Hospital healthcare service quality, patient satisfaction and loyalty

Priority nonconformity and service quality analysis of hospitals in Thailand: a care provider perspective

Purpose

The objectives of this research are to investigate service quality expectation, perception and satisfaction in outpatient departments and to propose the priority nonconformity index (PNCI) to assess overall prioritization of efforts in relation to expectations.

Design/methodology/approach

SERVQUAL has five dimensions: tangibility, reliability, responsiveness, assurance and empathy. It was used to gather data from multiple-responding care providers in 220 Thai hospitals nationwide. Paired-samples t-test and importance-performance analysis (IPA) were used for analysis. The PNCI was initiated to evaluate the overall conformity between expectation and perception and to suggest strategies for improvement.

Findings

It was found that assurance is the most important and the best performed dimension with the least dissatisfaction. Tangibility is the least important and the least performed dimension with the most dissatisfaction. From gap analysis, there are significant negative gaps in overall service quality, all dimensions and all indicators. IPA found assurance and responsiveness as strengths, and this suggests transfer of excessive resources from empathy to enhance reliability. PNCI of Thai hospitals is 0.8 and this has suggested similar strategies to IPA.

Originality/value

Findings from this study can be employed to develop strategic policy to improve Thai hospitals as a whole. The newly developed PNCI can be used as an indicator to assess efficiency of resource allocation to fit better with customer requirements.

Does descending health resources reform impact patient low-level hospital selection behavior? Evidence from Zhejiang, China

Background

Since 2013, China launched descending resources reform, which is a new attempt to correct unbalanced allocation of health resources through human capital spillovers and brand implantation from high-level hospitals. The purpose of this paper is to explore the patients’ hospital selection response to this reform with the focus of low-level hospitals to better understand the effect of this reform on correcting regional inequality of health resources allocation.

Methods

The European Consumer Satisfaction Index model (ECSI) was used to design a questionnaire, and cross-sectional data from 17 hospitals were collected through 1287 questionnaires from Zhejiang Province. Patient hospital selection (loyalty) is measured using ordinary variables by considering patient willingness to choose a low-level hospital when suffering an illness or severe illness. Analysis of variance (ANOVA) and the structure equation model are applied to examine the effect of reforms on patient behavior.

Results

The descending resources reform promotes improvements in the capabilities and medical environment of low-level hospitals, and descending doctors also have high accessibility. Perceived quality, patient expectations, and hospital image have significant positive effects on patient satisfaction, and the explanatory power of brand implantation from cooperative high-level hospitals and descending doctors is stronger than the image of the low-level hospital itself. And descending resources reform and patient satisfaction have significant positive impacts on patient’s choice for low-level hospitals with the existence of mediating effect of satisfaction.

Conclusions

This paper provides supporting empirical evidence of the descending resources reform’s impact on patients’ low-level hospital selection. This reform has been effective in improving the capabilities of low-level hospitals, and brand implantation of high-level hospitals shows strong explanatory power. China’s reform offers a distinct and valuable approach to correcting the uneven allocation of health resources. Besides, the findings also suggest that policymakers could pay more attention to the importance of information channels in impacting patient awareness, responses, and hospital selection.

Emotional Intelligence and Quality of Nursing Care: A Need for Continuous Professional Development

Background:

Emotional Intelligence (EI) is necessary for personal and professional success. This study aimed to determine the relationship between EI and quality of nursing care from the viewpoint of nurses and patients.

Materials and Methods:

This descriptive correlational study was conducted using convenience sampling to select the patients (n = 300) and census sampling to select the nurses (n = 100) at Amir Alam Hospital in Tabriz, Iran, in 2018. The data collection tools were the Quality Patient Care Scale (QUALPAC) and EI test by Bradberry-Greaves. Data analysis was performed in SPSS Version 20, using t-test, ANOVA, Chi-square, Pearson's correlation test, and multivariate analysis.

Results:

The mean (SD) score of EI was 91.17 (12.33) in nurses, and the mean (SD) score of nursing care quality was 184.01 (37.41) and 202.22 (22.30) from the viewpoint of patients and nurses, respectively. There was no significant difference between the two viewpoints (p = 0.652). However, there was a significant correlation between the nurses' EI and quality of nursing care (r = 1.00, p < 0.001). The educational level was the strongest predictor of increase in nursing care quality from the patients' viewpoint, according to the multivariate analysis (β = −0.27, p < 0.001).

Conclusions:

EI positively affects the quality of nursing care and its dimensions. Therefore, it is recommended that nursing policymakers consider educational programs to strengthen the nurses' EI and enhance the quality of nursing care. Patients, similar to nurses, can be proper indicators of the quality of nursing care; accordingly, simultaneous use of these indicators is suggested.

