Chronic kidney-disease screening service quality: questionnaire survey research evidence from Taichung City.

PubMed

Lin, Deng-Juin; Li, Ya-Hsin; Pai, Jar-Yuan; Sheu, Ing-Cheau; Glen, Robert; Chou, Ming-Jen; Lee, Ching-Yi

2009-12-19

Chronic kidney disease (CKD) is a serious public health problem in Taiwan and the world. The most effective, affordable treatments involve early prevention/detection/intervention, requiring screening. Successfully implementing CKD programs requires good patient participation, affected by patient perceptions of screening service quality. Service quality improvements can help make such programs more successful. Thus, good tools for assessing service quality perceptions are important. to investigate using a modified SERVQUAL questionnaire in assessing patient expectations, perceptions, and loyalty towards kidney disease screening service quality. 1595 kidney disease screening program patients in Taichung City were requested to complete and return a modified kidney disease screening SERVQUAL questionnaire. 1187 returned them. Incomplete ones (102) were culled and 1085 were chosen as effective for use. Paired t-tests, correlation tests, ANOVA, LSD test, and factor analysis identified the characteristics and factors of service quality. The paired t-test tested expectation score and perception score gaps. A structural equation modeling system examined satisfaction-based components' relationships. The effective response rate was 91.4%. Several methods verified validity. Cronbach's alpha on internal reliability was above 0.902. On patient satisfaction, expectation scores are high: 6.50 (0.82), but perception scores are significantly lower 6.14 (1.02). Older patients' perception scores are lower than younger patients'. Expectation and perception scores for patients with different types of jobs are significantly different. Patients higher on education have lower scores for expectation (r = -0.09) and perception (r = -0.26). Factor analysis identified three factors in the 22 item SERVQUAL form, which account for 80.8% of the total variance for the expectation scores and 86.9% of the total variance for the satisfaction scores. Expectation and perception score gaps in all 22 items are significant. The goodness-of-fit summary of the SEM results indicates that expectations and perceptions are positively correlated, perceptions and loyalty are positively correlated, but expectations and loyalty are not positively correlated. The results of this research suggest that the SERVQUAL instrument is a useful measurement tool in assessing and monitoring service quality in kidney disease screening services, enabling the staff to identify where service improvements are needed from the patients' perspectives.

Use of SERVQUAL to assess clinicians' satisfaction with the blood transfusion service.

PubMed

Raspollini, E; Pappalettera, M; Riccardi, D; Parravicini, A; Sestili, S; Rebulla, P; Sirchia, G

1997-01-01

Limited information is available on the level of satisfaction of clinicians with services delivered by blood banks. The purpose of this study was to evaluate the satisfaction of clinicians with our blood transfusion service. We prepared a questionnaire based on SERVQUAL, a method used to measure customers' appreciation of quality of service, by assessing the gap between perceived and expected quality. The questionnaire consisted of 14 items grouped according to five dimensions of quality of service: assurance, empathy, responsiveness, reliability, tangibles. Clinicians were asked to give two scores on a scale from 1 to 7 for each item, score (e) representing what they expected from an 'excellent' service, score (r) how they graded the service received. We considered wide differences in scores of service expectation and receipt for a question to be indicative of either service above expected levels (r > e) or service below expectation (r < e); similar scores for both expected and received service (within 1 point on the grading scale) were taken to indicate that the service received was that which was expected. A total of 184 questionnaires (49%) were returned. For the 14 items considered, the proportion of clinicians expressing levels of satisfaction similar to or above expectation ranged from 67 to 96%. Three critical areas, which clinicians considered important (expectation scores 6-7) were associated with satisfaction below expectation in more than 20% of responders. They were: clarity of procedures, clarity of blood request forms, and convenience of blood request and issuing times, which were rated as important by 77, 80 and 72% of clinicians, respectively. SERVQUAL was useful to gather information on the level of clinicians' satisfaction with our transfusion service.

Patient expectations of dental services. Image affects expectations, and expectations affect perceived service quality.

PubMed

Clow, K E; Fischer, A K; O'Bryan, D

1995-01-01

The authors construct a theoretical model of the antecedents of expectations for dental services by analyzing survey responses from 240 dental patients. The patients' image of the dentist, tangible cues, situational factors, and patient satisfaction with prior service encounters have the greatest influence on expectations of service, whereas marketing variables, such as price and advertising, appear to have no effect.

Analysis of Student Satisfaction Toward Quality of Service Facility

NASA Astrophysics Data System (ADS)

Napitupulu, D.; Rahim, R.; Abdullah, D.; Setiawan, MI; Abdillah, LA; Ahmar, AS; Simarmata, J.; Hidayat, R.; Nurdiyanto, H.; Pranolo, A.

2018-01-01

The development of higher education is very rapid rise to the tight competition both public universities and private colleges. XYZ University realized to win the competition, required continuous quality improvement, including the quality of existing service facilities. Amenities quality services is believed to support the success of the learning activities and improve user satisfaction. This study aims to determine the extent to which the quality of the services effect on user satisfaction. The research method used is survey-based questionnaire that measure perception and expectation. The results showed a gap between perception and expectations of the respondents have a negative value for each item. This means XYZ service facility at the university is not currently meet the expectations of society members. Three service facility that has the lowest index is based on the perception of respondents is a laboratory (2.56), computer and multimedia (2.63) as well as wifi network (2.99). The magnitude of the correlation between satisfaction with the quality of service facilities is 0.725 which means a strong and positive relationship. The influence of the quality of service facilities to the satisfaction of the students is 0.525 meaning that the variable quality of the services facility can explain 52.5% of the variable satisfaction. The study provided recommendations for improvements to enhance the quality of services facility at the XYZ university facilities.

Chronic kidney-disease screening service quality: questionnaire survey research evidence from Taichung city

PubMed Central

2009-01-01

Background Chronic kidney disease (CKD) is a serious public health problem in Taiwan and the world. The most effective, affordable treatments involve early prevention/detection/intervention, requiring screening. Successfully implementing CKD programs requires good patient participation, affected by patient perceptions of screening service quality. Service quality improvements can help make such programs more successful. Thus, good tools for assessing service quality perceptions are important. Aim: to investigate using a modified SERVQUAL questionnaire in assessing patient expectations, perceptions, and loyalty towards kidney disease screening service quality. Method 1595 kidney disease screening program patients in Taichung City were requested to complete and return a modified kidney disease screening SERVQUAL questionnaire. 1187 returned them. Incomplete ones (102) were culled and 1085 were chosen as effective for use. Paired t-tests, correlation tests, ANOVA, LSD test, and factor analysis identified the characteristics and factors of service quality. The paired t-test tested expectation score and perception score gaps. A structural equation modeling system examined satisfaction-based components' relationships. Results The effective response rate was 91.4%. Several methods verified validity. Cronbach's alpha on internal reliability was above 0.902. On patient satisfaction, expectation scores are high: 6.50 (0.82), but perception scores are significantly lower 6.14 (1.02). Older patients' perception scores are lower than younger patients'. Expectation and perception scores for patients with different types of jobs are significantly different. Patients higher on education have lower scores for expectation (r = -0.09) and perception (r = -0.26). Factor analysis identified three factors in the 22 item SERVQUAL form, which account for 80.8% of the total variance for the expectation scores and 86.9% of the total variance for the satisfaction scores. Expectation and perception score gaps in all 22 items are significant. The goodness-of-fit summary of the SEM results indicates that expectations and perceptions are positively correlated, perceptions and loyalty are positively correlated, but expectations and loyalty are not positively correlated. Conclusions The results of this research suggest that the SERVQUAL instrument is a useful measurement tool in assessing and monitoring service quality in kidney disease screening services, enabling the staff to identify where service improvements are needed from the patients' perspectives. PMID:20021684

[A cross-level analysis of the links between service quality and disconfirmation of expectations and customer satisfaction].

PubMed

Sánchez-Hernández, Rosa M; Martínez-Tur, Vicente; González-Morales, M Gloria; Ramos, José; Peiró, José M

2009-08-01

This article examines links between disconfirmation of expectations and functional and relational service quality perceived by employees and customer satisfaction. A total of 156 employees, who were working in 52 work units, participated in the research study. In addition, 517 customers who were assisted by these work units were surveyed. Using a cross-level approach, we used a random coefficient model to test the aforementioned relationships. A strong relationship between disconfirmation of expectations and customer satisfaction was observed. Also, the results confirmed that functional service quality maintains an additional and significant association with customer satisfaction. In contrast, there were no significant relationships between relational service quality and customer satisfaction. The article concludes with a discussion of these results.

Strategies for communicating quality expectations for environmental service contracts : final report.

DOT National Transportation Integrated Search

2017-03-01

This study explores the communication of quality expectations between the Office of Environment Services (OES) and environmental consulting firms contributing to the Plan Development Process of the Georgia Department of Transportation (GDOT). The ove...

[Care quality in intensive care evaluated by the patients using a service quality scale (SERVQUAL)].

PubMed

Regaira Martínez, E; Sola Iriarte, M; Goñi Viguria, R; Del Barrio Linares, M; Margall Coscojuela, M A; Asiain Erro, M C

2010-01-01

The evaluation made by the patients on the quality of service received is important to introduce improvement strategies in the care quality. 1. To evaluate the care quality through the analysis of the differences obtained between expectations and perceptions, that the patients have of the service received in the ICU. 2. To analyze if there is any relationship between care quality evaluated by the patients and the sociodemographic variables. A total of 86 patients who were conscious and oriented during their stay in the ICU were studied prospectively. At 24h of the discharge from the ICU, the SERVQUAL (Service Quality) scale, adapted for the hospital setting by Babakus and Mangold (1992), was applied. This scale measures the care quality based on the difference in scores obtained between expectations and perceptions of the patients. The positive scores indicate that the perceptions of the patients exceed their expectations. The scale has 5 dimensions: Tangibility, Reliability, Responsiveness, Assurances and Empathy. It includes 15 items for perceptions and the same for expectations, with 5 grades of response (1 totally disagree - 5 totally agree). The mean score of perceptions 66.92) exceeded that of the expectations (62.30). The mean score of the difference between perceptions and expectations for the total of the SERVQUAL scale was 4.62. It was also positive for each one of the dimensions: Tangibility=1.44, Reliability=0.53, Responsiveness=0.95, Assurances=0.99, Empathy=0.71. No statistically significant associations were found between care quality evaluated by the patients and the sociodemographic variables. The care quality perceived by the patients in the ICU exceeds their expectations, and had no relationship with the sociodemographic characteristics. Copyright 2009 Elsevier España, S.L. y SEEIUC. All rights reserved.

Using SERVQUAL in health libraries across Somerset, Devon and Cornwall.

PubMed

Martin, Susan

2003-03-01

This study provides the results of a survey conducted in the autumn of 2001 by ten NHS library services across Somerset, Devon and Cornwall. The aim of the project was to measure the service quality of each individual library and to provide an overall picture of the quality of library services within the south-west peninsula. The survey was based on SERVQUAL, a diagnostic tool developed in the 1980s, which measures service quality in terms of customer expectations and perceptions of service. The survey results have provided the librarians with a wealth of information about service quality. The service as a whole is perceived to be not only meeting but also exceeding expectations in terms of reliability, responsiveness, empathy and assurance. For the first time, the ten health library services can measure their own service quality as well as benchmark themselves against others.

Model construction of nursing service satisfaction in hospitalized tumor patients.

PubMed

Chen, Yongyi; Liu, Jingshi; Xiao, Shuiyuan; Liu, Xiangyu; Tang, Xinhui; Zhou, Yujuan

2014-01-01

This study aims to construct a satisfaction model on nursing service in hospitalized tumor patients. Using questionnaires, data about hospitalized tumor patients' expectation, quality perception and satisfaction of hospital nursing service were obtained. A satisfaction model of nursing service in hospitalized tumor patients was established through empirical study and by structural equation method. This model was suitable for tumor specialized hospital, with reliability and validity. Patient satisfaction was significantly affected by quality perception and patient expectation. Patient satisfaction and patient loyalty was also affected by disease pressure. Hospital brand was positively correlated with patient satisfaction and patient loyalty, negatively correlated with patient complaint. Patient satisfaction was positively correlated with patient loyalty, patient complaints, and quality perception, and negatively correlated with disease pressure and patient expectation. The satisfaction model on nursing service in hospitalized tumor patients fits well. By this model, the quality of hospital nursing care may be improved.

Model construction of nursing service satisfaction in hospitalized tumor patients

PubMed Central

Chen, Yongyi; Liu, Jingshi; Xiao, Shuiyuan; Liu, Xiangyu; Tang, Xinhui; Zhou, Yujuan

2014-01-01

This study aims to construct a satisfaction model on nursing service in hospitalized tumor patients. Using questionnaires, data about hospitalized tumor patients’ expectation, quality perception and satisfaction of hospital nursing service were obtained. A satisfaction model of nursing service in hospitalized tumor patients was established through empirical study and by structural equation method. This model was suitable for tumor specialized hospital, with reliability and validity. Patient satisfaction was significantly affected by quality perception and patient expectation. Patient satisfaction and patient loyalty was also affected by disease pressure. Hospital brand was positively correlated with patient satisfaction and patient loyalty, negatively correlated with patient complaint. Patient satisfaction was positively correlated with patient loyalty, patient complaints, and quality perception, and negatively correlated with disease pressure and patient expectation. The satisfaction model on nursing service in hospitalized tumor patients fits well. By this model, the quality of hospital nursing care may be improved. PMID:25419410

Service quality in community pharmacy: an exploration of determinants.

PubMed

White, Lesley; Klinner, Christiane

2012-01-01

Although various instruments have been developed to measure customer satisfaction with community pharmacy services, there is limited research regarding pharmacy staffs' understanding of service quality and its determinants. This study aimed to explore the perceptions of pharmacy staff regarding the factors that constitute a high level of service quality using the service quality determinants proposed by the Conceptual Model of Service Quality. Structured interviews were conducted with 27 pharmacy assistants and 6 pharmacists in 3 community pharmacies in Sydney. The interview questions focused on the participants' perceptions of consumer expectations, the translation of these perceptions into service quality specifications, the actual service delivery, and the communication to customers. From the pharmacy staff perspective, service quality is significantly limited by insufficient internal communication and control processes that impede role clarity and the resolution of conflicting role expectations among customer service personnel. Participants indicated that these problems could be alleviated through the implementation of more transparent, realistic, measurable, and accepted quality specifications by pharmacy management. The study indicates that the extent to which pharmacy management sets, maintains, and communicates service quality specifications to staff directly affects role clarity, role conflict, and organizational commitment among customer service staff, which in turn directly influence the level of service quality provided to the customers. Copyright © 2012 Elsevier Inc. All rights reserved.

Service quality perceptions in primary health care centres in Greece.

PubMed

Papanikolaou, Vicky; Zygiaris, Sotiris

2014-04-01

The paper refers to the increased competition between health care providers and the need for patient-centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients' perceptions rather than expectations. THIS paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations-perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. © 2012 John Wiley & Sons Ltd.

Quality gap in primary health care services in Isfahan: women's perspective

PubMed Central

Sharifirad, Gholam R.; Shamsi, Mohsen; Pirzadeh, Asiyeh; Farzanegan, Parvin D.

2012-01-01

Background: Quality gap is the gap between client's understanding and expectations. The first step in removing this gap is to recognize client's understanding and expectations of the services. This study aimed to determine women's viewpoint of quality gap in primary health care centers of Isfahan. Materials and Methods: This cross-sectional study was conducted on women who came to primary health care centers in Isfahan city. Sample size was 1280 people. Service Quality was used to collect data including tangible dimensions, confidence, responsiveness, assurance and sympathy in providing services. Data were analyzed by t test and chi square test. Results: The results showed that women had controversy over all 5 dimensions. The least mean quality gap was seen in assurance (-11.08) and the highest mean quality gap was seen in tangible dimension (-14.41). The difference between women's viewpoint in all 5 dimensions was significant. (P < 0.05) Conclusion: Negative difference means clients’ expectations are much higher than their understanding of the current situation, so there is a large space to improve services and satisfy clients. PMID:23555148

The quality assessment of family physician service in rural regions, Northeast of Iran in 2012

PubMed Central

Vafaee-Najar, Ali; Nejatzadegan, Zohreh; Pourtaleb, Arefeh; Kaffashi, Shahnaz; Vejdani, Marjan; Molavi-Taleghani, Yasamin; Ebrahimipour, Hosein

2014-01-01

Background: Following the implementation of family physician plan in rural areas, the quantity of provided services has been increased, but what leads on the next topic is the improvement in expected quality of service, as well. The present study aims at determining the gap between patients’ expectation and perception from the quality of services provided by family physicians during the spring and summer of 2012. Methods: This was a cross-sectional study in which 480 patients who referred to family physician centers were selected with clustering and simple randomized method. Data were collected through SERVQUAL standard questionnaire and were analyzed with descriptive statistics, using statistical T-test, Kruskal-Wallis, and Wilcoxon signed-rank tests by SPSS 16 at a significance level of 0.05. Results: The difference between the mean scores of expectation and perception was about -0.93, which is considered as statistically significant difference (P≤ 0.05). Also, the differences in five dimensions of quality were as follows: tangible -1.10, reliability -0.87, responsiveness -1.06, assurance -0.83, and empathy -0.82. Findings showed that there was a significant difference between expectation and perception in five concepts of the provided services (P≤ 0.05). Conclusion: There was a gap between the ideal situation and the current situation of family physician quality of services. Our suggestion is maintaining a strong focus on patients, creating a medical practice that would exceed patients’ expectations, providing high-quality healthcare services, and realizing the continuous improvement of all processes. In both tangible and responsive, the gap was greater than the other dimensions. It is recommended that more attention should be paid to the physical appearance of the health center environment and the availability of staff and employees. PMID:24757691

Quality gap of educational services in viewpoints of students in Hormozgan University of medical sciences.

PubMed

Aghamolaei, Teamur; Zare, Shahram

2008-06-18

Higher education is growing fast and every day it becomes more and more exposed to globalization processes. The aim of this study was to determine the quality gap of educational services by using a modified SERVQUAL instrument among students in Hormozgan University of Medical Sciences. A cross-sectional study was carried out at Hormozgan University of Medical Sciences in 2007. In this study, a total of 300 students were selected randomly and asked to complete a questionnaire that was designed according to SERVQUAL methods. This questionnaire measured students' perceptions and expectations in five dimensions of service that consists of assurance, responsiveness, empathy, reliability and tangibles. The quality gap of educational services was determined based on differences between students' perceptions and expectations. The results demonstrated that in each of the five SERVQUAL dimensions, there was a negative quality gap. The least and the most negative quality gap means were in the reliability (-0.71) and responsiveness (-1.14) dimensions respectively. Also, there were significant differences between perceptions and expectations of students in all of the five SERVQUAL dimensions (p < 0.001). Negative quality gaps mean students' expectations exceed their perceptions. Thus, improvements are needed across all five dimensions.

Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center.

PubMed

Manulik, Stanisław; Rosińczuk, Joanna; Karniej, Piotr

2016-01-01

Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUAL method is widely used for assessing the quality expected by patients and the quality of actually provided services. The main purpose of this study was to determine if patients from state and private health care facilities differed in terms of their qualitative priorities and assessments of received services. The study included a total of 412 patients: 211 treated at a state facility and 201 treated at a private facility. Each of the respondents completed a 5-domain, 22-item SERVQUAL questionnaire. The actual quality of health care services in both types of facilities proved significantly lower than expected. All the patients gave the highest scores to the domains constituting the core aspects of health care services. The private facility respondents had the highest expectations with regard to equipment, and the state facility ones regarding contacts with the medical personnel. Health care quality management should be oriented toward comprehensive optimization in all domains, rather than only within the domain identified as the qualitative priority for patients of a given facility.

The students' viewpoint on the quality gap in educational services.

PubMed

Rahim Khanli, Marziyeh; Daneshmandi, Hadi; Choobineh, Alireza

2014-07-01

Students and university community are social and human resources of the country. The students' viewpoints about the quality of educational services can be considered as a basis for planning quality promotion and improving organizational performance. This study was conducted to determine the quality gap in educational services by the students of Health and Nutrition School of Shiraz University of Medical Sciences. In this cross-sectional study, 140 students participated voluntarily (age range=19 to 40 years). The service quality (SERVQUAL) questionnaire was used for data collection. This questionnaire measured the quality gap in 5 dimensions of educational service including assurance, responsiveness, empathy, reliability, and tangibility. The students' perception about the current conditions and their expectations as to optimal conditions can be determined, using this questionnaire. The score of the gap in quality of educational services is calculated from difference between perception and expectation scores. Due to non-normality of data, non-parametric tests were used. To this end, data were analyzed by statistical tests including Wilcoxon, Friedman, Kruskal-Wallis and Mann-Whiteny tests in SPSS 14. The results showed that there was quality gap in all 5 dimensions of educational services. The largest and the smallest gaps were observed in "responsiveness" with a mean±SD of -0.94±0.74 and in "reliability" with a mean±SD of -0.76±0.69, respectively. There was a significant difference in quality gap between the 5 dimensions (p<0.001). According to the results, the students' expectations were higher than their perceptions of current conditions; also, in all aspects of the services their expectations were not met. It is recommended that workshops on customer services, communication skills and personnel's technical skills development should be planned and held. Also, allocating more resources for improving educational facilities and physical environment is recommended.

Gap between the Expectations and Perceptions of Students regarding the Educational Services Offered in a School of Nursing and Midwifery.

PubMed

Asefi, Fariba; Delaram, Masoumeh; Deris, Fatemeh

2017-04-01

Awareness of students' opinions about the various aspects of training provided is an essential factor to evaluate the quality of education. The aim of this study was to determine the gap between the students' expectations and perceptions from the educational services provided to them in the School of Nursing and Midwifery in Shahrekord University of Medical Sciences. In this cross-sectional study, 320 students were selected by stratified random sampling method and data were collected by SERVQUAL questionnaire to examine the areas of assurance, responsiveness, empathy, tangibles and confidence. Data analysis was conducted by descriptive (frequency, percentage, mean±SD) and analytical (paired t-test, independent t-test and One-Way ANOVA) statistics in SPSS 20. The mean scores of the students' expectations and perceptions of the educational services delivered to them were 4.34±0.63 and 3.56±0.68, respectively, with a significant, negative gap (-0.77±0.77, p<0.001). The lowest gap of quality was derived for assurance (-0.65) followed by reliability (-0.69), accountability (-0.74), and empathy (-0.81), and the greatest gap observed in tangibles (-0.96). A negative gap was observed between the students' expectations and perceptions of the quality of educational services delivered to them. This means that the quality of services delivered to students was less than what they expected. The highest gap was related to the tangibles. In order to improve the educational services, paying attention to different areas of quality of educational services, especially, the tangibles, is necessary.

Evaluation of service quality of hospital outpatient department services.

PubMed

Chakravarty, Abhijit

2011-07-01

It has become essential for hospital managers to understand and measure consumer perspectives and service quality gaps, so that any perceived gap in delivery of service is identified and suitably addressed. A study was conducted at a peripheral service hospital to ascertain any service gap between consumer expectations and perceptions in respect of the hospital outpatient department (OPD) services. A cross-sectional study was conducted using SERVQUAL as the survey instrument, the instrument being validated for use in the hospital environment. Consumer ratings across 22 items of the survey instrument were collected in paired expectation and perception scores and then service quality gaps were identified and statistically analysed. Service quality gaps were identified to exist across all the five dimensions of the survey instrument, with statistically significant gaps across the dimensions of 'tangibles' and 'responsiveness.' The quality gaps were further validated by a total unweighted SERVQUAL score of (-) 1.63. The study concludes that significant service quality gaps existed in the delivery of the hospital OPD services, which need to be addressed by focused improvement efforts by the hospital management.

Client expectations and satisfaction of quality in home care services. A consumer perspective.

PubMed

Samuelsson, G; Wister, A

2000-12-01

This study examines clients' expectations of quality in home care services and their perceived satisfaction with services among a random sample of 76 home care recipients in Vancouver, Canada. The researchers conducted face-to-face interviews that applied Multiattribute Utility Technology, a procedure that organizes several quality attributes of "ideal" home care into a tree structure to compare their relative importance and ranking from the clients' perspective. Participants also were asked to state their satisfaction or dissatisfaction with the services received in these domains. Among the five main quality attributes identified, the subjects ranked suitability of the home helper and its subset, personal competence, as the most important indicators of quality, followed by continuity in service. In addition, clients tended to have a high level of satisfaction with regard to the attributes of overall home care services. The highest level of satisfaction was reported for elements of personal dispositions of home care staff. The lowest level of satisfaction involved the time/availability components of the service. Finally, comparisons between client expectations and satisfaction of received home care services showed the highest discrepancy for the attributes of influence and time/availability and the greatest congruence for personal attributes of the staff. The results are discussed in terms of their implications for the delivery of home care services.

