Patient satisfaction with healthcare delivery systems

Measuring leprosy case detection delay and associated factors in Indonesia: a community-based study

BACKGROUND

Leprosy is a public health burden in Indonesia with a high number of new cases every year and a high proportion of disability among new cases. Case detection delay (CDD) can contribute to ongoing transmission and increased disability chances among leprosy patients. This study aimed to establish the CDD of leprosy and the factors associated with detection delay in Indonesia.

METHOD

Community-based study with a cross-sectional design. Data were collected through interviews about sociodemographic and behavioral factors, anticipated stigma, and duration of CDD. Leprosy classification and case detection methods were obtained from health service records. A random sample was taken of 126 leprosy patients registered between 1st October 2020 and 31st March 2022 in the Tegal regency in the Central Java Province. Data were analysed by descriptive and analytical statistics using multiple linear regression.

RESULTS

The mean CDD, patient delay, and health system delay were 13.0 months, 9.7 months, and 3.2 months, respectively. Factors associated with longer CDD are younger age (below 35 years), male, found through passive case detection, and not having a family member with leprosy. Factors associated with longer patient delay were being younger (below 35 years), being male, not having a family member with leprosy, and anticipated stigma of leprosy. It was not possible to reliably identify factors associated with health system delay.

CONCLUSION

CDD in leprosy should be reduced in Indonesia. The Indonesian National Leprosy Control Program (NLCP) is advised to adopt an integrated intervention programme combining active case detection with targeted health education to reduce CDD and thereby preventing disabilities in people affected by leprosy.

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.

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.

Evaluating the total quality and its role in measuring consumer satisfaction with e-healthcare services using the 5Qs model: a structure equation modeling approach

Purpose

This article initially aims to explore the factors of every quality construct of the 5Qs model of service quality and, second, identify the significant factors affecting the total quality of e-healthcare services and its association with consumer satisfaction using a multidimensional hierarchical 5Qs model of e-healthcare service quality.

Design/methodology/approach

Questionnaire-oriented research was performed at three public hospitals of Punjab and Chandigarh. In total, 53 variables were covered in all quality constructs for data collection from the designated public hospitals. The respondents who agreed to have knowledge regarding e-Healthcare services and were availing these services were included in the study. The analysis comprised structural equation modeling technique using AMOS 21.

Findings

The outcomes suggest that the 5Qs model is more comprehensive and can be used to evaluate service quality perceptions using e-Healthcare services. The research identified 11 sub-dimensions for the five quality constructs of the 5Qs model, representing total quality, which is primary to consumer satisfaction. “Overall objectivity” and “technical objectivity” defined the quality of object. The quality of process of e-Healthcare services was characterized by “functionality,” “timeliness” and “responsiveness.” Quality of infrastructure was defined by “technical infrastructure,” “physical infrastructure,” “manpower skills” and “organizational infrastructure.” “Manner of interaction” and “timely interaction” defined the quality of interaction. The atmosphere was represented by only one factor. The results also suggest that quality of infrastructure, quality of interaction and quality of atmosphere play the most significant role in total quality leading to consumer satisfaction.

Research limitations/implications

Theoretical implications: The multidimensional hierarchical model will help the researchers study the e-Healthcare service quality in a more organized manner, and the outcomes of this study can be linked with that of future studies for more generalized application in other public hospitals. The sub-dimensions of each quality construct of the 5Qs model can be applied in private hospitals, and the hierarchical model can be tested in different industries to measure service quality perceptions of the consumer

Practical implications

The outcomes of the study can be applied in various public sector hospitals to redesign the e-Healthcare services based on consumers' perception for better consumer satisfaction and quality services. This paper identifies the role of each quality construct in e-Healthcare services for improvement in the total quality, which in turn will lead to higher satisfaction for the consumers.

Originality/value

In this study, the original 5Qs model has been used for the first time in a new instrument to understand better and design quality e-Healthcare services. The paper explores the sub-factors of each quality construct and its significance in measuring the total quality.

The Impact of Service Quality on Patient Satisfaction and Revisiting Intentions: The Case of Public Emergency Departments

BACKGROUND AND OBJECTIVES

This study attempts to (a) identify the main quality indicators that affect "service quality" and (b) examine the effect of "patient satisfaction" on patient "revisiting intentions."

