Hospital healthcare service quality, patient satisfaction and loyalty

Nurses' perceptions of job security and performance: A comparative study between governmental and private hospitals

AIM

Job security and performance are crucial needs for nurses, greatly influencing their motivation and commitment to work. This study seeks to examine Jordanian nurses' perceptions of job security and employee performance and to compare these factors between government and private hospitals.

DESIGN

A descriptive, comparative cross-sectional design was used for the study.

METHODS

The study was conducted in two government and two private hospitals. A total of 156 nurses were conveniently sampled to participate. Data were collected using the Job Security Questionnaire and the Six-Dimension Scale of Nursing Performance.

RESULTS

The mean job security score was 3.26, indicating a moderate level of job security. The mean employee performance score was 2.68, reflecting a high level of job performance. Nurses in private hospitals had significantly higher scores in both job security (t =  -5.53, p <  0.001) and employee performance (M =  2.53, SD ±  0.53) compared to nurses in government hospitals.

CONCLUSION

Nurses with moderate job security levels achieved high job performance scores. Private hospitals demonstrated higher job security and employee performance levels than government hospitals. Future research could investigate specific aspects of the Jordanian nursing work environment that may contribute to the differences observed in job security and employee performance.

Antecedents of Patient Loyalty: Exploring Mediating and Moderating Paradigms in Public Hospitals

Purpose

Countries around the world acknowledge the vital role of effective healthcare services in fostering economic, social, and human development. Consequently, many are striving to enhance their medical facilities. This study specifically examines public hospitals in Pakistan and aims to create a framework for evaluating patient loyalty.

Methods

Responses from 650 patients were collected using a random sampling technique. The gathered data were analyzed using the Statistical Program for Social Sciences (SPSS) and Analysis of Moment Structures (AMOS).

Results

The analysis revealed significant relationships among administrative procedures, service effectiveness, patient satisfaction, and loyalty. Additionally, the study identified patient satisfaction and administrative procedures as mediators between service effectiveness and patient loyalty. It also investigated the moderating roles of participative leadership and brand image in shaping administrative procedures, patient satisfaction, and patient loyalty.

Conclusion

These findings offer valuable insights for healthcare authorities in formulating strategies to improve service delivery in public hospitals. Addressing existing deficiencies and enhancing healthcare systems is essential to fostering patient loyalty in these environments.

Characteristics of the Competency Ethical Principles for the Nurse Manager: A Systematic Review

Background: The escalating complexity of healthcare environments underscores the importance of nurse managers' ethical competency, which impacts organizational culture, work climate, and healthcare outcomes. Objective: The purposes of this study were to identify and describe the characteristics of nurse managers' competency in ethical principles in healthcare settings. Methods: A systematic search was conducted across the Web of Science, Scopus, and PubMed databases, covering the literature from January 1, 2014, to April 1, 2024. Articles were selected based on specific inclusion criteria, and data were extracted and analyzed using a frequency analysis of the identified characteristics. This systematic review adhered to the PRISMA guidelines and the Joanna Briggs Institute assessment tools. The review protocol was registered in PROSPERO (ID: CRD42024542594). Results: The review analyzed 22 studies, each focusing on nurse managers and their ethical competencies. Fourteen distinct characteristics of ethical competency were identified, with ethical leadership, ethical decision-making, and conflict resolution being the most prominent. Key ethical problems included conflicts between personal values and organizational policies, pressures to compromise ethical standards, and management of limited resources. These problems often led to significant consequences such as decreased staff morale, increased stress and burnout, and compromised patient care quality. Conclusions: The development of ethical leadership and the ability to make ethical decisions are fundamental for nurse managers to create supportive work environments and reduce burnout. Promoting continuous professional development and fostering an ethical culture is essential for maintaining high ethical standards. Future research should explore how cultural, organizational, and environmental differences influence ethical decision making and leadership. Implications for the Nursing Management: The development of ethical leadership and the ability to make ethical decisions are fundamental characteristics of ethical principles competency, as they facilitate the achievement of an adequate work environment and reduce burnout and emotional overload.

Patients' loyalty to primary care institutions and associated factors in China: a cross-sectional study

OBJECTIVES

This study aimed to examine patients' loyalty and explore some associated factors among PCIs in this country.

METHODS

A multistage stratified random sampling method was employed to collect data for this study. A structured self-administered questionnaire was distributed to 2,697 patients who had ever involved in seeking healthcare from PCIs across China between July and September in 2021. The Patients' Loyalty Scale (PLS) was measured with a 7-item scale. Group differences of PLS scores were estimated by the t-tests or ANOVA analysis. Stepwise regression analysis was used to identify the factors associated with patients' loyalty to PCIs.

RESULTS

Based on the PLS with a total score of 35, the average score of patients' loyalty was 23.81 (SD = 5.42). Multiple linear regression analysis indicated that respondents who were female (β = 0.502), older (β = 0.040), married (β = 0.568), with bachelor degree (β = 0.481), with more than three family members (β = 0.510), employees of enterprises and institutions (β = 1.079), with better self-reported health status (β = 1.938), or a moderate level of self-reported health status (β = 1.510), without a family doctor contract (β = 0.625), with willingness for medical treatment from PCIs (β = 1.172), with higher patients' trust (β = 0.311) or with higher patients' satisfaction (β = 0.368) reported a higher level of loyalty.

CONCLUSION

Patients' loyalty among PCIs was found to be above average in China. Gender, age, marital status, education level, occupation, health status, number of family members, family doctor contract, patients' trust, patients' satisfaction, and willingness to obtain medical treatment from PCIs were significant predictors of patients' loyalty.

Exploring patients' perspectives on healthcare service quality in outpatient settings at a public hospital in Palembang, Indonesia: A qualitative study

Background

In recent decades, the service sector has become a crucial driver of economic growth globally. However, research highlights the need for implementing a patient-centered design in hospital services and notes the limited literature on patient perceptions of healthcare service quality in Indonesia.

Objective

This study aimed to explore patients' perceptions of healthcare service quality in outpatient settings at a public hospital in Palembang, Indonesia.

Methods

The study employed a qualitative descriptive design, conducting face-to-face, in-depth interviews with 50 outpatients (ages ranging from 34 to 56 years) between October and November 2023. Purposive sampling was used to recruit participants, and thematic analysis was utilized for data analysis.

Results

The following themes emerged regarding patient perspectives on healthcare service quality: patients' perceived service quality, perceived value, satisfaction, and revisit intention. Factors influencing patient perceptions included the appearance of hospital staff, the quality of facilities and equipment, staff responsiveness, knowledge, courtesy, and empathy. Additionally, word-of-mouth significantly impacted patients' perceived value of care. Emotional factors, complaints, and trust were found to be crucial in shaping patient satisfaction, while the patient-provider relationship played a significant role in influencing revisit intention.

Conclusion

The research emphasizes the critical role of building strong patient-provider relationships to enhance overall service quality. It highlights the need for healthcare providers and nurses to focus on improving patient engagement and understanding how perceived service quality affects patient loyalty. Strengthening these areas is essential for advancing comfort, safety, and the overall quality of healthcare services.

The role of mental health in the relationship between nursing care satisfaction with nurse-patient relational care in Chinese emergency department nursing

BACKGROUND

The relationship between a nurse and a patient is a key part of nursing that can impact how happy the patient is with the care they receive. It appears that the nurse's mental health can also affect this connection. However, there is little research on this topic. So, the aim of the present study was to determine the correlation of nurse's mental health with nurse-patient relational care and nursing care satisfaction.

METHODS

A total of 532 nurses and 532 patients from 13 Level-III hospitals of Hubei province (China) completed a China Mental Health Survey, general information questionnaire, the Nursing Care Satisfaction Scale, and Relational Care Scale.

