Multi-criteria decision making methods based weighted SERVQUAL scales to measure perceived service quality in hospitals: a case study from Turkey

Assessing the Gap Between Women's Expectations and Perceptions of the Quality of Intrapartum Care in Jordan: A Two-Stage Study Using the SERVQUAL Model

INTRODUCTION

Although Jordan has made significant progress toward expanding the utilization of facility-based intrapartum care, prior research highlights that poor service quality is still persistent. This study aimed to identify quality gaps between women's expectations and perceptions of the actual intrapartum care received, while exploring the contributing factors.

METHODS

Utilizing a pre-post design, quality gaps in intrapartum care were assessed among 959 women pre- and postchildbirth at a prominent tertiary hospital in northern Jordan. Data were gathered using the SERVQUAL scale, measuring service quality across reliability, responsiveness, tangibles, assurance, and empathy dimensions.

RESULTS

The overall mean gap score between women's expectations and perceptions of the quality of intrapartum care was -0.60 (±0.56). The lowest and highest mean gap scores were found to be related to tangibles and assurance dimensions, -0.24 (±0.39) and -0.88 (±0.35), respectively. Significant negative quality gaps were identified in the dimensions of assurance, empathy, and responsiveness, as well as overall service quality (p < 0.001). The MLR analyses highlighted education (β = 0.61), mode of birth (β = -0.60), admission timing (β = -0.41), continuity of midwifery care (β = -0.43), physician's gender (β = -0.62), active labour duration (β = 0.37), and pain management (β = -0.33) to be the key determinants of the overall quality gap in intrapartum care.

CONCLUSION

Our findings underscore the importance of fostering a labour environment that prioritizes enhancing caregivers' empathetic, reassuring, and responsive skills to minimize service quality gaps and enhance the overall childbirth experience for women in Jordan.

PATIENT OR PUBLIC CONTRIBUTION

This paper is a collaborative effort involving women with lived experiences of childbirth, midwives, and obstetrics and gynaecologist physicians. The original idea, conceptualization, data generation, and coproduction, including manuscript editing, were shaped by the valuable contributions of stakeholders with unique perspectives on intrapartum care in Jordan.

A paradigm shift for medical health care to focus on a service-value approach to achieve greater patient satisfaction

PURPOSE

This study takes a divergent approach to exploring which construct is more predictive of patient satisfaction (SAT) in a service dominant economy within the context of a healthcare setting.

DESIGN/METHODOLOGY/APPROACH

Applying a critical analysis of literature, a service value (SV) model for customer SAT is proposed in this study, which is validated and confirmed with survey data from outpatients at Moorfields Eye Hospital - a world class specialist hospital based in the UK.

FINDINGS

Quality of service had the strongest impact on SV but SV had the strongest impact and mediation effect on patient SAT.

RESEARCH LIMITATIONS/IMPLICATIONS

The study concludes that since SV rather than quality of service is more predictive of patient SAT, health service providers should focus more on SV in addition to quality of service, if they are to meet the dynamic expectations of their patients.

PRACTICAL IMPLICATIONS

Health service providers should focus more on SV in addition to quality of service, if they are to meet the dynamic expectations of their patients.

SOCIAL IMPLICATIONS

This poses a strong argument in favour of a paradigm shift in focus from quality of service-based model to service value-based model for greater patient satisfaction.

ORIGINALITY/VALUE

This is the first study exploring the inter-relationship of four constructs of patient SAT within the context of a leading major UK healthcare hospital service.

A Systematic Review and Meta-Analysis of Health Care Quality in Iran Based on the Comprehensive Quality Measurement in Health Care Model

Background

Comprehensive assessment of health care quality is the first step in improving care and achieving health service goals. Therefore, this study aimed to conduct a systematic review and meta-analysis of health care quality in Iran based on the Comprehensive Quality Measurement in Health Care model.

Methods

In this study, the databases of PubMed, Scopus, Web of Science, Iranian Scientific Information Database (SID), MagIran, and Google Scholar were searched using English and Iran keywords without time limit. STATA 16 software and a random effect model were used for conducting meta-analysis.

Results

Of the 750 articles found, 20 were finally included; 13 of which were related to service quality, five to customer quality, and four to technical quality. Overall mean score of service quality was 7.79 [95% CI 7.43-8.15, df = 12, I² = 98.48, P value < 0.000] out of 10, and overall mean score of customer quality was 73.20 ± 4.56 [95% CI 65.18-81.22, df = 5, I² = 99.34, P value < 0.001] out of 100. Among the 12 dimensions of service quality, the confidentiality dimension (9.55 ± 0.12) had the highest mean score and the group support dimension (5.92 ± 0.901) had the lowest score. In general, from the viewpoint of service receivers, the technical quality is relatively favorable.

