Service quality in NHS hospitals

A Conceptual Model to Evaluate Service Quality of Direct-to-Consumer Telemedicine Consultation from Patient Perspective

Objective and Background: This research aims to develop a theoretical service quality (SQ) model for direct-to-consumer (DTC) telemedicine consultations. Although it can change care delivery for the better, it is crucial to create the appropriate measurement tool to collect and analyze patient's perceptions of SQ to identify any service pitfall and encourage a faster adoption. To the best of the authors' knowledge, this article is one of the first to investigate and propose a SQ model for DTC telemedicine consultations. This study is therefore motivated by a clear need for such a model as it is currently inexistent. Methods: A literature review of health and e-service quality (e-SQ) models was conducted to identify a suitable instrument for the research. A total of 60 studies were included. Results: The main findings are threefold: (1) DTC telemedicine SQ is interdisciplinary: it encompasses generic and context-specific dimensions from the health, e-SQ, and information system literature; (2) the existing SQ models are not adequate, they do not cover all dimensions of DTC telemedicine services; (3) although LeRouge et al.'s Telemedicine service encounter quality model was identified as a reference model, it is inadequate to simply transpose it to the context of the study. Thus, the elaboration of a more suitable instrument and creation of a new updated model by the authors. Conclusion: The conceptual model captures three primary dimensions (system quality, interaction quality and use quality) that represent SQ of DTC telemedicine consultations from a patient perspective.

Dimensions of service quality in healthcare: a systematic review of literature

PURPOSE

Various dimensions of healthcare service quality were used and discussed in literature across the globe. This study presents an updated meaningful review of the extensive research that has been conducted on measuring dimensions of healthcare service quality.

DATA SOURCES

Systematic review method in current study is based on PRISMA guidelines. We searched for literature using databases such as Google, Google Scholar, PubMed and Social Science, Citation Index.

STUDY SELECTION

In this study, we screened 1921 identified papers using search terms/phrases. Snowball strategies were adopted to extract published articles from January 1997 till December 2016.

DATA EXTRACTION

Two-hundred and fourteen papers were identified as relevant for data extraction; completed by two researchers, double checked by the other two to develop agreement in discrepancies. In total, 74 studies fulfilled our pre-defined inclusion and exclusion criteria for data analysis.

DATA SYNTHESIS

Service quality is mainly measured as technical and functional, incorporating many sub-dimensions. We synthesized the information about dimensions of healthcare service quality with reference to developed and developing countries. 'Tangibility' is found to be the most common contributing factor whereas 'SERVQUAL' as the most commonly used model to measure healthcare service quality.

CONCLUSION

There are core dimensions of healthcare service quality that are commonly found in all models used in current reviewed studies. We found a little difference in these core dimensions while focusing dimensions in both developed and developing countries, as mostly SERVQUAL is being used as the basic model to either generate a new one or to add further contextual dimensions. The current study ranked the contributing factors based on their frequency in literature. Based on these priorities, if factors are addressed irrespective of any context, may lead to contribute to improve healthcare quality and may provide an important information for evidence-informed decision-making.

Emotions and satisfaction at the hospital

Purpose

This study aims to compare public and private hospitals based on both cognitive and affective components of patients’ satisfaction.

Design/methodology/approach

A survey of 770 Italian patients from public and private hospitals was conducted. Then, hierarchical and non-hierarchical cluster analyses and a series of chi-squared tests were run with the aim of segmenting patients’ emotional response.

Findings

Respondents show different levels of satisfaction and a different emotional status based on the private or public nature of the service provider. The cluster analysis helped to identify two segments. Specifically, the cluster with the highest positive emotions is reported to have a higher level of satisfaction and a higher intention to return; this evidence is much stronger when a private service provider rather than a public one is considered. A series of chi-squared tests reveal that no significant differences exist among clusters based on socio-demographic characteristics.

Research limitations/implications

This study uses a convenience sample and is highly context specific, and thus the authors are unable to make generalizations.

