Expectations and perceptions of Greek patients regarding the quality of dental health care

Exploring dental students' attitudes toward patient-centered management of dental fear

PURPOSE/OBJECTIVES

A patient-centered care (PCC) paradigm undergirds modern dental education. PCC is particularly relevant in the management of patient dental fear. The aims of this study were three-fold: (a) to examine the preliminary psychometric properties of an author-designed survey administered to explore dental fear knowledge and perceptions, (b) to assess how 4th-year dental students regard dental fear, (c) and to investigate the relationship between students' knowledge and perceptions of dental fear and their clinical behavior.

METHODS

In 2022, 4th-year dental students (N = 453) participated in a cross-sectional study. Participants completed a 16-item survey that assessed (a) knowledge and perceptions about dental fear, (b) common biases in patient fear assessment, and (c) patient management behaviors when fear is encountered. Exploratory factor analysis, descriptive statistics, and logistic regressions were run to address the study's aims.

RESULTS

Exploratory factor analysis revealed three factors, with the two strongest factors pertaining to beliefs about the importance of dental fear (α = 0.87) and self-efficacy in managing fear (α = 0.74). Participants indicated that it is important to assess for dental fear and rated their self-efficacy in ability managing it as high. Ratings on both factors slightly increased the odds of engaging in routine patient screening for dental fear. Students also displayed assessment biases commonly seen among practicing dentists.

CONCLUSION(S)

Results indicate educational gaps within the current behavioral-science training for dental students. Changes to improve advanced dental students' appreciation of their patients' dental fear are warranted.

“It’s a waste of time coming here, better go to private clinics with wider options for treatment”: patient’s perception on dental services provided in Fiji

Background

Oral health can influence the quality of an individual’s life. Patient’s perception of the service plays a vital role in understanding the reasons as to why a patient may be satisfied or dissatisfied with the service that they accessed at a dental setting. As no studies have been done in Fiji until now, this study aimed to explore the perceptions of patients on services provided by the largest dental clinic in the Central/Eastern division in Fiji.

Method

A qualitative study was used to collect data from patients who visited the Colonial War Memorial Hospital (CWMH) dental clinic in Suva Fiji from 5^th August to 31^st October, 2020. All patients above the age of 18 of both genders and from any ethnicity who visited the CWMH dental clinic during the period of data collection were included the study. A total of 25 participants were interviewed for this study using the in-depth interview method till data saturation occurred. A semi-structured open-ended questionnaire was used to collect data using face-to-face in-depth interviews. The data were transcribed and analyzed using manual thematic analysis process to gather the themes and sub-themes for the results.

Results

A total of 25 patients were interviewed, with a majority (n = 14) being men and 15 were of I-Taukei background. Five themes emerging from data analysis include: Waiting time before treatment, Cost of Treatment, Accessibility of services, Privacy and confidentiality and Range of treatment options. The patients had an expectation to get the best treatment but face many hurdles while trying to get the treatment that they expect. The shortfalls on the part of this dental clinic caused an onset of negative perception among its users.

Conclusion

This study shows an overall dissatisfaction with regards to services delivery among the patients who use the CWMH dental clinic for dental care purposes. The decision makers need to look into the genuine concerns that have been raised by patients in order to create improvements in services delivery and create an array of satisfaction for its patients.

A Systematic Literature Review of Quality Management Initiatives in Dental Clinics

By considering the recently proposed definitions and metrics, oral healthcare quality management (OHQM) emerges as a distinct field in the wider healthcare area. The goal of this paper is to systematically review quality management initiatives (QMIs) implementation by dental clinics. The research methodology approach is a review of 72 sources that have been analyzed using the Context-Intervention-Mechanism-Outcome Framework (CIMO). The analysis identifies five mechanisms that explain how quality management initiatives are implemented by dental clinics. The simplest QMIs implementations are related to (1) overall quality. The next ones, in terms of complexity, are related to (2) patient satisfaction, (3) service quality, (4) internal processes improvement, and (5) business outcomes. This paper is the first attempt to provide a critical review of this topic and represents an important advancement by providing a theoretical framework that explains how quality management is implemented by practitioners in this field. The results can be used by scholars for advancing their studies related to this emerging research area and by healthcare managers in order to better implement their quality management initiatives.

A Consideration of Professionalism for Dental Professionals

Professionalism is an ubiquitous word in dentistry. Whilst we often feel we have an innate understanding of it, there is no single clear definition as to what professionalism in dentistry really means. Therefore, how can we truly comprehend what is expected of us? This article aims to explore current literature regarding professionalism and provide some clarity as to what this means with regards to dentistry in the United Kingdom. Guidance from the General Dental Council's (GDC) document Preparing for Practice¹ breaks professionalism into four categories: (1) patients and the public, (2) ethical and legal, (3) teamwork, and (4) development of self and others. Investigation into each of these categories alongside the GDC's most recent study Professionalism: A Mixed-Methods Research Study² enables an unambiguous view of professionalism in dentistry from the GDC's perspective. Whilst the GDC's Preparing for Practice and Professionalism: A Mixed-Methods Research Study are good starting points in improving our understanding of professionalism, it is still very much open to interpretation by the individual, owing to lack of a clear-cut definition. Overall, professionalism remains a vague and poorly defined concept in dentistry.

Quality assessment of services provided by health centers in Mashhad, Iran: SERVQUAL versus HEALTHQUAL scales

Background

Primary health care is the entry point to the health-care system and regarded as an essential step to achieving universal health coverage. The present study aimed at evaluating the quality of health-care services provided in health centers in Mashhad, Iran.

Methods

This was a cross-sectional study implemented among 200 health service users who were referring to four health centers in Mashhad during January to June 2019. The quality of services in health centers was evaluated with the SERVQUAL and HEALTHQUAL models. Data was analyzed by employing paired t-test and independent sample t-test using SPSS version 16 software. The Levene test was used for examining the equality of variance (homogeneity). Significance level of all the tests was considered when p ≤ 0.05.

Results

According to the results of SERVQUAL questionnaire, the average scores of health service users’ expectations and perceptions were 4.97 and 3.26, respectively, and the quality gap in the provided services was equal to − 1.7. Based on HEALTHQUAL questionnaire, the average scores of health service users’ perception and expectations were 4.72 and 3.25, respectively, and the quality gap in the provided services was equal to − 1.16. Empathy was the highest quality dimension (− 2.019) based on SERVQUAL model, and efficiency dimension was the highest based on HEALTHQUAL model (− 1.761).