RESULTS

Age, nurse working years, and night shift last month were correlated with mental health score (r = -0.142, r = -0.150, r = 0.164, p < 0.05). Nurse's mental health was correlated with relational care score and nursing care satisfaction score (r = -0.177, r = -0.325, p < 0.05). Also, relational care score, patients age and gender were correlated with nursing care satisfaction score (r = 0.584 and r = 0.143, x2 = 11.636, p < 0.05). Descriptive information of nurses had a direct impact on nurses' mental health (direct effect = 0.612, 0.419-0.713). Nurses' mental health had a direct effect on relational care score (direct effect = 0.493, 0.298-0.428) and an indirect effect on nursing care satisfaction score (indirect effect = 0.051, 0.032-0.074). Relational care score and patient's descriptive information had also a direct effect on nursing care satisfaction score (direct effect = 0.232, 0.057-0.172 and 0.057, 0.347-0.493).

CONCLUSION

This study showed that the better the mental health of nurses, the more patients feel satisfied with nursing services.

Ophthalmology Practice-Related Factors and Patient Loyalty: Mediating Role of Patient Satisfaction

Background

In the current period, competition among the healthcare sector has increased and healthcare providers try to get loyalty and satisfy the patients by establishing different strategies.

Purpose

: This current study aims to discover ophthalmology practice-related factors and patient loyalty and to analyze the mediating role of patient satisfaction in private ophthalmology services in various private centers in the Kingdom of Saudi Arabia.

Methods

: The nature of the study is quantitative, and data is collected with a questionnaire. We used a pre-tested questionnaire that was divided into different sections assessing ophthalmology practice-related factors, patient satisfaction, and patient loyalty. These were measured using a 5-point Likert scale, focusing on financial aspects, access to facilities, staff services, and ophthalmologist services. Further, the smartPLS technique was used to extract the results by using SmartPLS.

Results

: The analysis sample size consisted of 323 participants from Saudi Arabia. The results found that ophthalmologist service has a positive relationship with patient satisfaction (β= 0.369, p = 0.000) as well as patient loyalty (β= 0.234, p = 0.004), but there are some ophthalmology practice-related factors such as financial aspects, access and facilities, and staff service, which showed no relationship with patient loyalty but a positive relationship with patient satisfaction. Further analysis found that patient satisfaction as a mediator has a positive relationship between ophthalmology practice-related factors, namely, ophthalmologist service (β= 0.228, P= 0.000), financial aspects (β= 0.102, p = 0.019), access and facilities (β= 0.109, p =0.000), and staff service (β= 0.188, p = 0.000) with patient loyalty.

Conclusion

: The present study findings reveal the importance of focused patient satisfaction improvements in enhancing patient loyalty within ophthalmological clinic settings in Saudi Arabia. Furthermore, we recommend future exploratory prospective research to find the satisfaction and loyalty factors that change over a period of time.

Hospital Patient Satisfaction With Nursing Care in Saudi Arabia

Introduction Patient satisfaction is a critical indicator of health care quality, yet research exploring patient satisfaction with nursing care in Saudi Arabia (SA) remains limited. This study investigated patients' satisfaction with nursing care quality during their hospitalization in SA. Material and methods A cross-sectional study was conducted using a convenience sample of 746 patients from five hospitals in five different regions of SA. Data were collected using the Newcastle Satisfaction With Nursing Scale (NSMS), which has been shown to be valid and reliable. Results The average overall patient satisfaction with nursing care was 71.16 ± 13.51 out of 95 (75.96%), indicating a high level of satisfaction with the nursing care the patients received. The highest-scoring items of patient satisfaction were the nurses' manners when carrying out their duties, the amount of privacy the nurses provided and their capability to perform their jobs. However, the level of satisfaction regarding the frequency of nurse check-ins, time spent with patients, and support provided to patients' relatives indicated areas for potential improvement. Also, patients with primary education who were divorced or married and those admitted to the gynecology ward were more satisfied with nursing care. Conclusion This study's findings indicate that the patients were highly satisfied with the care their nurses provided, although opportunities for improvement in some areas of nursing care were identified. These findings may encourage nurses to be more attentive in meeting their patients' needs according to best nursing practices. It is recommended that hospital administrators prioritize initiatives to enhance the quality of nursing care, thereby improving overall patient satisfaction.

Examining Soft and Hard Attributes of Health Care Service Quality and Their Impacts on Patient Satisfaction and Loyalty

BACKGROUND AND OBJECTIVES

Many studies have confirmed the influences of various service quality dimensions on patient satisfaction and loyalty, but no existing theoretical model accounts for variation in how different types of patients evaluate service quality's soft and hard attributes. This research gap may cause problems for administrators needing to decide how to distribute resources appropriately across multiple departments. Therefore, this study establishes a theoretical model of the differences between inpatients' and outpatients' evaluations of hard and soft qualities and compares such evaluations' influences on patient satisfaction and loyalty. Also, to supplement statistical analysis and respond to scholars' calls for more mixed-methods studies of health care quality, this research incorporates analysis of online reviews to provide a holistic, close to real-time picture of patients' service experience perceptions.

METHODS

This study's survey sample comprised 292 inpatients and 137 outpatients from a Taiwanese hospital. We used partial least squares structural equation modeling to test the hypothetical model and importance-performance map analysis to identify factors that were significant to the service process but performed poorly. Finally, we used a text-mining technique to scrape 536 reviews posted on Google Maps, and Leximancer Portal to perform automated content and sentiment analyses on those data, as a means of mapping the critical concepts and themes that influenced patient experiences.

RESULTS

This study's analyses support the ideas that both hard and soft qualities are critical dimensions of service quality, and that each has different influences on inpatients' and outpatients' satisfaction and loyalty. Specifically, the sampled inpatients strongly valued the hard qualities of the hospital but were not satisfied with it. On the other hand, soft qualities attracted outpatients' attention and influenced their satisfaction and loyalty. In addition, content analysis revealed that soft qualities were the main reason patients left comments, whether positive or negative. Waiting time emerged as another critical element in triggering patients' unfavorable reviews.

CONCLUSIONS

Patient population type, whether inpatient or outpatient, has been found to impact perceptions of service quality within health care institutions. As such, health care administrators should be cognizant of this phenomenon and make informed and tailored decisions when addressing quality within their respective services. Emphasis on the development of both interpersonal and professional skills among health care personnel may prove beneficial in enhancing the patient experience and ultimately fostering positive online reviews.

The Delivery Model of Perceived Medical Service Quality Based on Donabedian's Framework

ABSTRACT

The implementation of the National Health Insurance has transformed the medical care landscape in Taiwan, rendering perceived medical service quality (PMSQ) and patient satisfaction significant focal points in medical care management. Past studies mostly focused on the technical aspects of medical care services, while overlooking the patients' perception of services and the delivery process of PMSQ in the medical care experience. This study integrated the theoretical framework of the Donabedian SPO model and the SERVQUAL questionnaire. The survey was conducted among the outpatients of three types of medical institutions in northern Taiwan: academic medical centers, metropolitan hospitals, and local community hospitals. A total of 400 questionnaires were collected, and 315 valid questionnaires remained after eliminating the incomplete ones. This study established a PMSQ delivery model to explore patients' perceptions of medical service quality. It was found that the variable, Assurance, could deliver the PMSQ and enhance the Medical outcome (MO), while improving the variable, Tangible, in medical institutions could not significantly enhance the MO. These findings emphasize the importance of healthcare institutions prioritizing the professional background, demeanor of their healthcare staff, treatment methods, and processes over tangible elements.

Can Positive Emotions Predict Consumer Satisfaction in Adverse Services?

Background

Managing emotions during hospital visits is important to enhance patient satisfaction. The purpose of this paper is to explore the relationship between patients' happiness and satisfaction through patients' mood and perceived service quality at a healthcare setup.

