Healthcare service quality: towards a broad definition

Measuring the impact of dental service quality on revisit intention using an extended SERVQUAL model

Background

The pursuit of quality services can lead to both service enhancement and increased motivation to visit dental centers for oral health treatment.

Aims

The purpose of this study is to investigate the effect of dental center service quality factors on revisit intention among adult patients by applying an extended service quality model (SERVQUAL).

Methods

This cross-sectional study was conducted between September and November 2023 in the outpatient waiting areas and clinical settings of Umm Al-Qura University Dental Teaching Hospital (UQU-DTH). A sample of 355 patients was invited by the convenience sampling method. The data was collected through a validated Arabic version of the extended SERVQUAL questionnaire. A hierarchical regression analysis was used to assess the incremental effects of the extended SERVQUAL factors on the intention of patients to revisit the UQU-DTH while controlling for demographic variables. Cronbach alpha was used to examine the internal consistency of each model factor.

Results

A total of 330 completed responses were received, with a 93% response rate. The findings indicated that demographic variables such as age and level of education contribute to some extent but become negligible when the extended SERVQUAL factors are included in the model. Moreover, the extended SERVQUAL model factors substantially improved the model. Three factors were found to positively and significantly affect the revisit intention, namely, "staff-related factors," "cost-effectiveness," and "responsiveness." Overall, the model explained 65.6% of the variance in the revisit intention (R2 = 0.656, p < 0.001).

Conclusion

The findings present a unique model that may be used to better understand the factors that influence patients' intentions to revisit dental centers in an educational setting. Additionally, it identified elements that dental center quality management needs to prioritize and address.

Measuring in-hospital quality multidimensionally by integrating patients', kin's and healthcare professionals' perspectives: development and validation of the FlaQuM-Quickscan

BACKGROUND

Measuring quality is essential to drive improvement initiatives in hospitals. An instrument that measures healthcare quality multidimensionally and integrates patients', kin's and professionals' perspectives is lacking. We aimed to develop and validate an instrument to measure healthcare quality multidimensionally from a multistakeholder perspective.

METHODS

A multi-method approach started by establishing content and face validity, followed by a multi-centre study in 17 Flemish (Belgian) hospitals to assess construct validity through confirmatory factor analysis, criterion validity through determining Pearson's correlations and reliability through Cronbach's alpha measurement. The instrument FlaQuM-Quickscan measures 'Healthcare quality for patients and kin' (part 1) and 'Healthcare quality for professionals' (part 2). This bipartite instrument mirrors 15 quality items and 3 general items (the overall quality score, recommendation score and intention-to-stay score). A process evaluation was organised to identify effective strategies in instrument distribution by conducting semi-structured interviews with quality managers.

RESULTS

By involving experts in the development of quality items and through pilot testing by a multi-stakeholder group, the content and face validity of instrument items was ensured. In total, 13,615 respondents (5,891 Patients/kin and 7,724 Professionals) completed the FlaQuM-Quickscan. Confirmatory factor analyses showed good to very good fit and correlations supported the associations between the quality items and general items for both instrument parts. Cronbach's alphas supported the internal consistency. The process evaluation revealed that supportive technical structures and approaching respondents individually were effective strategies to distribute the instrument.

CONCLUSIONS

The FlaQuM-Quickscan is a valid instrument to measure healthcare quality experiences multidimensionally from an integrated multistakeholder perspective. This new instrument offers unique and detailed data to design sustainable quality management systems in hospitals. Based on these data, hospital management and policymakers can set quality priorities for patients', kin's and professionals' care. Future research should investigate the transferability to other healthcare systems and examine between-stakeholders and between-hospitals variation.

Hearing the voices of adolescents: Evaluating the quality of care for young adults with chronic illnesses in the UAE

BACKGROUND

Quality care for adolescents and young adults with chronic illnesses has been under-explored in the United Arab Emirates (UAE) and internationally, especially from patients' perspectives. Most available international studies focused on quality of life and the transition to adulthood rather than service quality.

AIM

This research assesses care quality for adolescents with chronic illnesses in the UAE, aiming to understand their perspectives, appraise current practices, and identify service gaps.

METHODS

A cross-sectional survey employed a validated questionnaire examining 33 essential care components. Participants comprised 576 adolescents and young adults with chronic conditions from five UAE Emirates.

RESULTS

Participant's reports indicated that none of the 33 care elements were received consistently. Most participants (80.6%) reported crucial care aspects were absent, and across most investigated items, 19.4%-46.5% of participants reported receiving the services they were supposed to receive only some or many of the times, indicating significant areas for improvement.

CONCLUSIONS

Findings demonstrate significant care quality gaps for UAE's adolescents and young adults with chronic illnesses. These may critically affect their ability to manage their conditions and ensure holistic growth. These insights can guide healthcare enhancements tailored to this demographic.

PRACTICE IMPLICATIONS

There is an urgency for enhanced patient-centered care in UAE healthcare, emphasizing clinicians' roles in supporting adolescents with chronic illnesses, especially during transitions. Healthcare managers should prioritize standardized care policies, improved communication, and training that emphasizes consistent patient feedback and transition readiness. Further research into care gaps and tailored interventions within the region's distinct sociocultural setting is essential.

The pandemic's unseen wounds: COVID-19's profound effects on mental health

Objective

This review aims to explore the impact of the COVID-19 pandemic on mental health, with a focus on the physiological and psychological consequences, including comorbidities. The goal is to understand the direct and indirect populations affected by mental distress and identify potential interventions.

Methodology

A comprehensive literature search was conducted using various databases, including Google Scholar, ResearchGate, ScienceDirect, PubMed, PLoS One, and Web of Science. The search utilized relevant keywords to investigate the direct and indirect impacts of COVID-19 on mental health. The selected articles were critically evaluated and analyzed to identify key findings and insights.

Main findings

Mental health, being an intrinsic component of overall well-being, plays a vital role in physiological functioning. The COVID-19 pandemic, caused by the emergence of the novel SARS-CoV-2 virus, has had a devastating global impact. Beyond the respiratory symptoms, individuals recovering from COVID-19 commonly experience additional ailments, such as arrhythmia, depression, anxiety, and fatigue. Healthcare professionals on the frontlines face an elevated risk of mental illness. However, it is crucial to recognize that the general population also grapples with comparable levels of mental distress.

Conclusion

The COVID-19 pandemic has underscored the significance of addressing mental health concerns. Various strategies can help mitigate the impact, including counselling, fostering open lines of communication, providing mental support, ensuring comprehensive patient care, and administering appropriate medications. In severe cases, treatment may involve the supplementation of essential vitamins and antidepressant therapy. By understanding the direct and indirect impacts of COVID-19 on mental health, healthcare providers and policymakers can develop targeted interventions to support individuals and communities affected by the pandemic. Continued research and collaborative efforts are essential to address this pervasive issue effectively.

Role of patient and family engagement in quality improvement for pediatric surgery

In recent decades, the role of quality improvement (QI) in pediatric surgery has grown substantially. Patient and family engagement can help to maximize the impact of QI by enhancing safety and patient outcomes. Yet, broader, systematic efforts to actively involve patients and families in QI initiatives remain a persistent gap in pediatric surgery. To address this gap, we propose an agenda centered on three key goals for future quality improvement efforts: (1) building partnerships with patients and their families; (2) expanding the use of patient-reported outcomes (PROs) and novel, cross-disciplinary research methods; and (3) engaging patients and families consistently across all stages of pediatric surgical care. Fulfilling this agenda will be essential in shifting our mindset to view QI as a collective that involves patients, families, clinicians, and payers in continuous, system-wide opportunities to evaluate and improve care. Actively listening to and collaborating with patients and families may also help renew our focus on narrowing the gap between current practice and the best possible practice for children undergoing surgery.

