Health care service quality: a journey so far

Martin R, La Foucade A, Sarti FM. Determinants of Patients' Perception of Primary Healthcare Quality: Empirical Analysis in the Brazilian Health System

Background/Objectives: Primary healthcare (PHC) plays a central role in the promotion of universal healthcare coverage within the Brazilian health system. Nevertheless, inequalities across municipalities represent substantial barriers to achieving equity in access to health, particularly due to disparities in the quality of healthcare delivered to patients. Thus, the study aimed to investigate factors associated with perception of PHC quality among adult individuals using private and public facilities within the Brazilian health system. Methods: The empirical approach was based on quantitative analysis of cross-sectional data from five nationally representative surveys conducted by the Brazilian Institute for Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE) in 1998, 2003, 2008, 2013, and 2019. Pairwise comparisons and marginal analyses allowed for the assessment of differences in patients' perception of healthcare quality according to source of funding and type of healthcare quality. A logistic regression model was estimated to identify factors associated with the perception of good quality of care. Model discrimination, calibration, and goodness-of-fit were assessed to ensure the robustness of analyses. Results: The results indicate that patients' satisfaction was positively associated with level of implementation of the national program based on payment for performance in public healthcare facilities, PMAQ-AB (OR = 3.376; p < 0.001), self-assessment of good health status (OR = 3.209; p < 0.001), and healthcare financed through health insurance (OR = 2.344; p < 0.001). Contrarily, receiving healthcare in a public facility (OR = 0.358; p < 0.001) was negatively associated with the evaluation of good quality. Conclusions: The findings showed that patients' perception of quality of care presents significant associations with patients' health characteristics, healthcare funding source, and implementation of the PMAQ-AB. Furthermore, patients generally perceived lower healthcare quality in public facilities. The study indicates the need for evidence-based decision-making in public policies of health, particularly regarding further advances in payment for performance programs designed to foster improvements in quality of care within public PHC facilities in Brazil.

Performance measurement of Brazilian federal university hospitals: an overview of the public health care services through principal component analysis

PURPOSE

This paper aimed to contextualize the process of public hospital providing services, based on the measurement of the performance of Federal University Hospitals (HUFs) of Brazil, using the technique of multivariate statistics of principal component analysis.

DESIGN/METHODOLOGY/APPROACH

This research presented a descriptive and quantitative character, as well as exploratory purpose and followed the inductive logic, being empirically structured in two stages, that is, the application of principal component analysis (PCA) in four healthcare performance dimensions; subsequently, the full reapplication of principal component analysis in the most highly correlated variables, in module, with the first three main components (PC1, PC2 and PC3).

FINDINGS

From the principal component analysis, considering mainly component I, with twice the explanatory power of the second (PC2) and third components (PC3), it was possible to evidence the efficient or inefficient behavior of the HUFs evaluated through the production of medical residency, by specialty area. Finally, it was observed that the formation of two groups composed of seven and eight hospitals, that is, Groups II and IV shows that these groups reflect similarities with respect to the scores and importance of the variables for both hospitals' groups.

RESEARCH LIMITATIONS/IMPLICATIONS

Among the main limitations it was observed that there was incomplete data for some HUFs, which made it impossible to search for information to explain and better contextualize certain aspects. More specifically, a limited number of hospitals with complete information were dealt with for 60% of SIMEC/REHUF performance indicators.

PRACTICAL IMPLICATIONS

The use of PCA multivariate technique was of great contribution to the contextualization of the performance and productivity of homogeneous and autonomous units represented by the hospitals. It was possible to generate a large quantity of information in order to contribute with assumptions to complement the decision-making processes in these organizations.

SOCIAL IMPLICATIONS

Development of public policies with emphasis on hospitals linked to teaching centers represented by university hospitals. This also involved the projection of improvements in the reach of the efficiency of the services of assistance to the public health, from the qualified formation of professionals, both to academy, as to clinical practice.

