Service Quality of Hospitals Review

Service Quality of Public and Private Sector Hospitals with Special

Reference to Indore and Ujjain Cities: A Perceptual Study

Presented By:Harsha Rathore

At JNIBM VIKRAM UNIVERSITY, UJJAIN (M.P.) INDIA

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INTRODUCTIONINTRODUCTION

04/12/2304/12/23 IntroductionIntroduction 33

Hospitals also known as Health care centres where people get their health through products and services provided by hospital. Health is defined as state of complete physical, mental and social well being and just not the non-existence of diseases or ailment. Health care sector has been change with time to time. Earlier before independence health care was based on individual, medicinal properties of plants and herbs were passed from one generation to another. After independence Government of India laid down a stress on Primary health Care (PHC). But only government was not able to provide more facilities for health care. So to give more facilities to peoples government allowed private sector health care.

04/12/2304/12/23 IntroductionIntroduction 44

Service quality has been defined as “the outcome of an evaluation process where the consumer compares his expectations with the service he has received” or the difference between expected service and perceived service. Quality is considered as one of the important factors in differentiation and excellence of services and it is a basis of competitive advantage so that its understanding, measuring, and developing it are important challenges for all health services organizations. Service quality is the important reason patient select hospitals. The dimensions of patient perceived Hospital Service Quality (HSQ) are: Physical Environment and Infrastructure, Personnel Quality, Image, Trustworthiness, Support, Process of Clinical Care, Communication, Relationship, Personalization, Administrative Procedures.

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LITERATURE REVIEWLITERATURE REVIEW

Literature ReviewLiterature Review 66

Review of papers from 2004 to 2013 are as follows:1.1. Rameshan (2004), aimed to studied the quality of service of

primary health centers. He reveals that the services rendered by PHCs are deficient in many respects in the perception of customers and community members of the villages and that the doctors and the staff are unable to redress adequately the grievances raised by villagers. Villagers do not like the panchayat coming into the picture for improving the services of PHCs, district officials totally discount privatization as a means for providing effective primary health care in rural areas.

2.2. Mququ (2005), attempted to explore the customer satisfaction, expectations and perceptions as a measure of service quality. He shows that the SANBS customers are not satisfied with the service they receive, both on a zone (geographical) perspective and also on a customer group perspective. Expectations of private hospitals and rural state hospitals have higher ratings than those of urban state hospitals.

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3.3. Jain et al. (2006), studied the health seeking behavior and perception among rural community. He founds out that for health related problems, community members first discuss with family members and other influential persons of their caste community and accordingly take decision regarding where to seek care and/or treatment. Majority of people first try some home treatment and only when they are not relieved they opt for approaching any provider. Choice of health provider is in fact dependant on decision makers which could be elder male family members or some other person from the community Literacy status, socioeconomic status, past experience and perceived quality of health care services also play pivotal role in selection of provider. Quality of available health care services was poor in the opinion of respondents as a result of which rural community prefers to approach private providers ranging from indigenous medical practitioners, RMPs’ and qualified doctors.

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4.4. Rao et al. (2006), studied the use of 16-item scale having good reliability and validity. Patient perceptions of quality at public health facilities are slightly better than neutral. Multivariate regression analysis results indicate that for outpatients, doctor behavior has the largest effect on general patient satisfaction followed by medicine availability, hospital infrastructure, staff behavior, and medical information. For in-patients, staff behavior has the largest effect followed by doctor behavior, medicine availability, medical information, and hospital infrastructure.

5.5. Çaha (2007), indicates that patient’s perception towards the private hospitals was more due to believe that they provide qualitative health service. But large number of patients complains about services given by private hospitals. The complaints are mainly about the length of the time that they wait for treatment and the consultation time given to them. The lack of physical and human capacities of these hospitals seems to be the main reasons behind the quality of their service.

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6.6. Costa (2008), focuses on developing a health management information system. More physicians were worked on private sector located in urban areas. Access of women physicians was low (3.4%). All providers were negatively correlated to SC proportion and positively to ST proportions in the districts. Perception of policy maker on public and private health sector was value conflict and morality.

7.7. Anand and Sinha(2008), investigated the need of cognitive intermediation, which is likely to define core competence of health care organizations in India. It seems to have received relatively higher level of health workers’ visit. Level of public facilities’ utilization is higher in this segment. Adjusted segment characterized by higher literacy level, higher standard of living, high level of health workers’ visit and medium/high media exposure. Neglected and marginalized segment is characterized by the highest level of illiteracy, higher proportion of non-Hindu, not visited by health workers’ visits, low women autonomy, low media exposure.