Operations-oriented strategies and patient satisfaction: the mediating effect of service experience

Purpose

The purpose of this study is to explore the direct and indirect effects of perceived provider professionalism and service recovery in enhancing patient satisfaction in a developing country.

Design/methodology/approach

This study used a survey method to investigate satisfaction among health-care consumers. This study used data collected from 210 health-care consumers to empirically test the hypotheses via structural equation modeling

Findings

This study found that service recovery has a significant direct effect on patient satisfaction. Though this study did not find perceived provider professionalism to have a direct effect on patient satisfaction, it found an indirect effect in the relationship via service experience. Thus, service experience fully/completely mediates the relationship between perceived provider professionalism and patient satisfaction, while partially mediating the significant relationship between service recovery and patient satisfaction.

Originality/value

The results further underscore the need for health-care organizations in developing countries to focus on mindfully developing operations-oriented strategies that lead to the delivery of memorable service experiences for patients.

Antecedents and outcomes of patient satisfaction in healthcare: A conceptual model

This study develops a conceptual model and establishes the relationships between the variables, both influencing and affected by patient satisfaction. The authors conducted a thorough search for peer-reviewed articles obtaining a final sample of 64 studies. Service quality was found to be the only antecedent influencing patient satisfaction, while patient satisfaction was found to impact trust, loyalty and word of mouth, also mediating the influence of service quality on these variables. While the study integrates the scattered literature, from a practical standpoint it exhibits how increased patient satisfaction plays a key role in influencing patient trust, loyalty and word-of-mouth.

Analysis of the Relationship between the Psychological Well-Being, Emotional Intelligence, Willpower, and Job-Efficacy of Clinical Nurses: A Structural Model Application

The aim of this study to discover the relationship between psychological well-being, emotional intelligence, willpower, and job-efficacy. The data were collected from 26 May to 30 May 2020 by distributing a questionnaire to 317 clinical nurses with six months of experience in a general hospital located in Seoul. Three hundred copies were collected and used for final data analysis. The results of the study verified that the direct factors of psychological well-being, emotional intelligence, and willpower affect the job-efficacy of clinical nurses and confirmed that emotional intelligence is a mediating factor between psychological well-being and job-efficacy. This study is meaningful in that it proves the necessity of establishing various curriculums focusing on these factors so that nursing students can best perform their duties as professional nurses. In particular, it is suggested that an educational program and curriculum be established that can strengthen the psychological well-being and enhance the emotional intelligence of nursing students. It is expected that such training will equip professional clinical nurses to effectively handle future work in their stress-filled field.

Capturing rich person-centred discharge information: exploring the challenges in developing a new model

Purpose

Capture, consumption and use of person-centred information presents challenges for hospitals when operating within the scope of limited resources and the push for organisational routines and efficiencies. This paper explores these challenges for patients with Acute Coronary Syndrome (ACS) and the examination of information that supports successful hospital discharge. It aims to determine how the likelihood of readmission may be prevented through the capturing of rich, person-specific information during in-patient care to improve the process for discharge to home.

Design/methodology/approach

The authors combine four research data collection and analysis techniques: one, an analysis of the patient record; two, semi-structured longitudinal interviews; three, an analysis of the patient's journey using process mining to provide analytics about the discharge process, and four, a focus group with nurses to validate and confirm our findings.

Findings

The authors’ contribution is to show that information systems which support discharge need to consider models focused on individual patient stressors. The authors find that current discharge information capture does not provide the required person-centred information to support a successful discharge. Data indicate that rich, detailed information about the person acquired through additional nursing assessments are required to complement data provided about the patient's journey in order to support the patients’ post-discharge recovery at home.

Originality/value

Prior research has focused on information collection constrained by pre-determined limitations and barriers of system design. This work has not considered the information provided by multiple sources during the whole patient journey as a mechanism to reshape the discharge process to become more person-centred. Using a novel combination of research techniques and theory, the authors have shown that patient information collected through multiple channels across the patient care journey may significantly extend the quality of patient care beyond hospital discharge. Although not assessed in this study, rich, person-centred discharge information may also decrease the likelihood of patient readmission.

Evaluating the total quality and its role in measuring consumer satisfaction with e-healthcare services using the 5Qs model: a structure equation modeling approach

Purpose

This article initially aims to explore the factors of every quality construct of the 5Qs model of service quality and, second, identify the significant factors affecting the total quality of e-healthcare services and its association with consumer satisfaction using a multidimensional hierarchical 5Qs model of e-healthcare service quality.

Design/methodology/approach

Questionnaire-oriented research was performed at three public hospitals of Punjab and Chandigarh. In total, 53 variables were covered in all quality constructs for data collection from the designated public hospitals. The respondents who agreed to have knowledge regarding e-Healthcare services and were availing these services were included in the study. The analysis comprised structural equation modeling technique using AMOS 21.

