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

Impact of COVID-19 pandemic on health care workers (HCWs) in Sindh Province of Pakistan

BACKGROUND

In Pakistan, the COVID-19 outbreak posed a significant challenge for healthcare workers in the country's public hospitals. The HCWs faced several problems in terms of the COVID-19 pandemic. Therefore this study investigated how the COVID-19 pandemic has affected the medical staff at the public hospital in Sindh Province, Pakistan.

METHODS

In this study, a qualitative exploratory design was used. Semi-Structure interviews (SSI) were conducted by using an open-indeed questionnaire (OIQ) for data collection. An inductive approach was used for theoretical data analysis. A total of 320 HCWs participated to complete the criteria of the study from 10 different public hospitals.

RESULTS

The study result showed the Sindh public hospital's insufficient infrastructure, lack of health protective equipment, shortages of isolation rooms and beds, and emergencies during the COVID-19 pandemic caused HCWs to experience physical and psychological weariness, sleep disturbance, mental stress, and fear of infection.

CONCLUSION

The study concluded that public hospitals' insufficient infrastructure, furniture, emergency wards, and safety equipment during the COVID-19 pandemic significantly damaged HCWs' physical and psychological health, generating fear of infection and sleep disturbance. Additionally, Sindh healthcare workers' fear of illness and isolation may impair family connections.

Integration of human papillomavirus associated anal cancer screening into HIV care and treatment program in Pakistan: perceptions of policymakers, managers, and care providers

BACKGROUND

The incidence of anal cancer, largely associated with anal human papillomavirus (HPV) infection, is increasing among men who have sex with men (MSM), and transgender women living with or without HIV. Screening for anal cancer to detect anal precancerous lesions in high-risk groups is an important opportunity for prevention but still lacking in many low-and-middle-income countries. The aim of this study was to explore the readiness of Pakistan's healthcare system to integrate anal cancer and HPV screening into a national HIV program, as perceived by policymakers, health managers, and healthcare providers.

DESIGN

This qualitative study using key-informant interviews with participants influence in policy making, implementation and advocacy from public and private sector were conducted between March 2021 to August 2021 in Karachi Pakistan.

METHODS

Key informants were purposely selected from different domains of the healthcare system responsible for the target group of interest, MSM and transgender-women in general and people living with HIV in particular. A total of 18 key informants, at different levels of seniority were recruited from governmental and non-governmental organizations, high-level infectious disease healthcare managers, and United Nations Program representatives. Qualitative content analysis was used to identify the manifest and latent themes, based on socioecological framework.

RESULTS

The results were grouped into five major themes; (1) The policy context and priorities, (2) Health systems factors, (3) Community environment, (4) Healthcare setting & providers and (5) Individual-level obstacles. The policy actors expressed their concerns about their limited voice in country's health and health related priority setting. Informants reported a lack of political will and suggested that government should bring a change in the paradigm of healthcare service delivery from reactive to proactive approach. Although, participants unanimously favored integration of HPV preventive services into existing HIV program, they also identified several service delivery barriers including trained workforce shortage, limited capacity of information technology, lack of supplies needed for screening, lack of financing, and lack of services that could meet key-populations needs. Participants also predicted other implementation challenges such as stigma, social victimization, and systemic discrimination against at-risk groups at healthcare facilities.

CONCLUSION

Although policy makers and health providers in Pakistan saw a clear need to scale-up and integrate anal cancer screening for key populations, the feasibility of this is dependent on political will, financing, anti-stigma and discrimination interventions and health system efficiency.

