Service quality and satisfaction in healthcare sector of Pakistan- the patients' expectations

A nexus among high performance work systems, employee engagement, perspective-taking, trust in leader and organisational innovation: an insight from developing country

PURPOSE

The purpose of this research is to examine the relationship between high- performance work systems (HPWS) and organisational innovation in hospital settings, examining the role of employee engagement as a mediator in this relationship. Additionally, the study aims to investigate the moderating role of perspective-taking between HPWS and employee engagement as well as the moderating effect of trust in leader on the connection between employee engagement and organisational innovation.

DESIGN/METHODOLOGY/APPROACH

A quantitative-deductive causal method, along with a cross-sectional approach, was utilized. Structural equation modelling was applied to analyse data from a sample of 530 doctors employed in hospitals, practicing human resources management in the public and private sectors of Sindh province, Pakistan.

FINDINGS

The findings show positive effects of HPWS on employee engagement and organisational innovation. Additionally, employee's engagement partially mediates the relationship between HPWS and organisational innovation, while the moderating role of perspective-taking significantly influences the link between HPWS and employee engagement.

ORIGINALITY/VALUE

While HPWS are recognized for enhancing organisational innovation, this study confirms their positive effects on individual and organisational outcomes, particularly within the healthcare sector in Pakistan. This study suggests that when HPWS are effectively perceived and implemented, these integrated practices can be beneficial for both employees and organizations, even in challenging situations.

Can Positive Emotions Predict Consumer Satisfaction in Adverse Services?

Background

Managing emotions during hospital visits is important to enhance patient satisfaction. The purpose of this paper is to explore the relationship between patients' happiness and satisfaction through patients' mood and perceived service quality at a healthcare setup.

Methods

This study was conducted in a tertiary care hospital located in coastal Karnataka during the period from November to December 2021. Primary data was collected through a structured questionnaire from 227 respondents. "Statistical Package for the Social Sciences (SPSS) 27.0" and "SmartPLS 3.0" software was used for data analysis.

Results

Hypotheses proposed in this study were examined by comparing the direct effect of patients' happiness level on perceived service quality and the indirect effect of the level of patients' happiness on patient satisfaction. The influence of all the exogenous latent variables namely, happiness, mood, perceived service quality, on the endogenous latent variable of patient satisfaction is estimated to be moderate (R 2=62.5%).

Conclusion

This study empowers hospital managers to recognize how patient satisfaction is dependent on patients' happiness. In order to enhance patient satisfaction, the quality of care provided by health services, human resources, and infrastructure must be improved. As a result, the entire service encounter can be made enjoyable to the customers by reducing the distress caused by adverse services. Managers can utilize the outcomes of the study to develop marketing strategies to influence patients' emotions in the healthcare setup by modifying the servicescape elements.

Perceived Organizational Support and Reduced Job Performance During COVID-19

Current research aims to identify a framework to enhance the performance of employees in government sector healthcare during the COVID-19 pandemic. Perceived organizational support was identified to enhance employees' performance through the intervention of a psychological process containing 3 states, that is, psychological safety, felt obligation and organization-based self-esteem. Job performance is considered as planned behavior, and psychological links are developed on the basis of the theory of planned behavior. This study is quantitative and used an empirical survey. Respondents of the study were nursing staff of government hospitals in Pakistan. The data were collected during the first wave of COVID-19 in Pakistan through online distributed questionnaires, and the data were analyzed using Smart PLS. Results show that perceived organizational support positively affects job performance during the COVID-19 crisis, and all the psychological states mediate the relationship. The study results are helpful for decision-makers of public sector organizations dealing with the most common problem of performance reduction during COVID-19. Results are also helpful for policymakers to address reduced performance in most government hospitals. Future research should consider antecedents of the perception of organizational support in the context of government and private hospitals.

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.

Implementation evaluation of a leadership development intervention for improved family experience in a private paediatric care hospital, Pakistan

Background

A study from a tertiary care center in Pakistan demonstrated that a leadership development intervention led to improved family experience of care outcomes. The objective of the current paper is to assess the implementation of this intervention and identify barriers and facilitators to inform sustainability and scalability.

