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Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Experiencing health care service quality: through patients’ eyes

Sharon Schembri
+ Author Affiliations
- Author Affiliations

College of Business Administration, University of Texas–Pan American, 1201 West University Drive, Edinburg, TX 78541, USA. Email: schembrist@utpa.edu

Australian Health Review 39(1) 109-116 https://doi.org/10.1071/AH14079
Submitted: 12 March 2014  Accepted: 21 August 2014   Published: 16 October 2014

Abstract

Objective The primary aim of the present study was to consider health care service quality from the patients’ perspective, specifically through the patient’s eyes.

Method A narrative analysis was performed on 300 patient stories. This rigorous analysis of patient stories is designed to identify and describe health care service quality through patients’ eyes in an authentic and accurate, experiential manner.

Results The findings show that there are variant and complex ways that patients experience health care service quality.

Conclusion Patient stories offer an authentic view of the complex ways that patients experience health care service quality. Narrative analysis is a useful tool to identify and describe how patients experience health care service quality. Patients experience health care service quality in complex and varying ways.

What is known about the topic? Patient satisfaction measures are increasingly used for benchmark and accreditation purposes. Measures of patient satisfaction are considered indicative measures of service quality and quality of care. However, the measurement of patient satisfaction and service quality is not an accurate reflection of what and how patients experience health care.

What does this paper add? This paper takes a narrative approach and analyses 300 patient stories to demonstrate the essence of patients’ evaluation of health care service quality.

What are the implications for practitioners? Health care service quality is shown to be experienced in various ways. Identifying and describing these different ways of experiencing health care service quality provides practitioners with strategic insight into improving the quality of service they provide outside the realm of objective satisfaction measures. These findings also demonstrate the value in a third-party feedback system.

Additional keywords: narrative analysis, patient experience, patient opinion, patient satisfaction.


References

[1]  Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q 1966; 44 166–206.
Evaluating the quality of medical care.Crossref | GoogleScholarGoogle Scholar | 5338568PubMed |

[2]  Stewart M. Patient-centered medicine: transforming the clinical method. Oxon: Radcliffe Publishing; 2003.

[3]  Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington DC: Institute of Medicine of the National Academies; 2001 Available at: http://iom.edu/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx [verified 11 March 2014].

[4]  Grol R. Improving the quality of medical care: building bridges among professional pride, payer profit, and patient satisfaction. JAMA 2001; 286 2578–85.
Improving the quality of medical care: building bridges among professional pride, payer profit, and patient satisfaction.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mnpt12nug%3D%3D&md5=8809c97f1c009bb8f4c478b07311087bCAS | 11722272PubMed |

[5]  Gill L, White L. A critical review of patient satisfaction. Leadersh Health Serv 2009; 22 8–19.
A critical review of patient satisfaction.Crossref | GoogleScholarGoogle Scholar |

[6]  Hordacre AL, Taylor A, Pirone C, Adams RJ. Assessing patient satisfaction: implications for South Australian public hospitals. Aust Health Rev 2005; 29 439–46.
Assessing patient satisfaction: implications for South Australian public hospitals.Crossref | GoogleScholarGoogle Scholar | 16255709PubMed |

[7]  Kenagy JW, Berwick DM, Shore MF. Service quality in health care. JAMA 1999; 281 661–5.
Service quality in health care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M7ltFGruw%3D%3D&md5=a126fcd3fa4a061f5d2aed89257a52c7CAS | 10029131PubMed |

[8]  Greenfield D, Pawsey M, Hinchcliff R, Moldovan M, Braithwaite J. The standard of healthcare accreditation standards: a review of empirical research underpinning their development and impact. BMC Health Serv Res 2012; 12 329
The standard of healthcare accreditation standards: a review of empirical research underpinning their development and impact.Crossref | GoogleScholarGoogle Scholar | 22995152PubMed |

[9]  Hekkert KD, Cihangir S, Kleefstra SM, van den Berg B, Kool RB. Patient satisfaction revisited: a multilevel approach. Soc Sci Med 2009; 69 68–75.
Patient satisfaction revisited: a multilevel approach.Crossref | GoogleScholarGoogle Scholar | 19446942PubMed |

[10]  Henderson A, Caplan G, Daniel A. Patient satisfaction: the Australian patient perspective. Aust Health Rev 2004; 27 73–83.
Patient satisfaction: the Australian patient perspective.Crossref | GoogleScholarGoogle Scholar | 15362299PubMed |

[11]  Parsons T. The social system. London: Routledge; 1991.