Methods

This study was conducted in a tertiary care hospital located in coastal Karnataka during the period from November to December 2021. Primary data was collected through a structured questionnaire from 227 respondents. "Statistical Package for the Social Sciences (SPSS) 27.0" and "SmartPLS 3.0" software was used for data analysis.

Results

Hypotheses proposed in this study were examined by comparing the direct effect of patients' happiness level on perceived service quality and the indirect effect of the level of patients' happiness on patient satisfaction. The influence of all the exogenous latent variables namely, happiness, mood, perceived service quality, on the endogenous latent variable of patient satisfaction is estimated to be moderate (R 2=62.5%).

Conclusion

This study empowers hospital managers to recognize how patient satisfaction is dependent on patients' happiness. In order to enhance patient satisfaction, the quality of care provided by health services, human resources, and infrastructure must be improved. As a result, the entire service encounter can be made enjoyable to the customers by reducing the distress caused by adverse services. Managers can utilize the outcomes of the study to develop marketing strategies to influence patients' emotions in the healthcare setup by modifying the servicescape elements.

Patient satisfaction and associated factors among insured and uninsured patients in Deder General Hospital, eastern Ethiopia: a facility-based comparative cross-sectional study

Background

Patient satisfaction is a crucial measure of healthcare quality, as dissatisfied patients are more likely to miss appointments, disregard treatment plans, and leave hospitals, leading to poor treatment outcomes. Therefore, the study aimed to compare levels of satisfaction with health services and associated factors among insured and uninsured patients in Deder General Hospital, eastern Ethiopia.

Methods

A comparative cross-sectional study with 532 participants was conducted from December 1-30, 2021. Data was collected through a structured questionnaire, analyzed using SPSS, and predictors assessed using a multivariate logistic regression model. Statistical significance was set at p < 0.05.

Results

Overall, patient satisfaction with health services was 65.6% (95% CI: 61.5-69.5), and the level of patient satisfaction with health services among insured and noninsured patients was 68.8% (95% CI: 62.8-74.4) and 62.4% (95% CI: 56.8-68.0), respectively. In the final model of multivariable analysis, factors such as educational status of secondary school (AOR = 4.90; 95% CI: 2.05-11.76), and a higher level (AOR = 3.08; 95% CI: 1.05-9.03), getting the entire prescribed drugs (AOR = 3.49; 95% CI: 1.43-8.54), getting some of the ordered drugs (AOR = 3.34; 95% CI: 1.61-6.94), paying less than 100 Ethiopian birrs (AOR = 4.85; 1.35-17.40) were significantly associated with patient satisfaction among insured patients. Whereas getting the entire and some prescribed drugs were (AOR = 6.28; 95% CI: 3.26-12.05), and (AOR = 3.40; 95% CI: 1.70-6.78) times more likely to be satisfied with the service among noninsured patients as compared to their counterparts, respectively.

Conclusion

The study found that about six in 10 patients in the study area were satisfied with healthcare services, with insurance patients reporting higher satisfaction. Factors such as receiving prescribed drugs, paying less than 100 Ethiopian birr, having a secondary school education, and having a higher education were associated with satisfaction.

Ethical Leadership in LTC: From Caregivers' Customer Orientation to Senior's Satisfaction and Well-Being

Background

In response to the growth of the world's senior population, an investigation of ethical leadership on LTCs is needed, in particular in the impact it may have on customer orientation and on seniors' well-being.

Objective

We propose a model to identify the relationship between ethical leadership in LTCs and caregivers' customer orientation, and its influence on satisfaction with the service, satisfaction with life, and the quality of the interaction between caregivers and seniors.

Sampling

We present a matched sample of 277 caregivers and 277 elderly Brazilians, workers and seniors' in LTCs in Brazil. The minimum sample size was 222, determined using G-Power software version 3.1.9.2, based on the desired statistical power parameters and the number of predictors. Two structured questionnaires were developed, one for caregivers and the other for the elderly. 69 LTCs were contacted and 29 participated in the survey (10 nonprofit, 34.48%). Data were treated statistically using SEM modelling.

Results

We identified a positive influence of ethical leadership on caregivers' attitudes, favoring their orientation towards the seniors'. A positive relationship between customer-oriented caregivers and customer satisfaction, life satisfaction, and the quality of the senior's interaction. A customer-oriented caregiver exerts a mediating effect between ethical leadership and the seniors' related outcomes, making ethical leadership beneficial to seniors and their family members.

Conclusion

Ethical leadership favors successful management of LTCs, increasing customer orientation, and provides clues to establish a better causality and a chain of effects between leadership and senior-related outcomes. Therefore, LTCs may be the appropriate outlet for the role of ethics in leadership.

Practical Implications

This study provides managers with an understanding of the effects of ethical leadership in the context of LTCs, for both caregivers and seniors. The powerful effects of ethical leadership can be a stimulus to increase the role of ethics in LTCs, improving the quality of care, the well-being of the seniors, and, therefore, the human and financial performance of these institutions.

Effects of Servicescapes on Interaction Quality, Service Quality, and Behavioral Intention in a Healthcare Setting

This study develops a conceptual framework that encompasses servicescapes and customer perceptions and behaviors, and conducts an empirical investigation of healthcare service facilities. Structural equation modeling is performed using a sample of 271 patients who received treatment within one year at hospitals and clinics located in the metropolitan area of Seoul, South Korea. The results of the empirical analysis show that service quality improvements and patient revisits to healthcare facilities can be induced through servicescape improvements and interaction quality. These results make theoretical contributions to the service management literature and have practical implications for the operations of healthcare facilities.

The Impact of Visual Impairment on Healthcare Use among Four Medical Institution Types: A Nationwide Retrospective Cohort Study in Korea

PURPOSE

The aim of this study was to determine the effect of visual impairment (VI) onset on the use of healthcare services across four types of institutions in South Korea.

MATERIALS AND METHODS

We utilized data from the National Health Insurance Service database from 2006 to 2015 for 714 persons who experienced VI onset in 2009-2012 and for 2856 matched persons for a 1:4 ratio of matching controls. We compared trends in healthcare use and expenditures for eye diseases at clinics, hospitals, general hospitals, and tertiary teaching hospitals using 3 years of data prior to and after the onset of VI.

RESULTS

The inpatient and outpatient healthcare expenditures of individuals with VI were higher than those without VI, peaking at the pre-VI onset period in tertiary teaching hospitals. During the pre-VI onset period, the proportion of healthcare expenditures attributed to eye diseases ranged 11%-40.8% among individuals with VI, but 1.9%-11% among individuals without VI at the four types of institutions. The differences in healthcare use between the pre- and post-VI periods were primarily observed in tertiary teaching hospitals for inpatient care. There was a peak in utilization of outpatient care in the year preceding VI onset at tertiary teaching hospitals, clinics, and hospitals, but there was a decrease in outpatient care over time during the post-VI period.

CONCLUSION

Our findings suggest economic burden of healthcare in tertiary teaching hospitals during pre-VI onset period and a potential lack of regular management and continuity of care in post-VI periods.

Health systems responsiveness towards the Mentor Mother Program for preventing mother-to-child transmission of HIV in military hospitals

AIM

This study explored health systems responsiveness towards the Mentor Mother Program for PMTCT in the Nigeria Department of Defence hospitals. Factors affecting quality service were also highlighted, which gave helpful insights into the strategies employed by stakeholders to ensure that health systems responsiveness was propagated responsibly.

DESIGN

An exploratory qualitative interview study.

METHODS

Six semistructured interviews were conducted with six key informants (three doctors and three nurses) and one focus group session with six Mentor Mothers. Open coding of data was done to formulate themes and subthemes. Thematic analysis was adopted for analysis.

RESULTS

Four themes emerged-Service Quality, Basic Amenities, Patient-oriented Strategies and Factors affecting service Quality. These showcased the nonmedical components of health systems responsiveness and accentuated how well they were utilized to achieve health systems responsiveness.