Practical implications

Hospital managers should develop a customer-oriented approach, for example, by paying greater attention to patients’ emotions and experience, via conducting systematic surveys on patients’ emotions and improving the servicescape.

Originality/value

The main contribution of this study resides in simultaneously considering the role of cognitive and affective components on patients’ satisfaction and behavioural intention, and segmenting patients based on their emotional responses. Moreover, only few studies provide a comparison of public and private hospitals in Italy.

Hospital healthcare service quality, patient satisfaction and loyalty

Purpose

The purpose of this paper is to explain the patients’ views towards private healthcare service providers. The study focussed on hospital service quality and analysed the relative significance of quality measurements in anticipating the patients’ satisfaction and loyalty. The mediating role of patient satisfaction is assessed between quality of hospital healthcare services and patient loyalty.

Design/methodology/approach

A total 611 patients (both indoor and outdoor) participated in a questionnaire survey from the six private hospitals of capital city, Islamabad, Pakistan. Data were analysed through descriptive statistics, common method variance, reliability, correlation and regression in order to investigate customer perceived service quality and how the quality of services stimulates loyalty intentions towards private service suppliers.

Findings

Findings depict that private healthcare service providers are attempting to deliver well improved healthcare services to their customers. Results confirmed that better quality of healthcare services inclines to build satisfaction and loyalty among patients. The healthcare service quality aspects (i.e. physical environment, customer-friendly environment, responsiveness, communication, privacy and safety) are positively related with patient loyalty which is mediated through patient satisfaction.

Practical implications

Findings will help the hospital managers to articulate effective strategies in order to ensure superior quality of healthcare services to patients. The study will induce hospital management to deliver attentions towards the quality of private healthcare service systems and improvements towards the deficient healthcare services. Furthermore, the study will present a clear picture of patient’s behavioural attitudes; satisfaction and loyalty intentions towards the quality of healthcare services.

Originality/value

The study provides the views and perceptions of patients towards the quality of healthcare services. The healthcare service quality dimensions, i.e., physical environment, customer-friendly environment, responsiveness, communication, and privacy and safety were assessed. Hospital healthcare service quality was examined in order to find out its effect on patient satisfaction and patient loyalty.

Equating the expected and perceived service quality

Purpose

The purpose of this paper is to investigate patients’ views toward the perceived service quality of public and private healthcare service providers. Determinants of healthcare service quality were compared by carrying out a GAP analysis to equate perceived and expected services and examined differences in the service quality.

Design/methodology/approach

The study sample comprises 310 inpatients of public and private healthcare service providers. Self-administered questionnaires were used along a five-point Likert scale and analyzed through the Statistical Package for Social Sciences. GAP analysis was used to observe the difference between expectations and perceived service quality.

Findings

A cross-sectional study revealed significant quality gaps between the expected and perceived services of public and private healthcare service providers; conversely patients’ expectations are not fully met in both types of hospitals. Private hospitals surpassed in terms of overall perceived service quality from their counterparts. Perceived services were found better in terms of physician medical services in public sector hospitals, while rooms and housekeeping services were found better in terms of private sector hospitals.

Practical implications

The result can be used by both public and private healthcare service providers to restructure their quality management practices which could only be possible through effective management commitment, regular patients’ feedback and translucent complaint procedures.

Originality/value

The study conceptualizes the expected and perceived hospital service quality dimensions as an eight-dimensional framework. A comparison between public and private sector hospitals is made to get a better understanding about the differences in the perceived healthcare services among two sectors. Consequences of the study will aid hospital managers and policy makers to get a fuller picture of healthcare services in order to contrive enhancement practices.

Measuring patients’ healthcare service quality perceptions, satisfaction, and loyalty in public and private sector hospitals in Pakistan

Purpose

This study aims to explore the relationship between healthcare perceived service quality (HCSQ) and patient loyalty. Mediating role of patient satisfaction is also assessed between HCSQ and patient loyalty.

