Linking Service Quality, Patients’ Satisfaction and Behavioral Intentions: An Investigation on Private Healthcare in Malaysia

The role of perceived quality of care on outpatient visits to health centers in two rural districts of northeast Ethiopia: a community-based, cross-sectional study

BACKGROUND

Patients who have had a negative experience with the health care delivery bypass primary healthcare facilities and instead seek care in hospitals. There is a dearth of evidence on the role of users' perceptions of the quality of care on outpatient visits to primary care facilities. This study aimed to examine the relationship between perceived quality of care and the number of outpatient visits to nearby health centers.

METHODS

A community-based cross-sectional study was conducted in two rural districts of northeast Ethiopia among 1081 randomly selected rural households that had visited the outpatient units of a nearby health center at least once in the previous 12 months. Data were collected using an interviewer-administered questionnaire via an electronic data collection platform. A multivariable analysis was performed using zero-truncated negative binomial regression model to determine the association between variables. The degree of association was assessed using the incidence rate ratio, and statistical significance was determined at a 95% confidence interval.

RESULTS

A typical household makes roughly four outpatient visits to a nearby health center, with an annual per capita visit of 0.99. The mean perceived quality of care was 6.28 on a scale of 0-10 (SD = 1.05). The multivariable analysis revealed that perceived quality of care is strongly associated with the number of outpatient visits (IRR = 1.257; 95% CI: 1.094 to 1.374). In particular, a significant association was found for the dimensions of provider communication (IRR = 1.052; 95% CI: 1.012, 1.095), information provision (IRR = 1.088; 95% CI: 1.058, 1.120), and access to care (IRR = 1.058, 95% CI: 1.026, 1.091).

CONCLUSIONS

Service users' perceptions of the quality of care promote outpatient visits to primary healthcare facilities. Effective provider communication, information provision, and access to care quality dimensions are especially important in this regard. Concerted efforts are required to improve the quality of care that relies on service users' perceptions, with a special emphasis on improving health care providers' communication skills and removing facility-level access barriers.

Determinants of Continuous Usage Intention in Community Group Buying Platform in China: Based on the Information System Success Model and the Expanded Technology Acceptance Model

Community group buying is a new retail model with broad development prospects. The community group buying model in China has brought obvious social and economic benefits. However, the continuous usage rate on some community group buying platforms is relatively low. Consumers' continuous usage intentions are closely related to the sustainable development of community group buying platforms. Therefore, this study integrates the information system success model (D&M model) and the expanded technology acceptance model (TAM) to construct a research model that explores the factors influencing consumers' continuous usage intentions from both the platform's and consumers' perspectives. The survey data involving 418 respondents who used community group buying platforms were developed and analyzed for structural equation model (SEM) testing. The results show the following: (1) Perceived usefulness, perceived ease of use, service quality, perceived trust, expectation confirmation, and subjective norms significantly affect continuous usage intention. (2) Subjective norms are significantly related to continuous usage intention. Perceived usefulness, perceived ease of use, service quality, perceived trust, and expectation confirmation indirectly affect continuous usage intention through user satisfaction. This research provides a new perspective for the theoretical research of community group buying and helps to promote the sustainable development of community group buying platforms in management practice.

Perceived quality of care for severe acute malnutrition management among caregivers of under-five children with severe acute malnutrition in Addis Ababa, Ethiopia, 2022: a mixed-method study

Introduction

All the factors at the institutional, provider, and client levels have an impact on the quality of care. In low- and middle-income countries, poor quality of severe acute malnutrition (SAM) management at health institutions is a major contributor to child morbidity and mortality. This study aimed to determine the perceived quality of care for SAM management among caregivers of under-five children.

Methods

This study was conducted in public health facilities that provide inpatient SAM management in Addis Ababa, Ethiopia. An institution-based convergent mixed-method study design was implemented. Quantitative data were analyzed by using a logistic regression model, while thematic analysis was used to analyze the qualitative data.

Results

A total of 181 caregivers and 15 healthcare providers were recruited. The overall perceived quality of care for SAM management was 55.80% (CI: 48.5-63.10). Urban residence (AOR = 0.32, 95% CI: 0.16-0.66), college and above level education (AOR = 4.42, 95% CI: 1.41-13.86), working as a government employee (AOR = 2.72, 95% CI: 1.05-7.05), readmitted to the hospital (AOR = 0.47, 95% CI: 0.23-0.94), and length of hospital stays >7 days (AOR = 2.1, 95% CI: 1.01-4.27) were found to be significantly associated factors with perceived low-quality care for SAM management. Additionally, lack of support and attention from higher levels of management, and lack of supplements, separate units, and laboratory facilities were among the factors that impede the provision of quality care.

