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

The association between nurse managers' transformational leadership and quality of patient care: A systematic review

AIM

To examine and summarize the reported association of nurse managers' transformational leadership and quality of patient care based on the perceptions of registered nurses.

BACKGROUND

Transformational leadership behaviors of nurse managers result in staff nurses' satisfaction and retention and patient satisfaction. Patient safety and quality of care are vital to high-performing healthcare organizations. Perceptions of registered nurses are important because nurses are frontline healthcare providers fundamental to patient safety and quality of care and are considered the final line of defense in preventing adverse events and errors and improving the safety of patients.

MATERIALS AND METHODS

We  searched the CINAHL, ProQuest, PubMed, Science Direct, and Web of Science databases for evidence published between 2018 and 2022 in the English language. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in carrying out this meta-analysis.

RESULTS

Nine quantitative studies were appraised using the Joanna Briggs Institute checklists and were included in the final review that involved a total sample of 3633 registered nurses. The included studies were reported across Asian, Middle East, and European countries within the past five years. The association between the transformational leadership behaviors of nurse managers and the quality of patient care was found in varying degrees (i.e., insignificant, weak, indirect, and strong direct association) based on the perceptions of registered nurses.

CONCLUSIONS

There is a direct and indirect association between the transformational leadership behaviors of nurse managers and the quality of patient care internationally. This association is influenced by confounding and mediating factors, including gender, organizational culture, structural empowerment, and job satisfaction.

IMPLICATIONS FOR NURSING AND HEALTH POLICIES

Healthcare organizations need to support nursing leaders to have a stronger transformational leadership style by considering several factors that influence their leadership to improve the quality of patient care their staff nurses provide at the bedside.

Predicting Patients' Satisfaction With Doctors in Online Medical Communities

Online medical communities have revolutionized the way patients obtain medical-related information and services. Investigating what factors might influence patients’ satisfaction with doctors and predicting their satisfaction can help patients narrow down their choices and increase their loyalty towards online medical communities. Considering the imbalanced feature of dataset collected from Good Doctor, we integrated XGBoost and SMOTE algorithm to examine what factors and these factors can be used to predict patient satisfaction. SMOTE algorithm addresses the imbalanced issue by oversampling imbalanced classification datasets. And XGBoost algorithm is an ensemble of decision trees algorithm where new trees fix errors of existing trees. The experimental results demonstrate that SMOTE and XGBoost algorithm can achieve better performance. We further analyzed the role of features played in satisfaction prediction from two levels: individual feature level and feature combination level.

The Association between mHealth App Use and Healthcare Satisfaction among Clients at Outpatient Clinics: A Cross-Sectional Study in Inner Mongolia, China

Mobile health (mHealth) applications (apps) have been developed in hospital settings to allocate and manage medical care services, which is one of the national strategies to improve health care in China. Little is known about the comprehensive effects of hospital-based mHealth app use on client satisfaction. The aim of this study was to determine the relationship between the full range of mHealth app use and satisfaction domains among clients attending outpatient clinics. A cross-sectional survey was conducted from January to February 2021 in twelve tertiary hospitals in Inner Mongolia. After the construction of the mHealth app use, structural equation modeling was used for data analysis. Of 1889 participants, the standardized coefficients β on environment/convenience, health information, and medical service fees were 0.11 (p < 0.001), 0.06 (p = 0.039), and 0.08 (p = 0.004), respectively. However, app use was not significantly associated with satisfaction of doctor−patient communication (β = 0.05, p = 0.069), short-term outcomes (β = 0.05, p = 0.054), and general satisfaction (β = 0.02, p = 0.429). Clients of the study hospitals were satisfied with the services, but their satisfaction was not much associated with mHealth use. The limitation of the mHealth system should be improved to enhance communication and engagement among clients, doctors, and healthcare givers, as well as to pay more attention to health outcomes and satisfaction of clients.

Socio-demographic digital divide in mHealth app use among clients at outpatient departments in Inner Mongolia, China: a cross-sectional study (Preprint)

Background

Mobile health (mHealth) apps have become part of the infrastructure for access to health care in hospitals, especially during the COVID-19 pandemic. However, little is known about the effects of sociodemographic characteristics on the digital divide regarding the use of hospital-based mHealth apps and their benefits to patients and caregivers.

Objective

The aim of this study was to document the cascade of potential influences from digital access to digital use and then to mHealth use, as well as the potential influence of sociodemographic variables on elements of the cascade.

