Evaluation of healthcare service quality via Servqual scale: An application on a hospital

Drivers of Patients' Behavioral Intention toward Public and Private Clinics' Services

In an era of growing competition in the healthcare market, adopting a patient-centered approach is mandatory for the survival and growth of any public or private hospital. This requires a better understanding of patients' behavior and an increased focus on satisfying their needs and expectations. This paper was developed in this context and aims to study the main drivers of patients' behavioral intentions. A conceptual model was proposed, highlighting the linkages between service quality, doctors' reputation, patients' trust, service value, and patients' behavioral intentions. To examine the different research hypotheses, a quantitative study including 242 patients was conducted in Saudi Arabia using the convenience sampling method. The smart PLS approach was used to test the measurement and structural models. The findings indicated that trust and service value positively affected patients' behavioral intentions. Trust in the healthcare provider was positively affected by two dimensions of service quality: healthcare provider concern and physician concern. Trust in doctors was found to be positively related to the reputation of the doctor. Service value was positively influenced by the convenience of the healthcare process, healthcare provider concerns, and doctors' reputations. This study is original because it is among the few studies that investigate patients' behavioral intentions toward healthcare services in a developing country (Saudi Arabia). Furthermore, it is among the rare studies to examine the role of doctors' reputations in service values. The findings would offer meaningful implications for practitioners in the healthcare market for maintaining relationships with their patients.

Assessing the quality of hospital outpatient services in Iran: a systematic review and meta-analysis

BACKGROUND

Quality healthcare services are considered one of the most effective vehicles for healthcare managers to achieve organizational goals. Therefore, this study aimed to combine the findings of comparable studies to identify consistencies and contradictions in the quality of outpatient services in Iran.

METHODS

The current systematic review and meta-analysis study was conducted in 2022 according to PRISMA guideline. All relevant English and Persian studies were searched in databases, including Web of Sciences, PubMed, Scopus, Scientific Information Database, and Magiran. No year restriction was applied. The quality of the studies was assessed by the 22-item Strengthening the Reporting of Observational Studies in Epidemiology checklist. The meta-analysis was conducted by using Open Meta Analyst, and between-study heterogeneity was investigated with I-squared statistic.

RESULTS

Of the 106 retrieved articles, seven studies with a total sample size of 2600 were included in the meta-analysis. The pooled estimate of mean for overall perception was 3.95 (95% CI: 3.34- 4.55, P< 0.001, I2= 99.97), while the pooled estimate of the mean for the overall expectation was 4.43 (95% CI: 4.11- 4.75, P< 0.001, I2= 99.93). The highest and lowest perception mean scores were related to tangibility (3.52, Gap= -0.86) and responsiveness (3.30, Gap= -1.04) dimensions.

CONCLUSION

Responsiveness was identified as the weakest dimension. Therefore, managers are recommended to design suitable workforce-development programs which focus on the provision of timely and prompt services, polite and courteous interactions with patients, and prioritization of patients' needs. Moreover, training public sector practitioners along with incentives can fill up the existing gaps.

Is Hospital Service Quality Relevant During COVID-19 Pandemic?

The study captures hospital service quality expectations during the COVID-19 crisis and compares the same before the onset of COVID-19. The study also highlights which dimensions of service quality attenuate during a medical crisis. The authors used a service quality measurement instrument based on SERVQUAL to capture service quality expectation from patients between June 2019 and May 2020. A sample of 700 was obtained (pre COVID-19 sample size 350 and during COVID-19 sample size 350). The data was analysed using partial least squares, structural equation modelling (PLS-SEM) and ANOVA. Service quality and its dimensions of assurance, empathy, reliability, responsiveness and tangibility remain relevant during COVID-19 pandemic, however, there is a drop in service quality expectation in India in all the five dimensions of service quality. Service quality expectations in tangibility dropped by 11.59%, reliability dropped by 8.82%, responsiveness dropped by 11.56%, assurance dropped by 9.82% and empathy dropped by 12.29%. From a practical standpoint, the study also identifies service quality dimensions that hospitals need to focus on during a crisis. In India, hospitals handling COVID-19 patients need to pay special heed to reliability and responsiveness to improve their service quality and better manage care during the pandemic situation.