Methods

A working group designed the intervention using a theory-of-change model to strengthen leadership development to achieve greater employee engagement. The interventions included: i) purpose and vision through purpose-driven leadership skills trainings; ii) engaging managers via on-the-job mentorship programme for managers, iii) employee voice i.e., facilitation of upward communication to hear the employees using Facebook group and subsequently inviting them to lead quality improvement (QI) projects; and iv) demonstrating integrity by streamlining actions taken based on routine patient experience data. Implementation outcomes included acceptability, adoption, fidelity across degree & quality of execution and facilitators & barriers to the implementation. Data analyzed included project documentation records and posts on the Facebook group.

Analysis indicated acceptability and adoption of the intervention by the employees as178 applications for different QI projects were received. Leadership sessions were delivered to 455 (75%) of the employees and social media communication was effective to engage employees. However, mentorship package was not rolled out nor the streamlined processes for action on patient experience data achieved the desired fidelity. Only 6 QI projects were sustained for at least a year out of the 18 approved by the working group. Facilitators included leadership involvement, real-time recognition and feedback and value-creation through participation by national and international celebrities. Challenges identified were the short length of the intervention and incentives not being institutionalized.

The authors conclude that leadership development through short training sessions and on-going communications facilitated by social media were the key processes that helped achieve the outcomes. However, a long-term strategy is needed for individual managerial behaviours to sustain.

Factors influencing the elderly’s adoption of mHealth: an empirical study using extended UTAUT2 model

Background

Despite the high usage of mobile phones in daily life in developing countries like Bangladesh, the adoption and usage of mHealth services have been significantly low among the elderly population. When searching previous studies, the researchers have found that no studies have empirically investigated whether the quality of life and service quality are significant for mHealth adoption by elderlies in Bangladesh. Hence, this study aimed to extend the Unified Theory of Acceptance and Use of Technology by adding service quality and the quality of life to empirically find the key factors that influence elderlies’ intention to adopt and use mHealth services in Bangladesh.

Methods

A face-to-face structured questionnaire survey method was used to collect data from 493 elderlies (aged 60 years and above) in Bangladesh. The data were analyzed with the Structural Equations Modelling (SEM) and Fuzzy Set Qualitative Comparative Analysis (fsQCA).

Results

SEM results suggested that Social Influence, Hedonic Motivation, Price Value, Habit, and Service Quality had significant impact (p < 0.05) on the elderlies’ behavioral intention to adopt mHealth services. Service Quality, Quality of Life, and elderlies’ Habit were found significant in explaining the Use Behavior of mHealth services. Quality of Life did not show significant (p > 0.05) effect on Behavioral Intention, which is inconsistent with existing literature. In addition, fsQCA findings suggest how the intensity of the influencers may contribute to high versus low m-health behavioral outcomes.

Conclusions

The findings have significant implications for theory, practice and future research as explained in the paper. The originality of this study is the integration of quality of life and service quality into UTUAT2 to explain the users’ behavioural intention and use behaviour. Overall, the findings may contribute to shaping appropriate policies for designing and implementing mHealth services effectively for elderlies in developing countries.

The interplay between leaders’ personality traits and mentoring quality and their impact on mentees’ job satisfaction and job performance

This study focuses on examining the role of leaders’ Five-Factor Model (FFM) personality traits in their mentoring quality and mentees’ job satisfaction. It has also examined how leaders’ mentoring quality impacts mentees’ job satisfaction, leading to their job performance at the workplace. The study used an explanatory research methodology to determine the cause-and-effect relationship between mentors’ FFM personality characteristics, mentoring quality, and mentees’ job satisfaction and job performance. The study was based on path-goal theory and the Big Five-Factor Model of personality characteristics, and a questionnaire was utilized to collect information on the model’s constructs. Following the non-probability convenience sampling technique, the empirical data were collected from the academic and non-academic staff of public and private higher education institutions (HEIs) located within Pakistan on five-point Likert scale. The proposed hypotheses were tested by using PLS software. Four main conclusions were derived from this study. First, the leaders’ openness to new experiences, agreeableness, and emotional stability substantially influenced the mentees’ job satisfaction. Surprisingly, the leaders’ conscientiousness and extraversion qualities did not affect the job satisfaction of the mentees. Second, the findings demonstrated that the openness to experience, conscientiousness, and extroversion has a considerable influence on leaders’ mentoring quality, but agreeableness and emotional stability have a negligible impact. Third, the mentoring quality of the leader had a substantial effect on the job satisfaction and work performance of the mentees. Fourth, this study confirmed the belief that mentees’ job satisfaction has a favorable influence on their job performance within the context of Pakistan’s educational sector. The current study’s findings provided valuable insights to the educational institutions about which personality traits they need to foster in their leaders, making them an excellent leader to enhance their mentees’ job satisfaction and job performance within their organizational settings.