Corporate social responsibility and patient's intention to revisit: A serial mediation study witnessing the healthcare sector

The present study aims to identify the impact of corporate social responsibility on patients' intention to revisit the healthcare industry. Furthermore, mediating the role of patient satisfaction and patient loyalty along with serial mediation through corporate social responsibility =  > patient satisfaction =  > patient loyalty =  > intention to revisit was also tested. The present study is quantitative in nature, while the data for the study was collected using purposive sampling from 321 patients working in eight hospitals in Rawalpindi and Islamabad, Pakistan. For the data analysis, statistical package for the social sciences (SPSS) and structural equation modeling through the partial least square approach (smart-PLS v 3.3.9) were employed. The study results show that corporate social responsibility forms a significantly positive relationship with patient satisfaction, patient loyalty, and patient intention to revisit. Study findings confirmed the mediating role of patient satisfaction and patient loyalty. Furthermore, serial mediation through patient satisfaction and patient loyalty was also confirmed. In the current competitive environment, understanding the direct and indirect effects of CSR activities on patient satisfaction, patient loyalty, and intentions to revisit is of the utmost importance for hospitals. These activities provide hospitals with the opportunity to take certain actions to improve patient satisfaction, and these actions increase their loyalty, which in turn encourages their intention to revisit.

Robot-delivered tourism and hospitality services: How to evaluate the impact of health and safety considerations on visitors’ satisfaction and loyalty?

Due to the COVID-19 epidemic, visitors’ worries about health and safety in tourist destinations have become paramount. Consequently, this research aims to evaluate the impact of health and safety considerations on visitors’ satisfaction. It also examines the influence of health consciousness and satisfaction on visitors’ willingness toward robot-delivered tourism and hospitality services usage and the impact of destination healthcare system and satisfaction on loyalty intentions. Applying a quantitative-based methodology, 650 responses were collected from domestic tourists visiting Egyptian tourism destinations using multiple non-probability sampling techniques. Using PLS-SEM, the results articulated that emotional well-being, perceived safety, and perceived green image positively impacted visitors’ satisfaction, which in turn, positively affected their willingness toward service robot’s usage and loyalty. Tourists’ health consciousness also positively affected their satisfaction and intentions to use robot-delivered services. Additionally, destination healthcare system significantly influenced visitors’ satisfaction and loyalty intentions. Theoretical and managerial contributions as well as future research are outlined.

The Effect of Service Quality on Patient Citizenship Behaviors: Evidence from the Health Sector

BACKGROUND

Nowadays, health organizations seek to bring innovations to their services to stand out in competition with their rivals by improving service quality (SQ), encouraging patients to always make the same organizational choices, and enhance the behavior of patient citizenship.

OBJECTIVE

This study aims to determine the mediating role of patient satisfaction (PS), patient loyalty (PL), and employee responsiveness (ER) between the service quality and patient citizenship behaviors (PCB).

METHODS

In order to test the proposed hypotheses, quantitative research methods were utilized; cross-sectional data was collected using scales between December 2021 and March 2022. Results were obtained from 422 participants. The data were analyzed using descriptive statistics, correlation, confirmatory factor analysis, and structural equation modeling methods, using AMOS 21.

RESULTS

SQ was found to have a significant and positive effect on PL, PS, and ER. PL, PS, and ER were found to have a significant and positive effect on PCB. The indirect effect of SQ on PCB was found to be positive.

DISCUSSION

The findings demonstrate that SQ does not directly affect or create PCB, but it is affected by the mediators in order to create PCB via satisfaction, loyalty, and employee responsiveness.

Patients' Perception of Patient-Centered Care and Associated Factors Among Patients Admitted in Private and Public Hospitals: A Comparative Cross-Sectional Study

Introduction

The provision of patient-centered care is challenging around the globe, including in Ethiopia. There is a scarcity of information on this issue. Therefore, this study aimed to assess patients' perceptions of patient-centered care and associated factors among patients admitted to public and private hospitals in Bahir Dar city.

Methods

A facility-based comparative cross-sectional study was conducted from May 8-June 15, 2022. Using a multistage sampling approach, the study participants were selected. An interviewer was used to collect the data. Bi-variable and multivariable logistic regressions were used to analyze the data. Statistical significance was declared using a p value< 0.05.

Results

Overall, 53.7% of patients reported poor patient-centered care. And it was higher among public hospitals (66.3%) than private hospitals (40.3%). Length of stay (AOR = 4.2; 95% CI [1.1, 15.3] and AOR = 4.3; 95% CI [1.4, 13]), intimacy with providers (AOR = 2.4; 95% CI [1.2, 4.6] and AOR = 3.9; 95% CI [1.1-9.6]), privacy during care (AOR = 4.2; 95% CI [1.93, 8.9]and AOR=3.3;95% CI: [1.5-7]), easy access to service (AOR=2.76;95% CI [1.33, 5.74] and AOR=3.8;95% CI [1.15, 12.7]) were associated with patient-centered care in public and private hospitals respectively. Awareness of the disease (AOR = 2.3; 95% CI [1.12, 4.8]), information on plans of care (AOR = 4.6; 95% CI [1.9, 10]), and being involved in decisions (AOR = 2.7; 95% CI [1.28, 5.9]) were associated factors in private hospitals. The following factors were associated with the practice of patient-centered care only in public hospitals: residence (AOR = 2.9; 95% CI [1.4, 5.5]), medication information (AOR = 2.88; 95% CI [1.34, 6.2]), and external appearance of hospital (AOR = 2.27; 95% CI [1.04, 4.97]).

Conclusion

This study showed that the practice of patient-centered care in public hospitals was poor compared to that in private hospitals. Hence, hospitals should train their staff regarding a culture of patient-centered care in order to deliver high-quality and safer care.

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.

Quality of Service and its Effect on Patient Value, Patient Satisfaction, and Revisit Intention: Investigation of the Public Health Center in Jambi Province

BACKGROUND: Improving quality of service at the public health center (PHC) is very important to increase patient value, patient satisfaction, and ultimately encourage for behavior intention. AIM: This study aims to analyze the service quality model and its effect on patient value, patient satisfaction, and revisit interest to PHC in Jambi Province. METHODS: A cross-sectional research design was conducted through a survey of 12 PHC in Jambi Province which were selected by multistage random sampling. The research sample was outpatients who were selected using convenience sampling technique. A total of 600 questionnaires were distributed and returned completely. A 4-point Likert scale was used to measure the four variable constructs, namely, service quality, patient value, patient satisfaction, and revisit intention. Data analysis was carried out using partial least squares structural equation model. RESULTS: The study results obtained a construct of variables with valid and reliable indicators, and found five significant influence frameworks, namely, service quality to patient value (β = 0.203), service quality to patient satisfaction (β = 0.429), service quality to revisit intention (β = 0.254), patient value to patient satisfaction (β = 0.156), and patient satisfaction to revisit intention (β = 0.539), while patient value has no effect on revisit intention (β = 0.057). CONCLUSION: This research model is feasible to use in assessing service quality performance to assist PHC management practitioners in developing strategies that are able to encourage positive behavioral intentions to revisit to PHC.

