Do patients really perceive better quality of service in private hospitals than public hospitals in India?

Women's narratives of disrespect and abuse during facility-based childbirth in Kolkata, India

Quality of care during childbirth is crucial to maternal health outcomes. Studies from India that report on women's experiences of disrespect and abuse by healthcare providers during facility-based childbirth are limited to high-fertility states and predominantly focus on public hospitals. However, the quality of maternal care in states with low fertility rates like West Bengal needs further examination. This study aimed to understand women's experiences of disrespect and abuse and their perceptions of facility-based childbirth. The study focused on public, private, and charitable hospitals in Kolkata district of West Bengal that presents a higher institutional birth rate than the national average. The findings derive from a qualitative study using in-depth interviews with 17 postpartum women who had facility-based births within one year before data collection in May 2019. Grounded theory approach was used to iteratively code the interview transcripts, identify reappearing categories, and generate themes through abstraction. The participants' narratives revealed experiences of verbal abuse, neglect and abandonment, poor rapport between providers and women, improper conduct of procedures, health facility conditions and constraints, and instances of overlapping forms of disrespect and abuse. The findings demonstrate the nature of disrespect and abuse across different hospital types in a major metropolis of India. Normalisation of poor-quality care manifested in women's lack of expectations of patient education and attention from providers. Health system conditions and constraints can impact the quality of care that problematise the push for institutional deliveries as a panacea for poor maternal health outcomes. The findings add to long-standing calls for improving maternal experiences of birth with an emphasis on promoting autonomy. National and state guidelines related to maternal health need to be aligned with accepted standards of care. West Bengal must establish ways to assess the implementation of such guidelines on the ground.

The effect of health facility ownership on perceived healthcare quality: evidence from Ghana

Whether private healthcare providers should be encouraged over public providers remains unclear. On the one hand, because private providers are profit-driven, they are more motivated to compete for demand by enhancing quality if demand is elastic. However, because they are more motivated to maximize revenue, they may sacrifice quality to maximize profit. A crucial factor in determining whether private providers should be encouraged is the extent to which their quality exceeds or falls short of that of the public provider. This study, therefore, investigates whether the public and private differ in providing quality healthcare services using the 2014 Ghana Demographic and Health Survey. Our measure of healthcare quality is based on patient satisfaction level with nine healthcare services (cleanliness, waiting time, comfort and safety, consultation time, privacy, listening, explanation, treatment advice and confidentiality) provided by public and private healthcare facilities. We applied an instrumental variable approach to account for endogeneity issues related to the patient's choice of healthcare provider. We find that private facility users have a higher probability of being very satisfied with "waiting time", "consultation time", "listening", "cleanliness", "comfort and safety", "confidentiality", and "privacy" than public users, thus suggesting that private facilities provide better service than public. We thus recommend encouraging the private sector to enter the healthcare market. We also find that failing to account for endogeneity in provider choice when estimating the effect of healthcare facility ownership on healthcare service quality underestimates the effects.

The quality of Syrian healthcare services during COVID-19: A HEALTHQUAL approach

Syria is a developing country that face enormous healthcare challenges that aggravated with the outbreak of COVID-19. In the study, we evaluate the perceived healthcare service quality based on hospital type, public and private, using five HEALTHQUAL dimensions. We find that service quality in Syrian private hospitals is perceived better that in public hospitals. However, neither type of hospitals scores exceptionally high in any of the examined HEALTHQUAL dimensions. On the contrary, both hospitals score extremely low in the Improvement dimension. We argue that crowdedness environment, medical staff availability and their low salaries, pricing policies as well as the health insurance system, are to blame for such low perceived quality.