Impact of Magnetic Resonance Imaging on Healthcare in Low- and Middle-Income Countries

Magnetic resonance imaging (MRI) played a significant role in the digital health platforms that influenced and supported modern medicine. However, there is a shortage of MRI in low- and middle-income countries (LMICs). The International Society of Radiology offers a detailed plan for LMICs to advance imaging quality in the global health agenda. The overarching objective of this scoping review was to determine the impact of MRI in healthcare in LMICs. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify available evidence. We systematically searched four academic databases for peer-reviewed literature published between 2018 and 2021, namely, Medline, PubMed, Web of Science, and Scopus, as well as Google Scholar as a source for gray literature. The search identified 54 articles. We identified a range of reasons for introducing MRI in LMICs. Nonetheless, some challenges to accepting MRI as a method of healthcare have been reported, including technological, regulatory, and economical challenges. To implement the proposed plan, the involvement of professional and international organizations is considered crucial. The establishment of an International Commission on Medical Imaging under the umbrella of international organizations is suggested and collaboration with other diagnostic disciplines is encouraged to raise awareness of the importance of upscale diagnostics at large and to foster its integration into the care pathway globally.

Reconsidering Patient Value to Create Better Healthcare

Healthcare can be seen as a value shop, in which solutions to health problems are offered in exchange for valuable contributions. However, the full value exchange between the healthcare provider and the patient is not always apparent. The value shop concept runs the risk of considering only what the patient pays (i.e., money, either paid by the patient or reimbursed by the government) while ignoring another important value, data. Yet without this data, the patient’s problem cannot be solved. This article offers a new paradigm in which a health provider can deliver better value by integrating all dimensions of the provider’s and patient’s value.

Global, regional, and national burden and quality of care index of liver cirrhosis by cause from global burden of disease 1990-2019

BACKGROUND AND AIM

Cirrhosis and other chronic liver diseases are complex disorders with a known burden. Currently health systems have different approaches to dealing with this issue. The objective of this study is to describe the burden attributed to and quality of care for cirrhosis and other chronic liver diseases.

METHODS

Data of cirrhosis and other chronic liver diseases extracted from Global-Burden-of-Diseases 2019. Four indicators, including mortality to incidence ratio, prevalence to incidence ratio, disability-adjusted-life-years (DALYs) to prevalence ratio, and years-of-life-lost (YLLs) to years-lived-with-disability (YLDs) ratio, were defined and combined by the principal-components-analysis to construct the Quality-of-Care-Index (QCI).

RESULTS

The global QCI of cirrhosis increased from 71.0 in 1990 to 79.3 in 2019. The QCI showed a favorable situation in higher SDI countries compared with lower SDI countries, with a QCI of 86.8 in high SDI countries and 60.1 in low SDI countries. The highest QCI was found in Western Pacific Region (90.2), and the lowest was for African Region (60.4). Highest QCI belonged to the 50-54 age group (99.5), and the lowest was for the 30.34 age group (70.9). Among underlying causes of cirrhosis, the highest QCI belonged to alcohol use, followed by hepatitis C and NAFLD with QCIs of 86.1, 85.3, and 81.1.

CONCLUSIONS

There was a considerable variation in the QCI of cirrhosis and other chronic liver diseases. Countries with low QCI, mainly located in developing regions, need organized action to control the burden of cirrhosis and its underlying causes and improve their quality of care.

What is known about patient-centered care application in post-surgical breast cancer patients?

BACKGROUND

Over the past two decades, patient-centered care has become internationally recognized as a dimension of high-quality health care. Recent research has shown that patient-centered care has many benefits, which are broadly categorized as patient experience and clinical and operational benefits.

OBJECTIVE

The study aimed at analyzing the correlation between the application of patient-centered care (PCC) and length of stay, patient satisfaction, and clinical outcome of post-surgical breast cancer patients.

METHODS

The study design was cross-sectional. A sample of 100 patients was determined and selected with the inclusion criteria. Data were collected using measuring tools comprising patient-centered care and patient satisfaction questionnaires as well as medical records to evaluate the length of stay and clinical outcomes. Bivariate analysis was conducted to analyze the correlation between patient-centered-care and length of stay (LOS), patient satisfaction, and the clinical outcomes of inpatients.

RESULTS

A correlation was found between patient-centered care (PCC) application and patient satisfaction (p = 0.005), but no correlation was observed between PCC application and length of stay (LOS) (p = 0.176) as well as clinical outcome (p = 0.128).

CONCLUSIONS

The application of patient-centered care can be attributed to patient satisfaction but is not correlated to length of stay and clinical outcome of post-surgical breast cancer patients. The hospital should create an accepted definition and commonly agreed set of dimensions used for the concept of operationalization and its measurement to implement PCC and improve overall patient satisfaction and clinical outcome and reduce the length of stay as expected.

A Crisis in the Health System and Quality of Healthcare in Economically Developed Countries

A health crisis caused by a pandemic tested the effectiveness of national healthcare systems by testing both financing and organizational and technical performance of patient care. At that time, the structural flaws in healthcare systems and inequalities in the level of healthcare in its different dimensions and countries due to resource constraints were highlighted. Therefore, the paper concentrates on investigating how the crisis in the health system affects the quality of healthcare services as a result of changes in the availability of financial, material, and human resources belonging to this system. The quantitative data, in terms of healthcare characterizing the OECD countries and selected non-member economies, treated as an example of economically developed regions, were chosen for the analysis. The study included five areas of resources, i.e., demographic, financial, human, technical, and the delivery of basic services in healthcare. T-test method for dependent samples, supplemented with Hedge's g statistics, was applied to test the differences between the mean values of individual indicators. The results indicate the occurrence of changes in some areas of the healthcare system due to a crisis. Identifying areas that are particularly vulnerable to sudden changes in the healthcare system helps to understand which resource areas need to be strategically managed first, as shifts in levels respond to deteriorating healthcare quality outcomes.

How individual social capital affects residents' satisfaction with medical services: Based on the evidence from urban residents in China

Introduction

Residents' satisfaction with medical services has commonly been treated as both a medical and psychosocial process. The influence of psychosocial factors on residents' satisfaction with medical treatment is generally considered as important as that of medical factors. However, the effect of individual social capital on residents' satisfaction after medical treatment-an important psychosocial variable that may influence health status and access to medical services-has not received sufficient attention.

Methods

This study used the questionnaire survey data of urban residents in eight Chinese cities in 2014 to investigate how individual social capital affects residents' satisfaction with medical services over the past year.

Results

The results revealed a negative impact of individual social capital on residents' overall satisfaction with medical services. In addition, the use of individual social capital significantly improved residents' satisfaction with medical resources and significantly reduced residents' satisfaction with the medical system. Moreover, the negative impact of individual social capital on residents' overall satisfaction with medical services was greater for individuals with a lower likelihood of using this capital, which may lead to unequal allocation of medical resources and long-term life satisfaction.

Discussion

The heterogeneous impact and mechanism of individual social capital on residents' satisfaction with medical services was confirmed under the premise of self-selection bias.

Investigation of technical quality of antenatal and perinatal services in a nationally representative sample of health facilities in Nepal

Background

Access to routine antenatal and perinatal services is improved in the last two decades in Nepal. However, gaps remain in coverage and quality of care delivered from the health facilities. This study investigated the delivery of technical quality antenatal and perinatal services from health facilities and their associated determinants in Nepal.