Conclusions

The findings of the current study showed a negative gap between the service users’ expectations and perceptions in both models. Therefore, the results of this study helps the health managers and policymakers to plan effective interventions for improving the provided services emphasizing the dimensions with the wider gaps.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06405-4.

Developing Person-Centred Dental Care: The Perspectives of People Living in Poverty

Dentistry has seen a slow trend toward person-centred care (PCC), with most approaches developed by scholars who have tried to progress away from disease-centred care. Unfortunately, the perspectives and experiences of underprivileged people have not been considered in the development of these approaches. Our objective was thus to understand underprivileged people's experiences and expectations about dental care and contribute to the development of person-centred dentistry. We conducted a qualitative descriptive study with a sample of 13 people living in poverty. We used a maximum variation sampling strategy and selected them among the users of a free dental clinic in Montreal, Canada. We conducted semi-structured interviews that we audio recorded, transcribed verbatim, and thematically analysed. Our main finding is that participants wanted to feel human and respected by dentists. More specifically, they wanted to be more involved in the dental care process through quality time and empathetic conversations with the dentist. They also wished for an exchange of information free of technical terms and built on mutual trust. In conclusion, person-centred dental care models should emphasize empathy, trust, and quality care beyond technical skills. Clinicians should provide comprehensive information in dental encounters and treat their patients as whole persons.

A new service quality scale for hospital emergency rooms

Purpose

Service quality and patient satisfaction have a significant impact in healthcare. Health organizations have also begun to put the customer at the center and meet his or her needs. This study aims to indicate the need to develop a simple and appropriate scale for measuring quality of service in hospital emergency rooms.

Design/methodology/approach

The validity and reliability of the scale were established by three separated and independent studies that used exploratory factor analysis, confirmatory factor analysis and correlation analysis to test the nomological network validity of the scale. The data was collected randomly from an internet panel that comprises more than 50,000 people over the age of 18. The research is based on 1,002 Israelis who accompanied a patient to a hospital emergency room.

Findings

In total, 23 items comprised the new scale of emergency room service quality with three dimensions: “staff professionalism”, “staff caring” and “tangibles”. The internal reliability for the total scale was high with Cronbach'sαof 0.97.

Research limitations/implications

In Israel, there is a state health system, and therefore, it is necessary to check the scale elsewhere in the world.

Originality/value

The measurement of service quality for emergency room needed to be focused on the unique charters of the service provided in hospitals’ emergency room. The findings show that a client may assesses the service their loved one has received to decides whether to return to the same hospital and recommend it to his or her friends.

Quality of cross-infection control in dental laboratories. A critical systematic review

Purpose

To identify reported practices for cross-infection control in dental laboratories and to quantify the importance of the flaws encountered.

Data sources

Systematic search (cross-infection AND dental laboratory) at EMBASE, PubMed, SciELO and Scopus databases.

Study selection

Papers reporting on cross-sectional studies providing original data about cross-infection knowledge, practices and attitudes of dental technicians. Papers reporting on a single laboratory or institution were excluded.

Data extraction

Data extraction was undertaken independently by three reviewers using a purpose made form. The outcome of this study was analyzed in five aspects, namely process organization, disinfection, working environment, use of individual protective equipment and vaccination policy.

Results of data synthesis

The systematic search output was 1651 references and 11 papers were finally selected. Flaws were more frequently identified in terms of vaccination policy, biological safety of the working environment and use of individual protective equipment (100%). Slightly better results were found in terms of organization of the cross-infection control process (89.47%) and disinfection practices (85.71%). The application of the formula for disclosing the relative importance of the flaws identified in the literature prioritizes the need for interventions aimed at improving the organization of the cross-infection control procedures, followed by training in item disinfection. The control of the working environment together with the use of individual protective equipments rank closely in importance, followed by the existence of a vaccination policy.

Conclusions

Sub-standard cross-contamination practices seem to be a common finding in dental laboratories, which may well compromise the quality of certain dental treatments.

Service Quality Gaps in the Provision of Care to Surgical Patients: a Cross-Sectional Study in the Northwest of Iran

Introduction: The evaluation of service quality is a key measurement which provides the necessary information for effective decision making and providing high quality care. This study aimed to investigate the factors affecting the service quality gap for the provision of care from the perspective of surgical patients hospitalized in a teaching hospital in the Northwest of Iran in 2015.

Methods: In this descriptive cross-sectional study a total of 300 patients and 101 nurses were selected by random sampling method. The data regarding patients’ expectations and perceptions of the quality of healthcare services were collected using the SERVQUAL questionnaire. Also, the nurses’ demographic data were assessed using the demographic data tool.

Results: The mean and standard deviation of the patients’ expectations and perceptions of the quality of healthcare services were 66.59)8.52) and 51.81(11.97), respectively. In all dimensions of the quality of healthcare services, the patients’ perceptions were lower than their expectations. The greatest gap was observed in the dimensions of assurance and responsibility and the lowest gap was reported in the domains of reliability and empathy. There were statistically significant relationships between the nurses’ age, work experiences in surgical wards, professional experiences of nurses, patients’ income level and the gap in the quality of healthcare services.

Conclusion: Despite great efforts directed at the field, the healthcare system still faces numerous challenges in the provision of high quality healthcare services to the patients. The health system should support low-income people and employ professional and experienced nurses for improving the quality of healthcare services.

Dental professionalism and influencing factors: patients' perception

BACKGROUND

Professionalism was recognized as a fundamental competency of medical/dental practice at the beginning of the twenty-first century. Organizations and experts published several definitions of professionalism, but research on patients' perception of professionalism has been limited. To address this gap in literature, this study explored dental patients' perception of dental professionalism, and then compared their perception with that of dental professionals.

METHODS

Of the 800 questionnaires that were distributed to dental patients in public and private clinics and hospitals, 504 were returned and were used in the analysis. A factor analysis was used to generate themes and sub-themes. Independent sample t-tests were performed to compare two independent groups and the ANOVA tests to compare means in more than two independent groups.

RESULTS

A factor analysis revealed four factors: excellence and communication skills; humanism, commitment, and service mindedness; competence in practice; and dentists' duties and management skills. Adherence to sterilization and infection control rules and procedures; personal hygiene and clean professional attire; good communication skills; diagnostic and clinical judgment and provision of the most efficient dental treatment; and ethical decisions and ethical care were ranked as the first five most important elements of dental professionalism from patients' perspective. Several demographic factors showed significant differences in perception.