The influence of service quality and anticipated emotions on donor loyalty: an empirical analysis in blood centres in Spain

Blood donation centres need to recruit and retain donors to ensure the effectiveness and efficiency of healthcare systems, as COVID-19 has recently evidenced. In such risky settings, blood donation services must increase donations. Service quality can increase donations but its evaluation only amounts to a cognitive evaluation, and not to an emotional appraisal. Consequently, both service quality and emotions should be considered when predicting donor behaviour. In fact, donating blood is an emotionally charged service, thus representing an ideal setting to investigate how emotions influence consumer behaviour. This research proposes a new method to predict blood donors' intentions by integrating a cognitive approach measuring perceived quality, and an emotional approach including anticipated emotions (both positive and negative) of 'donation' and 'non-donation'. Based on a sample of 30,621 active Spanish donors, it is concluded that service quality is an antecedent for anticipated emotions and that both service quality and anticipated emotions influence donor loyalty. Designing the donation process based on quality criteria would provoke encouraging emotions and diminish discouraging emotions, therefore improving donor loyalty.

An application of quality function deployment and SERVQUAL approaches to enhance the service quality in radiology centres

Purpose

Meeting the patients' requirements as customers of the health care sector is crucially important as a social responsibility. According to the resource constraints, only an efficient utilisation of health services can provide that purpose. This study aims to develop a quantitative assessment framework for radiology centres as a vital section in healthcare to translate the patients' requirements into service quality specifications. This would help to achieve quality improvement by emphasising the voice of customers.

Design/methodology/approach

A literature review is conducted to specify the service quality criteria and the patients' requirements related to healthcare and hospitals. Based on the experts' opinions, these criteria and requirements are later customised for the radiology centres. Moreover, the requirements are categorised into five dimensions of SERVQUAL. The interrelations between service elements are also determined through expert group consensus using Pearson correlation. Afterwards, by applying the QFD method, the relations between the requirements and criteria are explored. Additionally, a customer satisfaction survey is executed in Tehran public hospitals to prioritise these requirements and provide an importance-satisfaction analysis.

Findings

Based on the result of the case study, service elements are prioritised for improvement, and practical suggestions are provided using the Delphi technique for quality improvement. In addition, a cause-and-effect diagram is presented to highlight the improvement area and provide enhancement suggestions.

Originality/value

This study is the first empirical attempt to benefit from the VOC in evaluating and enhancing the quality of service delivered to radiology patients. In doing so, the study applies a hybrid approach of QFD and SERVQUAL as well as other tools to highlight the improvement area and provide enhancement suggestions. The findings can be readily used by the practitioners.

Applicability of healthcare service quality models and dimensions: future research directions

Purpose

The purpose of this study is to explore the literature of healthcare service quality for identifying and analyzing the healthcare service quality models and dimensions and to present future research insights pertaining to the applications of these models and dimensions.

Design/methodology/approach

A literature review of healthcare service quality has been performed on 59 relevant studies after applying inclusion and exclusion criteria. Google Scholar and Scopus are the primary sources to find the relevant documents. Search was limited to keywords of “service quality,” “healthcare,” “models” and “dimensions.”

Findings

The results revealed that different models and dimensions have been evolved and developed after SERVQUAL in healthcare service quality literature. There is still a need to develop new models, add new contextual dimensions and items in existing models on different aspects of healthcare services. There is also a need to incorporate the perspective of service providers as respondents. Moreover, healthcare service quality models can be devolved or narrowed down at department and individual levels.

Originality/value

This study presents valuable research insights for the researchers and practitioners in ways that healthcare service quality models and dimensions can be developed, modified and tested further in different research contexts and settings. Besides, the literature on healthcare services can be enhanced and enriched.

Examining the behavioural intention of inpatients in Indian government hospitals

PURPOSE

The purpose of this research is to examine the impact of perceived service quality (PSQ) on the behavioural intention (BI) of patients in Indian government hospitals. The underlying mechanism of trust and patient satisfaction (SAT) is examined as multiple mediating effect.

DESIGN/METHODOLOGY/APPROACH

Data from 510 respondents were collected using structured questionnaires. Six government hospitals, namely, S.M.S. Hospital, J.L.N. Hospital, New Medical College Hospital, Maharana Bhupal Medical Hospital, Mathuradas Hospital and P.B.N. Hospital, were selected from the cities of Jaipur, Ajmer, Kota, Udaipur, Jodhpur and Bikaner, respectively. The data were collected from adult patients (>18 years old) who spent at least two nights in a government hospital between 1 October, 2020 and 30 December, 2020. PSQ formed as a reflective-formative model was analysed using the repeated indicator approach. Structural equation modelling (SEM) using SMART-PLS software was used to test the hypothesised model(s) derived deductively from literature.