Conclusions

According to the results of this study, the quality of health care in Iran is significantly far from ideal. Therefore, planning to improve providing health care is essential.

Logistics Service Provider Evaluation and Selection: Hybrid SERVQUAL–FAHP–TOPSIS Model

Production and business enterprises are aiming to improve their logistics activities in order to increase competitiveness. Therefore, the criteria and decision support models for selecting logistics service providers are significant to businesses. Fuzzy theory has been applied to almost all industrial engineering fields, such as decision making, operations research, quality control, project scheduling and many more. In this research, the authors combined fuzzy theory and a Multicriteria Decision Making (MCDM) model for the evaluation and selection of potential third-party logistics (3PL) providers. The goal is to take the advantages of these approaches and allow for more accurate and balanced (symmetric) decision making through their integration. The main contribution of this study is that it develops a complete approach to assessing the quality of the logistics service industry. The combined method of the SERVQUAL and FAHP–TOPSIS models not only provides reasonable results, but it also allows decision makers to visualize the impact of different criteria on the final outcome. Furthermore, this integrated model can provide valuable insights and methods for other areas to define service quality.

Application of Rough Set Theory to Improve Outpatient Medical Service Quality in Public Hospitals Based on the Patient Perspective

Purpose: To analyze the key factors and decision-making behaviors affecting overall satisfaction based on perceptual data of outpatients. Methods: The official satisfaction questionnaire developed by the National Health Commission of the People's Republic of China was used. Rough set theory was used to identify the perception patterns between condition attributes (i.e., service factors) and a decision attribute (i.e., overall service level) and to express them in rule form (i.e., if-then). Results: The four minimal-coverage rules, with strength exceeding 10% in the good class, and six crucial condition attributes were obtained: "Ease of registration (C ₁)," "Respected by registered staff (C ₂)," "Registered staff's listening (C ₃)," "Respected by doctor (C ₉)," "Signpost (C ₁₂)," and "Privacy (C ₁₆)." In addition, the average hit rate for 5-fold cross-validation was 90.86%. Conclusions: A series of decision rules could help decision-makers easily understand outpatients' situations and propose more suitable programs for improving hospital service quality because these decision rules are based on actual outpatient experiences.

Evaluating the association between urban green spaces and subjective well-being in Mexico city during the COVID-19 pandemic

This paper examines the association between the frequency of use of urban green spaces (UGS) and the subjective well-being (SWB) of Mexico City's residents during the COVID-19 pandemic. We conducted an online survey (N = 1954) regarding individuals' perceptions and use of UGS and their SWB, evaluated through the short version of the Warwick-Edinburgh mental well-being scale. Multilevel mixed-effects regression analyses were performed to investigate the association between the frequency of UGS use and SWB, including individual and municipal level characteristics as covariates. Our results suggest that respondents who used UGS once or more per week during the pandemic reported higher SWB scores (8.7%) than those with zero visits. These findings have public policy implications that could enhance the role of UGS in urban environments during times of crisis.

Gender Differences in Service Quality of Upazila Health Complex in Bangladesh

The gender-based differences in satisfaction on the service quality of the Upazila Health Complex (UHC) in Bangladesh are assessed in this paper using the SERVQUAL model. Two Upazila, field administrative unit of Bangladesh, of Meherpur district of Bangladesh, were selected to conduct the study. The study used a quantitative approach, primarily using the survey method. The research found that the perception of male and female on service quality of UHC varies significantly. Though they have a similar perception of reliability dimension, females still have a comparatively more positive perception of accessibility, tangibles, empathy, and responsiveness dimensions to UHC than male service receivers. The regression result showed that responsiveness is the key factor to bring satisfaction in service, while empathy and accessibility moderately influence service receivers’ satisfaction. The findings will be useful for policymakers, public health stakeholders, earnest learners, practitioners, and academia.

Perceived health-care quality in China: a comparison of second- and third-tier hospitals

OBJECTIVES

To evaluate disparity in service quality between second- and third-tier hospitals and explore factors that affect patients' perception of service quality in China.

DESIGN

Cross sectional study.

SETTING

Twelve hospitals in China.

PARTICIPANTS

5714 patients.

INTERVENTION

None.

MAIN OUTCOME MEASURE

Total score of the SERVQUAL scale and each of its five dimensions.