Findings

The outcomes suggest that the 5Qs model is more comprehensive and can be used to evaluate service quality perceptions using e-Healthcare services. The research identified 11 sub-dimensions for the five quality constructs of the 5Qs model, representing total quality, which is primary to consumer satisfaction. “Overall objectivity” and “technical objectivity” defined the quality of object. The quality of process of e-Healthcare services was characterized by “functionality,” “timeliness” and “responsiveness.” Quality of infrastructure was defined by “technical infrastructure,” “physical infrastructure,” “manpower skills” and “organizational infrastructure.” “Manner of interaction” and “timely interaction” defined the quality of interaction. The atmosphere was represented by only one factor. The results also suggest that quality of infrastructure, quality of interaction and quality of atmosphere play the most significant role in total quality leading to consumer satisfaction.

Research limitations/implications

Theoretical implications: The multidimensional hierarchical model will help the researchers study the e-Healthcare service quality in a more organized manner, and the outcomes of this study can be linked with that of future studies for more generalized application in other public hospitals. The sub-dimensions of each quality construct of the 5Qs model can be applied in private hospitals, and the hierarchical model can be tested in different industries to measure service quality perceptions of the consumer

Practical implications

The outcomes of the study can be applied in various public sector hospitals to redesign the e-Healthcare services based on consumers' perception for better consumer satisfaction and quality services. This paper identifies the role of each quality construct in e-Healthcare services for improvement in the total quality, which in turn will lead to higher satisfaction for the consumers.

Originality/value

In this study, the original 5Qs model has been used for the first time in a new instrument to understand better and design quality e-Healthcare services. The paper explores the sub-factors of each quality construct and its significance in measuring the total quality.

The Impact of Patient Satisfaction on Patient Loyalty with the Mediating Effect of Patient Trust

This research is primarily focused on the issues of customer loyalty in the healthcare industry, particularly from the perspective of public hospitals in China. The research developed a theoretical model to test the relationship between patient satisfaction (PS), patient trust (PT), and patient loyalty (PL). The empirical data were collected from 1696 patients through the survey questionnaires from the public hospitals in Henan province. This research is an explanatory study, and adopts quantitative method. The measurement scales used in the survey were assessed and refined and the data analysis was performed using AMOS 19.0 to test the theoretical model and hypotheses developed. In addition, an exploratory factor analysis was used to identify the dimensions of PS, PT, and PL. Their reliability and validity were established through confirmatory factor analysis, and the structural equation modeling (SEM) was used in the related hypotheses. The findings indicate that PT is an important antecedent of PL, and PS has no direct relationship with PL. It is worth noting that PS can lead to PL with PT as the mediating variable. The survey results will help public hospital managers to formulate effective strategies and provide a basis for studying PL. The research will prompt hospital managers to pay attention to the factors which contribute to PS, PT, and PL, and maintain the loyalty of patients to medical institutions. This study is one of the few studies on the relationship between PS, PT, and PL in Chinese public hospitals, and it also explores the direct and indirect effects of PT on PL. The results have practical implications for the Chinese healthcare industry.

Effect of service quality on doctor’s satisfaction and prescribing behavior in pharmaceutical supply chain – a study with reference to a major Indian pharmaceutical company

Purpose

The purpose of this paper is to develop a scale for the measurement of service quality at the manufacturer–doctor interface of the pharmaceutical supply chain and to study the impact of service quality on doctor’s satisfaction and doctor’s prescribing behavior. Doctors from two major states of South India were selected for the study. A doctor perceived service quality scale with three dimensions having eight items was developed through confirmatory factor analysis (CFA) in the pharmaceutical context. Structural equation modeling (SEM) technique was used to show the relationship between service quality, satisfaction and prescribing behavior. The critical factors of service quality were identified, and a model was developed showing the relationship between service quality, doctor’s satisfaction and doctor’s prescribing behavior which has not been explored in any research. This model will be helpful in further development of new concepts and for analyzing the reasons for the failure of doctors in providing quality service. 

Design/methodology/approach

A total of 200 doctors from three major cities of South India were selected. A doctor perceived service quality scale with three dimensions having eight items was developed through CFA using Parasuraman Service quality scale (Parasuraman, 1985, 1986, 1988) as the basis in the pharmaceutical context after focus group discussions with company experts, retailers, doctors and academicians. SEM technique was used to examine the impact of service quality on doctor’s satisfaction and prescribing behavior.

Findings

There is no universal set of dimensions and items that determine service quality in manufacturing industries, especially at the manufacturer–doctor interface of the pharmaceutical supply chain though service quality plays a very important role in affecting the performance of manufacturing industries. The critical factors affecting the quality of service for a pharmaceutical company at the manufacturer–doctor interface of the supply chain were identified, and its impact on doctor’s satisfaction and their prescribing behavior were studied.