ORIGINALITY/VALUE

The originality of this paper for the scenarios of the Brazilian public health sector and academic area involved the application of a consolidated performance analysis technique, that is, PCA, obtaining a rich work in relation to the extensive exploitation of techniques to support decision-making processes. In addition, the sequence and the way in which the content, formed by object of study and techniques, has been organized, generates a particular scenario for the measurement of performance in hospital organizations.

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

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

Assessment of satisfaction with a healthy life center, a new service model

Background

Healthy Life Centers have recently been added to Turkey's health system as a new service model.

Aim

This study aims to determine the level of satisfaction among service receivers with a Healthy Life Center by comparing their expectations at the application stage with their perception after receiving service, via the Servqual service quality measurement model.

Subjects and Methods

This descriptive and cross-sectional study was conducted in a Healthy Life Center in Kırklareli City in Turkey. Four hundred and thirty-two participants were included in the survey. In our study, the Servqual scale developed by A. Parasuraman, V. A. Zeithaml, and L. L. Berry and a reliability assessment of the Turkish form performed by Devebakan were used.

Results

The Tangibles dimension got the lowest (-0.68 ± 1.04) and the Empathy dimension got the highest (-0.02 ± 0.84) Servqual dimension score among all the dimensions of the scale. The overall Servqual scale score was computed as -0.27 ± 0.63 and there was a statistically significant difference between expectations and perceptions (<0.001).

Conclusions

Satisfaction from a healthy life center which is built as a new service model is not at the expected level yet. More studies like this one which is a first in its field in terms of methodology will set the ground for a better understanding of the service receivers' expectations and perceptions. That is how the decision-makers can shape up this new service model according to expectations.

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.

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.

Development and validation of a scale for measuring hospital service quality: a dyadic approach

Purpose

This study integrates the providers' perspective as well as the patient's perspective in developing and validating a scale to measure hospital service quality in multispecialty hospitals.

Design/methodology/approach

An exploratory sequential mixed-method approach was used in this study. The strategies used included a thematic literature review, semi-structured interviews, modified Delphi and confirmatory factor analysis.

Findings

The reliability coefficient of 41 item scale was 0.963 with each attribute, that is, pivotal, core and peripheral, having a Cronbach's alpha of 0.907, 0.91 and 0.891, with scale content validity (S-CVI Ave) of 0.9151. The composite reliability scores of all constructs were greater than 0.7, with an Average Variance Explained (AVE) of all items greater than 0.5.

Originality/value

The instrument can be used to measure the difference between what service providers believe customers expect and customers’ actual needs and expectations. The scale can be used to measure the difference between what is delivered (as perceived by the provider) and what customers perceive they have received (because they are unable to accurately evaluate service quality). The dyadic approach of administering this questionnaire in measuring hospital service quality will lead to the identification of a knowledge gap and a perception gap in delivering hospital service quality.

Patient-centered communication: an extension of the HCAHPS survey

Purpose

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) has been recognized as a “gold standard” set of “practical standardized measures” for assessing hospital service quality. Beginning with the HCAHPS, the purpose of this paper is to extend efforts to assess patient-centered communication (PCC) and the quality of healthcare and presents a scale for measuring patient perceptions and expectations of service quality in an emerging economy context.

Design/methodology/approach

A self-administered survey of patients in private hospitals (N = 171) was conducted to test the proposed framework. Exploratory and confirmatory factor analyses were used to establish the measurement model. Multiple regression analysis was used to explain the scale's predictive ability. ANOVA was used to analyze service quality gaps and rank patients' priorities.

Findings

Five components of PCC are identified. Among these, nurse affective communication has a significant positive effect on patient satisfaction. The gap analysis shows that patients have high expectations for doctors' affective communication, while they perceive a low level of service performance in the realm of nurse affective communication. The study highlights a new means of measuring “reliability” in healthcare. Important findings on patients' priorities are evaluated and discussed.

Practical implications

Healthcare organizations and practitioners can improve patient-centered care by stressing the dimensions of PCC, including clinicians' affective and instrumental communication.

Originality/value

The study expands the understanding of HCAHPS instruments in an emerging economy context and opens avenues for more widespread use of the measures. The research contributes to the literature on patient-centered care and healthcare service quality by proposing a scale for managing specific practices and interactions in healthcare.