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

Exploratory analysis of factors influencing hospital preferences among the Lebanese population: a cross-sectional study

OBJECTIVES

The primary aim of this research is to uncover the underlying factors that shape hospital selection criteria among individuals in Lebanon.

DESIGN

Cross-sectional study.

SETTING

A survey was circulated across social media platforms and messaging applications in Lebanon from February to May 2023. This questionnaire aimed to gauge participants' opinions on the importance of various factors in their hospital selection process.

PARTICIPANTS

A total of 746 participants filled out the survey. We targeted Lebanese adults who were not hospitalised at the time of survey submission.

MAIN OUTCOME MEASURES

We performed an exploratory factor analysis to examine the underlying structure of our 70-question survey. Reliability analysis was conducted using Cronbach's alpha and McDonald's omega. Factor scores were derived by aggregating raw scores and computing the mean.

RESULTS

The survey results identified eight key factors that accounted for 58.02% of the total variance, with excellent sampling adequacy (Kaiser-Meyer-Olkin=0.921, Bartlett's p<0.001). These factors exhibited good internal consistency, as indicated by Cronbach's alpha values for each factor. Ranked by importance for hospital selection, the factors are: staff qualities (α=0.773), administrative services (α=0.801), reputation (α=0.773), ease of access (α=0.704), room attributes (α=0.796), architectural and physical surroundings (α=0.828), luxury amenities (α=0.849) and affiliation and ownership (α=0.661).

CONCLUSION

This paper highlights the hospital characteristics that people may value before selecting a hospital. This insight provides an opportunity for hospital managers to refine their services, ensuring better resonance with people's anticipations. Beyond this, it sheds light on areas where hospitals could strategically invest to elevate their competitive edge in the healthcare market.

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.

Comparative Analysis of Patient Satisfaction Surveys-A Crucial Role in Raising the Standard of Healthcare Services

(1) Background: The study aimed to assess the patients' perception of the quality of the medical staff's care, the hotel's services, and the hospital's overall impression as well as to determine the best rating scale through a comparative analysis of patient satisfaction questionnaires. (2) Methods: A retrospective study was performed based on satisfaction questionnaires addressed to the patients hospitalized in the Orthopedics and Traumatology departments of the County Clinical Emergency Hospital Oradea between 2015 and 2019. Three different types of questionnaires were used during the study period, with the number of questions varying between 30 (variant A) and 37 (variant C). The evaluation was done using the Likert scales with three, four, or five answer variables. (3) Results: The items that we found to be present in all three categories of surveys and for which at least two different questionnaire variants used the Likert scales with various answer variables were chosen. In terms of the treatment given by the medical staff, hotel services, and the overall perception of the hospital, the patients perceive a higher level of quality. (4) Conclusions: The level of patient overall satisfaction or general impression about the hospital is strongly dependent on the quality of medical care provided by the doctors and the specific hotel conditions of the hospital. The quality assessment using the Likert rating scale with five binary variables is more accurate.

Factors affecting patient satisfaction at a plastic surgery outpatient department at a tertiary centre in South Africa

BACKGROUND

The main purpose of a medical facility is to improve the welfare of patients, and user satisfaction is one of its primary goals. This study aimed to identify variables influencing patient satisfaction at the Plastic Surgery Outpatient Department of Chris Hani Baragwanath Academic Hospital, Gauteng, South Africa. By identifying factors affecting patient satisfaction, the services provided to patients may be improved.

METHODS

A questionnaire was compiled focusing on patients over 18 years of age and using a Likert scale to measure factors influencing patients' satisfaction with the services received. Descriptive statistics were applied.

RESULTS

A total of 142 participants, 69% of whom were under age 40 and 52.8% were male, were recruited using a systematic sampling technique. In 78% of cases, this was the patient's first visit to the clinic. The results revealed that the patients were not satisfied with the ease of appointment scheduling and waiting times. A high level of satisfaction was reported for both nursing staff and doctors, aside from a lack of clear and prominent display of name badges. Overall satisfaction was at the "satisfied" level, and no participants reported lower than neutral feelings. The CSAT score was 79.5%, which is considered "good" for healthcare. The participant's level of education was significant in multiple items; those with the lowest education reported higher overall satisfaction. A model produced by regression analysis was found to be strongly significant statistically.