Determinants of Maternal Satisfaction with the Quality of Childbirth Services in a University Hospital in Kumasi, Ghana: A Cross-Sectional Study

Introduction. Rendering quality childbirth services that lead to higher levels of maternal satisfaction is an important goal of every health institution. Despite efforts at enhanced client satisfaction over the years, there are still some quality concerns for health policymakers and managers to address. This study sought to assess maternal satisfaction with childbirth services at a university hospital in Kumasi, Ghana. Methods. We conducted a facility-based cross-sectional study among women in postnatal wards after delivery at the University Hospital, Kwame Nkrumah University of Science and Technology. They were recruited using a systematic sampling method, and their perspective about the quality of childbirth services was assessed using a service quality (SERVQUAL) tool. Linear regression analysis was performed to identify the relationship between SERVQUAL attributes and maternal satisfaction. Statistical significance was set at $p$ value < 0.05 at a 95% confidence interval. Results. Of the 277 participants interviewed, 79.8% (221) were satisfied with the childbirth services. Delays (49.5%), unprofessional conduct from health workers (7.2%), poor facilities (10.8%), and an inadequate number of skilled staff (15.5%) were identified as the challenges mothers encountered at the facility. After adjusting for all the components of the SERVQUAL model, reliability (adjusted $\beta =-3.28$ , $p=0.001$ ) and empathy (adjusted $\beta =2.21$ , $p=0.028$ ) were the most significant predictors of maternal satisfaction with childbirth services. Conclusion. Majority of postnatal women were generally satisfied with the overall childbirth services they received at the University Hospital. The service quality components that significantly predicted maternal satisfaction with childbirth services were “reliability” and “empathy.”

Implementation evaluation of a leadership development intervention for improved family experience in a private paediatric care hospital, Pakistan

Background

A study from a tertiary care center in Pakistan demonstrated that a leadership development intervention led to improved family experience of care outcomes. The objective of the current paper is to assess the implementation of this intervention and identify barriers and facilitators to inform sustainability and scalability.

Methods

A working group designed the intervention using a theory-of-change model to strengthen leadership development to achieve greater employee engagement. The interventions included: i) purpose and vision through purpose-driven leadership skills trainings; ii) engaging managers via on-the-job mentorship programme for managers, iii) employee voice i.e., facilitation of upward communication to hear the employees using Facebook group and subsequently inviting them to lead quality improvement (QI) projects; and iv) demonstrating integrity by streamlining actions taken based on routine patient experience data. Implementation outcomes included acceptability, adoption, fidelity across degree & quality of execution and facilitators & barriers to the implementation. Data analyzed included project documentation records and posts on the Facebook group.

Analysis indicated acceptability and adoption of the intervention by the employees as178 applications for different QI projects were received. Leadership sessions were delivered to 455 (75%) of the employees and social media communication was effective to engage employees. However, mentorship package was not rolled out nor the streamlined processes for action on patient experience data achieved the desired fidelity. Only 6 QI projects were sustained for at least a year out of the 18 approved by the working group. Facilitators included leadership involvement, real-time recognition and feedback and value-creation through participation by national and international celebrities. Challenges identified were the short length of the intervention and incentives not being institutionalized.

The authors conclude that leadership development through short training sessions and on-going communications facilitated by social media were the key processes that helped achieve the outcomes. However, a long-term strategy is needed for individual managerial behaviours to sustain.

Hamid AB. Strategies to improve patient loyalty and medication adherence in Syrian healthcare setting: The mediating role of patient satisfaction

The purpose of this study is to empirically examine the relationships between service quality, patient satisfaction, patient loyalty and medication adherence in the Syrian healthcare setting from a patient's perspective. Based on random sampling technique, data collection was conducted in six hospitals located in the Syrian capital Damascus. The reliability and validity of the theoretical model had been confirmed using quantitative analyses SmartPLS software. The study indicated that our proposed model can significantly explain (35) per cent of patient satisfaction, (55) per cent of patient loyalty and (46) per cent medication adherence in a statistically manner. Our results highlighted that patient satisfaction mediated the relationship between patient loyalty and service quality (assurance, reliability and financial aspect). Besides, patient satisfaction had mediation effect on the relationship between medication adherence and service quality (reliability and financial aspect). Financial aspect had the highest impact on patient satisfaction (β = 0.242) and medication adherence (β = 0.302). In addition, reliability was the only dimension of service quality that had a significant direct impact on patient satisfaction, patient loyalty and medication adherence. To increase patient loyalty in Syrian hospitals, healthcare professionals should place a greater emphasis on the reliability and responsiveness elements of service quality. To the author's knowledge, this is the first study conducted during the COVID pandemic to evaluate the mediating role of patient satisfaction in the relationship between service quality, patient loyalty and medication adherence in the Syrian healthcare sector.

Antecedents, Consequences, and the Role of Third Parties in the Trust Repair Process: Evidence Taken from Orthodontics

Orthodontic treatment has popularized in Taiwan. Healthcare institutions can be responsive in their coping strategies and determine whether third-party intervention should take place involving medical disputes related to orthodontics in order to repair patient trust. This study draws on orthodontic treatment to explore the effect of various trust repair strategies employed by healthcare institutions and third-party involvement positively affecting outcomes related to trust repair. Patients were recruited among those who have undergone orthodontic treatments, and 353 valid scenario-based questionnaires were collected through an online survey. Results revealed that: (1) the affective and informational repair strategies positively impacted trust repair while the functional repair strategy did not; (2) trust repair positively impacted patient satisfaction/word-of-mouth and mediated between repair strategies and satisfaction/word-of-mouth; and (3) third-party involvement moderated the relationship between trust repair and word-of-mouth. The findings suggest that rather than receiving monetary compensation, patients usually prefer that healthcare institutions acknowledge their fault, offer apologies, and engage in active communications to clarify the causes of medical dispute. Further, an objective third party should be involved to mediate the medical disputes to afford satisfaction all around.

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.

Antecedents of Patient Satisfaction in Private Clinical Laboratories toward Patient Loyalty with Switching Cost and Location as Moderating Factors (An Empirical Study from Indonesia)

BACKGROUND: Clinical laboratory services are at the forefront to support healthcare services, particularly during the pandemic of COVID-19. The increasing number of private clinical laboratories at present days indicates the increase in patient needs, causing the healthcare service provider to face challenges as people have more options. Therefore fostering patient loyalty (PL) is a crucial success factor for the business growth of clinical laboratories as healthcare providers.   AIM: The purpose of this study is to analyse antecedents of patient satisfaction (PS) in clinical laboratories towards PL with the switching cost (SC) and location (LO) as moderating factors. METHODS: This study was done as a quantitative survey, and data were obtained by a cross-sectional approach with partial least squares structural equation modeling (PLS-SEM) for the data analysis method. There are 266 respondents eligible as samples, who undergo the phlebotomy process in a private laboratory located within a specific area. RESULTS:  This study demonstrated that all the 9 hypotheses supported with α: 0.05 and p < 0.05, include 6 independent variables named administrative process (AP), information availability (IA), the environment in the phlebotomy room (ER), phlebotomy process (PP), waiting time (WT) and result notification (RN) that influence PS. Patient satisfaction has been shown to have a direct effect on patient loyalty and also mediate the antecedents. Furthermore, SC and LO have demonstrated a significant effect to moderate this relationship. CONCLUSIONS: Patient satisfaction has been confirmed as the main construct to predict PL whereas the AP is the most important independent variable followed by IA. Clinical laboratory management should pay more attention to these antecedents in order to ensure PS and retain the clinic’s patients. The cost from the patient's perspective should be taken into account since this helps the clinical laboratory keep the patient loyal.

A Systematic Review on Hospital’s Patient Satisfaction and Loyalty in Indonesia

Background: Customer loyalty is identified as a critical component of a company's success and profitability including in hospitals. Customer loyalty can only be accomplished if the company can provide high-quality services. The purpose of this study was to understand the influence or factors behind patient loyalty. Methods: Systematic literature review methods were used to process articles found in various journals and databases such as Elsevier, NCBI, Lancet, Springer, Nature, Taylor and Francis, ProQuest, Emerald, JSTOR, Web of Science, and GARUDA SINTA (the Science and Technology Index of expertise in Indonesia).  Results: The initial search resulted in 1.174 (1 duplicated) and 1.173 were screened based on title and abstract. Finally, 29 articles were included for review regarding inclusion and exclusion criteria. The finding shows that concern for medical staff, perceived value, price, trust, treatment effectiveness, Service Quality, Interaction, Infrastructure, Process, and brand image, consequently affect patient satisfaction and loyalty. Those factors as an intervening variable in patient loyalty. Conclusion: In general, hospital health workers' competency, tangible factors (facilities), communication, punctuality in work (responsiveness), patient waiting time (facility satisfaction and responsiveness), queuing system, drug availability (price factor, facility satisfaction), providing information to clients (trust and communication, guarantees), equal treatment for uninsured patients, and complaint system for clients (Hospital Image) impact patient loyalty directly or indirectly.