Providing Solution in an Emergency: COVID-19 and Voice Behavior of Healthcare Professionals

This study investigates the mechanism between idiosyncratic deals (I-deals) and voice behavior, considering display aggression and deontic justice as mediating variables. We collected data from 702 nurses and their immediate supervisors who work with COVID-19 patients through survey questionnaires at two different times, and we analyzed the data using structural equation modeling (SEM). We found that I-deals are significantly associated with deontic justice and voice behavior. Moreover, I-deals are significant but negatively associated with displayed aggression, which is significant and negatively associated with voice behavior. In addition, deontic justice and display aggression mediate the association between I-deals and voice behavior. These findings suggest that the hospitals' top management should provide I-deals to nurses to improve their voice behavior.

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.

A quantitative framework for health‐care service quality assessment in India

Purpose

The present situation of COVID-19 pandemic has put the health-care systems under tremendous stress and stringent tests for their ability to offer expected quality of health-care services, as it decides the sustainability and growth of health-care service providers. This study aims to deliver a quantitative framework for service quality assessment in the health-care industry by classifying the health-care service quality parameters into four balanced scorecard (BSC) perspectives.

Design/methodology/approach

To determine the service quality for the Indian health-care system, decision-making trial and evaluation laboratory and analytical network process are integrated in a fuzzy environment to contemplate the interaction among BSC perspectives and respective performance measures.

Findings

The results indicate “internal processes” perspective assumes the key role within BSC perspectives, while performance measures “nursing staff turnover” and “staff training” play the key roles. The results also signify that “patient satisfaction” is the most vital issue and can be strongly influenced by measures belonging to the “learning and growth” perspective. In “learning and growth” perspective, “staff training” is the most decisive criteria, very highly influencing “patient satisfaction”, highly influencing “profitability,” “change of cost per patient (both in and out patients)” and “outpatient waiting time” while moderately influencing “staff satisfaction,” “bed occupancy” and “nursing staff turnover”. Moreover, “staff training” criteria have a positive influence on “nursing staff turnover.”

Originality/value

The contributions of this study are in two folds in the domain of quantification of service quality for the health-care system. First, it delivers an assessment framework for Indian health-care service quality. Second, it demonstrates an application of the framework for a case situation and validates the proposed framework.

The Quality of Services of Iran University Hospitals Based on SERVQUAL's Evaluation Model: A Systematic Review and Meta-Analysis

Introduction

Systematic evaluation of the quality of services provided in hospitals and healthcare centers is the first step toward standardization and improving their quality.

Methods

In this systematic review (meta-analysis) study, the information was collected by searching for the articles published in well-known Iranian and international and through searching for the keywords of SERVQUAL, services quality, gap, hospital, patients, Iran, and without language and time restrictions.

Results

A total of 18 articles were reviewed and opinions of 4,714 people who referred to hospitals and healthcare centers affiliated to Iran University of Medical Sciences during the past 10 years from 2010 to 2019 were examined in this study. The results showed that there was a quality gap in all 5 dimensions between the current status and desirable status of patients and based on a maximum score of 5, responsiveness (1.04), and assurance (0.99), empathy (0.95), reliability (0.91), and physical or tangible factors (0.86) were ranked first to fifth, respectively. According to the random effect model, the mean score of patients' perceptions and expectations and the gap between them was 3.59 (CI 95%: 3.73, 3.46), 4.66 (CI 95%: 4.33 and 4.66), and 0.86 (CI 95%: 1.00, 0.72), respectively.