Methods

A cross-sectional survey was conducted from January to February 2021 among adult clients at outpatient departments in 12 tertiary hospitals of Inner Mongolia, China. Structural equation modeling was conducted after the construct comprising digital access, digital use, and mHealth use was validated.

Results

Of 2115 participants, the β coefficients (95% CI) of potential influence of digital access on digital use, and potential influence of digital use on mHealth use, were 0.28 (95% CI 0.22-0.34) and 0.51 (95% CI 0.38-0.64), respectively. Older adults were disadvantaged with regard to mHealth access and use (β=–0.38 and β=–0.41), as were less educated subgroups (β=–0.24 and β=–0.27), and these two factors had nonsignificant direct effects on mHealth use.

Conclusions

To overcome the mHealth use divide, it is important to improve digital access and digital use among older adults and less educated groups.

Patient Satisfaction with Pharmacist-Provided Health-Related Services in a Primary Care Clinic

(1) Background: Patient satisfaction plays an important role in the perceived value, sustained utilization, and coverage of healthcare services by payers and clinics. (2) Methods: A 33-question survey was designed to assess patient satisfaction and perceived value for healthcare services provided by a clinical pharmacist in a single primary care facility. It included general items from validated patient satisfaction surveys (i.e., PROMIS^®, CAHPS) and pharmacist-specific items identified in selected literature. It was offered to all patients who were presenting for a new, unique visit with the clinical pharmacist at the medical clinic between May 2019 and April 2020. (3) Results: A total of 66 patients agreed to take the survey (RR = 100%), and the responses were overwhelmingly positive. However, men were more likely than women to report higher satisfaction (X2(1, n = 920) = 0.67, p = 0.027), and new patients reported higher satisfaction than existing patients (X2(1, n = 1211) = 1.698, p = 0.037). (4) Conclusions: The findings of this study indicate a high degree of patient satisfaction with pharmacist-provided healthcare services in the primary care setting.

Impact of the Work Environment on Patients' Safety as Perceived by Nurses in Poland-A Cross-Sectional Study

Numerous studies have found that organizational features connected with the work environment of nurses have a significant influence on patients' safety. The aim of this research was to capture nurses' opinions about patients' safety and discern relationships with work environment characteristics. This cross-sectional study surveyed 1825 nurses. The research used questionnaire consisting of four parts: (1) covered The Practice Environment Scale of the Nursing Work Index (PES-NWI); (2) assessed the quality of nursing care and care safety; (3) contained information on the most recent duty served by the nurses and (4) captured social and demographic data of participants. The research identified strong association between patient safety assessment and work environment of nurses in the aspect of employment adequacy, cooperation between nurses and doctors, support for nurses from the managing staff, the possibility to participate in the management as well as professional promotion of nurses employed in the hospital (p < 0.001). Nurses rated patient safety higher when responsible for a smaller number of patients. Work environment factors such as proper staffing, good cooperation with doctors, support from the management, as well as professional independence are significantly related to nurses' assessment of patients' safety.

Dissatisfaction with Local Medical Services for Middle-Aged and Elderly in China: What Is Relevant?

As violent clashes between doctors and patients in China intensify, patient dissatisfaction has been identified as a major concern in the current healthcare reform in China. This study aims to investigate the main determinants of dissatisfaction with local medical services attributable to middle-aged and elderly characteristics and identify areas for improvement. A total of 14,263 rural participants and 4898 urban participants were drawn from the China Health and Retirement Longitudinal Study in 2018. Dissatisfaction was measured by two methods: binary outcome (1 = Dissatisfaction; 0 = No) demonstrated the risk of occurring dissatisfaction among various characteristics, and continuous outcome (ranges from score 1 to 5) showed the degree. The mean score of dissatisfaction was 2.73 ± 1.08. Sixteen percent of rural participants and 19% of urban participants reported dissatisfaction with local medical services, respectively. The multilevel analyses demonstrated that participants' utilization of paid family doctor services decreased the risk of occurring dissatisfaction; dissatisfaction was less focused on females; having chronic diseases increased the risk of dissatisfaction. This study suggests promotion of family doctor services can effectively reduce middle-aged and elderly dissatisfaction with the local medical services. In addition, more attention should be focused on males and middle-aged and elderly with chronic diseases in order to decrease dissatisfaction.