Stakeholder Expectations of Service Quality in a University Web Portal

NASA Astrophysics Data System (ADS)

Tate, Mary; Evermann, Joerg; Hope, Beverley; Barnes, Stuart

Online service quality is a much-studied concept. There is considerable evidence that user expectations and perceptions of self-service and online service quality differ in different business domains. In addition, the nature of online services is continually changing and universities have been at the forefront of this change, with university websites increasingly acting as a portal for a wide range of online transactions for a wide range of stakeholders. In this qualitative study, we conduct focus groups with a range of stakeholders in a university web portal. Our study offers a number of insights into the changing nature of the relationship between organisations and customers. New technologies are influencing customer expectations. Customers increasingly expect organisations to have integrated information systems, and to utilise new technologies such as SMS and web portals. Organisations can be slow to adopt a customer-centric viewpoint, and persist in providing interfaces that are inconsistent or require inside knowledge of organisational structures and processes. This has a negative effect on customer perceptions.

Quality Is Key--The Impact of Community Service, Community Service Quality, and Reflection on Adolescents' Volunteering Intentions

ERIC Educational Resources Information Center

van Goethem, Anne A. J.; van Hoof, Anne; Orobio de Castro, Bram; van Aken, Marcel A. G.

2014-01-01

This study examined the effect of community service program-quality on changes in adolescents' intentions to volunteer. Based on the literature, volunteering intentions were expected to increase by programs with high quality community service activities (e.g., instructive activities) and educational activities including reflection. Adolescents (N=…

Quality Management and Information Brokerage.

ERIC Educational Resources Information Center

van Halm, Johan

1995-01-01

To compete effectively, information brokers need to adopt management and marketing tools; Total Quality Management can upgrade an organization's performance by using customer feedback of its services. SERVQUAL identifies gaps in service by assessing quality expectations versus quality experiences. (AEF)

Perceived Quality of Distance Education from the User Perspective

ERIC Educational Resources Information Center

Dursun, Tolga; Oskaybas, Kader; Gokmen, Cansu

2014-01-01

The purpose of this study is to measure the quality of distance education services received from educational institutions which are among the leading service enterprises. More specifically, the study aims to find out what the students' expectations are, to what extent the student expectations are met and whether or not the acquired findings vary…

Measuring Quality in Special Libraries: Lessons from Service Marketing.

ERIC Educational Resources Information Center

White, Marilyn Domas; Abels, Eileen G.

1995-01-01

Surveys the service marketing literature for models and data-gathering instruments measuring service quality, particularly the instruments SERVQUAL and SERVPERF, and assesses their applicability to special libraries and information centers. Topics include service characteristics and definitions of service; performance-minus-expectations and…

Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center

PubMed Central

Manulik, Stanisław; Rosińczuk, Joanna; Karniej, Piotr

2016-01-01

Introduction Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUAL method is widely used for assessing the quality expected by patients and the quality of actually provided services. Objectives The main purpose of this study was to determine if patients from state and private health care facilities differed in terms of their qualitative priorities and assessments of received services. Materials and methods The study included a total of 412 patients: 211 treated at a state facility and 201 treated at a private facility. Each of the respondents completed a 5-domain, 22-item SERVQUAL questionnaire. The actual quality of health care services in both types of facilities proved significantly lower than expected. Results All the patients gave the highest scores to the domains constituting the core aspects of health care services. The private facility respondents had the highest expectations with regard to equipment, and the state facility ones regarding contacts with the medical personnel. Conclusion Health care quality management should be oriented toward comprehensive optimization in all domains, rather than only within the domain identified as the qualitative priority for patients of a given facility. PMID:27536075

Patient perceptions and expectations of an anticoagulation service: a quantitative comparison study of clinic-based testers and patient self-testers.

PubMed

Money, Arthur G; Barnett, Julie; Kuljis, Jasna; Duffin, Debbie

2015-12-01

Government initiatives see the provision of technology-assisted self-care as one of the key areas in which there is capacity for improving quality of care whilst reducing costs. However, levels of patient engagement in self-testing and management (STM) remain low. Little emphasis has been placed on understanding the patients' perspectives of the reasons for this limited engagement. Typically, patient engagement in STM is achieved via the provision of patient education programmes, which aim to enable patients to make the changes necessary to become competent self-carers. However, placing the onus to change on the individual patient is unrealistic. If levels of patient engagement are to be improved, patient needs and expectations of clinical services must be better understood and service provision must be adapted accordingly. Explore patient perceptions and expectations of clinical service provision and their views of having and making choices about care. Participants [N = 191, 103 patient self-tester managers (PSTMs) and 87 clinic-based testers (CBTs)] completed the SERVQUAL and ChQ instruments to capture perspectives on service quality and choice, respectively. A comparative statistical analysis explored the similarities and differences between PSTMs' and CBTs' responses. Clinic-based testers' perceptions of service quality were significantly more positive than PSTMs', as were their expectations of the 'tangible' aspects of service delivery. PSTMs' expectations of service quality were significantly higher than their perceptions. PSTMs attributed significantly more value to making choices compared with CBTs. To close the gap between PSTMs expectations and perceptions of service quality and better cater for their choice preferences, service providers may benefit from taking into account the following practice considerations: maintain frequent, timely, personalised and direct interactions with PSTMs; prioritise investment in resources to facilitate patient/practitioner interaction over tangible facilities; ensure that PSTMs are given the opportunity to make choices about their care. © 2015 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.

Mission-Related Execution and Planning Through Quality of Service Methods

DTIC Science & Technology

2010-06-01

which maximizes a mission effectiveness functions is the ideal driver of QoS mechanisms. Service Quality Quality of Service may also exist in other...However, service quality is the originating concept of QoS and is the level of performance which one entity expects from another, including non-IT SoSs... Service quality may also be reflected in the context of a system’s purpose or an organization’s mission. Putting level of service values and

Caregivers’ Quality of Life and Quality of Services for Children with Cancer: A Review from Iran

PubMed Central

Sajjadi, Homeira; Vameghi, Meroe; Ghazinour, Mehdi; KhodaeiArdakani, Mohammadreza

2013-01-01

Objective: Caregivers of cancer patients are exposed to different types of psychosocial stress which influence their quality of life. The purposes of this study were to assess quality of life in caregivers of children with cancer and to investigate the relationship between the caregivers’ quality of life and quality of services in the social work section. Method: 125 caregivers were recruited. Quality of life was measured by the Iranian version of the WHOQOL-BREF questionnaire and data concerning service quality were obtained from the Iranian version of the SERVQUAL questionnaire. Findings: Scores in physical health, psychological status and environmental conditions for caregivers of children with cancer were significantly lower than the general population. There was a negative correlation between the tangible domain of SERVQUAL and the psychological status and environmental conditions of quality of life. The tangible dimension was the only aspect of service quality to predict caregivers’ quality of life regarding psychological status and environmental conditions. Conclusion: Caregivers of children with a disease are care consumers and, like all consumers, they expect good service. Delivering high quality services consistently is difficult but profitable for a service organization. In other words, trying to deliver more appropriate services than patients expect to receive from their social work care is one of the most reliable ways to promote caregivers’ satisfaction and quality of life. PMID:23618487

Caregivers' quality of life and quality of services for children with cancer: a review from iran.

PubMed

Sajjadi, Homeira; Vameghi, Meroe; Ghazinour, Mehdi; Khodaeiardekani, Mohammadreza

2013-03-04

Caregivers of cancer patients are exposed to different types of psychosocial stress which influence their quality of life. The purposes of this study were to assess quality of life in caregivers of children with cancer and to investigate the relationship between the caregivers' quality of life and quality of services in the social work section. 125 caregivers were recruited. Quality of life was measured by the Iranian version of the WHOQOL-BREF questionnaire and data concerning service quality were obtained from the Iranian version of the SERVQUAL questionnaire. Scores in physical health, psychological status and environmental conditions for caregivers of children with cancer were significantly lower than the general population. There was a negative correlation between the tangible domain of SERVQUAL and the psychological status and environmental conditions of quality of life. The tangible dimension was the only aspect of service quality to predict caregivers' quality of life regarding psychological status and environmental conditions. Caregivers of children with a disease are care consumers and, like all consumers, they expect good service. Delivering high quality services consistently is difficult but profitable for a service organization. In other words, trying to deliver more appropriate services than patients expect to receive from their social work care is one of the most reliable ways to promote caregivers' satisfaction and quality of life.

Service Quality and Student/Customer Satisfaction in the Private Tertiary Education Sector in Singapore

ERIC Educational Resources Information Center

Khoo, Susie; Ha, Huong; McGregor, Sue L. T.

2017-01-01

Purpose: This paper focuses on students' perceptions of the quality of non-academic services received in higher education. While the important role played by expectations and perceptions in students' evaluations of such services has been discussed in much of the service quality literature, there is insufficient work in the private tertiary…

Service quality perceptions in primary health care centres in Greece

PubMed Central

Papanikolaou, Vicky; Zygiaris, Sotiris

2012-01-01

Abstract Context  The paper refers to the increased competition between health care providers and the need for patient‐centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. Objective  To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. Strategy  SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. Results  The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients’ perceptions rather than expectations. Discussion and conclusions  This paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations–perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. PMID:22296402

The National Shipbuilding Research Program, 1991 Ship Production Symposium Proceedings: Paper No. IVA-3: Improving Your Competitive Position Through Total Quality Management (TQM)

DTIC Science & Technology

1991-09-01

process of TQM, it will expect help from suppliers in the pursuit of increased product and service quality . So if your customers are describing their...customer expectations typically prompt the changes. Remaining competitive in today’s global economy requires an increased level of product and service ... quality at lower cost. In government the motivation often arises from Presidential Order #12552, or more importantly, con- strained budgets. The

PubMed Central

2012-01-01

The Walt Disney Company has never lost sight of its founder's edict: “Give the public everything you can give them.” From this simple statement, everyone at Disney strives to exceed customer expectations every day. For more than 80 years this singular pursuit of excellence in delivering consistent quality service has earned the Disney organization a world-renowned reputation and ongoing business success. Uncover some of the secrets behind the Disney service culture and processes. In this session, you will examine the time-tested model for delivering world-class Guest service and discover how attention to detail creates a consistent, successful environment for both employees and customers. You can then use these ideas to transform and improve your own organization's delivery of quality service. You will learn how to: Develop an organizational culture that supports consistent delivery of quality service.Evaluate the Disney approach and tailor it to your business.Design quality service standards and processes to raise the level of customer satisfaction.Create metrics to gauge the needs, perceptions and expectations of your customers.Enable employees, settings and processes to convey your quality service commitment.Implement a strategic plan for monitoring the delivery of seamless customer experiences.

An Empirical Analysis of the Service Quality Gap in Business Education: Evidence from Higher Education in Pakistan

ERIC Educational Resources Information Center

Sardar, Amber; Amjad, Shehla; Ali, Ubaid

2016-01-01

This survey investigated the relationship and gap between students' expectations and perceptions of perceived service quality of education, emphasizing the least effective service quality dimension. The study was based on primary data, which turned out to be most significant. Data were collected from 349 of 405 students through a questionnaire…

Hospitals look to hospitality service firms to meet TQM goals.

PubMed

Hard, R

1992-05-20

Hospitals that hire contract service firms to manage one or all aspects of their hospitality service departments increasingly expect those firms to help meet total quality management goals as well as offer the more traditional cost reduction, quality improvement and specialized expertise, finds the 1992 Hospital Contract Services Survey conducted by Hospitals.

Measuring quality in services for children with an intellectual disability.

PubMed

Koornneef, Erik

2006-01-01

To evaluate the application of one particular quality measurement tool, the SERVQUAL instrument, as a potential mechanism to measure quality in services for children with disabilities Staff and family of children with an intellectual disability in two organisations providing specialist therapy and day completed an adapted SERVQUAL questionnaire. A total of 81 SERVQUAL questionnaires were distributed and 59 questionnaires were returned (response rate of 73 per cent). The SERVQUAL instrument can be considered as a useful diagnostic tool to identify particular strengths and areas for improvement in services for people with disabilities as the instrument lends itself for the monitoring of the effectiveness of quality improvement initiatives over time. The findings also showed relatively high customer expectations and the organisations involved in this research are currently not meeting all of these high expectations as significant quality gaps were found in the areas of reliability and responsiveness. The sample size was relatively small and the measurement of quality using the SERVQUAL instrument remains a challenge, due to the conceptual and empirical difficulties. The SERVQUAL instrument is probably most be attractive to service managers and funding organisations because of its ability to identify gaps in the quality of the service. The tool had been used to measure quality in services for people with disabilities and the research has shown that this tool might be an important additional quality measurement tool for services.

Measuring the quality of provided services for patients with chronic kidney disease.

PubMed

Bahadori, Mohammadkarim; Raadabadi, Mehdi; Heidari Jamebozorgi, Majid; Salesi, Mahmood; Ravangard, Ramin

2014-09-01

The healthcare organizations need to develop and implement quality improvement plans for their survival and success. Measuring quality in the healthcare competitive environment is an undeniable necessity for these organizations and will lead to improved patient satisfaction. This study aimed to measure the quality of provided services for patients with chronic kidney disease in Kerman in 2014. This cross-sectional, descriptive-analytic study was performed from 23 January 2014 to 14 February 2014 in four hemodialysis centers in Kerman. All of the patients on chronic hemodialysis (n = 195) who were referred to these four centers were selected and studied using census method. The required data were collected using the SERVQUAL questionnaire, consisting of two parts: questions related to the patients' demographic characteristics, and 28 items to measure the patients' expectations and perceptions of the five dimensions of service quality, including tangibility, reliability, responsiveness, assurance, and empathy. The collected data were analyzed using SPSS 21.0 through some statistical tests, including independent-samples t test, one-way ANOVA, and paired-samples t test. The results showed that the means of patients' expectations were more than their perceptions of the quality of provided services in all dimensions, which indicated that there were gaps in all dimensions. The highest and lowest means of negative gaps were related to empathy (-0.52 ± 0.48) and tangibility (-0.29 ± 0.51). In addition, among the studied patients' demographic characteristics and the five dimensions of service quality, only the difference between the patients' income levels and the gap in assurance were statistically significant (P < 0.001). Overall, the results of the present study showed that the expectations of patients on hemodialysis were more than their perceptions of provided services. The healthcare providers and employees should pay more attention to the patients' opinions and comments and use their feedback to solve the workplace problems and improve the quality of provided services. In addition, training the health staff to meet the patients' emotional needs and expectations is suggested.

Social Security: Views of Agency Personnel on Service Quality and Staff Reductions

DTIC Science & Technology

1989-02-10

decline was staff reductions, which are expected to continue through fiscal year 1990 (pp. 9 and 13). While service quality in general is perceived as...management forum initiative (and others) will have on service quality and employee morale is hard to predict. Further, SSA’s staff reduction program will...poor morale within the agency. We will provide your Committees with another report in May 1989 on the status of SSA staff cuts and service quality . As

Analysis of Gap in Service Quality in Drug Addiction Treatment Centers of Kerman, Iran, Using SERVQUAL Model.

PubMed

Naqavi, Mohammad Reza; Refaiee, Raheleh; Baneshi, Mohammad Reza; Nakhaee, Nouzar

2014-01-01

Treatment of drug addicts is one of the main strategies of drug control in Iran. Client satisfaction strongly influences the success of any treatment program. This study aimed to explore the difference between customer expectations and perceptions in drug addiction treatment centers of Kerman, Iran, using SERVQUAL model. Using a cross-sectional design 260 clients referring to drug addiction treatment centers of Kerman, were enrolled in 2012. From among 84 clinics, 20 centers were selected randomly. Based on the number of clients registered in each center, a random sample proportional to the size was selected and 290 subjects were invited for interviews. A well validated 22-item questionnaire, which measured the 5 dimensions of service quality (reliability, assurance, tangibility, empathy, and responsiveness), was completed by participants. Each item measured 2 aspects of service quality; expectations and perceptions. Mean ± SD (Standard deviation) age of the subjects was 37.7 ± 9.4. Most of them were male (87.7%). Less than half of them had an educational level lower than diploma. The total score of clients` expectations was higher than their perceptions (P < 0.001). Considering the 5 dimensions of the SERVQUAL model, only 1 dimension (i.e., assurance) showed no difference between perceptions and expectations of the participants (P = 0.134). There was a gap between the clients' expectations and what they actually perceived in the clinics. Thus, more attention should be devoted to the clients' views regarding service quality in addiction treatment clinics.

Assessment of Students' Satisfaction of Service Quality in Takoradi Polytechnic: The Students' Perspective

ERIC Educational Resources Information Center

Anwowie, Samuel; Amoako, Joseph; Abrefa, Amma Adomaa

2015-01-01

Higher educational institutions are increasingly placing greater emphasis on meeting students' expectations and needs as student perceptions of higher educational facilities and services are becoming more important. To investigate students' satisfaction of service quality at the Takoradi Polytechnic, a study was conducted using the SERVQUAL…

The model of flood control using servqual method and importance performance analysis in Surakarta City – Indonesia

NASA Astrophysics Data System (ADS)

Titi Purwantini, V.; Sutanto, Yusuf

2018-05-01

This research is to create a model of flood control in the city of Surakarta using Servqual method and Importance Performance Analysis. Service quality is generally defined as the overall assessment of a service by the customersor the extent to which a service meets customer’s needs or expectations. The purpose of this study is to find the first model of flood control that is appropriate to the condition of the community. Surakarta This means looking for a model that can provide satisfactory service for the people of Surakarta who are in the location of the flood. The second is to find the right model to improve service performance of Surakarta City Government in serving the people in flood location. The method used to determine the satisfaction of the public on the quality of service is to see the difference in the quality of service expected by the community with the reality. This method is Servqual Method While to assess the performance of city government officials is by comparing the actual performance with the quality of services provided, this method is This means looking for a model that can provide satisfactory service for the people of Surakarta who are in the location of the flood.The second is to find the right model to improve service performance of Surakarta City Government in serving the people in flood location. The method used to determine the satisfaction of the public on the quality of service is to see the difference in the quality of service expected by the community with the reality. This method is Servqual Method While to assess the performance of city government officials is by comparing the actual performance with the quality of services provided, this method is Importance Performance Analysis. Samples were people living in flooded areas in the city of Surakarta. Result this research is Satisfaction = Responsiveness+ Realibility + Assurance + Empathy+ Tangible (Servqual Model) and Importance Performance Analysis is From Cartesian diagram can be made Flood Control Formula as follow: Food Control = High performance

Managers and the new definition of quality.

PubMed

Chilgren, Allison A

2008-01-01

The manager, particularly the mid-level manager, has a vital role in the success of any healthcare organization, especially in the realm of patient perception of quality. To patients, "quality" means how well a service was delivered, not how technically superior the actual service or clinical component turned out. This definition of quality can also be referred to as patient satisfaction. Managers, with help of an integrative team, can develop quality processes geared toward patient expectations by doing a number of things, including the following: clearly identify outcomes, and empower employees to achieve those goals; form an integrated quality development team to establish quality metrics; build in cultural competence into quality processes; and align the organization's mission to the overall quality program. With a successful quality program, managers can expect a considerable return on investment, satisfied patients and staff, and improved clinical outcomes.

Perspectives on User Satisfaction Surveys.

ERIC Educational Resources Information Center

Cullen, Rowena

2001-01-01

Discusses academic libraries, digital environments, increasing competition, the relationship between service quality and user satisfaction, and user surveys. Describes the SERVQUAL model that measures service quality and user satisfaction in academic libraries; considers gaps between user expectations and managers' perceptions of user…

Improving student satisfaction of Andalas University Dormitory through Service Quality and Importance Performance Analysis

NASA Astrophysics Data System (ADS)

Putri, Nilda Tri; Anggraini, Larisa

2018-03-01

Residential satisfaction of university dormitories serve as one of the significant aspects in the framework of sustainability in higher education. This research investigated the quality of dormitory services in Andalas University Dormitory based on student’s satisfaction. According to management residential, the enrollment of residential student has increased gradually in Andalas University. In 2016, capacity of residential student is 1686, but only 1081 students can stay at dormitory because some rooms in bad condition. There are a lot of problems and complaints regarding dormitory’s service quality i.e water problems, leaky rooms and bathrooms, cleanliness and inadequate facilities in residential college. In addition, there are 20% of last year student’s residential check out before the time of contract runs out. The aim of this research are understanding the level of GAP exists between expectation and perception students’ residential in the content of service quality and evaluating the improvement priority services using Importance Performance Analysis. This study is measuring service quality by using Responsiveness, Assurance, Empathy, Reliability and Tangible dimension. A negative GAP indicates that the actual services are than what was expected and the GAP is highlighted area for improvement. Based on IPA, management should improve this following dimension services : responsiveness, tangible and assurance dimension.

An investigation on the quality of midwifery services from the viewpoint of the clients in Isfahan through SERVQUAL model.

PubMed

Oliaee, Zohreh; Jabbari, Alireza; Ehsanpour, Soheila

2016-01-01

Quality of care is of great importance in health services as these services have the important mission to preserve health, and to give care to the society. The present study aimed to investigate the quality of midwifery services from the viewpoint of the clients, under coverage of health care centers in Isfahan, through SERVQUAL model. This descriptive and analytical study was conducted on 218 subjects in 2014. Study population comprised the women referring to midwifery services clinics in health care centers in Isfahan. Data of the subjects (n = 218) were collected by SERVQUAL model containing the dimensions of tangibles, reliability, responsiveness, assurance, and empathy. Data were analyzed by paired t-test, Spearman and Pearson correlation coefficients, and independent t-test through SPSS 20. There was a negative gap in all five relevant dimensions of giving services. The widest gap was in the mean of dimension of tangibles (-1.5), and the narrowest gap was in the dimension of assurance (-0.9). There was no significant association between the scores of expectations and perceptions, and age, education level, occupation, and marital status. The obtained negative gap showed that the level of service receivers' perception from existing condition was far from their expectation, and there was a wide gap between attaining their satisfaction with midwifery services and their expectation and reaching their appropriate level of services.

The development of NEdSERV: quantitative instrumentation to measure service quality in nurse education.

PubMed

Roberts, P

1999-07-01

The political climate of health care provision and education for health care in the latter years of the 20th century is evolving from the uncertainty of newly created markets to a more clearly focused culture of collaboration, dissemination of good practice, with an increased emphasis on quality provision and its measurement. The need for provider units to prove and improve efficiency and effectiveness through evidence-based quality strategies in order to stay firmly in the market place has never been more necessary. The measurement of customer expectations and perceptions of delivered service quality is widely utilized as a basis for customer retention and business growth in both commercial and non-profit organizations. This paper describes the methodological development of NEdSERV--quantitative instrumentation designed to measure and respond to ongoing stakeholder expectations and perceptions of delivered service quality within nurse education.

The Quality Assessment of the Services Offered to the Students of the College of Education at King Saud University Using (SERVQUAL) Method

ERIC Educational Resources Information Center

Alhabeeb, Abdurrahman Mohammad

2015-01-01

The goal of this study is measuring the level of quality service offered to students at the college of education at King Saud University, specifically the gap between students' perceptions and expectations of the quality of the offered service. The descriptive analytical approach has been applied in the study using SERVQUAL method to collect data…

Analysis of Gap in Service Quality in Drug Addiction Treatment Centers of Kerman, Iran, Using SERVQUAL Model

PubMed Central

Naqavi, Mohammad Reza; Refaiee, Raheleh; Baneshi, Mohammad Reza; Nakhaee, Nouzar

2014-01-01

Background Treatment of drug addicts is one of the main strategies of drug control in Iran. Client satisfaction strongly influences the success of any treatment program. This study aimed to explore the difference between customer expectations and perceptions in drug addiction treatment centers of Kerman, Iran, using SERVQUAL model. Methods Using a cross-sectional design 260 clients referring to drug addiction treatment centers of Kerman, were enrolled in 2012. From among 84 clinics, 20 centers were selected randomly. Based on the number of clients registered in each center, a random sample proportional to the size was selected and 290 subjects were invited for interviews. A well validated 22-item questionnaire, which measured the 5 dimensions of service quality (reliability, assurance, tangibility, empathy, and responsiveness), was completed by participants. Each item measured 2 aspects of service quality; expectations and perceptions. Findings Mean ± SD (Standard deviation) age of the subjects was 37.7 ± 9.4. Most of them were male (87.7%). Less than half of them had an educational level lower than diploma. The total score of clients` expectations was higher than their perceptions (P < 0.001). Considering the 5 dimensions of the SERVQUAL model, only 1 dimension (i.e., assurance) showed no difference between perceptions and expectations of the participants (P = 0.134). Conclusion There was a gap between the clients’ expectations and what they actually perceived in the clinics. Thus, more attention should be devoted to the clients’ views regarding service quality in addiction treatment clinics. PMID:25984274

Through a Different Lens: Bridging the Expectation-Perception (Quality) Divide in Higher Education

ERIC Educational Resources Information Center

Yeo, Roland K.; Marquardt, Michael J.