CONCLUSION

Patients' and dentists' perception of dental professionalism and professional behavior vary in certain aspects. These differences must be addressed to ensure excellence of dental service. Dental professionals must also be aware of the personal factors that affect a patient's perception of professionalism.

Assessing quality of health services with the SERVQUAL model in Iran. A systematic review and meta-analysis

Purpose

The five-dimension service quality (SERVQUAL) scale is one of the most common tools for evaluating gaps between clients' perceptions and expectations. This study aimed to assess the quality of health services in Iran through a meta-analysis of all Iranian studies which used the SERVQUAL tool.

Data sources

A systematic literature review has been performed in Web of Science, PubMed, Scopus, Google Scholar, Iran Medex, Magiran and Scientific Information Database.

Study selection

All relevant English or Persian studies published between January 2009 and April 2016 were have been selected. Papers were considered if they regarded all five dimensions of the SERVQUAL tool for assessing the quality of health care services.

Data extraction

Two reviewer independently extracted mean and standard deviation of five dimensions and characteristics of studies. The quality of studies included in meta-analysis using STROBE checklist.

Results of data synthesis

Of 315 studies initially identified, 12 were included in our meta-analysis. All analyses were performed in Stata MP v. 14. Patients' perceptions were lower than their expectations (gap = -1.64). Responsibility (-1.22) and reliability (-1.15) had the lowest gaps, and tangibility and empathy (-1.03) had the largest gaps. Except gender, other variables had no significant associations with gaps. Patients in the cities of Arak (-3.47) and Shiraz (-3.02) had the largest gaps.

Conclusions

All dimensions of service quality were negative, which implies that the quality of health services in Iran has not been satisfying to patients and needs to be improved.

A cross-sectional study of confidence in minor surgical skills amongst junior dentists

INTRODUCTION

To work in the National Health Service (NHS) as a dentist, the practitioner needs to be on the UK dental "performer's list". To apply for access to this list and work as a General Dental Practitioner (GDP), dentists must be qualified from the European Economic Area (EEA) or, those trained in the UK, must undertake Dental Foundation Training (DFT). Dentists interested in further taught learning or pursuing specialist training must continue working as "Dental Core Trainees" (DCTs). Most of these jobs are available in Oral and Maxillofacial Surgery (OMFS) Units and require dentists to undertake unsupervised surgical procedures. It is currently estimated that over 400 "junior dentists" undertake DCT a year. It is the aim of this study to ascertain whether confidence in simple surgical procedures improves when compared to GDPs of similar experience.

METHODS

One hundred and two junior dentists, 34 DFTs, 20 DCT1s, 21 DCT2s and 27 second and third year post-DFT GDPs all working across the Midlands, UK, had Likert scale responses about confidence in 14 minor surgical skills assessed. Results were analysed to ascertain whether gender, year group and number of extractions had any effect on confidence.

CONCLUSIONS

We conclude that confidence in minor surgical procedures improves significantly when undertaking DCT OMFS posts, with the most significant improvement in confidence occurring within the first 6 months. Dental Core Trainees become significantly more confident in their surgical ability within the first 6 months when compared to GDPs with longer postgraduate experience.

The importance of the evaluation of expectations and perceptions to improve the dental service quality

Purpose The purpose of this paper is to evaluate the use of SERVQUAL to assess service quality in Dentistry, by evaluating patients' expectations and perceptions of dental care and their association to patients' sociodemographic data. Design/methodology/approach The sample constituted of 379 subjects in the first assessment and 155 in the second phase. All employees of the companies that were clients of the dental insurance participated, a total of four companies in two states (São Paulo and Minas Gerais) of Brazil. SERVQUAL questionnaires about expectations and sociodemographic data were dispatched in the first phase, and in a second phase SERVQUAL questionnaires about perceptions. Those who had not yet received dental treatment and had agreed to participate filled out their survey in the first phase. In the second phase, the respondents had to have completed their treatment. Findings When the value gap is considered, Reliability (as a dimension) had the smallest score (-3.71). This means that it was the worst result, i.e. there is a higher difference between expectations and perceptions, and problems can be identified here. t-test confirmed that all the dimensions had some statistically significant difference with p<0.05 in relation to expectations and perceptions. Women presented higher prevalence of dissatisfaction (Tangible and Reliability dimensions), as well as the oldest participants (Empathy dimension) and those with lower parental literacy (Assurance and Empathy dimensions). The only dimension that was not significantly associated was Responsiveness. Originality/value This research suggests that the patients evaluated the physical characteristics of the premises and the interaction with the staff as the priority issues that need special attention in this service. Moreover, the use of SERVQUAL was extremely relevant for the oral health service, because it assessed the users' subjective perceptions.

Patient’s Expectation and Perception for Preorthodontic Treatment Consultation: A Study in a Dental School

Objectives

The aim of the study is to explore the desired expectation (DE), adequate expectation (AE), zone of tolerance (ZoT), and perceived level (PL) from the patients attending a preorthodontic treatment consultation at Orthodontic Clinic, Dental School, Prince of Songkla University, Thailand.

Materials and Methods

A total of 170 patients aged 15 years and older were asked to express their DE and AE before the consultation and to give their PL after the consultation. Two sets of questionnaires were used in this study. The first set was designed to gain data regarding general information and the measured level of expectation. The second set was used to measure the PL of patients after the preorthodontic consultation. Both questionnaires contained four dimensions of the service: Dentist’s courtesy, dentist’s care and examination, dentist’s communication, and convenience of the services.

Results

The communication dimension especially information regarding the orthodontic treatment need got rather low PL compared to others.

Conclusion

The information regarding the orthodontic treatment need was the main item that patients need to receive in the consultation.

