Good customer service is needed in hospitals to enable health workers satisfy their patients. Though there is no competition in our public hospitals, customer satisfaction must always be a key factor in measuring our success (Frankel & Stein, 1999). Customers service is mostly know to be the effective marketing tool used by organizations to win, satisfy and retain their customers to beat their competitors [1,2]. Nonetheless our public hospitals are not profit making organization; customers need to be treated like the way profit making organizations treat their customers to provide the needed customer satisfaction [3]. Due to limited health facilities and health workers, the number of patients that attend our hospitals on a daily basis far outnumbers the number of doctor and nurses we have at the hospitals. This leads to patients experiencing low or no forms of customer service at all. Customers with unmet needs have no option than to return to the same hospitals and to the same workers who provide them with the dissatisfied service [4].

Recent undocumented report of out cries of customers by the media indicates, how badly patients and their relatives were treated in some hospitals. Most of patients accept any form of treatment offered them because they view hospital workers as superiors and do not know who to complain or seek redress. With low customer knowledge and less demand for better service delivery from patients, less or no attention is giving to customer service which can lead to improve healthcare delivery in our hospitals. Most customers (patients) find it difficult to

ask for a better understanding of how to apply the drugs given to them, left alone giving feedback to health workers about their reactions to the drug and other treatments observations [5]. Humiliating behaviours toward patients by hospital staff is not new and seemed not to go away soon. Though the effects of such behaviours have resulted in avoidable deaths less attention is still being paid to it. In mostly developed countries, patients right is not known as the patients themselves do not know they have right and others who even know they have right does do not demand for it [6].

Andaleeb [7] adaptation of customer service programmes in the hospitals of developed countries has send signals to the developing countries that it is not enough given a patient drugs but rather make the patient feel important as he or she is the reason for the existence of the health facilities and its workers. Better customer service in our hospitals can lead to better treatment of the sick since it will improve the understanding between patients and health workers. Improved customer service can give voice to customers and reduce situations in which customers are treated like objects rather than subjects in our hospitals.

Demographic characteristics of respondent

A total of 33% of the respondents in this study were aged between 35 and 44 years, while only 5.8% were over 55 year. Females made up the majority of respondent that is 59.2%, 64.1% of the respondents were Christians, with 32% being Muslims, while the rest belong to other minor religions. Most of the respondents (31.1%) are Akan, while 30.1% were Ewe. 57.3% of the respondent were married, 33.0% single and 2.9% co-habiting. In the case of occupation of respondents, 34.0% were civil servants, 20.4% were artisans while the rest belong to other professions. The greater parts of the respondents, 56.3%, were educated to the tertiary level, while only 7.9% had no form of formal education. 57.3% of the respondent had been to the hospital once or twice in the past two years, 23.3% have being to the hospital between three and four times in the last two years and 19.4% had visited the hospital more than four times in the last two years.

Determinant of respondents’ choice of hospitals to attend

The majority (79.6%) of respondents consider how close the hospital is to them when making the decision on which hospital to attend. 15.5% of the respondent paid attention to the colour of the hospital, while 84.5% of the respondents agreed that they consider the perceived qualifications of hospital staff when making the decision as to which hospital to attend.

The language mostly spoken in the hospital is a factor influencing the decision as to which hospital to attend according to 53.4% of the respondents. Most of the respondent (90.3%) considered the availability of equipment at the hospital and 73% considered the ownership of the hospital (government or individually owned) when making the decision as to which hospital to attend.

The results further indicated that respondents mostly consider the following factors when choosing hospitals: the majority (91.3%) consider the politeness of hospital staff, while (97.1) consider how clean the hospital and its environment is, 86.4% consider the length of time they spent at the hospital, 76.7% consider testimonies from others who attends the hospital, 70.9% consider if the hospital accepts National Health Insurance Cards and 74.8% consider the amounts the hospital charges.

Some negative experiences at the hospitals by respondents

The study revealed that, 29.2% of respondents said they were insulted by hospital staff at the hospital during treatment, 42.7% said they were shouted at by hospital staff at the hospital, while 49.5% said hospital staff were talking or chatting on their phones when they were talking to them. Other negative experiences by patients included been charged unapproved fees 21.4%, ignore the patients complains 45.6%, lack of detailed explanation on how to use their medicine 45.6%, while 12.6% of respondents claimed that hospital staff has demanded a bribe from them.

Some demands made by respondents when they visit hospitals

The majority (79.6%) of the respondent have sought detailed explanation as to how to take their medication from hospital staff, 50.5% demanded to know the reasons for charging them certain amounts of money, only 46.5% of respondents demanded to know the names of hospital staff. Only 18.4% of respondents reported wrong doing of hospital staff, while 38.3% has argued with hospital staff. Again only 24.7% of respondent have asked about the special qualifications of hospital staff and 42.7% have complained about unhygienic hospital environment.

The majority, 56.3% of respondents complained or asked to know the reasons for the long time spent at the hospital, 48.5% of respondents did not know who to complain too, while 23.2% of respondents demanded to know the telephone numbers of the hospitals they attend.