Design/methodology/approach

A sample of 600 was gathered using stratified random sampling technique from inpatients of public and private sector hospitals of Pakistan through self-administered questionnaire, and was analyzed through regression analysis.

Findings

Findings indicate that healthcare perceived service quality has a significant positive effect on patients’ loyalty. Patient satisfaction also mediates the relationship between HCSQ and patient loyalty. Findings state that there is a significant difference between HCSQ which is perceived by the patients of both public and private sector hospitals. Differences suggest that the patients of private sector hospitals were found more satisfied than their counterparts.

Practical implications

The results indicate that hospital managers should have knowledge about the perceptions and satisfaction of patients as it leads to a step towards introducing reforms in the quality of healthcare sector.

Originality/value

No such particular research in literature has been made earlier in Pakistan’s context which has assessed the perceptions of patients in terms of HCSQ dimensions as being addressed in this study. Thus, this study endeavors to fill that gap in terms of measuring healthcare services provided by both public and private sector hospitals. Outcomes of this study will enable hospitals’ managers to get a better understanding towards stronger as well as weaker aspects of service quality, and will help in observing factors which contribute towards patients’ satisfaction and patient loyalty in building long term relationships between hospital and patients.

Measuring patient-perceived hospital service quality: a conceptual framework

Purpose

Although measuring healthcare service quality is not a new phenomenon, the instruments used to measure are timeworn. With the shift in focus to patient centric processes in hospitals and recognising healthcare to be different compared to other services, service quality measurement needs to be tuned specifically to healthcare. The study’s purpose is to design a conceptual framework for measuring patient perceived hospital service quality, based on existing service quality literature

Design/methodology/approach

Using hospital service quality theories, expanding existing healthcare service models and literature, a conceptual framework is proposed to measure hospital service quality. The article outlines inpatient perceived service quality dimensions

Findings

An instrument for measuring hospital service quality dimensions is developed and compared with other service quality measuring instruments. The latest dimensions are in line with previous studies, but a relationship dimension is added.

Practical implications

The framework empowers managers to assess healthcare quality in corporate, public and teaching hospitals.

Originality/value

The article helps academics and practitioners to assess hospital service quality from a patient perspective.

P-TRANSQUAL: a service quality model of public land transport services

Purpose

– The purpose of this paper is to test a model of service quality of public land transport services, especially paratransit services.

Design/methodology/approach

– This study used quantitative approach. Data were collected through a survey method using questionnaire. The respondents of the study are 880 passengers of paratransit services in Indonesia. Exploratory factor analysis and confirmatory factor analysis were performed in order to identify the dimensions of service quality and test the convergent and discriminant validity of the dimensions. Cronbach’s α analysis was carried out to test the reliability of the dimensions. In addition, criterion-based validity and the stability of the service quality model were also tested.

Findings

– A model of service quality of public land transport, namely P-TRANSQUAL, was tested. P-TRANSQUAL consists of four dimensions, which are comfort, tangible, personnel, and reliability. The model has been proven to have good validity, reliability, and stability for measuring service quality of paratransit services in Indonesia.

Research limitations/implications

– This research was carried out in a single developing country, namely Indonesia. Hence, the stability of the model needs to be tested in different cultures.

Practical implications

– Public transport managers can use P-TRANSQUAL to monitor, measure, and improve the service quality of the public transport they manage.

Originality/value

– This paper has tested a new model of service quality for public transport services, especially paratransit services.

Dimensions of hospital service quality: a critical review: perspective of patients from global studies

PURPOSE

The purpose of this paper is to review the service quality dimensions established in various studies conducted across the world specifically applied to health care.

DESIGN/METHODOLOGY/APPROACH

Studies conducted on quality of care selected from literature databases - Ebsco, Emerald Insight, ABI/Inform - was subjected to a comprehensive in-depth content analysis.