The change of patient profile, attitudes and satisfaction in University Dental clinic after onset of economic crisis in Greece

Background/Aim: The aim of the study was to evaluate and compare patient profile, attitude and satisfaction of patients visiting a university periodontal clinic before and during the financial crisis in Greece. Material and Methods: In this cross-sectional study, adult consecutive patients that visited the undergraduate Periodontology clinic of the Aristotle University of Thessaloniki from October 2014 to July 2015 were invited to participate anonymously. The only exclusion criterion that was set was the age: all individuals had to be ≥18 years old. The questionnaire utilized in this study included six parts of questions: 1) demographic characteristics; 2) environmental and behavioral characteristics; 3) diagnosis of periodontal disease; 4) medical history; 5) difficulties-satisfaction-proposals about periodontal treatment; and 6) history of periodontal therapy. One hundred and fifty individuals, mean aged of 51.6±12.3 years were interviewed concerning their demographic and behavioral characteristics. Satisfaction level, reasons for selecting the university dental clinic and oral hygiene habits were also recorded. Results: The profile of the patient attending the university periodontal clinic was a female (54.0%), 51-year-old on average, of high education (76.0%), good oral hygiene habits (brushing ≥2 times/day: 49.3%, use of additional oral health care: 66.0%), heavy smoker (>15 cigarettes/day: 51.9%) and chronic periodontal disease (96.7%). Economic difficulties led the participants to seek periodontal treatment in the university clinic (30.7%), but the vast majority of them were highly satisfied (81.3%), confident (82.0%) and informed (51.3%) about the treatment. Before the financial collapse in Greece, the profile of the patients in the clinic was characterized by low socioeconomic status with poor oral hygiene, none or basic education and unemployed (no income) and retired individuals. Heavy smoking, diagnosis of chronic periodontal disease and satisfaction were also reported prior to the financial crisis. Conclusions: The demographic characteristics of those who seek treatment in a university setting have changed dramatically and younger, more highly educated and employed individuals attend the undergraduate Periodontology clinic of the Aristotle University of Thessaloniki, Greece compared with those who attended the university dental clinic prior to the financial crisis.

Predicting dental attendance from dental hygienists' autonomy support and patients' autonomous motivation: A randomised clinical trial

OBJECTIVE

To test the hypothesis that a Self-Determination Theory (SDT) intervention designed to promote oral health care competence in an autonomy-supportive way would predict change in caries competence relative to standard care. Further, to test the SDT process path-model hypotheses with: (1) the intervention and individual differences in relative autonomous locus of causality (RALOC) predicting increases in caries competence, which in turn would positively predict dental attendance; (2) RALOC negatively predicting dental anxiety, which would negatively predict dental attendance; (3) RALOC and caries disease referred to the dentist after an autonomy-supportive clinical exam directly positively predicting dental attendance; and (4) the intervention moderating the link between RALOC and dental attendance.

DESIGN

A randomised two-group experiment was conducted at a dental clinic with 138 patients (M_age = 23.31 yr., SD = 3.5), with pre- and post-measures in a period of 5.5 months.

RESULTS

The experimental model was supported. The SDT path model fit the data well and supported the hypotheses explaining 63% of the variance in dental attendance.

CONCLUSIONS

Patients personality (RALOC) and hygienists promoting oral health care competence in an autonomy-supportive way, performance of autonomy-supportive clinical exams and reductions of anxiety for dental treatment have important practical implications for patients' dental attendance.

Evaluating Service Quality from Patients' Perceptions: Application of Importance-performance Analysis Method

Objectives

Providing high service quality is one of the main functions of health systems. Measuring service quality is the basic prerequisite for improving quality. The aim of this study was to evaluate the quality of service in teaching hospitals using importance–performance analysis matrix.

Methods

A descriptive–analytic study was conducted through a cross-sectional method in six academic hospitals of Qazvin, Iran, in 2012. A total of 360 patients contributed to the study. The sampling technique was stratified random sampling. Required data were collected based on a standard questionnaire (SERVQUAL). Data analysis was done through SPSS version 18 statistical software and importance–performance analysis matrix.

Results

The results showed a significant gap between importance and performance in all five dimensions of service quality (p < 0.05). In reviewing the gap, “reliability” (2.36) and “assurance” (2.24) dimensions had the highest quality gap and “responsiveness” had the lowest gap (1.97). Also, according to findings, reliability and assurance were in Quadrant (I), empathy was in Quadrant (II), and tangibles and responsiveness were in Quadrant (IV) of the importance–performance matrix.

Conclusion

The negative gap in all dimensions of quality shows that quality improvement is necessary in all dimensions. Using quality and diagnosis measurement instruments such as importance–performance analysis will help hospital managers with planning of service quality improvement and achieving long-term goals.

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

Purpose

This study aims to explore the relationship between healthcare perceived service quality (HCSQ) and patient loyalty. Mediating role of patient satisfaction is also assessed between HCSQ and patient loyalty.

Design/methodology/approach

A sample of 600 was gathered using stratified random sampling technique from inpatients of public and private sector hospitals of Pakistan through self-administered questionnaire, and was analyzed through regression analysis.

Findings

Findings indicate that healthcare perceived service quality has a significant positive effect on patients’ loyalty. Patient satisfaction also mediates the relationship between HCSQ and patient loyalty. Findings state that there is a significant difference between HCSQ which is perceived by the patients of both public and private sector hospitals. Differences suggest that the patients of private sector hospitals were found more satisfied than their counterparts.

Practical implications

The results indicate that hospital managers should have knowledge about the perceptions and satisfaction of patients as it leads to a step towards introducing reforms in the quality of healthcare sector.

Originality/value

No such particular research in literature has been made earlier in Pakistan’s context which has assessed the perceptions of patients in terms of HCSQ dimensions as being addressed in this study. Thus, this study endeavors to fill that gap in terms of measuring healthcare services provided by both public and private sector hospitals. Outcomes of this study will enable hospitals’ managers to get a better understanding towards stronger as well as weaker aspects of service quality, and will help in observing factors which contribute towards patients’ satisfaction and patient loyalty in building long term relationships between hospital and patients.

Measurement of Quality of Educational Hospital Services by the SERVQUAL Model: The Iranian Patients' Perspective

Introduction

The main mission of hospitals in any health system is to deliver high quality healthcare for patients and meet their needs and expectations. The aim of the current study was to assess the quality of the service of educational hospitals affiliated with Kermanshah University of Medical Sciences in 2015, from the perspective of patients.

Methods

In this cross-sectional study, the perspectives of 400 patients were assessed about the quality of the services provided by educational hospitals in Kermanshah (western Iran) in 2015. The quality was assessed by the SERVQUAL questionnaire with five dimensions, i.e., tangibility, reliability, responsiveness, assurance, and empathy. In addition, the Wilcoxon test and the Kruskal-Wallis test were used to explore any association between the dependent variable and explanatory variables. The data were analyzed using Stata V.12 software.