Smoking Bans and Circulatory System Disease Mortality Reduction in Macao (China): Using GRA Models

This study evaluates the association between smoking rates and mortality from circulatory system diseases (CSD) after implementing a series of smoking bans in Macao (China). (1) Background: Macao phased in strict total smoking bans since 2012. During the past decade, smoking rates among Macao women have dropped by half. CSD mortalities in Macao also show a declining trend. (2) Method: Grey relational analysis (GRA) models were adopted to rank the importance of some key factors, such as income per capita, physician density, and smoking rates. Additionally, regressions were performed with the bootstrapping method. (3) Results: Overall, smoking rate was ranked as the most important factor affecting CSD mortality among the Macao population. It consistently remains the primary factor among Macao's female population. Each year, on average 5 CSD-caused deaths were avoided among every 100,000 women, equivalent to about 11.45% of the mean annual CSD mortality. (4) Conclusions: After the implementation of smoking bans in Macao, the decrease in smoking rate among women plays a primary role in the reduction in CSD mortality. To avoid excess CSD mortality due to smoking, Macao needs to continue to promote smoking cessation among the male population.

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

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

Particulate air pollution and metabolic risk factors: Which are more prone to cardiac mortality

This study explored multiplex, country-level connections between a wide range of cardiac risk factors and associated mortality within the South Asian Association for Regional Cooperation (SAARC) countries. The grey relational analysis (GRA) methodology is used to evaluate data from 2001 to 2018 to compute scores and rank countries based on cardiac mortality. Subsequently, we used the conservative (Min-Max) technique to determine which South Asian country contributes the most to cardiac mortality. The Hurwicz criterion is further applied for optimization by highlighting the risk factors with the highest impact on cardiac mortality. Empirical findings revealed that India and Nepal are the leading drivers of cardiovascular disease (CVD) mortality among all SAARC nations based on the results of the GRA methodology. Moreover, the outcomes based on the Hurwicz criterion and the conservative criterion indicated that CVD mortality is considerably impacted by household air pollution from the combustion of solid fuel, with India as a potential contributor in the SAARC region. The outcomes of this research may enable international organizations and public health policymakers to make better decisions and investments within the SAARC region to minimize the burden of CVD while also strengthening environmentally sustainable healthcare practices.

Providing Solution in an Emergency: COVID-19 and Voice Behavior of Healthcare Professionals

This study investigates the mechanism between idiosyncratic deals (I-deals) and voice behavior, considering display aggression and deontic justice as mediating variables. We collected data from 702 nurses and their immediate supervisors who work with COVID-19 patients through survey questionnaires at two different times, and we analyzed the data using structural equation modeling (SEM). We found that I-deals are significantly associated with deontic justice and voice behavior. Moreover, I-deals are significant but negatively associated with displayed aggression, which is significant and negatively associated with voice behavior. In addition, deontic justice and display aggression mediate the association between I-deals and voice behavior. These findings suggest that the hospitals' top management should provide I-deals to nurses to improve their voice behavior.

Responsiveness level and its effect on services quality from the viewpoints of the older adults hospitalized during COVID-19 pandemic

Background

Aging is a sensitive period of life. Attention to the needs of this stage is considered a social necessity. This study is conducted to investigate the responsiveness level and its effect on service quality from the hospitalized older adults’ viewpoints during the COVID-19 pandemic in the south of Iran.

Methods

It was a cross-sectional descriptive-analytic study that was conducted on 386 old patients. The study instrument was a standard questionnaire that includes three sections of demographic information, World Health Organization Responsiveness, and SERVQUAL. Data were analyzed applying descriptive and inferential statistics the same as Independent T-test, ANOVA, Pearson correlation, and multiple linear regression.

Results

The mean levels of responsiveness and service quality were 90.72 ± 9.38 (from 160) and 68.01 ± 8.51 (from 110) respectively. This indicates the average level of these variables from the old patients’ viewpoints. There was a significant positive correlation between responsiveness and service quality (r = 0.585). According to the results of multiple linear regression, the dimensions of communication, dignity, prompt attention, primary facilities, social support, information confidentiality, right to choose, and autonomy were identified as the predictors of service quality.

Conclusion

The average level of responsiveness and service quality perceived from the old patients’ viewpoints during the COVID-19 pandemic can be considered a necessity for supportive planning among the older adults. Meanwhile, according to the impacts of responsiveness on service quality, educational programs are recommended to promote the level of healthcare providers’ responsiveness.