Discussion

Perceived quality of SAM management services was low against the national goal of quality improvement to meet the expectations of both internal and external clients. Rural residents, those with more educational qualifications, government employees, newly admitted patients, and patients who stayed longer in hospitals were the most unsatisfied groups. Improving support and logistic supply to health facilities, providing client-centered care, and responding to caregivers' demands may help to improve quality and satisfaction.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

DISCUSSION

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

Patient satisfaction with quality of care in public hospitals in Albania

Healthcare service quality and hospitalized patient satisfaction in Albania have never truly received the necessary attention. The aim of this study is the assessment of key elements of service quality and their relationship with patients' satisfaction with receiving healthcare at public health institutions in Albania. The study examines five key dimensions of quality such as responsiveness, reliability, assurance, tangibles, and staff empathy to assess properly the healthcare quality and patient satisfaction in Albania based on the SERVQUAL instrument, which measures the differences between patient's perceptions of service quality received, and their expectations in terms of these five dimensions. A total of 800 randomly selected patients were interviewed in the main cities of Albania in public hospitals. A respective literature review was also a necessity to determine not only the appropriate methodology to be applied, together with the right quality dimensions to use but also for a better understanding of the link between service quality and patient satisfaction. The determination of the main quality factors which contribute to patient satisfaction, as well as, their order of importance, is another key aspect of the study, which finalizes with appropriate recommendations that might help quality improvement in future. The analysis shows that overall patient satisfaction is affected in public hospitals by all dimensions of service quality. Therefore, patients' perspective is extremely important in assessing healthcare service quality and should be taken into consideration by healthcare managers and policymakers in Albania, whenever significant reforms will be undertaken to improve the quality of services in this sector.

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

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

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.

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

Purpose

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

Design/methodology/approach

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

Findings

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

Originality/value

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

The Influence of Healthcare Service Quality on Public University Students’ Satisfaction and Behavioural Intention: Moderating Role of Trust

Healthcare service quality has been extensively studied over the past few decades. However, the topic remains imperative as it is the main contributor to patients’ satisfaction. It is considered as the yardstick to examine the desired service level that should be delivered to patients. Due to its importance, research was initiated to examine the influence of healthcare service quality on patients’ satisfaction by looking at the moderating effect of trust. The study was conducted in UiTM Selangor, Malaysia, involving 1,894 respondents who have experienced using the healthcare service provided by the institution. Based on the multiple regression analysis, all dimensions of healthcare service quality, namely reliability, assurance, tangibles, empathy and responsiveness, are significant to influence satisfaction and behavioural intention of patients. For satisfaction, trust moderates the relationship between empathy and satisfaction. For behavioural intention, trust moderates the relationship between tangibles and behavioural intention and the relationship between empathy and behavioural intention. The implications of the study are highlighted in this article.

Users' intention to continue using mHealth services: A DEMATEL approach during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) has changed the way we use and perceive online services. This study examined the influence of service quality factors during COVID-19 on individuals' intention to continue use mHealth services. A decision-making trial and evaluation laboratory (DEMATEL) approach was used to identify and analyse the relationships between service quality and individuals' intention to continue use mHealth during the COVID-19 pandemic. Individuals' direct, indirect, and interdependent behaviours in relation to service quality and continues use of mHealth were studied. A total of 126 respondents were involved in this study. The results identified several associations between service quality factors and individuals' continuous use of mHealth. The most important factor found to influence users' decision to continuously use mHealth was assurance, followed by hedonic benefits, efficiency, reliability, and content quality. The relevant cause-and-effect relationships were identified and the direction for quality improvement was discussed. The outcomes from this study can support healthcare policy makers to swiftly and widely respond to COVID-19 challenges. The findings provide fundamental insights for healthcare organisations to promote continuous use of mHealth among people by prioritising service improvements.

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

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

e-Healthcare service quality: consumer satisfaction and its association with demographic characteristics

PURPOSE

Use of technology for quality healthcare services has developed into a new field known as "e-Healthcare services." Healthcare providers often judge their quality of services with consumer satisfaction. With e-Healthcare services, consumer satisfaction is influenced by the quality of healthcare services provided and the demographic characteristics. The purpose of the present case study is to recognize the important predictors of quality, which are significant for consumer satisfaction with e-Healthcare services by using Zineldin's 5Qs model. It also aims to find the strength of association among the predictors of consumer satisfaction and the demographic characteristics of the respondents.