Implementation and Acceptance of Information and Communication Technology Incorporated into Long-Term Care

Every country in the world is facing serious demographic aging, since the average life expectancy is consistently increasing. Agencies involved in the implementation of caregiving through long-term care institutions can develop more convenient approaches using information and communication technology to enhance overall efficiency. Communication technology has enabled the strengthening of physiological instruments, improving the efficiency and quality of services, while integrating management systems for optimum efficiency. This work conducted empirical studies, collecting responses to questionnaires from residents and caregivers in five institutions located in the south of Taiwan. The PZB model, proposed by Parasuraman, Zeithaml, and Berry, was used to construct the questionnaire to analyze the service quality following the incorporation of information and communication technology. The results of the empirical study show that 34% and 63% of the relatives of the residents agreed and strongly agreed that the system was practical and convenient, respectively. As for the caregivers, 77% of them agreed or strongly agreed that the system was mobile, practical, and convenient, and they agreed that the system could significantly increase working efficiency, reduce waiting time, and improve administration for chronic diseases among care-home residents.

An application of quality function deployment and SERVQUAL approaches to enhance the service quality in radiology centres

Purpose

Meeting the patients' requirements as customers of the health care sector is crucially important as a social responsibility. According to the resource constraints, only an efficient utilisation of health services can provide that purpose. This study aims to develop a quantitative assessment framework for radiology centres as a vital section in healthcare to translate the patients' requirements into service quality specifications. This would help to achieve quality improvement by emphasising the voice of customers.

Design/methodology/approach

A literature review is conducted to specify the service quality criteria and the patients' requirements related to healthcare and hospitals. Based on the experts' opinions, these criteria and requirements are later customised for the radiology centres. Moreover, the requirements are categorised into five dimensions of SERVQUAL. The interrelations between service elements are also determined through expert group consensus using Pearson correlation. Afterwards, by applying the QFD method, the relations between the requirements and criteria are explored. Additionally, a customer satisfaction survey is executed in Tehran public hospitals to prioritise these requirements and provide an importance-satisfaction analysis.

Findings

Based on the result of the case study, service elements are prioritised for improvement, and practical suggestions are provided using the Delphi technique for quality improvement. In addition, a cause-and-effect diagram is presented to highlight the improvement area and provide enhancement suggestions.

Originality/value

This study is the first empirical attempt to benefit from the VOC in evaluating and enhancing the quality of service delivered to radiology patients. In doing so, the study applies a hybrid approach of QFD and SERVQUAL as well as other tools to highlight the improvement area and provide enhancement suggestions. The findings can be readily used by the practitioners.

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.

Comparative Analysis of Factors Affecting Quality of Community-Based Care Services in Korea

Aging societies have an increased need for care services. To solve the problem of care, we suggest community care, through which medical services are provided that meet individual needs. Korea provides care services in advance of the community care project and implements quality control to improve the quality of these social services. Therefore, this study aims to compare and analyze the factors affecting user satisfaction in care services in both 2013 and 2016. We analyzed secondary data from 2013 and 2016 collected by the Social Security Information Service. These data include standardized metrics for the quality of care. Based on the evaluation indexes for care service in 2013 and 2016, we used commonly used indexes for analysis. Specifically, non-profit organizations were influenced by sales, accounting management, lifetime tenure rate, etc., while for-profit organizations were affected by number of users, contract termination, etc. In addition, on-site evaluation had a negative effect on the change rate of user satisfaction. Therefore, in order to increase satisfaction with care services, evaluation indexes by service type should be diversified and differentiated. In addition, field evaluations related to user satisfaction should be performed in order to provide care services appropriate for local characteristics.