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

Purpose

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

Design/methodology/approach

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

Findings

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

Originality/value

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

[Factors associated with co-administration of birth dose vaccines in senegalese children]

INTRODUCTION

Co-administration of the bilié de Calmette et Guérin (BCG) and birth doses of oral polio (OPV zero) and hepatitis B (HepB BD) vaccines is strongly recommended. The objective was to determine the factors associated with this co-administration in the health district of Podor (Senegal).

METHODS

This cross-sectional study was conducted among 726 children aged 12 to 23 months. This was a two-stage cluster sampling. The data was collected in June 2020. An electronic questionnaire was developed using the Open Data Kit Collect application. Co-administration was modeled as one dose, two doses and three doses. Ordinal logistic regression was used to search for factors likely to influence co-administration.

RESULTS

Of the 726 children, 115 (16%), 234 (32%) and 377 (52%) received a single dose, two and three doses, respectively. Factors associated with co-administration were recognition by mothers or caregivers that several vaccines can be administered simultaneously (adjusted OR = 1.46, p-value = 0.017), availability of a health record kept at home (adjusted OR = 6.88, p-value = 0.006), hospitalization of the newborn after birth (adjusted OR = 1.74, p-value = 0.002) and receipt of advice during postnatal care (adjusted OR = 1.72, p-value = 0.01).

CONCLUSION

Co-administration of birth doses is an infrequent practice in Podor. Awareness and availability and proper maintenance of health information management tools would be necessary.

Hunting the Best Opportunity Through the Arrow of General Decision-Making Styles: Unfolding the Role of Social Capital and Entrepreneurial Intention

This research aims to identify the investor's decision-making styles and their impact on entrepreneurial opportunities through the mediation role of entrepreneurial intention and moderation effect of social capital in the healthcare sector of Pakistan. This study applied a structural equation modeling (SEM) to test the hypotheses on a sample of 400 healthcare investors. Our findings reveal that the conditional indirect relationship of entrepreneurial intention through social capital was significant on opportunity creation and an insignificant influence on opportunity discovery from decision-making styles. This study provides implications for policymakers to enhance entrepreneurial opportunity creation by providing robust social environment investors and encouraging them to create business ventures in the healthcare sector.

Cancer Care in Pakistan: A Descriptive Case Study

In this descriptive case study, we aimed to understand the experiences of cancer diagnosis, treatment, and palliative care in Pakistan. The case was limited to a hospital for cancer and hospice care in Karachi, Pakistan. Data collection included interviews with patients who had a cancer diagnosis, family members, healthcare providers, and unstructured observations. Two themes of suffering and late diagnosis were developed to describe the experiences of people with cancer. Suffering occurred as a result of poverty, social ideas about cancer, and physical suffering. Late diagnosis happened because of cultural ideas about health, low health literacy, and healthcare challenges, although both themes are interconnected. The findings illuminate three key pathways that will improve cancer diagnosis and palliative care in Pakistan: specifically, the need to (a) educate healthcare providers about cancer and palliative care, (b) eradicate corruption in healthcare, and (c) develop policies for universal access to health.

Patient satisfaction level and its determinants after admission in public and private tertiary care hospitals in Bangladesh

Introduction

Patient satisfaction is an important indicator of the quality of care provided by health care facilities. The objective of this study was to investigate the rate of satisfaction and its associated factors among the patients admitted to tertiary care hospitals in Bangladesh.

Methods

This cross-sectional study was conducted in a public and two private tertiary care hospitals in Bangladesh in December 2019, including 923 consecutive patients admitted to medical and surgical departments. Face-to-face interview using a structured questionnaire was conducted to collect patient-level data. Logistic regression models were used to determine the factors associated with patients' satisfaction.

