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Influence of Healthcare Facility Cleanliness on Patient Satisfaction in Nigerian Public Hospitals

Abstract

Healthcare facility cleanliness is an important component of quality healthcare delivery because a clean and hygienic healthcare environment may promote patient comfort, safety, dignity, and confidence in healthcare services. Patients' perceptions of cleanliness may also influence their overall assessment of healthcare facilities and willingness to use health services. Healthcare facility cleanliness refers to the extent to which hospital environments, including wards, consultation rooms, waiting areas, toilets, treatment areas, corridors, and other patient-accessible spaces, are maintained in a clean, hygienic, and orderly condition. Patient satisfaction refers to the extent to which patients perceive that the healthcare services and environment meet or exceed their expectations and needs. In Nigerian public hospitals, challenges such as inadequate cleaning personnel, insufficient cleaning materials, poor waste management, overcrowding, inadequate water supply, poor maintenance, and limited environmental sanitation resources may affect facility cleanliness. Poor cleanliness may create discomfort, reduce patients' confidence in healthcare institutions, and negatively influence their overall healthcare experience. Conversely, well-maintained healthcare environments may improve patients' perceptions of service quality and increase satisfaction with hospital services. Against this background, this study investigates the influence of healthcare facility cleanliness on patient satisfaction in Nigerian public hospitals. The study will be anchored on Donabedian's Structure-Process-Outcome Model, the SERVQUAL Model, and the Health Systems Framework. Donabedian's Model explains how healthcare structures and service processes influence outcomes and provides a basis for understanding how the physical healthcare environment may affect patient experiences. The SERVQUAL Model emphasizes dimensions of service quality, including tangibility, reliability, responsiveness, assurance, and empathy, with facility cleanliness forming an important aspect of the tangible dimension of healthcare services. The Health Systems Framework recognizes infrastructure, service delivery, human resources, and essential resources as important components of effective healthcare systems. Collectively, these theoretical perspectives provide a suitable framework for explaining how healthcare facility cleanliness may influence patient satisfaction in Nigerian public hospitals. The study will adopt a quantitative cross-sectional research design. Data will be collected from patients receiving care at selected public hospitals across selected locations in Nigeria. A multistage sampling technique will be used to select states, local government areas, hospitals, departments, and eligible patients. Healthcare facility cleanliness will be assessed using indicators such as cleanliness of wards, consultation rooms, waiting areas, toilets, treatment areas, corridors, floors, walls, windows, patient beds, availability of waste bins, frequency of cleaning, waste disposal practices, odour control, availability of water and cleaning materials, and general environmental hygiene. Patient satisfaction will be assessed using indicators such as satisfaction with the hospital environment, comfort, perceived hygiene, staff services, waiting environment, privacy, overall quality of care, and willingness to return to or recommend the facility. Structured questionnaires and facility observation checklists will be used for data collection. Descriptive statistics will be used to summarize participants' characteristics, facility cleanliness, and patient satisfaction levels. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple regression analysis, will be used to determine the influence of healthcare facility cleanliness on patient satisfaction. Diagnostic tests will also be conducted to assess the reliability of research instruments and the robustness of the findings. The study is expected to find that healthcare facility cleanliness has a significant positive influence on patient satisfaction in Nigerian public hospitals. Patients who receive care in clean, hygienic, well-maintained, and orderly environments are expected to report higher levels of satisfaction than patients attending facilities with poor environmental conditions. Clean wards, toilets, waiting areas, consultation rooms, and treatment spaces may improve patient comfort and create a positive perception of healthcare quality. Effective waste management and adequate sanitation may also increase patients' confidence in the safety and professionalism of the hospital. Conversely, unpleasant odours, dirty toilets, overflowing waste bins, unclean floors, inadequate water supply, and poorly maintained patient areas may contribute to dissatisfaction and negatively affect patients' perceptions of healthcare services. However, facility cleanliness alone may not fully determine patient satisfaction because waiting time, healthcare-worker attitudes, communication, availability of medicines, cost of care, quality of treatment, privacy, and accessibility may also influence patients' overall experiences. The study is expected to contribute to the literature on healthcare facility cleanliness, patient satisfaction, healthcare quality, environmental health, hospital management, patient experience, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, hospital management boards, public hospital administrators, environmental health officers, healthcare workers, infection prevention and control teams, and policymakers regarding strategies for improving healthcare environments. The study will also provide evidence-based recommendations for strengthening hospital cleaning systems, ensuring adequate cleaning personnel and supplies, improving water and sanitation facilities, strengthening healthcare waste management, establishing routine environmental hygiene inspections, monitoring cleanliness standards, and incorporating facility cleanliness indicators into broader quality-improvement programmes in Nigerian public hospitals.

Keywords: Healthcare facility cleanliness, patient satisfaction, Nigerian public hospitals, healthcare quality, environmental health, hospital hygiene, sanitation, patient experience, healthcare services, hospital management, public health.