Conclusion

The patients' expectations in university hospitals were higher than their perceptions. Therefore, it is recommended for Ministry of Health and Medical Education of Iran to monitor periodically the quality of hospitals while focusing on students' and patients' satisfaction and pay attention to dimensions that have the highest quality gap.

Systematic Review Registration

https://ethics.research.ac.ir/ProposalCertificateEn.php?id=167856&Print=true&NoPrintHeader=true&NoPrintFooter=true&NoPrintPageBorder=true&LetterPrint=true, identifier: IR.AJUMS.REC.1399.747.

Assessing service quality and the perceptual difference between employees and patients of public hospitals in a developing country

Purpose

This study aims to examine service quality in Nigerian general hospitals and determines possible differences in service quality perceptions between employees and patients.

Design/methodology/approach

Using the Servqual scale, data was collected from 328 employees and patients of two government hospitals in Abuja and Delta states. Analysis was carried out using SPSS 26 package for constructs reliability frequency, mean, standard deviation and t-statistics.

Findings

The study found significant differences in the perception of service quality between employees and patients of the Nigerian general hospitals. While employees gave a high rating to empathy, patients rated it low. Also, the patients’ poor perception of tangible did not match the employees’ high perception. Other specific findings are patients’ unfavourable assessment of the physical facilities and judged the staff to lack professional dressing. Patients felt the hospitals could not provide necessary equipment for their procedures and thus considered their services unreliable.

Practical implications

Reliability was perceived as a significant problem in this study; therefore, the hospitals management should ensure correct diagnoses and treatment results of the highest quality and timely services. Also, the management should invoke strong relationships between the employees and patients to earn patients’ trust. Employees should ensure to listen to patients’ complaints and find solutions promptly. Patients need health-care workers’ support and rely on their abilities; Therefore, health-care workers should be highly dependable and show empathic behaviour in discharging their duties. Health-care managers must access employees‘ and patients’ particular perceptual gaps and reconcile the difference before further quality improvement initiatives.

Originality/value

The findings in this study strengthen the clamour for assessing service quality from both employees and patients’ views in public hospitals. Hospital service quality is complex and primarily judged from the patients’ perspective. This study showed that health-care quality means different things to all stakeholders.

Dual Use of Public and Private Health Care Services in Brazil

(1) Background: Brazil has a universal public healthcare system, but individuals can still opt to buy private health insurance and/or pay out-of-pocket for healthcare. Past research suggests that Brazilians make combined use of public and private services, possibly causing double costs. This study aims to describe this dual use and assess its relationship with socioeconomic status (SES). (2) Methods: We calculated survey-weighted population estimates and descriptive statistics, and built a survey-weighted logistic regression model to explore the effect of SES on dual use of healthcare, including demographic characteristics and other variables related to healthcare need and use as additional explanatory variables using data from the 2019 Brazilian National Health Survey. (3) Results: An estimated 39,039,016 (n = 46,914; 18.6%) persons sought care in the two weeks before the survey, of which 5,576,216 were dual users (n = 6484; 14.7%). Dual use happened both in the direction of public to private (n = 4628; 67.3%), and of private to public (n = 1855; 32.7%). Higher income had a significant effect on dual use (p < 0.0001), suggesting a dose-response relationship, even after controlling for confounders. Significant effects were also found for region (p < 0.0001) and usual source of care (USC) (p < 0.0001). (4) Conclusion: A large number of Brazilians are seeking care from a source different than their regular system. Higher SES, region, and USC are associated factors, possibly leading to more health inequity. Due to its high prevalence and important implications, more research is warranted to illuminate the main causes of dual use.

Lean six sigma and stroke in rural hospital - The case of Baruch Padeh Medical Center

PURPOSE

This case study aims to demonstrate the strengths of the Lean Six Sigma (LSS) methodology to improve the acute ischemic stroke (AIS) treatment rates and reduce process lead time at Baruch Padeh Medical Center (BPMC), a rural hospital in the Galilee region of Northern Israel. The LSS project redefined the BPMC stroke care pathway and increased its efficacy.