Methods

Data for this study were derived from the Nepal Health Facility Survey 2015. The World Health Organization's Service Availability and Readiness Assessment framework was adopted to assess the technical quality of antenatal and perinatal services of health facilities. Outcome variables included technical quality scores of i) 269 facilities providing antenatal services and ii) 109 facilities providing childbirth and postnatal care services (perinatal care). Technical quality scores of health facilities were estimated adapting recommended antenatal and perinatal interventions. Independent variables included locations and types of health facilities and their management functions (e.g., supervision). We conducted a linear regression analysis to identify the determinants of better technical quality of health services in health facilities. Beta coefficients were exponentiated into odds ratios (ORs) and reported with 95% confidence intervals (CIs). The significance level was set at p-value < 0.05.

Results

The mean score of the technical quality of health facilities for each outcome variable (antenatal and perinatal services) was 0.55 (out of 1.00). Compared to province one, facilities of Madhesh province had 4% lower odds (adjusted OR = 0.96; 95%CI: 0.92, 0.99) of providing better quality antenatal services, while health facilities of Gandaki province had higher odds of providing better quality antenatal services (aOR = 1.05; 95% CI: 1.01, 1.10). Private facilities had higher odds (aOR = 1.13; 95% CI: 1.03, 1.23) of providing better quality perinatal services compared to public facilities.

Conclusions

Private facilities provide better quality antenatal and perinatal health services than public facilities, while health facilities of Madhesh province provide poor quality perinatal services. Health system needs to implement tailored strategies, including recruiting health workers, supervision and onsite coaching and access to necessary equipment and medicine in the facilities of Madhesh province. Health system inputs (trained human resources, equipment and supplies) are needed in the public facilities. Extending the safe delivery incentive programme to the privately managed facilities could also improve access to better quality health services in Nepal.

Virtual and augmented reality applications to improve older adults’ quality of life: A systematic mapping review and future directions

Objective

The use of virtual reality and augmented reality to improve older adults’ quality of life has rapidly increased in recent years. This systematic mapping review aimed to provide a comprehensive overview of existing research that identifies and classifies current virtual reality and augmented reality applications that enhance the quality of life of older adults to increase the understanding of the impact of these technologies.

Methods

To reach this objective, a systematic mapping review was conducted of the studies published between 2009 and 2020 in major scientific databases, such as IEEE Xplore, Web of Science, Scopus, and PubMed. A total of 57 studies were analyzed and classified into four main quality of life domains: physical, cognitive, psychological, and social well-being.

Results

The findings showed that virtual reality and augmented reality have found their places in many quality of life studies of older adults. Although virtual reality and augmented reality applications are notably growing in the physical and cognitive well-being domains in training and rehabilitation settings, they are still in the early stages of development in psychological and social well-being research as well as healthcare settings. Our findings also revealed that virtual reality games, particularly motion-based exergames, and 3D augmented reality systems are the most common virtual reality and augmented reality types among the reviewed studies. Moreover, balance and attention were the most prevalent physical and cognitive functions when using motion-based and immersive virtual reality exergames and augmented reality systems and games, respectively, while confidence and interaction were the most dominant psychological and social functions.

Conclusion

This mapping review provides a comprehensive overview of potential areas for further research in this field, thereby assisting researchers, technologists, and health practitioners in expanding this field of research.

Primary Health Institutions and Service Quality in China: Implications for Health Policy

BACKGROUND

To protect and improve the health of populations, the important role of primary health institutions has been strengthened through a series of health policies, especially the implementation of a national hierarchical diagnosis and treatment system. In this light, we aim to evaluate the development of primary health institutions between 2013, before the implementation of the hierarchical diagnosis and treatment system, and 2020 as well as people's perception of the quality of primary healthcare services.

METHOD

The national-level data (e.g., the numbers of primary health institutions, personnel, beds, visits, and hospitalizations) regarding primary health institutions were collected from the Health Statistics Yearbook, and the perceptions of the quality of primary healthcare services were collected by a web-based questionnaire survey using an internationally recognized assessment tool (i.e., PCAT-AE). In total, 10,850 persons were surveyed, and 10,419 participants were incorporated into the final analysis after removing invalid questionnaires. A descriptive statistical analysis (i.e., frequency and percentage) was used to analyze the national-level characteristics of primary health institutions and people's perceptions of the quality of primary healthcare services. Moreover, a logistic regression model was used to analyze the factors influencing the perceptions of the quality of primary healthcare services.

RESULTS

From the macro perspective, the number of primary health institutions, beds, and personnel per 10 thousand residents slightly increased from 2013 to 2020, especially in the eastern and central areas. However, the average number of visits and the hospitalization rate in primary health institutions showed a decrease, especially in central and eastern areas. Among participants, 92.2% (9606/10,419) of them had previously sought healthcare services in primary health institutions, and most were seeking general outpatient services (57.06-63.45%), followed by medicine purchasing (16.49-21.51%), physical examinations (9.91-11.49%), preventive health services (5.11-6.48%), and hospitalization services (3.17-5.67%). The total perception scores on the quality of primary healthcare services reported by the participants were 26.19 and 27.00 for rural and urban areas, respectively, which accounted for 65.5% and 67.5% of the total score, respectively, and 26.62, 26.86, and 25.89 for the eastern, central, and western areas, respectively, with percentages of 66.6%, 67.2%, and 64.7%. The perception score on the quality among people contracted with a family doctor (29.83, 74.58%) was much higher than those who were not (25.25, 63.13%), and the difference was statistically significant (p < 0.001). Moreover, people who were female, married, had higher incomes, and were diagnosed with various diseases had better perceptions of the primary healthcare services compared to their counterparts (p < 0.05).

CONCLUSION

Improvements were seen for primary health institutions, especially in terms of hardware resources such as beds and personnel. However, the service utilization in primary health institutions did not improve between 2013 and 2020. The perception score on the quality of primary healthcare was moderate to low in rural and urban as well as eastern, central, and western areas, but it was significantly higher among people contracted with a family doctor than those who were not. Therefore, it is important for policy makers to take or adjust measures focusing on quality improvement and increasing the service utilization in primary health institutions with good first contact, accessibility, continuity, comprehensiveness, and coordination, such as raising the enrollment rate of family doctors and promoting the provision of high-quality services.

Patients’ perception of service quality in a healthcare not-for-profit organisation

Background

Service organisations should be aware of those elements that are perceived as excellent quality and incorporate these as part of their service offering. However, a not-for-profit (NPO) healthcare organisation consists of a diverse group of stakeholders who have different perspectives and interests. Service quality therefore requires a multidimensional definition that comprehends all their needs and expectations.

Methods

Perceived service quality experienced by patients was measured by completion of the Service Performance (SERVPERF) questionnaire. A total of 111 patients completed the questionnaire across three mobile clinics supported by an NPO.

Results

The research results suggested that service quality at the mobile clinics was of a very high standard, with no meaningful differences between clinics, age groups or gender. However, the responses had very little variance and could have been subjected to response bias or extreme bias. The absence of a comparator organisation could also have had an influence on responses given by respondents.

Conclusion

Healthcare service organisations should strive towards maintaining high standards and engage in continuous measurement and improvement of their service quality as part of their quality management process. By measuring the current level of service experienced by patients, insights have been identified where adjustments might have a positive effect on perceived value. Future research recommendations include suggestions to increase the sample population, taking the service setting into account and further studies to confirm the validity and reliability of solicited service quality questionnaires in a NPO setting.

The role of information communication technologies as a moderator of knowledge creation and knowledge sharing in improving the quality of healthcare services

This study examines the role of knowledge creation, knowledge sharing and information communication technologies, which are organizational factors that influence the quality of healthcare services. In today’s knowledge-intensive environment, understanding and gaining in-depth knowledge on how to improve the quality of healthcare services is gaining in importance and recognition. Quantitative data collected in 2019 with 151 respondents employed in healthcare organizations was used. Running a series of hierarchical linear regression models, we found a significant positive relationship between knowledge creation and quality of healthcare services, and a significant positive relationship between knowledge sharing and quality of healthcare services. Empirical data additionally provides support for information communication technologies that act as a moderator both in the relationship between knowledge creation and knowledge sharing with quality of healthcare services. With our data, we provide empirical backing for the impact of knowledge creation, knowledge sharing and information communication technologies on the quality of healthcare services that are provided by Montenegrin healthcare organizations. Our paper offers theoretical and practical implications derived from our research study.