Results

There were negative gaps in all five dimensions. The highest and lowest gaps in the mean score were found in the assurance (−0.88) and responsiveness (−0.56) dimensions. The patients ranked responsiveness as the most important dimension of the quality of healthcare.

Conclusion

There were gaps between the patients’ perceptions and their expectation about the five dimensions that were studied based on the SERVQUAL model. Also, it is recommended that improving the quality of healthcare is possible by various policies, such as good responsiveness, access to health workers, and delivering healthcare in less time.

Quality assessment of clinical education services in teaching hospitals located in Kerman, Iran

Introduction

Clinical education is one of the most important components of the resource generation function of health systems, and it has a very important role in graduates’ competency with respect to effective, practical education. This study aimed to assess the quality of clinical services in Kerman’s teaching hospitals located in southeastern Iran.

Methods

This cross-sectional study was conducted in 2011 on 303 medical students at different levels of medical education at Kerman’s teaching hospitals. A modified SERVQUAL instrument was used to collect the data after its validity and reliability were checked. The data were analyzed by SPSS 18.0 using the paired t-test, Kruskal-Wallis, and post hoc tests, when appropriate.

Results

In all five dimensions of quality, gaps were observed between students’ perceptions and expectations as follows: Assurance (mean = −1.18), Responsiveness (−1.56), Empathy (−1.4), Reliability (−1.27), and Tangibles (−1.21). There was a significant difference between the quality perceptions and expectations of the medical students (p < 0.001). A significant difference was observed between three educational levels, including externships, internships, and assistantships regarding the dimensions of the quality gaps (p < 0.001).

Conclusion

The clinical services provided by teaching hospitals in the study did not meet the students’ expectations at any of the three educational levels. As we precisely assessed the dimensions and items that had the higher quality gaps, it was apparent that, for most part, clinical education officials could improve the quality by designing interventions, which would not be very difficult to do.

Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center

INTRODUCTION

Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUAL method is widely used for assessing the quality expected by patients and the quality of actually provided services.

OBJECTIVES

The main purpose of this study was to determine if patients from state and private health care facilities differed in terms of their qualitative priorities and assessments of received services.

MATERIALS AND METHODS

The study included a total of 412 patients: 211 treated at a state facility and 201 treated at a private facility. Each of the respondents completed a 5-domain, 22-item SERVQUAL questionnaire. The actual quality of health care services in both types of facilities proved significantly lower than expected.

RESULTS

All the patients gave the highest scores to the domains constituting the core aspects of health care services. The private facility respondents had the highest expectations with regard to equipment, and the state facility ones regarding contacts with the medical personnel.

CONCLUSION

Health care quality management should be oriented toward comprehensive optimization in all domains, rather than only within the domain identified as the qualitative priority for patients of a given facility.

Factors affecting dental service quality

PURPOSE

Measuring dental clinic service quality is the first and most important factor in improving care. The quality provided plays an important role in patient satisfaction. The purpose of this paper is to identify factors affecting dental service quality from the patients' viewpoint.

DESIGN/METHODOLOGY/APPROACH

This cross-sectional, descriptive-analytical study was conducted in a dental clinic in Tehran between January and June 2014. A sample of 385 patients was selected from two work shifts using stratified sampling proportional to size and simple random sampling methods. The data were collected, a self-administered questionnaire designed for the purpose of the study, based on the Parasuraman and Zeithaml's model of service quality which consisted of two parts: the patients' demographic characteristics and a 30-item questionnaire to measure the five dimensions of the service quality. The collected data were analysed using SPSS 21.0 and Amos 18.0 through some descriptive statistics such as mean, standard deviation, as well as analytical methods, including confirmatory factor.

FINDINGS

Results showed that the correlation coefficients for all dimensions were higher than 0.5. In this model, assurance (regression weight=0.99) and tangibility (regression weight=0.86) had, respectively, the highest and lowest effects on dental service quality.

PRACTICAL IMPLICATIONS

The Parasuraman and Zeithaml's model is suitable to measure quality in dental services. The variables related to dental services quality have been made according to the model.

ORIGINALITY/VALUE

This is a pioneering study that uses Parasuraman and Zeithaml's model and CFA in a dental setting. This study provides useful insights and guidance for dental service quality assurance.

Measuring the quality of provided services for patients with chronic kidney disease

Background:

The healthcare organizations need to develop and implement quality improvement plans for their survival and success. Measuring quality in the healthcare competitive environment is an undeniable necessity for these organizations and will lead to improved patient satisfaction.

Objectives:

This study aimed to measure the quality of provided services for patients with chronic kidney disease in Kerman in 2014.

Patients and Methods:

This cross-sectional, descriptive-analytic study was performed from 23 January 2014 to 14 February 2014 in four hemodialysis centers in Kerman. All of the patients on chronic hemodialysis (n = 195) who were referred to these four centers were selected and studied using census method. The required data were collected using the SERVQUAL questionnaire, consisting of two parts: questions related to the patients' demographic characteristics, and 28 items to measure the patients' expectations and perceptions of the five dimensions of service quality, including tangibility, reliability, responsiveness, assurance, and empathy. The collected data were analyzed using SPSS 21.0 through some statistical tests, including independent-samples t test, one-way ANOVA, and paired-samples t test.

Results:

The results showed that the means of patients' expectations were more than their perceptions of the quality of provided services in all dimensions, which indicated that there were gaps in all dimensions. The highest and lowest means of negative gaps were related to empathy (-0.52 ± 0.48) and tangibility (-0.29 ± 0.51). In addition, among the studied patients' demographic characteristics and the five dimensions of service quality, only the difference between the patients' income levels and the gap in assurance were statistically significant (P < 0.001).

Conclusions:

Overall, the results of the present study showed that the expectations of patients on hemodialysis were more than their perceptions of provided services. The healthcare providers and employees should pay more attention to the patients' opinions and comments and use their feedback to solve the workplace problems and improve the quality of provided services. In addition, training the health staff to meet the patients' emotional needs and expectations is suggested.