DESIGN/METHODOLOGY/APPROACH

The LSS methodology was implemented in September 2017 by integrating lean principles and the Six Sigma DMAIC (Define-Measure-Analyze-Improve-Control). Existing procedures, field observation, ad hoc measurement and in-depth interviews were utilized, and the GEMBA method was implemented to identify root cause and improve actions optimizing the stroke pathway.

FINDINGS

The presented case shows the usefulness of the LSS methodology in improving quality performance in a rural hospital. The intervention allowed the BPMC to improve the intravenous tissue plasminogen activator (IV-tPA) administration rate (+15.2%), reducing the process lead time. The lead time of door-to-computer tomography decreased from 52 to 26 min, and the door-to-needle time decreased from 94 to 75 min.

ORIGINALITY/VALUE

The present case study shows the implementation of the LSS methodology aimed to improve the IV-tPA administration rate and reduce the stroke pathway lead time in a rural hospital. The case demonstrates the potential for the LSS methodology to support the AIS pathway optimization and represents a guide for healthcare organizations located in rural areas.

SERVQUAL Method as an "Old New" Tool for Improving the Quality of Medical Services: A Literature Review

The second half of the 20th century saw the development of a new trend in the management of medical services across Europe. Those shifts were associated with the transformation of various spheres of human life, both on professional and private levels. The service market then turned back to "quality", already known in antiquity. According to Aristotle, "quality" is one of the basic categories of thought and reality of the human population. The research material was obtained from literature databases, including Scopus, Cochrane, Medline, and PubMed, as well as from literature reports, including monographs, research papers (e.g., doctoral dissertations), and others. The available literature was assessed with regards to the abovementioned objectives of our study and considering possible advantages from its implementation. Therefore, the applied research method was based on a bibliographic query and desktop data analysis. The adopted research methodology hinged on exploration, compilation, analysis, and processing of data and information from available sources, resulting in drawing up of summary conclusions. The obtained data were subjected to reciprocal confrontation with an attempt to evaluate new possibilities of using the method in other medical specialties. The Servqual method enables us to learn the patient's expectations, while the service provider can identify irregularities and implement corrections. It allows the executive staff of medical facilities to change elements of medical procedures, which improves the quality of the service provided and thus increases the satisfaction and compliance of patients.

Antecedents and outcomes of patient satisfaction in healthcare: A conceptual model

This study develops a conceptual model and establishes the relationships between the variables, both influencing and affected by patient satisfaction. The authors conducted a thorough search for peer-reviewed articles obtaining a final sample of 64 studies. Service quality was found to be the only antecedent influencing patient satisfaction, while patient satisfaction was found to impact trust, loyalty and word of mouth, also mediating the influence of service quality on these variables. While the study integrates the scattered literature, from a practical standpoint it exhibits how increased patient satisfaction plays a key role in influencing patient trust, loyalty and word-of-mouth.

Barriers to Medical Tourism Development in the United Arab Emirates (UAE)

Medical tourism is a thriving industry. Many destinations now seek to attract more medical tourists. The United Arab Emirates (UAE) is no exception. As one of the most important pillars of the UAE’s economy, tourism is considered a high priority. However, medical tourism in the UAE is still developing. This paper addresses the main challenges for medical tourism in the UAE and proposes methods to enhance its development. This research utilized qualitative analysis. Twelve professionals in medical tourism were interviewed to provide data. The data were then analyzed using NVivo 12 software. Our results indicate that the key barriers to medical tourism development in the UAE are high costs of medical tourism services, lack of marketing activities, lack of collaboration between medical and tourism service providers, and so forth. Although initiatives from the UAE government are very encouraging, more efficient medical care supply networks, tourism suppliers and intermediaries should be established to ensure its growth. This research could influence national tourism policies in the UAE as well as regional alliances in all Gulf Cooperation Council (GCC) and the Middle East and North Africa (MENA) countries.