RESULTS

Patients from third-tier hospitals rated significantly higher scores overall and in all the five dimensions of the SERVQUAL scale. Those with lower education, urban residents and those who had higher degree of life satisfaction and attention paid to health perceived higher service quality. Inpatients perceived higher service quality compared with outpatients.

CONCLUSION

We found a significant gap in patient's perceived service quality between second- and third-tier hospitals in China. A variety of demographic and personality factors were found to significantly influence patient's perceived service quality.

Evaluation of Service Quality From the Patients’ Viewpoint in the Oncology Setting of a University Hospital in Iran

Background: Hospitals are one of the most important units in providing healthcare services. The assessment of the quality of provided services is essential in these settings. Patient satisfaction is one of the key indicators of service quality in healthcare organizations. Objectives: This study aimed at investigating the gap between the perceptions and expectations of service recipients in Shohada-e-Tajrish Hospital (Tehran, Iran), using the SERVQUAL model in 2020. Methods: This cross-sectional study was conducted on patients with cancer, who were upon discharge from Shohada-e-Tajrish Hospital. Patients (> 18 years) with a cancer diagnosis, who were being discharged from the oncology ward of the hospital, were included in this study. The sample size was estimated at 118. The required information was collected, using the modified SERVQUAL questionnaire. Statistical analyses were performed in SPSS version 20, using a paired t test and one-sample t-test. Results: The results showed that the quality of the provided services from the patients’ perspective was significantly lower than their expectations. The mean gap between the expectations and perceptions of patients was significantly above zero (P < 0.001). The most influential factor in improving patient satisfaction with the quality of services was assurance, followed by reliability, while the least effective factor was empathy. The correlation coefficient between the general status of provided services from the patients’ point of view and loyalty was 0.740 (P < 0.001). Conclusions: The findings of the present study indicated that patient expectations were higher than their satisfaction. Therefore, hospital authorities should take major steps to improve the quality of services, especially reliability and responsiveness, through proper planning, prioritization of services, and review of processes contributing to patient expectations. The existing gaps can also be addressed by considering the perspectives of patients as the clients of healthcare organizations.

Health care service quality: a journey so far

Purpose

Health care service is a widely researched area. Several established models and instruments measuring health care service quality (HCSQ) are available in the published academic literature. The objective of this article is to summarize this vast pool of available knowledge under the themes of HCSQ, its determinants and measurement strategies.

Design/methodology/approach

Sixty-three available published studies in peer reviewed journal combed in EBSCO and Google Scholar database have been examined and presented in exemplary literature review.

Findings

The findings have been segregated under the themes of HCSQ, its dimensions and determinants. It can be deduced from the findings that in spite of health care being a professional service, the user defined service quality takes center stage.

Originality/value

Rather than the seeker of care, the authors call for further research by taking a dyadic view of professional exchanges and including providers' perspectives of care in service quality evaluations as well.

A Cross-Sectional Study of Overtreatment and Deintensification of Antidiabetic and Antihypertensive Medications in Diabetes Mellitus: The TEMD Overtreatment Study

INTRODUCTION

Targeting better glycated hemoglobin (HbA1c) and blood pressure (BP) goals may endanger older adults with type 2 diabetes mellitus (T2DM). Overtreatment of T2DM and hypertension is a trending issue, although undertreatment is still common. We investigated the rates and predictors of overtreatment and undertreatment of glycemia and BP in older adults with T2DM and physicians' attitudes to deintensify or intensify treatment.

METHODS

Data from older adults (≥ 65 years) enrolled in a large nationwide T2DM survey in 2017 across Turkey were analyzed. Overtreatment of glycemia was defined as HbA1c < 6.5% plus the use of ≥ 2 oral antihyperglycemics or insulin, and BP overtreatment was defined as systolic BP (SBP) < 120 mmHg or diastolic BP (DBP) < 65 mmHg plus the use of ≥ 2 drugs. Undertreatment of glycemia was defined as HbA1c > 9%, and BP undertreatment was defined as SBP > 150 mmHg or DBP > 90 mmHg. Deintensification or intensification rates were calculated according to treatment modification initiated by the treating physician(s).

RESULTS

The rate of overtreatment in the glycemia group (n = 1264) was 9.8% (n = 124) and that in the BP group (n = 1052) was 7.3% (n = 77), whereas the rate of undertreatment was 14.2% (n = 180) and 15.2% (n = 160), respectively. In the adjusted model, use of oral secretagogues (sulfonylureas or glinides) (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.2-3.1) and follow-up at a private clinic (OR 1.81, 95% CI 1.0-3.3) were predictors of glycemia overtreatment. BP overtreatment was independently associated with the use insulin-based diabetes therapies (OR 1.86, 95% CI 1.14-3.04). There was no independent association of BP undertreatment to the study confounders. The deintensification and intensification rates were 25 and 75.6%, respectively, for glycemia and 10.9 and 9.2%, respectively, for BP.

