Role of internal service quality in enhancing patient centricity and internal customer satisfaction

Purpose The purpose of this paper is to identify the antecedents and outcomes of internal service quality (ISQ) in a health-care environment. The relationships among the heterogeneous health-care environment, coordinated care, perceived organisational support (POS), ISQ, internal customer satisfaction and patient-centred care were explored. Design/methodology/approach Based on a review of the literature, a structural model was developed. A 37-item questionnaire was circulated among service providers in the health-care system, including doctors, nurses and system staff, all over India. The random sampling method was adopted to collect data. A total of 238 valid responses were received. The data were analysed using structural equation modelling. Findings The results show that the heterogeneous environment, coordinated care and POS act as antecedents of ISQ, which drives internal customer satisfaction and patient centricity in health care. Research limitations/implications The paper contributes to the health-care literature by identifying the antecedents and consequences of ISQ and developing a structural relationship among ISQ, the heterogeneous health-care environment, coordinated care, POS, internal customer satisfaction and patient-centred care. Practical implications Hospital administrators may use various constructs of POS, ISQ and coordinated care to measure process and employee performance, which may aid the design of appropriate processes and improve employee selection. The constructs of patient centricity and internal customer satisfaction may be used as benchmarking tools to facilitate the formulation of immediate corrective actions and policies for future courses of action. Social implications This paper highlights how patient centricity may be achieved by focussing on ISQ, coordinated care processes and a facilitative internal environment. This understanding may aid the design of processes that in turn deliver health as a social good in an effective manner. Originality/value This paper extends past research on ISQ by showing that ISQ affects internal customer satisfaction and, in turn, the quality of service delivery in the system. In the health-care context, heterogeneity in patient needs, coordinated care and organisational support play crucial roles in determining ISQ, which in turn influences the level of patient-centred care.

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Not for the faint of heart

Qualitative Research in Organizations and Management An International Journal ◽

10.1108/qrom-10-2012-1107 ◽

2014 ◽

Vol 9 (1) ◽

pp. 47-65 ◽

Cited By ~ 5

Author(s):

Ann-Marie Urban ◽

Elizabeth Quinlan

Keyword(s):

Health Care ◽

Data Collection ◽

Health Care Organizations ◽

Institutional Ethnography ◽

Health Care Environment ◽

Care Environment ◽

Collection Method ◽

Content Type ◽

Data Collection Method ◽

Health Care Context

Purpose – The purpose of this paper is to share two researcher's experience about the challenges associated with shadowing within the health care context. Design/methodology/approach – Institutional ethnography and shadowing. Findings – Shadowing is increasingly being used as a data collection method, however, before proceeding to use this approach in today's health care environment, the researcher must give thoughtful consideration to the context. Originality/value – This paper provides a reflexive elaboration of the differences between the insider and outsider perspective when using the shadowing data collection method within health care organizations.

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The perceived impact of restructuring on service quality in a health care environment

Corporate Ownership and Control ◽

10.22495/cocv10i1c4art2 ◽

2012 ◽

Vol 10 (1) ◽

pp. 408-420

Author(s):

Lisebo Ntsatsi ◽

Sanjana Brijball Parumasur

Keyword(s):

Health Care ◽

Service Quality ◽

Health Care Organization ◽

Hospital Environment ◽

Cluster Sampling ◽

Care Organization ◽

Health Care Environment ◽

Care Environment ◽

Health Care Employees ◽

Regional Hospitals

This study evaluates health care employees’ perceptions of service quality in a hospital environment after the process of restructuring and assesses whether their perceptions are influenced by biographical profiles. A sample of 143 clinical and non-clinical employees from three of the largest regional hospitals within the Ministry of Health in Lesotho was drawn using cluster sampling. Data was collected using an adapted version of SERVQUAL whose psychometric properties were statistically determined. Data was analyzed using descriptive and inferential statistics. The results indicate that employees were fairly convinced that the process of transformation undertaken in the health care organization led to enhanced service quality in terms of improved empathy, assurance, responsiveness, tangibles and reliability, although in varying degrees and, reflect areas for improvement

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Planned change and service quality in a health care environment: assessing outcomes

Corporate Ownership and Control ◽

10.22495/cocv11i1c10p2 ◽

2013 ◽

Vol 11 (1) ◽

pp. 838-848

Author(s):