DESIGN/METHODOLOGY/APPROACH

A questionnaire-based study was conducted at a public (PGIMER, Chandigarh) and a private hospital (Fortis Hospital, Mohali) of Punjab, India, from February 2018 to March 2019. The structured, closed-ended questionnaire, to be marked on a 1-5 point Likert scale, was adapted from Zineldin's 5Qs model and was distributed to the respondents sitting in the waiting halls of the selected hospitals. The respondents comprised of both the patients and their attendants who were aware of e-Healthcare services and were using them.

FINDINGS

The analysis identified quality of interaction, quality of hospital atmosphere and quality of object to be the key predictors of consumer satisfaction with e-Healthcare services. The results reveal a strong association between different demographic characteristics and overall consumer satisfaction with e-Healthcare services.

PRACTICAL IMPLICATIONS

The results suggest that improvements in the quality of interaction, quality of hospital atmosphere and quality of object may result in higher consumer satisfaction with e-Healthcare services. Working on the identified dimensions of quality will help the e-Healthcare providers in identifying functional problems of e-Healthcare services and developing improvement strategies, which will also result in better health and quality outcomes. The results of this study will help the e-Healthcare providers in better segmentation of e-Healthcare consumers based on their demographic characteristics and in developing better marketing strategies.

ORIGINALITY/VALUE

This paper focuses on the quality of e-Healthcare services only and attempts to identify the quality dimensions, which leads to the satisfaction of e-Healthcare consumers. The identified quality dimensions will help in designing better e-Healthcare services and framing policies. It also highlights the association of demographic characteristics with important quality dimensions.

Introducing an efficient sampling method for national surveys with limited sample sizes: application to a national study to determine quality and cost of healthcare

Background

Sampling a small number of participants from an entire country is not straightforward. In this case, researchers reluctantly sample from a single setting or few settings, which limits the generalizability of findings. Therefore, there is a need to design efficient sampling method for small sample size surveys that can produce generalizable results at the country level.

Methods

Data comprised of twenty proxy variables to measure health services demands, structures, and outcomes of 413 districts of Iran. We used two data mining methods (hierarchical clustering method (HCM) and model-based clustering method (MCM)) to create homogenous groups of districts, i.e., strata based on these variables. We compared the internal and stability validity of the methods by statistical indices. An expert group checked the face validity of the methods, particularly regarding the total number of strata and the combination of districts in each stratum. The efficiency of selected method, which is measured by the inverse of variance, was compared with a simple random sampling (SRS) through simulation. The sampling design was tested in a national study in Iran, which aimed to evaluate the quality and costs of medical care for eight selected diseases by only recruiting 300 participants per disease at the country level.

Results

MCM and HCM divided the districts into eight and two clusters, respectively. The measures of internal and stability validity showed that clusters created by MCM were more separated, compact, and stable, thus forming our optimum strata. The probability of death from stroke, chronic obstructive pulmonary disease, and in-hospital mortality rate were the most important indicators that distinguished the eight strata. Based on the simulation results, MCM increased the efficiency of the sampling design up to 1.7 times compared to SRS.

Conclusions

The use of data mining improved the efficiency of sampling up to 1.7 times greater than SRS and markedly reduced the number of strata to eight in the entire country. The proposed sampling design also identified key variables that could be used to classify districts in Iran for sampling from these target populations in the future studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11441-0.

Obstetrics services in Malaysia: factors influencing patient loyalty

Purpose

This study aims to investigate the link of functional service quality (hospital’s reputation, administrative procedures, trustworthiness, patient-care provider relationship and waiting time), satisfaction and patient loyalty on the obstetrics services in private health-care in Malaysia.

Design/methodology/approach

A total of 419 mothers who had obtained obstetrics services had participated in this study in a continuous and coordinated manner. The study was conducted in 10 private hospitals in Malaysia throughout April 2018.

Findings

Results show that providing excellent service had increased the level of patient satisfaction and achieved patient loyalty. Patients tend to switch to other obstetricians if they are unhappy with the current services that are being offered. The findings showed that patient satisfaction was found to be mediating the relationship between hospital reputation and patient loyalty; trustworthiness and patient loyalty; patient care relationship and patient loyalty; and waiting time and patient loyalty. However, this study also found that administrative procedures do not influence patient satisfaction significantly.