METHODS

The sample includes patients of 2 hospitals, 1 urban and 1 provincial. The comparative analysis of 2 emergency departments (EDs) with different characteristics aims at understanding their diverse problems and their specific needs from a patient point of view. Empirical data were collected in the fall of 2015. Three hundred questionnaires were distributed in person. A total of 169 valid questionnaires, 80 from hospital A and 89 from hospital B, were returned, with a response rate of 56.3%.

RESULTS

The Structural Equation Modeling technique revealed that overall satisfaction is strongly influenced by "perceived service quality" (β = .79), while it positively affects patient "behavioral intentions" (β = .39). Also, "perceived waiting time" proved to have a more intense impact on "perceived service quality" (β = -.59), rather than on "perceived technical and functional quality" (β = .18). Moreover, it was determined that patients visiting the urban ED pay more attention in waiting times, while patients visiting the provincial ED care about receiving both quality and timely health care services. Overall, the study provides insight about the main factors affecting "perceived service quality" and "overall satisfaction." These factors fall into 2 distinct categories: "perceived technical and functional quality" and "perceived waiting time."

CONCLUSIONS

The study concludes that "overall satisfaction" acts as a mediator between "perceived service quality" and patient "behavioral intentions," while "perceived waiting time" is the most significant indicator of service quality and the most crucial predictor of ED patient satisfaction. Moreover, it offers empirical evidence concerning the differences in the way patients rate the services offered by a hospital, based on the hospital size and the region it is located (urban or provincial).

Improving Patient behavioral Consent through Different Service Quality Dimensions: Assessing the Mediating Role of Patient Satisfaction

This study aimed to examine the impact of the five-dimensional health care service quality (SQ) on patient behavioral consent (PBC). This study further explored the mediating role of patient satisfaction (PS) on the SQ–PBC relationship. A survey questionnaire was used to collect the data from public sector hospitals situated in Bahawalpur division, Punjab, Pakistan. We used confirmatory factor analysis (CFA) and structural equation modeling (SEM) to test the hypotheses. This study found positive and significant relationships between SQ and PBC, SQ and PS, and PS and PBC. Our results further revealed that PS partially mediates the relationship between SQ and PBC. Our study offers a comprehensive theoretical framework of several service quality attributes (SQs) affecting patient behavioral consent (PBC) and patient satisfaction (PS) in health care institutions. Testing these above relationships via a mediation approach is novel and contributed to the current study on service quality.

Role of internal service quality in enhancing patient centricity and internal customer satisfaction

Purpose

The purpose of this paper is to identify the antecedents and outcomes of internal service quality (ISQ) in a health-care environment. The relationships among the heterogeneous health-care environment, coordinated care, perceived organisational support (POS), ISQ, internal customer satisfaction and patient-centred care were explored.

Design/methodology/approach

Based on a review of the literature, a structural model was developed. A 37-item questionnaire was circulated among service providers in the health-care system, including doctors, nurses and system staff, all over India. The random sampling method was adopted to collect data. A total of 238 valid responses were received. The data were analysed using structural equation modelling.

Findings

The results show that the heterogeneous environment, coordinated care and POS act as antecedents of ISQ, which drives internal customer satisfaction and patient centricity in health care.

Research limitations/implications

The paper contributes to the health-care literature by identifying the antecedents and consequences of ISQ and developing a structural relationship among ISQ, the heterogeneous health-care environment, coordinated care, POS, internal customer satisfaction and patient-centred care.

Practical implications

Hospital administrators may use various constructs of POS, ISQ and coordinated care to measure process and employee performance, which may aid the design of appropriate processes and improve employee selection. The constructs of patient centricity and internal customer satisfaction may be used as benchmarking tools to facilitate the formulation of immediate corrective actions and policies for future courses of action.

Social implications

This paper highlights how patient centricity may be achieved by focussing on ISQ, coordinated care processes and a facilitative internal environment. This understanding may aid the design of processes that in turn deliver health as a social good in an effective manner.

Originality/value

This paper extends past research on ISQ by showing that ISQ affects internal customer satisfaction and, in turn, the quality of service delivery in the system. In the health-care context, heterogeneity in patient needs, coordinated care and organisational support play crucial roles in determining ISQ, which in turn influences the level of patient-centred care.

Hospital service quality as antecedent of patient satisfaction – a conceptual framework

Purpose

The purpose of this paper is to explore dimensions of perceived service quality in hospitals and to develop a conceptual framework showing relationship between hospital service quality, patient satisfaction and their behavioural intention.

