A comparative study of resident, family, and administrator expectations for service quality in nursing homes

A qualitative study of the current situation of elderly care in Iran: what can we do for the future?

Background

With the successful improvement of global health systems and social security in societies, the world is now advancing toward aging. All countries have to face the phenomenon of population aging sooner or later depending on their degree of development; however, elderly care is predicted to soon become a major concern for developing countries such as Iran.

Objectives

This study was conducted to identify the challenges of elderly care in Iran and to help policymakers develop roadmaps for the future through providing a clearer image of the current state of affairs in this area of healthcare.

Design

This study has adopted a framework approach to qualitative data analysis. For this purpose, 37 semi-structured interviews were conducted in 2015 with a number of key informants in elderly care who were familiar with the process at macro-, meso-, and micro-levels. Maximum variation purposive sampling was performed to select the study samples. A conceptual framework was designed using a review of the literature, and key issues were then identified for data analysis.

Results

The elderly care process yielded five major challenges, including policymaking, access, technical infrastructure, integrity and coordination, and health-based care services.

Discussion

According to the stakeholders of elderly care in Iran, the current care system is not well-suited for meeting the needs of the elderly, as the elderly tend to receive the services they need sporadically and in a non-coherent manner. Given the rapid growth of the elderly population in the coming decades, it is the authorities’ job to concentrate on the challenges faced by the health system and to use foresight methods for the comprehensive and systematical management of the issue.

Patient and staff views of quality in forensic psychiatric inpatient care

The study describes and compares perceived quality of care among patients and staff using the Quality in Psychiatric Care-Forensic In-Patient and the Quality in Psychiatric Care-Forensic In-Patient Staff questionnaires. The questionnaires are both based on the perception of the quality of the forensic psychiatric care given to the patients, but the wording is adjusted to fit patients or staff. The study sample consisted of 66 patients and 202 staff members from 12 forensic units in Sweden. Using multiple regression analyses to adjust for demographic variables, it was found that patients perceived the quality of support and secluded environment lower than did staff, whereas staff had lower perceptions than patients of the quality of secure environment. The combination of these questionnaires provides new possibilities for assessing the quality of forensic psychiatric care and evaluating interventions, important factors in the management and planning of forensic care.

A three-model comparison of the relationship between quality, satisfaction and loyalty: an empirical study of the Chinese healthcare system

Background

Previous research has addressed the relationship between customer satisfaction, perceived quality and customer loyalty intentions in consumer markets. In this study, we test and compare three theoretical models of the quality–satisfaction–loyalty relationship in the Chinese healthcare system.

Methods

This research focuses on hospital patients as participants in the process of healthcare procurement. Empirical data were obtained from six Chinese public hospitals in Shanghai. A total of 630 questionnaires were collected in two studies. Study 1 tested the research instruments, and Study 2 tested the three models. Confirmatory factor analysis was used to assess the scales’ construct validity by testing convergent and discriminant validity. A structural equation model (SEM) specified the distinctions between each construct. A comparison of the three theoretical models was conducted via AMOS analysis.

Results

The results of the SEM demonstrate that quality and satisfaction are distinct concepts and that the first model (satisfaction mediates quality and loyalty) is the most appropriate one in the context of the Chinese healthcare environment.

Conclusions

In this study, we test and compare three theoretical models of the quality–satisfaction–loyalty relationship in the Chinese healthcare system. Findings show that perceived quality improvement does not lead directly to customer loyalty. The strategy of using quality improvement to maintain patient loyalty depends on the level of patient satisfaction. This implies that the measurement of patient experiences should include topics of importance for patients’ satisfaction with health care services.

Service quality perceptions in primary health care centres in Greece

CONTEXT

The paper refers to the increased competition between health care providers and the need for patient-centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres.

OBJECTIVE

To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece.

STRATEGY

SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others.

RESULTS

The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients' perceptions rather than expectations.

DISCUSSION AND CONCLUSIONS

THIS paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations-perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services.

Measuring quality in long-term care: a 360-degree approach

Policy makers and providers have taken steps to address quality concerns in acute and Long-term care (LTC); however, serious quality problems remain. Efforts to measure quality have focused primarily on technical quality, assessing whether certain healthcare outcomes are achieved. Advocates for a patient-centered approach urge a shift to an assessment of functional quality that would include an overall evaluation of the service encounter that is heavily reliant on input from the service recipient. This article provides a discussion of why measuring quality in LTC is more challenging. Because a more comprehensive approach to quality is warranted in LTC, recommendations are made for using a 360-degree approach.

A comparative study of patients’ and nurses’ perceptions of the quality of nursing services, satisfaction and intent to revisit the hospital: A questionnaire survey

BACKGROUND

Although it is very important to clarify the factors influencing the patients' and nurses' satisfaction with nursing services, very little research has been performed in this area.

