Service quality and performance in the public health-care sector

The purpose of this article is to evaluate service quality and service performance relationship in the health-care sector using respective developed multidimensional scales. Data were collected from 400 inpatient respondents, using stratified sampling method from five departments, namely general medicine, surgery, pediatrics, orthopedics, gynecology, and ENT of a tertiary hospital (North India). The results confirm significant relationship among subdimensions of physical environment quality and interaction quality (service quality) and four service performance measures, namely waiting time, patient satisfaction, patient loyalty, and image in public hospitals.     

Patient perceptions of service quality in group versus solo practice clinics.

OBJECTIVE: To compare patient perceptions of service quality at solo and group practices, and to examine the association of perceptions with 'potential patient loyalty' (PPL), the potential for seeking future service from the same clinic. DESIGN: A self-administered, cross-sectional survey of clinic outpatients, using an adapted SERVQUAL questionnaire translated into Chinese, with additional items on overall satisfaction and intent to return/recommend the clinic to others. Sampling and study subjects. Every third outpatient at all newly started group practices (four) and solo clinics (thirteen) in Taiwan in the preceding 4-7 months, including 150 and 50 patients from each group and solo practice, respectively, for a total of 1250 patients. MAIN OUTCOME MEASURES: Perceived service quality on five dimensions-tangibles, reliability, responsiveness, assurance, and empathy-and PPL. All constructs were measured on a five-point scale. RESULTS: After accounting for random effects of clinical and geographical location, group practice patients perceived significantly higher service quality on all dimensions relative to solo practice patients, after adjusting for age, gender, education, and illness type. All service quality dimensions except assurance were significantly positively associated with PPL after adjusting for age, gender, education, and illness type, and random effects at the clinical and geographical location levels. CONCLUSIONS: Patients perceive better service quality at group practices compared with solo practices on all dimensions. Patients' quality perceptions are significant predictors of PPL. The implications for physician practices both internationally and in Taiwan are discussed, as well as policy implications for the Taiwan government.     

Hospital financial condition and the quality of patient care

Concerns about deficiencies in the quality of care delivered in US hospitals grew during a time period when an increasing number of hospitals were experiencing financial problems. Our study examines a six-year longitudinal database of general acute care hospitals in 11 states to assess the relationship between hospital financial condition and quality of care. We evaluate two measures of financial performance: operating margin and a broader profitability measure that encompasses both operating and non-operating sources of income. Our model specification allows for gradual adjustments in quality-enhancing activities and recognizes that current realizations of patient quality may affect future financial performance. Empirical results suggest that there is a relationship between financial performance and quality of care, but not as strong as suggested in earlier research. Overall, our results suggest that deep financial problems that go beyond the patient care side of business may be important to prompting quality problems.     

Quotable Quotes

Patient adherence is extremely important to achieve positive outcome. While quality of healthcare service has been studied as a determinant of patient satisfaction and loyalty, its impact on patient adherence has not been examined. The authors attempt to determine dimensions of quality and their impact on patient adherence in primary healthcare in India. Exploratory factor analysis resulted into seven factors. Factor scores were used for regression to identify the influence of dimensions of service quality on patient adherence. Quality of healthcare emerged as a determinant of patient adherence.     

A conceptual framework of quality of life in chronic kidney disease in Turkey: A patient-focused approach

This study aimed to determine the quality of life of patients with chronic kidney disease who were receiving dialysis treatment. It also aimed to identify the factors affecting the quality of life of these patients. The independent variables analyzed were: patients' sociodemographic characteristics, organizational characteristics, adherence to treatment, patient-physician relationship, and patient activation level. The sample consisted of 328 patients with chronic kidney disease who received services from dialysis units of two university hospitals and two private dialysis centers. Data analysis was performed through multivariate regression. Results showed that receiving treatment from a hospital-based dialysis unit may have a positive effect in patients' quality of life; and patient-physician relationship, patient activity, and adherence to treatment may positively affect quality of life. Thus, planning of health service delivery that focus on improving the quality of life of patients who are more active by allowing them to establish positive relationships with their physicians and to have a better adherence to treatment should be adopted. These findings may provide health managers, health professionals, and individual patients with evidence-based information about treatment management and health service planning processes related to chronic kidney disease.     