Design/methodology/approach

This paper is based on extensive review of existing literature on hospital service quality, patient satisfaction and behavioural intention. Critical analysis of these literature studies has resulted in determining and defining the dimensions of perceived service quality and establishing relationship between hospital service quality, patient satisfaction and behavioural intention.

Findings

This study has identified six major areas through which patients perceive quality of service in hospitals. These six areas are technical quality, procedural quality, infrastructural quality, interactional quality, personnel quality, social support quality. Further 20 dimensions of hospital service quality are identified under these 6 major areas. These are clinical procedure, quality of outcome, admission, discharge, waiting time, patient safety, billing and price, follow-up, ambience, availability of resources, accessibility, food, staff attitude, personalised attention, information availability, staff competency, trustworthiness, staff diversity, hospital image and social responsibility. The conceptual framework proposes direct relationship between service quality, patient satisfaction and behavioural intention.

Originality/value

Though many studies have been conducted on hospital service quality, none of them has been able to project all the possible dimensions to measure the same. The “6-Q framework” developed by this study explores all the possible dimensions of perceived service quality in hospitals.

Evidence-based design and transformative service research for the healthcare in hospitals

Purpose

The purpose of this study is to combine the two fields of transformative service research (TSR) and evidence-based design (EBD) to improve the healthcare service provided in hospitals. TSR and EBD are two separate research fields that aim to improve the well-being of consumers within the service sector. Research propositions for making changes in the hospital physical environment to improve the patient well-being are developed to link the two fields.

Design/methodology/approach

This work takes a theoretical approach to develop research propositions based on the literature. The research propositions guide the development of the framework developed for future studies under TSR and EBD.

Findings

The research propositions should be tested empirically in future studies to develop a methodology for transforming a hospital physical environment. The implementation of these propositions would allow hospitals to reach a new and more sustainable competitive advantage.

Originality/value

The relationship between the domains of TSR and EBD has not been explored before in the literature. This study presents an unprecedented work that is needed to improve patient well-being. It contributes to TSR and EBD by providing a research agenda for healthcare practitioners and researchers to pave the way for achieving improved healthcare services focusing on patient well-being and sustainability.

Establishing an ISO 10001-based promise in inpatients care

PURPOSE

The purpose of this paper is to explore ISO 10001:2007 in planning, designing and developing a customer satisfaction promise (CSP) intended for inpatients care.

DESIGN/METHODOLOGY/APPROACH

Through meetings and interviews with research participants, who included a program manager, unit managers and registered nurses, information about potential promises and their implementation was obtained and analyzed. A number of promises were drafted and one was finally selected to be developed as a CSP.

FINDINGS

Applying the standard required adaptation and novel interpretation. Additionally, ISO 10002:2004 (Clause 7) was used to design the feedback handling activities. A promise initially chosen for development turned out to be difficult to implement, experience that helped in selecting and developing the final promise. Research participants found the ISO 10001-based method useful and comprehensible.

PRACTICAL IMPLICATIONS

This paper presents a specific health care example of how to adapt a standard's guideline in establishing customer promises. The authors show how a promise can be used in alleviating an existing issue (i.e. communication between carers and patients). The learning can be beneficial in various health care settings.

ORIGINALITY/VALUE

To the knowledge, this paper shows the first example of applying ISO 10001:2007 in a health care case. A few activities suggested by the standard are further detailed, and a new activity is introduced. The integrated use of ISO 10001:2007 and 10002:2004 is presented and how one can be "augmented" by the other is demonstrated.

Perceived service quality's effect on patient satisfaction and behavioural compliance

PURPOSE

The purpose of this paper is to advance healthcare service quality research using hierarchical component models.

DESIGN/METHODOLOGY/APPROACH

This study used a quantitative approach with cross-sectional design as a survey method, combining cluster and convenience sampling and partial least square structural equation modelling (PLS-SEM) to validate the research model and test the hypotheses.

FINDINGS

The study extends health service quality literature by showing that: patient satisfaction (PS) is dominant, significant and indirect determinant of behavioural compliance (BC); perceived service quality has the strongest effect on BC via PS.

RESEARCH LIMITATIONS/IMPLICATIONS

Only one hospital was evaluated.

PRACTICAL IMPLICATIONS

The study provides managers with a service quality model for conducting integrated service delivery systems analysis and design.