2011-01-01

The paper draws on the underpinnings of SERVQUAL (a Service Quality measurement model) and explores three key aspects of service standards as adopted by an Engineering School in Singapore: customer orientation, course design/delivery and support services. Qualitative methodology was employed and data were collected by means of structured in-depth…

International Students' Perceptions of Service Quality in the UK Banking Sector: An Exploratory Study

ERIC Educational Resources Information Center

Bond, Christopher; Hsu, Marc Ting-Chun

2011-01-01

This study reviews and evaluates international students' perceptions of UK banks. The specific research objectives were to identify international students' expectations and perceptions of service quality from UK banks and to assess the quality GAP or dissonance between these. A total of 297 international students studying in the UK responded to…

Quality Assurance: Adapting SERVQUAL to Measure the Perceived Quality of Pre-Service Teachers' Teaching Practice Experience

ERIC Educational Resources Information Center

Oliver, Henry; Koeberg, Jeremy

2013-01-01

This article describes a work in progress study which extends traditional quality assurance mechanisms through the application of the SERVQUAL instrument. It assesses the difference between pre-service teacher expectations and actual experience during a Teaching Practice period. Anecdotal evidence points to students being the recipients of poor…

Toward a TQM Paradigm: Using SERVQUAL to Measure Library Service Quality.

ERIC Educational Resources Information Center

Coleman, Vicki; And Others

1997-01-01

Texas A&M University's Evans Library conducted a survey (SERVQUAL) to measure service quality in terms of tangibles (appearance of facilities, equipment, personnel, and communication materials), reliability, responsiveness, assurance, and empathy. Discrepancies between expectations and perceptions were found in reliability, responsiveness,…

Using Modeling and Simulation to Examine the Benefits of a Network Tasking Order

DTIC Science & Technology

2010-01-01

Without careful planning, the topolo- gies that form can suffer from poor Quality of Service (QoS). The networks could have bottlenecks, or worse, be... quality of service Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to...mission type include: • expected communications partners; • type of data transmitted; • bandwidth required (average, burst); • quality of service

Evaluation of the Quality of Health Service Providers: The Iranian People Perspective 2014.

PubMed

Asefzadeh, Saeed; Gholami, Soheyla; Rajaee, Roya; Najafi, Marziye; Alijanzadeh, Mehran

2016-03-01

Quality is the center of attention in all service providing organizations that are effective in promoting satisfaction of patients who are referred to medical centers. The aim of this study was to investigate the quality of health service providers in a case study of Qazvin, Iran, in 2014. This descriptive study was conducted on 1,002 people who were residents of Qazvin Province (Iran) in 2014. The people were selected randomly from the population of the study area. The main variables studied were education, perceptions, expectations, and gaps in service quality. The data collection tool was the standard Servequal questionnaire. To determine the reliability of the research tool, we used Cronbach's Alpha coefficient and the test-retest method. Statistical analyses were conducted using SPSS and the ANOVA test. The mean age of people included in the study was 32 ± 9.9 years, and the average waiting time to receive services was 73 ± 47 minutes. Hospitals and doctors' offices had the highest quality gap of -1.420 ± 0.82 and -1.01 ± 0.75, respectively. The service quality gaps in medical centers, health providers of rural area, and health providers of urban area were -0.883 ± 0.67, -0.882 ± 0.83, and -0.804 ± 0.62, respectively. There was a significant relationship between peoples' perceptions and expectations concerning the quality of health services and their educational levels. The higher gaps in quality in hospitals and in doctors' offices require more attention. Managers and policy makers should consider developing and implementing plans to reduce these gaps in quality and to promote better health services in these two sectors.

Evaluation of the Quality of Health Service Providers: The Iranian People Perspective 2014

PubMed Central

Asefzadeh, Saeed; Gholami, Soheyla; Rajaee, Roya; Najafi, Marziye; Alijanzadeh, Mehran

2016-01-01

Introduction Quality is the center of attention in all service providing organizations that are effective in promoting satisfaction of patients who are referred to medical centers. The aim of this study was to investigate the quality of health service providers in a case study of Qazvin, Iran, in 2014. Methods This descriptive study was conducted on 1,002 people who were residents of Qazvin Province (Iran) in 2014. The people were selected randomly from the population of the study area. The main variables studied were education, perceptions, expectations, and gaps in service quality. The data collection tool was the standard Servequal questionnaire. To determine the reliability of the research tool, we used Cronbach’s Alpha coefficient and the test-retest method. Statistical analyses were conducted using SPSS and the ANOVA test. Results The mean age of people included in the study was 32 ± 9.9 years, and the average waiting time to receive services was 73 ± 47 minutes. Hospitals and doctors’ offices had the highest quality gap of −1.420 ± 0.82 and −1.01 ± 0.75, respectively. The service quality gaps in medical centers, health providers of rural area, and health providers of urban area were −0.883 ± 0.67, −0.882 ± 0.83, and −0.804 ± 0.62, respectively. There was a significant relationship between peoples’ perceptions and expectations concerning the quality of health services and their educational levels. Conclusion The higher gaps in quality in hospitals and in doctors’ offices require more attention. Managers and policy makers should consider developing and implementing plans to reduce these gaps in quality and to promote better health services in these two sectors. PMID:27123214

An investigation on the quality of midwifery services from the viewpoint of the clients in Isfahan through SERVQUAL model

PubMed Central

Oliaee, Zohreh; Jabbari, Alireza; Ehsanpour, Soheila

2016-01-01

Background: Quality of care is of great importance in health services as these services have the important mission to preserve health, and to give care to the society. The present study aimed to investigate the quality of midwifery services from the viewpoint of the clients, under coverage of health care centers in Isfahan, through SERVQUAL model. Materials and Methods: This descriptive and analytical study was conducted on 218 subjects in 2014. Study population comprised the women referring to midwifery services clinics in health care centers in Isfahan. Data of the subjects (n = 218) were collected by SERVQUAL model containing the dimensions of tangibles, reliability, responsiveness, assurance, and empathy. Data were analyzed by paired t-test, Spearman and Pearson correlation coefficients, and independent t-test through SPSS 20. Results: There was a negative gap in all five relevant dimensions of giving services. The widest gap was in the mean of dimension of tangibles (−1.5), and the narrowest gap was in the dimension of assurance (−0.9). There was no significant association between the scores of expectations and perceptions, and age, education level, occupation, and marital status. Conclusions: The obtained negative gap showed that the level of service receivers' perception from existing condition was far from their expectation, and there was a wide gap between attaining their satisfaction with midwifery services and their expectation and reaching their appropriate level of services. PMID:27186207

Mothers’ Perception of Quality of Services from Health Centers after Perinatal Loss

PubMed Central

Sereshti, Manije; Nahidi, Fateme; Simbar, Masomeh; Ahmadi, Fazlollah; Bakhtiari, Maryam; Zayeri, Farid

2016-01-01

Introduction Perinatal loss is one of the most stressful life events that parents and caregivers experience. Providing an empathetic, caring environment to support mothers who experience perinatal loss is necessary. The aim of this study was to assess mothers’ perception of the quality of services received from health centers after perinatal loss. Methods This study was conducted in 2014–2015 using qualitative content analysis. Participants in the study were 40 women with a history of miscarriage, stillbirth, or neonatal death who live in Tehran and Shahrekord, Iran. Data were collected from the participants through semi-structured, in-depth interviews, and they were analyzed using qualitative content analysis. Results One theme and six main categories were developed, and they indicated the mothers’ experiences and understandings of the quality of service received after perinatal loss. The major theme was ‘dissatisfaction with the quality of care received.’ The main categories included: 1) effective communication, 2) expecting responsiveness, 3) expecting to respect the patient’s dignity, 4) expecting better care, 5) tension of medical expenses, and 6) insufficient facilities. Conclusion The findings of this study highlighted the weaknesses, inadequacies, strengths, and opportunities in providing health services. They can help reproductive health policy-makers reduce the pain and suffering of the affected families with appropriate measures. PMID:27054012

Data envelopment analysis in service quality evaluation: an empirical study

NASA Astrophysics Data System (ADS)

Najafi, Seyedvahid; Saati, Saber; Tavana, Madjid

2015-09-01

Service quality is often conceptualized as the comparison between service expectations and the actual performance perceptions. It enhances customer satisfaction, decreases customer defection, and promotes customer loyalty. Substantial literature has examined the concept of service quality, its dimensions, and measurement methods. We introduce the perceived service quality index (PSQI) as a single measure for evaluating the multiple-item service quality construct based on the SERVQUAL model. A slack-based measure (SBM) of efficiency with constant inputs is used to calculate the PSQI. In addition, a non-linear programming model based on the SBM is proposed to delineate an improvement guideline and improve service quality. An empirical study is conducted to assess the applicability of the method proposed in this study. A large number of studies have used DEA as a benchmarking tool to measure service quality. These models do not propose a coherent performance evaluation construct and consequently fail to deliver improvement guidelines for improving service quality. The DEA models proposed in this study are designed to evaluate and improve service quality within a comprehensive framework and without any dependency on external data.

Reducing Health Inequalities in Scotland: The Involvement of People with Learning Disabilities as National Health Service Reviewers

ERIC Educational Resources Information Center

Campbell, Martin; Martin, Mike

2010-01-01

Reducing health inequalities is a key priority for the Scottish Government. Health authorities are expected to meet quality targets. The involvement of people with learning disabilities in health service review teams has been one of the initiatives used in by National Health Service Quality Improvement Scotland to empower patients and improve…

A Collaborative Approach to College and University Student Health and Wellness

ERIC Educational Resources Information Center

Fullerton, Darren S.

2011-01-01

As colleges and universities around the country face extreme financial pressures, they also face mounting public expectations to improve and increase the quality and number of services they provide to their students. Some of these expectations include the presumption that the institutions will offer quality health care, fitness, and wellness…

Service quality framework for clinical laboratories.

PubMed

Ramessur, Vinaysing; Hurreeram, Dinesh Kumar; Maistry, Kaylasson

2015-01-01

The purpose of this paper is to illustrate a service quality framework that enhances service delivery in clinical laboratories by gauging medical practitioner satisfaction and by providing avenues for continuous improvement. The case study method has been used for conducting the exploratory study, with focus on the Mauritian public clinical laboratory. A structured questionnaire based on the SERVQUAL service quality model was used for data collection, analysis and for the development of the service quality framework. The study confirms the pertinence of the following service quality dimensions within the context of clinical laboratories: tangibility, reliability, responsiveness, turnaround time, technology, test reports, communication and laboratory staff attitude and behaviour. The service quality framework developed, termed LabSERV, is vital for clinical laboratories in the search for improving service delivery to medical practitioners. This is a pioneering work carried out in the clinical laboratory sector in Mauritius. Medical practitioner expectations and perceptions have been simultaneously considered to generate a novel service quality framework for clinical laboratories.

Managing hospital quality performance in two related areas: patient care and customer service.

PubMed

Dwore, R B

1993-01-01

The Joint Commission on Accreditation of Healthcare Organization's new emphasis on continuous quality improvement provides hospitals with an opportunity to enhance both customer service as well as patient care. Both are expected by patients and delivered by providers. Patient care is the core product; customer service augments it by adding value and providing the opportunity for a competitive advantage. This article discusses issues for administrators to consider before including customer service as a component of continuous quality improvement and then presents methods for bringing about change.

Service quality: understanding and implementing the concept in the clinical laboratory. Match service quality to consumer expectations.

PubMed

O'Connor, S J

1989-01-01

The increasingly competitive health-care marketplace has mandated that health-care managers pay careful attention to the issue of quality from the perspective of the consumer. The importance of this issue is underscored by the fact that numerous health-care institutions and associations have recently begun to recognize the urgent need to obtain a greater understanding of service quality in a health-care situation. This article suggests means to understand, identify, improve, and implement effective approaches to this vital aspect of the marketing mix.

Applicability of SWOT analysis for measuring quality of public oral health services as perceived by adult patients in Finland. Strengths, weaknesses, opportunities and threats.

PubMed

Toivanen, T; Lahti, S; Leino-Kilpi, H

1999-10-01

To determine the applicability of SWOT analysis for measuring the quality of public oral health services from the adult client's perspective. Data were collected using a structured questionnaire developed in an earlier study. The study group consisted of all adult (over 18 years of age) clients (n = 256) using public municipal oral health services in Kirkkonummi, Finland, during 2 weeks in 1995. Before treatment, patients filled out a questionnaire that measured the importance of their expectations in different aspects of oral care. After the appointment, they filled out a similar questionnaire that measured the enactment of these expectations in the treatment situation. The response rate was 51%. The difference between subjective importance and enactment of expectations was tested by Wilcoxon's signed rank test. Results were interpreted using both a conventional analysis of "expectation enacted or not" and SWOT analysis, which is used in strategic planning to identify areas of strengths (S), weaknesses (W), opportunities (O) and threats (T) in an organisation. In 28 statements out of 35, the two analyses revealed similar interpretations. In most areas the patient-perceived quality of the services was good. Weaknesses were found in the following areas: communicating to patients the causes and risk of developing oral diseases, informing them about different treatment possibilities, and including patients in decision-making when choosing restorative materials. SWOT analysis provided more structured interpretation of the results, and can be more easily transferred to development of services.

Assessing quality of health services with the SERVQUAL model in Iran. A systematic review and meta-analysis.

PubMed

Teshnizi, Saeed Hosseini; Aghamolaei, Teamur; Kahnouji, Kobra; Teshnizi, Seyyed Mehrdad Hosseini; Ghani, Jalil

2018-03-01

The five-dimension service quality (SERVQUAL) scale is one of the most common tools for evaluating gaps between clients' perceptions and expectations. This study aimed to assess the quality of health services in Iran through a meta-analysis of all Iranian studies which used the SERVQUAL tool. A systematic literature review has been performed in Web of Science, PubMed, Scopus, Google Scholar, Iran Medex, Magiran and Scientific Information Database. All relevant English or Persian studies published between January 2009 and April 2016 were have been selected. Papers were considered if they regarded all five dimensions of the SERVQUAL tool for assessing the quality of health care services. Two reviewer independently extracted mean and standard deviation of five dimensions and characteristics of studies. The quality of studies included in meta-analysis using STROBE checklist. Of 315 studies initially identified, 12 were included in our meta-analysis. All analyses were performed in Stata MP v. 14. Patients' perceptions were lower than their expectations (gap = -1.64). Responsibility (-1.22) and reliability (-1.15) had the lowest gaps, and tangibility and empathy (-1.03) had the largest gaps. Except gender, other variables had no significant associations with gaps. Patients in the cities of Arak (-3.47) and Shiraz (-3.02) had the largest gaps. All dimensions of service quality were negative, which implies that the quality of health services in Iran has not been satisfying to patients and needs to be improved.

Measuring patient's expectation and the perception of quality in LASIK services.

PubMed

Lin, Deng-Juin; Sheu, Ing-Cheau; Pai, Jar-Yuan; Bair, Alex; Hung, Che-Yu; Yeh, Yuan-Hung; Chou, Ming-Jen

2009-07-10

LASIK is the use of excimer lasers to treat therapeutic and refractive visual disorders, ranging from superficial scars to nearsightedness (myopia), and from astigmatism to farsightedness (hyperopia). The purposes of this study are to checking the applicability and psychometric properties of the SERVQUAL on Lasik surgery population. Second, use SEM methods to investigate the loyalty, perceptions and expectations relationship on LASIK surgery. The method with which this study was conducted was questionnaire development. A total of 463 consecutive patients, attending LASIK surgery affiliated with Chung Shan Medical University Eye Center, enrolled in this study. All participants were asked to complete revised SERVQUAL questionnaires. Student t test, correlation test, and ANOVA and factor analyses were used to identify the characters and factors of service quality. Paired t test were used to test the gap between expectation and perception scores and structural equation modeling was used to examine relationships among satisfaction components. The effective response rate was 97.3%. Validity was verified by several methods and internal reliability Cronbach's alpha was > 0.958. The results from patient's scores were very high with an overall score of 6.41(0.66), expectations at 6.68(0.47), and perceptions at 6.51(0.57). The gap between expectations and perceptions was significant, however, (t = 6.08). Furthermore, there were significant differences in the expectation scores among the different jobs. Also, the results showed that the higher the education of the patient, the lower their perception score (r = -0.10). The factor loading results of factor analysis showed 5 factors of the 22 items of the SERVQUAL model. The 5 factors of perception explained 72.94% of the total variance there; and on expectations it explained 77.12% of the total variance of satisfaction scores.The goodness-of-fit summary, of structure equation modeling, showed trends in concept on expectations, perceptions, and loyalty. The results of this research appear to show that the SERVQUAL instrument is a useful measurement tool in assessing and monitoring service quality in LASIK service, and enabling staff to identify where improvements are needed, from the patients' perspective. There were service quality gaps in the reliability, assurance, and empathy. This study suggested that physicians should increase their discussions with patients; which has, of course, already been proven to be an effective way to increase patient's satisfaction with medical care, regardless of the procedure received.

Comparison of veterinary health services expectations and perceptions between oncologic pet owners, non-oncologic pet owners and veterinary staff using the SERVQUAL methodology

PubMed Central

Gregório, Hugo; Santos, Patricia; Pires, Isabel; Prada, Justina; Queiroga, Felisbina Luísa

2016-01-01

Aim: Client satisfaction gained great importance in health care as a measurement of service quality. One of the most popular methods to evaluate client satisfaction is the SERVQUAL inquiry which measures service quality by evaluating client expectations and services towards a service in five dimensions: Tangibles, Empathy, Assurance, Reliability and Responsiveness. Materials and Methods: In order to evaluate if owners of pets with cancer constitute a distinctive group from the general pet owner population and if these differences were perceived by the hospital staff we applied a SERVQUAL questionnaire to 51 owners of pet with cancer, 68 owners from the general pet population and 14 staff members. Results: Owners of oncologic pets had different expectations of an ideal service granting importance to Assurance questions (6.75 vs 6.5, p= 0.045) while showing unmet needs in Reliability and Empathy dimensions. Veterinarians failed to understand these specificities and over evaluated characteristics of Tangible dimension (6.75 vs 6.25, p=0.027). Conclusion: Owners of pet with cancer seem to constitute a specific subpopulation with special needs and veterinary staff should invest resources towards Assurance instead of privileging tangible aspects of veterinary services. By aligning professionals expectations with those of pet owners veterinarians can achieve better client satisfaction, improved compliance and stronger doctor-owner relationships. PMID:27956781

Comparison of veterinary health services expectations and perceptions between oncologic pet owners, non-oncologic pet owners and veterinary staff using the SERVQUAL methodology.

PubMed

Gregório, Hugo; Santos, Patricia; Pires, Isabel; Prada, Justina; Queiroga, Felisbina Luísa

2016-11-01

Client satisfaction gained great importance in health care as a measurement of service quality. One of the most popular methods to evaluate client satisfaction is the SERVQUAL inquiry which measures service quality by evaluating client expectations and services towards a service in five dimensions: Tangibles, Empathy, Assurance, Reliability and Responsiveness. In order to evaluate if owners of pets with cancer constitute a distinctive group from the general pet owner population and if these differences were perceived by the hospital staff we applied a SERVQUAL questionnaire to 51 owners of pet with cancer, 68 owners from the general pet population and 14 staff members. Owners of oncologic pets had different expectations of an ideal service granting importance to Assurance questions (6.75 vs 6.5, p= 0.045) while showing unmet needs in Reliability and Empathy dimensions. Veterinarians failed to understand these specificities and over evaluated characteristics of Tangible dimension (6.75 vs 6.25, p=0.027). Owners of pet with cancer seem to constitute a specific subpopulation with special needs and veterinary staff should invest resources towards Assurance instead of privileging tangible aspects of veterinary services. By aligning professionals expectations with those of pet owners veterinarians can achieve better client satisfaction, improved compliance and stronger doctor-owner relationships.

Using a relational database to improve mortality and length of stay for a department of surgery: a comparative review of 5200 patients.

PubMed

Ang, Darwin N; Behrns, Kevin E

2013-07-01

The emphasis on high-quality care has spawned the development of quality programs, most of which focus on broad outcome measures across a diverse group of providers. Our aim was to investigate the clinical outcomes for a department of surgery with multiple service lines of patient care using a relational database. Mortality, length of stay (LOS), patient safety indicators (PSIs), and hospital-acquired conditions were examined for each service line. Expected values for mortality and LOS were derived from University HealthSystem Consortium regression models, whereas expected values for PSIs were derived from Agency for Healthcare Research and Quality regression models. Overall, 5200 patients were evaluated from the months of January through May of both 2011 (n = 2550) and 2012 (n = 2650). The overall observed-to-expected (O/E) ratio of mortality improved from 1.03 to 0.92. The overall O/E ratio for LOS improved from 0.92 to 0.89. PSIs that predicted mortality included postoperative sepsis (O/E:1.89), postoperative respiratory failure (O/E:1.83), postoperative metabolic derangement (O/E:1.81), and postoperative deep vein thrombosis or pulmonary embolus (O/E:1.8). Mortality and LOS can be improved by using a relational database with outcomes reported to specific service lines. Service line quality can be influenced by distribution of frequent reports, group meetings, and service line-directed interventions.

Gap Analysis between Perceptions and Expectations of Medical-Surgical Patients in a Public Hospital in Saudi Arabia.

PubMed

Al-Momani, Mohammed Mahmoud

2016-01-01

To investigate patients' satisfaction with nursing care by measuring the gap between patients' expectations of care and perceptions of the actual care provided and to identify the areas of nursing care that need improvement. A cross-sectional survey was conducted among patients who were admitted to the Departments of Medicine and Surgery at King Saud Medical City, Riyadh, Saudi Arabia. A modified Service Quality (SERVQUAL) instrument was adapted to collect information from a convenience sample of 432 patients from November 25, 2012, to February 3, 2013. The instrument comprised 22 pairs of questions assessing 5 dimensions of the nursing care provided to patients during hospitalizations. The mean patient expectations and perceptions as well as the gap score values for each dimension of nursing service were tested for differences between the mean scores of the sample at a level of significance of 0.05 using a t test. The gap score for all of the 5 dimensions of nursing services were: responsiveness, -1.71; reliability, -1.48; tangibles, -1.36; assurance, -1.26, and empathy, -0.96. Service quality across the dimensions of responsiveness and reliability was statistically significant (p < 0.05). This result indicated that patients were not satisfied with the nursing service quality in relation to all dimensions. Our study showed negative gaps for the 5 nursing service quality dimensions evaluated. This could provide nurses with information about the aspects of nursing care that promote more positive patient outcomes and satisfaction. © 2015 S. Karger AG, Basel.

Students' perception of quality of medical education in a medical college in west Bengal, India.

PubMed

Mukhopadhyay, Dipta Kanti

2016-01-01

Students' perceived quality of educational service is an important field of educational research. To identify the gaps in the quality of educational services as perceived by students in a medical college in West Bengal, India. In a cross-sectional study, educational quality was measured using validated SERVQUAL instrument between two randomly selected groups of undergraduate medical students (n = 179). This five-point Likert scale questionnaire measured the expectation and perception of students on 26 items under five dimensions of quality of educational services, viz., tangible (physical facilities, equipment, and appearance of personnel), reliability (accuracy and consistency of a department in providing educational services), responsiveness (eagerness to help and commitment), assurance (ability of teaching departments to earn students' confidence), and empathy (ability to communicate care and understanding). Dimension-wise difference in the mean scores for expectation and perception was calculated and was considered as quality gaps in educational services. Significant negative quality gaps were noted in all five dimensions. The highest gap was found in tangible (-1.67) followed by empathy (-1.64) although the mean score of perceived quality in the dimension of empathy was the lowest (2.53). This indicates the need for improvement in physical facilities as well as behavior of teachers and staff toward students. The smallest gap was noted in the dimension of assurance (-1.29), which indicates the students' overall confidence in teaching departments regarding their management or content expertise. These findings underscore students' aspiration for the overall improvement of educational services that can be taken into consideration during development planning.