Who Is More Satisfied with Health Services? A Cross-Sectional Study in China

This cross-sectional study aims to assess the Chinese population’s satisfaction with health service and identify 2 types of variables, Andersen’s behavioral model related variables and social environment variables associated with high satisfaction. Data were derived from the 2013 Chinese General Social Survey (CGSS). Using exploratory factor analysis, the original questionnaire’s 10 health services were grouped into 2 dimensions, including “health management service” and “public health service.” Then, the satisfaction was described. The associations between satisfaction and factors were assessed using a multivariable logistic regression model. As a result, a total of 5283 subjects were enrolled. The satisfaction was 56.74% for “health management service” and 54.48% for “public health service.” Those with older age, lower education level, positive social environment factors (ie, higher perceived social class, higher perceived social trust, and perceived social equity), and having pension were more likely to report high satisfaction. Moreover, compared to the east region (the most prosperous region), the individuals from the central region or the north-east region (both regional economic levels were medium) had lower odds of reporting high satisfaction. In comparison, those from the west region (the least developed region) had higher odds. In conclusion, actionable measures to increase satisfaction should be proposed by the Chinese government, including increasing pension insurance coverage, increasing investment in health services, creating an excellent social environment, etc.

Research on Teleconsultation service quality based on multi-granularity linguistic information: the perspective of regional doctors

Background

Due to the increasing complexity in socioeconomic environments and the ambiguity in human cognition, decision makers prefer to give linguistic cognitive information with different granularities according to their own preferences. Consequently, to consider the uncertainty and preferences in the evaluation process, a method based on Multi-Granularity Linguistic Information (MGLI) for evaluating teleconsultation service quality is proposed, which provides a new research direction for scientific evaluation and improvement of teleconsultation service quality.

Methods

Firstly, this paper explored a service quality evaluation system from the perspective of regional doctors. And then considering the uncertainty and preferences of decision makers, MGLI was used to optimize the index system according to the similarity degree between the linguistic evaluation information and a given linguistic term set. Finally, the empirical research was conducted using Henan Province Telemedicine Center of China (HTCC) as an example to identify the direction for improving the service quality in teleconsultation.

Results

This study found that the number of consulting rooms, attitude of operators, consultation duration, charges, and attitude of experts are the key factors affecting the quality of teleconsultation service.

Conclusions

Suggestions for improving the quality of teleconsultation service are put forward in terms of optimizing the allocation of consulting rooms, improving regional doctors’ experience and standardizing charging standards, which provides a new direction for improving the quality of teleconsultation service.

Aspects of Marketing in Dental Tourism—Factor of Sustainable Development in Romania

Dental tourism is a growing and emerging phenomenon that is becoming more attractive to patients due to its potential for decreased expenses, increased convenience, and immediacy of treatment. The necessity for travel is the primary motivation for seeking dental treatment due to the successful cooperation between tourism and healthcare. While dental tourism has been largely researched from the perspective of the patient, our research is the first research to apply a concomitant approach on dental clinics and tourism agencies. The aim of our study wasto provide comprehensive empirical evidence from the perspective of the dental clinics and tourism agencies in Romanian dental tourism. We used a representative sampling with an online questionnaire on 160 dental clinics and 32 tourism agencies. The results indicate that both entities have small amounts of information, but they are interested in investing, promoting, and creating a partnership to create a sustainable industry of dental tourism. Dental tourism could strongly contribute to the country’s image and help to prolong the seasonality of tourism activity by enhancing the strategic marketing of dental clinics and tourism agencies toward sustainable health tourism.

Relationships among Country Image, Tour Motivations, Tour Quality, Tour Satisfaction, and Attitudinal Loyalty: The Case of Chinese Travelers to Korea

This study examined the antecedents and the consequences of tour motivations. More specifically, this study proposed how two sub-dimensions of a country’s image, such as the cognitive and the affective destination images, affect tour motivations. In addition, it was proposed that tour motivation helps to enhance tour quality and tour satisfaction. Lastly, this study examined the effect of tour quality the tour satisfaction on word-of-mouth. A total of 623 samples were employed in order to test the seven hypotheses. This study employed the AMOS program to conduct confirmatory factor analysis and structural equation modeling. The results of the data analysis showed that the cognitive and the affective destination images play an important role in the formation of the tour motivation. This study also found that tour motivation has a positive influence on tour quality. Additionally, the current study confirmed the effect of tour quality on tour satisfaction. Lastly, the influences of tour quality on tour satisfaction and word-of-mouth were identified.