Lisebo Ntsatsi ◽

Sanjana Brijball Parumasur

Keyword(s):

Health Care ◽

Service Quality ◽

Psychometric Properties ◽

Planned Change ◽

Hospital Environment ◽

Cluster Sampling ◽

Care Hospital ◽

Health Care Environment ◽

Care Environment ◽

Regional Hospitals

This study assesses the outcomes of a process of planned change undertaken in a health care hospital environment in Lesotho in terms of service quality. A sample of 143 clinical and non-clinical employees from three of the largest regional hospitals within the Ministry of Health in Lesotho was drawn using cluster sampling. Data was collected using an adapted version of SERVQUAL whose psychometric properties were statistically determined. Data was analyzed using descriptive and inferential statistics. The results indicate that the process of transformation significantly contributed to all the sub-dimensions of service quality (tangibles, reliability, responsiveness, assurance, empathy) except the process before restructuring which did not contribute to responsiveness, assurance and empathy respectively. Furthermore, all the sub-dimensions of the process of transformation significantly impact on the different sub-dimensions of service quality, although not optimally

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Impact of service attributes on customer satisfaction and loyalty in a healthcare context

Leadership in Health Services ◽

10.1108/lhs-12-2013-0045 ◽

2015 ◽

Vol 28 (2) ◽

pp. 149-166 ◽

Cited By ~ 7

Author(s):

Subash Lonial ◽

P.S. Raju

Keyword(s):

Health Care ◽

Customer Satisfaction ◽

Service Quality ◽

Care Setting ◽

Customer Relationship ◽

Strong Impact ◽

Content Type ◽

Customer Satisfaction And Loyalty ◽

Service Attribute

Purpose – The purpose of this paper is to examine the role of perceived service attributes in the development of overall customer satisfaction (OCS) and customer loyalty (CL) in a health-care setting. This paper also sheds light on the role of hospitalist physicians (HPs) and offers suggestions to improve patient satisfaction and loyalty. Design/methodology/approach – A telephone survey was used to collect data from recently hospitalized patients with respect to their HP. Structural equations modeling (SEM) was used to confirm the overall relationships between perceived service quality (PSQ), OCS and CL. The sample was then divided into customer relationship groups (CRGs) based on satisfaction and loyalty measures. Discriminant analysis was used to determine which attributes differentiated most between high and low satisfaction and loyalty groups. Findings – Overall relationships among PSQ, OCS and CL were in conformity with the conceptual model. Findings also revealed that service attributes played an important role in distinguishing between high and low satisfaction and loyalty groups, although some attributes were more important than others and different attributes emerged as being key influencers for satisfaction and loyalty. Research limitations/implications – The conceptual model used is a fairly straight forward model, and we have not considered the impact of individual factors such as expectations and value perceptions or involvement levels and demographic characteristics on service quality and overall satisfaction. The data for this study were provided by a major health maintenance organization (HMO), and there is room for improvement in the manner in which certain constructs were measured. For example, OCS, recommendation and retention all used single item measures, and it might have been preferable to use multiple item measures for these constructs. Practical implications – The study shows that organizations can benefit by identifying and focusing on critical attributes as part of their customer relationship management program. Social implications – The SEM results provide strong support for the overall model linking service quality, OCS and CL in a health-care setting. As one would expect, PSQ has a strong impact on OCS, which, in turn, has a fairly strong impact on CL. However, there is also a significant direct linkage between PSQ and CL. This linkage shows that at least a certain portion of CL could evolve independent of the satisfaction level with the HP. This shows that, in addition to trying to improve satisfaction, organizations should also explore influencing loyalty directly, perhaps by the strategic use of service attribute perceptions. Originality/value – The study shows that customer perceptions at the service attribute level can often be the key to the generation and management of customer satisfaction and loyalty. It also has significance for how satisfaction and loyalty with HPs can be improved in a hospital setting.