Research limitations/implications

This research contributes to the development of service quality scale for measuring service quality in pharmaceutical manufacturing company, especially with reference to manufacturer–doctor interface of the supply chain which was not thoroughly explored earlier. A model was developed showing the positive relationship between service quality and doctor’s satisfaction and doctor’s prescribing behavior in pharmaceutical supply chain which is a new concept not proved experimentally.

Practical implications

The study is very useful for the pharmaceutical manufacturing companies to identify the service quality factors affecting doctor’s satisfaction and their prescribing behavior thereby leading to development of new measures for improving the performance of the pharmaceutical supply chain. This study can lead to identification of problems involved in pharmaceutical supply chain and also leads to generation of new ideas and development of new concepts for influencing doctor’s satisfaction and doctor’s prescribing behavior which in turn can help in providing better health.

Social implications

This study actually has a direct impact on the society. If factors affecting doctor’s satisfaction and prescribing behavior are identified automatically, the end consumer, i.e. patient, can be satisfied in a better way, and better medical care can be provided. If doctor’s problems are identified, then better solutions can be provided to patients; this in turn has a lot of positive impact on the pharmaceutical company and society in general.

Originality/value

This research will act as a base for generating ideas relating to how quality service provided by a company will have an impact on doctor’s satisfaction and his prescribing behavior in pharmaceutical supply chain .To the best of the authors’ knowledge, this study is the first of its kind of the conceptual aspects of service quality, satisfaction and loyalty explained in terms of pharmaceutical supply chain as service quality, doctor’s satisfaction and doctor’s prescribing behavior and proved experimentally.

The Effect of Perceived Value, Trust, and Commitment on Patient Loyalty in Taiwan

Increasing patient loyalty through improved health care quality and patient–provider relationships becomes the key factor in medical providers’ successes. This study explored the mediated relationship of patients’ perceived value, patient commitment, and patient loyalty and the moderating effect of patient trust on the mediated relationship. A cross-sectional research design was adopted. Mediation and moderated mediation were tested using the PROCESS macro v3.5 for the SPSS supplement. Convenience sampling was used for the distribution of questionnaires to members of the public with experience of seeking medical attention in Taiwan. Among the 254 valid questionnaires recovered, 59.4% of the respondents were male, 38.6% were married, 90.2% were in the 20 to 49 year age range, and 54.7% had a bachelor’s degree or above. This study indicated a significant mediated relationship among patients’ perceived value of medical services, commitment to the patient–provider relationship, and patient loyalty. Furthermore, when the patient demonstrated higher levels of trust in a healthcare provider, the relationship of perceived value, commitment, and patient loyalty was also enhanced. This study discussed and demonstrated the effect of perceived value, trust, and commitment on patient loyalty. The research suggests that improving patient loyalty benefits sustainable operation of medical providers and the treatment effects for patients.

Factors influencing patient loyalty to outpatient medical services: an empirical analysis of the UAE's government healthcare system

Purpose

The aim of this research is to uncover issues that inhibit patients' satisfaction and loyalty and identify factors that could enhance customer retention by government hospitals in the United Arab Emirates (UAE). The mediating impact of outpatient satisfaction on service quality, word of mouth (WoM), hospital image, outpatient–physician relationship and outpatient loyalty were tested.

Design/methodology/approach

The sample data used to test the hypotheses were drawn from a pool of patients served by a government healthcare agency in Abu Dhabi. Questionnaires were provided to 418 participants using methods such as short message service, e-mail and face-to-face delivery. The data were analyzed using SmartPLS 3.3.2 software.

Findings

The results indicate that service quality, WoM and outpatient–physician relationship positively impact outpatient satisfaction and indirectly effect outpatient loyalty; that hospital image positively impacts outpatient satisfaction and loyalty and has a partially mediating effect on loyalty; that waiting time satisfaction has no effect on outpatient satisfaction and no moderating effect on the outpatient satisfaction–loyalty relationship and that switching cost has a positive effect on loyalty but no moderating effect on the outpatient satisfaction–loyalty relationship.

Research limitations/implications

The first limitation of this study concerns the fact that only patients who had previously been served by these hospitals' outpatient units were included. Furthermore, the research was not able to obtain extensive findings related to the various factors that negatively impacted patient satisfaction and loyalty among all of the departments of government hospitals, such as inpatient care and emergency care.

Practical implications

Centered on the findings from this research, increasing switching costs would prevent patients from switching to other healthcare providers. Therefore, it has the potential to create a false loyalty or a hostage customer (Jones and Sasser, 1995). Additionally, making patients feel connected to their treatment plan and engaged in their care by developing a tool to maintain their enthusiasm about their health is important. It is therefore recommended that government hospital care providers and management consider providing online tools that patients can use to self-manage their care.