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.

Public satisfaction with the healthcare system in China during 2013-2015: a cross-sectional survey of the associated factors

OBJECTIVE

We explore how public satisfaction with the healthcare system in China varies with social and economic factors, especially regional variations and changes during 2013-2015.

DESIGN

Population-based, cross-sectional survey performed between July 2013 and July 2015.

SETTING

General population of China during 2013-2015.

PARTICIPANTS

A total of 15 969 participants (women=49.4%, sample-weighted average age=51.9).

PRIMARY OUTCOME MEASURE

Public satisfaction with the healthcare system, defined as 'being satisfied' if a respondent's satisfaction score is ≥70 points.

RESULTS

The 2-year mean of the satisfaction score of the sample is 68.5 out of 100 points and the score in 2015 is higher than 2013 by 3.5 points. Senior respondents (OR=1.19, p<0.001), rural respondents (OR=1.23, p=0.009) and those with higher socioeconomic status are more likely to report being satisfied. Internal migrants (OR=0.75, p<0.001) and those with a higher level of education are less likely to report being satisfied. Total health expenditure as percentage of gross domestic product and density of hospital beds have a significantly positive association with satisfaction (OR=1.13, p<0.001). Meanwhile, the government's share in total healthcare expenditures has a moderately negative association with satisfaction (OR=0.97, p<0.001). In rural areas, the density of hospital beds has a positive association with satisfaction (OR=1.26, p=0.002). The Northeast region and Shanghai (OR=0.49, p<0.001; OR=0.71, p=0.034) are less likely to report being satisfied and this remained unchanged in 2015.

CONCLUSION

There are considerable disparities in public satisfaction with the healthcare system in China, associated with demographic and socioeconomic characteristics, regional locations, urban-rural environment, and regional health resource abundance. Actions are recommended to improve satisfaction with the public healthcare system, especially in the Northeast region of China.

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.

ARTQUAL

Purpose

The purpose of this paper is to formulate and validate a measurement model to evaluate the service quality of cultural centers. This study aims to expand the domain of service quality measurement models by extending the SERVQUAL model to an alternative measurement tool called the ARTQUAL model based on three different preferences and scenarios including concert halls, theater halls and art galleries.

Design/methodology/approach

The data were collected from 15 cultural centers. Structural equation modeling (SEM) was utilized in the current research to study the association between aesthetic environments and service quality. An exploratory factor analysis took place to formulate the fundamentals of the measurement model. The validation process is based on a hybrid framework integrating the covariance-based SEM along with the partial least square technique to present a robust validity of the ARTQUAL model. Ultimately, an extensive managerial analysis has been established to show the practicality of the ARTQUAL model.

Findings

This study provides empirical evidence that the ARTQUAL instrument is proven to be valid, reliable and appropriate to evaluate the service quality of cultural centers. Based on the real-world managerial analysis, the ARTQUAL model showed a significant practicality in quality evaluation of aesthetic environments.

Research limitations/implications

One of the most important limitations of quantitative studies, based on aesthetic features, is the cultural preferences. This limitation is due to the nature of cultural preferences and partialities applied in different countries based on the definition of quality involving aesthetic aspects such as age, sex and culture. Meanwhile, the findings of this study can guide the service management experts to better understand and improve customers’ perceptions and orientations of service quality in aesthetic environments.

Originality/value

This paper presents a novel service quality measurement model in order to evaluate the service quality of cultural centers. The originality of the current study is not merely limited to the suggestion of a new quality measurement model, a hybrid statistical validation framework has been provided as well. Therefore, this study provides valuable guidelines to both practitioners and academics to enhance the quality of service measurements in cultural centers.

Promoting OPD Patient Satisfaction through Different Healthcare Determinants: A Study of Public Sector Hospitals

Patient satisfaction is a core tool for measuring the performance of the hospitals as well as the service provider and the services that they are providing to the patients. The aim of this research is to evaluate how information received, medical equipment, distance from the hospital, and physical infrastructure influenced patient satisfaction at public hospitals in Southern Punjab, Pakistan. An exploratory research technique was used. We distributed 700 questionnaires through a random method, and 579 provided proper responses. A confirmatory factor analysis (CFA) and a regression analysis were used for the data analysis. The study results illustrated that medical equipment, information received, distance from the hospital, and physical infrastructure had significantly positive impacts (p = 0.001) on patient satisfaction. To promote higher level of satisfaction, there is a need to take appropriate steps for improvement.