Brewing Service Quality in Higher Education: Characteristics of Ingredients that Make up the Recipe

ERIC Educational Resources Information Center

Yeo, Roland K.

2008-01-01

Purpose: The paper seeks to explore the influences of service quality in higher education and the perceptions associated with the implementation of a Singapore tertiary institution. It draws on the underpinnings of SERVQUAL, and discusses the dichotomy and interrelation between customer perception and expectation. Design/methodology/approach:…

Short-Term International Experience (STIE) and Students' Understanding of Quality Early Childhood Service Provision

ERIC Educational Resources Information Center

Sims, Margaret; Nishida, Yukiyo

2018-01-01

Exposing pre-service teachers to international professional experiences through a short-term visiting programme serves to challenge their understandings of good quality practice through disturbing assumptions and expectations previously formed through experiences in their own country/culture. Much of the research in international study focuses on…

Measuring Service Quality in a Nontraditional Institution Using Importance-Performance Gap Analysis

ERIC Educational Resources Information Center

Mugdh, Mrinal

2004-01-01

nd wants of these students, nontraditional colleges have adopted research strategies that take into account both student expectations as well as their perception of satisfaction to assess service quality at their institutions. As one of the model adult learner focused institutions, Empire State College used Noel-Levitz Adult Learner Inventory in…

Perspectives of Nurses Toward Telehealth Efficacy and Quality of Health Care: Pilot Study.

PubMed

Bashir, Ayisha; Bastola, Dhundy R

2018-05-25

Telehealth nursing, or the delivery, management, and coordination of nursing care services provided via telecommunications technology, is one of the methods of delivering health care to patients in the United States. It is important to assess the service quality of the involved health professionals as well as the telehealth nursing process. The focus of this study is the innovative model of telehealth care delivery by nurses for managing patients with chronic disease while they are living in their own residence. The primary objective of this pilot study was to examine whether telehealth technology impacts the perceived level of internal service quality delivered by nurses within a telehealth organization. To address this research goal, the notion of telehealth nursing service quality (TNSQ) is empirically tested and validated with a survey instrument. Data were collected from nurses belonging to a home care agency based on interview questions inquiring about facilitators and inhibitors to TNSQ. A survey to measure TNSQ based on the SERVQUAL instrument was completed by adjusting descriptions of the original instrument to suit the context. Follow-up interviews were conducted to validate questions on the revised instrument. The findings of this survey research were positive, based on mean differences between expectations and perceptions of TNSQ. This indicates satisfaction with TNSQ and shows that the quality of the service is higher than what the respondents expect. The Wilcoxon signed-rank test using the P value for the test, which is .35, did not show a statistically significant change between the median differences of perception and expectation. The total number of respondents was 13. Results indicate that overall perceived service quality is a positive value (0.05332). This means the perceptions of the level of service are slightly higher than what they expect, indicating there is satisfaction with TNSQ. The responses to the interview questions and data gathered from the survey showed overall satisfaction with TNSQ. The SERVQUAL instrument was a good framework to assess TNSQ. In a nutshell, the study highlighted how the telehealth process provides daily monitoring of patient health, leading to the benefits of immediate feedback for patients, family, and caregivers as well as convenience of scheduling. ©Ayisha Bashir, Dhundy R Bastola. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 25.05.2018.

Perspectives of Nurses Toward Telehealth Efficacy and Quality of Health Care: Pilot Study

PubMed Central

Bastola, Dhundy R

2018-01-01

Background Telehealth nursing, or the delivery, management, and coordination of nursing care services provided via telecommunications technology, is one of the methods of delivering health care to patients in the United States. It is important to assess the service quality of the involved health professionals as well as the telehealth nursing process. The focus of this study is the innovative model of telehealth care delivery by nurses for managing patients with chronic disease while they are living in their own residence. Objective The primary objective of this pilot study was to examine whether telehealth technology impacts the perceived level of internal service quality delivered by nurses within a telehealth organization. To address this research goal, the notion of telehealth nursing service quality (TNSQ) is empirically tested and validated with a survey instrument. Methods Data were collected from nurses belonging to a home care agency based on interview questions inquiring about facilitators and inhibitors to TNSQ. A survey to measure TNSQ based on the SERVQUAL instrument was completed by adjusting descriptions of the original instrument to suit the context. Follow-up interviews were conducted to validate questions on the revised instrument. Results The findings of this survey research were positive, based on mean differences between expectations and perceptions of TNSQ. This indicates satisfaction with TNSQ and shows that the quality of the service is higher than what the respondents expect. The Wilcoxon signed-rank test using the P value for the test, which is .35, did not show a statistically significant change between the median differences of perception and expectation. The total number of respondents was 13. Results indicate that overall perceived service quality is a positive value (0.05332). This means the perceptions of the level of service are slightly higher than what they expect, indicating there is satisfaction with TNSQ. Conclusions The responses to the interview questions and data gathered from the survey showed overall satisfaction with TNSQ. The SERVQUAL instrument was a good framework to assess TNSQ. In a nutshell, the study highlighted how the telehealth process provides daily monitoring of patient health, leading to the benefits of immediate feedback for patients, family, and caregivers as well as convenience of scheduling. PMID:29802089

Service quality in public health clinics: perceptions of users and health professionals.

PubMed

Campos, Domingos Fernandes; Negromonte Filho, Rinaldo Bezerra; Castro, Felipe Nalon

2017-10-09

Purpose The purpose of this paper is to investigate the expectations and quality gaps in services provided at city public health clinics in the city of Natal, Brazil, from the perspective of patients and healthcare service providers. Design/methodology/approach The research sample consisted of 1,200 patients who used public health services and 265 providers - doctors, nutritionists, physiotherapists, psychologists, pharmacists and managers at three health clinics in the city of Natal, Brazil. A scale with 25 health service attributes was used in data collection. Summary statistics and t-test were used to analyze the data. Findings The results show that the providers think that users have lower levels of expectations than those indicated by the users in all attributes. Providers and users have the most approximate insights into what attributes are considered most important: explanations, level of knowledge and attention dispensed by health professionals. Users and providers perceived similar quality gaps for most of the attributes. The gaps were statistically the same, when comparing the mean quality shortcomings by means of a Student's test, considering a significance level of 5 percent, obtained independently by the manifestation of users and providers. Research limitations/implications The results reveal only a photograph of the moment. The study did not consider the differences that may exist between groups with different income levels, genders or age groups. A qualitative study could improve the understanding of the differences and coincidences of the diverse points of views. A more advanced research could even study possibilities so that health managers could promote changes in the service, some of them low cost, as the health professionals training for contact with patients. Practical implications The evaluation of the service quality complemented by the matrix of opportunities, importance × quality gaps generates information to help make decisions in the rational allocation of available resources and improvement of the quality of the service delivered to patients. Besides, it offers a focus to prioritize specific actions. Originality/value It is important to compare the perceptions of service quality between patients and the healthcare service providers who work in direct contact with them. The managers can smooth out these differences and ensure, over time, customer satisfaction. In this study, providers were asked to express what they think about the expectations of patients and about their own service performance delivered. Thus, not only the traditional gap 5 was measured, but it was also possible to evaluate the distance between what providers think that patients need and their actual needs.

The Students' Viewpoint on Quality of Educational Services in Iran.

PubMed

Siamian, Hasan; Rostami, Farideh; Ghara, Aliasghar Nadi; Abedi, Ghassem

2017-03-01

Recently, focusing on higher education quality has got increasingly critical. The novel managerial attitudes have defined the customer-demanded quality. Based on this, recognizing the receivers' perception of the quality of the services offered and evaluating the quality of the service is considered of the basic measures taken in order to develop quality promotion programs. Therefore, this is a qualitative research conducted for students' viewpoint on quality of educational services. This qualitative study has been performed by the phenomenological method. The samples have been selected based on goal-oriented approach. In this qualitative research, the required data have been collected in two phases (90 individual interviews and 30 focus group discussions) at Mazandaran University of Medical Sciences during which the participants have conveyed their experiences and expectations encountering the educational quality topic. All the interviews have been recorded and implemented. The interviews analysis has been carried out simultaneously with the implementation and using theme analysis by Smith method. According to the findings regarding the definition of quality, the students have emphasized two important aspects including "educational services standards by the teacher "and "the students' satisfaction". Thus the final education quality resulted from the students' experiences and perception is this way: "Presenting the students educational services in class and out of class compatible with the educational services standards so that it results in the students' satisfaction". When a person views her/him-self rightful as a customer, whatever seems necessary to them appears like a requirement. Then regarding paying attention and reflecting on the customers' perceived needs, it is possible to determine their expectations limit to some extent. Therefore, designing educational quality standards in order to evaluate the teachers' function without taking the stakeholders' perspective into account is not practical. This research-extracted finding can present the stakeholders' perspective encountering the educational quality.

The Students’ Viewpoint on Quality of Educational Services in Iran

PubMed Central

Siamian, Hasan; Rostami, Farideh; Ghara, Aliasghar Nadi; Abedi, Ghassem

2017-01-01

Background: Recently, focusing on higher education quality has got increasingly critical. The novel managerial attitudes have defined the customer-demanded quality. Based on this, recognizing the receivers’ perception of the quality of the services offered and evaluating the quality of the service is considered of the basic measures taken in order to develop quality promotion programs. Therefore, this is a qualitative research conducted for students’ viewpoint on quality of educational services. Material and Methods: This qualitative study has been performed by the phenomenological method. The samples have been selected based on goal-oriented approach. In this qualitative research, the required data have been collected in two phases (90 individual interviews and 30 focus group discussions) at Mazandaran University of Medical Sciences during which the participants have conveyed their experiences and expectations encountering the educational quality topic. All the interviews have been recorded and implemented. The interviews analysis has been carried out simultaneously with the implementation and using theme analysis by Smith method. Results: According to the findings regarding the definition of quality, the students have emphasized two important aspects including “educational services standards by the teacher “and “the students’ satisfaction”. Thus the final education quality resulted from the students’ experiences and perception is this way: “Presenting the students educational services in class and out of class compatible with the educational services standards so that it results in the students’ satisfaction”. When a person views her/him-self rightful as a customer, whatever seems necessary to them appears like a requirement. Then regarding paying attention and reflecting on the customers’ perceived needs, it is possible to determine their expectations limit to some extent. Conclusion: Therefore, designing educational quality standards in order to evaluate the teachers’ function without taking the stakeholders’ perspective into account is not practical. This research-extracted finding can present the stakeholders’ perspective encountering the educational quality. PMID:28484355

Quality assessment of clinical education services in teaching hospitals located in Kerman, Iran.

PubMed

Yazdi-Feyzabadi, Vahid; Gozashti, Mohammad Hossein; Komsari, Samane; Mohammadtaghizadeh, Sedigheh; Amiresmaili, Mohammadreza

2015-11-01

Clinical education is one of the most important components of the resource generation function of health systems, and it has a very important role in graduates' competency with respect to effective, practical education. This study aimed to assess the quality of clinical services in Kerman's teaching hospitals located in southeastern Iran. This cross-sectional study was conducted in 2011 on 303 medical students at different levels of medical education at Kerman's teaching hospitals. A modified SERVQUAL instrument was used to collect the data after its validity and reliability were checked. The data were analyzed by SPSS 18.0 using the paired t-test, Kruskal-Wallis, and post hoc tests, when appropriate. In all five dimensions of quality, gaps were observed between students' perceptions and expectations as follows: Assurance (mean = -1.18), Responsiveness (-1.56), Empathy (-1.4), Reliability (-1.27), and Tangibles (-1.21). There was a significant difference between the quality perceptions and expectations of the medical students (p < 0.001). A significant difference was observed between three educational levels, including externships, internships, and assistantships regarding the dimensions of the quality gaps (p < 0.001). The clinical services provided by teaching hospitals in the study did not meet the students' expectations at any of the three educational levels. As we precisely assessed the dimensions and items that had the higher quality gaps, it was apparent that, for most part, clinical education officials could improve the quality by designing interventions, which would not be very difficult to do.

The quality improvement strategy.

PubMed

Burns, L R; Beach, L R

1994-01-01

To prepare for managed competition, many hospitals now focus on service quality as a means to improve their competitive position. To aid in decisions about where best to direct limited resources, managers need physician feedback about how the hospital's services compare with its competitors' services (competitive advantage) and about the degree to which the hospital's services fall short of, meet, or exceed physicians' expectations (customer satisfaction). This article describes a strategy for acquiring information about competitive advantage and customer satisfaction and for using the information to identify optimal service improvement opportunities. It then presents a step-by-step application of the Quality Improvement Strategy (QIS) for a large urban hospital.

[Voluntary help in dementia - predictors for utilisation and expected quality from a family caregiver's point of view].

PubMed

Grässel, E; Luttenberger, K; Römer, H; Donath, C

2010-09-01

Although support services are considered cost-effective in the relief of care-giving family members of dementia patients, there has been little research to date on the predictors of use and quality expectations. These two questions are examined for the first time based on cross-sectional data of 404 care-giving family members, users and non-users of voluntary help services. Quantitative data are evaluated using binary logistical regression analysis, qualitative data using content analysis. The rating of how helpful the use of a voluntary help service is in the personal situation was found to be the only significant predictor of use. With respect to quality, it is most important that the persons giving support be punctual and well-trained. To increase the rate of use, care-giving family members must be convinced of the relevant benefits of using a voluntary help service. In addition, attention must be paid to the professional organization and training of voluntary helpers. Georg Thieme Verlag KG Stuttgart, New York.

How To Stretch Your Food Service Dollars

ERIC Educational Resources Information Center

Anderson, B. Robert

1973-01-01

The implications of any program as large as food service suggests that the administrator be conversant with the total field of food service distribution and the extras'' available as part of a burgeoning industry. An administrator has the right to expect competitive prices, excellent quality, good delivery, and superior peripheral services.…

Adapting the SERVQUAL scale to hospital services: an empirical investigation.

PubMed Central

Babakus, E; Mangold, W G

1992-01-01

Defining and measuring the quality of service has been a major challenge for health care marketers. A comprehensive service quality measurement scale (SERVQUAL) is empirically evaluated for its potential usefulness in a hospital service environment. Active participation by hospital management helped to address practical and user-related aspects of the assessment. The completed expectations and perceptions scales met various criteria for reliability and validity. Suggestions are provided for the managerial use of the scale, and a number of future research issues are identified. PMID:1737708

Improving Library Service Quality to Graduate Students: LibQual+[TM] Survey Results in a Practical Setting

ERIC Educational Resources Information Center

Jankowska, Maria Anna; Hertel, Karen; Young, Nancy J.

2006-01-01

The LibQUAL+[TM] survey was conducted to determine user satisfaction and expectations concerning library service quality. The results of the "22 items and a box" constituted a rich source of information for the University of Idaho (UI) Library's strategic planning process. Focusing on graduate students, this study used three…

Variations in Student Perceptions of Service Quality of Higher Education Institutions in Brazil: A Longitudinal Study

ERIC Educational Resources Information Center

Campos, Domingos Fernandes; dos Santos, Guido Salvi; Castro, Felipe Nalon

2017-01-01

Purpose: The purpose of this paper is to examine, through a longitudinal study, undergraduate student perceptions of service expectations, priorities and quality of the higher education institution that they attend, using an importance-performance rating matrix. Design/methodology/approach: This research was carried out with students exposed to a…

Gearing service quality into public and private hospitals in small islands: empirical evidence from Cyprus.

PubMed

Arasli, Huseyin; Ekiz, Erdogan Haktan; Katircioglu, Salih Turan

2008-01-01

The purpose of this research is to develop and compare some determinants of service quality in both the public and private hospitals of Northern Cyprus. There is considerable lack of literature with respect to service quality in public and private hospitals. Randomly, 454 respondents, who have recently benefited from hospital services in Famagusta, were selected to answer a modified version of the SERVQUAL Instrument. The instrument contained both service expectations and perceptions questions. This study identifies six factors regarding the service quality as perceived in both public and private Northern Cyprus hospitals. These are: empathy, giving priority to the inpatients needs, relationships between staff and patients, professionalism of staff, food and the physical environment. Research results revealed that the various expectations of inpatients have not been met in either the public or the private hospitals At the micro level, the lack of management commitment to service quality in both hospital settings leads doctors and nurses to expend less effort increasing or improving inpatient satisfaction. Hospital managers should also satisfy their employees, since job satisfaction leads to customer satisfaction and loyalty. Additionally, hospital administrations need to gather systematic feedback from their inpatients, establish visible and transparent complaint procedures so that inpatients' complaints can be addressed effectively and efficiently. The hospitals need to organize training sessions based on the critical importance of service quality and the crucial role of inpatient satisfaction in the health care industry. Future studies should include the remaining regions in Cyprus in order to increase research findings' generalizability. Additionally, including other dimensions such as hospital processes and discharge management and co-ordination may provide further insights into understanding inpatients' perceptions and intentions.

Total Quality Management of Information System for Quality Assessment of Pesantren Using Fuzzy-SERVQUAL

NASA Astrophysics Data System (ADS)

Faizah, Arbiati; Syafei, Wahyul Amien; Isnanto, R. Rizal

2018-02-01

This research proposed a model combining an approach of Total Quality Management (TQM) and Fuzzy method of Service Quality (SERVQUAL) to asses service quality. TQM implementation was as quality management orienting on customer's satisfaction by involving all stakeholders. SERVQUAL model was used to measure quality service based on five dimensions such as tangible, reliability, responsiveness, assurance, and empathy. Fuzzy set theory was to accommodate subjectivity and ambiguity of quality assessment. Input data consisted of indicator data and quality assessment aspect. Input data was, then, processed to be service quality assessment questionnaires of Pesantren by using Fuzzy method to get service quality score. This process consisted of some steps as follows : inputting dimension and questionnaire data to data base system, filling questionnaire through system, then, system calculated fuzzification, defuzzification, gap of quality expected and received by service receivers, and calculating each dimension rating showing quality refinement priority. Rating of each quality dimension was, then, displayed at dashboard system to enable users to see information. From system having been built, it could be known that tangible dimension had the highest gap, -0.399, thus it needs to be prioritized and gets evaluation and refinement action soon.

Healthcare service quality: towards a broad definition.

PubMed

Mosadeghrad, Ali Mohammad

2013-01-01

The main purpose of this study is to define healthcare quality to encompass healthcare stakeholder needs and expectations because healthcare quality has varying definitions for clients, professionals, managers, policy makers and payers. This study represents an exploratory effort to understand healthcare quality in an Iranian context. In-depth individual and focus group interviews were conducted with key healthcare stakeholders. Quality healthcare is defined as "consistently delighting the patient by providing efficacious, effective and efficient healthcare services according to the latest clinical guidelines and standards, which meet the patient's needs and satisfies providers". Healthcare quality definitions common to all stakeholders involve offering effective care that contributes to the patient well-being and satisfaction. This study helps us to understand quality healthcare, highlighting its complex nature, which has direct implications for healthcare providers who are encouraged to regularly monitor healthcare quality using the attributes identified in this study. Accordingly, they can initiate continuous quality improvement programmes to maintain high patient-satisfaction levels. This is the first time a comprehensive healthcare quality definition has been developed using various healthcare stakeholder perceptions and expectations.

Measuring patient's expectation and the perception of quality in LASIK services

PubMed Central

Lin, Deng-Juin; Sheu, Ing-Cheau; Pai, Jar-Yuan; Bair, Alex; Hung, Che-Yu; Yeh, Yuan-Hung; Chou, Ming-Jen

2009-01-01

Background LASIK is the use of excimer lasers to treat therapeutic and refractive visual disorders, ranging from superficial scars to nearsightedness (myopia), and from astigmatism to farsightedness (hyperopia). The purposes of this study are to checking the applicability and psychometric properties of the SERVQUAL on Lasik surgery population. Second, use SEM methods to investigate the loyalty, perceptions and expectations relationship on LASIK surgery. Methods The method with which this study was conducted was questionnaire development. A total of 463 consecutive patients, attending LASIK surgery affiliated with Chung Shan Medical University Eye Center, enrolled in this study. All participants were asked to complete revised SERVQUAL questionnaires. Student t test, correlation test, and ANOVA and factor analyses were used to identify the characters and factors of service quality. Paired t test were used to test the gap between expectation and perception scores and structural equation modeling was used to examine relationships among satisfaction components. Results The effective response rate was 97.3%. Validity was verified by several methods and internal reliability Cronbach's alpha was > 0.958. The results from patient's scores were very high with an overall score of 6.41(0.66), expectations at 6.68(0.47), and perceptions at 6.51(0.57). The gap between expectations and perceptions was significant, however, (t = 6.08). Furthermore, there were significant differences in the expectation scores among the different jobs. Also, the results showed that the higher the education of the patient, the lower their perception score (r = -0.10). The factor loading results of factor analysis showed 5 factors of the 22 items of the SERVQUAL model. The 5 factors of perception explained 72.94% of the total variance there; and on expectations it explained 77.12% of the total variance of satisfaction scores. The goodness-of-fit summary, of structure equation modeling, showed trends in concept on expectations, perceptions, and loyalty. Conclusion The results of this research appear to show that the SERVQUAL instrument is a useful measurement tool in assessing and monitoring service quality in LASIK service, and enabling staff to identify where improvements are needed, from the patients' perspective. There were service quality gaps in the reliability, assurance, and empathy. This study suggested that physicians should increase their discussions with patients; which has, of course, already been proven to be an effective way to increase patient's satisfaction with medical care, regardless of the procedure received. PMID:19591682

Using the "customer service framework" to successfully implement patient- and family-centered care.

PubMed

Rangachari, Pavani; Bhat, Anita; Seol, Yoon-Ho

2011-01-01

Despite the growing momentum toward patient- and family-centered care at the federal policy level, the organizational literature remains divided on its effectiveness, especially in regard to its key dimension of involving patients and families in treatment decisions and safety practices. Although some have argued for the universal adoption of patient involvement, others have questioned both the effectiveness and feasibility of patient involvement. In this article, we apply a well-established theoretical perspective, that is, the Service Quality Model (SQM) (also known as the "customer service framework") to the health care context, to reconcile the debate related to patient involvement. The application helps support the case for universal adoption of patient involvement and also question the arguments against it. A key contribution of the SQM lies in highlighting a set of fundamental service quality determinants emanating from basic consumer service needs. It also provides a simple framework for understanding how gaps between consumer expectations and management perceptions of those expectations can affect the gap between "expected" and "perceived" service quality from a consumer's perspective. Simultaneously, the SQM also outlines "management requirements" for the successful implementation of a customer service strategy. Applying the SQM to the health care context therefore, in addition to reconciling the debate on patient involvement, helps identify specific steps health care managers could take to successfully implement patient- and family-centered care. Correspondingly, the application also provides insights into strategies for the successful implementation of policy recommendations related to patient- and family-centered care in health care organizations.

Using fuzzy gap analysis to measure service quality of medical tourism in Taiwan.

PubMed

Ho, Li-Hsing; Feng, Shu-Yun; Yen, Tieh-Min

2015-01-01

The purpose of this paper is intended to create a model to measure quality of service, using fuzzy linguistics to analyze the quality of service of medical tourism in Taiwan so as to find the direction for improvement of service quality in medical tourism. The study developed fuzzy questionnaires based on the characteristics of medical tourism quality of service in Taiwan. Questionnaires were delivered and recovered from February to April 2014, using random sampling according to the proportion of medical tourism companies in each region, and 150 effective samples were obtained. The critical quality of service level is found through the fuzzy gap analysis using questionnaires examining expectations and perceptions of customers, as the direction for continuous improvement. From the study, the primary five critical service items that improve the quality of service for medical tourism in Taiwan include, in order: the capability of the service provider to provide committed medical tourism services reliably and accurately, facility service providers in conjunction with the services provided, the cordial and polite attitude of the service provider eliciting a sense of trust from the customer, professional ability of medical (nursing) personnel in hospital and reliability of service provider. The contribution of this study is to create a fuzzy gap analysis to assess the performance of medical tourism service quality, identify key quality characteristics and provide a direction for improvement and development for medical tourism service quality in Taiwan.