Patient satisfaction and its health provider-related determinants in primary health facilities in rural China

Background

Patient satisfaction is an important outcome measure of health service and is one of the main reasons for the gradual deterioration of doctor–patient relationships in China. This study used the standardized patient (SP) method to explore patient satisfaction and its health provider-related determinants among primary health facilities in rural China.

Methods

The dataset comprised 1138 clinic cases in 728 rural primary health facilities in 31 counties, spread across four provinces. Information regarding the consultation interaction between the unannounced SPs and primary physicians was recorded. Patient satisfaction was gathered from the feedback of SPs after the visit.

Results

The overall average score of SP satisfaction with rural primary health facilities was only 13.65 (SD = 3.22) out of 20. The SP scores were found to be consistent with those of real patients. After controlling variances in patient population via the SP method, the regression analysis demonstrated that health provider-related factors, such as physician-level characteristics, consultation process, affordability, and convenience, have a significant correlation with patient satisfaction among primary physicians. Among factors relating to physician-level characteristics, affordability, convenience and the consultation process of the visit, the quality of the consultation process (e.g., consultation time, proactively providing necessary instructions and other crucial information) were found to be the prominent determinants.

Conclusions

This study revealed the need to improve patient satisfaction in primary health facilities in rural China. To solve this issue, we recommend that policies to increase medical service quality be implemented in rural primary healthcare systems.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08349-9.

Consumer or Patient Determinants of Hospital Brand Equity-A Systematic Literature Review

The purpose of this study was to analyze consumer or patient determinants of hospital brand equity (HBE) based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement. A search of six databases: Scopus, Web of Sciences, PubMed, Google Scholar, Ebsco, and Elsevier was conducted. A search for studies published up to January 2022 was performed between 15 February and 5 March 2022. Article type, peer-reviewed papers, and studies based on empirical research were used as inclusion criteria. Non-English language papers, dissertations, short reports, works in progress, conference publications, and book chapters were excluded. As a result, a final set of 32 studies were selected for the analysis. Three research questions were formulated on the main determinants of HBE, brand-related factors, and specific medical-related factors. The studies included in the systematic literature review were analyzed in three areas: study description, key findings, and practical recommendations. Among the traditional HBE factors, brand loyalty has been analyzed most often, and the following have also been studied: perceived quality, brand associations, brand awareness, and brand image. Patient satisfaction, service quality, perception of the treatment process, and the work of medical staff were found to be specific medical-related factors. Other factors related to the management process, brand, and patients were also identified. It was noted that the number and variety of medical and other determinants of HBE have increased in recent years. The results of this systematic literature review are relevant to the analysis of consumer/patient behavior in choosing a hospital or other health care facility as they provide a deeper understanding of the increasingly differentiated needs of patients and the way in which the quality of health care services is evaluated.

Patterns of Outpatient Service Satisfaction among Low-Income Adults in Rural China: A Latent Class Analysis

(1) Background: Low-income rural residents in China are disadvantaged due to their financial vulnerability and insufficient access to resources, and this situation demands more research effort. This study examined the pattern of outpatient service satisfaction and its determinants among low-income adults in rural China. (2) Methods: Rural low-income respondents who used outpatient services in their local healthcare facilities in Jiangsu, China evaluated the access, cost, environment, doctor–patient interaction, and other topics during their outpatient visit (N = 662). Latent class analysis was used to identify the groups characterized by various dimensions of outpatient satisfaction. Multinomial logistic regression explored the determinants of class membership. (3) Results: Three latent classes were identified: 28.70% had low satisfaction, unsatisfied with every dimension; 20.69% reported medium satisfaction that valued doctor–patient relationships; and 50.60% had high satisfaction but thought that costs were high. Both low and medium satisfaction were associated with a higher proportion of self-paid fees. (4) Conclusions: Healthcare costs were an important determinant of outpatient service satisfaction. Medical social workers are suggested to be included in the medical team to help patients identify financial assistance. Special aid programs may be developed to help relieve rural low-income patients’ medical cost-related burden.

What Quality of Care Means? Exploring Clinical Nurses’ Perceptions on the Concept of Quality Care: A Qualitative Study

Quality is a multidimensional issue involving various features that depend on service performance and personal assessment. Clarifying the concept of quality is essential in order to further facilitate the understanding and improvement of quality in healthcare. The purpose of this study was to investigate how clinical nurses, providing care to adult medical patients, perceive and define the concept of quality nursing care. A descriptive qualitative research design was applied. A purposive sampling strategy was used to recruit nurses from the clinical sector of a general public hospital in Athens, Greece. Ten female nurses from the medical sector participated the study. Data collection was conducted through in-depth, semi-structured interviews. Conventional content analysis was used to analyze the verbatim data. Four categories were revealed from the data analysis, namely: (a) “Quality care is holistic care”, (b) “Good care is an interpersonal issue”, (c) “Leadership is crucial”, and (d) “Best care is our responsibility”. Quality care was defined as holistic care, addressing all patient needs with competency and aiming for the best patient outcomes. It was associated with communication, teamwork, good leadership, and personal commitment. By developing an in-depth and mutual understanding about what quality means, nurse leaders and practitioners may collaborate in finding common paths to support quality interventions and enhance quality nursing care in clinical practice.

Impacts of service quality, brand image, and perceived value on outpatient's loyalty to China's private dental clinics with service satisfaction as a mediator

BACKGROUND

This study explores the effects and influence paths of service quality, brand image, perceived value, and service satisfaction on outpatients' loyalty to China's private dental clinics.

METHODS

A cross-sectional survey study was conducted in Dongguan City, Guangdong Province, China in January 2019. The participants were selected using the convenience sampling method. Of the 230 residents surveyed, 125 had received services in private dental clinics, being the valid sample of this study. A multiple linear regression model was used in exploring factors influencing patient loyalty. Subsequently, the path analysis was used in investigating the relationships among service quality, brand image, perceived value, patient satisfaction, and patient loyalty.

RESULTS

After the effects of demographic and socioeconomic variables were controlled, perceived value and patient satisfaction showed significant influences on patient loyalty. Path analysis indicated that perceived value, perceived quality, and expected quality have direct effects on patient satisfaction and have indirect effects on patient loyalty, and patient satisfaction is a mediator.

CONCLUSION

Perceived service quality influences patient loyalty through the effect of patient satisfaction, which plays a key role in promoting patient loyalty. This study implies that managers in private dental clinics can gain support from customers by building customer loyalty toward dental clinics.

Exploring the Relationship Between Hospital Service Quality, Patient Trust, and Loyalty From a Service Encounter Perspective in Elderly With Chronic Diseases

Based on the service encounter perspective, this study combines theoretical foundations for such factors as service quality and the characteristics of the hospital service industry to develop a research model scale to investigate whether the quality of hospital services affects patients' perceptions of health service encounters, trust, and loyalty. Nowadays, with the advancement of medical technology, patients pay more attention to the quality of medical services and good service encounters provided by healthcare professionals in order to establish positive patient relationships; hospitals need to improve their own service quality and establish good patient trust relationships so that doctor-patient satisfaction and loyalty can be improved. In a review of related literature, this study found that most past studies focused on issues related of quality of medical services and patient satisfaction, but ignored those related to the relationship between medical service encounters and patient trust and loyalty, as well as the lack of scientific measurement markers for service encounters in the Chinese medical service industry. Therefore, this study uses the Service Encounter Perspective and Service Quality Theory Development Research Scale to collect and analyze data for a typical case of a Chinese tertiary hospital. Finally, this study explores the relationship between the four variables of service quality, service encounter, trust, and loyalty by means of a questionnaire and statistical analysis of the data. Finally, it is concluded that the higher the service quality of the hospital, the higher the customer trust, the higher the service encounter, and in the greater the doctor-patient loyalty.