Using creative problem solving (TRIZ) in improving the quality of hospital services

TRIZ is an initiative and SERVQUAL is a structured methodology for quality improvement. Using these tools, inventive problem solving can be applied for quality improvement, and the highest quality can be reached using creative quality improvement methodology. The present study seeks to determine the priority of quality aspects of services provided for patients in the hospital as well as how TRIZ can help in improving the quality of those services. This Study is an applied research which used a dynamic qualitative descriptive survey method during year 2011. Statistical population includes every patient who visited in one of the University Hospitals from March 2011. There existed a big gap between patients’ expectations from what seemingly is seen (the design of the hospital) and timely provision of services with their perceptions. Also, quality aspects of services were prioritized as follows: keeping the appearance of hospital (the design), accountability, assurance, credibility and having empathy. Thus, the only thing which mattered most for all staff and managers of studied hospital was the appearance of hospital as well as its staff look. This can grasp a high percentage of patients’ satisfaction. By referring to contradiction matrix, the most important principles of TRIZ model were related to tangible factors including principles No. 13 (discarding and recovering), 25 (self-service), 35 (parameter changes), and 2 (taking out). Furthermore, in addition to these four principles, principle No. 24 (intermediary) was repeated most among the others. By utilizing TRIZ, hospital problems can be examined with a more open view, Go beyond The conceptual framework of the organization and responded more quickly to patients ’ needs.

Service quality assessment of a referral hospital in southern Iran with SERVQUAL technique: patients' perspective

BACKGROUND

Providing services to patients according to their expectations and needs is necessary for the success of an organization in order to remain in the competitive market. Recognizing these needs and expectations is an important step in offering high quality services. This study was designed to determine the service quality gap of the main hospital of Hormozgan province.

METHODS

This cross sectional study was conducted in 2013 in Bandar Abbas ShahidMohammadi Hospital in the south of Iran. All 96 participants of this study were provided by SERVQUAL questionnaire. Data was analyzed by Wilcoxon and Kruskal-Wallis tests.

RESULTS

Service quality gaps were seen in all five service quality dimensions and the overall quality of service. The mean of quality perception score and quality expectation score was 3.44 ± 0.693 and 4.736 ± 0.34, respectively. The highest perception was in assurance dimension and the highest expectation was in Responsiveness and assurance dimensions. Also, the lowest perception was in responsiveness dimension and the lowest expectation was about empathy. In this study, 56.1% of participants defined the quality of services as average.

CONCLUSION

According to the results, this hospital was not able to meet patients' expectations completely. Therefore, action must be taken to decrease the gap between the perception and expectation of the patients.

Evaluation of patient perspective on quality of oral health care in Germany--an exploratory study

BACKGROUND

Patients' evaluation of care presents an essential dimension of the quality of care. The aim of this exploratory study was to determine which factors of EUROPEP-Dental were associated with overall patients' evaluation of oral health care.

METHODS

Data were collected from 8,160 patients from 106 dental practices (response rate 77%) who completed the 30-item EUROPEP-Dental questionnaire. The possible answers ranged from 1 (poor) to 5 (excellent). The EUROPEP-Dental questionnaire covers four domains: 'dentist-patient relationship' (11 items), 'accessibility and waiting time' (10 items), 'quality of care' (six items), 'costs of care' (three items). Each domain was aggregated by mean scores of the associated items. Regression analyses were performed in addition to descriptive analyses.

RESULTS

Over 66% of the patients were overall positive with their dental care. Linear regression analyses were performed with patient satisfaction as the dependent outcome variable. The item 'medical-technical quality of care' showed the highest score (R2 = 0.378) of explained variance, while the EUROPEP-Dental domain 'quality of care' showed the highest score (R2 = 0.467) for explained variance regarding overall patient satisfaction.

CONCLUSIONS

The results are important for understanding patients' priorities with regard to oral health care and for identifying possible areas for improvement of quality. The evaluation of patient perspective on quality of oral health care is likely to continue to be an important aspect of oral health-care evaluation.

Denture wearer's perception of ambient care. Part 2. Analyses of data

OBJECTIVE

The aim was to investigate to what extent denture wearers were satisfied with the ambient care (care) received.

MATERIALS AND METHODS

A study sample of 117 completely edentulous and 56 partially edentulous patients, who had received their dentures in the period 1997-2005 at Bergen School of Dentistry, completed a questionnaire containing eight specific items regarding different aspects of care, each with two positive (a and b) and two negative (c and d) categories, and four global items. The care items, including confidence in the dental team, information, waiting time and cost, constitute the Ambient Care Scale; the global items were concerned with overall care, satisfaction with dentures, self-reported oral and general health.

RESULTS

Between 91-100% of Ambient Care Scale responses were in the two positive categories. The completely edentulous group was significantly more satisfied than the partially edentulous group regarding several Ambient Care Scale items and oral health. Also, ratios between categories b and a showed systematic higher degrees of satisfaction for the completely edentulous group than the partially edentulous group. Fifty-six per cent in the completely edentulous group and 36% in the partially edentulous group were very satisfied, i.e. with ≥ 6 of 8 possible responses in category a. Analysis of the very satisfied showed that the highest degrees of satisfaction for both groups were found regarding students and staff, the lowest regarding cost and waiting times.

CONCLUSIONS

Patient satisfaction with care was very high. Completely edentulous patients were systematically more satisfied than partially edentulous ones.

Denture wearer's perception of ambient care, part 1: validation of a preliminary scale

OBJECTIVE

The aim of the present study was to investigate if a preliminary Ambient Care Scale (ACS), intended to measure ambient care in complete denture wearers, had acceptable reliability and validity.

MATERIALS AND METHODS

A sample of 117 patients who had received complete dentures in both jaws in the period 1997-2005 at Bergen School of Dentistry completed a questionnaire containing eight items regarding the patients' relationship with the student and clinical personnel, to what extent they were informed and consulted during treatment, waiting times and cost. In addition, information was gathered regarding demographics, The Psychological General Well-Being index (WHO-5), global ambient care, satisfaction with dentures and how patients viewed their oral health.

RESULTS

Cronbach's alpha coefficient was 0.76 for the ACS, indicating acceptable internal consistency. From principle component analysis, three factors were extracted, correlating with ACS with coefficients of 0.72, 0.58 and 0.59, respectively. Acceptable construct validity was indicated by the fact that items were formulated by common agreement among three experienced prosthodontists, the extremely low frequency of missing data (<2%) and that ACS, as expected, was able to discriminate between patients satisfied and dissatisfied with their dentures (p = 0.005) and oral health (p = 0.042), but not between those who had high or low WHO-5 scores (p = 0.77).

CONCLUSIONS

The ACS appears to have acceptable psychometric properties.