Social implications

The results regarding patients' satisfaction level suggest several areas for improvement. The first pertains to waiting area entertainment and comfort because patients indicated that there is not enough entertainment or ways to pass the time when waiting for services. In addition to enhancing the entertainment and comfort of waiting areas, government hospital staff should maintain contact with patients who are waiting to ensure that they are aware of the time they will spend. Another area for improvement is the parking lot. During summer, patients prefer to walk less in the sun, which causes them to seek parking closer to the door. Government hospital management should consider different methods for transporting patients closer to the door, such as golf carts or valet services.

Originality/value

This is the first study to investigate the mediating impact of outpatients' satisfaction between its antecedents and loyalty in the UAE. These results provide an improved understanding of the factors influencing patient choices and establish more accurate methods for increasing patient loyalty to retain more patients.

Morality traits for an ideal nurse manager: A multicentre cross-sectional study

AIMS

To investigate which morality traits are more important for nurses to determine positive opinions of their nurse manager.

BACKGROUND

People selected morality more often than sociability and competence when forming a positive opinion towards an ideal or a newcomer manager.

METHODS

A multicentre, cross-sectional study was carried out by administering two questionnaires to 775 nurses on the influence of morality, sociability and competence traits on their impression formation processes.

RESULTS

Regarding nurses' perceptions about the morality, sociability and competence traits of an ideal nurse manager, the total score for morality was 20.0; for sociability, it was 14.2; and for competence, it was 19.6. For nurses' opinions about a new nurse manager, the total score of the morality section was 16.2, which was very similar to the total score of the competence section (mean = 16.1).

CONCLUSION

Morality positively influences nurses' initial impression of an ideal manager, and though it seems to be a necessary condition, it is not sufficient by itself to support the nursing staff's perception towards a new manager.

IMPLICATIONS FOR NURSING MANAGEMENT

Our findings could be useful in better understanding the role of morality in social perceptions and behavioural consequences of staff nurses towards their nurse manager.

Effects of internal service quality on nurses' job satisfaction, commitment and performance: Mediating role of employee well-being

AIM

The attitudes and behaviours of nursing staff are critical to determine patients' satisfaction and to have a competitive advantage for any healthcare organization. This study is set to investigate the effects of internal service quality (ISQ) on nurses' job satisfaction, employee commitment, well-being and job performance in the healthcare sector of Pakistan. Further, this study also examines the mediating role of nurses' well-being for the relationship of job satisfaction and commitment with their job performance.

METHODS

This was a cross-sectional quantitative research. A self-administered survey was used to collect data from 412 nursing employees of 20 private sector healthcare centres operating in Pakistan. Partial least square of structural equation model (PLS-SEM) and structural equation modelling (SEM) were employed through Smart PLS 3.2.8 for data analysis.

RESULTS

Study results revealed that ISQ directly effects employees' satisfaction, commitment, well-being of the nursing employees. Moreover, employees' well-being has mediated job satisfaction and job performance relationship; however, well-being did not mediate the relationship between commitment and job performance.

Health Investment Management and Healthcare Quality in the Public System: A Gender Perspective

The aim of this empirical research was to provide useful information for health system managers on the costs and investments involved in improving the quality of the National Health Service (NHS) based on patient assessments and from a gender perspective, i.e., without assuming that the perceived experience is identical for men and women. A cross-sectional study of 31 variables was applied using partial least squares structural equation modeling (PLS-SEM) as a research tool. The data were obtained from the Spanish Ministry of Health, Consumption, and Social Welfare for the entire Spanish territory between 2005 and 2018. The influence of expenditure, resource allocation, and mortality was hypothesized with regard to patient satisfaction according to disconfirmation theory. Patient satisfaction reflects clinical effectiveness, and therefore is a measure of health system quality. The results show that women are more sensitive to public investment in health than men, i.e., an increase in the level of spending and resources increases satisfaction more in women. In both sexes, the level of expenditure has a direct influence on patient satisfaction, and therefore on the quality of the healthcare system. It is important to increase spending on primary care, especially on specialized medical care and diagnostic equipment. However, reducing the use of drugs in favor of alternative treatments or therapies is considered to be positive. Likewise, spending has an impact on available resources, and these, in turn, have a positive influence on the level of use and a negative impact on mortality. Resources, especially healthcare staff, nuclear magnetic resonance equipment, and the number of posts in day hospitals, increase patients’ positive perception of the NHS.