Determinants of patient behavioural loyalty on primary health centres: Evidence from a cross-sectional study in Indonesia

Background: Patients’ loyalty to visit and use the services provided by the primary health centers (PHCs) is an important requirement of a patient referral system in many countries. The aim of this study was to examine the influence of internal service factors (service provider, service process, and service environment) on service quality and behavioural loyalty of patients in Indonesian PHCs.

Methods: A cross-sectional study was conducted in 14 districts in Aceh Province, Indonesia between September and December 2020. Data were collected in 102 PHCs that were selected randomly from 137 PHCs that have an Inpatient Unit in the province. A proportional number of patients were recruited from each PHC and 389 patients were included. The demographic data, three components of internal service factors (service provider, service process, and service environment), the service quality and behavioural loyalty were assessed using a validated questionnaire. Hypothesis testing was conducted by using the structural equation model (SEM).

Results: Our data suggested that two elements of internal service factors (service provider and service environment) had a positive and significant influence on service quality of the PHCs with p<0.001 and p=0.021, respectively. Service quality had a positive and significant influence of behavioural loyalty of patients to the PHCs (p=0.003). Service quality however did not serve as an intervening variable between internal service factors (service provider, service process, and service environment) and behavioural loyalty of patients, with p=0.091, p=0.230 and p=0.260, respectively. 

Conclusions: Service provider and service environment are two main factors that influence the service quality and the service quality directly influence the behavioural loyalty on PHC users. Therefore, to increase the patients’ loyalty to use the PHC services, the quality of the services should be improved by levelling up the quality of providers and both physical and social environments in the PHCs.

Effect of relationship marketing on hospital loyalty: the mediating role of patient satisfaction

Purpose

This study aims to reveal the mediating role of patient satisfaction on the impact of relationship marketing on hospital loyalty.

Design/methodology/approach

The scale questionnaires used in the study was the Relationship Marketing, Hospital Loyalty and the Patient Satisfaction Scale. The population of the study is made up of the patients who received in-hospital services in private hospitals operating in Kocaeli province. The field study was conducted between August 1 and October 31, 2019. After determining the sample size, the study was conducted on 401 patients in private hospitals primarily using the purposive sampling method. Descriptive statistics, correlation analysis and statistical package for the social sciences Process Macro were used to analyze the data.

Findings

According to the findings of this study, patient satisfaction has an effect on hospital loyalty. Relationship marketing has an impact on hospital loyalty, and this effect is further enhanced by patient satisfaction. In other words, patient satisfaction has a mediating role in the impact of relationship marketing on hospital loyalty. Relationship marketing plays an important role in creating hospital loyalty and patient satisfaction. For this reason, it is recommended that health institutions adopt relationship marketing practices. Hospital loyalty and patient satisfaction will be ensured through relationship marketing. This will allow the health-care institution to continue to exist and to be more advantageous than other institutions.

Originality/value

The uniqueness of the paper lies not only in the only regression findings but also in the methodology used to capture the impact of the lagged effect of marketing relationships on hospital loyalty. Specifically, a regression model is based on both direct and indirect effects.

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.

Digitized Prenatal Newsletter: Impact on Obstetric Patient Satisfaction and Loyalty

The high demand for health information from pregnant women has encouraged the creation of an informative program through a weekly digital newsletter. The objective of this study is to evaluate its quality as a digital communication medium, in terms of satisfaction and loyalty to the pregnancy follow-up and delivery service. A cross-sectional, prospective study was carried out, surveying 179 patients by means of an online self-referral questionnaire including variables related to humanization, information needs, perceived accompaniment and satisfaction, as well as factors related to its influence on their decision to remain loyal to the center. A total of 81.2% of the participants showed high levels of satisfaction with the program. Satisfaction among nulliparous patients was significantly lower in several aspects. The resolution of doubts and the perception of peace of mind following the information received was positive for 54.8%. Of the patients in the program, 88.8% finally remained at the center, showing a strong influence of the program on their decision (mean value 75 on 1 to 100 scale). A weekly digital newsletter with specific information reduced the demand for information from pregnant women, generating high levels of satisfaction and positively influencing the decision to remain loyal to the Center.

Mother’s Behavior on Knowledge and Attitudes Toward Child Nutritional Status in Magetan Regency, East Java, Indonesia

BACKGROUND: Toddler nutritional status is an indicator of toddler growth. Basic Health Research, 2010 states: 5.4% malnutrition status and 13.0% malnutrition. In 2013, the proportion of malnutrition status was 5.7% and malnutrition was 13.9%, from the target of 19.6%, and in 2018, the proportion of malnutrition was 3.9% and malnutrition was 13.8% of the target of 17.7%. AIM: The research objective to determine the effect of maternal knowledge and attitudes on the nutritional status of children under five. METHODS: This study was cross-sectional study design. Population 135 and a sample of 94 people. Sampling technique: Simple random sampling. Independent variable: Knowledge and attitudes of the mother, while the dependent variable: Nutritional status of children. Data collection techniques: Questionnaires and baby scales. To analyze the effect of the independent variable on the dependent variable, multiple logistic regression with a significance of 0.05 was used. RESULTS: Knowledge of mother Group b affected 3.2% with poor nutritional status and 34% affected good nutritional status. Mother’s attitude affects 1.1% of children under five with poor nutritional status and affects 16% of children with good nutritional status. From the results of the analysis using multiple logistic regression, it was found that the effect of the knowledge variable on nutritional status was 0.000 (<0.05), while the effect of attitude on nutritional status was 0.000 (<0.05). CONCLUSION: There is an influence of knowledge and attitudes of mothers of children under five on the nutritional status of children under five. SUGGESTION: To reduce the incidence of malnutrition and malnutrition in Indonesia is to increase the knowledge and attitudes of mothers under five in providing menus according to the needs and age of the child.

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.

The Interplay Between Technology Performativity and Health Care Professionals in Hospital Settings: Service Design Approach

BACKGROUND

The unexpected outbreak of the COVID-19 pandemic and the preventive measures of physical distancing have further necessitated the application of information and communication technologies (ICTs) to enhance the efficiency of work activities in health care. Although the interplay between human agency and technology performativity is critical to the success or failure of ICTs use in routine practice, it is rarely explored when designing health ICTs for hospital settings within the sub-Saharan Africa context.

OBJECTIVE

The objective of this study is to explore how the service delivery quality is being influenced by the technology-enabled activities of health care professionals at points of care using a service design strategy.

METHODS

An interpretivist stance was assumed to understand the socially constructed realities of health care professionals at points of care in a hospital setting. A service design strategy was identified as suitable for engaging health care professionals in co-design sessions to collect data. A purposive sampling technique was used to identify the participants. Open-ended questions were administered to gain insights into the work activities of physicians and nurses at points of care. Qualitative (textual) data were analyzed using thematic analysis. Ethical concerns about the safety and privacy of participants' data were addressed as per the university ethics review committee and provincial department of health.

