SERVICE QUALITY ASYMMETRIC EFFECT ON PATIENT SATISFACTION FOR PRIMARY HEALTHCARE SERVICES

Transcription

1 SERVICE QUALITY ASYMMETRIC EFFECT ON PATIENT SATISFACTION FOR PRIMARY HEALTHCARE SERVICES Giovanis Apostolos 1 ; Pierrakos George 1 ; Kyriakidou Niki 2 ; Yfantopoulos John 3 ; Goula Aspasia 1 ; Latsou Dimitra 1 ; Tomaras Petros 1, Sarris Markos 1 1 Technological Educational Institute of Athens, Athens, Greece 2 Leeds Metropolitan University, UK 3 National and Kapodistrian University of Athens, Athens, Greece

2 Agenda Introduction Research objective Conceptual background Patient satisfaction Service quality attributes characterization Research methodology Results Discussion of findings Implications - limitations

3 Introduction Primary health care is a major element of any health care system, since it brings healthcare closer to citizens place of residence and work, operating as their first level of contact with health care system The effectiveness of the system in Greece is still underperforming and needs to be improved by upgrading the relevant services offered, especially at a regional revel. Literature suggest that patient satisfaction is considered as a good index to assess system s effectiveness and prioritize service delivery improvements

4 Introduction Service delivery assessment and its effects on patient satisfaction are very important for healthcare managers as it affects healthcare results and organizations operational expenses management Satisfied patients: are more inclined to follow doctor s prescription, which in turn will affect their satisfaction with the service outcome (e.g. symptoms relief) avoid complaining and lawsuits are more loyal to and provides positive referrals about the service provider affect staff satisfaction

5 Previous research approaches: Introduction service quality attribute-level performance have a symmetric influence on patient satisfaction (the effects of service quality deterioration on dissatisfaction will be the same with the relevant effect on satisfaction caused by an equal increase in service quality) Use importance-performance analysis (IPA) for service attributes characterization and service improvements characterization Recent perspective: the relationship between attribute-level performance and customer satisfaction can be asymmetric (the importance of satisfaction determinants may vary according to their current level of attribute-performance) In such a case the results of IPA are misleading

6 Research objective Understand the nature of the relationship between service quality attributes level and patient satisfaction in the primary healthcare services context using an empirical study Implement penalty-reward-contrast analysis (PRCA) for primary healthcare services attributes categorization, which is based on the nature of their relationship with patient satisfaction Utilize the results in order to provide an efficient prioritization schedule for service process improvement Implement impact range-performance (IRPA) and impact-asymmetry (IA) analysis

7 Conceptual background Patient Satisfaction is the gap between expected and perceived characteristics of a service (Fitzpatrick and Hopkins 1983), is a special form of attitude, reflecting the extent to which a patient liked or disliked the service after having experienced it (Woodside et al., 1989). can be viewed as an attitude resulting from the confirmation or disconfirmation of expectations (result perspective) or as a process, resulting from the level of expectations the patient takes to the service experience (process perspective) John (1991),

8 Conceptual background Primary healthcare system service attributes Donabedian (1980): Service quality assessment should include an analysis of structure to achieve a given level of healthcare quality (the characteristics of doctors, hospitals and staff) the process (interaction with the structure) the result (what happens to the patient after the medical act). The problem with the result dimension of healthcare services Difficult to measure (very large period of time between the moment when service is provided and the results revealing) (Choi et al., 2005). It is a consequence of the service s quality and not one of its components (focus on the structure and the process when analyzing service quality in health care services) (Peyrot et al., 1993; Boller et al., 2003)

9 Conceptual background Primary healthcare system service attributes Carr-Hill (1992): patient s satisfaction determinants medical care and information food and physical facilities non-tangible environment nursing care quantity of food appointment bookings Raposo et al. (2009): patient s satisfaction determinants Medical care Nursing care Facilities condition Administrative services

10 Conceptual background Service quality and patient satisfaction relationship Kano et al. (1984) were the first who classified products/services attributes by considering their potentiality in creating customer satisfaction. The three-factor theory, proposed by Kano et al. (1984) presumes that the effect of a product/service attribute on customer satisfaction varies according to its performance This fact signifies the existence of asymmetric relationships among serviceattributes and overall satisfaction.

11 Conceptual background Service attributes characterization (Matzler et al., 2004): Basic: they reflect the minimum requirements that service providers have to offer to the customers. They may cause dissatisfaction, if they are not offered, but do create high satisfaction, if they are not offered. When performance of the basic factors is low, their influence on satisfaction becomes very important, while when their performance is high, their influence on satisfaction decreases and become unimportant. Performance: they produce high satisfaction when they are offered, but they may also produce dissatisfaction, if they are not offered. The effect on overall satisfaction is linear and symmetric. Excitement: they reflected unexpected aspects of services offered given that their existence may produce high satisfaction, but their absence does not create dissatisfaction. The importance of the excitement factors increases when their performances are high, but they become unimportant when they underperform.