FINDINGS

The findings support the following conclusions: (1) the positive relationship between PSQ and BI is significant; (2) SAT mediates the PSQ and BI relationship; (3) trust mediates the PSQ and BI relationship; (4) the mediation effect of SAT is stronger than that of trust.

PRACTICAL IMPLICATIONS

The results indicate that, in order to enhance the positive BI of patients towards government hospitals, it is necessary for the hospitals to work on strategies to enhance the service quality provided to patients. The outcome of this study will enable state government hospitals to get a better understanding of the different dimensions of service quality and will help in observing the factors that contribute to patients' satisfaction and trust in building long-term relationships by encouraging a positive BI.

ORIGINALITY/VALUE

There is a dearth of research in India that evaluates the relationships between the constructs PSQ, trust, BI and SAT in the context of healthcare service. This empirical study is an attempt to fill this gap by focussing on the government hospitals in India.

Basic Health Units services quality assessment through Kano and SERVQUAL models

Purpose

The present research aims to evaluate the quality of services provided by the Basic Health Units (UBS) of the Unified Health System (SUS) located in the city of Recife, in the state of Pernambuco, Brazil, using the Kano model integrated with the dimensions of quality proposed by the service quality (SERVQUAL) model.

Design/methodology/approach

The research was classified as bibliographic, descriptive, quantitative and surveyable. A structured questionnaire based on the Kano Model integrated with the dimensions of quality proposed by the SERVQUAL model, applied online through Google Forms. The questionnaires were distributed on social networks, obtaining a non-probabilistic sample of 120 individuals, collected for convenience.

Findings

Through the analysis of the Kano Model, it was possible to observe that all the investigated attributes are classified as one-dimensional. Among the attributes that deserve to be highlighted are attributes “Clean and pleasant environment”, “Reliability and security of information”, “Knowledge of employees to perform services”, “Service performed in the promised time”, “Polite and kind staff in dealing with users” and “Effectiveness of the service provided” due to having the longest intervals when considering the satisfaction and dissatisfaction coefficients, above 1.575. These attributes must be considered as critical priorities when implementing improvements, since their presence considerably increases users' satisfaction, as well as their absence generates great dissatisfaction.

Originality/value

The research is original and justified by the potential use of a quality assessment tool in the public health service, especially primary care. It is noteworthy that there are few works that integrate the Kano and SERVQUAL models applied in the public health service and that this integration can contribute to the national and international literature, mainly in the identification and prioritization of areas for improvement.

e-Healthcare service quality: consumer satisfaction and its association with demographic characteristics

PURPOSE

Use of technology for quality healthcare services has developed into a new field known as "e-Healthcare services." Healthcare providers often judge their quality of services with consumer satisfaction. With e-Healthcare services, consumer satisfaction is influenced by the quality of healthcare services provided and the demographic characteristics. The purpose of the present case study is to recognize the important predictors of quality, which are significant for consumer satisfaction with e-Healthcare services by using Zineldin's 5Qs model. It also aims to find the strength of association among the predictors of consumer satisfaction and the demographic characteristics of the respondents.

DESIGN/METHODOLOGY/APPROACH

A questionnaire-based study was conducted at a public (PGIMER, Chandigarh) and a private hospital (Fortis Hospital, Mohali) of Punjab, India, from February 2018 to March 2019. The structured, closed-ended questionnaire, to be marked on a 1-5 point Likert scale, was adapted from Zineldin's 5Qs model and was distributed to the respondents sitting in the waiting halls of the selected hospitals. The respondents comprised of both the patients and their attendants who were aware of e-Healthcare services and were using them.

FINDINGS

The analysis identified quality of interaction, quality of hospital atmosphere and quality of object to be the key predictors of consumer satisfaction with e-Healthcare services. The results reveal a strong association between different demographic characteristics and overall consumer satisfaction with e-Healthcare services.