RESULTS

The findings show that the attributes of human agency and technology features that drive technology performativity result in an interplay between social concepts and technical features that influence the transformation of human-machine interactions. In addition, the interplay of the double dance of agency model can be divided into 2 successive phases: intermediate and advanced. Intermediate interplay results in the perceived suitability or discomfort of health ICTs as experienced by health care professionals at initial interactions during the execution of work activities. Subsequently, the advanced interplay determines the usefulness and effectiveness of health ICTs in aiding task performance, which ultimately leads to either the satisfaction or dissatisfaction of health care professionals in the completion of their work activities at points of care.

CONCLUSIONS

The adopted service design strategy revealed that the interaction moments of the tasks performed by health care professionals during the execution of their work activities at point of care determine the features of health ICTs relevant to work activities. Consequently, the ensuing experience of health care professionals at the completion of their work activities influences the use or discontinuation of health ICTs. Health care professionals consider the value-added benefits from the automation of their work activities to ultimately influence the quality of service delivery. The major knowledge contribution of this study is the awareness drawn to both the intermediate and advanced interplay of human-machine interaction when designing health ICTs.

Behavior of mother to visit posyandu in magetan regency, indonesia

Introduction: The purpose of this study was to develop a model of precede-proceed and social capital influence the improvement of maternal behavior visit to posyandu (the integrated service post). Methods: This study was create model of  behavior with cross sectional design. The population was mothers in Magetan and the sample size was 400, selected using simple random sampling. Exogenous variable was social capital, while endogenous variables were predisposing factors, reinforcing factors, enabling factors, and behavior. Statistical analysis was Confirmatory Factor Analysis and Structural Equation Modeling with the program of Amos 18. Phase 2 was non-equivalent control group pretest-posttest. The independent variable was behavioral models, while dependent variable was the behavior of the mother visited posyandu. Statistical analysis was T-Test. Results and analysis: Intervention precede-proceed model of social capital influence the improvement of maternal behavior to visit posyandu (p-value = 0.000). Conclusion: The intervention precede-proceed model and social capital influence the improvement of maternal behavior to visit posyandu.

The Quality of Pharmaceutical Services in the New Normal Era on Outpatient Loyalty at the Pharmacy Installation of the Daya General Hospital

Background: The quality of pharmaceutical services is an important factor in ensuring the quality of health services in hospitals. In this current era of the new normal, improving the quality of pharmaceutical services is closely related to patient satisfaction and loyalty. Objective: The purpose of this study was to examine and analyze the effect of pharmaceutical service quality on loyalty through mediating outpatient satisfaction at the Pharmacy Installation of Daya General Hospital. Method: This research was a quantitative study with an analytical observational study design. Respondents in this study were 120 outpatients at the Pharmacy Installation. The data analysis method used was univariate and bivariate analysis through the Statistical Package for the Social Sciences (SPSS) program and multivariate Structural Equation Modeling (SEM) with the AMOS program. Results: Satisfaction affected the loyalty of outpatients at the Pharmacy Installation. The most dominant indicator was feeling satisfied in the satisfaction variable, with a loading factor of 0.93. In the loyalty variable, the most dominant indicator was the loyalty aspect, with a loading factor of 0.41. The direct effect of pharmaceutical service quality on loyalty was 0.550, while the indirect effect mediated by patient satisfaction was 0.303. Conclusion: The direct effect was greater than the indirect effect of service quality on the loyalty of outpatients at Daya General Hospital.

Impact of Service Quality on In-Patients' Satisfaction, Perceived Value, and Customer Loyalty: A Mixed-Methods Study from a Developing Country

PURPOSE

Recent literature on healthcare quality demands more contextualized and patient-perspective research, as models from developed countries are not suitable for developing countries. Moreover, research on private healthcare services in Vietnam has long been underestimated by academia, but it has significant economic and commercial value. Hence, this study explores the dimensions of service quality in private healthcare and how they impact in-patient satisfaction, perceived value, and customer loyalty in Vietnam.

METHODS

This mixed-method study had a sample size of five inpatients for the qualitative phase and 368 inpatients for the quantitative phase from hospitals in Vietnam. The qualitative analysis explores service quality dimensions in private healthcare and incorporates them with the literature to develop a conceptual model. The quantitative phase tests the relationship between each construct in the conceptual model via structural equation modeling.

RESULTS

The four dimensions of service quality were emotion, function, social influence, and trust. Most of these dimensions have a significant impact on customer perceived value and satisfaction. However, emotion does not significantly influence customer perceived value, and function does not considerably impact customer satisfaction. In addition, social influence is an underrepresented variable in the service quality literature, but it has the most substantial impact on customer perceived value and customer satisfaction. The quantitative results also confirm that customer satisfaction and customer perceived value significantly impact customer loyalty (word-of-mouth and revisit intention); however, customer perceived value does not significantly impact customer satisfaction.

CONCLUSION

The study suggests that private healthcare providers and the government in Vietnam should allocate resources to improve service quality. Practitioners should invest in social branding and e-services to reach out to their customers. Future research should focus on a cost-benefit analysis and compare the effectiveness of service quality dimensions on customer behavioral intention.

Consideration factors of older adults seeking medical treatment at outpatient services in Taiwan

BACKGROUND

Taiwan will become a super-aged society by 2025, leading to the more frequent use of outpatient services by older adults for medical treatment compared with other age groups. Understanding the outpatient service consideration factors of older adults seeking medical treatment can improve health care quality. This study explored the selection factors and crucial considerations of older adults for outpatient services.

METHODS

Qualitative study was conducted. Purposive sampling was used to recruit 16 older adults over 65 years of age with chronic disease who were patients of an internal medicine department and regularly returned for checkups. Data including reasons for receiving medical treatment, factors affecting their choice of hospitals, and health care and environmental considerations were collected through structured interviews.

RESULTS

The older adults identified four factors. (1) The care of doctors: The doctors possessed professional skill, allocate sufficient consultation time, and undertake effective communication. (2) The care of other medical professionals: Other medical professionals provided services in a cordial manner. (3) The accessibility and convenience of outpatient services: Convenient transportation and registration as well as short consultation wait time. (4) Environment and equipment: The hospital had the novel facilities and satisfactory barrier-free equipment.

CONCLUSIONS

The older adults cared most about the adequacy of diagnosis and treatment by doctors and other medical professionals. In addition, they reported having higher satisfaction with hospitals that provide comprehensive medical facilities, fast and convenient medical procedures, and short wait times.

Managing the resource allocation for the COVID-19 pandemic in healthcare institutions: a pluralistic perspective

Purpose

As COVID-19 outbreak has created a global crisis, treating patients with minimum resources and traditional methods has become a hectic task. In this technological era, the rapid growth of coronavirus has affected the countries in lightspeed manner. Therefore, the present study proposes a model to analyse the resource allocation for the COVID-19 pandemic from a pluralistic perspective.

Design/methodology/approach

The present study has combined data analytics with the K-mean clustering and probability queueing theory (PQT) and analysed the evolution of COVID-19 all over the world from the data obtained from public repositories. By using K-mean clustering, partitioning of patients’ records along with their status of hospitalization can be mapped and clustered. After K-mean analysis, cluster functions are trained and modelled along with eigen vectors and eigen functions.

Findings

After successful iterative training, the model is programmed using R functions and given as input to Bayesian filter for predictive model analysis. Through the proposed model, disposal rate; PPE (personal protective equipment) utilization and recycle rate for different countries were calculated.

Research limitations/implications

Using probabilistic queueing theory and clustering, the study was able to predict the resource allocation for patients. Also, the study has tried to model the failure quotient ratio upon unsuccessful delivery rate in crisis condition.

Practical implications

The study has gathered epidemiological and clinical data from various government websites and research laboratories. Using these data, the study has identified the COVID-19 impact in various countries. Further, effective decision-making for resource allocation in pluralistic setting has being evaluated for the practitioner's reference.

Originality/value

Further, the proposed model is a two-stage approach for vulnerability mapping in a pandemic situation in a healthcare setting for resource allocation and utilization.