感受服务在非全麻手术患者护理中的应用

目的探讨护士模拟非全麻手术患者的“感受服务”,提高护理质量和患者满意度的效果。方法手术室护士模拟患者,体验其围手术期的各种感受和需求,讨论总结后制定出满足患者需求的护理措施,落实并收集患者的反馈意见及建议,再针对存在问题进行改进和再体验。结果护士为非全麻手术患者提供服务的主动性增强,患者对手术室护理工作满意度显著提高,手术室护理服务质量实现了可持续发展。结论开展感受服务是提高非全麻手术患者满意度和促进手术室护理服务质量可持续发展的有效途径。     

新形势下医患关系和医疗服务的伦理学思考

本文对新形势下医患关系和医疗服务进行伦理学思考。介绍医学伦理学慨念和医患关系的发展趋势,提出构建和谐医患关系的办法策略,以及加强医疗服务工作的具体措施。     

浅谈医患关系紧张的原因及对策

医患关系紧张、医疗纠纷增加，是当前医疗服务中一个十分突出的问题。医患之间缺乏信任和理解，医患关系紧张的现状不容乐观。其产生的原因应该是多方面的：医疗资源配置的不合理和国家与社会医疗投入比重降低、医疗机构自身的原因、患者的因素等。解决这些矛盾应该重视调整医疗资源的合理性配置，更多的体现医疗服务的公平性及可及性。加强对医疗机构的监控力度，提高医务人员的自身素质，普及医疗知识的宣传教育，加强医患双方的沟通和理解。建立医患互信的良好关系，完善现有的法律法规，通过人性化、制度化的有效措施缓解医患关系的紧张。     

Improving quality: bridging the health sector divide.

ISSUE: All too often, quality assurance looks at just one small part of the complex system that is health care. However, evidently each individual patient has one set of experiences and outcomes, often involving a range of health professionals in a number of settings across multiple sectors. ADDRESSING THE ISSUE: In order to solve the problems of this complexity, we need to establish high-quality electronic recording in each of the settings. In the UK, primary care has been leading the way in adopting information technology and can now use databases for individual clinical care, for quality assurance using significant event and conventional auditing, and for research. BUILDING TOWARDS A SOLUTION: Before we can understand and quality-assure the whole health care system, we need electronic patient records in all settings and good communication to build a summary electronic health record for each patient. Such an electronic health record will be under the control of the patient concerned, will be shared with the explicit consent of the patient, and will form the vehicle for quality assurance across all sectors of the health service.     

基于患者特征的医院服务质量评价体系与影响因素研究

以格罗鲁斯及Parasuraman，Zeithaml，Berty的服务质量理论为依据，运用SERVPEHF评价技术．对上海市医院系统服务质量的影响因素进行研究，建立了医院服务质量的评价体系，分析了医院不同患者群体对医疗服务质量的影响．以期为医院的医疗服务质量管理提供快速解决方案。     

Quality of care from the patients' perspective: from theoretical concept to a new measuring instrument

Introduction

Patient views on quality of care are of paramount importance with respect to the implementation of quality assurance (QA) and improvement (QI) programmes. However, the relevance of patient satisfaction studies is often questioned because of conceptual and methodological problems. Here, it is our belief that a different strategy is necessary.

Objective

To develop a conceptual framework for measuring quality of care seen through the patients' eyes, based on the existing literature on consumer satisfaction in health care and business research.

Results

Patient or consumer satisfaction is regarded as a multidimensional concept, based on a relationship between experiences and expectations. However, where most health care researchers tend to concentrate on the result, patient (dis)satisfaction, a more fruitful approach is to look at the basic components of the concept: expectations (or `needs') and experiences. A conceptual framework – based on the sequence performance, importance, impact – and quality judgements of different categories of patients derived from importance and performance scores of different health care aspects, is elaborated upon and illustrated with empirical evidence.