Patient satisfaction analysis on service quality of dental health care based on empathy and responsiveness

BACKGROUND

Transformation of health care is underway from sellers' market to consumers' market, where the satisfaction of the patients' need is a primary concern while defining the service quality. Hence, commitment to provide a high-quality service and achieving patients' satisfaction becomes an important issue for dental health care provider. The aim of this research is to investigate the quality of dental health care service based on empathy and responsiveness aspects.

METHODS

A total of 90 questionnaires were completed by the dental patients who came to dental polyclinic located in Government Hospital, West Java, Indonesia. The questionnaire was concerned on two dimensions of service quality model, i.e. empathy and responsiveness. The obtained data were analyzed using inferential statistics (t test) and also descriptive statistics with importance-performance analysis.

RESULTS

All the attributes tested by t test showed that perception and expectation differed significantly, except for responsiveness, i.e. ability of dental assistants in assisting the dentist (t test 0.505<t table 1.987). The most important factor in evaluating patient satisfaction is the response given by administration staff related to long waiting time (t test 5.377), followed by dental assistant's knowledge about the patient's need during treatment (t test 4.822) and explanation that was given by dentist (t test 4.700).

CONCLUSION

It can be inferred from IPA that priority should be given to dentist's communication and dental assistant's knowledge toward patient's needs to enhance the service quality.

Views of patients and general dental practitioners on the organizational aspects of a general dental practice

OBJECTIVE

To examine the views of patients and general dental practitioners (GDPs) on the organizational aspects of a general dental practice and to see whether their views differ.

BACKGROUND

Health care has increasingly centred on the patient over the last two decades, and the patients' opinions have been taken more seriously. Although in other health-care sectors research on organizational aspects has been performed, research in dental care is lacking on this subject.

DESIGN

We developed two questionnaires covering 41 organizational aspects of a general dental practice: one for GDPs and one for dental patients. The questionnaires were handed out in dental practices to 5000 patients and sent to 500 GDPs.

RESULTS

We describe the results of the organizational aspects mentioned most by 25% of the dental patients. For most aspects, the views of the patients and GDPs differed significantly. However, both respondent groups mentioned the same category the most.

CONCLUSIONS

The results of this study could be used on a policy level for the development of guidelines and on a practice level for individual GDPs to adjust practice management to the preferences of patients.

The 'secret' of success part 4

Practice success is defined across the four'dimensions' of oral health, patient satisfaction, job satisfaction and financial profit. It is suggested that the'secret' of success in dental practice is to make patient (customer) satisfaction the primary focus. Not a very earth shattering or surprising 'secret' perhaps! This is hardly a new idea, and not a concept restricted to dental practice. This principle applies to all businesses. This series of articles reviews evidence from across a broad spectrum of publications: from populist business publications through to refereed scientific papers, this'secret' seems to be confirmed. The evidence for which aspects of our service are most important in achieving patient satisfaction (and therefore success) is explored.

CLINICAL RELEVANCE

Good oral health outcomes for patients are defined as the primary purpose of dental practice and, therefore, an essential dimension of success. The link between positive patient perceptions of general care and their own oral health to practice success is explored.

Measuring service quality of public dental health care facilities in Kelantan, Malaysia

This study investigates patients' expectations and perceptions of service quality in public dental health care and measures their "satisfaction gap." This descriptive study involved 481 dental outpatients in Kelantan, Malaysia. A modified SERVQUAL 20-item instrument was used to assess patients' expectations before and perceptions after receiving dental treatment. The "satisfaction gap" was then measured.

RESULTS

showed that patients visiting for management of dental pain were more satisfied (P = .007) than those visiting with appointment. The most significant service quality dimensions were related to responsiveness, assurance, and empathy of the dental health care providers. There was a significant difference between the patients' expectations and their perceptions of service provided (P < .01) with regard to all dimensions. In conclusion, dental service providers should give emphasis to the compassionate and emotional aspects of care and to remember that they are integral components of quality service.

Chronic kidney-disease screening service quality: questionnaire survey research evidence from Taichung City

BACKGROUND

Chronic kidney disease (CKD) is a serious public health problem in Taiwan and the world. The most effective, affordable treatments involve early prevention/detection/intervention, requiring screening. Successfully implementing CKD programs requires good patient participation, affected by patient perceptions of screening service quality. Service quality improvements can help make such programs more successful. Thus, good tools for assessing service quality perceptions are important.

AIM

to investigate using a modified SERVQUAL questionnaire in assessing patient expectations, perceptions, and loyalty towards kidney disease screening service quality.

METHOD

1595 kidney disease screening program patients in Taichung City were requested to complete and return a modified kidney disease screening SERVQUAL questionnaire. 1187 returned them. Incomplete ones (102) were culled and 1085 were chosen as effective for use. Paired t-tests, correlation tests, ANOVA, LSD test, and factor analysis identified the characteristics and factors of service quality. The paired t-test tested expectation score and perception score gaps. A structural equation modeling system examined satisfaction-based components' relationships.

RESULTS

The effective response rate was 91.4%. Several methods verified validity. Cronbach's alpha on internal reliability was above 0.902. On patient satisfaction, expectation scores are high: 6.50 (0.82), but perception scores are significantly lower 6.14 (1.02). Older patients' perception scores are lower than younger patients'. Expectation and perception scores for patients with different types of jobs are significantly different. Patients higher on education have lower scores for expectation (r = -0.09) and perception (r = -0.26). Factor analysis identified three factors in the 22 item SERVQUAL form, which account for 80.8% of the total variance for the expectation scores and 86.9% of the total variance for the satisfaction scores. Expectation and perception score gaps in all 22 items are significant. The goodness-of-fit summary of the SEM results indicates that expectations and perceptions are positively correlated, perceptions and loyalty are positively correlated, but expectations and loyalty are not positively correlated.

CONCLUSIONS

The results of this research suggest that the SERVQUAL instrument is a useful measurement tool in assessing and monitoring service quality in kidney disease screening services, enabling the staff to identify where service improvements are needed from the patients' perspectives.

Measuring patient's expectation and the perception of quality in LASIK services

Background

LASIK is the use of excimer lasers to treat therapeutic and refractive visual disorders, ranging from superficial scars to nearsightedness (myopia), and from astigmatism to farsightedness (hyperopia). The purposes of this study are to checking the applicability and psychometric properties of the SERVQUAL on Lasik surgery population. Second, use SEM methods to investigate the loyalty, perceptions and expectations relationship on LASIK surgery.

