Modelling the influence of healthcare facilities management service quality on patients satisfaction

Transnational learning and teaching activities: Smart Healthcare Engineering

The new maintenance engineers become self-taught and learn from daily dedication, from solving repetitive problems, from exchanging experiences with a colleague, from reading a recommended book and little else. Their own experience has been the main reference for maintenance professionals who have not given up and have become experts. And within the maintenance activities, sanitary engineering plays a very important role. Through the Smart Healthcare Engineering project we have facilitated a close connection between 3 universities and 3 hospitals from 3 countries (Spain, Turkey and Romania), which benefit from each other's experience, transferring the know-how available in a single country. The study involves 7 students from each university, meaning that 21 students have worked and studied together for 2 weeks in Spain in the field of healthcare engineering. The chosen hospital was Dr. Negrin Hospital from Gran Canaria. Results at the organizational level include the modernization of content and the provision of resources for healthcare engineering training, the introduction of innovative educational concepts in healthcare engineering and the integration of blended learning methodologies in practical teaching and training activities. A tighter connection and transnational collaboration were established between European hospitals and universities in healthcare engineering, together with unrestricted access to routinely updated information. The specific results for each participant indicated their capacity to engage in the intricate processes of repair and maintenance within a practical context, making real-time judgments on-site.

The influence of hospital services on patient satisfaction in OPDs: evidence from the transition to a digital system in South Punjab, Pakistan

BACKGROUND

Pakistani's health services delivery system has been rarely evaluated regarding patient satisfaction. This study examined the performance of the Pakistani health system from the perspective of doctor services (DS), digital payment system (DPS), nurses' services (NS), laboratory services (LS), pharmacy services (PHS), registration services (RS), physical services (environmentally and tangible) and doctor-patient communication (DPC) about patient satisfaction. A random sampling technique was adopted for data collection.

METHODOLOGY

The Social Science Statistical Package (SPSS), analysis of moment structures (AMOS), and structural equation modeling were used to analyze the data for reliability, validity, correlations, and descriptive findings. The 879 responses were used for study analysis.

RESULTS

The study revealed that patient satisfaction was found to be significantly affected positively by LS, PHS, DS, NS, and DPS, while DPC, RS, and PF were impacted non-significantly. Consequently, there is a considerable communication gap in the doctor-patient interaction, and Pakistan's healthcare system is confronted with a shortage of physical infrastructure and challenges in the digital system.

CONCLUSION

Furthermore, the insufficient emphasis on registration services necessitates immediate action to improve the entire patient experience and satisfaction. Identifying these shortcomings has the potential to result in a healthcare system that is more efficient and focused on the needs of the patients.

Development and Psychometric Test of the Inpatients Experiences Measurement Scale (IEMS)

Purpose

In South Korea, hospitalized patients' experiences significantly impact satisfaction and treatment outcomes. This study developed and evaluated the Inpatients Experience Measurement Scale (IEMS) for its psychometric properties.

Patients and Methods

Participants from three hospitals were recruited using convenience sampling. Scale item generation involved patient interviews and a Delphi survey with experts. Psychometric testing used Exploratory Factor Analysis (EFA) with 150 participants and Confirmatory Factor Analysis (CFA) with 151 participants.

Results

A total of 301 patients participated, resulting in a 20-item scale across four factors: "Care Quality and Information Provision", "Patient Safety and Dietary Services", "Facility and Comfort Infrastructure", and "Comprehensive Patient Support Services". Rated on a 5-point Likert scale, the scale showed a high Content Validity Index (CVI) over 0.80. EFA explained 61.43% of the variance. The four-factor model was validated using CFA with favorable fit indices. The IEMS demonstrated strong convergent validity, supported by high composite reliability (CR) and average variance extracted (AVE) values. Significant correlations with the Patient Satisfaction Scale reinforced its convergent validity. Discriminant validity was confirmed, and all reliability measures exceeded the minimum threshold of 0.80.

Conclusion

The IEMS effectively captures inpatients' experiences, demonstrating robust reliability and validity. This scale is a valuable tool for assessing patient experiences, facilitating enhancements in patient care and satisfaction within hospital settings.

Assessment of facilities management sourcing approaches in hotels in Ghana: a study of selected hotels in Wa

Purpose

The study aims to assess the sourcing approaches used in providing facilities management (FM) services in hotels. It further explores the factors that influence hotels' choice of sourcing approach and the challenges.

Design/methodology/approach

The study used a case study design. Simple random, census and purposive sampling techniques were used to select the hotels and respondents. Data were collected using interviews and analysed thematically. The data were presented in narration and direct quotes from the respondents. The critical factors influencing outsourcing decisions were ranked using the relative importance index. This study is based on a single case. Therefore, further research should be conducted to expand the scope of study nationwide as a step toward making the results more robust.