ORIGINALITY/VALUE

Overall, the study makes a significant contribution to healthcare organizations, better health outcomes for patients and better quality of life for the community.

An empirical investigation to determine patient satisfaction factors at tertiary care hospitals in India

Purpose

– The purpose of this study is to investigate and test a six-factor model that explains considerable variation in patient satisfaction with tertiary care hospitals in India.

Design/methodology/approach

– The data of this study were collected through a systematic randomly distributed questionnaire. A pre-tested and contextually prepared structured questionnaire was used to gather 436 responses from selected tertiary care hospitals located in Hyderabad. Descriptive statistics, confirmatory factor analysis and Cronbach’s alpha are used to measure the internal consistency of the scale using the computer software SPSS 20.0.

Findings

– The findings of this study highlight six distinct dimensions of patient satisfaction and the relationships among them. Positive and significant relationships among the dimensions and patient satisfaction have been found.

Research limitations/implications

– One limitation to this study was the inclusion of the selected tertiary care hospitals in Hyderabad city and responses are collected from inpatients who were admitted in the surgical departments of these hospitals.

Practical implications

– This instrument would enable patients to provide feedback to hospitals regarding the quality of health care received by them. Hospitals could use this feedback to analyze their performance, satisfaction and benchmark their performance against competitive hospitals. This study has directs implications for health care service providers to provide quality of services to patients, to maintain high level of patient’s satisfaction and re-intentions.

Originality/value

– Few studies identified and examined the factors that influence patient’s perceived satisfaction. This study adds value by investigating what factors influences patient satisfaction among selected tertiary care hospitals located in Hyderabad.

Measuring patient satisfaction

Purpose

– The purpose of this study was to understand the different dimensions patients staying in a hospital perceived as important for satisfaction and how those dimensions affected their overall satisfaction levels.

Design/methodology/approach

– A scale comprising 21 items to measure patient experience in a hospital was developed based on literature review. After purification of the scale, a field survey was administered to patients who were discharged in the recent past from a public or a private hospital in the city. The data collected were analyzed using multivariate techniques.

Findings

– The data analysis highlighted four important dimensions of patient satisfaction. The four dimensions significantly and positively affected patient’s overall satisfaction level.

Research limitations/implications

– This research study was conducted in one of the four major metropolitan cities of India. Nonetheless, the study provides valuable insights into the patient satisfaction dimensions in an Indian context and how those dimensions affected patient’s overall satisfaction.

Practical implications

– Hospitals, in general, can use the study findings to measure and improve their operational performance.

Originality/value

– This study was not limited to one or few hospitals, but covered many hospitals in one of the four metropolitan cities of India. It provides a comprehensive picture of how many hospitals in the city fared in terms of satisfying their patients.

Communication needs of medical tourists: an exploratory study in Thailand

Purpose

– The aim of this paper is to contribute a conceptualization of the information and communication needs of medical tourists from Western countries in an Asian health care context.

Design/methodology/approach

– Multi-phase, semi-structured, in-depth interviews and observations were conducted with 27 multi-source informants who have communication experience in the international healthcare setting.

Findings

– Multi-level information provision should be used to address communicative incongruence in Asian healthcare provider – Western patient encounters as was self-reported by the participants and observed by authors. The use of an informative communication model is proposed in order to facilitate interaction and the effective transfer of information with Western patients to overcome negative, underlying emotions and enable autonomous decision making by the patients.

Research limitations/implications

– This exploratory study is focused on Western patients and Asian practitioners in Thailand. Future research in other countries and with patients from other geographical areas could expand to generalize findings.

Practical implications

– Fostering information sharing with Western patients by using an integrative communication model can improve patient satisfaction and health outcomes. The need for developing and implementing these improved practices for communicating with Western patients is reflected by the healthcare industry's current developmental trends helping to lead to a future of health service internationalization.

Originality/value

– This is the first empirical study to provide insights concerning the communication needs and coping strategies of Western patients with Asian doctors in developing countries.