TQM implementation practices and performance outcome of Indian hospitals: exploratory findings

Purpose

This paper explores and interprets the linkage between total quality management (TQM) practices and organizational performance measures for improving the healthcare firms’ performance. Indian healthcare firms are aware of TQM practices and their benefits, but the awareness level varies among the firms and staff. The study looks into the effectiveness of quality awareness to meet quality performance in Indian hospitals.

Design/methodology/approach

A questionnaire based on previous research was circulated among the managers and medical staff. The model linking TQM and organizational performance is analyzed with structural equation modelling and confirmed the hypotheses stated. Interpretations to improve hospital performance are made.

Findings

The study identified ten relevant TQM factors and confirmed their importance towards the improved organizational performance of Indian hospitals. Top management initiative, continuous process improvement and team work are the most contributing TQM factors. Differences in the awareness levels by the management staff and medical staff are attributed. The managers and medical staff are aware of the benefits of TQM towards firm performance, but it is to be improved further.

Research limitations/implications

Cross-validation and interpretation are affected due to the limited sample size. Longitudinal study is recommended to explore the individual hospital as specific cases. Larger sample size is suggested as an extended work to overcome the demographic and infrastructural limitations of the firms included.

Practical implications

The management is more interested in TQM, but there is lack of awareness among the staff. The quality awareness and customer focus by medical staff are the most weakly loaded factors, and the weaknesses can be remedied by the lead role by the hospital management in providing proper training and thereby improving the attitude of the medical staff.

Social implications

Effectiveness of hospital operations is highly dependent on customer focus. Properly communicated, committed and trained staff with good-quality awareness can better implement TQM and thereby improve hospital performance. Lead role by the management is very important, and the paper lists ways to attain these outcomes.

Originality/value

Very little is reported from the Indian healthcare sector linking TQM and outcome performance. The quality awareness, customer focus, communication and learning by the medical staff are to be improved, and the paper suggests ways to link TQM more effectively to improve the performance in hospitals. These findings may be useful to the managers, medical staff and researchers in healthcare to bring better results.

Patient loyalty to HIV care in an HIV facility in Eldoret, Kenya: A mediated mediation

Patient loyalty is the continuous commitment and engagement in care where patients can improve and sustain quality of life through continuous use of medical care. Identifying strengths and weaknesses in providing excellent quality care is a key measure of success of healthcare professionals and hospital management. However, few studies have examined patient loyalty from a strategic leadership perspective within HIV health care systems. The purpose of this study is to determine how patient loyalty to HIV care is influenced by multiple factors in a healthcare system environment. The study employs a mixed-methods approach guided by the complexity theory and the theory of planned behavior. A total of 444 surveys with (50 healthcare providers and 394 adult HIV-infected patients) currently on antiretroviral drugs, as well as 22 in-depth interviews with healthcare providers will be conducted. The study will be done at AMPATH Eldoret Kenya. We will use stratified proportionate and census sampling methods to select study participants for the survey while purposive and convenient sampling techniques will be used for in-depth interviews. Structured questionnaires and interviewer guides will guide data collection. Quantitative data analysis will entail hierarchical regression to test direct effects while multiple regression will test the mediation effects using the Hayes PROCESS Model No.6 in SPSS. Qualitative data analysis will be conducted using a thematic analytical method.

A systematic review of responsiveness to develop future research agenda: a TCCM and bibliometric analysis

Purpose

This paper aims to epistemologically extend and explore the present theories from prior research conducted in the area of responsiveness. Furthermore, it determines to benchmark the prominent theories, characteristics, context and methodologies (TCCM) used in the domain since its inception to advance the science and practice of marketing and logistics discipline.

Design/methodology/approach

A seven-step methodology (SSM) has been introduced to create a comprehensive dataset. Based upon the selection criteria of high-ranked journals and language, the research studies have been retrieved from Scopus, Web of Science, Business Source Complete and journal homepage to avoid the error of exclusion. Moreover, the dataset has been compiled using manual and electronic searches without any limitation of time.

Findings

The search for a suitable dataset retrieved 642 documents by identifying “1969” as the beginning year of research in the subject domain. The analysis found that responsiveness has been prominently studied in the manufacturing industry. The results also advocate responsiveness as the vital antecedent to performance and satisfaction. Frameworks have been proposed with significant propositions for future empirical testing and theory inventiveness by researchers.

Originality/value

The study pioneers its utility for retailers to recognize the firms' inherent abilities and strengths, which can be promoted to create responsiveness more than ever. The analysis results can act as the compelling force to understand the driving power of various factors influencing responsiveness.

Understanding patient satisfaction and loyalty in public and private primary health care

Background: The quality of health centers, patient satisfaction, and loyalty are three key factors that enable health care providers to improve their services and cost-effectiveness. This study, therefore, aims to determine patient satisfaction and loyalty in public and private primary health care centers.