Findings

Both in-house and outsourcing sourcing approaches were used to provide FM services. In-house FM services mainly focused on cleaning, security and aspects of maintenance. Internet and information technology related services and other maintenance activities were also outsourced. Outsourcing decisions in the various hotel categories were mostly guided by the cost of outsourcing, core business, lack of in-house skills and hotel size.

Practical implications

FM strategy can be developed to guide the management of FM activities in hotels. An approach that adds value and enhances the activities of hotels and provides convenience to customers must be adopted by hotels. Further studies should be conducted on the cost implications of the two main sourcing approaches, as well as the impact of sourcing approaches on customer satisfaction. An additional study should focus on the driving factors influencing the cost and quality of outsourced FM services in hotels. This will help provide comprehensive information on effective FM sourcing approaches and the operations of hotels.

Originality/value

The study focused on the sourcing approaches used by hotels to provide FM services. It also explored the influencing factors and challenges of FM practices in hotels.

Critical Device Reliability Assessment in Healthcare Services

Medical device reliability is the ability of medical devices to endure functioning and is indispensable to ensure service delivery to patients. Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) technique was employed in May 2021 to evaluate existing reporting guidelines on medical device reliability. The systematic searching is conducted in eight different databases, including Web of Science, Science Direct, Scopus, IEEE Explorer, Emerald, MEDLINE Complete, Dimensions, and Springer Link, with 36 articles shortlisted from the year 2010 to May 2021. This study aims to epitomize existing literature on medical device reliability, scrutinize existing literature outcomes, investigate parameters affecting medical device reliability, and determine the scientific research gaps. The result of the systematic review listed three main topics on medical device reliability: risk management, performance prediction using Artificial Intelligence or machine learning, and management system. The medical device reliability assessment challenges are inadequate maintenance cost data, determining significant input parameter selection, difficulties accessing healthcare facilities, and limited age in service. Medical device systems are interconnected and interoperating, which increases complexity in assessing their reliability. To the best of our knowledge, although machine learning has become popular in predicting medical device performance, the existing models are only applicable to selected devices such as infant incubators, syringe pumps, and defibrillators. Despite the importance of medical device reliability assessment, there is no explicit protocol and predictive model to anticipate the situation. The problem worsens with the unavailability of a comprehensive assessment strategy for critical medical devices. Therefore, this study reviews the current state of critical device reliability in healthcare facilities. The present knowledge can be improved by adding new scientific data emphasis on critical medical devices used in healthcare services.

The relationship between facilities management service quality and patients’ health-care experience: the mediating effect of adequacy of health-care resource

Purpose

With challenges in health-care facilities management (FM) and adequacy of health-care resources constraints in most developing countries, improving patient’s health-care experience has become of strategic importance in public health-care delivery. This paper aims to investigate the mediating effect of adequacy of health-care resources on the relationship between the quality of health-care FM services and patient’s health-care experience.

Design/methodology/approach

This cross-sectional study adopts a quantitative approach based on a questionnaire survey conducted on 660 patients of three teaching hospitals in Ghana. In total, 622 valid questionnaires were used for data analysis using partial least squares structural equation modelling.

Findings

The mediating effect of adequacy of health-care resources on the relationship between responsiveness and tangibility and patients’ health-care experience were supported, while that of empathy, reliability and assurance were not supported. The relationship between and adequacy of health-care resources and patients’ health-care experience was also supported.

Research limitations/implications

The study limitation is that it was only the teaching hospitals that were surveyed. In future studies, a comparative analysis can be conducted between both public and private hospitals. Other constructs and relationships such as the mediating effect of the quality of health-care administrative process on the relationship between FM service quality and patients’ health-care experience as well as the moderation effect of adequacy of health-care resource on the relationship between FM service quality and patients’ health-care experience can also be tested. Future studies on the same subject can use health-care workers as the respondents of the study.

Practical implications

The result should inspire health-care managers to prioritize attention on health-care FM to create and sustain a decent health-care environment. Facilities managers should ensure standards are not compromised by keeping health-care resources in good condition through the organisation and management of resources.

Originality/value

To the best of the authors’ knowledge, this paper is one of the pioneer studies to test the mediating effect of adequacy of health-care resources on the relationship between patient’s health-care experience and health-care FM service quality. The proposed framework can be adapted to various sectors and countries as this empirical validation extends knowledge.