Methods

The method with which this study was conducted was questionnaire development. A total of 463 consecutive patients, attending LASIK surgery affiliated with Chung Shan Medical University Eye Center, enrolled in this study. All participants were asked to complete revised SERVQUAL questionnaires. Student t test, correlation test, and ANOVA and factor analyses were used to identify the characters and factors of service quality. Paired t test were used to test the gap between expectation and perception scores and structural equation modeling was used to examine relationships among satisfaction components.

Results

The effective response rate was 97.3%. Validity was verified by several methods and internal reliability Cronbach's alpha was > 0.958. The results from patient's scores were very high with an overall score of 6.41(0.66), expectations at 6.68(0.47), and perceptions at 6.51(0.57). The gap between expectations and perceptions was significant, however, (t = 6.08). Furthermore, there were significant differences in the expectation scores among the different jobs. Also, the results showed that the higher the education of the patient, the lower their perception score (r = -0.10). The factor loading results of factor analysis showed 5 factors of the 22 items of the SERVQUAL model. The 5 factors of perception explained 72.94% of the total variance there; and on expectations it explained 77.12% of the total variance of satisfaction scores.

The goodness-of-fit summary, of structure equation modeling, showed trends in concept on expectations, perceptions, and loyalty.

Conclusion

The results of this research appear to show that the SERVQUAL instrument is a useful measurement tool in assessing and monitoring service quality in LASIK service, and enabling staff to identify where improvements are needed, from the patients' perspective. There were service quality gaps in the reliability, assurance, and empathy. This study suggested that physicians should increase their discussions with patients; which has, of course, already been proven to be an effective way to increase patient's satisfaction with medical care, regardless of the procedure received.

Satisfação com o atendimento odontológico: estudo qualitativo com mães de crianças atendidas na Universidade Federal de Santa Catarina

Esta pesquisa objetivou conhecer a percepção de mães em relação ao atendimento odontológico prestado em clínicas de odontopediatria da Universidade Federal de Santa Catarina (UFSC), bem como sua concepção sobre como seria o dentista "ideal". O método utilizado foi o qualitativo, tipo estudo de caso. A coleta de dados foi feita através de entrevista semi-estruturada e a população estudada constituiu-se de sete mães de crianças atendidas em clínicas de odontopediatria da UFSC. Observou-se que, para as mães entrevistadas, o dentista ideal deveria reunir habilidades afetivas, psicomotoras e cognitivas, tais como: gostar do que faz, ser atencioso e amigável, fornecer informações claras sobre saúde bucal, resolver os problemas bucais do paciente e manter-se atualizado. Os aspectos interpessoais foram fundamentais para a satisfação com o atendimento na universidade, além da capacidade técnica dos alunos e a facilidade para conseguir uma vaga no serviço de odontopediatria. Sugere-se maior entendimento, por parte dos profissionais, dos aspectos que envolvem a relação dentista-paciente, de maneira a associar fatores afetivos aos cognitivos e psicomotores no dia-a dia da prática odontológica.

Analysing the Greek health system: a tale of fragmentation and inertia

The Greek health system does not yet offer universal coverage and has fragmented funding and delivery. Funding is regressive, with a reliance on informal payments, and there are inequities in access, supply and quality of services. Inefficiencies arise from an over reliance on relatively expensive inputs, as evidenced by the oversupply of specialists and under-supply of nurses. Resource allocation mechanisms are historical and political with no relation to performance or output, therefore providers have little incentive to improve productivity. Some options for future health system reform include focusing on coordinating funding by developing a monopsony purchaser with the aim of improving quality of services and efficiency in the health system and changing provider incentives to improve productivity.

Dentist-patient relationship and quality care 3. Communication

Besides technical expertise, the success of dental care depends on the behavioural patterns of the dentist and the patient and the way they interact with each other. Since communication is involved in the process of care, in many ways it is a 'key' concept of this interaction. As patient satisfaction and quality care are closely related with the dentist's positive attitudes and communicative skills, dentists need to focus on patients as 'individuals' and have 'real'communication with them.

Adolescents' perception of the quality of orthodontic treatment

The aim was to describe quality of care from a patient perspective among adolescents receiving orthodontic treatment and to assess the relationship between quality of care and outcome-related aspects. The research design was cross-sectional. The sample consisted of 151 young people (mean age 17.1 years, SD: 2.2; 53% girls and 47% boys) receiving orthodontic treatment in the Stockholm region in Sweden (response rate 75%). Data were collected using the Quality from the Patient's Perspective questionnaire. The highest quality of care perceptions were noted on items dealing with receiving the best possible orthodontic treatment and being treated with respect. Less favourable perceptions of the quality of care were found regarding the opportunity to participate in the decisions related to the orthodontic treatment. In order to improve the quality of care a more active involvement of these patients in the decision-making process is suggested. The item 'I received the best possible orthodontic treatment' noted the highest subjective importance rating. The youngest participants reported the most favourable scores and the oldest the least. The majority (74%) reported that they were 'completely satisfied' with the result of the orthodontic treatment. However, 52% claimed that they had not followed all of the advice obtained during the treatment period, and 29% indicated some or more hesitation about attending the same dentist for future treatment.

Patient expectations of emergency dental services: a qualitative interview study

OBJECTIVE

To describe the expectations of walk-in patients seeking emergency dental care out-of-hours.

BASIC DESIGN

Consecutive patients attending two emergency dental clinics at weekends were interviewed prior to seeing the dentist. The audio-recorded interview transcripts were analysed using the "framework" method of applied qualitative data analysis.

SUBJECTS AND SETTING

Forty-four walk-in emergency dental patients at a community-based dental clinic and a dental hospital emergency clinic at the weekend.

RESULTS

In addition to symptom relief, the main desired outcome for emergency dental patients may be informational and psychological--especially reassurance that the problem is not serious, and reduced uncertainty about the cause of the pain. In general, patients' stated expectations for specific treatments (such as antibiotics, or tooth extraction) were not absolute: rather, they implied these expectations were conditional upon the dentist deciding they were necessary.

CONCLUSIONS

Emergency dental services, some of which are still dominantly treatment-focused, should reflect that many emergency dental attenders want advice and reassurance as much as relief from symptoms. This reinforces the importance of effective and sympathetic dentist-patient communication within emergency or out-of-hours consultations. It also implies that dentists' skills in listening, explaining and reassuring should be captured in any patient satisfaction or outcome measure designed for this patient group.