Results

Patients' overall satisfaction level was 65% (51% in public and 75% in private hospitals) with a satisfaction rate of 63% in hospital staff courtesy, 56.5% in a hospital environment, 67% in physician care, 63% in general patient satisfaction, and 58% in patient's family care. Private hospitals (aOR 3.64, 95% CI 2.2-6.03), conservative management (aOR 3.34, 95% CI 2.10-5.33), shorter hospital stay (aOR 1.58, 95% CI 1.05-2.37) and perceived improvement after treatment (aOR 1.67, 95% CI 1.01-2.76) were associated with patients' satisfaction. In contrast, patients' accommodation on the floor (aOR 0.38, aOR 0.22-0.66) and high health care costs (aOR 0.97, 95% CI 0.95-0.99) were associated with patients' dissatisfaction with the in-patient service they received in both public and private hospitals.

Conclusion

Almost two-thirds of the patients were satisfied with the inpatient service they received, though, the satisfaction rate was higher in private hospitals. Treatment modality, cost, and outcome, as well as hospital environment like accommodation, were associated with their satisfaction level.

The quality of patient care in oncology departments in Karachi, Pakistan: patients' perceptions

PURPOSE

This study aims to assess the quality of care among adult oncology patients in tertiary care hospitals in Karachi by using an international standard of quality of care and to identify domains where improvement is needed.

DESIGN/METHODOLOGY/APPROACH

This is a cross-sectional study carried out at two tertiary care hospitals of Karachi, Pakistan, belonging to private and public sector, respectively, between February and April 2018. Face-to-face interviews were conducted using a modified questionnaire having five-point Likert scale questions regarding satisfaction of patients with doctors, nursing staff, information provided and the hospital standards. SPSS 20 was used for statistical analysis, and the results were expressed using mean, frequencies, percentages and p-values.

FINDINGS

The authors approached 415 patients, out of which 389 patients agreed to participate in the study. For both hospitals, the lowest mean scores were for sections pertaining to satisfaction with psychosocial support and information provided. The mean satisfaction score of patients from the private hospital were found to be significantly higher as compared to patients from the public hospital for all domains of patient care (p-value < 0.01 using t-test for two independent samples). The data showed an increasing trend of "satisfied" responses as the household income increased.

RESEARCH LIMITATIONS/IMPLICATIONS

A comparative study should be conducted with the aim of pinpointing the differences in areas in which there is a significant difference in positive satisfaction levels between private and public sectors. Similar research could also be expanded adding other variables that affect quality of care such as doctor's approach to their patients, time given during each consultation and patient's understanding of doctor's knowledge. Further studies can be done to bridge the gaps between what a doctor views as standard care and what the patient knows will help them receive a more holistic approach to care.

PRACTICAL IMPLICATIONS

Assessing the quality of care helps determine gaps in care and allocating health resources accordingly. In clinical practice, emphasis needs to be given on increased duration and improved quality of patient counselling to improve the low satisfaction levels of patients regarding the psychosocial support. Addressing patients' concerns should be made part of clinical teaching from an undergraduate level. As far as patient access to doctors of the specific speciality is concerned, hospital managements should adopt systems to ensure continuum of care and come up with mechanisms to bridge the discrepancy between a patient's needs and doctor availability.

SOCIAL IMPLICATIONS

After being identified as a major deficiency, training doctors in the sensitivities of the population and demographics, especially with respect to socio-economic statuses, can aid in enhancing patient satisfaction to the treatment. Implementation of patient-centred care leads to greater satisfaction with care, which, in turn, increases a patient's self efficacy in managing important aspects of their care and improves health care-related quality of life.

ORIGINALITY/VALUE

Cancer patients have long-term exposure to the hospital environment. A patient's satisfaction with the quality of care is an important determinant in patient compliance to the treatment protocol and required hospital visits. There is a dearth of research on the outpatient quality of care in the oncology departments in Karachi. This study provides an overview of the quality of care available to cancer patients in Karachi both in public and private sectors. The results of our study identify the gaps in the quality of care being provided to the patients in a developing country like Pakistan, which can be used to improve the quality of care, leading to better patient outcomes.

