Assessing the competitive effectiveness of hospitals: The role of quality improvement initiatives

Understanding service quality: insights from the literature

Purpose

The purpose of this paper is to review the service quality (SQ) literature in order to understand issues involved in its conceptualization and operationalization.

Design/methodology/approach

The paper uses systematic literature review method. The unit of analysis is peer-reviewed journal articles published during 1984 to 2017.

Findings

Findings suggest manufacturing, banking, information technology, higher education, healthcare are the top sectors contributing to the SQ literature. More than 60 models of the SQ have been identified. Service-driven capabilities may be structured along adaptation with strategic drivers and imperatives, learning and alignment, and problem structuring. In doing so the SQ literature is evolving across overlapping phases of conceptualization, expansion, re-conceptualization and integration.

Research limitations/implications

The paper contributes to the body of knowledge by presenting a unified synthesis of more than 814 articles published in the last three decades.

Practical implications

Insights from the paper will help practitioners in understanding customers’ expectations and accordingly configuring effective service delivery systems, setting standards and communicating value to end-customers. This in turn helps them in developing service-based competencies and achievement of competitive advantage.

Social implications

Insights from the paper may help in conceptualizing and delivering SQ-driven public services.

Originality/value

The paper synthesizes and presents various facets of the SQ as a unified body of knowledge.

Implementing health care reform: implications for performance of public hospitals in central Ethiopia

Background

Understanding the way health care reforms have succeeded or failed thus far would help policy makers cater continued reform efforts in the future and provides insight into possible levels of improvement in the health care system. This work aims to assess and describe the implications of health care reform on the performance of public hospitals in central Ethiopia.

Methods

A facility-based, cross-sectional study was carried out in five public hospitals with different operational characteristics that have been implementing health care reform in central Ethiopia. The reform documents were reviewed to assess the nature and targets of the reform for interpretive analysis. Adopting dimensions of health system performance as the theoretical framework, a self-administered questionnaire was developed. Consenting health care professionals who have been involved in the reform from inception to implementation filled the questionnaire. Cronbach’s alpha was measured to ensure internal consistency of the instrument. Descriptive statistics, weighted median score, χ², and Mann-Whitney U and Kruskal-Wallis tests were used for data analysis.

Result

s Despite implementation of the reform, the health care system in public hospitals was still fragmented as confirmed by 50% of respondents. Limited effects were reported in favour of quality (48%), access (50%), efficiency (51%), sustainability (53%), and equity (61%) of care, while poor effects were reported in patient-provider (41%) and provider-management (32%) interactions. Though there was substantial gain in infrastructure and workspace, stewardship of health care resources was less benefited. The predominant hindrances of the reform were the working environment (adjusted Odds Ratio (aOR) = 2.27, 95% confidence interval (CI): 1.15-4.47), financial resources (aOR = 3.54, 95%CI = 1.97-6.33), management (aOR = 2.27, 95% CI = 1.15-4.47), and information technology system (aOR = 3.15, 95% CI = 1.57-6.32).

Conclusion

s The Ethiopian health care reform has laid the groundwork for health system improvement, but progress was slow and the health care delivery system was still fragile. Healthcare reform efforts in such settings are feasible, but with regular mapping of programmatic outcomes and bringing a common understanding of the reform among stakeholders.