Design and Methods: Data were obtained from a cross-sectional design of 1470 self-administered questionnaires and analyzed based on mean, standard deviation, and correlation coefficients.

Results: The results showed respectively a strong and moderate correlation between patient satisfaction and loyalty in private (r=0.767) and public (r=0.54) primary health care centers, respectively. In addition, in both centers patients received adequate medical services, with social aspects as the least important factors affecting patient satisfaction.

Conclusions: In conclusion, primary health care practices need to recognize the needs that influence patients’ satisfaction and loyalty, to improve the quality of their services.

Health promoting hospital: A practical strategy to improve patient loyalty in public sector

Background: The Health-Promoting Hospital (HPH) aims to improve the overall quality of health services for patient, families, and the community as a whole, with assessment and intervention as the essential components. In hospitals, this activity needs to be vigorously developed through interdisciplinary teamwork, shared decision-making process, and by involving patients and families during treatment and through the delivery of an evidence-based health promotion process. Previous studies analyzed some steps to improve patient loyalty through the HPH. However, limited studies were carried out on its use in the public sector. This study, therefore, aims to analyze the impact of HPHs to improve patient loyalty in the public sector.

Design and Methods: The simple random sampling method was used to obtain data from 101 respondents in a public hospital, with the cross-sectional design used to gain a better understanding of patient loyalty.

Results: The result showed that HPHs influenced patient expectations (P=0.030), which in turn affected perceived value (P=0.014) and satisfaction (P=0.002). In addition, perceived value and satisfaction have effects on patients’ loyalty (P=0.001).

Conclusion: In conclusion, HPHs have a positive impact on patient loyalty. Therefore, the public sector needs to enhance its services in accordance with the standards and guidelines.

Significance for public health

Health-promoting hospital (HPH) aims to improve the quality of health services for patients, families, visitors, stakeholders, and the community as a whole. In Indonesia, the current implementation of HPH is not yet optimal. Limited studies analyzed some steps to improve patient loyalty through the health-promoting hospital, and its use in the public sector. This study describes the impact of HPH to improve patient loyalty in the public sector through expectations, perceived value, and satisfaction.

Healthcare supply chain management: Application in the Maltese Healthcare System

Introduction

Hospital supply chains are complex systems ensuring flow of products/services to satisfy patients. The aim of this exploratory study is to improve the Maltese health care system’s efficiency using supply chain management principles in three hospital settings. The theoretical basis underlying the study is the supply chain decision-making framework.

Methods

Using observation and focus groups, the following steps were undertaken: (i) mapping healthcare supply chain processes and identifying challenges; (ii) understanding competitive strategy through implied demand uncertainty; (iii) deriving supply chain strategies through supply chain drivers; (iv) optimizing healthcare supply chain (right balance between cost and responsiveness); (v) identifying critical success factors for healthcare supply chains.

Results

In line with their competitive and supply chain strategies, the three settings have well-defined primary goals, stakeholders’ needs/demands/expectations, as well as clear-cut, albeit some similar, criteria and sub-criteria for improving the quality and quantity of their services. The trade-offs between efficiency and responsiveness for the supply chain drivers are distinctive and in line with their competitive strategies, hence achieving the desired fit with the healthcare supply chain strategies.

Conclusions

By adopting healthcare supply chain principles, there should be improved services in each setting, which in turn should lead to system-wide results.

The influence of servicescape and service credibility on older adults' intention to recover

PURPOSE

Based on the stimuli-organism-response (SOR) model and relationship marketing theory, the paper aims to examine whether servicescape influences trust, service credibility and affective commitment amongst older adults, and their effects on the intention to recover in a rehabilitation setting.

DESIGN/METHODOLOGY/APPROACH

The study takes a quantitative approach, applying confirmatory factor analysis and structural equation model to examine the responses. A total of 400 data were collected using questionnaires distributed to older adults in Malaysia. Respondents were selected based on two criteria: they should be over 65 years, and they should have been visiting the rehabilitation centres in the last 12 months.

FINDINGS

The results suggest that trust and affective commitment play significant roles in increasing the intention of older adults to recover. Contradicting previous research findings, service credibility does not have any significant impact on the intention to recover as hypothesised. The direct effect of service credibility on trust and affective commitment enhances the premise further that the relationship between service credibility and intention to recover is primarily indirect. Even though we expect servicescape to be a significant driver in forming the behaviour of older adults, its impact on intention to recover, trust and affective commitment remain non-significant, with the exception of service credibility.

ORIGINALITY/VALUE

Past studies have focused on the roles of servicescape and service credibility separately. We have extended the literature by examining the combined effects of both servicescape and service credibility. The findings, therefore, contribute to a deeper understanding of the literature on the intention-behaviour relationship in the context of healthcare, as well as in service marketing.