FINDINGS

Service quality has been extensively studied with considerable efforts taken to develop survey instruments for measuring purposes. The number of dimensional structure varies across the studies. Self-administered questionnaire dominates in terms of mode of administration adopted in the studies, with respondents ranging from 18 to 85 years. Target sample size ranged from 84-2,000 respondents in self-administered questionnaires and for mail administration ranged from 300-2,600 respondents. Studies vary in terms of the scores used ranging from four to ten-point scale. A total of 27 of the studies have used EFA, 11 studies have used structural equation modelling and eight studies used gap scores. Cronbach's alpha is the most commonly used measure of scale reliability. There is variation in terms of measuring the content, criteria and construct validation among the studies.

PRACTICAL IMPLICATIONS

The literature offers dimensions used in assessing patient perceived service quality. The review reveals diversity and a plethora of dimensions and methodology to develop the construct discussed.

ORIGINALITY/VALUE

The reported study describes and contrasts a large number of service-quality measurement constructs and highlights the usage of dimensions. The findings are valuable to academics in terms of dimensions and methodology used, approach for analysis; whereas findings are of value to practitioners in terms of the dimensions found in the research and to identify the gap in their setting.

Service Quality, Customer (Patient) Satisfaction and Behavioural Intention in Health Care Services: Exploring the Indian Perspective

As the health care sector in India gets more competitive, health care practitioners and academic researchers are increasingly interested in exploring how patients perceive the quality before building up their satisfaction levels and generating behavioural intentions. Hospitals today are increasingly realizing the need to focus on service quality as a measure to improve their competitive position. Customer based determinants and perceptions of service quality, therefore, play an important role when choosing a hospital. In this paper, we examine and measure the quality of services and its outcomes (patient’s satisfaction and behavioural intentions) provided by hospitals. In this regard, a review of literature on measuring service quality, patient satisfaction and behavioural intentions in health care scenario has been considered to investigate the direct influence of service quality on behavioural intentions and the mediating role of customer satisfaction on influencing behavioural intentions. The study focuses only on health care services offered by hospitals. Till today, few studies in the developing nations were conducted to understand the types of relationship that exists between three key constructs—service quality, patient satisfaction and behavioural intentions. Majority of the studies have been done in the developed country context, which cannot be generalized in the Indian context. It has been contended that constructs of service quality that are developed in one culture might not be applicable in another culture. This study analyses the suitability of service quality to improve customer satisfaction and in the process positively impacting behavioural intentions in the health care setting.

Traveling abroad for medical care: U.S. medical tourists' expectations and perceptions of service quality

The SERVQUAL scale has been widely used to measure service quality in the health care industry. This research is the first study that used SERVQUAL to assess U.S. medical tourists' expectations and perceptions of the service quality of health care facilities located outside the United States. Based on a sample of U.S. consumers, who had traveled abroad for medical care, the results indicated that there were significant differences between U.S. medical tourists' perceived level of service provided and their expectations of the service that should be provided for four of the five dimensions of service quality. Reliability had the largest service quality gap followed by assurance, tangibles, and empathy. Responsiveness was the only dimension without a significantly different gap score. The study establishes a foundation for future research on service quality in the rapidly growing medical tourism industry.

[Perceived quality: illusion or perception]

Patients as human beings determined by their structure cannot, while having an experience, distinguish between an illusion and reality, therefore they experience the different domains of existence and the different domains of reality. For them, the perception of service quality is experienced as a personal domain of reality, and this reality is a personal construction, generating as many realities as patients perceiving their experience with elements of their experience, whose distinctions that validate it are not necessarily shared or agreed. Health management must abandon the idea in that it is possible to build an objective quality service, to be able to make progress in building effective communication strategies and common consensus criteria for a quality service of distinction, in order to achieve effective satisfaction and patient loyalty.

Development of service quality scale for surgical hospitalization

BACKGROUND/PURPOSE

Findings from literature showed inconsistent results for applying service quality scale in hospitals. Moreover, hospitalization services are provided by diversified departments and a scale designed to measure the overall hospitalization quality is difficult and capturing special characteristics of different departments is also not an easy task. This study attempted to develop a service quality scale for surgical hospitalization (SQSH).