8.8. Padma et al. (2009), studied two instruments for measuring the dimensions of hospital service quality, one each from the perspective of patients and attendants, are proposed.

9.9. Singh (2010), concluded that the important reasons to visit government hospitals are fewer charges, geographical proximity, recommended by their friends or relatives. Patients are found to be dissatisfied with the doctors’ checkups. Mostly patients were found dissatisfied with the hygiene and overall condition of the basic amenities. Half of the patients were satisfied with the recovery since admission in the hospital. Majority of patients were satisfied with various diagnostic services provided by hospitals. Mostly patients did not lodge complaint against the behavior of staff and quality of services.


10.10. Narichiti (2010), clearly reveal that the perception of doctors and nursing staff in case of Government General Hospital. There is a perceptible gap in the minds of doctors and nursing staff and also on the dimensions of service expected and received by the patients on the environment created for achieving patient centre hospitals. However, the gap is thin in case of the doctors and nursing staff of St. Joseph’s and NRI General Hospitals.

11.11. Rajendran et al. (2010), identifies that patients and attendants treat the interpersonal aspect of care as the most important one, as they cannot fully evaluate the technical quality of healthcare services. The study also revealed that the hospital service providers have to understand the needs of both patients and attendants in order to gather a holistic view of their services.


12.12. Shah et al. (2010), indicates that the deficiencies in the public health delivery system of India, was the key to growth of private infrastructure in healthcare. The shift of hospital industry for ‘welfare orientation’ to ‘business orientation’ was marked by the advent of corporate hospitals, supported by various policy level initiatives made by the government. This paper tracks the various government initiatives to promote private investment in healthcare and attempts to explore the reasons for preference of the private sector. Surprisingly, in contrast to contemporary belief, quality of medical care doesn’t seem to be the leading cause for preference of the private sector. Except for a few select corporate and trust hospitals, quality of medical care in private sector seems to be poor and at times compromised.

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13.13. Chunduri (2011), clearly reveal that service quality was the one of the important drivers in selection of a hospital. The researcher would like to state that each demographic was associated with the choice of hospitals. The results of analysis show that the attitudes of the patients within each dimension having a uniform or equal attitude for any item between hospitals.

14.14. Sharma (2011), shows that ‘Healthcare delivery’ and ‘financial and physical access to care’ significantly impacted the perception among men while among women it was ‘healthcare delivery’ and ‘health personnel conduct and drug availability’. With improved income and education, the expectations of the respondents also increased. The overall quality of healthcare services is perceived to be higher in Primary Healthcare Centers than in Community Healthcare Centers (CHCs). Inadequate availability of doctors and medical equipments, poor clinical examination and poor quality of drugs were the important drawbacks reported at CHCs.


Another interesting finding that emerged was with respect to IPD and OPD patients and their intention to visit the health centre in future. For those visiting the hospital for minor health problems, physical and financial access to health centers, and availability of doctors providing sufficient time, and satisfactory prescription to help them recover fast were more important than other factors.

15.15. Natarajan (2011), reveals that Gujarat has a socio-economic environment which is conducive to achieve these goals. Significant gains have been made in improving the health care indicators in the State by increasing financial support, a planned approach to improve the health care system and involvement of all stakeholders to attain the desired goals.


16.16. Irfan (2011), studied that private hospitals in Pakistan are making better efforts as compared to the public hospitals. Private hospitals like the other service organizations are focusing on their patients demands and developing themselves in order to provide maximum healthcare facilities to their patients. Whereas the poor quality of healthcare services delivered to patients by public hospitals as compare to the private hospitals are due to the many factors. These factors include: government funding, lack of government interest in development of new healthcare projects rural areas and over burdened public hospitals due to rapid growth in population and people trends to move from rural areas to major cities. These factors are affecting the service quality of public hospitals.

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17.17. Itumalla (2011), concluded that Patients have pointed out several shortcomings including lack of responsiveness to patients’ needs, delays, unreliable supply of medicines in hospital, maintaining cleanliness and inadequate availability of diagnosis services. Health personnel conduct and practices was rated lowest with 84.4%out of four aspects of service quality such as Health personnel conduct and practices, Adequacy of resources and services, healthcare delivery and financial and physical accessibility. Overall respondents in hospital based study perceived quality of care at the hospital OPD as favourable.