Linking water quality and well-being for improved assessment and valuation of ecosystem services

PubMed Central

Keeler, Bonnie L.; Polasky, Stephen; Brauman, Kate A.; Johnson, Kris A.; Finlay, Jacques C.; O’Neill, Ann; Kovacs, Kent; Dalzell, Brent

2012-01-01

Despite broad recognition of the value of the goods and services provided by nature, existing tools for assessing and valuing ecosystem services often fall short of the needs and expectations of decision makers. Here we address one of the most important missing components in the current ecosystem services toolbox: a comprehensive and generalizable framework for describing and valuing water quality-related services. Water quality is often misrepresented as a final ecosystem service. We argue that it is actually an important contributor to many different services, from recreation to human health. We present a valuation approach for water quality-related services that is sensitive to different actions that affect water quality, identifies aquatic endpoints where the consequences of changing water quality on human well-being are realized, and recognizes the unique groups of beneficiaries affected by those changes. We describe the multiple biophysical and economic pathways that link actions to changes in water quality-related ecosystem goods and services and provide guidance to researchers interested in valuing these changes. Finally, we present a valuation template that integrates biophysical and economic models, links actions to changes in service provision and value estimates, and considers multiple sources of water quality-related ecosystem service values without double counting. PMID:23091018

Linking water quality and well-being for improved assessment and valuation of ecosystem services.

PubMed

Keeler, Bonnie L; Polasky, Stephen; Brauman, Kate A; Johnson, Kris A; Finlay, Jacques C; O'Neill, Ann; Kovacs, Kent; Dalzell, Brent

2012-11-06

Despite broad recognition of the value of the goods and services provided by nature, existing tools for assessing and valuing ecosystem services often fall short of the needs and expectations of decision makers. Here we address one of the most important missing components in the current ecosystem services toolbox: a comprehensive and generalizable framework for describing and valuing water quality-related services. Water quality is often misrepresented as a final ecosystem service. We argue that it is actually an important contributor to many different services, from recreation to human health. We present a valuation approach for water quality-related services that is sensitive to different actions that affect water quality, identifies aquatic endpoints where the consequences of changing water quality on human well-being are realized, and recognizes the unique groups of beneficiaries affected by those changes. We describe the multiple biophysical and economic pathways that link actions to changes in water quality-related ecosystem goods and services and provide guidance to researchers interested in valuing these changes. Finally, we present a valuation template that integrates biophysical and economic models, links actions to changes in service provision and value estimates, and considers multiple sources of water quality-related ecosystem service values without double counting.

[Professional's expectations to improve quality of care and social services utilization in geriatric oncology].

PubMed

Antoine, Valéry; de Wazières, Benoît; Houédé, Nadine

2015-02-01

Coordination of a multidisciplinary and multi-professional intervention is a key issue in the management of elderly cancer patients to improve health status and quality of life. Optimizing the links between professionals is needed to improve care planning, health and social services utilization. Descriptive study in a French University Hospital. A 6-item structured questionnaire was addressed to professionals involved in global and supportive cares of elderly cancer patients (name, location, effective health care and services offered, needs to improve the quality of their intervention). After the analysis of answers, definition of propositions to improve cares and services utilization. The 37 respondents identified a total of 166 needs to improve quality of care in geriatric oncology. Major expectations were concerning improvement of global/supportive cares and health care services utilization, a better coordination between geriatric teams and oncologists. Ten propositions, including a model of in-hospital health care planning, were defined to answer to professional's needs with the aim of optimizing cancer treatment and global cares. Identification of effective services and needs can represent a first step in a continuous program to improve quality of cares, according to the French national cancer plan 2014-2019. It allows federating professionals for a coordination effort, a better organization of the clinical activity in geriatric oncology, to optimize clinical practice and global cares. Copyright © 2014 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Quality assessment of clinical education services in teaching hospitals located in Kerman, Iran

PubMed Central

Yazdi-Feyzabadi, Vahid; Gozashti, Mohammad Hossein; Komsari, Samane; Mohammadtaghizadeh, Sedigheh; Amiresmaili, Mohammadreza

2015-01-01

Introduction Clinical education is one of the most important components of the resource generation function of health systems, and it has a very important role in graduates’ competency with respect to effective, practical education. This study aimed to assess the quality of clinical services in Kerman’s teaching hospitals located in southeastern Iran. Methods This cross-sectional study was conducted in 2011 on 303 medical students at different levels of medical education at Kerman’s teaching hospitals. A modified SERVQUAL instrument was used to collect the data after its validity and reliability were checked. The data were analyzed by SPSS 18.0 using the paired t-test, Kruskal-Wallis, and post hoc tests, when appropriate. Results In all five dimensions of quality, gaps were observed between students’ perceptions and expectations as follows: Assurance (mean = −1.18), Responsiveness (−1.56), Empathy (−1.4), Reliability (−1.27), and Tangibles (−1.21). There was a significant difference between the quality perceptions and expectations of the medical students (p < 0.001). A significant difference was observed between three educational levels, including externships, internships, and assistantships regarding the dimensions of the quality gaps (p < 0.001). Conclusion The clinical services provided by teaching hospitals in the study did not meet the students’ expectations at any of the three educational levels. As we precisely assessed the dimensions and items that had the higher quality gaps, it was apparent that, for most part, clinical education officials could improve the quality by designing interventions, which would not be very difficult to do. PMID:26767094

Establishing a competitive advantage through quality management.

PubMed

George, R J

1996-06-01

The successful dentist of the future will establish a sustainable competitive advantage in the marketplace by recognising that patients undergoing dental treatment cannot see the result before purchase, and that they therefore look for signs of service quality to reduce uncertainty. Thus the successful dentist will implement a quality programme that recognises not only that quality is defined by meeting patients' needs and expectations, but also that quality service is fundamental to successful business strategy. Finally, the successful dentist of the future will realise that the pursuit of quality is a never-ending process which requires leadership by example.

A Study Investigating the Perceived Service Quality Levels of Sport Center Members: A Kano Model Perspective

ERIC Educational Resources Information Center

Yildiz, Kadir; Polat, Ercan; Güzel, Pinar

2018-01-01

The purpose of this study is to investigate sport center members' perceived service quality levels with a view to Kano customer expectations and requirements model. To that end, a descriptive approach and a correlational research design featuring survey method is adopted. Research group consists of 680 (300 women, 380 men) sport center members who…

Member’s Perception of Service Quality At the Nellis Air Force Base Officers Open Mess

DTIC Science & Technology

1993-05-01

35 Consumer Behavior ............................... 36 Perceptions ...................................... 37 Value...110 Table 13. Problem Resolution: Overall Service Quality .... 111 ix LIST OF FIGURES Figure 1. Faith Popcorn’s Ten Changes in Consumer Behavior .......................................... 16...military club has the same characteristics as their civilian counterparts in regards to consumer behavior , needs, and expectations; S3: The miliary

The Impact of Information Behavior in Academic Library Service Quality: A Case Study of the Science and Technology Area in Spain

ERIC Educational Resources Information Center

Pinto, Maria; Fernandez-Marcial, Viviana; Gomez-Camarero, Carmen

2010-01-01

This research explores the extent of service quality in Spanish university science and technology libraries, based on the expectations and perceptions of their users: faculty and researchers. Users' information behavior is analyzed with the specially designed BiQual tool, which reveals specific needs such as the greater importance of electronic…

The influence of service quality and patients' emotions on satisfaction.

PubMed

Vinagre, Maria Helena; Neves, José

2008-01-01

The purpose of this research is to develop and empirically test a model to examine the major factors affecting patients' satisfaction that depict and estimate the relationships between service quality, patient's emotions, expectations and involvement. The approach was tested using structural equation modeling, with a sample of 317 patients from six Portuguese public healthcare centres, using a revised SERVQUAL scale for service quality evaluation and an adapted DESII scale for assessing patient emotions. The scales used to evaluate service quality and emotional experience appears valid. The results support process complexity that leads to health service satisfaction, which involves diverse phenomena within the cognitive and emotional domain, revealing that all the predictors have a significant effect on satisfaction. The emotions inventory, although showing good internal consistency, might be enlarged to other typologies in further research--needed to confirm these findings. Patient's satisfaction mechanisms are important for improving service quality. The research shows empirical evidence about the effect of both patient's emotions and service quality on satisfaction with healthcare services. Findings also provide a model that includes valid and reliable measures.

A survey of Estonian consumer expectations from the pharmacy service and a comparison with the opinions of pharmacists.

PubMed

Villako, Peeter; Raal, Ain

2007-10-01

To assess the preferences of pharmacy customers when choosing a pharmacy and their expectations of the service, and comparing these with the opinions of pharmacists. Opinion and satisfaction of community pharmacy clients in Estonia. A written survey was carried out among pharmacy customers (n=1979) in cities (in 3 community pharmacies), towns (in 2 community pharmacies), and in small towns (in 2 community pharmacies). The survey was also carried out among community pharmacists (n=135) in different regions of Estonia. When choosing a pharmacy, its location was considered most important, costs and wide choice are less important. The most important expectations of customers' included help choosing the right medicine, as well as professional consultation. Preferences and expectations of pharmacy customers depended on their age, gender and income. Parking space, quickness and pleasantness were considered important by men. Costs and wide choice were considered to be more important by women. Pharmacists wish to give patients more information, but they overestimate the importance of quick service. Customers favoured privacy, discretion and confidentiality more. These characteristics were especially important to younger well-paid people living in big cities. In contrast to the opinions offered by pharmacists', a rapid customer service is so not as important as the quality of service in pharmacy according to customers. They also emphasised that pharmacies should highlight the choice of products, quality of service, a professional consultation, as well as ensure privacy.

Service quality of delivered care from the perception of women with caesarean section and normal delivery.

PubMed

Tabrizi, Jafar S; Askari, Samira; Fardiazar, Zahra; Koshavar, Hossein; Gholipour, Kamal

2014-01-01

Our aim was to determine the service quality of delivered care for people with Caesarean Section and Normal Delivery. A cross-sectional study was conducted among 200 people who had caesarean section and normal delivery in Al-Zahra Teaching Hospital in Tabriz, north western Iran. Service quality was calculated using: Service Quality = 10 - (Importance × Performance) based on importance and performance of service quality aspects from the postpartum women's perspective.A hierarchical regression analysis was applied in two steps using the enter method to examine the associations between demographics and SQ scores. Data were analysed using the SPSS-17 software. "Confidentiality", "autonomy", "choice of care provider" and "communication" achieved scores at the highest level of quality; and "support group", "prompt attention", "prevention and early detection", "continuity of care", "dignity", "safety", "accessibility and "basic amenities" got service quality score less than eight. Statistically significant relationship was found between service quality score and continuity of care (P=0.008). A notable gap between the participants‟ expectations and what they have actually received in most aspects of provided care. So, there is an opportunityto improve the quality of delivered care.

Assessing the multidimensional and hierarchical structure of SERVQUAL.

PubMed

Ma, Jun; Harvey, Milton E; Hu, Michael Y

2007-10-01

Parasuraman, Zeithaml, and Berry introduced SERVQUAL in 1998 as a scale to measure service quality. Since then, researchers have proposed several variations. This study examines the development of the tool. Marketing researchers have first challenged the conceptualization of a perceptions-expectations gap and have concluded that the performance-based measures are adequate to capture consumers' perception of service quality. Some researchers have argued that the five dimensions of the SERVQUAL scale only focus on the process of service delivery and have extended the SERVQUAL scale into six dimensions by including the service outcome dimension. Others have proposed that service quality is a multilevel construct and should be measured accordingly. From a sample of 467 undergraduate students data on service quality toward up-scale restaurants were collected. Using the structural equation approach, two measurement models of service quality were compared, the extended SERVQUAL model and the restructured multilevel SERVQUAL model. Analysis suggested that the latter model fits the data better than the extended one.

User library service expectations in health science vs. other settings: a LibQUAL+ Study.

PubMed

Thompson, Bruce; Kyrillidou, Martha; Cook, Colleen

2007-12-01

To explore how the library service expectations and perceptions of users might differ across health-related libraries as against major research libraries not operating in a medical context; to determine whether users of medical libraries demand better library service quality, because the inability of users to access needed literature promptly may lead to a patient who cannot be properly diagnosed, or a diagnosis that cannot be properly treated. We compared LibQUAL+ total and subscale scores across three groups of US, Canadian and British libraries for this purpose. Anticipated differences in expectations for health as other library settings did not emerge. The expectations and perceptions are similar across different types of health science library settings, hospital and academic, and across other general research libraries.

Analysis of NPS Contracting Service Quality

DTIC Science & Technology

2014-12-01

customer expectations is what they “hear from other customers ” or word of mouth communications (Zeithaml et al., 1990). The second factor... satisfaction and customer satisfaction (Hallowell et al., 1996). If a service quality gap exists between the provider and the customer , that gap could...identify a problem with provider job satisfaction , customer satisfaction , or both. In turn, by identifying potential problems in these areas, it could

Prader-Willi Syndrome: Quality of Life Issues in Home, School and Community.

ERIC Educational Resources Information Center

James, Terrance N.; Brown, Roy I.

1993-01-01

Management of psychosocial aspects of Prader-Willi syndrome is considered for several quality of life issues, including social change, increased life expectancy, parent stress, child stress, independence, residential options, and access to services. (JDD)

How to assess quality in your sexual health service.

PubMed

Hathorn, Emma; Land, Lucy; Ross, Jonathan D C

2011-10-01

Previous improvements in NHS have largely focused on increasing service capacity to ensure the provision of universal, comprehensive healthcare at the point of need in the UK. However, public expectations of the NHS are changing, triggered by increased access to information and media coverage of a series of lapses in quality and geographical inequity of care. The NHS also faces the challenges posed by a changing family structure, an ageing population, advancing technology and economic uncertainty. To meet these challenges, improvements in quality rather than just quantity have become a focus of the new NHS. This article provides an overview of quality and how to measure it in sexual health services.

Small and big quality in health care.

PubMed

Lillrank, Paul Martin

2015-01-01

The purpose of this paper is to clarify healthcare quality's ontological and epistemological foundations; and examine how these lead to different measurements and technologies. Conceptual analysis. Small quality denotes conformance to ex ante requirements. Big quality includes product and service design, based on customer requirements and expectations. Healthcare quality can be divided into three areas: clinical decision making; patient safety; and patient experience, each with distinct measurement and improvement technologies. The conceptual model is expected to bring clarity to constructing specific definitions, measures, objectives and technologies for improving healthcare. This paper claims that before healthcare quality can be defined, measured and integrated into systems, it needs to be clearly separated into ontologically and epistemologically different parts.

Applying revised gap analysis model in measuring hotel service quality.

PubMed

Lee, Yu-Cheng; Wang, Yu-Che; Chien, Chih-Hung; Wu, Chia-Huei; Lu, Shu-Chiung; Tsai, Sang-Bing; Dong, Weiwei

2016-01-01

With the number of tourists coming to Taiwan growing by 10-20 % since 2010, the number has increased due to an increasing number of foreign tourists, particularly after deregulation allowed admitting tourist groups, followed later on by foreign individual tourists, from mainland China. The purpose of this study is to propose a revised gap model to evaluate and improve service quality in Taiwanese hotel industry. Thus, service quality could be clearly measured through gap analysis, which was more effective for offering direction in developing and improving service quality. The HOLSERV instrument was used to identify and analyze service gaps from the perceptions of internal and external customers. The sample for this study included three main categories of respondents: tourists, employees, and managers. The results show that five gaps influenced tourists' evaluations of service quality. In particular, the study revealed that Gap 1 (management perceptions vs. customer expectations) and Gap 9 (service provider perceptions of management perceptions vs. service delivery) were more critical than the others in affecting perceived service quality, making service delivery the main area of improvement. This study contributes toward an evaluation of the service quality of the Taiwanese hotel industry from the perspectives of customers, service providers, and managers, which is considerably valuable for hotel managers. It was the aim of this study to explore all of these together in order to better understand the possible gaps in the hotel industry in Taiwan.

Expectations and perceptions of clients concerning the quality of care provided at a Brazilian hospital facility.

PubMed

Mendes, Isabel Amélia Costa; Trevizan, Maria Auxiliadora; de Godoy, Simone; Nogueira, Paula Cristina; Ventura, Carla Aparecida Arena; Furlan, Claudia Elizangela Bis

2018-02-01

To identify the expectations and perceptions of clients concerning the quality of hospital care provided to them and their respective companions at a private Brazilian hospital using SERVQUAL. The SERVQUAL questionnaire can provide information concerning expectations and perceptions of clients. In addition, it is able to identify the participation of frontline employees and how they contribute to the organization's end product (service delivery). In total, 172 inpatients for surgical reasons answered the SERVQUAL questionnaire. It consists of 23 pairs of statements, 22 of which are distributed into the dimensions of tangibles, reliability, responsiveness, assurance and empathy. Statement 23 refers to the overall quality of care. Exploratory analysis, internal consistency (Cronbach's alpha) and the kappa Coefficient were calculated using the Statistical Package for Social Sciences and SAS 9.2. Ethical approval was obtained from the Institutional Review Board at the Hospital das Clínicas at the University of São Paulo at Ribeirao Preto Medical School. Most participants had a bachelor's degree and were over than 60years old. Cronbach's alpha coefficients indicated good internal consistency (α=0.93) and high levels of agreement were observed (91.10%). The SERVQUAL questionnaire was sensitive to items in each dimension for which clients' perceptions surpassed their expectations. The continuous quality assessment of health services is mandatory for nursing leadership. The nursing leadership can further explore the SERVQUAL with a view to better attending to the clients' expectations. Copyright © 2017. Published by Elsevier Inc.

Patients'/Clients' Expectation Toward and Satisfaction from Pharmacy Services

PubMed Central

Ayalew, Mohammed Biset; Taye, Kaleab; Asfaw, Daniel; Lemma, Bethlehem; Dadi, Filagot; Solomon, Habtamu; Tazeze, Haile; Tsega, Bayew

2017-01-01

Objective: Satisfaction is becoming a popular health-care quality indicator as it reflects the reality of service or care provided. The aim of this study was to assess the level of patients' expectation toward and satisfaction from pharmacy service provided and to identify associated factor that might affect their expectation and satisfaction. Methods: A cross-sectional study was conducted on 287 patients, who were served in five pharmacies of Gondar University Hospital in May 2015. Data regarding socio-demographic characteristics and parameters that measure patients' expectation and satisfaction were collected through interview using the Amharic version of the questionnaire. Data were entered into SPSS version 21, and descriptive statistics, cross-tabs, and binary logistic regressions were utilized. P < 0.05 was used to declare association. Findings: Among 287 respondents involved in the study, 149 (51.9%) claimed to be satisfied with the pharmacy service and setting. Two hundred and twenty-nine (79.4%) respondents have high expectation toward gaining good services. Even though significant association was observed between the pharmacy type and patients level of satisfaction, sociodemographic characteristics of a patient were not found to predict the level of satisfaction. There is a higher level of expectation among study participants who earn higher income per month (>(2000 Ethiopian birr [ETB]) than those who get less income (<1000 ETB). Conclusion: Although patients have a higher level of expectation toward pharmacy services, their satisfaction from the service was found to be low. PMID:28331862

Changing the Concept and Measure of Service Quality in Academic Libraries.

ERIC Educational Resources Information Center

Nitecki, Danuta A.

1996-01-01

The diagnostic instrument SERVQUAL has been developed to measure customer expectations and perceptions of service. This article describes a study that investigated how applicable SERVQUAL is to academic libraries and how influential the study's findings might be in changing concepts of the management of academic library services. Two SERVQUAL…

Expectations versus Realities of Higher Education: Gap Analysis and University Service Examination

ERIC Educational Resources Information Center

Yooyen, Ayooth; Pirani, Mohammed; Mujtaba, Bahaudin G.

2011-01-01

The university education providers are waking to student recruitment challenges, competition, and the realities of marketing. With these changes, a related and equally important issue has emerged; that is, the student service quality and evaluating of the educational encounter. Using university services as the primary study setting, the study…

75 FR 20427 - Agency Information Collection (Insurance Surveys) Activities Under OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-19

... to determine the kind and quality of services they want and their level of satisfaction with existing service. Customer satisfaction surveys are used to gauge customer perceptions of VA services as well as customer expectations and desires. An agency may not conduct or sponsor, and a person is not required to...

Measuring the performance of G2G services in Iran

NASA Astrophysics Data System (ADS)

Zarei, Behrouz; Safdari, Maryam

To highlight the growth of e-government and the importance of its services it is essential to evaluate the performance of the service delivery to customers. Research indicates that traditional performance indexes are not suitable for this evaluation; moreover, it is noticeable that the e-government services are intangible and invisible. Among different e-government services, measurement of quality government to government (G2G) services has been less attractive for researchers while crucial for government policy-makers. This calls for a better understanding of the specific needs of users of these services in order to provide appropriate type and level of services that meets those needs. In this paper, the performance of the G2G services is measured in the Iranian context. For this purpose, SERVQUAL, which is a well-known method for assessing service quality, is employed. This study proposes and tests a five-factor of SERVQUAL instrument to explain user satisfaction and gap analysis, between expectations and perceptions of its customers, consisting thirty ministries and main governmental organizations. Based on a Chi-square test, factor analysis, gap analysis and correlations, it is concluded the gap between expectations and perceptions of G2G customers is significant and customer satisfaction of G2G services is at low level.

The Quality of Work in the Belgian Service Voucher System.

PubMed

Mousaid, Sarah; Huegaerts, Kelly; Bosmans, Kim; Julià, Mireia; Benach, Joan; Vanroelen, Christophe

2017-01-01

Several European countries implemented initiatives to boost the growth of the domestic cleaning sector. Few studies investigated the quality of work in these initiatives, although effects on workers' health and on social health inequalities can be expected. This study contributes to the scant research on this subject, by investigating the quality of work in the Belgian service voucher system - a subsidized system for domestic work. The applied research methodology includes a qualitative content analysis of parliamentary debates, legislation and previous research about the service voucher system and of 40 in-depth interviews with service voucher workers. The study shows that the legal framework that regulates the system must be further enhanced in order to improve the quality of work in the service voucher system. In addition, the actors involved must be better controlled, and sanctioned in case of non-compliance with legislation. © The Author(s) 2016.

A customer satisfaction model for a utility service industry

NASA Astrophysics Data System (ADS)

Jamil, Jastini Mohd; Nawawi, Mohd Kamal Mohd; Ramli, Razamin

2016-08-01

This paper explores the effect of Image, Customer Expectation, Perceived Quality and Perceived Value on Customer Satisfaction, and to investigate the effect of Image and Customer Satisfaction on Customer Loyalty of mobile phone provider in Malaysia. The result of this research is based on data gathered online from international students in one of the public university in Malaysia. Partial Least Squares Structural Equation Modeling (PLS-SEM) has been used to analyze the data that have been collected from the international students' perceptions. The results found that Image and Perceived Quality have significant impact on Customer Satisfaction. Image and Customer Satisfaction ware also found to have significantly related to Customer Loyalty. However, no significant impact has been found between Customer Expectation with Customer Satisfaction, Perceived Value with Customer Satisfaction, and Customer Expectation with Perceived Value. We hope that the findings may assist the mobile phone provider in production and promotion of their services.

Measurement of Quality of Educational Hospital Services by the SERVQUAL Model: The Iranian Patients' Perspective.

PubMed

Rezaei, Satar; Matin, Behzad Karami; Moradi, Khalil; Bijan, Behroz; Fallahi, Masoud; Shokati, Behnam; Saeidi, Hamid

2016-03-01

The main mission of hospitals in any health system is to deliver high quality healthcare for patients and meet their needs and expectations. The aim of the current study was to assess the quality of the service of educational hospitals affiliated with Kermanshah University of Medical Sciences in 2015, from the perspective of patients. In this cross-sectional study, the perspectives of 400 patients were assessed about the quality of the services provided by educational hospitals in Kermanshah (western Iran) in 2015. The quality was assessed by the SERVQUAL questionnaire with five dimensions, i.e., tangibility, reliability, responsiveness, assurance, and empathy. In addition, the Wilcoxon test and the Kruskal-Wallis test were used to explore any association between the dependent variable and explanatory variables. The data were analyzed using Stata V.12 software. There were negative gaps in all five dimensions. The highest and lowest gaps in the mean score were found in the assurance (-0.88) and responsiveness (-0.56) dimensions. The patients ranked responsiveness as the most important dimension of the quality of healthcare. There were gaps between the patients' perceptions and their expectation about the five dimensions that were studied based on the SERVQUAL model. Also, it is recommended that improving the quality of healthcare is possible by various policies, such as good responsiveness, access to health workers, and delivering healthcare in less time.