Patients satisfaction of core health-care business: the mediating effect of the quality of health-care infrastructure and equipment

Purpose

Although the quality of health-care infrastructure and equipment influences patient’s overall health-care experience, health-care infrastructure and equipment are not always managed and maintained with the attention required. This is due mainly to the complexity of health-care infrastructure and equipment and shortage of maintenance budget. This study aims to determine if patient’s satisfaction of core health-care business is mediated by the quality of health-care infrastructure and equipment.

Design/methodology/approach

This cross-sectional study comprises 622 adult patients at the Physician OPD and Polyclinic of Komfo Anokye Teaching hospital, Tamale Teaching hospital and Cape Coast Teaching hospital in Ghana. Structural equation model Smart PLS was used to analyse the data.

Findings

The study results showed that the quality of health-care infrastructure and equipment has a positive significant influence (mediation) on the relationship between health-care delivery and patient’s satisfaction as well as the relationship between adequacy of health-care resources and patient’s satisfaction. However, it was shown not to have a positive significant influence (mediation) on the relationship between quality of health-care personnel and patients’ satisfaction as well as health-care administrative process and patient’s satisfaction.

Research limitations/implications

First, the study findings are centred on cross-sectional data, which capture the opinion of the patients at a specific time period instead of over a period of time. Consequently, in future, though difficult to achieve, a longitudinal study can be piloted to provide more insight. Second, the data was collected from only one country (Ghana); thus, the ability to generalise the results may be a challenge.

Practical implications

The implication of this study is that there is the need to prudently maintain hospital infrastructure and equipment in good working condition as it has a positive effect on patients’ satisfaction of their overall health-care experience.

Originality/value

Most studies have concentrated on patient’s health-care experience. This study extends the knowledge of patient’s health-care experience by determining the mediating role of quality of health-care infrastructure and equipment on the relationship between patient’s satisfaction and core health-care business. There are limited studies of such nature in Ghana. Therefore, this study will provide invaluable empirical data for the health-care sector of a developing African country.

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

Purpose

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

Design/methodology/approach

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

Findings

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

Originality/value

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

A quantitative framework for health‐care service quality assessment in India

Purpose

The present situation of COVID-19 pandemic has put the health-care systems under tremendous stress and stringent tests for their ability to offer expected quality of health-care services, as it decides the sustainability and growth of health-care service providers. This study aims to deliver a quantitative framework for service quality assessment in the health-care industry by classifying the health-care service quality parameters into four balanced scorecard (BSC) perspectives.

Design/methodology/approach

To determine the service quality for the Indian health-care system, decision-making trial and evaluation laboratory and analytical network process are integrated in a fuzzy environment to contemplate the interaction among BSC perspectives and respective performance measures.

Findings

The results indicate “internal processes” perspective assumes the key role within BSC perspectives, while performance measures “nursing staff turnover” and “staff training” play the key roles. The results also signify that “patient satisfaction” is the most vital issue and can be strongly influenced by measures belonging to the “learning and growth” perspective. In “learning and growth” perspective, “staff training” is the most decisive criteria, very highly influencing “patient satisfaction”, highly influencing “profitability,” “change of cost per patient (both in and out patients)” and “outpatient waiting time” while moderately influencing “staff satisfaction,” “bed occupancy” and “nursing staff turnover”. Moreover, “staff training” criteria have a positive influence on “nursing staff turnover.”

Originality/value

The contributions of this study are in two folds in the domain of quantification of service quality for the health-care system. First, it delivers an assessment framework for Indian health-care service quality. Second, it demonstrates an application of the framework for a case situation and validates the proposed framework.

An Equity Evaluation on Accessibility of Primary Healthcare Facilities by Using V2SFCA Method: Taking Fukuoka City, Japan, as a Case Study

The primary healthcare facilities are among the most basic needs of the residents, huge in quantity and widespread. Their distributions are directly related to people’s health, which affects the sustainable development of cities. The accessibility calculation of primary level healthcare facilities and the equity evaluation of accessibility from the perspective of medical service category and urban population is very important for the decision-making of layout and configuration but has been ignored for a long time. This study took the primary healthcare facilities of Fukuoka city in Japan as research objects; it first used the variable two-step floating catchment area (V2SFCA) method to calculate the healthcare catchment areas (HCAs) of medical service providers and the population catchment area (PCAs) of medical demand locations, and then obtained the accessibility to primary healthcare facilities. Finally, the spatial disparities of accessibility were evaluated from three aspects: overall space distribution by using Global and Local Moran’s I, service quality, and the population to be served. The results showed that HCAs were from 500 m to 6400 m, PCAs ranged from 500 m to 3000 m, the use of variable catchments can improve the accuracy of accessibility assessment results; the accessibility of primary healthcare facilities was clustered and had significant spatial differences, which were high in urban center and low in suburban area; the obvious differences in the accessibility distribution characteristics of clinics in differential diagnosis and treatment departments led to different degrees of unsaturation in the types of medical services obtained by residents; although the elderly’s demand for basic medical care was many times higher than that of other age groups, the accessibility in high-demand areas was generally low, and the situation in severely high-demand areas was more serious. This work puts forward a multi-dimensional realistic evaluation system for equality accessibility of primary healthcare facilities, providing the data support for the medical resources and facilities’ allocation and the intensive land use.