Measuring OPD Patient Satisfaction with Different Service Delivery Aspects at Public Hospitals in Pakistan

The satisfaction of the patient is believed to be one of the preferred results of healthcare, and it is directly connected with the usage of health services. This study aimed to assess how doctor services, nurses’ services, and waiting time predict patient satisfaction (PS) with the service delivery of healthcare in Southern Punjab, Pakistan. The study used an exploratory research method, in which 1000 participants were selected, and used a random technique, in which 850 responses were received. Multiple regression analysis and a confirmatory factor were employed to analyze the collected data. The findings showed that doctor services (β = 0.232; p = 0.01), nurses services (β = 0.256; p = 0.01), and waiting time (β = 0.091; p = 0.03) had positive significant impacts on PS, while registration services (β = 0.028; p = 0.390) had an insignificant association with PS. Hence, a significant gap existed in the registration services that were totally ignored in hospitals of Pakistan which needed proper considerations for improvements.

What Factors Affect Patient Satisfaction in Public Sector Hospitals: Evidence from an Emerging Economy

Patient satisfaction can identify specific areas of improvement in public sector hospitals. However, the Pakistani healthcare system, and quality of service delivery is rarely assessed through the perspective of patient satisfaction. Our study demonstrated the performance of public healthcare systems in Pakistan by interacting with physical services (tangible and environmental), doctor⁻patient communication, and pharmacy and laboratory services based on patient satisfaction. Primary data were collected from the patients by using a random sampling method. Patients who participated in the study were visitors of public hospitals' outpatient departments. A total of 554 questionnaires were circulated, and 445 were received. The confirmatory factor and multiple regression analyses were employed to analyze the collected data. The results revealed that laboratory, as well pharmacy services, had positive significant effects (p = 0.000) on patient satisfaction, while doctor⁻patient communication (p = 0.189) and physical facilities (p = 0.85) had an insignificant relationship with patient satisfaction. Therefore, it is suggested that a significant communication gap exists in the doctor⁻patient setting, and that Pakistan's healthcare system is deprived of physical facilities. Consequently, such services need further improvements.

Patients' satisfaction and public and private sectors' health care service quality in Pakistan: Application of grey decision analysis approaches

PURPOSE

The study aims to evaluate the comprehensive relationship between patient satisfaction and five dimensions of health care service quality in Pakistani public/private health care sectors, using a novel grey relational analysis (GRA) models and the Hurwicz criteria of decision making under uncertainty.

DESIGN/METHODOLOGY/APPROACH

Data were collected from private and public health care facilities of Pakistan through an improved SERVQUAL instrument. Deng's GRA, absolute GRA, and the second synthetic GRA models were applied to address the problem under study.

FINDINGS

Grey relational analysis models revealed that reliability and responsiveness are most strongly predicting patient satisfaction in public and private health care sectors, respectively. The Hurwicz criteria showed that patients are more likely to be satisfied from private health care facilities.

LIMITATIONS/IMPLICATIONS

Limitations of SERVQUAL model are also the limitations of the study; eg, the study suggests that because of the absence of "cost," which is a key quality indicator of Pakistani public sector health care facilities, the model was unable to comprehensively evaluate the health care situation in light of the observations of price-focused Pakistani patients. The study recommends tailoring of SERVQUAL model for the resource-scant and underdeveloped countries where people's evaluation of the quality of the hospitals is likely to be influenced by the price of services.

ORIGINALITY/VALUE

The study is a pioneer in health care evaluation of public and private sectors of Lahore and Rawalpindi while using GRA models, in general, and the second synthetic GRA model, in particular. It presents an alternative method to the statistical way of analyzing data by successfully demonstrating the use of grey methods, which can make reasonable decisions even through small samples.