Impact of Point of Care Quality Improvement Training and Coaching on Quality Perceptions of Health Care Workers: Implication for Quality Policy

Background

The quality of infant healthcare service is one of the essential factors in preventing infant mortality. The purpose of the study was to analyze the quality performance in primary healthcare centers (PHC) and hospitals before and after the point of care quality improvement (POCQI) training for Infant Healthcare Services (IHS).

Methods

This is a mixed-method study design with convergence triangulation strategy, conducted at six public PHCs and four hospitals in two districts of West Java Province, Indonesia. One hundred health care workers (HCWs) were involved for quantitative study at baseline and end of intervention. An additional 40 patients participated as informants for qualitative study. Quantitative data analysis was performed by Rasch modeling and independent t-test for all variables, followed by content analysis for qualitative data.

Results

There were significant changes in the variables of POCQI skill (mean diff: 5.14, p=0.001), quality improvement (QI) understanding (mean diff: 1.2; p=0.001), and QI engagement (mean diff: 1.7; p=0.001) in the PHC group. Although there was an increase in process and outcome variables, the changes were not significant. There was a significant change in all variables in the hospital group which were outcome (mean diff: 2.32 (p=0.19); POCQI skill (mean diff: 2.80, p=0.001); process (mean diff: 1.48, p= 0.01); QI understanding (mean diff: 1.01; p=0.01), and QI engagement (mean diff: 1.52; p=0.03). Patient perception in the qualitative study showed that PHCs and Hospitals’ services improved. Moreover, health care workers found they have a better understanding of service quality and created quality changes and improved POCQI steps.

Conclusion

Implementation of POCQI in PHC and hospitals improved the performance of the quality of his, therefore assuring that POCQI is an appropriate approach and tool to be adopted in the policy for strengthening the health system.

The perception of health care quality by primary health care managers in Ukraine

Background

Ukraine is reforming its health care system to improve quality of health care. Insight into how primary health care managers perceive quality is important for the ongoing reform as well as for the improvement of medical services.

Methods

An online survey was conducted as part of the Ukrainian-Swiss project “Medical Educational Development” in April–May 2019 based on the contact list of USAID project “Health Reform Support”, and additionally on the database of the National Health Service of Ukraine and other channels. Data were analyzed using descriptive statistics and qualitative data analysis.

Results

In total, 302 health care managers took part in the study. The majority of primary health care managers perceive quality in health care as process quality. They associate quality mostly with compliance to standards. At the same time, primary health care managers prefer to assess outcome quality via a system of indicators and feedback. There appears to be a lack of consensus about health care quality. This may be due to a lack of awareness of the national strategy for better quality of health care service.

Conclusions

Our study provides new insights into primary care managers' perceptions of health care quality in Ukraine. The absence of a clear consensus about quality complicates the discussion about quality and how to measure quality in health care. This appears to be one of the obstacles to system-wide quality improvement.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08300-y.

Evaluation of patient satisfaction with nursing services before and after implementation of the Health System Transformation Plan in Iran: A cross‐sectional study

Background and Aims

How healthcare service delivery is achieved after implementing the Health System Transformation Plan (HSTP) is investigated in the present study by assessing the patients' satisfaction with nursing care services compared to before HSTP.

Methods

This cross‐sectional study was conducted in Iranian hospitals during two periods, that is, before (N = 300) and after (N = 279) HSTP, whereas the Patient Satisfaction Instrument was used to assess the satisfaction with nursing services.

Results

About 57.7% and 4.7% of the patients were dissatisfied with nursing care services, whereas 34% and 77.4% for moderate satisfaction, and 8.3% and 17.9% for total satisfaction, before and after HSTP, respectively. The mean score of overall satisfaction was 57.33 (±11.17) and 70.84 (±11.99) before and after HSTP, respectively (p < 0.001), which represents there is an improvement in healthcare services delivery after HSTP. Although none of the sociodemographic factors were significantly associated with satisfaction, higher satisfaction was found among the coronary care unit (CCU) hospitalized patients.

Conclusion

The patients' overall satisfaction with nursing care services after HSTP was increased, although higher satisfaction was observed in the patients of special wards such as CCU. Therefore, using more care facilities and equipment and engaging more skilled nursing staff in other wards is highly recommended.

Service process factors affecting patients' and clinicians' experiences on rapid teleconsultation implementation in out-patient neurology services during COVID-19 pandemic: a scoping review

Background

The adoption of teleconsultation for outpatient neurology services was limited until the onset of the COVID-19 pandemic which forced many outpatient neurology services to rapidly switch to virtual models. However, it remains unclear how this change has impacted patients’ and clinicians’ perceptions of service quality. The purpose of this scoping review is to identify process factors that influence patients’ and clinicians’ experiences of outpatient teleconsultation services during COVID-19.

Methods

Arksey and O’Malley scoping review framework was used to search PubMed, Scopus, CINAHL, and PsycInfo for original peer-reviewed research studies that examined the experiences of synchronous teleconsultation between a clinician and patient in a home-setting since the World Health Organization announced the COVID-19 global pandemic. The service quality model SERVQUAL was used to conduct a deductive thematic analysis to identify the key factors that impacted the patients’ and clinicians’ perception of teleconsultation services.

Results

A total of nineteen studies published between January 1, 2020, and April 17, 2021, were identified. The most common service process factors affecting the patients’ and clinicians’ experiences of teleconsultation were technical issues, addressing logistical needs, communication, ability to perform clinical activities, appropriate triage, and administrative support.

Conclusions

Our findings identified six key service process factors affecting the patients’ and clinicians’ teleconsultation experiences in outpatient neurology services. The need for improvement of triage process and standardizing administrative virtual care pathway are identified as important steps to improve patients and clinicians’ teleconsultation experiences compared to pre-COVID era. More research is needed to assess outpatient neurology teleconsultation service quality from patients’ and clinicians’ perspectives.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07908-4.

The impact of quality framework application on patients’ satisfaction

Purpose

This study aims to explore if the application of the customer results criteria contained within the King Abdullah II Award for Excellence (KAIIAE) is correlated with high levels of patient satisfaction within a large hospital based in Jordan.

Design/methodology/approach

Using a mixed methodology, supported by a pragmatist theoretical approach, a satisfaction survey was conducted with patients accessing the hospital as an in-patient across a range of specialities gathering feedback about different aspects of their care. The results were compared with a self-assessment completed by different speciality teams about the existence and maturity of customer result arrangements implemented as a result of the (KAIIAE).

Findings

The findings confirmed that quality awards such as the KAIIAE can effectively be applied in a health-care setting and can help provide a framework for improving patient experience and satisfaction. A correlation was found with those specialties that self-assessed themselves more highly in terms of these arrangements and the overall levels of patient satisfaction with that specialty, suggesting that the products of working towards the KAIIAE such as establishing effective patient experience monitoring arrangements and improved learning from complaints, has a positive impact on patient satisfaction.

Originality/value

There are limited studies which focus specifically on customer results and on the use of the KAIIAE more generally. This study therefore makes a valuable contribution in adding to the debate about the strategic value of working towards formal quality improvement models and awards in health-care settings.

Assessing service quality and the perceptual difference between employees and patients of public hospitals in a developing country

Purpose

This study aims to examine service quality in Nigerian general hospitals and determines possible differences in service quality perceptions between employees and patients.