The Client Capital in Nursing Management in Hospitals

Abstract Objective: To analyze how the components of the client's capital are used in the management of nursing in hospitals. Method: A qualitative research carried out in five public hospitals, four private hospitals and three philanthropic hospitals in the period from October 2014 to May 2015. Data were collected through a semi-structured interview with twelve nursing managers and analyzed according to content analysis. Results: The components of the Client's Capital were used by the nurses when performing the management of the client service to promote changes and improve the service after evaluating the satisfaction of the nursing care through active systematic search, with its own evaluation tools and the ombudsman's information and in the interaction with suppliers of materials, equipment and services. Conclusion and implications for practice: The managers use managerial actions for the development of the client's capital of organizations. In order to improve them, they must evaluate the nursing care in a continuous and strategic process to satisfy the clients, throughout their trajectory in the organization, since clients are permanent sources of innovation that affect professional and organizational development and productivity.

Satisfaction attributes related to safety and quality perceived in the experience of hospitalized patients

OBJECTIVE

To unveil patient satisfaction attributes related to safety and quality of care.

METHODS

Qualitative study carried out in a public university hospital in the south region of Brazil. Data were collected in November 2018 through 24 interviews with patients/families from 12 clinical and surgical hospitalization units. Thematic analysis was carried out.

RESULTS

The satisfaction attributes were categorized in terms of structure, process, and care outcome, and they were related to: access to the service, amount of personnel, environment, interaction with the health team, staff's technical competence, perception of safety with the presence of a relative, assistance patterns present in the care, and change in the health status of the patients.

CONCLUSIONS

It was verified that the structural aspects were relevant in the patient's experience, besides the relationship established with the health team in the care process, and the technical assistance standards perceived in the staff's work.

Senior citizens’ acceptance of connected health technologies in their homes

Purpose

The objective of this paper is to focus on seniors’ acceptance of the usage of connected healthcare technologies in their homes. The authors integrated into technology acceptance model (TAM) several latent variables such as social presence, trust and degree of intrusiveness perceived with the use of connected health technologies.

Design/methodology/approach

The authors distributed the survey by post to 605 seniors. The authors targeted elderly people using connected health technologies (assistive alarm, telecare, sensors, etc.) at home and/or receiving healthcare at home. The authors received 213 questionnaires back. As The authors had several latent variables, the authors used partial least squares (PLS), a variance-based structural equation modeling method.

Findings

The results show that the level of trust in these technologies impacts significantly the perception of usefulness and the degree of intrusiveness. In parallel, the degree of usefulness of these technologies impacts positively elderly people’s intention to accept their usage. Finally, one can claim that the perception of the social presence with the use of these technologies impacts positively the degree of perceived usefulness, trust and intrusiveness.

Research limitations/implications

The sample covers a population benefiting from similar connected health technologies. It was difficult to distinguish and interpret the added value of each technology separately. As more and more elderly people use or are least familiarizing themselves with a range of connected technologies it would be interesting to identify which sets of connected technologies contribute the most to a positive feeling of social presence.

Social implications

These results are particularly relevant to stakeholders in the health industry in their quest to improve their products/services. A better understanding of the relation that the elderly have with connected health technologies is an essential prerequisite to supporting the development of new solutions capable of meeting the specific needs of our seniors.

Originality/value

The authors want to apply the TAM to connected health technologies designed for elderly people and the authors also want to extend it by integrating the social presence, trust and degree of intrusiveness variables to our research model.

Patient satisfaction with primary healthcare services in Lebanon

BACKGROUND

Reorienting the model of care towards preventive services is integral to successfully move towards a people-centered healthcare system. Patient satisfaction is an essential component of people-centered care and an important quality of care indicator. In its efforts to strengthen primary healthcare, the Ministry of Public Health in Lebanon assessed patient satisfaction with services offered at primary healthcare centers (PHCCs) and explored the relationship between patient satisfaction and patient characteristics and accreditation.

METHODOLOGY

The study followed a cross-sectional design. A survey was administered through phone calls with 1313 patients receiving services as part of a benefits package provided by 59 PHCCs. The survey collected data on patients' sociodemographic characteristics, perceptions, and satisfaction.

RESULTS

Overall, 96.66% of surveyed patients reported being either satisfied (60.23%) or very satisfied (36.43%) with the services provided at the PHCCs. Patients' perceptions of patient-provider communication, healthcare provider competency, and health education quality constituted strong predictors for satisfaction. However, facilities' accreditation status was not associated with satisfaction with PHC services.

CONCLUSION

Patient satisfaction with primary healthcare services in Lebanon was remarkably high. Findings highlighted the need for quality improvement particularly in health education and the alignment of accreditation standards with patient needs and expectations.