This cross sectional study conducted within Tema in the greater Accra region of Ghana to identify factors that influence patients choice of hospital, some negative experiences of patients in the hospital and some demands made on patients when they visit the hospital and demands made by patients from hospital staff.

Demographic characteristic of respondents

The majority (33%) of the respondents were aged between 35 and 44-years as this reflects the young population of the country. More women than men visit the hospitals. In the study women formed 59.2%, Christian religion covers more than 50% of the Ghanaian population and as show in the study 64.1% of the respondents belong to the Christian faith. Ghana has a lot of tribes; the Akan are the most dominant, as they are found in about seven out of the ten regions in the country and 33.1% of the respondent were Akan. Since the study was undertaken at Tema and most of the respondents (66.3%) lived there and were educated to the tertiary level. The level of education is the reflection of the study population not the national data. The majority (57.3%) of the respondents have been to hospital about once or twice in the past two years, this enable the respondent to share their own experiences in the study.

Determinant of respondents’ choice of hospitals

The majority of respondent (79.6%) claimed they consider how close the hospital is to them as a factor determining which hospital to attend. This corresponded with the government of Ghana agenda of building hospitals at every district of the country and making their health facilities available to bring health to the door step of the people (Better Ghana Agenda, 2015). A study by Peprah [8] indicate that most of the district hospitals which are close to people are ill equipped and also lack medical staff; this may impede the quality of health delivery and not make customer service a reality. The perceived qualification of hospital staff is a major factor in considering which hospital a person attends, according to 84.5% of the respondents, while 53.4% consider the language mostly spoken at the hospital. Though respondents may not know the actual qualification of hospital staff, they have their own ways of judging and determining how qualified a hospital staff is. The English language is mostly spoken by hospital staff, but for better understanding, speaking one of our local languages could have made communication easier.

In developing it is difficult for a patient (customer) to assess the qualification and experience of a hospital staff, as such details are not displayed in the hospitals and there is no data base for customers to access information from. These have given birth to the rise of fake hospital staff in some hospitals and some fake doctors have practised the profession for not less than 20 years, though these are serious challenges to health delivery, these issues are not mostly documented and are sometimes over looked by researchers Perceived availability of equipment at the hospitals is very important, as agreed by 90.3% of the respondents, having up to date equipment at the hospital makes the hospital admired by customers, lack of equipment increases the cost of customers as they have to travel to another hospitals for services such as a scan and others [10]. 61.2% of respondent also alleged that they consider the ownership of the hospital when making decision as to which hospital to attend.

In Ghana private hospitals are known for delivery quality but they charge higher amount of money compared to government owned hospitals. Ghana Demographic and Health Survey (GDHS, 2015) shows that people attend government owned hospital more than private hospitals but undocumented evidence also indicates that people who can pay for health prefer the private hospitals. According to the respondents, three major factor which mostly influence their decision of choice of hospital are politeness of hospital staff (91.3%), how clean the hospital environment is (97.1%) and length of time spend at the hospital (86.4%), these factors determine which hospital a patient attends. Though customers consider these factors as influencing their choice of hospitals much attention is not being given to these factors [11]. Most hospital staff has come under criticism for impolite behaviour in various hospitals of the country. While most patients (customers) complained about the length of time wasted at the public hospital. Unhygienic environments result in patient getting different illness from the hospital where they seek treatment. Research by Atinga et al. [12] states that the hospital environment is a very important factor in health delivery and it is for hospital staff to keep the environment hygienic.

Some negative experiences at the hospitals by respondents

Some negative experiences that patients go through at the various hospitals were highlighted. 29% of respondent asserted that they were insulted at the hospital by hospital staff; some respondents said they were yelled at (42.7%) while 49.5% complained about hospital staff chatting on their phones while they were talking to them. These attitudes of hospital worker may have negative impact on health delivery. Rude behaviour of hospital staff is very common in developing countries, as it is hard to hear of any disciplinary action put in place to control or check such behaviours. Patients who experienced terrible behaviour may stop going to the hospital or seek health from alternative health centres [13]. According to According to Torpie [14] customers (patients) need empathy and care which is above customer service, this is directly opposite of what some hospitals deliver.

The study also revealed that 12.4% of respondents complain of being charged unapproved fees, most patients do not know what they are being charged for, as the items on the bill was not explained to them and they were mostly ordered to go and pay without questioning what actually went into the billing. Customers would have reacted if they had been told what they are being charged for [15].

‘Hospital workers ignored us, when we are seeking information’; this claim was made by 21.4% of respondents. Most health workers perceived patients as knowing little about their health conditions therefore choose to ignore them when they tried to seek information. Patients are seen as objects during treatment instead of subject. It is very important for patients to have detailed information about their medication, but 45.6% of respondents alleged that they lack detailed explanations about their medication; this may affect the effectiveness of the medication and impacted negatively on treatment.