Design/methodology/approach

Using the Servqual scale, data was collected from 328 employees and patients of two government hospitals in Abuja and Delta states. Analysis was carried out using SPSS 26 package for constructs reliability frequency, mean, standard deviation and t-statistics.

Findings

The study found significant differences in the perception of service quality between employees and patients of the Nigerian general hospitals. While employees gave a high rating to empathy, patients rated it low. Also, the patients’ poor perception of tangible did not match the employees’ high perception. Other specific findings are patients’ unfavourable assessment of the physical facilities and judged the staff to lack professional dressing. Patients felt the hospitals could not provide necessary equipment for their procedures and thus considered their services unreliable.

Practical implications

Reliability was perceived as a significant problem in this study; therefore, the hospitals management should ensure correct diagnoses and treatment results of the highest quality and timely services. Also, the management should invoke strong relationships between the employees and patients to earn patients’ trust. Employees should ensure to listen to patients’ complaints and find solutions promptly. Patients need health-care workers’ support and rely on their abilities; Therefore, health-care workers should be highly dependable and show empathic behaviour in discharging their duties. Health-care managers must access employees‘ and patients’ particular perceptual gaps and reconcile the difference before further quality improvement initiatives.

Originality/value

The findings in this study strengthen the clamour for assessing service quality from both employees and patients’ views in public hospitals. Hospital service quality is complex and primarily judged from the patients’ perspective. This study showed that health-care quality means different things to all stakeholders.

The Impact of Healthcare 4.0 on the Healthcare Service Quality: A Systematic Literature Review

Healthcare 4.0 is inspired by Industry 4.0 and its application has resulted in a paradigmatic shift in the field of healthcare. However, the impact of this digital revolution in the healthcare system on healthcare service quality is not known. The purpose of this study is to examine the impact of healthcare 4.0 on healthcare service quality. This study used the systematic literature review methodology suggested by Transfield et al. to critically examine 67 articles. The impact of healthcare 4.0 is analyzed in-depth in terms of the interpersonal, technical, environmental, and administrative aspect of healthcare service quality. This study will be useful to hospitals and other stakeholders to understand the impact of healthcare 4.0 on the service quality of health systems. Besides, this study critically analyses the existing literature and identifies research areas in this field and hence will be beneficial to researchers. Though there are few literature reviews in healthcare 4.0, this is the first study to examine the impact of Healthcare 4.0 on healthcare service quality.

Missing the point: Quality-driven healthcare institutions may mistakenly disregard their role in nursing and medical education

Aligned with international standards, the UAE Government and many other developing countries in the region (GCC and MENA) have started to implement strict quality improvement initiatives to develop their healthcare systems. Most of these initiatives are geared toward meeting patient satisfaction and avoiding circumstances or events that would dissatisfy patients. It is also used to measure healthcare institution performance, assess efficiency and determine their funding and reimbursement. With this emphasis on quality, it is also important for healthcare organizations to fulfill their other functions. Among the most important is performing their teaching role to prepare future healthcare professionals, and attracting and retaining healthcare professionals. These roles are also a paramount for a quality, sustained healthcare system. However, clinical educators and managers reflect on how these roles seem to be frequently missed or at least compromised while applying the quality assurance measures in the region developing countries. This reflective paper discusses this concern and suggests possible strategies that may help overcome this challenge and thus contributing to the achievement of the quality goal of the service in a more comprehensive and sustainable manner. The similarities between the UAE healthcare system and neighboring Gulf Cooperation Council and the Middle East/North African countries mean these challenges and solutions may resonate with these countries and support the implementation of effective health services in these countries as well.

Mobile Health Systems Affordability in India: Perspectives of Stakeholders

Purpose:

The purpose of this study were to identify stakeholder perspective for achieving affordable and cost-effective system outcomes and what describes success associated with mHealth systems in India. This study identifies stakeholder views on (a) fundamental conditions for initiating mobile health (mHealth) systems and (b) desirable outcomes regarding affordable and cost-effectiveness of successful mHealth systems.

Design/Methodology/Approach:

This qualitative study uses existing models of affordability and used an inductive approach to organise emerging codes as per a priori themes. Data were collected from direct observations and 17 in-depth interviews both online and offline involving stakeholder, namely healthcare professionals, technology entrepreneurs and software developers working on health information and mHealth systems.

Findings:

Findings illustrated people’s need and unwillingness, lack of application infrastructure, ecosystem development, governmental policies, and training and support as factors influencing successful mHealth systems in India.

Originality/Value:

Earlier studies were less adequate in explaining mHealth systems affordability and cost-effectiveness from the perspective of stakeholder. The current study attempts to provide fundamental conditions and desirable outcomes that are considered to be valuable for developing mHealth systems. This makes healthcare providers with information of what needs to be considered for developing mHealth systems.

Comparison of Visit Length and Waiting Time of Patients in Public and Private Clinics in the North of Iran

Background: The visit length is considered one of the indicators for assessing patients’ satisfaction. Factors such as waiting time for getting a visit affects the desirability of the visit. Objectives: This study aimed to investigate the visit length and waiting time of patients in public and private clinics in Tabriz. Methods: This is a descriptive-analytic study conducted in five clinics in 2018. A questionnaire-based survey was used to collect data from 386 participants recruited through simple random sampling. Mann-Whitney U and Kruskal-Wallis tests were applied to analyze the data using SPSS version 22.0. Results: Overall, the mean visit length was 25.5 and 25.4 min in public and private centers, respectively, while the mean waiting time was 141.2 and 156.4 min in public and private centers, respectively. There was no significant difference between public and private centers regarding the visit length (P > 0.05); however, there was a significant difference between public and private centers in terms of waiting time (P < 0.05). Conclusions: The waiting time was too much, especially in private clinics, which can negatively affect patient satisfaction. Therefore, suggested interventions may consist of using internet and telephone admission, scheduling a waiting list, and requiring physicians to be present on time.

The Interactive Effect of COVID-19 Risk and Hospital Measures on Turnover Intentions of Healthcare Workers: A Time-Lagged Study

COVID-19 has led to a global health emergency worldwide. As a result, healthcare workers undergo distress mainly due to the perceived risk of contracting the virus. Such stress might cause them to leave their jobs. In this context, the current study: (1) introduced the concept of perceived risk of COVID-19 and measured it by adapting and validating an existing scale available on the risk of infectious diseases and (2) investigated its outcomes, underlying mechanisms, and boundary conditions for healthcare workers. With the support of conservation of resources theory, the current study aimed to investigate the association between perceived risk of COVID-19 and turnover intentions among healthcare workers, particularly Doctors, nurses, and paramedics staff. This study also aimed to investigate the mediating role of perceived fear of COVID-19 between perceived risk of COVID-19 and turnover intention. The current study also aimed to examine the buffering role that perceptions of hospital measures against COVID-19 could have on diminishing workers’ turnover intentions. Data were collected through a three time-lag email survey of healthcare workers in Pakistan (N = 178) who currently provide treatment to COVID-19 patients. The results supported the hypothesis that perceived risk of COVID-19 enhances fear of COVID-19 among healthcare workers and, consequently, their turnover intentions. Perceptions of hospital measures against COVID-19 weaken the relationship between perceived risk of COVID-19 and fear of COVID-19, which reduces turnover intentions of health care workers. The current study offers implications for theory, practitioners, and society.

Measuring Regional Performance in the Italian NHS: Are Disparities Decreasing?

