Hospital Service Quality Based on HEALTHQUAL Model and Trusting Nurses at Iranian University and Non-University Hospitals: A Comparative Study

Abstract

Background: Establishment and improvement of patients’ trust in healthcare organizations like hospitals necessitate delivering high-quality services by nurses, as the largest group of healthcare providers. The present study aimed to compare hospital service quality based on the HEALTHQUAL model and trusting nurses at university and non-university hospitals in Iran.Methods: This comparative cross-sectional study was conducted on 990 patients admitted to university and non-university hospitals located in Bushehr Province, southern Iran, who were selected using the stratified random sampling method. The data were collected through the HEALTHQUAL questionnaire and the Trust in Nurses Scale, and then analyzed via the SPSS Statistics software (version 22) as well as the General Linear Model (GLM) univariate procedure and the Chi-square test with a significance level of 0.05.Results: The study findings revealed that the mean values of real quality (perceptions) and ideal quality (expectations) were 3.89±0.69 4.55±0.47, respectively. The gap between the real and ideal quality (-0.64) was also higher at the non-university hospital from the patients’ viewpoints. Comparing various dimensions of service quality, the largest gap at university and non-university hospitals was associated with “environment” (-0.13) and “empathy” (-0.18), respectively. Additionally, the mean scores of patient trust in nurses at university and non-university hospitals were 10.34±5.81 and 8.71±4.05, respectively, being a statistically significant difference (p<0.001).Conclusion: The study results demonstrated that hospital service quality and trusting in nurses were at higher levels at the university hospital than the non-university one; however, hospital service quality was lower than what the patients had expected. Accordingly, hospital managers and policy-makers were suggested to focus on patients to reduce gaps in service quality, to promote service quality, and to provide better healthcare services to patients.

Quality assessment of services provided by health centers in Mashhad, Iran: SERVQUAL versus HEALTHQUAL scales

“…This result was in consistent with Nemati et al study. This study showed that patients at hospitals paid more attention to "environment" dimension based on HEALTHQUAL model [20]. Since Tangibility dimension in SERVQUAL refers to physical and observable services same as the Environment dimension in HEALTHQUAL, it can be approved that the two questionnaires present had almost similar results in terms of service users' expectations.…”

“…Mosadeghrad and Sokhanvar revealed that the quality gaps in the provided health-care services were (− 0.57) and (− 0.58), respectively in two studies conducted based on HEALTHQUAL model [21]. Nemati et al, in a study aimed to compare the Iranian university and non-university hospitals service quality based on the HEALTHQUAL model, found that the quality gap was − 0.42 and − 0.64 for university and nonuniversity hospitals respectively [20]. The quality gap reported in these studies was less than the value mentioned in the present study, and this can be attributed to the difference between the population and study setting (hospital vs. health centers).…”

“…Two studies evaluated the quality of services in hospitals using HEALTHQUAL instrument. In these studies, the lowest average score of perceptions was related to "Efficiency" dimension [20,21]. In HEAL THQUAL model, efficiency refers to factors such as waiting time, speed of service delivery and costeffectiveness of healthcare services.…”

“…Various studies have investigated service quality and addressed the quality gap in services provided in comprehensive health service centers and hospitals. The results of these studies suggest that there is an improper responsiveness of health system to people’s health priorities and raised health-care costs [ 12 – 16 , 22 , 23 ]. Despite many studies carried out on quality of health-care services in Iran, there is a lack of evidence for health-care quality in Mashhad.…”

“…Therefore, by conducting studies in health-care context in Iran, a tool called HEALTHQUAL was designed to give a better image about the quality of health-care services [18,19]. This questionnaire has been previously employed in several studies to evaluate the quality of health-care services [20,21].…”