METHODS

Forty-two items were designed via literature review, interviews with patients, health professionals and experienced care givers. A cross-sectional survey was conducted in one hospital. A total of 271 patients in surgical wards were chosen using stratified random sampling; 57.7% of the sampled patients were aged below 55, and 52.2% were male.

RESULTS

The response rate was 93.4%. Twenty-nine items were retained through the scale development process and six factors were formed: needs management, assurance, sanitation, customization, convenience and quiet, and attention. Six factors explained 57.3% of total variance. Five experts assessed the content validity; content validity index was 0.964. Furthermore, all Cronbach's alpha exceeded 0.642 and all factor loadings exceeded 0.5. The concurrent validity correlation was 0.583, which had a p value below 0.01.

CONCLUSION

The SQSH has sufficient usefulness, reliability and validity. Future research on service quality can apply the SQSH scale to link with utilization intention and patient loyalty and attempt to develop a hospitalization quality scale for other departments.

Computerized telephone nurse triage. An evaluation of service quality and cost

The current reimbursement structure of health care in the United States motivates the providers of health care services to deliver these services with a cost-conscious mentality without compromising quality. This has led to the development of alternative methods of delivering health care services, one of which is computerized telephone nurse triage. This study investigates service quality from the perception of callers who used this system on behalf of a pediatric client. Cost was evaluated by comparing what the caller would have done if they did not speak with nurse triage with what they actually did after their interaction. A modified version of the SERVQUAL tool was administered via telephone survey to members of a managed health care plan who recently used nurse triage services for a pediatric patient. Findings were that the majority of callers--employed female parents--rated the level of service quality very highly. Education, employment status, age of the caller, child gender, birth order among siblings, and age of child did not affect the rating of service quality. Relationship to the child had an effect on the rating of service quality as men/fathers rated the level of service quality slightly lower than their female/mother counterparts. The evaluation of cost revealed that the action taken by the caller after they spoke with the nurse resulted in significant cost savings. Computerized telephone nurse triage is a well-accepted cost-saving alternative method of health care delivery that can effectively serve a variety of callers and pediatric patients.

[The perceived quality of hospital care]

INTRODUCTION

SERVQUAL has been introduced in the healthcare sector as an alternative to the patient satisfaction measures. SERVQUAL is one of the most used questionnaires to measure the customers' perceived quality. It is based on the disconfirmation paradigm (expectations-minus-perceptions). However, the structure, validity and reliability of this questionnaire have not been assessed in the Spanish hospital context.

METHODS

Three main targets defined in this study: 1) analyze the SERVQUAL's factorial solution, 2) determine which of its scales (perceptions, expectations, and expectations-minus-perceptions) has higher predictive efficiency, and 3) develop a new version for hospital setting (which was called SERVQHOS). A descriptive study based on surveys with multivariate analysis of data was conducted. Eight-hundred-twenty-six subjects were interviewed. All were attended in the Alicante's, Elche's, or Elda's hospital.

RESULTS

A five-factor solution of the SERVQUAL was not corroborated. The perceptions scale obtained a higher predictive efficiency than expectations and expectations-minus-perceptions scales. Four factors were identified using SERVQHOS (56% explained variance). Perceptions-SERVQHOS gathered a greater predictive capacity that the scores derived from the difference among expectations and perceptions. This result was obtained in both criteria: patient satisfaction (55% explained variance) and whether the respondents would recommend the hospital (76.36% right classifications with respect to response levels of the criterion).

CONCLUSIONS

Before using SERVQUAL is highly recommended to realize a validation procedure of this questionnaire. SERVQHOS has shown adequate reliability and validity. However, there were some methodological problems using it. The most important inconvenience was that perceptions' scores showed greater predictive capacity than expectations-minus-perceptions.