The roles of economic growth and health expenditure on CO2 emissions in selected Asian countries: a quantile regression model approach

Continuous economic growth and the rise in energy consumption are linked with environmental pollution. Demand for health care expenditure increased after the COVID-19 pandemic. This study is interesting in modeling the nexus between public and private health expenditure, carbon dioxide emissions, and economic growth. To this end, the present study analyzed the nexus between public and private health care expenditure, economic growth, and environmental pollution for 36 Asian countries for the period 1991-2017. FMOLS, GMM, and quantile regression analysis confirm the EKC hypothesis in Asia. Besides, FMOLS and quantile regressions reached the reducing effects of government and private health expenditures on CO₂ emissions. While quantile regression results show that public and private health expenditures can mitigate CO₂ emissions; however, these results differ for various levels of CO₂. Findings of quantile regression show a significant impact of both public and private health expenditures in reducing CO₂ at the 50^th and 75^th quantiles but results are insignificant for the 25^th quantile. Overall, the paper concludes that both government and private health sectors' expenditures caused CO₂ emissions to decrease in Asia and that the negative impact of the private health sector on CO₂ emissions is greater than that of the government health sector. The concluding remark is that the higher the health spending, the higher the environmental quality will be in Asia. Hence, the health administrators need to increase public and private health expenditures with an effective cost-service and energy-efficient management approach to reach sustainable health services and a sustainable environment in Asia.

Pharmacists’ Insights and Behaviors in Preventing the Misuse of Topical Corticosteroids in Pakistan: A Mixed-Method Study

Topical corticosteroids (TCs) misuse has become a common issue for healthcare professionals and patients, particularly in Pakistan, as no stringent laws or rules are prohibiting the selling of over-the-counter medicines. The present study was designed to examine pharmacists’ insights and behaviors regarding TCs and their potential role in preventing the misuse of TCs in Pakistan. The study was a cross-sectional mixed-methods research design (phase 1, quantitative; and phase 2, qualitative) conducted from January to June 2021. The pharmacists working in various settings in Karachi were approached through different social media platforms. Data were collected through a web link of an online questionnaire with 30 closed-ended questions. Different statistical methods were employed for tabulating the quantitative data, while inductive thematic analysis was directed to classify themes from the qualitative data and to conclude findings. The mean cumulative knowledge score was 10.59 ± 1.63. The community pharmacists knew more about the available over-the-counter TCs (p = 0.041). The experienced pharmacists were more conversant than fresh pharmacists, regarding the mode of action (p = 0.008), choice of TC potency (p = 0.001), and most common local and systemic adverse effects of TCs (p = 0.001). Overall, respondents had a favorable attitude, with more than 80% agreeing that pharmacists could ensure that important safety issues are communicated with patients, and assist considerably in avoiding TC misuse. Analysis of data has produced 7 themes, 10 sub-themes, and 30 categories. Major themes included: use and misuse of TCs, adverse drug events due to TCs, cosmeto-vigilance, patient education, referral to a physician, and future perspectives for preventing TC misuse. The respondents were well versed with the dilemma of TCs misuse, and they considered patient characteristics, free availability of TCs, and lack of physician-pharmacist coordination as the major reasons. The major barriers for patient education stated by nearly all the respondents were a lack of time and lack of material/information for counseling. They emphasized the need for stringent legal strategies and the enforcement of current drug-control regulations, so that TCs are not supplied without appropriate prescriptions. The present findings indicate that pharmacists had appropriate knowledge and a positive attitude towards their potential role in preventing the misuse of TCs. Further education and sensitization in areas of deprived knowledge will undoubtedly aid in the prevention of TCs misuse by the community.

Quality Evaluation of Health Services Using the Kano Model in Two Hospitals in Peru

Public–private partnerships (PPP) represent an alternative model of health management focused on improving the quality of health services, particularly in emerging countries. To date, a systematic method to improve the perceived quality of health services by healthcare users in Peru has not been established. The purpose of this study was to evaluate the quality of health services in two PPP hospitals in Peru using the Kano model. A prospective cross-sectional descriptive observational study was carried out through a health service satisfaction survey using the Kano model methodology, measuring six categories of attributes. A total of 250 users of the health services were surveyed in the two PPP hospitals, located in Lima and Callao, using non-probability convenience sampling. Of the 31 attributes evaluated by the patients, 27 (81%) were classified as having a one-dimensional-type attribute, 3 (10%) were reported as mandatory, and 1 (3%) was considered as inverse. These results suggest that the presence of most of the attributes evaluated was relevant to maintaining the level of user satisfaction and that the absence of these attributes generated dissatisfaction in the users. The results showed that the users’ evaluation of health services was multidimensional—namely, their evaluation was focused not only on the interaction space between the patient and medical personnel but also addressed other interaction services.