Malott and Ayala specified that patients (customers) are interested in having more information about their treatment. Making information available to them may speed the healing process. Giving a bribe is common in Ghanaian institutions as there are a lot of allegations about bribing against public workers. 12.6% of the respondent asserted that hospital workers demanded a bribe from them.

What do respondents demand to know when they attend hospitals?

Respondent were asked whether they ask questions to enable them to understand better the treatment process or to identify the person giving them the treatment.

Explanations as to how to take medication is very important in the healing process. 79.6% of the respondent had asked for details about how to take their drugs. Asking for explanations will help them remember the process of applying the drugs effectively. Only (50.5%) of respondent asked to know what goes into their billing, this helped them know the reasons why they pay certain amounts at the hospital. With explanations on the details of the billing, patients will be able to clear any perception of being unduly charged. This will help shift the understanding of health delivery from hospital staff to patients [16].

It is common to know or ask the name of the worker who serves us at various organization we have to deal with, but 55.5% of the respondents did not know the name of any hospital staff at the hospital where they sought treatment and as little as 32.2% knew the telephone number of the hospital staff or the contact number of the hospital. This is an indication of poor communication between hospital staff and patients. Agyapong [17] indicates that knowing the names of service providers is a basic element in customer service, but because hospital staff do not introduce themselves to patients (customers) it is difficult for them to know the names of people who attend to them.

Patients cannot seek any information unless they walk to the hospitals. Not knowing the contact number of a hospital or hospital staff may lead to a waste of time and resources and also congest the hospitals as people may walk to the hospitals to seek information that they could have sought by making a simple telephone call. Although in other organizations staffs introduce themselves to customers by mentioning their names, same cannot be said about hospital staff. This delays communication and makes it difficult to refer to the person they dealt with for further explanation [18].

Some respondents agreed that they have had confrontations with hospital workers. 38.8% claim they have had an argument with hospital workers at the hospital, only 18.4% reported any wrong doing by hospital workers and 48.5% said they do not know whom to report any misbehaviour of hospital workers to. It is very difficult for a patient (customer) to even question the action of hospital workers, so a patient has to be bold enough to dare argue with hospital staff.

According to Omid et al. [19] monitoring such negative acts at the hospital can help improves service delivery. Patients who may be bold enough to report wrong doing may not be able to do so for the reason that they do not know whom to report to or the processes involved in the reporting. Some unacceptable conducts of hospital staff in developing countries are not only abuse issues but some were issue of violence [20].

It is common to ask of the experience and specialization of people offering services to us but the same cannot be said when it comes to hospitals staff, as only 24.7% of respondents were able to ask to know the specialization of people who treated them. Most people do not know who is in charge in a hospital and who they may contact if they wish to make a complaint and whom to contact to seek the necessary information.

When asked what they complain about, 56.3% of respondents said they complained about lateness of hospital workers to attend to them, while 42.7% complained about unhygienic hospital environment and 24.3% agreed that they have bribed hospital worker before being seen to. Observation made at the hospital reveal that hospital staff are sometimes late to attend to patients, giving explanation to the reason for being late and saying sorry can reduce the anger of patients, but it appears to be difficult for a hospital staff to say sorry to a patients. Customer service is missing in our hospitals as patients (customer) are treated as objects instead of being subject [21].

Customer service is a basic component in both the service and the manufacturing industry. Most organizations see the customer as the sole reason for their existence, this causes them to treat their customers as kings (customers are always right), but in Ghanaian public hospitals, the patients, who are the customers and the purchasers of health, are seen as people who come to seek a favour from the hospital staff. Public hospitals are known to be non- profit making organization and as such see no need for customer service.

The study revealed that factors which influence choice of hospital are; perceived qualification of hospital staff, availability of equipment at the hospital, politeness of hospital staff, hygiene of hospital environment, and length of time spent at the hospital and the amount of money charged for treatment.

It was divulged in the study that insult from hospital staff, hospital staff yelling at patients (customers), hospital staff chatting on the phone while being talk to, charging unapproved fees, lack of details as to how to take their medication and ignoring complaints from patients were some of the negative experiences patients suffered at the hands of hospital staff. The study also shows that not all patients were able to ask question when they do not understand how to take their medication and only a few of them seek information about the person giving them treatment.

Customer service can help improve health delivery at our hospitals, as it has brought a lot of changes to the service industry. The increasing incidences of patient abuse has emphasised the need to introduce customer service to our health education institutions and hospitals, existing hospital staff need to be taken through customer service training. Authorities must build a well-equipped customer service centre (Patient advocacy Centre) within our hospital to enable patients seek information and for dissatisfied patients to seek redress.

The authorities must empower patients to ask questions and seek meaning about the kind of treatment being given to them and patients must be fully involved in treatment decisions. Measures should be put in place to reduce time spend at the hospital by streamlining hospital activities to reduce the amount of paper work.

Finally, everybody must learn to say sorry, while hospitals must improve their use of technology to improve their services. Putting patient documents online, networking the entire hospital as being done in the banks and online booking will help solve some of the challenges.