CONCLUSIONS

The results show that one in ten older adults with T2DM are overtreated while one in four require modification of their current antihyperglycemic and antihypertensive treatments. Physicians are eager to intensify medications while they largely ignore deintensification in diabetes management. These results warrant enforced measures to improve the care of older adults with T2DM.

TRIAL REGISTRATION

ClinicalTrials.gov identifier, NCT03455101.

An integrated approach for healthcare services risk assessment and quality enhancement

Purpose

The purpose of this paper is to introduce an integrated approach using failure modes and effects analysis (FMEA), multiple-criteria decision making (MCDM), mathematical modeling and quality function deployment (QFD) techniques, for risk assessment and service quality enhancement in coronary artery bypass grafting (CABG) as a treatment for cardiovascular diseases (CVDs).

Design/methodology/approach

First, the disruptions in the CABG process are identified and prioritized following FMEA instructions, using two MCDM techniques, called analytic hierarchy process (AHP) and TOPSIS. Consequently, several corrective activities are identified and weighted on the basis of QFD. Finally, a mathematical model is established to determine the most cost-effective activities for implementation. The approach is developed in a fuzzy environment to reflect the uncertainty and ambiguity of human reasoning.

Findings

Regarding the CABG process disruption, a total of 30 failure modes in four main categories were identified and prioritized. Moreover, eight corrective activities were devised and ranked according to their impact on the failure modes. Finally, considering a limited amount of budget, a sensitivity analysis on the mathematical model’s objective function indicated that using 30 percent of the total budget, required to implement all corrective activities, was enough to cover more than 70 percent of the effects of corrective activities on the failure modes.

Originality/value

This paper contributes to the quality risk assessment knowledge by introducing an integrated approach to evaluate and improve healthcare services quality. Also, the case study conducted on the CABG process has not been done by other related studies in the literature.

A New Methodology for Improving Service Quality Measurement: Delphi-FUCOM-SERVQUAL Model

The daily requirements and needs imposed on the executors of logistics services imply the need for a higher level of quality. In this, the proper execution of all sustainability processes and activities plays an important role. In this paper, a new methodology for improving the measurement of the quality of the service consisting of three phases has been developed. The first phase is the application of the Delphi method to determine the quality dimension ranking. After that, in the second phase, using the FUCOM (full consistency method), we determined the weight coefficients of the quality dimensions. The third phase represents determining the level of quality using the SERVQUAL (service quality) model, or the difference between the established gaps. The new methodology considers the assessment of the quality dimensions of a large number of participants (customers), on the one hand, and experts’ assessments on the other hand. The methodology was verified through the research carried out in an express post company. After processing and analyzing the collected data, the Cronbach alpha coefficient for each dimension of the SERVQUAL model for determining the reliability of the response was calculated. To determine the validity of the results and the developed methodology, an extensive statistical analysis (ANOVA, Duncan, Signum, and chi square tests) was carried out. The integration of certain methods and models into the new methodology has demonstrated greater objectivity and more precise results in determining the level of quality of sustainability processes and activities.

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

Purpose

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

Data sources

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

Study selection

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

Data extraction

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

Results of data synthesis

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

Conclusions

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

Perceptions of Healthcare Service End Users

The main objective of this study was to compare users’ perception and evaluation of both public and private healthcare services, distinguishing between primary and specialty care, with a cross-cultural approach in two Mediterranean countries: Italy and Spain.

Within an exploratory approach and following a descriptive aim, we have conducted a quantitative methodology: after a literature review about health marketing and health management, we have developed a questionnaire and collected end users’ perceptions in both countries.

Results highlight different aspects shaping the multidimensional healthcare service, such as the waiting lists, their experienced sensations, word-of-mouth (WOM) relevance and their behavioural intentions in the future

Out of the results, implications for scholars interested in the marketing of public services are proposed in terms of the idiosyncrasy of health consumer behaviour: satisfaction with and willingness to recommend a service provider (public or private) according to comparative service provision (primary or specialized care service) and geographical context (Italy and Spain). Implications for health managers highlight the relevance of time management, experiential marketing in health service provision, WOM relevance and behavioural intentions.

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

Background:

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

Objectives:

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

Patients and Methods:

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

Results:

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

Conclusions:

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