Dissatisfaction with Local Medical Services for Middle-Aged and Elderly in China: What Is Relevant?

As violent clashes between doctors and patients in China intensify, patient dissatisfaction has been identified as a major concern in the current healthcare reform in China. This study aims to investigate the main determinants of dissatisfaction with local medical services attributable to middle-aged and elderly characteristics and identify areas for improvement. A total of 14,263 rural participants and 4898 urban participants were drawn from the China Health and Retirement Longitudinal Study in 2018. Dissatisfaction was measured by two methods: binary outcome (1 = Dissatisfaction; 0 = No) demonstrated the risk of occurring dissatisfaction among various characteristics, and continuous outcome (ranges from score 1 to 5) showed the degree. The mean score of dissatisfaction was 2.73 ± 1.08. Sixteen percent of rural participants and 19% of urban participants reported dissatisfaction with local medical services, respectively. The multilevel analyses demonstrated that participants' utilization of paid family doctor services decreased the risk of occurring dissatisfaction; dissatisfaction was less focused on females; having chronic diseases increased the risk of dissatisfaction. This study suggests promotion of family doctor services can effectively reduce middle-aged and elderly dissatisfaction with the local medical services. In addition, more attention should be focused on males and middle-aged and elderly with chronic diseases in order to decrease dissatisfaction.

Effects of internal service quality on nurses' job satisfaction, commitment and performance: Mediating role of employee well-being

AIM

The attitudes and behaviours of nursing staff are critical to determine patients' satisfaction and to have a competitive advantage for any healthcare organization. This study is set to investigate the effects of internal service quality (ISQ) on nurses' job satisfaction, employee commitment, well-being and job performance in the healthcare sector of Pakistan. Further, this study also examines the mediating role of nurses' well-being for the relationship of job satisfaction and commitment with their job performance.

METHODS

This was a cross-sectional quantitative research. A self-administered survey was used to collect data from 412 nursing employees of 20 private sector healthcare centres operating in Pakistan. Partial least square of structural equation model (PLS-SEM) and structural equation modelling (SEM) were employed through Smart PLS 3.2.8 for data analysis.

RESULTS

Study results revealed that ISQ directly effects employees' satisfaction, commitment, well-being of the nursing employees. Moreover, employees' well-being has mediated job satisfaction and job performance relationship; however, well-being did not mediate the relationship between commitment and job performance.

Ranking the Healthcare Resource Factors for Public Satisfaction with Health System in China-Based on the Grey Relational Analysis Models

(1) Background: Public satisfaction with the health system is a very important comprehensive indicator. Given the limited healthcare resources in a society, it is always important for policymakers to have full information about the priority and the ranking order of the factors of healthcare resources for improving public satisfaction. (2) Methods: Grey Relational Analysis (GRA) is advantageous for satisfaction analysis because satisfaction is a “grey concept” of “having a clear boundary but vague connotation”. The data were from the CGSS and the China Health Statistics Yearbook (2013 and 2015), with a total of 15,969 samples (average satisfaction score = 68.5, age = 51.9, female = 49.4%). (3) Results: The government’s percentage of total expenditure on healthcare was ranked as the most important factor for public satisfaction with the health system in China in both 2013 and 2015. The second most important factor changed from “Out-of-pocket percentage of individuals” in 2013 to “Hospital beds per thousand populations” in 2015. Meanwhile, “Healthcare workforce per thousand populations” increased from the least important factor in 2013 to the 3rd in 2015. Disparities in the ranking orders of the factors among regions of China were identified too. (4) Conclusions: The analysis results suggest that during recent years the priority of Chinese residents’ healthcare satisfaction for healthcare resources has shifted on the national level from economic affordability to more intensive “people-centered” services, while the regional disparities and gaps need to receive more attention and be further improved in the healthcare reform of next round.