Perceived Service Quality in HRI: Applying the SERVBOT Framework

Services are intangible in nature and as a result, it is often difficult to measure the quality of the service. In the service literature, the service is usually delivered by a human to a human customer and the quality of the service is often evaluated using the SERVQUAL dimensions. An extensive review of the literature shows there is a lack of an empirical model to assess the perceived service quality provided by a social robot. Furthermore, the social robot literature highlights key differences between human service and social robots. For example, scholars have highlighted the importance of entertainment value and engagement in the adoption of social robots in the service industry. However, it is unclear whether the SERVQUAL dimensions are appropriate to measure social robot's service quality. The paper proposes the SERVBOT model to assess a social robot's service quality. It identifies, reliability, responsiveness, assurance, empathy, and entertainment as the five dimensions of SERVBOT. Further, the research will investigate how these five factors influence emotional engagement and future intentions to use the social robot in a concierge service setting. The model was tested using student sampling, and a total of 94 responses were collected for the study. The findings indicate empathy and entertainment value as key predictors of emotional engagement. Further, emotional engagement is a strong predictor of future intention to use a social robot in a service setting. This study is the first to propose the SERVBOT model to measure social robot's service quality. The model provides a theoretical underpinning on the key service quality dimensions of a social robot and gives scholars and managers a method to track the service quality of a social robot. The study also extends on the literature by exploring the key factors that influence the use of social robots (i.e., emotional engagement).

Framework for Promotion of Medical Tourism: A Case of India

Medical tourism is quickly growing in developing countries. The healthcare players have recognized it as a potential area for economic diversification. The major factors affecting medical tourism in a country are cost, quality, language, and ease of travel. The healthcare services in India cost significantly lower than in western countries and the middle east. That is one of the reasons behind India attracting customers from these countries. The government promotes India as a premier healthcare destination and has made policies to ease travel for medical tourism purposes. Quality has been one of the important criteria for the selection of healthcare providers even for price-conscious customers. This study uses the case of the eastern part of the state of Uttar Pradesh to investigate the reason behind the low penetration of medical tourism in the region. The study identifies factors affecting medical tourism in post-COVID times and maps them with enablers using a focus group discussion. The study further uses SERVQUAL, a multidimensional research instrument to measure service quality by capturing patient’s expectations and perceptions along five dimensions of service quality. The study contributes to the existing literature in two ways. It provides the framework for the promotion of medical tourism in a region. Second, it provides future directions for research in the area of medical tourism in the post-COVID world.

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

Background

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

The Gaps of Healthcare Service Quality in Nurse Practitioner Practice and Its Associated Factors From the Patients' Perspective

PURPOSE

This study investigates the expectations, perceptions, and gaps of the healthcare service quality (HSQ) from the patients' perspective, and explores the significant demographic and clinical factors associated with the HSQ in nurse practitioner practice (NPP).

DESIGN

A cross-sectional design was carried out, with convenience sampling performed under the NPP in Taiwan, from June to November 2016.

METHODS

The Nurse Practitioner Healthcare Service Quality Scale was used to assess the expectations, perceptions, and gaps of the HSQ. The demographics, clinical characteristics, and symptom severity of patients were collected, and the Importance-Performance Analysis was applied to identify the priority of ranking items for the improvement of nurse practitioners (NPs). The Generalized Estimating Equation was used to explore the factors associated with the HSQ in NPP.

FINDINGS

A total of 200 patients completed the questionnaires. The results revealed that the patients had overall high expectations (M = 6.35, SD = 0.46), moderate perceptions (M = 4.21, SD = 0.95), and a mild HSQ gap (M = -2.14, SD = 0.69), with statistically significant differences (p < .001). In NPP, the largest gap in the HSQ dimensions was reliable responsiveness, followed by empathy, assurance, and tangibility. Patients with greater symptom severity and a longer in-hospital stay were associated with larger HSQ gaps; however, patients who were transferred from the emergency department had smaller gaps than those in the outpatient department.

CONCLUSIONS

The patients' expectations were not fully satisfied in the NPP, especially for the dimensions of reliable responsiveness and empathy. The patients' symptom severity was a significant factor related to the gaps in the HSQ. The awareness of unmet needs, from the patients' perspective, could guide the convergence of a rational policy to promote healthcare delivery in the NPP.

CLINICAL RELEVANCE

The managers of NPP need to pay attention to increasing NPs' reliable responsiveness and empathy, by setting the appropriate scope of practice, regulating the NP-to-patient ratio, applying for certification programs in prescribing training, and cultivating patient-centered care with shared decision making. In addition, building up the knowledge and competency of symptom management is also suggested for NP training.