Given the regional disparities that historically characterize the Italian context, in this paper we propose a framework to evaluate the regional health care systems' performance in order to contribute to the debate on the relationship between decentralisation of health care and equity. To investigate the regional health systems performance, we refer to the OECD Health Care Quality Indicators project to construct of a set of five composite indexes. The composite indexes are built on the basis of the non-compensatory Adjusted Mazziotta-Pareto Index, that allows comparability of the data across units and over time. We propose three indexes of health system performance, namely Quality Index, Accessibility Index and Cost-Expenditure Index, along with a Health Status Index and a Lifestyles Index. Our framework highlights that regional disparities still persist. Consistently with the evidence at the institutional level, there are regions, particularly in Southern Italy, which record lower levels of performance with high levels of expenditure. Continuous research is needed to provide policy makers with appropriate data and tools to build a cohesive health care system for the benefit of the whole population. Even if future research is needed to integrate our framework with new indicators for the calculation of the indexes and with the identification of new indexes, the study shows that a scientific reflection on decentralisation of health systems is necessary in order to reduce inequalities.

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.

Modelling enablers of efficiency and sustainability of healthcare: a m-TISM approach

Purpose

It would not be an exaggeration to say that healthcare is the most crucial one in today's perspective. The healthcare sector, in general, is engaged in working on various dimensions simultaneously like the safety, care, quality and cost of services, etc. Still, the desired outcomes from this sector are far away, and it becomes pertinent to address all such issues associated with healthcare on a priority basis for sustaining the outcomes in a long-term perspective. The present study aims to explore the healthcare sector and list out the directly associated enablers contributing to increasing the viability of the healthcare sector. Besides, the interrelationship among the enlisted enablers needs to be studied, which further helps in setting-out the priority to deal with individual enablers based on their impedance in the contribution towards viability increment.

Design/methodology/approach

The authors have done an extensive review to list out the enablers of the healthcare sector to perform efficiently and effectively. Further, the attempt has been made on the enablers to rank them by using the modified Total Interpretative Structure Modelling (m-TISM) approach. The validation of the study reveals the importance of enablers based on their position in the hierarchical structure. Further, the MICMAC analysis on the identified enabler is performed to categorize the identified enablers in the different clusters based on their driving power and dependence.

Findings

The research tries to envisage the importance of the healthcare sector and its contribution towards national development. The outcomes of the m-TISM model in the present study reveal the noteworthy contribution of the organizational structure in managing the healthcare facilities and represented it as the perspective of future growth. The well-designed organizational structure in the healthcare industry helps in establishing better employee–employer cooperation, workforce coordination and inter-department cooperation.

Research limitations/implications

Every research work has limitations. Likewise, the present research work also has limitations, i.e. input taken for developing the models are from very few experts that may not reflect the opinion of the whole sector.

Practical implications

The healthcare sector is the growing sector in the present-day scenario, and it is essential to keep the quality of treatment in check along with the quantity. The present study has laid down the practical foundations for improvement in the healthcare sector viability. Besides, the study emphasized on accountability of the healthcare sector officials to go with the enablers having the strong driving power for effective utilization of all the resources. This would further help them in customer (patients) satisfaction.

Originality/value

Despite an increase in demand for good quality healthcare facilities worldwide, the growth of this sector is bounded by the economic, demographic, cultural and environmental concerns, etc. The present study proposed a unique framework that provides a better understanding of the enablers. It would further help in playing a key role in increasing the viability of the healthcare sector. The hierarchy developed with the help of m-TISM and MICMAC analysis will help the viewers to recognize the important enablers based on their contribution to the viability improvement of the healthcare sector.

Emotional intelligence: predictor of employees' wellbeing, quality of patient care, and psychological empowerment

BACKGROUND

The study explored the role of emotional intelligence (EI) on employees' perceived wellbeing and empowerment, as well as their performance, by measuring their quality of care.

METHODS

The baseline data for the present project was collected from 78 staff of a Victorian aged care organization in Australia. Self-administered surveys were used to assess participants' emotional intelligence, general well-being, psychological empowerment, quality of care, and demographic characteristics. The model fit was assessed using structural equation modelling by AMOS (v 24) software.

RESULTS

The evaluated model confirmed that emotional intelligence predicts the employees' psychological empowerment, wellbeing, and quality of care in a statistically significant way.

CONCLUSIONS

The current research indicates that employees with higher EI will more likely deliver a better quality of patient care. Present research extends the current knowledge of the psychological empowerment and wellbeing of employees with a particular focus on emotional intelligence as an antecedent in an under-investigated setting like aged care setting in Australia.

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.

Perspectives of Australian hospital leaders on the provision of safe care: implications for safety I and safety II

Purpose

There is evidence that patient safety has not improved commensurate with the global attention and resources dedicated to achieving it. The authors explored the perspectives of hospital leaders on the challenges of leading safe care.

Design/methodology/approach

This paper reports the findings of a three-year longitudinal study of eight Australian hospitals. A representative sample of hospital leaders, comprising board members, senior and middle managers and clinical leaders, participated in focus groups twice a year from 2015 to 2017.

Findings

Although the participating hospitals had safety I systems, the leaders consistently reported that they relied predominantly on their competent well-meaning staff to ensure patient safety, more of a safety II perspective. This trust was based on perceptions of the patient safety actions of staff, rather than actual knowledge about staff abilities or behaviours. The findings of this study suggest this hegemonic relational trust was a defence mechanism for leaders in complex adaptive systems (CASs) unable to influence care delivery at the front line and explores potential contributing factors to these perceptions.

Practical implications

In CASs, leaders have limited control over the bedside care processes and so have little alternative but to trust in “good staff providing good care” as a strategy for safe care. However, trust, coupled with a predominantly safety 1 approach is not achieving harm reduction. The findings of the study suggest that the beliefs the leaders held about the role their staff play in assuring safe care contribute to the lack of progress in patient safety. The authors recommend three evidence-based leadership activities to transition to the proactive safety II approach to pursuing safe care.

Originality/value

This is the first longitudinal study to provide the perspectives of leaders on the provision of quality and safety in their hospitals. A large sample of board members, managers and clinical leaders provides extensive data on their perspectives on quality and safety.

Demographics matter: the potentially disproportionate effect of COVID-19 on hospital ratings

Objective

To identify how features of the community in which a hospital serves differentially relate to its patients' experiences based on the quality of that hospital.

Design

A Finite Mixture Model (FMM) is used to uncover a mix of two latent groups of hospitals that differ in quality. In the FMM, a multinomial logistic equation relates hospital-level factors to the odds of being in either group. A multiple linear regression relates the characteristics of communities served by hospitals to the patients' expected ratings of their experiences at hospitals in each group. Thus, this association potentially varies with hospital quality. The analysis was conducted via Stata.

Setting

Hospital ratings are measured by Hospital Compare using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, a patient satisfaction survey required by the Centers for Medicare and Medicaid Services for hospitals in the USA.

Participants

2,816 Medicare-certified acute care hospitals across all US states.

Intervention

None.

Main Outcome Measure

Differences in the marginal impacts of key community demographics on patient experiences between the two groups of hospitals.

Results

We provide evidence that low-rated hospitals have much more variability in patient experience ratings than high-rated ones. Moreover, the experiences at low-rated hospitals are more sensitive to county demographic factors, which means exogenous shocks, like coronavirus disease-2019 (COVID-19), will likely affect these hospitals differently, as such shocks are known to disproportionately affect their communities.

Conclusions

Our results imply that low-rated hospitals with more variability in their HCAHPS responses are more likely to face adverse patient experiences due to COVID-19 than high-rated hospitals. Pandemics like COVID-19 create conditions that intensify the already high demands placed on hospitals and care providers and make it even more challenging to deliver quality care.

Perceived health-care quality in China: a comparison of second- and third-tier hospitals

OBJECTIVES

To evaluate disparity in service quality between second- and third-tier hospitals and explore factors that affect patients' perception of service quality in China.

DESIGN

Cross sectional study.

SETTING

Twelve hospitals in China.