A practical framework for performance measurement of facilities management services in developing countries’ public hospitals

Purpose

Facilities management (FM) plays a vital role toward creating the hospitable environment that supports the core clinical business of rendering quality health care. To ensure optimal performance of FM, public hospitals require a performance measurement (PM) framework that could guide and assist facilities managers in their operations. This paper aims to respond to this need by developing a performance measurement framework useful to improve FM performance within the context of developing countries hospital FM services delivery.

Design/methodology/approach

The paper synthesizes knowledge from a comprehensive review of FM performance measurement literature and the results of an earlier PhD research on FM performance measurement in Ghana’s public hospitals.

Findings

The paper presents a simplified performance measurement framework which demonstrates four key performance measurement tasks: establishing performance goals; measuring the FM service delivery; evaluating FM outcomes; and performance review and reporting. The study suggests the establishment of a central coordination point to enhance performance measurement activities of public hospitals’ FM practices.

Research limitations/implications

Although reference is made to research on key performance indicators (KPIs), future study is recommended to develop appropriate methodology for selecting relevant KPIs. The author also intends to pilot the framework to a health facility in Ghana to leverage its usefulness, given the fact that it has not been tested empirically.

Practical implications

The application of the framework is expected to lead to the identification of performance gaps and weakness which when acted upon could lead to operational effectiveness and efficiency of the FM process, ultimately leading to improved FM performance.

Originality/value

The paper develops a novel performance measurement framework useful within the context of the nascent FM industry in the developing world.

The mediation effects of finance on the relationship between service quality and performance of hospital facilities management services

Purpose

With rising health-care costs and the financial constraints in most developing countries, prioritization of needs have become an issue of strategic importance in public hospitals. As a result, there is the intense competition of scare resources between core health care and non-core facilities management (FM) services. Given that financial resources are needed to facilitate the smooth operation of the FM department, this paper aims to investigate the direct and indirect effects of finance on the relationship between service quality and performance of hospital FM services.

Design/methodology/approach

The paper adopts a quantitative approach following a general questionnaire survey which was conducted on the research population. Partial least squares structural equation modelling was used to investigate the relationships between service quality and performance of hospital FM services.

Findings

The study highlights the relevance of service quality to improving FM performance and demonstrate the direct and indirect influence of finance to ensure quality FM services delivery to improve core health care outcomes in hospitals.

Practical implications

The result of this study should motivate hospital management to prioritize attention on FM in scare resources management in public hospitals to create and maintain a decent health-care environment for better health outcomes. Further, managerial commitment to facilitate employee training, empowerment, incentives, awards and compensation should be strengthened in the quest of ensuring quality services delivery.

Originality/value

The paper extends knowledge by mediating the influence of finance on the relationship between service quality and FM performance. Proposes a parsimonious financial mediation framework which can easily be adaptable to several developing countries health-care FM management.

FM and clinical employees' involvement in the design of eight Norwegian hospital projects

Purpose

This paper aims to gain insight in how the involvement of facilities management (FM) and clinical employees are practiced in new Norwegian hospital projects and to study the benefits and lessons learned from the involvement.

Design/methodology/approach

This study is conducted by cross-sectional case studies of eight hospital projects by using a literature review, interviews and document studies of FM and clinical employees and project leaders (PLs) among Sykehusbygg.

Findings

The service design approach with a structured interaction between the PL’s of Sykehusbygg, and the different disciplines of clinical employees and FM specialist was rewarding and efficient. The facilitator role of Sykehusbygg is essential to manage such a broad and complex involvement process using a wide range of various techniques at the different stages of the projects (dialogue meetings, review meetings, workshops, post-it notes, 2-D drawings, mock-up and 3-D models, as well as virtual reality (VR) and Building Information Modeling technology). The clinical employees’ framework is stronger and much more structured than the involvement of FM competences through the different stages of the projects. The property management competences were involved at the early concept phase and design phase, whereas the Operation and Maintenance (O&M) competences were getting involved through the construction and commissioning phase. The value of FM involvement in all stages of the project is seen beneficial, particularly when the FM specialist become a part of the design team and located physically at the same place. The main reported benefits of early FM involvement are cost-effective technical solutions and installations, less design flaws and improved functionality, as well as a stronger ownership and mutual respect between the clinical and FM disciplines. However, not all hospital organizations see the benefits of the FM involvement of all stages, as they are driven by reducing capital cost. In one of the new projects, other ways of involving the FM competences were tested. Additionally, particularly for the O&M competences, a dialogue meeting with a clear focus of sharing experiences with different technical solution was found rewarding in terms of cost benefits.

