number of people present. The greater the number, the longer the waiting time and vice versa.

We observed 88.4% satisfaction for the quality of reception by phone. This is higher than that observed at ´La Villa´ laboratory with a satisfaction of 75.0%. This can be explained by the fact that most people find it easier to be more professional on phone than by direct contact.

Our highest satisfaction was observed for the quality of sample collection with a 93.2% being higher than that observed at ´La Villa´ laboratory with a satisfaction of 89.0%. This can be explained by the fact that the phlebotomists at Centre Pasteur are highly qualified for their job and have a good mastery of it and during their training emphasis was placed on the medical act of reassuring the patients and doing their job well.

We observed a percentage satisfaction of 82.7% for the handling of emergency. This result is due to the fact that there is an indication on every laboratory request which is urgent and equally, every disposition has been put in place to handle emergency cases such as phlebotomists displacing themselves towards patients who cannot move in order to collect their specimen as well as the immediate analysis of emergency samples arriving from hospitals.

We observed a percentage satisfaction of 73.4% for the result release deadline. This is lower than that observed at ´La Villa´ laboratory with a 78.0% satisfaction. Reason being that analysis differ and there are set norms that have to be followed before result release especially in Bacteriology where bacteria have periods during which they grow, if present. Unfortunately clients do not understand this and so always regard result release deadline as being long.

Several comments and suggestions were given; opinions indicated the non professionalism of the ladies at the counters (cashiers). There were several comments about the fact that these ladies do not speak nicely to clients and usually ask the patients to go look for change whenever this is lacking, something which under normal circumstances is not done. There were equally comments on the in appropriate nature of the toilets due to in availability of water, soap and toilet tissue. Actually there was a feed back when inquired from the cleaner that the clients themselves are the ones who usually render the toilets unusable and take away toilet tissue.

At the end of our survey on client satisfaction, which had as objectives to evaluate the satisfaction of clients, measure the satisfaction of the different domains of the service and obtain comments ∕ suggestions for amelioration, we conclude that:

  • These objectives were met according to the following results obtained and we confirm that clients at Centre Pasteur are satisfied of the services rendered them, satisfaction being 82.9%.
  • There is satisfaction on the different domains of the services, highest being sample collection (93.2%) and least being the waiting time lapse (60.5%).
  • Clients suggest above all on the amelioration of the professionalism of personnel (31.8%), amelioration of the waiting time lapse (20.7%), amelioration of the result release deadline (10.4%).

Recommendations

  • The entire personnel (Receptionists, secretaries, phlebotomists, cashiers especially, administration as well as technicians) should be sensitized on how to receive and interact with clients.
  • Measures should be put in place to reduce the waiting time lapse by employing more personnel.
  • Centre Pasteur should never forget that the client is king and is always right and so should always treat the client as such.

We note that interview administered questionnaire is not the only method used in obtaining information but also has it’s drawbacks such as possibility of low response rates therefore it is recommended to place questionnaires on the website and to run phone interviews as well.

Acknowledgments

The authors wish to thank all of the study subjects who participated in this study.

Conflict of interest

The Author(s) declare(s) that there is no conflict of interest’