Practical implications

The outcome of this study able to assist the management of the private hospitals to have more operational and practical strategies that would enhance their service quality for the betterment in their services for their patients in this competitive industry.

Originality/value

This paper provides patients’ perception of their loyalty towards obstetrics services offered by private hospitals in Malaysia.

Medical service quality, patient satisfaction and intent to revisit: Case study of public hub hospitals in the Republic of Korea

This study aimed to construct and test structural equation modeling of the causal relationship between quality of healthcare, patient satisfaction, and intent to revisit perceived by patients using regional hub public hospitals. In this study, data of 2,951 outpatients and 3,135 inpatients were collected using the “2018 Regional Hub Public Hospital Operational Evaluation.” A structural equation model was used to understand the relationship between patient satisfaction and intent to revisit, and bootstrap analysis was performed. In the direct effect, outpatients were presented in the order of the physician’s practice service, the hospital’s environment, and patient satisfaction. Inpatients were in the order of the physician’s practice service and, medical staff’s kindness and consideration,; patient satisfaction was shown in this order. In the indirect effect, the outpatients were presented in the order of physician’s practice service, medical staff’s kindness and consideration, and hospital’s physical environment. Inpatients were introduced in the order of medical staff’s kindness and consideration, nurse’s practice service, physician’s practice service, and patient satisfaction. Regional hub public hospitals need high-quality medical services and efforts from all departments to treat patients with sincerity to improve patient satisfaction and increase intent to revisit.

Health Investment Management and Healthcare Quality in the Public System: A Gender Perspective

The aim of this empirical research was to provide useful information for health system managers on the costs and investments involved in improving the quality of the National Health Service (NHS) based on patient assessments and from a gender perspective, i.e., without assuming that the perceived experience is identical for men and women. A cross-sectional study of 31 variables was applied using partial least squares structural equation modeling (PLS-SEM) as a research tool. The data were obtained from the Spanish Ministry of Health, Consumption, and Social Welfare for the entire Spanish territory between 2005 and 2018. The influence of expenditure, resource allocation, and mortality was hypothesized with regard to patient satisfaction according to disconfirmation theory. Patient satisfaction reflects clinical effectiveness, and therefore is a measure of health system quality. The results show that women are more sensitive to public investment in health than men, i.e., an increase in the level of spending and resources increases satisfaction more in women. In both sexes, the level of expenditure has a direct influence on patient satisfaction, and therefore on the quality of the healthcare system. It is important to increase spending on primary care, especially on specialized medical care and diagnostic equipment. However, reducing the use of drugs in favor of alternative treatments or therapies is considered to be positive. Likewise, spending has an impact on available resources, and these, in turn, have a positive influence on the level of use and a negative impact on mortality. Resources, especially healthcare staff, nuclear magnetic resonance equipment, and the number of posts in day hospitals, increase patients’ positive perception of the NHS.

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

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

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

BACKGROUND

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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Patient satisfaction in the context of public–private partnerships

Purpose

This study aims to provide insights into the public–private partnerships (PPP) concept and its performance measurement in the health-care sector, identifying and refining critical success factors, including the perceived quality of health care, as evidenced by patient satisfaction and policy requirements for successful PPP implementation.

Design/methodology/approach

This theoretical study explores the existing literature on the relationship between service quality and patient satisfaction, to propose a culture-specific conceptual model interlinking the drivers of patient satisfaction with PPP. The in-depth theoretical research focuses on the qualitative performance indicators of PPPs, as well as their corresponding peripheral factors.

Findings

The research presents theoretical evidence that the concept of patient satisfaction can only be viewed through a multifactor perspective that incorporates demographics of patients, perceived service quality factors and emotions. It is found that significant improvements in service quality and patient satisfaction do, indeed, emphasize the effective role of PPP in hospitals.

Practical implications

The theoretical model is based on a comprehensive set of both cognitive and affective determinants. And considering these, as well as their causes, effects and interrelations, sets the foundations for testing and for further research to develop. Moreover, the outcomes of this study can be used as a theoretical base for the development of a PPP qualitative performance measurement framework.

Originality/value

This study attempts to fill the gap in knowledge on service quality and patient satisfaction as qualitative indicators for hospital performance after and toward PPP, while setting explicit factors and opening clear research avenues for further studies to follow.

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.