12 Methodology Survey Instrument - Measures Data were collected through a questionnaire developed to understand patients perception about primary healthcare service quality. The questionnaire was divided in five sections: the first addressing general information about respondents demographics and primary health care usage pattern (frequency and motives). The next four sections addressed specific questions about patients perception on hospital s facilities condition, administrative processes, medical and nursing care. The scales used to measure the four primary healthcare service attributes were adopted from the studies of Dagger et al. (2007) and Raposo et al. (2009). The scale proposed by Oliver (1980) was used to measure patient satisfaction All items were measured on 5-point Likert scales

13 Methodology Data collection Target population: Users of primary healthcare services in 8 state-owned hospitals located in the district of Athens specific disease hospitals: 4 general hospitals: 4 Sampling: stratified random sampling with a sampling ratio of 1:5 meaning that for every five patients that got out of the clinics one was interviewed Data collection: personal interviews The fieldwork was conducted during April and May questionnaires were distributed (550 in morning clinics and 150 in afternoon clinics) Contacts were made at different times of the day and days of the week in order for day and time related bias to be eliminated Usable data set: 407 usable responses (out of 420 filled questionnaires) - net response rate ~ 58%

14 Methodology Sample profile Gender: 57.3 % of the respondents were female Age groups: 18-24: 14%; 25-34: 19%; 35-44: 19%; 45-54: 20%; 55-64:13%; 65+:13% Marital status: Married - 54% Monthly income: < 1,000: 33%; 1,000-1,999: 19%; 2,000+: 6% Educational background: university degree - 34% Service usage during the last 6 months: < 6: 56%; 6-20: 13%; 20+: 3%

15 Results: measurement model assessment Items F1 F2 F3 F4 F5 MV SD MDC1 time spend with the patient MDC2 accurate info about illness MDC3 medication instructions given MDC4 lifestyle instructions given MDC5 kindness MDC6 communication MDC7 trustworthiness MDC8 interest NSD1 willingness to serve NSD2 family support given NSD3 kindness NSD4 communication NSD5 trustworthiness NSD6 personal support given NSD7 service speed NSD8 interest ADS1 admittance procedures ADS2 discharge procedures ADS3 staff s service speed ADS4 staff s behavior ADS5 waiting time ADS6 consistency ADS7 interest ADS8 communication FCQ1 premises cleanliness FCQ2 toilet cleanliness FCQ3 waiting areas comfort FCQ4 premises adequacy FCQ5 room temperature FCQ6 access for people with disabilities FCQ7 signing FCQ8 operation time comfort PS1 general satisfaction PS2 expectations matching PS3 needs fulfilment Eigenvalues % variance Cumulative % Cronbach's a NSC FCQ MDC ADS PS MV SD NSC FCQ MDC ADS PS Sampling adequacy: KMO = 0.95 (> 0.80) Percentage of total variance: 70.93% (> 50%) Scales reliability: Cronbach s alpha > 0.77 Convergent validity: Most of factor loadings > 0.5 Discriminant validity: Cross-loadings < 0.4

16 Results: penalty-rewards-contrast analysis PHCSQ factors Regression coefficients a Reward indices b Dummy variable regression coefficients Penalty indices Parameters equality test t- value Factors classification Nursing Care 0.33 *** 0.25 *** *** 3.17 *** Excitement Facilities 0.35 *** 0.18 *** *** 0.89 (ns) Performance Medical Care 0.39 *** 0.31 *** *** 3.95 *** Excitement Administrative Services 0.30 *** 0.12 ** *** 2.08 *** Basic F *** *** R Notes: All regression coefficients are standardized coefficients a symmetric influences of service quality attributes b asymmetric influences of service quality attributes * p < 0.1 ** p < 0.05 *** p < 0.001

17 Results: IRPA-IA analysis

18 Results: IRPA-IA table Construct Performance RIOCS SGP DGP IA NSC FCQ MDC ADS

19 Results: IPA vs. IAA analysis Service attributes characterization Basic Administrative Services: low-impact dissatisfier with low performance (3.25) Excitement Medical Care: high-impact satisfier with high performance (3.81) Nursing Care: medium-impact satisfier with relative low performance (3.41) Performance Facilities Condition: medium-impact hybrid with relative low performance (3.40)

20 Discussion and implications Setting satisfaction improvement priorities 1. Nursing & medical care: more resources should be allocated in advancing this services 2. Facilities condition: any improvement in that attribute will improve patient satisfaction 3. Administrative services: retention of current level of performance should be the target of the management since only its performance decrease will negatively affect patient satisfaction

21 Limitation and future research The findings and the implications of this research were obtained using a cross-sectional study. o This reduces the ability of the study to reflect the temporal changes in the research constructs o Longitudinal studies is necessary in order to clarify the effects of temporal changes The relationships among primary healthcare service attributes and patient satisfaction were validated with data from one country. o Performing the study across different countries would provide evidence about the generalizability of the service quality dimensions and the robustness of the relationships among the constructs determining patient satisfaction.

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