Conclusions

The new conceptual model, with quality of care indices derived from importance and performance scores, can serve as a framework for QA and QI programmes from the patients' perspective. For selecting quality of care aspects, a category-specific approach is recommended including the use of focus group discussions.

     

加强医患沟通缓解医患关系

在日常的医疗活动中,医患之间对医疗结果不可避免地存在着不同认知,故医患关系的不协调或医患冲突难以避免.近年来医患关系紧张成为了大众关心的热门话题,而医患关系紧张的其中一个重要原因是缺乏沟通,医患之间没有建立融洽、互相信任的关系,这就使加强医患沟通显得十分重要,加强医患沟通不仅是减少医疗纠纷、缓解医患关系的重要手段,同时也是提高医疗质量、提高医院声誉的需要.     

Patient-reported service quality on a medicine unit.

PURPOSE: Service quality, defined as patients' self-reported experience of care, is used as a metric for evaluating quality. Most studies rely on retrospective consumer surveys rather then more intensive data collection methods, possibly underestimating the incidence of service quality incidents. SUBJECTS AND METHODS: The objective of the study was to characterize patient-reported service quality deficiencies on a general medicine unit. We studied a cohort of 228 adult inpatients at a Boston teaching hospital. Investigators reviewed medical records and interviewed patients during the hospitalization and by telephone after discharge. Physician investigators classified patients' incident reports. We calculated the rate of service incidents, characterized incident types, and used multivariable Poisson and logistic regression models to examine factors associated with patient reporting and overall rating of the hospitalization. RESULTS: Eighty-eight (38.6%) of 228 patients experienced 157 service quality incidents during the admission, for a rate of 68.9 incidents per 100 admissions. The most common service quality problems involved waits and delays (n = 45), problems with communication between staff and patients (n = 36), and environmental issues and amenities (n = 35). In the multivariable analysis, men (IRR 1.6, 95% CI 1.1-2.2), patients covered by hospitalists (1.5, 1.1-2.2), and patients with more medication allergies (1.1 per allergy, 1.1-1.2) reported more service incidents; patients with Medicaid or free care reported fewer (0.5, 0.3-0.9). Patients with service quality incidents were more likely to describe the hospitalization as other than excellent (adjusted OR 1.8 per incident, 95% CI 1.3-2.5). CONCLUSION: Service quality deficiencies are common among medical inpatients, and are strongly associated with patients' dissatisfaction with the hospitalization.     

浅谈医患关系"寒冷期"的形成原因与对策

医患关系是一种特殊的社会人际关系，其好坏程度直接影响社会的稳定，由于种种原因，此关系目前进入了一个相对的“寒冷期”，严重影响着医患双方的行为，进而影响卫生事业的发展和人民群众的生命健康。该文初步探讨了其形成原因有：（1）医者的支配地位与患者自我保护意识增强之间的矛盾。（2）医疗的高风险性与患者高期望值之间的矛盾。（3）医疗费用上涨过快与患者经济承受能力低下之间的矛盾。（4）传统价值观与现实之间的矛盾。（5）新闻媒体的炒作起着推波助澜的作用。针对上述原因，应采取的对策有：（1）加强信息交流，提高医患双方的风险意识。（2）服务到位，心理相融，建立新型服务关系。（3）增加收费透明度，切实减轻患者经济负担。（4）加强职业修养。（5）明确卫生政策定位，政府增加投入。     

Relationship Between Clinical Quality and Patient Experience: Analysis of Data From the English Quality and Outcomes Framework and the National GP Patient Survey

PURPOSE

Clinical quality and patient experience are both widely used to evaluate the quality of health care, but the relationship between these 2 domains remains uncertain. The aim of this study was to examine this relationship using data from 2 established measures of quality in primary care in England.

METHODS

Practice-level analyses (N = 7,759 practices in England) were conducted on measures of patient experience from the national General Practice Patient Survey (GPPS), and measures of clinical quality from the national pay-for-performance scheme (Quality and Outcomes Framework). Spearman’s rank correlation and multiple linear regression were used on practice-level estimates.