Examining the Quasi-Public Spaces in Commercial Complexes

Commercial complexes are steadily expanding in size and function and plying roles as quasi-public spaces. This study investigated quasi-public spaces in contemporary commercial complexes by posting two questions: the physical features of quasi-public spaces in commercial complexes and how these characteristics promote sociability in commercial complexes? To answers these questions, a questionnaire survey was administered, and various observations were made in Intime City, Wanda Plaza and Western City Square, three prominent commercial complexes in Hangzhou City (Zhejiang Province, China), to enrich the analysis. Confirmatory factor analyses were used to examine the collected data. The results show that commercial complexes are also used as quasi-public spaces: they provide a more secure and well-maintained environment, playful conversations take place freely and democratically, promote socialization, and also increase consumption. In the existing literature, there is a dearth of theoretical and empirical studies on the emergence of quasi-public spaces.

Outpatients' Satisfaction in the Context of 10 Years of Health-Care Reform: A Cross-Sectional Study of Tertiary Hospitals in Shiyan, China

PURPOSE

This study aimed to evaluate outpatient satisfaction in tertiary hospitals in Shiyan, China, to predict which items had highest priorities for outpatient satisfaction, and to identify population groups on which the medical institutions should focus.

PATIENTS AND METHODS

A cross-sectional survey was conducted at three tertiary hospitals in Shiyan city of China, from March to June 2018. An 18-item outpatient satisfaction questionnaire was applied. We conducted matrix analysis to describe the distribution of satisfaction score and the degree of influence of the items. Outpatient satisfaction was classified into the lowest and highest groups according to the 80/20 rule. Logistic regression model was used to identify demographic factors which might influence outpatient satisfaction.

RESULTS

A total of 2109 valid questionnaires were completed. The "waiting time", "diagnosis and treatment time" and "medical charges" items showed relatively higher degrees of influence but earned lower levels of satisfaction. Outpatients with a college level or above educational background (AOR=1.36, 95% CI=1.03-1.79) and with a family per-capita monthly income (FPMI)>7000 CNY (AOR=3.30, 95% CI=1.60-6.81) were more prevalent in the lowest satisfaction group. Outpatients with college level or above education background (COR=0.77, 95% CI=0.60-0.99), FPMI of 3001-5000 CNY (AOR=0.76, 95% CI=0.60-0.96), non-local residents (AOR=1.48, 95% CI=1.07-2.04), and urban workers with medical insurance (AOR=1.74, 95% CI=1.27-2.39) were more prevalent in the highest satisfaction group.

CONCLUSION

The survey indicated that "long time to wait for treatment", "short treatment time", and "medical charges too expensive" were the top three aspects that need to be improved with priority by medical institutions. Education level, income level, residence and type of health insurance were the sociodemographic characteristics that significantly affect the outpatient satisfaction in tertiary hospitals. These factors need to be paid more attention by healthcare professionals to improve the patients' satisfaction.

The Antecedents and Consequences of Travelers' Well-Being Perceptions: Focusing on Chinese Tourist Shopping at a Duty Free

The purpose of this study was to explore the antecedents and consequences of travelers’ well-being perceptions in the context of a duty-free shop. For this, data were collected from 742 Chinese tourists who purchased goods at duty free shops while traveling in Korea within the past year using an online survey company’s system in China. The results indicated that pragmatic, hedonic, and sociability experiences have a positive influence on travelers’ well-being perceptions. In addition, travelers’ well-being perceptions aided the enhancement of brand attitude and brand preference, which in turn positively affected word-of-mouth. Novelty is the originality of this study as very few studies on this topic are presented in the extant literature and practical implications are also discussed.

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.

Assessing the Moderating Effect of Corruption on the E-Government and Trust Relationship: An Evidence of an Emerging Economy

The foremost purpose of this article is to investigate the effect of electronic-government (e-government) on public trust and the moderating impact of corruption on this relationship. The data was obtained through a structural questionnaire involving 800 Pakistani citizens at the local level. The true response rate was 58.3%. The data was analyzed using confirmatory factor analysis, multiple regression and stepwise hierarchal regression. The results showed there is an empirically significant association among e-government practices and public trust in local self-government and a negative moderating role of corruption. The findings suggest that e-government can develop a procedure-based trust by advancing connections with people and their insights of responsiveness. The individuals’ viewpoints about the state, including trust, are fundamental concerns for the governance and administrative system. Testing these above associations via a moderation technique is a novel process which contributed to the current study on e-government.