PARTICIPANTS

5714 patients.

INTERVENTION

None.

MAIN OUTCOME MEASURE

Total score of the SERVQUAL scale and each of its five dimensions.

RESULTS

Patients from third-tier hospitals rated significantly higher scores overall and in all the five dimensions of the SERVQUAL scale. Those with lower education, urban residents and those who had higher degree of life satisfaction and attention paid to health perceived higher service quality. Inpatients perceived higher service quality compared with outpatients.

CONCLUSION

We found a significant gap in patient's perceived service quality between second- and third-tier hospitals in China. A variety of demographic and personality factors were found to significantly influence patient's perceived service quality.

The Gaps of Healthcare Service Quality in Nurse Practitioner Practice and Its Associated Factors From the Patients' Perspective

PURPOSE

This study investigates the expectations, perceptions, and gaps of the healthcare service quality (HSQ) from the patients' perspective, and explores the significant demographic and clinical factors associated with the HSQ in nurse practitioner practice (NPP).

DESIGN

A cross-sectional design was carried out, with convenience sampling performed under the NPP in Taiwan, from June to November 2016.

METHODS

The Nurse Practitioner Healthcare Service Quality Scale was used to assess the expectations, perceptions, and gaps of the HSQ. The demographics, clinical characteristics, and symptom severity of patients were collected, and the Importance-Performance Analysis was applied to identify the priority of ranking items for the improvement of nurse practitioners (NPs). The Generalized Estimating Equation was used to explore the factors associated with the HSQ in NPP.

FINDINGS

A total of 200 patients completed the questionnaires. The results revealed that the patients had overall high expectations (M = 6.35, SD = 0.46), moderate perceptions (M = 4.21, SD = 0.95), and a mild HSQ gap (M = -2.14, SD = 0.69), with statistically significant differences (p < .001). In NPP, the largest gap in the HSQ dimensions was reliable responsiveness, followed by empathy, assurance, and tangibility. Patients with greater symptom severity and a longer in-hospital stay were associated with larger HSQ gaps; however, patients who were transferred from the emergency department had smaller gaps than those in the outpatient department.

CONCLUSIONS

The patients' expectations were not fully satisfied in the NPP, especially for the dimensions of reliable responsiveness and empathy. The patients' symptom severity was a significant factor related to the gaps in the HSQ. The awareness of unmet needs, from the patients' perspective, could guide the convergence of a rational policy to promote healthcare delivery in the NPP.

CLINICAL RELEVANCE

The managers of NPP need to pay attention to increasing NPs' reliable responsiveness and empathy, by setting the appropriate scope of practice, regulating the NP-to-patient ratio, applying for certification programs in prescribing training, and cultivating patient-centered care with shared decision making. In addition, building up the knowledge and competency of symptom management is also suggested for NP training.

Ascertaining service quality and medical practitioners' sensitivity towards surgical instruments using SERVQUAL

Purpose

Service quality (SQ) has become an essential and indispensable component in healthcare and many other industries. SQ can deliver guaranteed stakeholder value and consequent consumer delight in the healthcare sector. The purpose of this study is to identify the relationships of various SERVQUAL elements with respect to the SQ of surgical instrument suppliers among surgeons.

Design/methodology/approach

Data were collected from a sample of 112 surgeons working in the USA using the “snowball sampling” technique. A few standardised questionnaires, including SERQUAL, were used to collect the data. R-programming was used to perform structural equation modelling (SEM) analysis on the collected data.

Findings

The research study identified that service delivery factors and the SQ of surgical instruments contribute significantly towards medical practitioner sensitivity in the US healthcare industry. Word of mouth (WOM) did not have any significant impact on the medical practitioners' sensitivity.

Originality/value

A review of related literature revealed that studies that examine the surgeon's perspectives of SQ are scarce. Thus, the present study is directed towards this gap in literature. The findings of the study are significant in nature and have made a substantial contribution to management literature.

Divergent notions of "quality" in healthcare policy implementation: a framing perspective

PURPOSE

This paper examines how "quality" was framed in the design and implementation of a policy to reform hospital funding and associated care delivery. The aims of the study were: (1) To describe how government policy-makers who designed the policy and managers and clinicians who implemented the policy framed the concept of "quality" and (2) To explore how frames of quality and the framing process may have influenced policy implementation.

DESIGN/METHODOLOGY/APPROACH

The authors conducted a secondary analysis of data from a qualitative case study involving semi-structured interviews with 45 purposefully selected key informants involved in the design and implementation of the quality-based procedures policy in Ontario, Canada. The authors used framing theory to inform coding and analysis.

FINDINGS

The authors found that policy designers perpetuated a broader frame of quality than implementers who held more narrow frames of quality. Frame divergence was further characterized by how informants framed the relationship between clinical and financial domains of quality. Several environmental and organizational factors influenced how quality was framed by implementers.

ORIGINALITY/VALUE

As health systems around the world increasingly implement new models of governance and financing to strengthen quality of care, there is a need to consider how "quality" is framed in the context of these policies and with what effect. This is the first framing analysis of "quality" in health policy.

Selecting home care quality indicators based on the Resident Assessment Instrument-Home Care (RAI-HC) for Switzerland: A public health and healthcare providers' perspective

Background

Despite an increasing importance of home care, quality assurance in this healthcare sector in Switzerland is hardly established. In 2010, Swiss home care quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) were developed. However, these QIs have not been revised since, although internationally new RAI-HC QIs have emerged. The objective of this study was to assess the appropriateness of RAI-HC QIs to measure quality of home care in Switzerland from a public health and healthcare providers’ perspective.

Methods

First, the appropriateness of RAI-HC QIs, identified in a recent systematic review, was assessed by a multidisciplinary expert panel based on the RAND/UCLA Appropriateness Method taking into account indicators’ public health relevance, potential of influence, and comprehensibility. Second, the QIs selected by the experts were afterwards rated regarding their relevance, potential of influence, and practicability from a healthcare providers’ perspective in focus groups with home care nurses based on the Nominal-Group-Technique. Data were analyzed using median scores and the Disagreement Index.

Results

18 of 43 RAI-HC QIs were rated appropriate by the experts from a public health perspective. The 18 QIs cover clinical, psychosocial, functional and service use aspects. Seven of the 18 QIs were subsequently rated appropriate by home care nurses from a healthcare providers’ perspective. The focus of these QIs is narrow, because three of seven QIs are pain-related. From both perspectives, the majority of RAI-HC QIs were rated inappropriate because of insufficient potential of influence, with healthcare providers rating them more critically.

Conclusions

The study shows that the appropriateness of RAI-HC QIs differs according to the stakeholder perspective and the intended use of QIs. The findings of this study can guide policy-makers and home care organizations on selecting QIs and to critically reflect on their appropriate use.

Nurses' perception regarding patient safety climate and quality of health care in general hospitals in Japan

AIM

To clarify perceptions of nurses towards patient safety climate and quality of health care in Japan.

BACKGROUND

Nurses' perceptions of patient safety climate and quality of health care services are not well-known.

METHOD

The survey was conducted at general hospitals with 200 beds or more using the Patient Safety Climate Scale and the Modified multiple-item scale for consumer perceptions of health care service quality.

RESULTS

Significant positive correlations were found among nurses' perception towards patient safety and health care service quality. The experience of nurses as members of the committee on patient safety and their employment position did not show any significant difference in the perception towards patient safety and health care services quality. Perceptions of health care service quality were lower among those with 6- to 10-year experience than with over 21 years.

CONCLUSION

In the perception of nurses and nurse managers' continuous improvement, perceptions towards patient safety were related to reliability, assurance, responsiveness and empathy in health care service quality.