[12]  Williams B. Patient satisfaction: a valid concept? Soc Sci Med 1994; 38 509–16.
Patient satisfaction: a valid concept?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2c3ktVGmuw%3D%3D&md5=e22984f48c926431b28a0d8cbb0ba08dCAS | 8184314PubMed |

[13]  Calnan M. Toward a conceptual framework of lay evaluation of health care. Soc Sci Med 1988; 27 927–33.
Toward a conceptual framework of lay evaluation of health care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL1M7ks1eitQ%3D%3D&md5=d44b67db35c5dd3de0d5a0d51d33f11bCAS | 3227389PubMed |

[14]  Entwistle V, Firnigl D, Ryan M, Francis J, Kinghorn P. Which experiences of health care delivery matter to service users and why? A critical interpretive synthesis and conceptual map. J Health Serv Res Policy 2012; 17 70–8.
Which experiences of health care delivery matter to service users and why? A critical interpretive synthesis and conceptual map.Crossref | GoogleScholarGoogle Scholar | 21967821PubMed |

[15]  Schembri S, Sandberg J. Service quality and the consumer’s experience: towards an interpretive approach. Mark Theory 2002; 2 189–205.
Service quality and the consumer’s experience: towards an interpretive approach.Crossref | GoogleScholarGoogle Scholar |

[16]  Schembri S, Sandberg J. The experiential meaning of service quality. Mark Theory 2011; 11 165–86.
The experiential meaning of service quality.Crossref | GoogleScholarGoogle Scholar |

[17]  Aharony L, Strasser S. Patient satisfaction: what we know about and what we still need to explore. Med Care Rev 1993; 50 49–79.
Patient satisfaction: what we know about and what we still need to explore.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3s3jtlequg%3D%3D&md5=5f46ffa829d7b931284875295876f8ffCAS | 10125117PubMed |

[18]  Mulhall K, Ahmed A, Masterson E. The ‘doctor–customer’ relationship: Hippocrates in the modern marketplace. Int J Health Care Qual Assur 2002; 15 9–10.
The ‘doctor–customer’ relationship: Hippocrates in the modern marketplace.Crossref | GoogleScholarGoogle Scholar |

[19]  Nair BR. Patient, client or customer? Med J Aust 1998; 169 593–7.
| 1:STN:280:DyaK1M7gsVynuw%3D%3D&md5=1edc27f3f134d5a8b82b194db07c8346CAS | 9887902PubMed |

[20]  Grøndahl VA, Karlsson I, Hall‐Lord ML, Appelgren J, Wilde‐Larsson B. Quality of care from patients’ perspective: impact of the combination of person‐related and external objective care conditions. J Clin Nurs 2011; 20 2540–51.
Quality of care from patients’ perspective: impact of the combination of person‐related and external objective care conditions.Crossref | GoogleScholarGoogle Scholar | 21749512PubMed |

[21]  Grøndahl VA, Wilde-Larsson B, Karlsson I, Hall-Lord ML. Patients’ experiences of care quality and satisfaction during hospital stay: a qualitative study. Eur J Person Centered Healthcare 2013; 1 185–92.
Patients’ experiences of care quality and satisfaction during hospital stay: a qualitative study.Crossref | GoogleScholarGoogle Scholar |

[22]  Lengnick-Hall CA. The patient as a pivot point for quality in health care delivery. Hosp Health Serv Adm 1995; 40 25–39.
| 1:STN:280:DyaK2M3htlWqug%3D%3D&md5=ea5fb33cf0dd3f4e02a4f8ad415a41ecCAS | 10140872PubMed |

[23]  Roter D, Hall J. Doctors talking with patients/patients talking with doctors: improving communication in medical visits. Westport, CT: Auburn House; 1992.