The Influence of Destination Image on Tourist Loyalty and Intention to Visit: Testing a Multiple Mediation Approach

Pakistan holds an important geographical status, but extremism and sabotage have severely damaged the tourism industry. In the present study, we examined the impact of destination image (DI) on tourist loyalty (TL) and intension to visit (IV) in Pakistan. Additionally, the study analyzed the mediation effects of electronic word of mouth (eWOM) and tourist satisfaction (TS) on these relationships. Data was collected from 780 tourists in Pakistan. We used confirmatory factor analysis (CFA) and structural equation modeling (SEM) to obtain the results. Our results demonstrated the positive relationships among DI, eWOM, TS, TL, and IV. This study also disclosed that eWOM has a partial mediation effect on the DI–TL relationship, and both eWOM and TS fully mediate the association between DI and IV. Hence, tourist satisfaction can be enhanced by eWOM and destination image, which directly effect tourist loyalty and intention to visit in Pakistan. The proposed framework and research findings will help stakeholders significantly to recognize the multi-facet association in the tourism industry of Pakistan. Testing the above relationships through multiple mediators is a relatively novel idea.

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.

Patient Satisfaction with Health Care Services; An Application of Physician's Behavior as a Moderator

Patient satisfaction is a measure of the extent to which a patient is content with the health care they received from their health care provider. Patient satisfaction is one of the most important factors to determine the success of a health care facility. The purpose of this study was to determine patient satisfaction with healthcare services and encompass the physician’s behavior as moderation between patient satisfaction and healthcare services. The study seeks to measure the health care services, like a laboratory and diagnostic care, preventive healthcare and prenatal care, to patient satisfaction in the public health sectors of Pakistan. A descriptive survey research design was used for this study. The target population was patients from the out-patient department (OPD) of three public hospitals from Pakistan. By using the convenient sampling technique, 290 sample participants were selected from the target population. The reliability scales were tallied by using Cronbach’s Alpha. The findings of the study are gleaned by using regression to explore patient satisfaction with the health care services, and whether or not the physician’s behavior moderates the link of patient satisfaction and healthcare services. SPSS Hayes process was used for the moderation effect of the physician’s behavior. The main results of the regression analysis validate that health care services, such as laboratory and diagnostic care, preventive healthcare, and prenatal care, have a significant and positive effect on patient satisfaction. Specifically, the study suggests that the physician’s behavior significantly moderates the effect of health care services on the satisfaction of patients. The overall opinions about the satisfaction level of patients for the availability of health services in the hospitals were good. The degree of satisfaction was satisfactory with respect to laboratory and diagnostic care, preventive healthcare, and prenatal care services. Based on the outcomes, the study confirms that the proposed hypotheses are statistically significant. Furthermore, the directions for future research of the study are offered.

Can Leadership Enhance Patient Satisfaction? Assessing the Role of Administrative and Medical Quality

This paper aimed to investigate the relationships between participative leadership (PL), administrative quality (AQ), medical quality (MQ), and patient satisfaction (PS) using the Malcolm Baldrige National Quality Award Healthcare Criteria (MBNQA) criteria. The study further examined the intervening influence of administrative quality and medical quality on the relationship between participative leadership and patient satisfaction. The data was obtained from 123 public sector hospitals in Pakistan. We employed confirmatory factor analysis (CFA) and structural equation modeling (SEM) techniques to test the structural model. From the study results, we found significant and positive relationships between participative, administrative quality, medical quality, and patient satisfaction. In addition, our research found administrative quality and medical quality as potential mediators on PL-PS relation. Adopting participative leadership as an exogenous factor, and both administrative and medical quality as potential mediators of patient satisfaction, provided new insights into MBNQA criteria.

Linking Transformational Leadership with Nurse-Assessed Adverse Patient Outcomes and the Quality of Care: Assessing the Role of Job Satisfaction and Structural Empowerment

The purpose of this study was to examine the relationships between transformational leadership (TL), structural empowerment (SE), job satisfaction (JS), nurse-assessed adverse patient outcomes (APO), and the quality of care (QOC). The study further investigates the mediating effects of SE and JS on TL-APO and TL-QOC relationships. A total of 600 nurses working at 17 government hospitals in Pakistan completed the survey. The hypothesized model was tested using a confirmatory factor analysis and structural equation modeling. We found a positive relationship between TL, SE, JS, and QOC but negative relationships between TL and APO, SE and APO, and JS and APO. Our study further suggests that SE and JS strongly mediate both TL-APO and TL-QOC relationships.