Ascertaining service quality and medical practitioners' sensitivity towards surgical instruments using SERVQUAL

Purpose

Service quality (SQ) has become an essential and indispensable component in healthcare and many other industries. SQ can deliver guaranteed stakeholder value and consequent consumer delight in the healthcare sector. The purpose of this study is to identify the relationships of various SERVQUAL elements with respect to the SQ of surgical instrument suppliers among surgeons.

Design/methodology/approach

Data were collected from a sample of 112 surgeons working in the USA using the “snowball sampling” technique. A few standardised questionnaires, including SERQUAL, were used to collect the data. R-programming was used to perform structural equation modelling (SEM) analysis on the collected data.

Findings

The research study identified that service delivery factors and the SQ of surgical instruments contribute significantly towards medical practitioner sensitivity in the US healthcare industry. Word of mouth (WOM) did not have any significant impact on the medical practitioners' sensitivity.

Originality/value

A review of related literature revealed that studies that examine the surgeon's perspectives of SQ are scarce. Thus, the present study is directed towards this gap in literature. The findings of the study are significant in nature and have made a substantial contribution to management literature.

Hospital service quality based on HEALTHQUAL model and trusting nurses at Iranian university and non-university hospitals: a comparative study

Background

Establishment and improvement of patients’ trust in healthcare organizations like hospitals necessitate delivery of high-quality services by nurses, as the largest group of healthcare providers. The present study aimed to compare hospital service quality based on the HEALTHQUAL model and trusting nurses at university and non-university hospitals in Iran.

Methods

This comparative cross-sectional study was conducted on 990 patients admitted to university and non-university hospitals located in Bushehr Province, southern Iran, who were selected using the stratified random sampling method. The data were collected through the HEALTHQUAL questionnaire and the Trust in Nurses Scale, and then analyzed via the SPSS Statistics software (version 22) as well as the General Linear Model (GLM) univariate procedure and the Chi-square test with a significance level of 0.05.

Results

The study findings revealed that the mean values of real quality (perceptions) and ideal quality (expectations) were 3.89 ± 0.69 and 4.55 ± 0.47, respectively. The gap between the real and ideal quality (− 0.64) was also larger at non-university hospitals from the patients’ viewpoints. Comparing various dimensions of service quality, the largest gap at university and non-university hospitals was associated with “environment” (− 0.13) and “empathy” (− 0.18), respectively. Additionally, the mean scores of the patient trust in nurses at university and non-university hospitals were 10.34 ± 5.81 and 8.71 ± 4.05, respectively, being a statistically significant difference (p <  0.001).

Conclusion

The study results demonstrated that hospital service quality and trusting in nurses were at higher levels at the university hospital than the non-university one; however, hospital service quality was at a lower level than what the patients had expected. Accordingly, hospital managers and policy-makers were suggested to focus on patients to reduce gaps in service quality, to promote service quality, and to provide better healthcare services to patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-020-00513-y.

Examining the Moderating Effect of Perceived Benefits of Maintaining Social Distance on E-learning Quality During COVID-19 Pandemic

Technology has influenced every aspect of our living, and education is not an exception. During the current pandemic period of COVID-19, the latent motive of maintaining social distancing is leading to be one of the prime reasons for the students to get enrolled in online courses. Although the benefits of e-learning have been discussed in various previous studies, it is important to understand the quality of e-learning and the satisfaction level of learners during this forceful shift toward e-learning amid the pandemic of COVID-19. This research proposes a conceptual model for understanding the variables influencing e-learning quality (ELQ) and learner satisfaction under the moderating effect of maintaining social distancing. The model is empirically validated by means of the partial least square approach through structural equation modeling based on 435 responses of university students in India. The results suggest that assurance, reliability, responsiveness, and website content are the factors that influence the ELQ of the online courses during the pandemic. ELQ also strongly influences the learner’s satisfaction. Interestingly, perceived benefits of maintaining social distancing have a significant negative moderating effect only between empathy and ELQ, which leads to the satisfaction of the learners.

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.