Consumer Behavior in Shopping Streets: The Importance of the Salesperson's Professional Personal Attention

PubMed Central

Medrano, Natalia; Olarte-Pascual, Cristina; Pelegrín-Borondo, Jorge; Sierra-Murillo, Yolanda

2016-01-01

Since the early 2010s, the emergence of a new consumer has begun. In this context, consumer behavior represents one of the greatest interests of marketing scholars and business managers due to their need to adapt their companies' strategies to the new frontier. In order to advance understanding of this new consumer, this article focuses on analyzing consumer behavior in shopping streets. Thus, the aim of this research is to know what customers value in terms of salesperson–customer interaction quality nowadays. To achieve this, the authors conducted two studies. The results of the first study show that customers cite personal attention as the primary factor motivating their preference for small retailers in shopping streets. However, this motivation is not as relevant one for those who prefer malls. This result provides a point on which to research service quality incorporating personal attention in a second study. Using the SERVQUAL-P scale, the authors elaborate three lenses through which the quality of service from the customer's point of view can be analyzed: normative expectations, predictive expectations, and the importance of each attribute. The most striking result is that the dimensions of expectations (normative and predictive) are the same; these results demonstrate that customers are coherent in making assessments of their expectations, evaluating service quality and satisfaction with similar criteria. However, these dimensions are different from the dimensions of importance. Our main contribution lies in the finding that personal attention, when assessed using the scale of attribute importance, is split into two dimensions: (1) courteous attention and (2) personal relationship. Courteous attention is always welcome, but personal relationships are less valued and are often even rejected. The article concludes with a discussion of the implications of these findings for marketing practices and research. PMID:26903927

Consumer Behavior in Shopping Streets: The Importance of the Salesperson's Professional Personal Attention.

PubMed

Medrano, Natalia; Olarte-Pascual, Cristina; Pelegrín-Borondo, Jorge; Sierra-Murillo, Yolanda

2016-01-01

Since the early 2010s, the emergence of a new consumer has begun. In this context, consumer behavior represents one of the greatest interests of marketing scholars and business managers due to their need to adapt their companies' strategies to the new frontier. In order to advance understanding of this new consumer, this article focuses on analyzing consumer behavior in shopping streets. Thus, the aim of this research is to know what customers value in terms of salesperson-customer interaction quality nowadays. To achieve this, the authors conducted two studies. The results of the first study show that customers cite personal attention as the primary factor motivating their preference for small retailers in shopping streets. However, this motivation is not as relevant one for those who prefer malls. This result provides a point on which to research service quality incorporating personal attention in a second study. Using the SERVQUAL-P scale, the authors elaborate three lenses through which the quality of service from the customer's point of view can be analyzed: normative expectations, predictive expectations, and the importance of each attribute. The most striking result is that the dimensions of expectations (normative and predictive) are the same; these results demonstrate that customers are coherent in making assessments of their expectations, evaluating service quality and satisfaction with similar criteria. However, these dimensions are different from the dimensions of importance. Our main contribution lies in the finding that personal attention, when assessed using the scale of attribute importance, is split into two dimensions: (1) courteous attention and (2) personal relationship. Courteous attention is always welcome, but personal relationships are less valued and are often even rejected. The article concludes with a discussion of the implications of these findings for marketing practices and research.

Inclusive Assessment: Toward a Socially-Just Methodology for Measuring Institution-Wide Engagement

ERIC Educational Resources Information Center

Getto, Guiseppe; McCunney, Dennis

2015-01-01

Institutions are increasingly being called upon to collect large amounts of data to demonstrate community impact. At institutions with strong and wide-reaching public engagement/service missions, this expectation is even greater--both for quality improvement and for demonstrating regional transformation. Despite these expectations, the…

Workplace Congruence and Occupational Outcomes among Social Service Workers.

PubMed

Graham, John R; Shier, Micheal L; Nicholas, David

2016-06-01

Workplace expectations reflect an important consideration in employee experience. A higher prevalence of workplace congruence between worker and employer expectations has been associated with higher levels of productivity and overall workplace satisfaction across multiple occupational groups. Little research has investigated the relationship between workplace congruence and occupational health outcomes among social service workers. This study sought to better understand the extent to which occupational congruence contributes to occupational outcomes by surveying unionised social service workers ( n = 674) employed with the Government of Alberta, Canada. Multiple regression analysis shows that greater congruence between workplace and worker expectations around workloads, workplace values and the quality of the work environment significantly: (i) decreases symptoms related to distress and secondary traumatic stress; (ii) decreases intentions to leave; and (iii) increases overall life satisfaction. The findings provide some evidence of areas within the workplace of large government run social welfare programmes that can be better aligned to worker expectations to improve occupational outcomes among social service workers.

Workplace Congruence and Occupational Outcomes among Social Service Workers

PubMed Central

Graham, John R.; Shier, Micheal L.; Nicholas, David

2016-01-01

Workplace expectations reflect an important consideration in employee experience. A higher prevalence of workplace congruence between worker and employer expectations has been associated with higher levels of productivity and overall workplace satisfaction across multiple occupational groups. Little research has investigated the relationship between workplace congruence and occupational health outcomes among social service workers. This study sought to better understand the extent to which occupational congruence contributes to occupational outcomes by surveying unionised social service workers (n = 674) employed with the Government of Alberta, Canada. Multiple regression analysis shows that greater congruence between workplace and worker expectations around workloads, workplace values and the quality of the work environment significantly: (i) decreases symptoms related to distress and secondary traumatic stress; (ii) decreases intentions to leave; and (iii) increases overall life satisfaction. The findings provide some evidence of areas within the workplace of large government run social welfare programmes that can be better aligned to worker expectations to improve occupational outcomes among social service workers. PMID:27559216

Transformation management of primary health care services in two selected local authorities in Gauteng.

PubMed

Sibaya, W; Muller, M

2000-12-01

The transformation of health services in South Africa today is governed by the political, policy and legislative frameworks. This article focuses on the transformation of a primary health care service within a local authority in Gauteng. The purpose with this article is to explore and describe the perceptions (expectations and fears) of selected managers employed in this primary health care service. The results are utilised to compile a strategy (framework) for transformation management and leadership within the primary health care service. A qualitative research design was utilised and the data was collected by means of individual interviews with selected managers in the service, followed by a content analysis. The expectations and fears of managers focus mainly on personnel matters, community participation/satisfaction, salaries and parity, inadequate stocks/supplies and medication, the deterioration of quality service delivery and the need for training and empowerment. These results are divided into structure, process and outcome dimensions and are embodied in the conceptual framework for the transformation and leadership strategy. It is recommended that standards for transformation management be formulated and that the quality of transformation management be evaluated accordingly.

Faculty Perception of Information Control Using LibQUAL+[TM] Indicators

ERIC Educational Resources Information Center

Kayongo, Jessica; Jones, Sherri

2008-01-01

The LibQUAL+[TM] survey was used in 2006 to assess library service quality at the University of Notre Dame. While results showed that the Libraries were meeting users' expectations for service in most areas, a closer examination of the data revealed dissatisfaction from a subgroup of users in one particular dimension of library services. This…

Determination of Appropriate Service Delivery Level for Quantitative Attributes of Household Toilets in Rural Settlements of India from Users' Perspective

NASA Astrophysics Data System (ADS)

Rashid, Mohammad; Pandit, Debapratim

2018-04-01

Improvement of quality of sanitation services in rural settlements is an important development goal in developing countries including India and accordingly several strategies are adopted which promote the demand and use of household toilets through creating awareness and providing subsidies to poor people for construction of household toilets with service-level standards specified from experts' perspective. In many cases, users are unsatisfied with the quality of toilets constructed using subsidies and the same remain unused. Users' satisfaction depends on their perceptions of service quality of individual attributes and overall service quality of the household toilets, which is an important determinant of sustainability and sustained use of toilets. This study aims to assess and benchmark the appropriate service delivery level for quantitative attributes of rural household toilets based on user perception. The service quality is determined with the help of level of service (LOS) scales developed using successive interval scaling technique, the zone of tolerance (ZOT), and users satisfaction level (USL) which relates service delivery levels with user satisfaction directly. The study finds that the service quality of most of the attributes of household toilets constructed using subsidies is perceived as poor. The results also suggest that most of the users expect to have a toilet with the service level of attributes ranging between LOS A and LOS B.

Determination of Appropriate Service Delivery Level for Quantitative Attributes of Household Toilets in Rural Settlements of India from Users' Perspective.

PubMed

Rashid, Mohammad; Pandit, Debapratim

2018-04-01

Improvement of quality of sanitation services in rural settlements is an important development goal in developing countries including India and accordingly several strategies are adopted which promote the demand and use of household toilets through creating awareness and providing subsidies to poor people for construction of household toilets with service-level standards specified from experts' perspective. In many cases, users are unsatisfied with the quality of toilets constructed using subsidies and the same remain unused. Users' satisfaction depends on their perceptions of service quality of individual attributes and overall service quality of the household toilets, which is an important determinant of sustainability and sustained use of toilets. This study aims to assess and benchmark the appropriate service delivery level for quantitative attributes of rural household toilets based on user perception. The service quality is determined with the help of level of service (LOS) scales developed using successive interval scaling technique, the zone of tolerance (ZOT), and users satisfaction level (USL) which relates service delivery levels with user satisfaction directly. The study finds that the service quality of most of the attributes of household toilets constructed using subsidies is perceived as poor. The results also suggest that most of the users expect to have a toilet with the service level of attributes ranging between LOS A and LOS B.

Patient expectations from an emergency medical service.

PubMed

Qidwai, Waris; Ali, Syed Sohail; Baqir, Muhammad; Ayub, Semi

2005-01-01

Patient expectation survey at the Emergency Medical Services can improve patient satisfaction. A need was established to conduct such a survey in order to recommend its use as a quality improvement tool. The study was conducted on patients visiting the Emergency Medical Services, Aga Khan University, Karachi. A questionnaire was used to collect information on the demographic profile, and expectations of patients. The ethical requirements for conducting the study were met. A hundred patients were surveyed. The majority was relatively young, married men and women, well educated and better socio-economically placed. The majority of the patients expected a waiting time and a consultation time of less than 30 minutes and 20 minutes, respectively. The majority of respondents expected and agreed to be examined by a trainee but there were reluctant to be examined by the students. There was an expectation that the consultant will examine patients and not advice the attending team over the phone. The majority of the patients expected intravenous fluid therapy. There was a desire to have patient attendant present during the consultation process. The majority of the patients expected to pay less than three thousand rupees for the visit. An expectation exists for investigations and hospitalization. Involvement of patients in decisions concerning their treatment and written feedback on their visit was expected. We have documented the need and value of patient expectation survey at the Emergency Medical Services department. The use of such a tool is recommended in order to improve the satisfaction levels of patients visiting such facilities.

Provider perceptions of reproductive health service quality in jordanian public community health centers.

PubMed

Al-Qutob, Raeda; Nasir, Laeth S

2008-05-01

Enhancing the quality of reproductive health care delivery in developing countries is a key prerequisite to increased utilization and sustainability of these services in the target population. Our objective was to assess the perception of quality of reproductive health (RH) care services provided by Jordanian Ministry of Health community-based centers from the perspective of service providers in these settings. A purposeful nationwide sample of 50 primary health care providers took part in five focus group discussions with the purpose of exploring their perceptions of the quality of care provided by their centers and perceived barriers to the provision of quality RH care. Health care providers felt that the quality of RH care provided by their centers was suboptimal. Focus group participants reported numerous barriers to the provision of high quality-care in the clinical setting. These included issues related to patient overload, patient and physician characteristics, as well as problems inherent to supervisory and administrative functions. Exploring and aligning goals and expectations of RH care providers and administrators may result in improvements in the quality of RH care service delivery and morale in public health settings in Jordan, which is a requirement for public sector reform.

Effect of Total Quality Management on the Quality and Productivity of Human Resources

NASA Astrophysics Data System (ADS)

Siregar, I.; Nasution, A. A.; Sari, R. M.

2017-03-01

Human resources is the main factor in improving company performance not only in industrial products but also services. Therefore, all of the organization performers involved must work together to achieve product quality services expected by consumers. Educational institutions are the service industries which are educators and instructor involved in it. Quality of product and services produced depends on the education organization performers. This study did a survey of instructors in public and private universities in North Sumatra to obtain the factors that affect quality of human resources and productivity of human resources. Human resources quality is viewed by the elements of TQM. TQM elements that are discussed in this study are leadership, communication, training and education, support structure, measurement and reward and recognition. The results of this study showed a correlation numbers across the exogenous variables on endogenous variables relationships tend to be strong and be positive. In addition, elements of TQM are discussed except the support structure which has a direct influence on the quality of human resources. Variable leadership, reward and recognition and quality of human resources have a significant effect on productivity.

Building intentions with the Theory of Planned Behaviour: the mediating role of knowledge and expectations in implementing new pharmaceutical services in Malaysia.

PubMed

Tan, Christine L; Gan, Vincent B; Saleem, Fahad; Hassali, Mohamed A

2016-01-01

Pharmacy value added services (PVAS) was introduced as a matter of public health policy by Malaysia's Ministry of Health to improve health outcomes through public healthcare services. For example, drive through pharmacy services is a major policy implementation of the Ministry. However, adoption rates are low and therefore hampering the achievement of national health policy goals. Our objective is to explore the key determinants and mediators of successful implementation of new public pharmaceutical services by investigating the cognitive perspectives of patients' intentions to adopt with the Theory of Planned Behavior as the theoretical framework. A two phase mixed methodology involving first a qualitative exploration and the second a quantitative phase was conducted in public health facilities in Negeri Sembilan, Malaysia. Multiple regression and mediation analysis were performed. Subjective norms, perceived behavioural control, knowledge and expectations are found to be significant predictors of intentions to adopt PVAS. Knowledge and expectations are found to exert significant indirect effects on intentions. Overall, we suggest that patient knowledge be enhanced through appropriate channels and expectations of service quality be met to increase intentions.

Current Perception of Telemedicine in an EU Country

PubMed Central

POENARU, Calin; POENARU, Elena; VINEREANU, Dragos

2014-01-01

Objectives: To assess the perception and expectation of beneficiaries and providers of telemedicine services in Romania. Methods: Interview (on-line and face-to-face) of 109 representatives of medical community, from two categories: physicians, involved directly in the patient care, and medical and information technology directors of state and private owned clinics and hospitals. A third group, formed by executives from main technology service provider companies, was added in order to expand the results with their vision as potential suppliers of telemedicine projects. Outcomes: We evaluated 4 important aspects of telemedicine: actual status of the services, development efforts and allocated budget, expected future services, and stoppers and enablers. On the actual status we identified in 48% of the cases the existence of core services good enough to start advanced telemedicine services. We developed a metric (SOR = Supporter/Opponents Ratio) to evaluate the suitability of telemedicine services to evolve and to deliver on expectations. The analysis shows that physicians see potential for development for EHR and PACS (both with SOR >25), but the executives start looking forward to more advanced services like remote patient monitoring. Main impact is expected in collaboration and patient quality life areas and, by far, the main stoppers are reduced budgets and organizational problems to adapt to the new data models. Conclusions: We identified a strong support from the physicians related with the introduction of new type of healthcare services accompanied with high expectations. On the executive level, the expectations are different, ranging from low optimism on the technology side, to serious support on the medical side. However, there is a clear trend, able to create the first telemedicine services during the next years. PMID:25705307

Qualitative assessment of the dental health services provided at a dental school in Kerman, Iran.

PubMed

Rad, Maryam; Haghani, Jahangir; Shahravan, Arash; Khosravifar, Ali

2009-01-01

Increasing the quality of the services provided in a Dental School can raise the satisfaction level of patients and consequently increase the level of their oral health. This study was conducted to evaluate the quality of dental care and services provided to patients referred to a Dental School in Kerman, Iran. In this qualitative study, face-to-face, in-depth interviews were conducted with 41 participants [25 patients (P), 5 nurses (N), 6 dental academic staff (AS), and 5 dental students (S)]. Then, the interviews were transcribed and analyzed, using content analysis of data. Data analysis in qualitative research involves breaking down the data and searching for codes and categories that are then reassembled to form themes. Both positive and negative themes emerged. Positive themes included: good infection control, service accessibility, patient appointments and visits were not assigned on merit, precise examinations, and comprehensive treatment plans. Negative themes included: long wait time, lack of options to pass waiting time, such as newspapers and television, an insufficient number of nurses, and not enough professors for supervision. In addition, the results of this study show that the patients and dental staff have high expectations in relation to dental services, and that implementation of these expectations would increase the overall satisfaction with and the quality of the level of services. Finally, some recommendations for improving services in the Kerman Dental School were given to the managing team of the Dental School.

Image and Academic Expectations of Different Levels of University Students: A South African Case

ERIC Educational Resources Information Center

Tait, M.; de Jager, J. W.

2009-01-01

Over the past decade the educational environment has not only become more competitive but also more commercialised. These trends have contributed to the introduction of service quality measurement at higher education institutions. Traditionally institutions assume that students have relatively homogeneous needs and expectations and the result is…

A Standardized Approach to Assessing Physician Expectations and Perceptions of Continuing Medical Education

ERIC Educational Resources Information Center

Shewchuk, Richard M.; Schmidt, Hilary J.; Benarous, Alexandra; Bennett, Nancy L.; Abdolrasulnia, Maziar; Casebeer, Linda L.

2007-01-01

Introduction: Rapidly expanding science and mandates for maintaining credentials place increasing demands on continuing medical education (CME) activities to provide information that is current and relevant to patient care. Quality may be seen as the perceived level of service measured against consumer expectations. Standard tools have not been…

Consideration of IP Telephony Quality on the IEEE802.11a Wireless LAN

NASA Astrophysics Data System (ADS)

Miyashita, Michifumi; Takamatsu, Hideyuki; Kurono, Masahiro

Recently, IP telephony services in wired network are started, and paid attention for its charge-free nature due to IP technology. On the other hand, the Hot-Spot service, which provides one to access the Internet at the public space such as cafe, using the IEEE wireless LAN has been evolved, and it is expected that the IP telephony service on the Hot-Spot network will be developed. However, the IP telephony quality on the IEEE802.11a wireless LAN has not been fully studied yet. In this paper, we discuss about the quality of IP telephony service on the IEEE802.11a wireless LAN from the aspect of R-value, and show ability to improve the IP telephony quality on the Hot-Spot network employing PLC function defined in the ITU-T Recommendation G.711 Appendix I.

Evaluating Library Staff: A Performance Appraisal System.

ERIC Educational Resources Information Center

Belcastro, Patricia

This manual provides librarians and library managers with a performance appraisal system that measures staff fairly and objectively and links performance to the goals of the library. The following topics are addressed: (1) identifying expectations for quality service or standards of performance; (2) the importance of a library's code of service,…

Measurement of Quality of Educational Hospital Services by the SERVQUAL Model: The Iranian Patients’ Perspective

PubMed Central

Rezaei, Satar; Matin, Behzad Karami; Moradi, Khalil; Bijan, Behroz; Fallahi, Masoud; Shokati, Behnam; Saeidi, Hamid

2016-01-01

Introduction The main mission of hospitals in any health system is to deliver high quality healthcare for patients and meet their needs and expectations. The aim of the current study was to assess the quality of the service of educational hospitals affiliated with Kermanshah University of Medical Sciences in 2015, from the perspective of patients. Methods In this cross-sectional study, the perspectives of 400 patients were assessed about the quality of the services provided by educational hospitals in Kermanshah (western Iran) in 2015. The quality was assessed by the SERVQUAL questionnaire with five dimensions, i.e., tangibility, reliability, responsiveness, assurance, and empathy. In addition, the Wilcoxon test and the Kruskal-Wallis test were used to explore any association between the dependent variable and explanatory variables. The data were analyzed using Stata V.12 software. Results There were negative gaps in all five dimensions. The highest and lowest gaps in the mean score were found in the assurance (−0.88) and responsiveness (−0.56) dimensions. The patients ranked responsiveness as the most important dimension of the quality of healthcare. Conclusion There were gaps between the patients’ perceptions and their expectation about the five dimensions that were studied based on the SERVQUAL model. Also, it is recommended that improving the quality of healthcare is possible by various policies, such as good responsiveness, access to health workers, and delivering healthcare in less time. PMID:27123218

78 FR 18318 - U.S. Healthcare Trade Mission to Turkey

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-26

... 64. Average life expectancy is 75 years. It has a fast-growing middle class that is willing to spend more on quality goods and services, and a democratically elected government which has historically... Turkish government has made healthcare access and quality a priority. To improve healthcare access for its...

32 CFR 861.4 - DOD air transportation quality and safety requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... experience, and the individual's potential to perform safely. Freedom from alcohol abuse and illegal drugs is.... Freedom from alcohol abuse and illegal drugs is required. (ii) Quality assurance. A system that... certificate are expected. Safety equipment is available in hangars, shops, etc., and is serviceable. Shipping...

32 CFR 861.4 - DOD air transportation quality and safety requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... experience, and the individual's potential to perform safely. Freedom from alcohol abuse and illegal drugs is.... Freedom from alcohol abuse and illegal drugs is required. (ii) Quality assurance. A system that... certificate are expected. Safety equipment is available in hangars, shops, etc., and is serviceable. Shipping...

32 CFR 861.4 - DOD air transportation quality and safety requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... experience, and the individual's potential to perform safely. Freedom from alcohol abuse and illegal drugs is.... Freedom from alcohol abuse and illegal drugs is required. (ii) Quality assurance. A system that... certificate are expected. Safety equipment is available in hangars, shops, etc., and is serviceable. Shipping...

32 CFR 861.4 - DOD air transportation quality and safety requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... experience, and the individual's potential to perform safely. Freedom from alcohol abuse and illegal drugs is.... Freedom from alcohol abuse and illegal drugs is required. (ii) Quality assurance. A system that... certificate are expected. Safety equipment is available in hangars, shops, etc., and is serviceable. Shipping...

[Consumer perspective and quality development in ambulatory nursing care].

PubMed

Wingenfeld, K; Schaeffer, D

2001-04-01

In the 1990s, the debate surrounding the issue of quality in outpatient nursing care was given a remarkable boost. Also the conviction steadily grew that quality assurance should be more adjusted to values and expectations of people in need of nursing care, the addressees of such services. But a critical analysis is required to determine to what extent the role of "customer" or "consumer", a role often ascribed to them in this context, can actually be reconciled with their possibilities, expectations and interests. Based on the results of empirical studies, the following article shows that the patient's view, his expectations and evaluations largely depend on some specific consequences of being in need of care and using outpatient nursing care. The article goes into the divergent perspectives that, on the one hand, are characteristic of patients and, on the other, of the nursing staff and other bodies concerned with quality of care.

Measuring corporate culture to ensure mission fulfillment.

PubMed

Hulsebus-Fong, C

1988-11-01

Ancilla Systems, Inc., Elk Grove Village, Il, developed a mission-based performance evaluation program to provide tangible evidence of mission fulfillment and ensure the provision of high-quality healthcare. the program--Characteristics of Service--translates the language of healthcare action and evaluates corporate culture to ensure that it fulfills the expectations of its sponsor. The nine Characteristics of Service are: Respect for the dignity of all persons. Orientation toward the family unit. Quality and personalized services. Local health systems with a spectrum of services responsive to the unique needs of the community. Formal and informal partnerships with physicians. Active participation and collaboration with related community service agencies and other healthcare providers. Faithfulness to Catholic identity through close relationships with Church and religious institute resources. Effective political advocacy through education. Research and development of innovative approaches to healthcare. In establishing the behavior standards that would exemplify the characteristics, program developers used terms that correspond to specific, observable, measurable performance. All healthcare facilities are evaluated on how well they meet the behavior standards. The evaluation process includes data collection, analysis, and a final report. Data collection begins with a review of regular hospital-conducted surveys, which provide quantifiable information to measure performance against key expected behaviors. Additional data are derived from medical staff development plans and the monthly quality assurance audit. On-site surveys fill information gaps that remain after all written reports are collected.

The importance of the evaluation of expectations and perceptions to improve the dental service quality.