DISCUSSION

Batho Pele principles in South Africa provide a framework for consulting with service consumers, ascertaining their happiness, and identifying methods to enhance their experience. According to this survey, people are happy with the human part of the services received, although areas such as scheduling appointments and the physical surroundings still need much work.

CONCLUSION

These aspects of treatment are occasionally disregarded in a medical organisation with insufficient finances. Developing these areas can help turn patients into devoted patrons of a healthcare facility. An effective strategy to boost customer satisfaction has been suggested to enhance service quality and, especially in South Africa, conform to Batho Pele service standards.

Patient satisfaction and quality of hospital care

The analysis summarises the experience of a sample of patient at the University Polyclinic in Messina (Italy) and provides a detailed assessment of the satisfaction of patients experiencing healthcare at different Departments. Information collected through a specific survey allowed to build a dataset with more than 350 observations. Regressors were carefully selected and compared through a radar chart. The estimation of a logistic model was then carried out. The results outlined the relevant factors for patient satisfaction: they depend both on the ambulatory where the care is provided and the judgement about quality of care. Other crucial factors in determining a higher satisfaction were the availability of parking lots, the cleaning of structures and the judgment on physicians, the latter endorsing the probability of being highly satisfied when expectations on physicians' competences and professionalism are confirmed. The "Contact details", i.e., the indications of the people to contact in case of need, strengthen the overall patients' positive experience. The study enriches the existing literature on patient satisfaction and is aimed at rethinking the organization of the health assistance offered at University Polyclinics, outlining the aspects to improve, with the objective to guarantee the highest patient satisfaction.

The role of service quality in fostering different types of perceived value for student blended learning satisfaction

The present study aims to conceptualize service quality and perceived value in the context of blended learning by redefining and modifying the existing SERVQUAL model, reviewing prior marketing literature on perceived value, and examining the relationships between service quality, perceived value, and student satisfaction. The sample was restricted to colleges in South Korea, where blended learning programs have started to receive much attention. We examined our hypotheses by using regression analysis via the statistical programs Amos 22.0 and SPSS 23.0. The following results are produced. First, the conceptualization of service quality and perceived value was confirmed. Second, the different effects of online and offline service quality on each perceived value are confirmed. Offline service quality is more effective in generating perceived epistemic value, perceived social value, and perceived emotional value than online service quality, whereas online service quality is more effective in triggering perceived conditional value than offline service quality. Finally, perceived emotional value and perceived conditional value are the important determinants of student satisfaction. We address the theoretical implications that (1) service quality and perceived value are conceptualized through modification, refinement, and empirical testing and develop a multidimensional scale for service quality and perceived value, and (2) the sequential and causal relationships among service quality, perceived value, and student satisfaction are confirmed. Practically, we expect that our measurement scales for service quality and perceived value, which have high validity and reliability, can serve as diagnostic tools for blended learning program evaluation from students' perspective.

Organizational support and perceived environment impact on quality of care and job satisfaction: a study with Pakistani nurses

Purpose

Referring to the theory of organizational empowerment, the purpose of this study is to examine the relationship of organizational support and perceived environment on quality of care and job satisfaction, with organizational commitment as a mediator for the first variable.

Design/methodology/approach

This study employed a cross-sectional research design and data was collected from seven private and public sector hospitals in Pakistan, involving 352 nurses on a voluntary basis through a self-administered survey.

Findings

The results showed that organizational commitment mediates the relationship between organizational support and job satisfaction with the quality of care. Moreover, the perceived environment has an impact on job satisfaction and quality of care.

Originality/value

Healthcare service quality seems strictly dependent on the perceived quality of care and job satisfaction among healthcare workers. Theoretical and practical implications for policymakers and HR management are discussed.

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.

Assessment of Emergency Department Satisfaction Level in Saudi Arabia General Hospital

Background and objectives:

An overcrowded emergency department (ED) cannot meet the patients’ growing demand. This situation harms employees’ performance and, alternatively, causes anxiety and dissatisfaction among patients since the quality of healthcare outcomes fall below their expectations. This study aimed at improving and validating a scale for assessing patient satisfaction in the ED.