RESULTS

Although all the correlations between clinical quality summary scores and patient survey scores are positive, and most are statistically significant, the strength of the associations was weak, with the highest correlation coefficient reaching 0.18, and more than one-half were 0.11 or less. Correlations with clinical quality were highest for patient-reported access scores (telephone access 0.16, availability of urgent appointments 0.15, ability to book ahead 0.18, ability to see preferred doctor 0.17) and overall satisfaction (0.15).

CONCLUSION

Although there are associations between clinical quality and measures of patient experience, the 2 domains of care quality remain predominantly distinct. The strongest correlations are observed between practice clinical quality and practice access, with very low correlations between clinical quality and interpersonal aspects of care. The quality of clinical care and the quality of interpersonal care should be considered separately to give an overall assessment of medical care.     

A Sociocognitive Approach to Service Quality and Adherence Amongst Elderly Patients: A Pilot Study

This article examines the relationship between patients' perceptions of emotional intelligence (EI), health competence, service quality, and adherence behavior in the Home Medicines Review (HMR) setting. Participants were purposively recruited from different urban and regional areas in Australia and qualitative data were obtained from in-depth interviews with 20 HMR patients.

Service quality is conceptualized from a sociocognitive perspective by incorporating psycho-socio factors such as EI and health competence as moderators to overall service quality and adherence. The findings suggest that EI and health competence influence patient perceptions of service quality and nonadherence at multiple levels of abstraction. Implications are that staff training and development programs that incorporate EI could improve service delivery which could increase patient perceptions of service quality and adherence. Designing intervention initiatives aimed at increasing patient awareness and education of their health conditions could also improve service quality perceptions and adherence behavior.     

Patients' Satisfaction with Health Care Chaplaincy and Affecting Factors: An Exploratory Study in the German Part of Switzerland

Surveying patients' satisfaction with chaplaincy services contributes to improving the quality of health care chaplaincy. Therefore, 679 patients from 32 general hospitals and psychiatric clinics in the German part of Switzerland were surveyed in a cross-sectional design. Seven factors influencing patients' satisfaction with health care chaplaincy were identified. They pertain, on one hand, to the chaplain–patient relationship (“Respect and friendliness,” “Empathy,” “Negative relationship”) and, on the other hand, to the evaluation of chaplains' interventions (“Religious/spiritual interventions,” “Religious/spiritual issues,” “Clarification, coping and support,” “Conflict management and forgiveness”). Whereas the patient–chaplain relationship was significantly associated with the patient's age and religiosity, the apprehension of pastoral intervention was significantly associated with the patient's religiosity and denomination, length of stay, admission to hospital, and the patient's health status. The results suggest that chaplains have to take account of the situational circumstances and personal characteristics of patients in order to optimize their service.     

北京市市属医院患者满意度评价的探索及实践

患者满意度测评是评价医疗服务质量与医护人员工作绩效的有力工具。随着医改的深入,为科学评价新医改前期实施成效,北京市医院管理局制定医院患者满意度评价方案,并且积极推动评价方案的实施。实施结果显示,患者满意度评价对于指导医院改进,完善服务,构建和谐医患关系有重要的现实意义。     

The Relationship between Patients' Perception of Care and Measures of Hospital Quality and Safety

Background

The extent to which patient experiences with hospital care are related to other measures of hospital quality and safety is unknown.

Methods

We examined the relationship between Hospital Consumer Assessment of Healthcare Providers and Systems scores and technical measures of quality and safety using service-line specific data in 927 hospitals. We used data from the Hospital Quality Alliance to assess technical performance in medical and surgical processes of care and calculated Patient Safety Indicators to measure medical and surgical complication rates.

Results

The overall rating of the hospital and willingness to recommend the hospital had strong relationships with technical performance in all medical conditions and surgical care (correlation coefficients ranging from 0.15 to 0.63; p<.05 for all). Better patient experiences for each measure domain were associated with lower decubitus ulcer rates (correlations −0.17 to −0.35; p<.05 for all), and for at least some domains with each of the other assessed complications, such as infections due to medical care.

Conclusions

Patient experiences of care were related to measures of technical quality of care, supporting their validity as summary measures of hospital quality. Further study may elucidate implications of these relationships for improving hospital care.