OBJECTIVES

The purpose of this study was to compare the nursing service quality, satisfaction and intent to revisit the hospital perceived by hospitalized patients and nurses in Korea.

METHODS

SERVQUAL scale, an overall satisfaction and intent to revisit the hospital questionnaires were used. The sample consisted of 272 patients and 282 nurses. The data were collected using paper and pencil self-rating questionnaires and analyzed using frequency, %, mean, standard deviation, t-test and Pearson correlation coefficient.

RESULTS

Overall, nurses' expectations and performance were higher than those of patients, while patients' overall satisfaction with nursing and medical care was higher than that of nurses. There was a strong positive relationship between satisfaction with nursing and medical care and intent to revisit the hospital for both groups.

CONCLUSIONS

The performance was relatively lower than expectations, resulting in poor nursing care quality. Differences between expectations and performance for both patients and nurses need to be further reduced.

What is a health expectation? Developing a pragmatic conceptual model from psychological theory

INTRODUCTION

Examination of the existing literature in respect of health expectations revealed both ambiguity in relation to terminology, and relatively little work in respect of how abstract theories of expectancy in the psychological literature might be used in empirical research into the influence of expectations on attitudes and behaviours in the real world. This paper presents a conceptual model for the development of health expectations with specific reference to Alzheimer's disease.

METHOD

Literature review, synthesis and conceptual model development, illustrated by the case of a person with newly diagnosed, early-stage Alzheimer's disease, and her caregiver.

OUTCOME

Our model envisages the development of a health expectation as incorporating several longitudinal phases (precipitating phenomenon, prior understanding, cognitive processing, expectation formulation, outcome, post-outcome cognitive processing).

CONCLUSION

Expectations are a highly important but still relatively poorly understood phenomenon in relation to the experience of health and health care. We suggest a pragmatic conceptual model designed to clarify the process of expectation development, in order to inform future research into the measurement of health expectations and to enhance our understanding of the influence of expectations on health behaviours and attitudes.

Patient-reported service quality on a medicine unit

PURPOSE

Service quality, defined as patients' self-reported experience of care, is used as a metric for evaluating quality. Most studies rely on retrospective consumer surveys rather then more intensive data collection methods, possibly underestimating the incidence of service quality incidents.

SUBJECTS AND METHODS

The objective of the study was to characterize patient-reported service quality deficiencies on a general medicine unit. We studied a cohort of 228 adult inpatients at a Boston teaching hospital. Investigators reviewed medical records and interviewed patients during the hospitalization and by telephone after discharge. Physician investigators classified patients' incident reports. We calculated the rate of service incidents, characterized incident types, and used multivariable Poisson and logistic regression models to examine factors associated with patient reporting and overall rating of the hospitalization.

RESULTS

Eighty-eight (38.6%) of 228 patients experienced 157 service quality incidents during the admission, for a rate of 68.9 incidents per 100 admissions. The most common service quality problems involved waits and delays (n = 45), problems with communication between staff and patients (n = 36), and environmental issues and amenities (n = 35). In the multivariable analysis, men (IRR 1.6, 95% CI 1.1-2.2), patients covered by hospitalists (1.5, 1.1-2.2), and patients with more medication allergies (1.1 per allergy, 1.1-1.2) reported more service incidents; patients with Medicaid or free care reported fewer (0.5, 0.3-0.9). Patients with service quality incidents were more likely to describe the hospitalization as other than excellent (adjusted OR 1.8 per incident, 95% CI 1.3-2.5).

CONCLUSION

Service quality deficiencies are common among medical inpatients, and are strongly associated with patients' dissatisfaction with the hospitalization.

Are family members suitable proxies for transitional care unit residents when collecting satisfaction information?

OBJECTIVE

To examine the agreement and association of elders' responses with family member proxy responses using the same, previously validated satisfaction instrument on both groups of respondents.

METHODS

Satisfaction data came from transitional care unit residents and family members (N = 462 paired responses) from one facility and were collected between 1999 and 2000. The satisfaction questionnaire consisted of 17 items evaluating the art of care, technical quality, efficacy, amenities of the care environment, and global satisfaction. Bias indexes and intraclass correlation coefficients were used to examine the satisfaction scores.

RESULTS

In general, proxy satisfaction ratings were higher than ratings of residents. The results also show that proxy ratings varied less from resident ratings for the amenity items, which were considered the most concrete items. Proxy ratings were much higher for the art of care and efficacy domain items, which were considered the least concrete items.

CONCLUSION

The results of this investigation show that proxy ratings do not necessarily substitute for resident ratings.