Methods:

In this study, 134 participants from Wadi Al-Dawasir General Hospital were enrolled using a convenient sampling technique. A cross-sectional survey was conducted using 5-point Likert scales.

Results:

All tested hypotheses showed statistical significance (P < 0.05). Our results show that male employees were more satisfied compared with their female counterparts. Furthermore, Saudi employees were more satisfied with the health services than non-Saudi ones.

Conclusion:

The findings of this study brought to the fore that patients and their families were satisfied with the healthcare services and their quality. This means better service delivery played a crucial role in enhancing satisfaction levels. Nevertheless, this study also highlights that overcrowding is a significant problem for healthcare organizations. Wadi al-Dawasir General Hospital's ED should continually improve its quality to meet the growing needs of its clients.

How to improve patient satisfaction behavioral compliance and hospital image through nurse caring: Strategizing for healthcare during COVID-19

We investigated the impact of nurse caring on patient satisfaction, behavioral compliance, and organization image from a patient's perspective in the private healthcare sector in the Syrian capital-Damascus. The conceptual model can significantly explain 40, 64, and 49% of satisfaction, compliance, and organization image, respectively in a statistical manner. Responsiveness had more influence on patient satisfaction than communication skills. Friendship behavior had no significant effect on satisfaction, and behavioral compliance. The most important aspect that influenced the organization's image was the nurse's communication skills followed by responsiveness and service friendship behavior.

The Impact of Patient Satisfaction on Patient Loyalty with the Mediating Effect of Patient Trust

This research is primarily focused on the issues of customer loyalty in the healthcare industry, particularly from the perspective of public hospitals in China. The research developed a theoretical model to test the relationship between patient satisfaction (PS), patient trust (PT), and patient loyalty (PL). The empirical data were collected from 1696 patients through the survey questionnaires from the public hospitals in Henan province. This research is an explanatory study, and adopts quantitative method. The measurement scales used in the survey were assessed and refined and the data analysis was performed using AMOS 19.0 to test the theoretical model and hypotheses developed. In addition, an exploratory factor analysis was used to identify the dimensions of PS, PT, and PL. Their reliability and validity were established through confirmatory factor analysis, and the structural equation modeling (SEM) was used in the related hypotheses. The findings indicate that PT is an important antecedent of PL, and PS has no direct relationship with PL. It is worth noting that PS can lead to PL with PT as the mediating variable. The survey results will help public hospital managers to formulate effective strategies and provide a basis for studying PL. The research will prompt hospital managers to pay attention to the factors which contribute to PS, PT, and PL, and maintain the loyalty of patients to medical institutions. This study is one of the few studies on the relationship between PS, PT, and PL in Chinese public hospitals, and it also explores the direct and indirect effects of PT on PL. The results have practical implications for the Chinese healthcare industry.

Cleaner production practices at company level enhance the desire of employees to have a significant positive impact on society through work

Implementation of cleaner production practices (CPP), service quality (SQ) and corporate social responsibility (CSR) is often studied at organizational level. A number of studies on trio have reported it's significant impact on overall organizational performance and profitability across the globe. However, not much is studied about the individual level micro influence of these constructs on employee engagement (EE), organizational pride (OP), organizational identification (OI) and "desire to have a significant impact through work" (DSIW). Therefore, this study presents a comprehensive framework for assessing the impact of the implementation of CPP, SQ and CSR on EE, OP, OI and DSIW. Data collected from 320 non-managerial staff members employed at a garments manufacturing company in Pakistan was analyzed using partial least square (PLS) approach. Findings revealed that the implementation of CPP, SQ and CSR plays an important role in shaping EE, OP, OI and DSIW in the garments manufacturing industry. Further, it is found that the implementation of CPP has a non-significant impact on SQ. Additionally, results of the importance-performance map analysis (IPMA) have also confirmed that the implementation of CPP at company level has shown a highest importance and performance amongst all the latent constructs proposed as predictors of DSIW in the garments manufacturing industry. These findings are a step forward and unique contribution of this study in the domain of CPP, SQ, CSR, EE, OP, OI and DSIW.