REFERENCES

  1. Adsit, D. (2007), "What the Call Center Industry Can Learn from Manufacturing: Part I". National Association of Call Centers’, Retrieved  December 2012.
  2. Andaleeb, S. (2001), Service quality perceptions and patient satisfaction: a study of hospitals in a developing country. Social Science Medicine, Vol.52, pp. 1359–1370.
  3. ATOUTBIO: BRIGNON AND THOMAS 2012.
  4.  Bernhart, M.H., Wiadnyana, I.G. and Wihardjo, H. (1999), ‘Patient satisfaction in developing countries’. Social Science Medicine, Vol. 48, pp.989–996.
  5. DEMING. (2001),  ‘Le Créateur De La Qualité Totale’, accessed  August 2005.
  6. Dreux, C. (2008) ‘L'avenir de la biologie médicale en France bulletin Academique’. Natle Médecine, Tome. 192 N°, 6, pp. 1261à1276.
  7.  ESGM. (2000),’ Le Sphinx’, accessed June 2005.
  8.  Faison, C., Horlick, J., Merkel, W. and White, V. (2006), National Voluntary Laboratory Accreditation 15th ed.
  9.  FBC. (1997), ‘Serving the American Public Best Practices in Customer Driven Strategic Planning’, accessed 2003.
  10. FAO. (1992), ‘Conduite de petites enquêtes nutritionnelles Manuel de terrain Rome’, accessed  May 1998
  11. Francis, P., Muzaffer, U. and Vincent, P. (2010) ‘Tourist customer service satisfaction: An encounter approach, 1st ed., Advances in tourism.
  12. Hanan, M. and Karp, P. (1989), ‘Customer Satisfaction: How to Maximize, Measure, and Market Your Company’s “Ultimate Product” American Management Association, Vol. 9, pp. 9.
  13. Herve, L. and Vilcot, C. (2013). ‘Mesure de la satisfaction du client’. Qualité, métrologie, client fournisseur Tome.72 No, 1, pp. 1à10.
  14.  ISO 15189. (2012), ‘Medical laboratories, demands concerning quality and competence’, accessed June 2013
  15.  ISO 9000. (2005), ‘Quality management systems, essential principles and vocabulary’, accessed February 2006
  16.  ISO 9001. (2010), ‘Dépasser la conformité pour aller vers l’efficacité’ La satisfaction client ou l’importance de la qualité perçue, accessed July 31, 2011.
  17.  ISO 9001. (2000), ‘Quality management systems requirements’, accessed October 2001.
  18. ISO 9001. (2008), ‘Quality management systems requirements’, accessed September 2009.
  19. ISO 9004. ( 2009), ‘Managing for the sustained success of an organization – A quality’, accessed August 2010.
  20. Ja, P.I., Kouri, T.T. and Pakarinen, A.J. (2009), ‘Utilization of customer feedback in a university hospital laboratory’, Accreditation Quality Assurance, Vol, 14, pp.193–197.
  21. Jones, B.A., Bekeris, L.G. and Nakhleh, R.E. (2009), ‘Physician satisfaction with clinical laboratory services: a College of American Pathologists Q-Probes study of 138 institutions’. Arch Pathology Laboratory Medicine, Vol, 133, pp. 38–43.
  22. Jones, B.A., Walsh, M.K. and Ruby, S.G. (2006), ‘Hospital nursing satisfaction with clinical laboratory services: a College of American Pathologists Q-Probes study of 162 Institutions’. Arch Pathology Laboratory Medicine. Vol, 130, pp.1756–1761.
  23. Kaldenberg, D. and Regrut, B. (1999), “Do Satisfied Patients Depend On Satisfied Employees? Or, Do Satisfied Employees Depend On Satisfied Patients?” The Satisfaction Report, vol, 3, pp 3.
  24. Krebs, G. (2014), ‘Paru dans Tendances Qualité’, Client interne, client externe même combat, Tome. 1 N° 37, pp 1.
  25. Marinescu, M.A. (2010), ‘Continuous Improvement in Implementing Public Funded Projects; Proceedings of the 17th IGWT Symposium “Facing the Challenges of the Future’, Excellence in Business and Commodity Science”, Vol.1 No 1, pp. 337-381.
  26. NPR. (1996), ‘Serving the American People: Best Practices in Resolving Customer Complaints’, accessed January 1997.
  27. NRCPI. (2004), ‘Patient Experience vs. Patient Nick Wreden: What’s Better than Customer Satisfaction?” Viewpoint’, accessed May 24, 2004.
  28.  OMS. (2014), ‘Fiche contenu 13-1 vue d’ensemble du service clients’, accessed September 2014.
  29. Rodrigo, A. (1996), “Literature Review on Consumer Satisfaction in Modern Marketing.”, accessed December 5, 1996,
  31. Ron, Z. and Dick, S. (1989), ‘The Service Edge: 101Companies that Profit from Customer Care’, accessed January 1990.
  32.  Schaaf, D. (1995),’ Keeping the Edge: Giving Customers the Service they Demand’, accessed September 1996.
  33. Schneider, B. and Bowen, D. (1995), ‘Winning the Service Game’, Seminar in Consumer Research, Faculty of Commerce and Administration, Concordia, Vol. 34 No 3, pp. 463–465.
  34. Smith, M. and Engelbrecht, B. (2001), ‘Guide to assessing Client Satisfaction at District Hospitals’, accessed June 2001.
  35. TDMR, INC. (2012), “The Voice of the Customer: Improving Customer Service and Satisfaction’, International journal of research in commerce and management, Vol. 8 No 3, pp. 6– 8.
  36. THEA. (2005),’European Approaches and Experiences with User Involvement and Customer Satisfaction in Social Services’, accessed May 2005.
  37. Thomas, C. and Truax, P. (2001), ‘Surprises, Humility and Rising Rankings: The Satisfaction Monitor ‘, accessed March/April 2001.
  38.  UPTON. (2002), “What Your Customers Want,” accessed May 2002.
  39.  Zerah, S. and Vassault, A. (2012), ‘Management de la qualité dans les laboratoires d'analyses de Biologie Médicale’, accessed November 2012.

Journal of Clinical Case Reports, Medical Images and Health Sciences (ISSN 2832-1286) is a peer-reviewed journal dedicated to publishing clinical images from all sectors of medicine. The goal of this magazine is to disseminate information about new discoveries and treatments in science and medicine.

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