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Knowledge-based lean six sigma system for enhancing quality management performance in healthcare environment

International Journal of Lean Six Sigma ◽

10.1108/ijlss-06-2017-0066 ◽

2019 ◽

Vol 10 (1) ◽

pp. 211-233 ◽

Cited By ~ 6

Author(s):

Yousuf Nasser Al Khamisi ◽

M. Khurshid Khan ◽

J. Eduardo Munive-Hernandez

Keyword(s):

Health Care ◽

Decision Making ◽

Quality Management ◽

Six Sigma ◽

Best Practice ◽

Lean Six Sigma ◽

Health Care Environment ◽

Care Environment ◽

Content Type ◽

Knowledge Based

PurposeThis paper aims to present the development of a knowledge-based system (KBS) to support the implementation of Lean Six Sigma (L6s) principles applied to enhance quality management (QM) performance within a health-care environment. Design/methodology/approachThe process of KBS building has been started by acquiring knowledge from experts in field of L6σ and QM in health care. The acquired knowledge has been represented in a rule-based approach for capturing L6σ practices. These rules are produced in IF […].THEN way where IF is the premise and THEN is the action. The produced rules have been integrated with gauging absence pre-requisites (GAP) technique to facilitate benchmarking of best practice in a health-care environment. A comprehensive review of the structure of the system is given, detailing a typical output of the KBS. FindingsImplementation of L6s principles to enhance QM performance in a health-care environment requires a pre-assessment of the organisation’s competences. The KBS provides an enhanced strategic and operational decision-making hierarchy for achieving a performance benchmark. Research limitations/implicationsThe KBS needs validation in real health-care environment, which will be done in Oman’s hospitals. Practical implicationsThe paper is intended to benefit QM practitioners in the health-care sector during decision-making to achieve performance improvement against a best practice benchmark. Originality/valueThis research presents a novel application of a hybrid KBS with GAP methodology to support the implementation of L6s principles to enhance QM performance in a health-care environment.

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Antibiotic-Selected Gene Amplification Heightens Metal Resistance

mBio ◽

10.1128/mbio.02994-20 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

David A. Hufnagel ◽

Jacob E. Choby ◽

Samantha Hao ◽

Anders F. Johnson ◽

Eileen M. Burd ◽

...

Keyword(s):

Health Care ◽

Bacterial Colonization ◽

Multidrug Resistant ◽

Metal Resistance ◽

Health Care Facilities ◽

Health Care Environment ◽

Nickel Resistance ◽

Care Environment ◽

Content Type ◽

Implanted Devices

ABSTRACT The increasing frequency of antibiotic resistance poses myriad challenges to modern medicine. Environmental survival of multidrug-resistant bacteria in health care facilities, including hospitals, creates reservoirs for transmission of these difficult to treat pathogens. To prevent bacterial colonization, these facilities deploy an array of infection control measures, including bactericidal metals on surfaces, as well as implanted devices. Although antibiotics are routinely used in these health care environments, it is unknown whether and how antibiotic exposure affects metal resistance. We identified a multidrug-resistant Enterobacter clinical isolate that displayed heteroresistance to the antibiotic colistin, where only a minor fraction of cells within the population resist the drug. When this isolate was grown in the presence of colistin, a 9-kb DNA region was duplicated in the surviving resistant subpopulation, but surprisingly, was not required for colistin heteroresistance. Instead, the amplified region included a three-gene locus (ncrABC) that conferred resistance to the bactericidal metal, nickel. ncrABC expression alone was sufficient to confer nickel resistance to E. coli K-12. Due to its selection for the colistin-resistant subpopulation harboring the duplicated 9-kb region that includes ncrABC, colistin treatment led to enhanced nickel resistance. Taken together, these data suggest that the use of antibiotics may inadvertently promote enhanced resistance to antimicrobial metals, with potentially profound implications for bacterial colonization and transmission in the health care environment. IMPORTANCE To inhibit bacterial transmission and infection, health care facilities use bactericidal metal coatings to prevent colonization of surfaces and implanted devices. In these environments, antibiotics are commonly used, but their effect on metal resistance is unclear. The data described here reveal that exposure of a human isolate of Enterobacter cloacae to a last-line antibiotic, colistin, resulted in a DNA amplification that does not confer antibiotic resistance but instead facilitates resistance to the toxic metal nickel. This highlights a novel aspect of antibiotic and metal interplay. Concerningly, these data suggest the use of antibiotics could in some cases promote bacterial survival and colonization in the health care environment and ultimately increase transmission and infection of patients.

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