The Impact of Patient Satisfaction on Patient Commitment and the Mediating Role of Patient Trust

The purpose of this study is to determine the effect of patient satisfaction on patient commitment and the mediating role of patient trust in this effect. The study was conducted with 595 patients receiving healthcare services from the city center of Sakarya in Turkey. The data were collected between March 30, 2017, and May 29, 2017, via questionnaire method. The Patient Satisfaction Scale by Chang et al, the Patient Commitment Scale by Torres et al, the Patient Trust Scale by Ozawa, and an Introductory Information Form were used as the data collection tools in the study. Descriptive statistical methods, exploratory factor analysis, reliability analysis, correlation analysis, and Model 4 within the Process Macro regression analysis for SPSS developed by Hayes in order to determine the mediating role were used for the data analysis. The analyses were made at a 95% confidence interval, and the variables of patient satisfaction, patient trust, and patient commitment have a strong positive correlation. The result of this study demonstrated that patient satisfaction affects patient trust and patient commitment. Another outcome of this study is that there is a mediating effect of patient trust in the impact of patient satisfaction on patient commitment. In conclusion, these related concepts might influence the beliefs and behavior of the patient concerning the healthcare institution in question or the services that they have received.

Perception of service quality, satisfaction, and behavioral intentions in Ayurveda healthcare

BACKGROUND

Based on the previous literature it is confirmed that Performance-based service quality and patient satisfaction are major antecedents of behavioral intentions in the healthcare sector. Here, the study deals with the same variables under the framework of Ayurveda healthcare.

OBJECTIVES

The study is an attempt to understand the perceptional differences of healthcare consumers in Ayurveda, by analyzing the relationship between the service quality, satisfaction, and behavioral intentions in Ayurveda.

MATERIALS AND METHODS

Using the convenient sampling technique, 404 samples were collected through direct interview, with a structured questionnaire from the in-patients of 20 accredited Ayurveda hospitals from the northern part of Kerala, a southern state of India. Respondents of the study consist of mostly women who were aged above 40. ANOVA and t-test were used to evaluate the differences in the perception of healthcare consumers, and multiple regression analysis and structural equation modeling were applied to propose two relationship models from the study.

RESULTS

The perception of healthcare consumers are found to vary for service quality and patient satisfaction according to socio-economic variables except for the education factor. Later the test on the impact of performance-based service quality on patient satisfaction and the mediation model showed a significant influence between the variables.

CONCLUSION

The results of the study could empirically prove the relationships of these variables significantly and it can assure some quality contributions to the healthcare managers to modify their business policies in the future.

A Family-Centered Intervention to Monitor Children's Development in a Pediatric Outpatient Setting: Design and Feasibility Testing

The patient experience team at a private tertiary care hospital used the Theory of Change to design a family-centered developmental monitoring intervention, building on an ongoing initiative. The design entailed (i) a monitoring form: Survey of Well-Being of Young Children (SWYC) being an easy parent-report measure; (ii) family support intervention: the Care for Child Development module to enhance parent-child interactions; (iii) timing: utilizing wait time to also enhance families' experience; (iv) the service providers: psychology trainees as volunteers; and (v) reinforcement: by the pediatrician in the regular consultation health visit capitalizing on the established rapport with families. All families with children under 5 years 5 months 31 days of age in selected acute, complex, and developmental care clinics were eligible. Feedback from stakeholders indicated that the monitoring process was useful and imparted important information for parents and pediatricians, while the trainees felt the experience to be significant for their own learning. The authors conclude that the designed intervention model for a family-centric approach was acceptable and feasible. Key recommendations have been presented for further scale-up.

Health promoting hospital: A practical strategy to improve patient loyalty in public sector

Background: The Health-Promoting Hospital (HPH) aims to improve the overall quality of health services for patient, families, and the community as a whole, with assessment and intervention as the essential components. In hospitals, this activity needs to be vigorously developed through interdisciplinary teamwork, shared decision-making process, and by involving patients and families during treatment and through the delivery of an evidence-based health promotion process. Previous studies analyzed some steps to improve patient loyalty through the HPH. However, limited studies were carried out on its use in the public sector. This study, therefore, aims to analyze the impact of HPHs to improve patient loyalty in the public sector.

Design and Methods: The simple random sampling method was used to obtain data from 101 respondents in a public hospital, with the cross-sectional design used to gain a better understanding of patient loyalty.