[24]  Williams SJ, Calnan M. Key determinants of consumer satisfaction with general practice. Fam Pract 1991; 8 237–42.
Key determinants of consumer satisfaction with general practice.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK38%2FntVKmsw%3D%3D&md5=dd9fe43c19c6ce9269e5275d1a56e52bCAS | 1959723PubMed |

[25]  Dougall A, Russell A, Rubin G, Ling J. Rethinking patient satisfaction: patient experiences of an open access flexible simoidoscopy service. Soc Sci Med 2000; 50 53–62.
Rethinking patient satisfaction: patient experiences of an open access flexible simoidoscopy service.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c%2Fos1CjtA%3D%3D&md5=2d811291ea8e4354e519b9d29a820d41CAS | 10622694PubMed |

[26]  Vuori H. Patient satisfaction: does it matter? Qual Assur Health Care 1991; 3 183–9.
Patient satisfaction: does it matter?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK387ksV2msw%3D%3D&md5=f08459e5247c708c6bd41b0083452394CAS | 1782386PubMed |

[27]  Greco M, Sweeney K, Brownlea A, McGovern J. The practice accreditation and improvement survey (PAIS): what patients think. Aust Fam Physician 2001; 30 1096–100.
| 1:STN:280:DC%2BD38%2FjtlSgsA%3D%3D&md5=ba06b72c1b01bd1ded51595464360b87CAS | 11759463PubMed |

[28]  Taylor SA. Distinguishing service quality from patient satisfaction in developing health care marketing strategies. Hosp Health Serv Adm 1994; 39 221–36.
| 1:STN:280:DyaK2c3nsVCntA%3D%3D&md5=6394a3e76e98acff79c81fbb1234ef2bCAS | 10134419PubMed |

[29]  Salisbury C, Wallace M, Montgomery AA. Patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling. BMJ 2010; 341 c5004
| 20940212PubMed |

[30]  American College of Healthcare Executives (ACHE). Beyond the silver bullet: ensuring patient and employee satisfaction. Chicago: ACHE; 2006. Available at: https://www.ache.org/seminars/seminar.cfm?PC=CRSVC [verified 11 March 2014].

[31]  Seth N, Deshmukh SG, Vrat P. Service quality models: a review. Int J Qual Reliab Manage 2005; 22 913–49.
Service quality models: a review.Crossref | GoogleScholarGoogle Scholar |

[32]  Ladhari R. A review of twenty years of SERVQUAL research. Int J Qual Serv Sci 2009; 1 172–98.
A review of twenty years of SERVQUAL research.Crossref | GoogleScholarGoogle Scholar |

[33]  Fiala TG. What do patients want? Technical quality versus functional quality. Aesthet Surg J 2012; 32 751–9.
What do patients want? Technical quality versus functional quality.Crossref | GoogleScholarGoogle Scholar | 22859547PubMed |

[34]  Rashid WEW, Jusoff HK. Service quality in health care setting. Int J Health Care Qual Assur 2009; 22 471–82.
Service quality in health care setting.Crossref | GoogleScholarGoogle Scholar |

[35]  Grönroos C. A service quality model and its marketing implications. Eur J Mark 1984; 18 36–44.
A service quality model and its marketing implications.Crossref | GoogleScholarGoogle Scholar |

[36]  Asubonteng P, McCleary KJ, Swan JE. SERVQUAL revisited: a critical review of service quality. J Serv Mark 1996; 10 62–81.
SERVQUAL revisited: a critical review of service quality.Crossref | GoogleScholarGoogle Scholar |

[37]  Babakus E, Mangold WG. Adapting the SERVQUAL scale to hospital services: an empirical investigation. Health Serv Res 1992; 26 767–86.
| 1:STN:280:DyaK387kslCgtQ%3D%3D&md5=d9f8fb243da9541061ba587976939e8aCAS | 1737708PubMed |

[38]  Parasuraman A, Zeithaml V, Berry L. Reassessment of expectations as a comparison standard in measuring service quality: implications for future research. J Mark 1994; 58 111–24.
Reassessment of expectations as a comparison standard in measuring service quality: implications for future research.Crossref | GoogleScholarGoogle Scholar |

[39]  Parasuraman A, Zeithaml V, Berry L. Refinement and reassessment of the SERVQUAL scale. J Retailing 1991; 67 420–50.

