Taṣvīr-i salāmat (Sep 2021)
Quality of Health Services and the Factors Affecting it: A Cross-Sectional Study in Pilot Hospitals for Electronic Referral System
Abstract
Background and objectives Health system services are not reliable without quality assessment. It is important to explore gaps between standard services and existing situation to improve the quality of health system. His study aimed at studding the quality assessment of electronic referral system in one of the major provinces of Iran. Material and Methods This study was a cross-sectional study utilizing SERVQUAL model. The population comprised 3 groups totaling approximately 11,004 people. The sample size allocated to each city was determined in view of the ratio of patients. A sample of 384 patients who used electronic referral service at level 2 and revived outpatient services constructed the population of study. The data were collected through a two-part questionnaire. The validity of the questionnaire was confirmed by 10 experts including senior and mid-level managers and medical science university faculty members. The questionnaire assessed demographic data and the patients' perceptions and expectations. Data was analyzed using descriptive statistics and analytical statistics such as nonparametric mean comparison tests, in view of the normality assumption,) including Wilcoxon test, Mann-Whitney and Kruskal-Wallis. Spearman correlation test was used to determine the intensity of correlation between the study variables. The significance level of all tests was considered 0.05. Results There were identified gaps throughout all dimensions of health service among the studied clinics (P 0.05). But the gap in service quality was significantly associated with the patients' gender (P = 0.005) and education level (P = 0.028). So that the biggest gap was related to women and illiterate people. Also, the quality gap was different according to the city (P = 0.028), with the largest gap related to Aq-Qala city. Conclusion The results showed that the studied hospitals could not meet the expectations of the patients in any of the five components of service quality, with the perceived quality always lagging behind the expected quality. This highlights need to improve the quality of services through paying more attention to people in the community in order to deliver committed services reliably, accurately and correctly in a timely manner, as well as, enhancing the knowledge, etiquette and ability of employees to build trust and confidence in customers. Since at the time of the study, only three cities, Bandar-e-Turkmen, Aq-Qala and Aliabad-e-Katoul, were implementing an electronic referral system, it was not possible to study other cities in this field and the statistical population was outpatients from level 1 to level 2. A wider study should be conducted at the provincial level to include all referrals to family physicians at level one and all inpatient and outpatient referrals. In addition, the SERVQUAL questionnaire does not cover all the expectations, perceptions and beliefs of patients, so the use of qualitative study methods along with quantitative methods in future studies could provide a better understanding of the issue of quality. Practical implications of research According to the results of this study, it is suggested that officials and providers of health services should prioritize:- Continuous improvement and evaluation of service quality in planning;- Equipping medical centers with efficient and new equipment;- Providing services at the promised time and in the shortest time to clients;- Availability of staff and service providers when patients are referred;- Familiarity with the knowledge and skills of the day to meet the needs of clients and- Understanding the values and emotions of clients Ethical considerations study protocol, with the number IR.GOUMS.REC.1397.289, was ethically approved by the Research Ethics committee of Golestan University of Medical Sciences. At the time of data collection, respondents were assured that their information would remain confidential and the questionnaire was completed anonymously. Meanwhile, those who did not want to participate in the study were excluded from the study. Conflict of interest The authors state that there is no conflict of interest in the present study. Acknowledgement The Vice Chancellor for Research and Technology of Golestan University of Medical Sciences and the Research Center for Health Management and Social Development for approving the research plan with code 110602 and the assistance of officials and staff of selected hospitals in conducting this research plan are appreciated.
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