Results: The result showed that HPHs influenced patient expectations (P=0.030), which in turn affected perceived value (P=0.014) and satisfaction (P=0.002). In addition, perceived value and satisfaction have effects on patients’ loyalty (P=0.001).

Conclusion: In conclusion, HPHs have a positive impact on patient loyalty. Therefore, the public sector needs to enhance its services in accordance with the standards and guidelines.

Comparing public and private hospitals’ service quality

Background

Saudi Arabia’s health care system has undergone major changes in recent years to enhance the quality of the services it renders to the community. This study is designed to measure the quality of health care services from the patients’ perspective and to compare the service quality of public and private hospitals in the eastern region of Saudi Arabia.

Methods

The study has a quantitative cross-sectional design, with a questionnaire based on the SERVQUAL dimensional model. It was a random sample of 258 inpatients at private and public hospitals in Eastern Saudi Arabia.

Results

Patients at private hospitals perceived a higher level of quality of the health care services (t = 3.390, p < 0.01).

Conclusions

Further research on the financial and leadership dimensions of health care quality will contribute to improved planning for health care services.

Satisfaction Level of Tuberculosis Patients Regarding Their Access to TB Care and Prevention Services, Delivered Through a Public-Private Mix Model in Pakistan

Objective: The private healthcare providers (PHCP) are believed to improve access to healthcare services in public–private mix (PPM) projects, as they are considered first point of contact for healthcare. The purpose of this study was to determine the satisfaction level of tuberculosis (TB) patients. Design: A questionnaire-based, cross-sectional study was carried out during November and December 2017 for 572 under-treatment patients registered with PHCPs in the PPM project. Lot quality assurance sampling technique was used to randomly select 19 districts from a sample frame of 75 districts. In each selected district, the data collector retrieved a TB register of 8 months (January–August 2017) and systematically selected patients by fixed periodic interval. SPSS version 24.0 (IBM Corp, Amonk, NY, USA) was used to analyze the data. Results: This study included 53% (n = 301) males and 47% (n = 271) females, with mean age of 38 years (SD, ±18). Almost half of the participants were illiterate (51%, n = 289), and 64% (n = 365) were non-earning members of the family. In practice, most of the participants visit private providers (71%, n = 407), including private hospitals/clinics (44%) and traditional practitioners (27%; n = 153); 55% of participants visited their current doctor because of the clinic’s proximity to their residence. Of the participants, 82% (n = 469) were satisfied with TB care services and 85% (n = 488) said that they would recommend this clinic to others. Conclusion: PHCPs are preferred providers for individuals, which is consistent with findings of other studies. Though they are satisfied with TB care and services, interventions should be introduced to reduce the financial burden on the patient. Partnering PHCP is a way forward to ensure universal health coverage and better health outcomes of the population.

Patient Satisfaction with Health Care Services; An Application of Physician's Behavior as a Moderator

Patient satisfaction is a measure of the extent to which a patient is content with the health care they received from their health care provider. Patient satisfaction is one of the most important factors to determine the success of a health care facility. The purpose of this study was to determine patient satisfaction with healthcare services and encompass the physician’s behavior as moderation between patient satisfaction and healthcare services. The study seeks to measure the health care services, like a laboratory and diagnostic care, preventive healthcare and prenatal care, to patient satisfaction in the public health sectors of Pakistan. A descriptive survey research design was used for this study. The target population was patients from the out-patient department (OPD) of three public hospitals from Pakistan. By using the convenient sampling technique, 290 sample participants were selected from the target population. The reliability scales were tallied by using Cronbach’s Alpha. The findings of the study are gleaned by using regression to explore patient satisfaction with the health care services, and whether or not the physician’s behavior moderates the link of patient satisfaction and healthcare services. SPSS Hayes process was used for the moderation effect of the physician’s behavior. The main results of the regression analysis validate that health care services, such as laboratory and diagnostic care, preventive healthcare, and prenatal care, have a significant and positive effect on patient satisfaction. Specifically, the study suggests that the physician’s behavior significantly moderates the effect of health care services on the satisfaction of patients. The overall opinions about the satisfaction level of patients for the availability of health services in the hospitals were good. The degree of satisfaction was satisfactory with respect to laboratory and diagnostic care, preventive healthcare, and prenatal care services. Based on the outcomes, the study confirms that the proposed hypotheses are statistically significant. Furthermore, the directions for future research of the study are offered.