IMPLICATIONS FOR NURSING MANAGEMENT

Generalist nurses with 21 years or more experiences in multiple departments showed high perception towards health care service quality. Experienced nurses' perceptions of activities to improve patient safety and quality of health care services are important.

Challenges for developing health-care knowledge in the digital age

Purpose

Health-care knowledge is dispersed among different departments in a health care organization, which makes it difficult at times to provide quality care services to patients. Therefore, this study aims to identify the main challenges in adopting health information technology (HIT).

Design/methodology/approach

This study surveyed 148 stakeholders in 4 key categories [patients, health-care providers, United Arab Emirates (UAE) citizens and foresight experts] to identify the challenges they face in adopting health care technologies. Responses were analyzed using exploratory (EFA) and confirmatory factor analysis (CFA).

Findings

EFA revealed four key latent factors predicting resistance to HIT adoption, namely, organizational strategy (ORGS); technical barriers; readiness for big data and the internet of things (IoT); and orientation (ORI). ORGS accounted for the greatest amount of variance. CFA indicated that readiness for big data and the IoT was only moderately correlated with HIT adoption, but the other three factors were strongly correlated. Specific items relating to cost, the effectiveness and usability of the technology and the organization were strongly correlated with HIT adoption. These results indicate that, in addition to financial considerations, effective HIT adoption requires ensuring that technologies will be easy to implement to ensure their long-term use.

Research limitations/implications

The results indicate that readiness for big data and the IoT-related infrastructure poses a challenge to HIT adoption in the UAE context. Respondents believed that the infrastructure of big data can be helpful in more efficiently storing and sharing health-care information. On the technological side, respondents felt that they may experience a steep learning curve. Regarding ORI, stakeholders expected many more such initiatives from health-care providers to make it more knowledge-specific and proactive.

Practical implications

This study has implications for knowledge management in the health -care sector for information technologies. The HIT can help firms in creating a knowledge eco-system, which is not possible in a dispersed knowledge environment. The utilization of the knowledge base that emerged from the practices and data can help the health care sector to set new standards of information flow and other clinical services such as monitoring the self-health condition. The HIT can further influence the actions of the pharmaceutical and medical device industry.

Originality/value

This paper highlights the challenges in HIT adoption and the most prominent factors. The conceptual model was empirically tested after the collection of primary data from the UAE using stakeholder theory.

Nurses' stressors and their quality of life: A study on nurses caring for older patients

Aim

To determine the sources of occupational stress and the level of quality of life among nurses caring for older people in Lebanon and examine the underlying factors to predict nurses' quality of life.

Design

A descriptive correlational design.

Methods

Data were collected from 119 nurses using Nursing Stress Scale and WHO‐Quality of Life Brief.

Results

Nurses reported the highest frequency of stressful events related to their workload (mean = 16.42, SD 1.03), followed by “death and dying” (mean = 14.61, SD 1.02). Nurses reported the highest level of quality of life domains was physical health (mean = 15.74, SD = 2.63), while the lowest level was environmental domain (mean = 11.15, SD = 1.86). After controlling for demographic and work‐related variables, occupational stress explained a large variance in the physical (R² change = .43), psychological (R² change = .44) and social relationship (R² change = .35) domains of quality of life.

Quality management effects on operating theater's productivity: a participatory action research

Purpose

The operating theater (OT) is resource-intensive, costly and assuring its productivity is a high priority. This study aimed to examine a quality management model's effects on a hospital's OT productivity.

Design/methodology/approach

The participatory action research approach was used for the intervention. A multidisciplinary quality improvement team was formed. The team improved OT operational processes using an eight-step quality management model. OT’s key performance indicators such as surgical cases, surgical cancellation, bill deductions, successful cardiopulmonary resuscitation, patients' complaints and employees' job satisfaction were collected before the intervention and compared with those of after intervention to determine the efficacy of the quality management model.

Findings

Applying a quality management strategy increased surgical patients' number by 14.96%, reduced surgery operations cancellation by 14.6 %, and decreased bill deduction by 44.9%. Besides, successful cardiopulmonary resuscitation increased by 21.17%, patients' complaints reduced by 61.5% and, finally, staff satisfaction increased by 15.6 %. Improved OT productivity resulted in improved financial performance. As a result, the OT revenue has risen by 68.8%.

Originality/value

This study highlights that implementing the right quality management model properly enhances hospitals' productivity. It also offers suggestions on how to implement a quality management model successfully in a hospital setting.

Measuring Perceived Service Quality in Healthcare Setting in Developing Countries: A Review for Enhancing Managerial Decision-making

Healthcare is vital for the overall well-being of an individual. The service quality in healthcare is a matter of great importance for health institutions across the world. With increasing patient awareness and rising competition among hospitals, patient perception of healthcare quality has become very relevant. This study aims to review the literature to explore the concepts of perceived service quality, customer satisfaction, and behavioural intentions. The study has attempted to look into the relationship between perceived healthcare service quality, patient satisfaction, and behavioural intentions of patients. Healthcare service quality is measured using SERVQUAL dimensions as well as other dimensions specific to the healthcare sector. The findings clearly show that perceived healthcare service quality, patient satisfaction, and behavioural intentions are closely related to each other, and high-quality services lead to satisfied patients who further exhibit positive behavioural intentions.

Dimensions of authentic leadership and patient care quality

PURPOSE

The purpose of this study is to investigate the causal relationships between the dimensions of authentic leadership and patient care quality in the nursing profession of Ghana.

DESIGN/METHODOLOGY/APPROACH

The study used explanatory and cross-sectional survey designs. The data were obtained from 400 respondents, consisting of 200 nurses and 200 patients in selected general hospitals. The analysis was done using descriptive statistics, correlation and multi-linear regression techniques.

FINDINGS

The study found that all four dimensions of authentic leadership, namely, self-awareness, internalized moral perspective, balanced processing and relational transparency positively correlated with patient care quality, however, only internalized moral perspective and self-awareness have positive significant association with patient care quality and internalized moral perspective being the highest predictor. Thus, the results suggest that authentic leadership can positively predict patient care quality.

PRACTICAL IMPLICATIONS

The study contributes to the understanding of how dimensions of authentic leadership practices affect patient care quality. This understanding is relevant to academics in general and Ghanaian policymakers in particular.

ORIGINALITY/VALUE

The research makes a significant contribution to the existing authentic leadership literature by establishing that the dimensions of authentic leadership predict patient care quality with an internalized moral perspective being the highest predictor followed by self-awareness. Furthermore, the authors anticipate that the outcomes of this research, which so far is the first study in the Ghanaian context, can significantly shape nursing leadership discourse, practices and policies in Ghana and in other developing countries to improve patient care quality.

Studying the Efficiency of Waiting Time in Outpatient Pharmacy

In general, the pharmacy is the last department to be visited for outpatient in the hospitals, and therefore its efficiency is directly linked to patients’ satisfactions and more important the reputation of the entire hospital. The study here is based on Medical City that is located in Riyadh, Saudi Arabia. It serves patients from all over Saudi Arabia. The aim of the study is to improve the efficiency of waiting time of outpatient pharmacy based on the problems that have been observed using management quality tools and techniques. After analyzing the data for the current situation, then trying to propose changes for improvement in system efficiency. Results showed that by proposing automated waiting system with automated prescriptions, patient categorization, reduce the unclaimed prescriptions, and modify the pharmacy's layout. All of that will help in reducing the waiting time as well as increasing the patients' satisfaction which will lead to improve the pharmacy's efficiency. From reviewing the literature, it concludes that applying management quality tools and techniques will tremendously improve the quality of services in healthcare systems. The statistical analysis presented shows some outliers points when serving patients which were studied and recommendations were proposed. This is new approach to enhance the quality of healthcare management and leads to increase in the efficiency of the outpatient pharmacies.