PubMed

Rocha, Juliana; Pinto, Andres; Batista, Marilia; Paula, Janice Simpson de; Ambrosano, Glaucia

2017-07-10

Purpose The purpose of this paper is to evaluate the use of SERVQUAL to assess service quality in Dentistry, by evaluating patients' expectations and perceptions of dental care and their association to patients' sociodemographic data. Design/methodology/approach The sample constituted of 379 subjects in the first assessment and 155 in the second phase. All employees of the companies that were clients of the dental insurance participated, a total of four companies in two states (São Paulo and Minas Gerais) of Brazil. SERVQUAL questionnaires about expectations and sociodemographic data were dispatched in the first phase, and in a second phase SERVQUAL questionnaires about perceptions. Those who had not yet received dental treatment and had agreed to participate filled out their survey in the first phase. In the second phase, the respondents had to have completed their treatment. Findings When the value gap is considered, Reliability (as a dimension) had the smallest score (-3.71). This means that it was the worst result, i.e. there is a higher difference between expectations and perceptions, and problems can be identified here. t-test confirmed that all the dimensions had some statistically significant difference with p<0.05 in relation to expectations and perceptions. Women presented higher prevalence of dissatisfaction (Tangible and Reliability dimensions), as well as the oldest participants (Empathy dimension) and those with lower parental literacy (Assurance and Empathy dimensions). The only dimension that was not significantly associated was Responsiveness. Originality/value This research suggests that the patients evaluated the physical characteristics of the premises and the interaction with the staff as the priority issues that need special attention in this service. Moreover, the use of SERVQUAL was extremely relevant for the oral health service, because it assessed the users' subjective perceptions.

The impact of social services interventions in developing countries: a review of the evidence of impact on clinical outcomes in people living with HIV.

PubMed

Bateganya, Moses H; Dong, Maxia; Oguntomilade, John; Suraratdecha, Chutima

2015-04-15

Social service interventions have been implemented in many countries to help people living with HIV (PLHIV) and household members cope with economic burden as a result of reduced earning or increased spending on health care. However, the evidence for specific interventions-economic strengthening and legal services-on key health outcomes has not been appraised. We searched electronic databases from January 1995 to May 2014 and reviewed relevant literature from resource-limited settings on the impact of social service interventions on mortality, morbidity, retention in HIV care, quality of life, and ongoing HIV transmission and their cost-effectiveness. Of 1685 citations, 8 articles reported the health impact of economic strengthening interventions among PLHIV in resource-limited settings. None reported on legal services. Six of the 8 studies were conducted in sub-Saharan Africa: 1 reported on all 5 outcomes and 2 reported on 4 and 2 outcomes, respectively. The remaining 5 reported on 1 outcome each. Seven studies reported on quality of life. Although all studies reported some association between economic strengthening interventions and HIV care outcomes, the quality of evidence was rated fair or poor because studies were of low research rigor (observational or qualitative), had small sample size, or had other limitations. The expected impact of economic strengthening interventions was rated as high for quality of life but uncertain for all the other outcomes. Implementation of economic strengthening interventions is expected to have a high impact on the quality of life for PLHIV but uncertain impact on mortality, morbidity, retention in care, and HIV transmission. More rigorous research is needed to explore the impact of more targeted intervention components on health outcomes.

Activity-based funding for National Health Service hospitals in England: managers' experience and expectations.

PubMed

Sussex, Jonathan; Farrar, Shelley

2009-05-01

Activity-based funding of hospital services has been introduced progressively since 2003 in the National Health Service (NHS) in England, under the name 'Payment by Results' (PbR). It represents a major change from previous funding arrangements based on annual "block" payments for large bundles of services. We interviewed senior local NHS managers about their experience and expectations of the impact of PbR. A high degree of 'NHS solidarity' was apparent, and competition between NHS hospitals was muted. PbR has been introduced against a background of numerous other efficiency incentives, and managers did not detect a further PbR-specific boost to efficiency. No impact on care quality, either positive or negative, is yet evident.

Convenience, quality and choice: Patient and service-provider perspectives for treating primary care complaints in urgent care settings.

PubMed

Sturgeon, David

2017-11-01

To investigate why patients chose to attend two, nurse-led, minor injury units (MIUs) to access primary healthcare services rather than attend their GP practice. Since the 1980's, healthcare organisations in the UK and elsewhere have implemented an increasingly consumer-orientated model of healthcare provision. As a result, patients with non-urgent presentations are attending Emergency Departments (EDs) and other urgent care facilities in growing numbers. A comparative case study approach was adopted and between October 2014 and May 2015 the researcher was embedded as a participant observer as part of the emergency nurse practitioner team at two, nurse-led, MIUs (site A and B). During this time, 40 patients, 17 service-providers and 1 senior manager were interviewed. Patients and service-providers at both sites identified convenience and quality of care as the principle reasons patients presented for primary healthcare services at MIUs rather than their GP practice. Service-providers were aware that by providing treatment, they established a precedent and a sense of expectation for future care. Patients are acting rationally and predictably in response to healthcare policy promises regarding choice, expectation created by service-providers, and local demographic factors. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

[Geriatric institutions, between ambulatory and hospital care: patients' description and performance assessment].

PubMed

Eggli, Yves; Schaller, Philippe; Baudoin, Florence

2015-01-01

To describe patients admitted to a geriatric institution, providing short-term hospitalizations in the context of ambulatory care in the canton of Geneva. To measure the performances of thisstructure in terms of quality ofcare and costs. Data related to the clinical,functioning and participation profiles of the first 100 patients were collected. Data related to effects (readmission, deaths, satisfaction, complications), services and resources were also documented over an 8-month period to measure various quality and costindicators. Observed values were systematically compared to expected values, adjustedfor case mix. Explicit criteria were proposed to focus on the suitable patients, excluding situations in which other structures were considered to be more appropriate. The specificity of this intermediate structure was to immediately organize, upon discharge, outpatient services at home. The low rate of potentially avoidable readmissions, the high patient satisfaction scores, the absence of premature death and the low number of iatrogenic complications suggest that medical and nursing care delivered reflect a good quality of services. The cost was significantly lower than expected, after adjusting for case mix. The pilot experience showed that a short-stay hospitalization unit was feasible with acceptable security conditions. The attending physician's knowledge of the patients allowed this system tofocus on essential issues without proposing inappropriate services.

The management service company's expectation of the customer.

PubMed

Kuykendall, R D

1992-02-01

The one constant factor in health care today is change. Choose your management support company carefully, expect high quality results, and communicate both positive and negative feedback immediately. This formula will give you excellent results as well as a long-term productive partnership in which cost, risk, and the end objectives can be balanced for maximum benefit.

The clinical research triad: how can we ensure quality in out-sourced clinical trials?

PubMed

Strause, L G; Vogel, J R

1999-01-01

The importance of quality within clinical trials cannot be underestimated. Built on the foundation of patient care where quality may simply be understood and expected, the business of conducting clinical trials must evolve to instill quality and ensure that quality is maintained. How that is accomplished within the drug development process is complicated by the relationship between the vendors--the sponsor, the contractor and the investigative site. This article will discuss the dynamics of the drug development triad from the perspective of the authors. Who are the players and what is quality from each of their perspectives? Communication among all parties is essential in order to ensure that quality is maintained. Unfortunately, even with optimal communication, if expectations and goals are not clearly defined, the results may be unsatisfactory. Vision and values of each player contributes to the success of the relationship and the quality of the service.

Opinions and expectations of women in the treatment of cervical and uterine cancer in Spain.

PubMed

Rodríguez, María Angeles Prieto; Suess, Astrid; Cerdá, Joan Carles March; Carretero, María Escudero; Danet, Alina

2011-11-01

To know the experiences, needs and expectations of women in the treatment of cervical and uterine cancer in the Andalusian Health Service. Focus groups and in-depth interviews with women being treated for cervical-uterine cancer within the Andalusian Health Service. Analysis with Nudist Vivo 1.0 (QSR International Pty Ltd, Doncaster, Victoria, Australia). The needs and expectations detected were: coherence in the promotion strategies and the presence of a proactive approach by health professionals, availability of comprehensive information and understanding, possibility of expressing to health professionals one's doubts and fears, and of participation in decision-making, technical quality, humane treatment and continuity of care and attention to psychosocial aspects. The knowledge of women in the treatment of cancer of the cervix and uterus plays a crucial part in improving the delivery of these services.

Pedagogical Shift in the Twenty-First Century: Preparing Teachers to Teach with New Technologies

ERIC Educational Resources Information Center

Chigona, Agnes

2015-01-01

The expectation in education today is that pre-service teachers should graduate from teacher education adequately prepared to teach with Information Communication Technologies (ICTs) that have potential to enhance curriculum delivery, hence improving quality of education. However, research shows that pre-service teachers are graduating from…

At Your Service

ERIC Educational Resources Information Center

Giltner, Terri

2012-01-01

As the number of two- and four-year college options available to community members grows, so too does the competition among institutions of higher education to land new students. Expectations are high. Today's students want more than a quality education. They also want a college with a service culture--one that works with them to create an…

Size Matters — Determinants of Modern, Community-Oriented Mental Health Services

PubMed Central

Ala-Nikkola, Taina; Pirkola, Sami; Kontio, Raija; Joffe, Grigori; Pankakoski, Maiju; Malin, Maili; Sadeniemi, Minna; Kaila, Minna; Wahlbeck, Kristian

2014-01-01

Governances, structures and contents of mental health services are being reformed across countries. There is a need for data to support those changes. The aim of this study was to explore the quality, i.e., diversity and community orientation, and quantity, i.e., personnel resources, of mental health and substance abuse services (MHS) and evaluate correlation between population needs and quality and quantity of MHS. The European Service Mapping Schedule—Revised (ESMS-R) was used to classify mental health and substance abuse services in southern Finland. Municipal-level aggregate data, local data on unemployment rate, length of education, age of retirement, proportion of single households, alcohol sales and a composite mental health index were used as indicators of population mental health needs. Population size correlated strongly with service diversity, explaining 84% of the variance. Personnel resources did not associate with diversity or community orientation. The indicators of mental health services need did not have the expected association with quality and quantity of services. In terms of service organization, the results may support larger population bases, at least 150,000 adult inhabitants, when aiming for higher diversity. PMID:25153471

Quality Control through Design and Process: Gambrel Roof Truss Challenge

ERIC Educational Resources Information Center

Ward, Dell; Jones, James

2011-01-01

Customers determine whether a product fulfills their needs or satisfies them. "Quality control", then, is the process of finding out what the customer wants, along with designing, producing, delivering, and servicing the product--and ultimately satisfying the customer's expectations. For many years, people considered a product to be of good…

Professional Conversations: A Collaborative Approach to Support Policy Implementation, Professional Learning and Practice Change in ECEC

ERIC Educational Resources Information Center

Irvine, Susan; Price, Julie

2014-01-01

In 2012, Australia introduced a new "National Quality Framework" (NQF), comprising enhanced quality expectations for early childhood education and care services, two national learning frameworks and a new assessment and rating system spanning childcare centres, kindergartens and preschools, family day care and outside school hours care.…

Comparison of information about the quality of apparel in three retail formats.

PubMed

Bye, Elizabeth K; Reiley, Kathryn

2003-06-01

Multiple options are available for selection and purchase of apparel including in-store, catalogue, and Internet. The present purpose was to compare information about quality available to consumers in three retail formats. Students studying quality of apparel selected a product which could be purchased in each of the three formats, completed an evaluation from both a consumer's and preprofessional perspective, and made recommendations for improving information on quality. A total of 413 recommendations were categorized and tested for independence. Students had similar expectations for cues of quality across Internet, catalogue, and in-store formats including fiber content, country of origin, 3-dimensional information about fit, color accuracy, size charts, and strong customer service. Students expected a uniform array of information on quality regardless of the shopping format. Merchandisers must be aware of the total image across formats and be prepared to explore methods for improving communication of information on quality in each.

Brand strengthening decision making delved from brand-contacts in health services organizations.

PubMed

Takayanagi, Kazue; Hagihara, Yukiko

2007-01-01

Under the Japanese Government's strong enforcement of Japanese national medical cost reduction, only hospitals which emphasize patient values, and creation of brands according to them can survive. This study extracted patients' expectations as brand from Campbell's Brand-Contact lists. The authors also proposed to add Brand-strengthening strategies both for short-term strategies (large improvement is not required) and for long-term strategies (restructuring hardware and systems). This method would enable hospitals to collect customers' underlying expectations, and would create high-value brands. Trustful medical service would provide mutual and synergetic medical care effects. It is already considered out of date to conduct qualitative patient satisfaction interviews on current medical services to current customers. It is the only way to survive that hospitals themselves produce their original brands to increase patient loyalty and customer satisfaction. In the process, customer value should be reconsidered from both aspects of the quality of clinical care and of other medically related services. Then hospitals would be able to satisfy both customers' output and process expectations.

Service user satisfaction with cognitive behavioural therapy for psychosis: Associations with therapy outcomes and perceptions of the therapist.

PubMed

Lawlor, Caroline; Sharma, Bina; Khondoker, Mizanur; Peters, Emmanuelle; Kuipers, Elizabeth; Johns, Louise

2017-03-01

Few studies have investigated service user satisfaction with cognitive behavioural therapy for psychosis (CBTp). This study explored its associations with clinical presentation and outcomes, retrospective expectations of progress, perceptions of the therapist, and demographic variables. One hundred and sixty-five service users completed self-report questionnaires pre- and post-CBTp in relation to the constructs of interest. Regression analyses explored associations with (1) overall satisfaction with therapy and (2) perceived progress, skills, and knowledge gained. Ninety-six per cent of service users reported satisfaction with therapy. Higher levels of overall satisfaction with, and perceived benefit from, therapy were associated with positive therapy expectations, positive ratings of therapist's personal qualities, competence and trustworthiness, lower pre-therapy depression, and improvements in quality of life. Symptom improvements were not related to overall satisfaction with therapy; however, with the exception of voices, better clinical outcomes were associated with subjective ratings of having made more progress and gained more CBT skills and knowledge. Demographic factors were not associated with satisfaction or perceived progress. In multiple regression analyses, expectations of progress showed the strongest associations with both satisfaction and perceived benefits. Other remaining significant associations consisted of perceptions of the therapist for satisfaction, and both pre-therapy levels of, and changes in, depression for perceived benefits. Qualitative feedback emphasized the importance of the therapeutic relationship and developing new coping strategies. The findings provide preliminary evidence that high levels of satisfaction with therapy are not contingent on good clinical outcomes and are instead associated with positive therapy expectations and perceptions of the therapist. Therapy expectations represent a neglected area of research and may have implications for levels of satisfaction with therapy and perceived benefit. The findings reinforce the importance of cognitive behavioural therapy for psychosis (CBTp) therapists demonstrating that they are supportive, competent, and trustworthy. The findings suggest that positive experiences of therapy do not require changes in psychosis symptoms and are instead related to changes in quality of life. Depressive symptoms at the start of therapy may adversely influence the extent to which CBT skills and knowledge are gained and levels of perceived progress at the end of therapy. The present sample was restricted to service users who completed therapy. Satisfaction levels were high. Further research is needed to explore factors associated with dissatisfaction with therapy. © 2016 The British Psychological Society.

The bridge between real and ideal: students perception on quality gap in reality and their educational expectations.

PubMed

Nabilou, Bahram; Khorasani-Zavareh, Davoud

2014-09-01

Studies in higher education indicated that students' expectation for their educational services are not provided sufficiently, particularly in developing countries that implies on gap between the students perception on current situation and their expectations from educational services. The aim of this study was to determine the gap between student perception and expectations of students in various levels of the undergraduate educational courses at Urmia University of Medical Sciences, Iran. This is a longitudinal study, which was conducted in academic year 2007-2008 at the Urmia University of Medical Sciences. In total, 173 students were selected as sample size, among various courses. SERVQUAL questionnaire was used as instrument. Descriptive statistics following by Friedman and Wilcoxon tests were used to determining significance of quality gap between five dimensions and to evaluate significant gap between student perceptions and their expectations, respectively. Spearman test was also used to determine the relationship between dimensions. In overall, 80% of educational expectations were not meet; there was a negative gap at all phrases and dimensions and the gap was more negative for educational experts (-1.45 ± 0.89) compared to teachers (-0.97 ± 0.97). The highest gap for teachers was in empathy dimension (-1.11 ± 1.51), while for experts it was in assurance dimension (-1.58 ± 1). Existences of gap in dimensions indicated that expectations of students are not met and it indicates their dissatisfaction, and thus it is a necessity for improvement in all dimensions.

Effectiveness of Learning Process Using "Web Technology" in the Distance Learning System

ERIC Educational Resources Information Center

Killedar, Manoj

2008-01-01

Web is a globally distributed, still highly personalized media for cost-effective delivery of multimedia information and services. Web is expected to have a strong impact on almost every aspect of how we learn. "Total Quality" is the totality of features, as perceived by the customers of the product or service. Totality of features…

Optimising value and quality in general practice within the primary health care sector through relationship marketing: a conceptual framework.

PubMed

Bansal, Manjit K

2004-01-01

Discusses the rationale of applying relationship marketing and service quality concepts within the primary health care sector. The use of relational strategies in general practice, by modelling the relationships between practitioners and patients from a marketing perspective, could potentially lead to sustained high quality service being provided, and to more efficient use of resources. This essentially conceptually focused paper addresses an area that has not yet been researched in detail, and furthers understanding of the relationships that facilitate exchange within general practice and service delivery in non-profit, resource-constrained conditions. Deeper understanding of the needs and expectations of patients and the way these can be delivered by general practice can only lead to improvements for all parties involved. The relationship marketing paradigm presents itself as a potentially exciting way of addressing issues associated with ensuring that the highest level of quality is delivered in this area of the UK National Health Service.

Product-line administration: a framework for redefining medical record department services.

PubMed

Postal, S N

1990-06-01

Product-line administration is a viable approach for managing medical records services in an environment that demands high quantity and quality service levels. Product-line administration directs medical record department team members to look outside of the department and seek input from the customers it is intended to serve. The feedback received may be alarming at first, as the current state of products usually reveals a true lack of customer input. As the planning, defining, managing, and marketing phases are implemented, the road will not be easy and rewards will be slow to come. Product-line administration does not provide quick fixes, but it does provide long-term problem resolution as products are refined and new products developed to meet customer needs and expectations. In addition to better meeting the needs of the department's external customers, the department's internal customers' needs and expectations will be addressed. The participative management approach will help nurture each team member's creativity. The team members will have the opportunity to reach their full potential while reaping the rewards and benefits of providing products and services that meet the needs and expectations of all department customers. The future of the health care industry promises more changes as the country moves toward some form of prospective payment in the ambulatory setting. Reactive management and the constant struggle to catch up can no longer be accepted as a management approach. It is imperative that the medical record department be viewed as a business with product lines composed of quality products. The planning, defining, managing, and marketing components of product-line administration afford responsiveness to the current situation and the development of quality products that will ensure that medical record departments are prepared for the future.

The quality of health care in prison: results of a year's programme of semistructured inspections.

PubMed Central

Reed, J.; Lyne, M.

1997-01-01

OBJECTIVES: To assess, as part of wider inspections by HM Inspectorate of Prisons, the extent and quality of health care in prisons in England and Wales. DESIGN: Inspections based on a set of "expectations" derived mainly from existing healthcare quality standards published by the prison service and existing ethical guidelines; questionnaire survey of prisoners. SUBJECTS: 19 prisons in England and Wales, 1996-7. MAIN OUTCOME MEASURES: Appraisals of needs assessment and the commissioning and delivery of health care against the inspectorate's expectations. RESULTS: The quality of health care varied greatly. A few prisons provided health care broadly equivalent to NHS care, but in many the health care was of low quality, some doctors were not adequately trained to do the work they faced, and some care failed to meet proper ethical standards. Little professional support was available to healthcare staff. CONCLUSIONS: The current policy for improving health care in prisons is not likely to achieve its objectives and is potentially wasteful. The prison service needs to recognise that expertise in the commissioning and delivery of health care is overwhelming based in the NHS. The current review of the provision of health care in prisons offers an opportunity to ensure that prisoners are not excluded from high quality health care. PMID:9418090

Experimenting Design and Implementation of an Educational Services Management System Based on ISO/IEC 20000 Standard

NASA Astrophysics Data System (ADS)

Lezcano, Jean-Marc; Adachihara, Hatsuo; Prunier, Marc

European higher education organizations are encouraged to implement quality management practices. Existing quality standards and frameworks do not capitalize an important set of best practices addressing educational services delivery. The ISO/IEC 20000 standard, elaborated from IT service management issues, is widening its field of application and may represent an interesting alternative. A specific approach is needed to apprehend the particular nature of educational services, consider the systemic cooperating roles of educational system and learning system, and define ISO/IEC 20000 vocabulary and concepts adapted to the domain. ISO/IEC 20000 may provide an answer to European Standard Guideline compliance and improve educational services management. The current experimentation is expected to cast light on the complexity, practicality and effectiveness of the use of ISO/IEC 20000 in a first field of "non IT" services.

Co-designing for quality: Creating a user-driven tool to improve quality in youth mental health services.

PubMed

Hackett, Christina L; Mulvale, Gillian; Miatello, Ashleigh

2018-04-29

Although high quality mental health care for children and youth is a goal of many health systems, little is known about the dimensions of quality mental health care from users' perspectives. We engaged young people, caregivers and service providers to share experiences, which shed light on quality dimensions for youth mental health care. Using experience-based co-design, we collected qualitative data from young people aged 16-24 with a mental disorder (n = 19), identified caregivers (n = 12) and service providers (n = 14) about their experiences with respect to youth mental health services. Experience data were collected using multiple approaches including interviews, a suite of online and smartphone applications (n = 22), and a co-design event (n = 16) and analysed to extract touch points. These touch points were used to prioritize and co-design a user-driven prototype of a questionnaire to provide feedback to service providers. Young people, caregiver and service provider reports of service experiences were used to identify aspects of care quality at eight mental health service contact points: Access to mental health care; Transfer to/from hospital; Intake into hospital; Services provided; Assessment and treatment; Treatment environment; and Caregiver involvement in care. In some cases, low quality care was harmful to users and their caregivers. Young people co-designed a prototype of a user-driven feedback questionnaire to improve quality of service experiences that was supported by service providers and caregivers at the co-design event. By using EBCD to capture in-depth data regarding experiences of young people, their caregivers and service providers, study participants have begun to establish a baseline for acceptable quality of mental health care for young people. © 2018 The Authors. Health Expectations published by John Wiley & Sons Ltd.

LISTENing to healthcare students: the impact of new library facilities on the quality of services.

PubMed

Haldane, Graham C

2003-06-01

Following a low assessment of 'Learning resources' provision by the Quality Assurance Agency, the librarian of Homerton College, School of Health Studies commenced the LISTEN Project, a long-term study to monitor the effects of planned interventions on the quality of library provision. Surveys of entry-to-register student nurses & midwives were conducted in 1999 and 2001 by extensive questionnaires, inviting Likert-scaled and free text responses. Following a college relocation, students made greater than expected use of a new health studies library in Cambridge, and significantly less use of the local teaching hospital library. Using both a satisfaction index and a non-parametric test of mean scores, student evaluation of library services in Cambridge significantly improved following relocation. The physical accommodation and location of library services remain important to healthcare students. Identifiable improvements to the quality of services, however, will overcome initial resistance to change. Education providers must ensure the best mix of physical and electronic services for students who spend much of their time on clinical placement.

EQUIP: A European Survey of Quality Criteria for the Evaluation of Databases.

ERIC Educational Resources Information Center

Wilson, T. D.

1998-01-01

Reports on two stages of an investigation into the perceived quality of online databases. Presents data from 989 questionnaires from 600 database users in 12 European and Scandinavian countries and results of a test of the SERVQUAL methodology for identifying user expectations about database services. Lists statements used in the SERVQUAL survey.…

Quality of the ECEC Workforce in Romania: Empirical Evidence from Parents' Experiences

ERIC Educational Resources Information Center

Matei, Aniela; Ghenta, Mihaela

2018-01-01

The quality of the early childhood workforce is central to service provision in this area, being a major factor in determining children's development over the course of their lives. Specific skills and competencies are expected from early childhood education and care (ECEC) workforce. Well-trained staff from ECEC settings are an extremely…

Kimball, Nebraska: Economic and Community Development Plan

DTIC Science & Technology

1985-05-20

1,550,363 . advertising and promotion canpaign; i anventnsy of goods and services; Other $1,477,027 $1,666,288 $1,840,457 12,407,133 . merch...Kimball. (197 miles from KimbalI) should be advertised more effectively; .Take advantage of the cuimmainity’s quality services and facili- .promotion...retail sales and services that Kimball County could reasonably expect to have today with Improved: " advertising and promotion campaign; " inventory of

Exploring competing experiences and expectations of the revitalized community health worker programme in Mozambique: an equity analysis.