Patients' perceptions of healthcare quality in Ghana

PURPOSE

The purpose of this paper is to investigate the role of service quality (SQ), customer satisfaction (CS) and customer loyalty (CL) in Ghana's health sector and a comparative analysis of private and public hospital SQ.

DESIGN/METHODOLOGY/APPROACH

A convenient sample of 1,236 respondents was generated from both private and public hospitals. The study utilises an asymptotic distribution free estimation technique in CB-SEM using LISREL to test the relationships, while Wilcoxon-Mann-Whitney test was used to determine the differences in SQ performances between private and public hospitals.

FINDINGS

The study found a significant positive relationship between SQ and CS. Also, the study found a significant positive relationship between CS and CL. Finally, SQ was found to be better in private hospitals, resulting higher CS and CL.

PRACTICAL IMPLICATIONS

The study highlights the significant role SQ plays in generating CS and CL to guide healthcare provider policy decision making to improve healthcare delivery. It also serves as a guide to patients to make informed decisions regarding the choice of alternative hospitals.

ORIGINALITY/VALUE

The study provides a useful guide to strategy and policy formulation in the healthcare sector by exploring the potential viability of SERVQUAL-related model as a relevant tool for assessing SQ in Ghana's health sector. The results also identified SQ gap between private and public hospitals and thus have implications on how hospitals should strategise to improve their SQ.

What Factors Affect Patient Satisfaction in Public Sector Hospitals: Evidence from an Emerging Economy

Patient satisfaction can identify specific areas of improvement in public sector hospitals. However, the Pakistani healthcare system, and quality of service delivery is rarely assessed through the perspective of patient satisfaction. Our study demonstrated the performance of public healthcare systems in Pakistan by interacting with physical services (tangible and environmental), doctor⁻patient communication, and pharmacy and laboratory services based on patient satisfaction. Primary data were collected from the patients by using a random sampling method. Patients who participated in the study were visitors of public hospitals' outpatient departments. A total of 554 questionnaires were circulated, and 445 were received. The confirmatory factor and multiple regression analyses were employed to analyze the collected data. The results revealed that laboratory, as well pharmacy services, had positive significant effects (p = 0.000) on patient satisfaction, while doctor⁻patient communication (p = 0.189) and physical facilities (p = 0.85) had an insignificant relationship with patient satisfaction. Therefore, it is suggested that a significant communication gap exists in the doctor⁻patient setting, and that Pakistan's healthcare system is deprived of physical facilities. Consequently, such services need further improvements.

Service quality and satisfaction in healthcare sector of Pakistan- the patients' expectations

Purpose The purpose of this paper is to assess the influence of patients' expectations from healthcare service quality on their satisfaction with nursing in public and private hospitals of Pakistan. Design/methodology/approach Data ( n=456) were collected from three public sector hospitals and three private sector hospitals of Lahore, the capital of Pakistan's most populous province. Male and female patients who have experience of both sectors were surveyed using a self-administered questionnaire developed using the original SERVQUAL approach. Data were analyzed using the statistical techniques and the Laplace criterion. Findings This paper attempts to explain degree of influences of five service quality constructs (empathy, responsiveness, tangibility, reliability and assurance) on Pakistani patients' expectations from the private and public sector hospitals and thus patient satisfaction. Further, this work can offer several intuitions into the effect of five constructs of service quality on patients' expectations of healthcare service quality and patient satisfaction with the service providers/nursing. The results reveal that the patient satisfaction is most strongly related to empathy in public sector and to responsiveness in private sector. Research limitations/implications In light of the previous studies and the current research findings, the study anticipates no apparently significant improvement in healthcare sector of Pakistan in near future considering various factors discussed in the study. The study will also help the service providers and the policy makers in understanding the deteriorating situation of the Pakistani healthcare sector and will guide them in identifying the areas by improving which not only the healthcare service quality in the country can be improved but also the image of healthcare sector among the masses and competitiveness of the healthcare sector can be enhanced. Originality/value The value of the study rests in its critical analysis of the current status of the healthcare sector of Pakistan with a view to suggest the areas that need to be worked on by the service providers and policy makers. Also, the study tries to settle a controversy within Pakistani healthcare literature concerning the question that who is producing more satisfied patients: private hospitals or their public counterparts?