[40]  Parasuraman A, Zeithaml V, Berry L. SERVQUAL: a multiple-item scale for measuring consumer perceptions of service quality. J Retailing 1988; 64 12–39.

[41]  Greaves F, Ramirez-Cano D, Millett C, Darzi A, Donaldson L. Harnessing the cloud of patient experience: using social media to detect poor quality healthcare. BMJ Qual Saf 2013; 22 251–255.
Harnessing the cloud of patient experience: using social media to detect poor quality healthcare.Crossref | GoogleScholarGoogle Scholar | 23349387PubMed |

[42]  Greaves F, Pape UJ, King D, Darzi A, Majeed A, Wachter RM, Millett C. Associations between internet-based patient ratings and conventional surveys of patient experience in the English NHS: an observational study. BMJ Qual Saf 2012; 21 600–605.
Associations between internet-based patient ratings and conventional surveys of patient experience in the English NHS: an observational study.Crossref | GoogleScholarGoogle Scholar | 22523318PubMed |

[43]  Merkouris A, Papathanassoglou ED, Lemonidou C. Evaluation of patient satisfaction with nursing care: quantitative or qualitative approach? Int J Nurs Stud 2004; 41 355–67.
Evaluation of patient satisfaction with nursing care: quantitative or qualitative approach?Crossref | GoogleScholarGoogle Scholar | 15050847PubMed |

[44]  Mpinga EK, Chastonay P. Satisfaction of patients: a right to health indicator? Health Policy 2011; 100 144–50.
Satisfaction of patients: a right to health indicator?Crossref | GoogleScholarGoogle Scholar | 21126793PubMed |

[45]  Tsianakas V, Maben J, Wiseman T, Robe G, Richardson A, Madden P, Griffin M, Davies EA. Using patients’ experiences to identify priorities for quality improvement in breast cancer care: patient narratives, surveys or both? BMC Health Serv Res 2012; 12 271
Using patients’ experiences to identify priorities for quality improvement in breast cancer care: patient narratives, surveys or both?Crossref | GoogleScholarGoogle Scholar | 22913525PubMed |

[46]  Kleinman A. The illness narratives: suffering, healing, and the human condition. New York: Basic Books; 1988.

[47]  Polkinghorne DE. Narrative knowing and the human sciences. Albany, NY: Suny Press; 1988.

[48]  Frank AW. The wounded storyteller: body, illness, and ethics. Chicago: University of Chicago Press; 2013.

[49]  Becker G. Disrupted lives: how people create meaning in a chaotic world. Berkeley, CA: University of California Press; 1997.

[50]  Riessman CK. Narrative analysis. Vol 30. Newbury Park, CA: Sage; 1993.

[51]  Riessman CK. Narrative analysis. In: Huberman M, Miles MB, editors. The qualitative researcher’s companion. Thousand Oaks, CA: Sage; 2002. pp. 217–70.

[52]  Macquarrie J, Robinson E (Transl). Being and Time by M Heidegger. New York: Harper; 1962.

[53]  Husserl E. The crisis of European sciences and transcendental phenomenology: an introduction to phenomenological philosophy. Evaston, IL: Northwestern University Press; 1970.

[54]  Smith C (Transl.) Phenomenology of perception by M Merleau-Ponty. London: Routledge; 1962.

[55]  Strauss AL. Qualitative analysis for social scientists. New York: Cambridge University Press, 1987.

[56]  Koffka K. Principles of gestalt psychology. London: Lund Humphries; 1935.