Measuring the Efficiency of Economic Growth towards Sustainable Growth with Grey System Theory

In the paper, a new indicator exemplifying the conversion efficiency of expenditures towards economic growth into results pertaining to sustainable development, dubbed the “Synthetic Efficiency Indicator for Economic Growth” (hereinafter: “SEI-EG”) has been proposed. The inspiration for proposing such an indicator was the identification of the lack of connections between research on economic convergence and the research area connected with sustainable growth category. It was assumed that, in the first place, outcomes of the proposed convergence will be visible in developed economies, represented by EU15 member states. The set goal was to provide an answer to the question of difference between EU15 member states with respect to efficiency of converging expenditures exemplifying economic growth into results pertaining to sustainable growth. The research was conducted for 2016–2018 using Grey System Theory. With the use of the elaborated indicator, the authors created a ranking list of countries based on the efficiency of economic growth towards sustainable growth criterion. The conducted research proved that, in general, the smaller EU member states are characterized by significantly higher efficiency of converging expenditures exemplifying economic growth into results pertaining to sustainable development in the researched area. Among the countries with large economies, only Germany showed efficiency comparable to smaller ones.

Determinants of depression in women with chronic disease: Evidence from a sample of poor loan takers from Pakistan

Depression is one of the most common mental health problems in Pakistani women, with prevalence rates estimated to be above 30%. Identification of the determinants of depression in chronically ill, poor, and debt-ridden women of the country is a neglected area. A quantitative survey using standardized tools was used to sample women from across Pakistan. It was found that women had higher odds of depression when they (a) perceived unfavorable self-health, (b) had less health decision-making power, (c) encountered difficulties in healthcare services, and (d) faced food insecurity. Key reforms are recommended to improve state protection policies, mental healthcare services, and cultural support for disadvantaged women in the country.

Understanding patient satisfaction and loyalty in public and private primary health care

Background: The quality of health centers, patient satisfaction, and loyalty are three key factors that enable health care providers to improve their services and cost-effectiveness. This study, therefore, aims to determine patient satisfaction and loyalty in public and private primary health care centers.

Design and Methods: Data were obtained from a cross-sectional design of 1470 self-administered questionnaires and analyzed based on mean, standard deviation, and correlation coefficients.

Results: The results showed respectively a strong and moderate correlation between patient satisfaction and loyalty in private (r=0.767) and public (r=0.54) primary health care centers, respectively. In addition, in both centers patients received adequate medical services, with social aspects as the least important factors affecting patient satisfaction.

Conclusions: In conclusion, primary health care practices need to recognize the needs that influence patients’ satisfaction and loyalty, to improve the quality of their services.

Public satisfaction with the healthcare system in China during 2013-2015: a cross-sectional survey of the associated factors

OBJECTIVE

We explore how public satisfaction with the healthcare system in China varies with social and economic factors, especially regional variations and changes during 2013-2015.

DESIGN

Population-based, cross-sectional survey performed between July 2013 and July 2015.

SETTING

General population of China during 2013-2015.

PARTICIPANTS

A total of 15 969 participants (women=49.4%, sample-weighted average age=51.9).

PRIMARY OUTCOME MEASURE

Public satisfaction with the healthcare system, defined as 'being satisfied' if a respondent's satisfaction score is ≥70 points.