Portuguese university hospital patient satisfaction and service quality

Purpose The purpose of this paper is to investigate Portuguese hospital inpatient satisfaction. Design/methodology/approach The study was conducted at a major university hospital in Portugal. Using the IAQH-IA mailed questionnaire, data were collected over three months (March to June 2015) from patients and families. From 1,500 former inpatients, 434 participated (29 percent response rate). Using the structural equation modeling, the authors derived satisfaction models and analyzed the relationship between quality, satisfaction and patient attitudes. Inferential statistics (bivariate analysis) were used to deal with global satisfaction determinants. Findings The satisfaction model was confirmed using factor analysis. Results show that developing a system for delivering timely information to both patient and relatives is relevant. Communication is a fundamental aspect for patients, which to date, seems to have been neglected by hospital managers. Education and current perceived health are important global satisfaction determinants. Practical implications Hospital managers can use the authors' findings to measure and improve operational performance. Originality/value Knowledge about patient perception and satisfaction leads to continuing improvement in healthcare quality.

The effect of patient satisfaction with academic hospitals on their loyalty

OBJECTIVES

Patients' loyalty to a health care institution can lead to the aggregation of patients' medical history in an institution and facilitating access to records by health care providers. Considering the increase of the competition between providers, it is important to gain patients' satisfaction, which leads to their return and loyalty. Therefore, this study evaluated the effect of patients' satisfaction with service quality on their loyalty.

METHODS

A cross-sectional descriptive and analytical study was carried out in academic hospitals. A sample of 260 patients admitted to these hospitals was recruited. The data gathering tool was an expert-validated questionnaire which its reliability was confirmed by Cronbach's alpha. Data were analyzed using descriptive statistics, correlation coefficient, and multivariate regression analysis in SPSS20.

RESULTS

The mean score of service quality was calculated 74.23 out of 100. Among the quality dimensions, "physician visit" had the highest score with 84.01 ± 20, and the "waiting time" dimension had the lowest score with the mean score of 62.45 ± 27.53. The mean score of patients' loyalty was 67.88 ± 29.79. Satisfaction with the six dimensions of service quality: "cost of services," "hospital environment," "delivered services," "access to physicians and health care institutions," "provision of information to patients," and "acquaintance with hospitals" were identified as the most influencing factors on loyalty.

CONCLUSIONS

The results showed that patient satisfaction with service quality affects their hospital choices and increases loyalty. In order to increase patient loyalty to academic hospitals, improving the services quality along with delivering cost-effective cares, improving hospital environment, and providing useful information to patients are recommended.

Patients' satisfaction and public and private sectors' health care service quality in Pakistan: Application of grey decision analysis approaches

PURPOSE

The study aims to evaluate the comprehensive relationship between patient satisfaction and five dimensions of health care service quality in Pakistani public/private health care sectors, using a novel grey relational analysis (GRA) models and the Hurwicz criteria of decision making under uncertainty.

DESIGN/METHODOLOGY/APPROACH

Data were collected from private and public health care facilities of Pakistan through an improved SERVQUAL instrument. Deng's GRA, absolute GRA, and the second synthetic GRA models were applied to address the problem under study.

FINDINGS

Grey relational analysis models revealed that reliability and responsiveness are most strongly predicting patient satisfaction in public and private health care sectors, respectively. The Hurwicz criteria showed that patients are more likely to be satisfied from private health care facilities.

LIMITATIONS/IMPLICATIONS

Limitations of SERVQUAL model are also the limitations of the study; eg, the study suggests that because of the absence of "cost," which is a key quality indicator of Pakistani public sector health care facilities, the model was unable to comprehensively evaluate the health care situation in light of the observations of price-focused Pakistani patients. The study recommends tailoring of SERVQUAL model for the resource-scant and underdeveloped countries where people's evaluation of the quality of the hospitals is likely to be influenced by the price of services.

ORIGINALITY/VALUE

The study is a pioneer in health care evaluation of public and private sectors of Lahore and Rawalpindi while using GRA models, in general, and the second synthetic GRA model, in particular. It presents an alternative method to the statistical way of analyzing data by successfully demonstrating the use of grey methods, which can make reasonable decisions even through small samples.