Patient Satisfaction and Consumer Behavioural Intentions

As health care services get more competitive, health care practitioners and academic researchers are increasingly interested in exploring how patients perceive quality before building up their satisfaction levels and generating behavioural intentions. Hospitals today are increasingly realizing the need to focus on service quality as a measure to improve their competitive position. Customer based determinants and perceptions of service quality therefore play an important role when choosing a hospital. In this article we examine and measure the quality of services and its outcomes (patient’s satisfaction and behavioural intentions) provided by private hospitals in Bhopal city of central India. The study resulted in the development of a comprehensive scale for measuring service quality, patient satisfaction and behavioural intentions in the health care scenario. Multiple regression analysis was used to examine the proposed relationships. The results establish the direct influence of service quality on behavioural intentions, and the mediating role of customer satisfaction on influencing behavioural intentions. Service quality and patient satisfaction are found to be strong drivers of behavioural intentions in the context of health care services in India. This study analyzes the suitability of service quality to improve customer satisfaction and in the process positively impacts behavioural intentions in the health care setting.

Exploring Competitiveness of the Indian Health Sector

Purpose

The Indian health care industry, on account of its cost advantage, is fast emerging as the first choice of patients throughout the globe. The modern day Indian health care industry, as a matter of fact, has a dual role to play. First, coming up to the expectations of global and elite Indian patients. Second, fulfilling its social obligations by catering to the needs of a huge lower-middle class of people suffering from various ailments. The litmus test for the Indian health care industry is the way in which strikes a balance in between its commercial and social obligations. The best way under the prevailing situation is to keep patients’ faith intact by rendering quality services without bothering too much about the profit. Service quality, in fact, is dependent upon the service performance and how far it is able to satisfy customers. The present study makes an endeavour to gauge the service quality in selected multi-specialty hospitals of India by garnering the views of the patients/observers pertaining to their expectations and actual perception about the services being rendered to them. The study assumes a greater importance as the players chosen for the study represent both public as well as private sector.

Research Type

Empirical

Findings

There exists a difference in the perception and expectations of the patients/observers as far as their evaluation of the hospitals on various dimensions of service quality is concerned. Both the selected hospitals have been found to be struggling on the service quality dimensions such as accessibility, promptness and timeliness. The public hospital enjoys an edge over its private counterpart on the security, accuracy and reliability aspects. The private hospital, meanwhile, has a better rating on the impressiveness front. Both hospitals have done reasonably well on the competence, customization and ambience fronts.

Practical Implications

The administrative wing of the hospitals may start viewing service quality from the clients’ perspective and make necessary changes in their service quality endeavours.

Research Limitations

Technicalities involved in understanding of the concept of service quality might have acted as a handicap for the patients/observers in giving prompt and accurate answers to the questions in hand.

The impact of total quality service (TQS) on healthcare and patient satisfaction: an empirical study of Turkish private and public hospitals

This paper attempts to measure patients' perceptions of the quality of services in public and private healthcare centers in Turkey. The main aim was to examine the impact of the dimensions of patient-perceived total quality service (TQS) on patients' satisfaction. The research framework and hypotheses are derived from a literature review of service quality and quality in the healthcare industry. The research data were collected through questionnaires and then statistically analyzed using descriptive statistics, Pearson product moment correlation and linear regression. The results suggest that service quality perceptions positively influence patient satisfaction with overall hospital care (SOHC). The most important factors identified in the regression model regarding patient SOHC are the quality of the hospital's social responsibility, administrative processes and overall experience of medical care received. These factors explain 74% of the variance in SOHC. The findings of the study can be used to improve TQS in both private and public hospitals.

General Public Expectation from the Communication Process with their Healthcare Providers

The current study aimed to explore the public views and expectation about a successful communication process between the healthcare providers/physicians and patients in Penang Island, Malaysia. A cross-sectional study was conducted in Penang Island using a 14-item questionnaire. Statistical Package for Social Sciences (SPSS) software version 15.0^® were used to analyze the collected data. A nonparametric statistics was applied; the Chi-square test was applied to measure the association among the variables. P-values less than 0.05 were considered statistically significant. A total of N (500) respondents have shown willingness to participate in the study with a response rate of 83.3%. The majority 319 (63.9%) have disclosed to communicate with their healthcare providers in the Malay language and about 401 (80.4%) of the respondents were found satisfied with the information provided by the physician. It was a common expectation by the most of the sample to focus more on the patient history before prescribing any medicine. Moreover, about 60.0% of the respondents expected that the healthcare providers must show patience to the patient's queries. The level of satisfaction with the information shared by the healthcare providers was higher among the respondents with a higher education level. Furthermore, patients with higher level of education expect that physician shouldwell understand their views and medical history to prescribe a better therapeutic regimen.