18. 18. Brahmbhatt et al. (2011), shows that Out of 5 dimensions Private hospitals perform better than public hospital in 4 dimensions namely Physical Aspects, Encounter, Process and Policy, while public sector hospitals perform better than private sector only in one dimension namely Reliability. Overall private sector is performing better in Encounter dimension, but specific Encounter-Responsiveness public sector has lowest score.

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19.19. Narang (2011), aims to investigate differences across various socio-demographic characteristics of the respondents. The opinions of the respondents towards health care quality were not very favourable. Negative scores were obtained on items, “availability of adequate medical equipments” and “availability of doctors for women”. Education, gender and income were found to be significantly associated with user perception.

20.20. Kavitha (2012), measures the gap between the management’s perceptions of patient expectations and the patients‟ expectations of service quality. The perceptions of the Doctors representing the management about the patient’s expectations of service are very high when compared to the patient’s expectations in both hospitals. Aggregate mean values of the two hospitals are calculated and it is found that for all the dimensions, there is significant difference between the mean scores of management’s perceptions of patient expectations and patients’ expectations.


However, as between the hospitals, there is no significant difference between the hospitals in the doctor’s perceptions about patient’s expectations.

21.21. Murthy(2012), shows that macro and micro factors affect the health care situation and identifies Empathy as a key factor on which private hospitals score over public hospitals. The nurse acts as an interface between customer and hospital and thus is very important from the point of view of customer satisfaction. The registration desk was to improve to ease of registration. The private sector scores over the public sector in having access to the most modern equipment and technology.


22.22. Grøndahl (2012), concludes that patients’ perceptions of quality of care and patient satisfaction ranged from lower to higher depending on whether all patients or groups of patients were studied. 3 clusters of patients were identified regarding their scores on patient satisfaction and patients’ perceptions of quality of care. One group consisted of patients who were most satisfied and had the best perceptions of quality of care, a second group of patients who were less satisfied and had better perceptions, and a third group of patients who were less satisfied and had the worst perceptions. The qualitative study revealed 4 categories of importance for patients’ satisfaction: desire to regain health, need to be met in a professional way as a unique person, perspective on life, and need to have balance between privacy and companionship.


23.23. Sharmila (2013), study indicates that service quality in private hospitals is meeting patients‘ satisfactions and private hospitals are delivering better healthcare services. The result can be used by the hospitals to reengineer and redesign creatively their quality management processes and the future direction of their more effective healthcare quality strategies.

24.24. Vashist and Jain (2013), concludes Private sector delivers awareness about quality of medical care, greater penetration of insurance, increased purchasing power, changing demographic structure, etc. Private sector also changes day to day. As healthcare was viewed as a profitable venture, corporate culture takes part in healthcare delivery. Inherent factors like improved efficiency, better quality, greater reliability and transparency has also aided in the growth of private sector in healthcare.


25.25. Wani et al.(2013), study shows that India lags behind in regard of health improvement as compared to U.S.A, Canada, China, and Brazil, but contrary to other developing countries like Pakistan, Bangladesh the scenario is better with life expectancy, Mortality ratios, health care spending speak volumes about the healthcare status. When analyzed through the prism eye, within India there are large disparities amongst states in achieving health outcomes as well. Before liberalization the improvement was at a snail’s pace, but after liberalization the whole picture changed because the key initiatives to improve the current healthcare standard a two prong strategy focusing on the infrastructure needs and the technology solution were implemented, which resulted in the healthy scenario of the healthcare industry.

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ConclusionConclusion

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On the basis of above studies, it has been found that numbers of

studies have been conducted on service quality of hospital sector.

This is one of the rapid growing sectors of India. But still number of

geographical regions have been uncovered in the above studies i.e.

Malwa region of Madhya Pradesh. The title of the proposed

research is also focusing on the different dimensions of service

quality which have been studied at different geographical regions in

India. The proposed research will also be covering the service

quality part of hospitals of two cities (i.e. Indore and Ujjain) of

Malwa region. These two cities are nearby each other but

demography of people is different. Both are divisions of Madhya

Pradesh, one is (i.e. Indore) fast growing commercial city and

another (i.e. Ujjain) is the religious city of Madhya Pradesh. The

present research topic is an effort to understand the service quality

of hospital sector with special reference to Indore and Ujjain cities

of Madhya Pradesh.

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