Assessing service quality and customer behavioral responses in hospital outpatient services

Purpose

In contrast to the reflective approach of service quality measurement, this paper aims to propose and validate a parsimonious multidimensional second-order formatively measured model of service quality for primary health-care services provided by hospital outpatient departments. The index’s empirical validity is examined by investigating the strength of its relationship with certain behavioral responses such as patient satisfaction and behavioral intentions.

Design/methodology/approach

Data were collected through a stratified random sampling from eight hospital outpatient departments in Greece. Covariance-based structural equation modeling techniques were used to validate the proposed service quality index and further investigate its effect on patient satisfaction and behavioral intention.

Findings

The data analysis indicated that the proposed formative index is fully functional with medical care being the factor and mostly contributes to service quality perception, followed by administrative service and staff performance, and facilities condition and nursing care. It, further, confirmed the partial mediating role of satisfaction, as it enhances the high impact of service quality on behavioral intentions.

Research limitations/implications

The relationships among hospital outpatient departments service quality, patient satisfaction and behavioral intentions were validated with data from one country and a health-care system which is state driven and funded.

Practical implications

An understanding of hospital primary health-care service quality formation is important to health-care decision makers because it offers them the opportunity to consider patients’ needs and wants, and takes the appropriate actions for improving the relevant underling procedures in a more efficient manner to achieve favorable behavioral responses.

Originality/value

The paper manages to propose and empirically evaluate a formatively measured approach of service quality and investigate the effects of the proposed index on patient satisfaction and behavioral intention, especially in the hospital outpatient services context in Greece.

Hospital healthcare service quality, patient satisfaction and loyalty

Purpose

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

Design/methodology/approach

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

Findings

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

Practical implications

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

Originality/value

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

Equating the expected and perceived service quality

Purpose

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

Design/methodology/approach

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

Findings

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

Practical implications

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

Originality/value

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

Service Quality Assessment of Hospitals in Asian Context: An Empirical Evidence From Pakistan

Hospitals vary from one another in terms of their specialty, services offered, and resource availability. Their services are widely measured with scales that gauge patients’ perspective. Therefore, there is a need for research to develop a scale that measures hospital service quality in Asian hospitals, regardless of their nature or ownership. To address this research need, this study adapted the SERVQUAL instrument to develop a service quality measurement scale. Data were collected from inpatients and outpatients at 9 different hospitals, and the scale was developed using structural equation modeling. The developed scale was then validated by identifying service quality gaps and ranking the areas that require managerial effort. The findings indicated that all 5 dimensions of SERVQUAL are valid in Asian countries such as Pakistan, with 13 items retained. Reliability, tangibility, responsiveness, empathy, and assurance were ranked first, second, third, fourth, and fifth, respectively, in terms of the size of the quality gap. The gaps were statistically significant, with values ≤.05; therefore, hospital administrators must focus on each of these areas. By focusing on the identified areas of improvement, health care authorities, managers, practitioners, and decision makers can bring substantial change within hospitals.

Service quality, patient satisfaction and loyalty in the Bangladesh healthcare sector

Purpose

The purpose of this paper is to investigate service quality, patient satisfaction and loyalty in Bangladesh’s healthcare sector. It identifies healthcare quality conformance, patient satisfaction and loyalty based on demographics such as gender, age and marital status. It examines the differences between public and private healthcare sectors regarding service quality, patient satisfaction and loyalty.

Design/methodology/approach

The authors distributed 450 self-administered questionnaires to hospital patients resulting in 204 useful responses (45.3 per cent response rate). Data were analysed based on reliability analysis, exploratory factor analysis, independent samples t-tests, ANOVA and discriminant analysis using SPSS version 23.

Findings

Findings indicate that single patients perceive tangibles, reliability, empathy and loyalty higher compared to married patients. Young patients (⩽20 years) have a higher tangibles, empathy and loyalty scores compared to other age groups. The authors observed that private hospital patients perceive healthcare service quality performance higher compared to patients in public hospitals.

Research limitations/implications

The authors focussed solely on the Bangladesh health sector, so the results might not be applicable to other countries.

Originality/value

The findings provide guidelines for enhancing service quality, patient satisfaction and loyalty in the Bangladesh healthcare sector and other countries.