Research limitations/implications

This study does not consider the social impact of the choices made in the design phase. The findings also indicated a certain development of the FM involvement. This is not studied in two of the newest projects where they are still in the design phase and the FM role was not interviewed.

Practical implications

The PL role is important as a facilitator role of the involvement process.

Social implications

A dialogue meeting with a group of O&M people was found rewarding and valuable for knowledge sharing. This methodology can be further developed and tested, as this group of stakeholders is not always available for giving input in the project.

Originality/value

The value of this study is the description of the interaction between the PLs and the hospital organization in the eight projects and lessons learned by the involvement of FM competences and clinical employees.

Evaluating the total quality and its role in measuring consumer satisfaction with e-healthcare services using the 5Qs model: a structure equation modeling approach

Purpose

This article initially aims to explore the factors of every quality construct of the 5Qs model of service quality and, second, identify the significant factors affecting the total quality of e-healthcare services and its association with consumer satisfaction using a multidimensional hierarchical 5Qs model of e-healthcare service quality.

Design/methodology/approach

Questionnaire-oriented research was performed at three public hospitals of Punjab and Chandigarh. In total, 53 variables were covered in all quality constructs for data collection from the designated public hospitals. The respondents who agreed to have knowledge regarding e-Healthcare services and were availing these services were included in the study. The analysis comprised structural equation modeling technique using AMOS 21.

Findings

The outcomes suggest that the 5Qs model is more comprehensive and can be used to evaluate service quality perceptions using e-Healthcare services. The research identified 11 sub-dimensions for the five quality constructs of the 5Qs model, representing total quality, which is primary to consumer satisfaction. “Overall objectivity” and “technical objectivity” defined the quality of object. The quality of process of e-Healthcare services was characterized by “functionality,” “timeliness” and “responsiveness.” Quality of infrastructure was defined by “technical infrastructure,” “physical infrastructure,” “manpower skills” and “organizational infrastructure.” “Manner of interaction” and “timely interaction” defined the quality of interaction. The atmosphere was represented by only one factor. The results also suggest that quality of infrastructure, quality of interaction and quality of atmosphere play the most significant role in total quality leading to consumer satisfaction.

Research limitations/implications

Theoretical implications: The multidimensional hierarchical model will help the researchers study the e-Healthcare service quality in a more organized manner, and the outcomes of this study can be linked with that of future studies for more generalized application in other public hospitals. The sub-dimensions of each quality construct of the 5Qs model can be applied in private hospitals, and the hierarchical model can be tested in different industries to measure service quality perceptions of the consumer

Practical implications

The outcomes of the study can be applied in various public sector hospitals to redesign the e-Healthcare services based on consumers' perception for better consumer satisfaction and quality services. This paper identifies the role of each quality construct in e-Healthcare services for improvement in the total quality, which in turn will lead to higher satisfaction for the consumers.

Originality/value

In this study, the original 5Qs model has been used for the first time in a new instrument to understand better and design quality e-Healthcare services. The paper explores the sub-factors of each quality construct and its significance in measuring the total quality.

DEVELOPING A STRATEGIC SUSTAINABLE FACILITY PLAN FOR A HOSPITAL LAYOUT USING ELECTRE AND APPLES PROCEDURE

Today healthcare globally is growing at a rapid pace and despite the huge technological advancement, healthcare still faces primitive challenges and hence results in the poor service and facility to the needy. Layout planning acts as one major reason which requires improvements for the effective and efficient working of the healthcare facilities. This research aims at optimizing several quantitative criteria related to economic, technology and society which are taken into consideration for the decision-making during the evaluation, analysing and selection of the best layout for an existing healthcare facility. Critical areas for the improvement were found out using statistical analysis based on a survey questionnaire and Apple’s layout procedure is utilised to design the different possible layouts for an efficient facility. The seven criteria namely inter-departmental satisfactory level, the average distance travelled and the average time required for staff flow, the average distance travelled and the average time required for patient flow, the average distance travelled and the average time required for material flow were taken into consideration. The ELECTRE methodology was used as multi-criteria decision making based on decided seven criteria for comparing the different layout by methodical and orderly thinking.