The “service excellence chain”: an empirical investigation in the healthcare field

Purpose

The linkage between internal and external satisfaction is an understudied topic in the service field. This study aims to address this gap by proposing an original research model, the service excellence chain (SEC), that connects the internal and external perspectives by conjoining performance-excellence models and the service-profit-chain approach. Theoretical assumptions and quantitative measures are proposed by using advanced statistical techniques.

Design/methodology/approach

The SEC is investigated through an empirical study in the healthcare sector, focusing on an Italian hospital and involving two of its core units. Qualitative and quantitative approaches were used. First, internal and external customer satisfaction were separately tested through structural equation modeling. The linkage between internal and external satisfaction is then proposed by mathematically defining a synthetic index, the internal and external customer satisfaction index (IEGSI), modeled through Bayesian networks (BNs) and object-oriented BNs to provide an overall measure able to predict organizational improvement.

Findings

The distinct measured models show good internal validity and adequate fit both for patients' and employees' perspectives. The IEGSI allows rigorously connecting internal and external satisfaction by developing conjoint scenarios for organizational improvement.

Originality/value

This study proposes the SEC model as an innovative way to connect internal and external satisfaction. The findings can be useful both for private and public organizations and may provide several useful insights for healthcare managers as well as for policy-makers in relation to developing strategies for improving service quality.

Quality of Pediatric Healthcare Services and Associated Factors in Felege-Hiwot Comprehensive Specialized Hospital, North-West Ethiopia: Parental Perception

BACKGROUND

Poor quality of pediatric healthcare services at health facilities is a major contributing factor to child morbidity and mortality in low- and middle-income countries, including Ethiopia, and it brings parental dissatisfaction. Eliciting parents' perception is an important method used to assess functionality or quality of pediatric healthcare services. Thus, the objective of this study was to assess the perceived quality of pediatric healthcare services and to identify factors for it in Felege-Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia.

METHODS

A facility-based cross-sectional study was conducted among parents of childhood patients from September 15, 2019 to October 15, 2019; 407 participants were recruited. Stratified random sampling was used to select respondents and data were collected using face-to-face interviews. Frequencies, percentages, and means with standard deviations were used to describe profiles of respondents. Both bi-variable and multivariable logistic regressions were used to model the odds of perceived quality of pediatric healthcare services.

RESULTS

The proportion of perceived quality of pediatric healthcare services was 57.6% (95% CI:52.6-62.3%). College and above parental education status (AOR=5.22, 95% CI:2.39-11.38), urban residency (AOR=3.35, 95% CI:1.97-5.72), outpatient services (AOR=2.52, 95% CI:1.35-4.71), and surgical illnesses (AOR=2.18, 95% CI:1.28-3.73) were independent determinants for increased parental lower perceived level of quality. The odd of parental lower perceived level of quality was 2.42-times greater in those parents who did not prefer the hospital for revisiting (AOR=2.42, 95% CI:1.36-4.30).

CONCLUSION

Perceived quality of healthcare services in the hospital was low compared to the national plan which reflected that childhood patients did not receive optimal care. Educational status, place of residence, service delivering unit, illness type, and intention of hospital preference were independent determinants for parental perceived quality of pediatric healthcare service delivery. Continuous and periodic parental feedback should be considered in order to assess their satisfaction which in turn is an insight for quality improvement to be taken by the facility managers.

Patient Satisfaction in the Spanish National Health Service: Partial Least Squares Structural Equation Modeling

The aim of this article was to determine which key indicators influence patient satisfaction with the Spanish NHS to provide useful information for policy decision-making. A total of 33 variables for each of the 17 Spanish autonomous communities were collected from the statistical portal of the Spanish Ministry of Health, Social Services, and Equality between 2005 and 2016. A cross-sectional study was applied using Partial Least Squares to a Structural Equation Model (PLS-SEM). The influence of expenditures, resource allocation, and safety were hypothesized about patient satisfaction. Gross Domestic Product (GDP) and life expectancy were used as control variables. Moreover, the influence of resource allocation on use was tested. The model explained 57.1% of patient satisfaction with the Spanish NHS. It was positively influenced mainly by resource allocation and expenditures, followed by safety and life expectancy. Additionally, resources directly influenced the level of use. The number of hospital beds, hemodialysis equipment, rate of adverse drug reactions, and expenditure positively influenced patient satisfaction. In contrast, the number of posts in day hospitals, the hospital infection rate, and the percentage of pharmacy spending negatively influenced patient satisfaction.

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

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

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

Purpose

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

Design/methodology/approach

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

Findings

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

Research limitations/implications

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

Originality/value

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