Assessing the quality of hospital services in medical training centers of Qazvin University of Medical Sciences, using performance importance analysis (1391-2012)

Abstract:

Introduction: Providing quality services is one of the main functions of the health system. Customer satisfaction is at the heart of every organization and is considered as the ultimate goal of every organizational strategy. Patient satisfaction is a concept that has become very important in medical care today and plays an important role in the health care process. Service quality measurement is a basic prerequisite for quality improvement. The purpose of this research is to measure the quality of services using performance-importance analysis in the hospitals of Qazvin University of Medical Sciences.

Materials and methods: This is a descriptive-analytical and cross-sectional study that was conducted on 298 hospitalized patients in 1992-1991 in hospitals affiliated to Qazvin University of Medical Sciences to evaluate the quality of services to identify the weaknesses and strengths of service quality. The data collection was based on the standard Serqual questionnaire, the reliability and validity of this questionnaire has already been confirmed by the studies conducted in Iran and other countries. This study is based on performance-importance analysis, which in this model, each component of the five dimensions of SERVQUAL is evaluated with two components of "importance and performance". Data analysis was done using SPSS software and ANOVA statistical test.  

Findings: The results showed that there is a significant gap between importance and performance in all five dimensions (p<0.05). In the examination of the gap between the credibility dimension (2.36) and the quality (2.24), the highest gap was found in the quality dimension and the accountability dimension (1.97) had the lowest gap. Also, in these findings, in the analysis of the 4 areas of the importance-performance matrix [area of ??focus (A), continuation of the situation (B), low priority (C) and waste of resources (D)] the dimensions of credibility and assurance in area (A), the dimension of empathy in area (B), and the dimensions of concreteness and accountability in area (D) were included. All dimensions are necessary. In order to reduce the gap between the five dimensions of quality and provide optimal services to patients and to be in the area of ??continued good status (b), it is suggested that hospital managers pay special attention to the needs of patients with their optimal planning and management.

Key words: importance-performance model, quality of health services, patient satisfaction.

Introduction

The Ministry of Health, Treatment and Medical Education, as the custodian of people's health, is always trying to use the most effective solutions in order to achieve health goals by accurately understanding the health needs and risks of individuals and communities and using new and scientific methods of policy making and decision making. Ensuring the provision of quality and safe services, as one of the main functions of the health system, is of special importance and priority, and naturally, proper policy making, planning, implementation and control in this field requires special attention and reflection (Ministry of Health 2019). Also, good quality care is critical to achieving the Millennium Development Goals (MDGs). Health care managers need a thorough understanding of ways to increase the quality of care in a practical way (Sodani, 2012). Among the organizations that provide healthcare services are hospitals (Asefzadeh, 2016). The issue of improving the quality of the organization's performance is considered one of the important approaches in development (Sadighi et al., 2014). Nowadays, the quality of services has become increasingly important, especially in institutions that face a high volume of clients, such as financial and care services, and it can be considered as an essential strategy that helps the institution to achieve desirable results in the competitive market and achieve the necessary profitability in the long run. Improving service quality has become a major challenge for service institutions to meet the expectations of service recipients and their satisfaction (Prattana et al, 2012). Service quality as an effective and comprehensive strategy has been included in the management agenda (Sahney et al, 2006).Therefore, obtaining satisfaction is at the heart of every organization's mission and is considered as the ultimate goal for every organizational strategy (Zairi, 2000). By maintaining high quality, it is a prerequisite for the success of service organizations (Wong et al, 2003). Customer satisfaction is one of the most important and vital topics for today's organizations. Today, the failure or success of the organization is determined based on the satisfaction of its customers from the company's products or services (Zineldin, 2000). Because identifying the customer's needs and ensuring his satisfaction, keeps the customer for the organization. A forward-thinking organization needs to take a close look at issues related to customer satisfaction. In fact, satisfaction is a customer's evaluation and measurement of the experience he gets after using a product or service, the result of satisfaction is introduced and explained as consumer utility (Johnson et al, 1995). Kotler's definition is that satisfaction is a person's pleasant feeling or disappointment, which is obtained by comparing the perceived performance of a product or service with his expectations (Kotler et al., 2014). In other words, satisfaction is the customer's response to the fulfillment of his needs. In fact, the level of customer satisfaction and the desirability of consuming goods and services for him in relation to the satisfaction of his needs express his satisfaction (Andaleeb, 2006).

The issue of quality has been widely considered in the fields of production and industry, but in the service sector, due to the main characteristic of services, i.e., its intangibility, this issue has been less addressed. Among the service sub-sectors, the health and medical services sector has a special place. Because in this section, any type of mistake is not allowed, even a small one. This department communicates with a wide segment of the society, and more importantly, this department is responsible for maintaining the health of the society, and effective action to improve the service method and obtain customer satisfaction is of particular importance in this department (Murphy, 2007). Healthcare providers want to use high levels of service quality to increase patient satisfaction. In fact, satisfaction surveys have been widely used as a management tool to address access and performance problems. It has also been a tool in helping organizations identify target groups, clarify goals, define performance criteria, and develop performance information systems. In addition, in the new health care literature, it is considered that attention to patient satisfaction is a dominant concern that is intertwined with strategic decisions in health services (Gilbert et al, 1992). The ultimate goal of quality is to satisfy customers. Therefore, we must know their needs and expectations in order to satisfy them (Fuentes, 1999). Therefore, service quality is known as the main determinant of an organization's success in today's competitive environment, and any decrease in customer satisfaction due to poor service quality is cause for concern. Quality is meeting the needs and demands of customers and it is the customers who define it. The problem of service quality occurs mostly in organizations that do not focus on knowing and meeting the needs and expectations of customers. The service organization should put itself in the place of customers and base its policies on their point of view.  The lack of direct communication with the customer causes the decision-makers and planners to not be able to determine the priority of the affairs correctly, and this causes the service performance to not be able to meet the expectations of the customers, and as a result, there is a difference of opinion between the customers in the field of service quality. The basic step to compensate for this difference is to know his perceptions and expectations of service quality and determine the amount of the difference. In this case, not only the prioritization and allocation of resources is facilitated, but also a basis is provided to improve the quality of the services provided (Agha Melai et al., 2007).

Through conflict analysis, managers can clearly determine when and in which aspect of the service, the expectations and experiences of the service recipients are not compatible with each other and will probably lead to dissatisfaction (Karydis, et al, 2001).