PRACTICAL IMPLICATIONS

The results suggest that improvements in the quality of interaction, quality of hospital atmosphere and quality of object may result in higher consumer satisfaction with e-Healthcare services. Working on the identified dimensions of quality will help the e-Healthcare providers in identifying functional problems of e-Healthcare services and developing improvement strategies, which will also result in better health and quality outcomes. The results of this study will help the e-Healthcare providers in better segmentation of e-Healthcare consumers based on their demographic characteristics and in developing better marketing strategies.

ORIGINALITY/VALUE

This paper focuses on the quality of e-Healthcare services only and attempts to identify the quality dimensions, which leads to the satisfaction of e-Healthcare consumers. The identified quality dimensions will help in designing better e-Healthcare services and framing policies. It also highlights the association of demographic characteristics with important quality dimensions.

Children's education and level of health care utilization among parents: a pooled cross-sectional study from national population-based survey in India

The study of upward spill over on parents of their offspring's education is vital for understanding the family dynamics and role of adult children in the decisions of parents. Such association has widespread implication and application on ageing policies. We use pooled data from population-based cross-sectional health consumption surveys conducted by the National Sample Survey Organization in 2014 and 2018 (rounds 71 and 75, respectively) in this study. The analysis is restricted to individuals aged 60 and above, who are head of the household or their spouse and have children aged 25 years or above. The analysis is carried out for inpatient and outpatient cases separately. For inpatient analysis, the dependent variable is designed as a rank variable representing an increasing level of health care utilization. For the same partial proportional odds are calculated. For outpatient cases, the dependent variable is binary that takes the value 0 if the parents use public facilities and 1 if private facilities are used. Here, binary logistic regression is used for analysis. The odds of parents using a higher level of inpatient as well as outpatient health care are higher for those with better-educated children (inpatient: OR are 2.6 (p < 0.001, CI: 2.0-3.5); outpatient: OR are 1.5 (p < 0.001, CI: 1.1-2.2)). Education of children does influence the level of health care utilization among parents. Therefore, policy interventions can target offspring of working age group, who can assimilate information better and transfer it to their parents.

Sustainable human resource planning for hospitals in tier 2/3 cities: evidence from India

Purpose

To evolve sustainable practices for human resource planning (HRP) for hospitals being set up in Tier 2/3 cities in India. The purpose of this study is to determine the strategic challenges are faced by hospitals in Tier 2/3 cities. To align HRP/workforce planning to departmental strategic/business planning of the hospital in the defined context. To address the dilemmas of the prospective health-care workforce in Tier 2/3 cities.

Design/methodology/approach

The integrated methodology adopted uses the grounded approach for building theory from practice. Due to the lack of research in the identified context, the study relies on a review of literature related to health-care practices, HRP and general management inputs to evolve the exact interview questionnaire. The subsequent empirical analysis is based on interviews of niche human resource experts in private hospitals.

Findings

The traditional and successful model of private hospitals in the metro cities cannot be transplanted to the Tier 2/3 cities. The thumb rule on a ratio between the doctors, paramedic staff, nurses and other support staff requires to be modified as necessary. Uncertainty in the new context requires the outlook to be basic, uncomplicated, flexible and agile. Attracting and recruitment strategies require adopting an innovative and multipronged approach. Sourcing high-end specialists need not follow the retainership model of employment.

Practical implications

The need to penetrate health-care services to the Tier 2/3 cities within India cannot be disputed. With the increase in disposable income and standard of living in these cities, access to quality and affordable health care is also imperative. The study is a pioneering effort to suggest a practicable and uncomplicated model for hospital setup in the identified context, with a focus on HRP.

Originality/value

This paper offers novel perspectives to the HRP of health-care personnel for a hospital setup in Tier 2/3 cities in India. For the success of private hospitals and their financial viability, this planning is of utmost importance. There is an attempt to fill the knowledge gap in the context which has been rarely explored or ventured. In addition, the policy initiatives suggested are expected to encourage the growth of private hospitals within the Tier 2/3 cities in India.

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.

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

Purpose

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

Design/methodology/approach

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

Findings

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

Research limitations/implications

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

Practical implications

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

Social implications

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

Originality/value

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