RESULTS

The 2-year mean of the satisfaction score of the sample is 68.5 out of 100 points and the score in 2015 is higher than 2013 by 3.5 points. Senior respondents (OR=1.19, p<0.001), rural respondents (OR=1.23, p=0.009) and those with higher socioeconomic status are more likely to report being satisfied. Internal migrants (OR=0.75, p<0.001) and those with a higher level of education are less likely to report being satisfied. Total health expenditure as percentage of gross domestic product and density of hospital beds have a significantly positive association with satisfaction (OR=1.13, p<0.001). Meanwhile, the government's share in total healthcare expenditures has a moderately negative association with satisfaction (OR=0.97, p<0.001). In rural areas, the density of hospital beds has a positive association with satisfaction (OR=1.26, p=0.002). The Northeast region and Shanghai (OR=0.49, p<0.001; OR=0.71, p=0.034) are less likely to report being satisfied and this remained unchanged in 2015.

CONCLUSION

There are considerable disparities in public satisfaction with the healthcare system in China, associated with demographic and socioeconomic characteristics, regional locations, urban-rural environment, and regional health resource abundance. Actions are recommended to improve satisfaction with the public healthcare system, especially in the Northeast region of China.

Promoting OPD Patient Satisfaction through Different Healthcare Determinants: A Study of Public Sector Hospitals

Patient satisfaction is a core tool for measuring the performance of the hospitals as well as the service provider and the services that they are providing to the patients. The aim of this research is to evaluate how information received, medical equipment, distance from the hospital, and physical infrastructure influenced patient satisfaction at public hospitals in Southern Punjab, Pakistan. An exploratory research technique was used. We distributed 700 questionnaires through a random method, and 579 provided proper responses. A confirmatory factor analysis (CFA) and a regression analysis were used for the data analysis. The study results illustrated that medical equipment, information received, distance from the hospital, and physical infrastructure had significantly positive impacts (p = 0.001) on patient satisfaction. To promote higher level of satisfaction, there is a need to take appropriate steps for improvement.

Systems Evaluation through New Grey Relational Analysis Approach: An Application on Thermal Conductivity—Petrophysical Parameters’ Relationships

The current study introduces a new technique for the analysis of uncertain systems and uncertain processes in geothermics/earth sciences. The method is the second synthetic grey relational analysis (SSGRA) model, which incorporated the advantages of both Deng’s GRA model and the bidirectional absolute GRA model. The SSGRA model has been earlier successfully applied in project management and healthcare systems. The current study is a pioneer in demonstrating the feasibility of the SSGRA model in a geothermal environment. In the current study, the model was used to determine the associations between thermal conductivity and petrophysical parameters in an Algerian reservoir. The results revealed that thermal conductivity is most strongly associated with porosity followed by density and permeability. Their relationships are also discussed. The study concludes with valuable insights about the model and its application in engineering and natural sciences especially when the system contains uncertainty, which may arise either due to insufficient data or uncertain relationships among the parameters associated with the system or its processes.

A novel algorithm for solving resource-constrained project scheduling problems: a case study

Purpose

Construction projects managers try their best for the project to go according to the plans. They always attempt to complete the projects on time and consistent with the predetermined budgets. Amid so many problems in project planning, the most critical and well-known problem is the Resource-Constrained Project Scheduling Problem (RCPSP). The purpose of this paper is to solve RCPSP using hybrid algorithm ICA/PSO.

Design/methodology/approach

Due to the existence of various forms for scheduling the problem and also the diversity of constraints and objective functions, myriad of research studies have been conducted in this realm of study. Since most of these problems are NP-hard ones, heuristic and meta-heuristic methods are used for solving these problems. In this research, a novel hybrid method which is composed of meta-heuristic methods of particle swarm optimization (PSO) and imperialist competitive algorithm (ICA) has been used to solve RCPSP. Finally, a railway project has been examined for RCPS Problem in a real-world situation.

Findings

According to the results of the case study, ICA/PSO algorithm has better results than ICAs and PSO individually.

Practical implications

ICA/PSO algorithm could be used for solving problems in a multi-mode situation of activities or considering more constraints on the resources, such as the existence of non-renewable resources and renewable. Based on the case study in construction project, ICA/PSO algorithm has a better solution than PSO and ICA.

Originality/value

In this study, by combining PSO and ICA algorithms and creating a new hybrid algorithm, better solutions have been achieved in RCPSP. In order to validate the method, standard problems available in PSPLib library were used.