PubMed

Give, Celso Soares; Sidat, Mohsin; Ormel, Hermen; Ndima, Sozinho; McCollum, Rosalind; Taegtmeyer, Miriam

2015-09-01

Mozambique launched its revitalized community health programme in 2010 in response to inequitable coverage and quality of health services. The programme is focused on health promotion and disease prevention, with 20 % of community health workers' (known in Mozambique as Agentes Polivalentes Elementares (APEs)) time spent on curative services and 80 % on activities promoting health and preventing illness. We set out to conduct a health system and equity analysis, exploring experiences and expectations of APEs, community members and healthcare workers supervising APEs. This exploratory qualitative study captured the perspectives of a range of participants including women caring for children under 5 years (service clients), community leaders, service providers (APEs) and their supervisors. Participants in the Moamba and Manhiça districts, located in Maputo Province (Mozambique), were selected purposively. In total, 29 in-depth interviews and 9 focus group discussions were conducted in the local language and/or Portuguese. A framework approach was used for analysis, assisted by NVivo10 software. Our analysis revealed that health equity is viewed as linked to the quality and coverage of the APE programme. Demand and supply factors interplay to shape health equity. The availability of responsive and appropriate services led to tensions between community expectations for curative services (and APEs' willingness to perform them) and official policy focusing APE efforts mainly on preventive services and health promotion. The demand for more curative services by community members is a result of having limited access to healthcare services other than those offered by APEs. This study highlights the need to pay attention to the determinants of demand and supply of community interventions in health, to understand the opportunities and challenges of the difficult interface role played by APEs and to create communication among stakeholders in order to build a stronger, more effective and equitable community programme.

Exceeding Parents' Expectations in Ear-Nose-Throat Outpatient Facilities: The Development and Analysis of a Questionnaire

ERIC Educational Resources Information Center

Margaritis, Eleftherios; Katharaki, Maria; Katharakis, George

2012-01-01

The study attempts to develop an outpatient service quality scale by investigating the key dimensions which assess parental satisfaction and provides a recommendation on an improved health service delivery system. The survey was conducted in an Ear-Nose-Throat outpatient clinic of a Greek public pediatric hospital. A total of 127 parents in…

2009 Mississippi Curriculum Framework: Postsecondary Funeral Service Technology. (Program CIP-12.0301 - Funeral Service and Mortuary Science)

ERIC Educational Resources Information Center

Anderson, Larry; Dickerson, Octavia; Harvey, Bill; Moore, Tony

2009-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

Outsourcing of KyTC project delivery functions.

DOT National Transportation Integrated Search

2005-06-01

The rise in daily travelers on highways due to population growth, and higher quality and service expectations of the public, are putting increased demands on DOTs today. These demands, combined with decreasing staff sizes and changing resources, are ...

CONSUMER EXPECTATION ON SERVICE QUALITY PROVIDE BY PHARMACIST IN SELF MEDICATION PRACTICES AND ITS ASSOCIATED FACTORS IN BANDUNG, INDONESIA.

PubMed

Alfian, Sofa D; Sinuraya, Rano K; Kautsar, Angga P; Abdulah, Rizky

2016-11-01

Self-medication is the use of medicines for therapeutic intent without a clinician’s advice or prescription. The National Socioeconomic Survey for Indonesia in 2009 found the percentage of the Indonesians engaging in self-medication is increasing. The objectives of this study were to assess consumers’ expectations regarding service quality provide by pharmacist in self-medication practices and determine the factors associated with self-medication in Bandung, Indonesia. We conduct a cross-sectional survey at eight randomly selected community pharmacies during July-November 2012 and purposely sampled 1,200 costumers purchasing medication at those sites. Subjects reported they understood the information about the medicines given by the pharmacist but still wanted more information and time to consult with the pharmacist about their medicines. Factors associated with self-medication were younger age, male gender, greater education and lower income. The intervention is needed to improve appropriate self-medication.

Telehealth: seven strategies to successfully implement disruptive technology and transform health care.

PubMed

Schwamm, Lee H

2014-02-01

"Telehealth" refers to the use of electronic services to support a broad range of remote services, such as patient care, education, and monitoring. Telehealth must be integrated into traditional ambulatory and hospital-based practices if it is to achieve its full potential, including addressing the six domains of care quality defined by the Institute of Medicine: safe, effective, patient-centered, timely, efficient, and equitable. Telehealth is a disruptive technology that appears to threaten traditional health care delivery but has the potential to reform and transform the industry by reducing costs and increasing quality and patient satisfaction. This article outlines seven strategies critical to successful telehealth implementation: understanding patients' and providers' expectations, untethering telehealth from traditional revenue expectations, deconstructing the traditional health care encounter, being open to discovery, being mindful of the importance of space, redesigning care to improve value in health care, and being bold and visionary.

A 2-1-1 Research Collaboration

PubMed Central

Eddens, Katherine S.; Alcaraz, Kassandra I.; Kreuter, Matthew W.; Rath, Suchitra; Greer, Regina

2012-01-01

Background 2-1-1 serves as a lifeline in times of crises. These crises often cause a spike in call volume that can challenge 2-1-1’s ability to meet their service quality standards. For researchers gathering data through 2-1-1s, a sudden increase in call volume might reduce accrual as 2-1-1 has less time to administer study protocols. Research activities imbedded in 2-1-1 systems may directly affect 2-1-1 service quality indicators. Purpose Using data from a 2-1-1 research collaboration, this paper examines the impact of crises on call volume to 2-1-1, how call volume affects research participant accrual through 2-1-1, and how research recruitment efforts affect 2-1-1 service quality indicators. Methods t-tests were used to examine the effect of call volume on research participant accrual. Linear and logistic regressions were used to examine the effect of research participant accrual on 2-1-1 service quality indicators. Data were collected June 2010–December 2011; data were analyzed in 2012. Results Findings from this collaboration suggest that crises causing spikes in call volume adversely affect 2-1-1 service quality indicators as well as accrual of research participants. Administering a brief (2–3 minute) health risk assessment did not negatively affect service quality, but administering a longer (15–18 minute) survey had a modest adverse effect on these indicators. Conclusions In 2-1-1 research collaborations, both partners need to understand the dynamic relationship between call volume, research accrual, and service quality, and adjust expectations accordingly. If research goals include administering a longer survey, increased staffing of 2-1-1 call centers may be needed to avoid compromising service quality. PMID:23157769

Care in the Community

NASA Astrophysics Data System (ADS)

Brown, S.; Hine, N.; Sixsmith, A.; Garner, P.

The UK population is ageing. At the time of the 2001 census there were 8.1 million people aged over 65 living in the UK, 3.1 million of them living alone. By 2011 the number of over 65s is projected to reach just under 12 million, and by 2026 over 13 million [1]. The extra workload this will place on health and care services will be compounded by political ambitions aimed at meeting the challenges of rising patient expectations [2]. In addition to this, the Department of Health aims to promote the independence of older people by providing enhanced services from the National Health Service (NHS) and councils to prevent unnecessary hospital admission [3]. As a result we can expect to see a continuing rise in the number of elderly people living at home and requiring good-quality health and social care services.

Bridging existing governance gaps: five evidence-based actions that boards can take to pursue high quality care.

PubMed

Leggat, Sandra G; Balding, Cathy

2017-11-13

Objective To explore the impact of the organisational quality systems on quality of care in Victorian health services. Methods During 2015 a total of 55 focus groups were conducted with more than 350 managers, clinical staff and board members in eight Victorian health services to explore the effectiveness of health service quality systems. A review of the quality and safety goals and strategies outlined in the strategic and operating plans of the participating health services was also undertaken. Results This paper focuses on the data related to the leadership role of health service boards in ensuring safe, high-quality care. The findings suggest that health service boards are not fully meeting their governance accountability to ensure consistently high-quality care. The data uncovered major clinical governance gaps between stated board and executive aspirations for quality and safety and the implementation of these expectations at point of care. These gaps were further compounded by quality system confusion, over-reliance on compliance, and inadequate staff engagement. Conclusion Based on the existing evidence we propose five specific actions boards can take to close the gaps, thereby supporting improved care for all consumers. What is known about this topic? Effective governance is essential for high-quality healthcare delivery. Boards are required to play an active role in their organisation's pursuit of high quality care. What does this paper add? Recent government reports suggest that Australian health service boards are not fully meeting their governance requirements for high quality, safe care delivery, and our research pinpoints key governance gaps. What are the implications for practitioners? Based on our research findings we outline five evidence-based actions for boards to improve their governance of quality care delivery. These actions focus on an organisational strategy for high-quality care, with the chief executive officer held accountable for successful implementation, which is actively guided and monitored by the board.

Business process re-engineering--saviour or just another fad? One UK health care perspective.

PubMed

Patwardhan, Anjali; Patwardhan, Dhruv

2008-01-01

Pressure to change is politically driven owing to escalating healthcare costs and an emphasis on efficiency gains, value for money and improved performance proof in terms of productivity and recently to some extent by demands from less satisfied patients and stakeholders. In a background of newly immerging expensive techniques and drugs, there is an increasing consumer expectation, i.e. quality services. At the same time, health system managers and practitioners are finding it difficult to cope with demand and quality expectations. Clinicians are frustrated because they are not recognised for their contribution. Managers are frustrated because meaningful dialogue with clinicians is lacking, which has intensified the need for change to a more efficient system that satisfies all arguments about cost effectiveness and sustainable quality services. Various strategies, originally developed by management quality "gurus" for engineering industries, have been applied to health industries with variable success, which largely depends on the type of health care system to which they are applied. Business process re-engineering is examined as a quality management tool using past and recent publications. The paper finds that applying business process re-engineering in the right circumstances and selected settings for quality improvement is critical for its success. It is certainly "not for everybody". The paper provides a critical appraisal of business process re-engineering experiences in UK healthcare. Lessons learned regarding selecting organisations and agreeing realistic expectations are addressed. Business process re-engineering has been evaluated and reviewed since 1987 in US managed health care, with no clear lessons learned possibly because unit selection and simultaneous comparison between two units virtually performing at opposite ends has never been done before. Two UK pilot studies, however, add useful insights.

Healthcare Finance in the Kingdom of Saudi Arabia: A Qualitative Study of Householders' Attitudes.

PubMed

Al-Hanawi, Mohammed Khaled; Alsharqi, Omar; Almazrou, Saja; Vaidya, Kirit

2018-02-01

The public sector healthcare system in Saudi Arabia, essentially financed by oil revenues and 'free at the point of delivery', is coming under increasing strain due to escalating expenditure and an increasingly volatile oil market and is likely to be unsustainable in the medium to long term. This study examines how satisfied the Saudi people are with their public sector healthcare services and assesses their willingness to contribute to financing the system through a national health insurance scheme. The study also examines public preferences and expectations of a future national health insurance system. A total of 36 heads of households participated in face-to-face audio-recorded semi-structured interviews. The participants were purposefully selected based on different socio-economic and socio-demographic factors from urban and rural areas to represent the geographical diversity that would presumably influence individual views, expectations, preferences and healthcare experiences. The evidence showed some dissatisfaction with the provision and quality of current public sector healthcare services, including the availability of appointments, waiting times and the availability of drugs. The households indicated a willingness to contribute to a national insurance scheme, conditional upon improvements in the quality of public sector healthcare services. The results also revealed a variety of preferences and expectations regarding the proposed national health insurance scheme. Quality improvement is a key factor that could motivate the Saudi people to contribute to financing the healthcare system. A new authority, consisting of a partnership between the public and private sectors under government supervision, could represent an acceptable option for addressing the variation in public preferences.

The Bridge Between Real and Ideal: Students Perception on Quality Gap in Reality and Their Educational Expectations

PubMed Central

Nabilou, Bahram; Khorasani-Zavareh, Davoud

2014-01-01

Background: Studies in higher education indicated that students’ expectation for their educational services are not provided sufficiently, particularly in developing countries that implies on gap between the students perception on current situation and their expectations from educational services. Objectives: The aim of this study was to determine the gap between student perception and expectations of students in various levels of the undergraduate educational courses at Urmia University of Medical Sciences, Iran. Patients and Methods: This is a longitudinal study, which was conducted in academic year 2007-2008 at the Urmia University of Medical Sciences. In total, 173 students were selected as sample size, among various courses. SERVQUAL questionnaire was used as instrument. Descriptive statistics following by Friedman and Wilcoxon tests were used to determining significance of quality gap between five dimensions and to evaluate significant gap between student perceptions and their expectations, respectively. Spearman test was also used to determine the relationship between dimensions. Results: In overall, 80% of educational expectations were not meet; there was a negative gap at all phrases and dimensions and the gap was more negative for educational experts (-1.45 ± 0.89) compared to teachers (-0.97 ± 0.97). The highest gap for teachers was in empathy dimension (-1.11 ± 1.51), while for experts it was in assurance dimension (-1.58 ± 1). Conclusions: Existences of gap in dimensions indicated that expectations of students are not met and it indicates their dissatisfaction, and thus it is a necessity for improvement in all dimensions. PMID:25593712

Mobile contract services: what you need to know.

PubMed

Inman, M

2000-01-01

With sufficient planning and ongoing attention to detail, the performance of a mobile imaging service provider can exceed expectations and requirements. The relationship can prove to be mutually agreeable and profitable for many years. But, when contracting mobile services, you cannot spend too much time on initial research and detail. Several scenarios present outsourcing or mobile services as an acceptable alternative to purchase or lease: outdated equipment, novel or under-utilized technologies, the need for incrementally added or temporary service. To find suitable providers, check with peer sources in your area for recommendations; look specifically for facilities that are comparable in size and volume to your facility. Expect that larger volume facilities will rate more favorable schedules or pricing. Obtain and check references. Require mobile service providers to adhere to the same state and federal laws, rules and regulations that govern your facility; receive the assurance of compliance in writing if it is not specifically addressed in the contract. JCAHO requires that any contract service provider be governed by the same requirements as the accredited facility. Several other rules or licensing requirements may also pertain to mobile services. A prevailing reason for outsourcing imaging services is high equipment costs that cannot be justified with current volume projections. However, equipment quality should not be compromised; it must meet your needs and be in good repair. The mobile service provider you choose should be an extension of your department; quality standards must exist unilaterally. The set rule for assessing mobile service fees is that there is no set rule. There are many ways to negotiate the fee schedule so that it meets the needs of both parties. An effective marketing campaign lets physicians and patients know what you have available. Work with the mobile service provider to plan an initial announcement or open house. The mobile provider should also have patient education materials for referring physicians and your hospital. Having the mobile technologist meet with the radiologists to discuss written protocols will eliminate misunderstandings concerning expectations of both parties; ongoing communication is vital.

SERVQUAL: a tool for evaluating patient satisfaction with nursing care.

PubMed

Scardina, S A

1994-01-01

Rising health care costs and competition among hospital facilities have resulted in the need to recognize patient satisfaction as an important indicator of quality care. Nurses provide the primary service to patients; therefore, their role is influential in overall satisfaction. Several instruments have been developed to measure patient satisfaction with nursing care; however, most of them focus only on patient perceptions. One such approach to evaluating patient satisfaction with nursing care involves an instrument, SERVQUAL, derived from a marketing service perspective. Adapting SERVQUAL for use in evaluating nursing care is the focus of this article. SERVQUAL assesses both patient perceptions and expectations of quality service and permits managers and clinicians to view the gaps between the two; thus, the overall areas of improvement in nursing services can be determined.

PLANNING THE WEDDING: DEVELOPMENT BASED UPON ECOSYSTEMS

EPA Science Inventory

Changing land uses to meet needs and expectations of the growing human population is largely responsible for habitat loss, species extinctions, deterioration of water quality and quantity, soil losses and depletion, and ecosystem goods and services. Although such development is...

Quality circles and their potential application to rural health care in Papua New Guinea.

PubMed

Cibulskis, R E; Edwards, K N

1993-06-01

A quality circle is a group of service providers who meet regularly to solve problems relating to the quality of their work. This is an example of bottom-up rather than top-down management which has found considerable success in the industries of the developed world. This article describes the principles which govern the operation of quality circles, the expected benefits and how best to introduce them. The problems relating to the provision of quality health care in rural areas and the potential application of the quality circle methodology are discussed.

Water Quality Is a Poor Predictor of Recreational Hotspots in England

PubMed Central

Mullin, Karen; Boeuf, Blandine; Fincham, William; Taylor, Nigel; Villalobos-Jiménez, Giovanna; von Vittorelli, Laura; Wolf, Christine; Fritsch, Oliver; Strauch, Michael; Seppelt, Ralf; Volk, Martin; Beckmann, Michael

2016-01-01

Maintaining and improving water quality is key to the protection and restoration of aquatic ecosystems, which provide important benefits to society. In Europe, the Water Framework Directive (WFD) defines water quality based on a set of biological, hydro-morphological and chemical targets, and aims to reach good quality conditions in all river bodies by the year 2027. While recently it has been argued that achieving these goals will deliver and enhance ecosystem services, in particular recreational services, there is little empirical evidence demonstrating so. Here we test the hypothesis that good water quality is associated with increased utilization of recreational services, combining four surveys covering walking, boating, fishing and swimming visits, together with water quality data for all water bodies in eight River Basin Districts (RBDs) in England. We compared the percentage of visits in areas of good water quality to a set of null models accounting for population density, income, age distribution, travel distance, public access, and substitutability. We expect such association to be positive, at least for fishing (which relies on fish stocks) and swimming (with direct contact to water). We also test if these services have stronger association with water quality relative to boating and walking alongside rivers, canals or lakeshores. In only two of eight RBDs (Northumbria and Anglian) were both criteria met (positive association, strongest for fishing and swimming) when comparing to at least one of the null models. This conclusion is robust to variations in dataset size. Our study suggests that achieving the WFD water quality goals may not enhance recreational ecosystem services, and calls for further empirical research on the connection between water quality and ecosystem services. PMID:27875562

A 2-1-1 research collaboration: participant accrual and service quality indicators.

PubMed

Eddens, Katherine S; Alcaraz, Kassandra I; Kreuter, Matthew W; Rath, Suchitra; Greer, Regina

2012-12-01

In times of crises, 2-1-1 serves as a lifeline in many ways. These crises often cause a spike in call volume that can challenge 2-1-1's ability to meet its service quality standards. For researchers gathering data through 2-1-1s, a sudden increase in call volume might reduce accrual as 2-1-1 has less time to administer study protocols. Research activities imbedded in 2-1-1 systems may affect directly 2-1-1 service quality indicators. Using data from a 2-1-1 research collaboration, this paper examines the impact of crises on call volume to 2-1-1, how call volume affects research participant accrual through 2-1-1, and how research recruitment efforts affect 2-1-1 service quality indicators. t-tests were used to examine the effect of call volume on research participant accrual. Linear and logistic regressions were used to examine the effect of research participant accrual on 2-1-1 service quality indicators. Data were collected June 2010-December 2011; data were analyzed in 2012. Findings from this collaboration suggest that crises causing spikes in call volume adversely affect 2-1-1 service quality indicators as well as accrual of research participants. Administering a brief (2-3 minute) health risk assessment did not affect service quality negatively, but administering a longer (15-18 minute) survey had a modest adverse effect on these indicators. In 2-1-1 research collaborations, both partners need to understand the dynamic relationship among call volume, research accrual, and service quality and adjust expectations accordingly. If research goals include administering a longer survey, increased staffing of 2-1-1 call centers may be needed to avoid compromising service quality. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Using creative problem solving (TRIZ) in improving the quality of hospital services.

PubMed

LariSemnani, Behrouz; Mohebbi Far, Rafat; Shalipoor, Elham; Mohseni, Mohammad

2014-08-14

TRIZ is an initiative and SERVQUAL is a structured methodology for quality improvement. Using these tools, inventive problem solving can be applied for quality improvement, and the highest quality can be reached using creative quality improvement methodology. The present study seeks to determine the priority of quality aspects of services provided for patients in the hospital as well as how TRIZ can help in improving the quality of those services. This Study is an applied research which used a dynamic qualitative descriptive survey method during year 2011. Statistical population includes every patient who visited in one of the University Hospitals from March 2011. There existed a big gap between patients' expectations from what seemingly is seen (the design of the hospital) and timely provision of services with their perceptions. Also, quality aspects of services were prioritized as follows: keeping the appearance of hospital (the design), accountability, assurance, credibility and having empathy. Thus, the only thing which mattered most for all staff and managers of studied hospital was the appearance of hospital as well as its staff look. This can grasp a high percentage of patients' satisfaction. By referring to contradiction matrix, the most important principles of TRIZ model were related to tangible factors including principles No. 13 (discarding and recovering), 25 (self-service), 35 (parameter changes), and 2 (taking out). Furthermore, in addition to these four principles, principle No. 24 (intermediary) was repeated most among the others. By utilizing TRIZ, hospital problems can be examined with a more open view, Go beyond The conceptual framework of the organization and responded more quickly to patients ' needs.

An Empirical Study on the Efficiency of College Teachers and Their Attitude in Teaching in Kancheepuram District

ERIC Educational Resources Information Center

Brindhamani, M.; Manichander, T.

2014-01-01

The quality of teaching depends upon the dedication of the teachers towards their profession and the improvisation of it depends upon the training, both pre-service and in-service they receive when they undergo the period of probation. A teacher is expected to have subject competency as well as linguistic competency. The main objective of the…

Pre-Service Science Teacher Preparation in Europe: Comparing Pre-Service Teacher Preparation Programs in England, France, Finland and Cyprus

ERIC Educational Resources Information Center

Evagorou, Maria; Dillon, Justin; Viiri, Jouni; Albe, Virginie

2015-01-01

A number of reports recently identify that the quality of science education in a number of European countries is lower than expected. One of the reasons for the apparent underachievement in this generally economically prosperous continent might be a pedagogy of science that lacks variety, or a pedagogy that is less engaging than other subjects.…

[Health care units image development on the market of medical services].

PubMed

Kemicer-Chmielewska, Ewa; Karakiewicz, Beata

2010-01-01

The cause for this document is to present a deliberation on public health facility image development on the medical services market. Marketization of the health service, growing awareness of Polish citizens and their expectation of high service quality as well as increased competition in the healthcare system market is the reason why health unit managers need to put a lot of strength and effort in sustaining or improving the image of the facility they run. Such action gives a chance for obtaining a competitive advantage.

Estimating the cost of improving service quality in water supply: A shadow price approach for England and wales.

PubMed

Molinos-Senante, María; Maziotis, Alexandros; Sala-Garrido, Ramón

2016-01-01

Service quality to customers is an aspect that cannot be ignored in the performance assessment of water companies. Nowadays water regulators introduce awards or penalties to incentivize companies to improve service quality to customers when setting prices. In this study, the directional distance function is employed to estimate the shadow prices of variables indicating the lack of service quality to customers in the water industry i.e., written complaints, unplanned interruptions and properties below the reference level. To calculate the shadow price of each undesirable output for each water company, it is needed to ascribe a reference price for the desirable output which is the volume of water delivered. An empirical application is carried out for water companies in England and Wales. Hence, the shadow price of each undesirable output is expressed both as a percentage of the price of the desirable output and in pence per cubic meter of water delivered The estimated results indicate that on average, each additional written complaint that needs to be dealt with by the water company includes a service quality cost of 0.399p/m(3). As expected, when looking at the other service quality variables which involve network repair or replacement, these values are considerably higher. On average, the water company must spend an extra 0.622p/m(3) to prevent one unplanned interruption and 0.702p/m(3) to avoid one water pressure below the reference level. The findings of this study are of great importance for regulated companies and regulators as it has been illustrated that improvements in the service quality in terms of customer service could be challenging and therefore ongoing investments will be required to address these issues. Copyright © 2015 Elsevier B.V. All rights reserved.

A Study of Quality of Service Communication for High-Speed Packet-Switching Computer Sub-Networks

NASA Technical Reports Server (NTRS)

Cui, Zhenqian

1999-01-01

With the development of high-speed networking technology, computer networks, including local-area networks (LANs), wide-area networks (WANs) and the Internet, are extending their traditional roles of carrying computer data. They are being used for Internet telephony, multimedia applications such as conferencing and video on demand, distributed simulations, and other real-time applications. LANs are even used for distributed real-time process control and computing as a cost-effective approach. Differing from traditional data transfer, these new classes of high-speed network applications (video, audio, real-time process control, and others) are delay sensitive. The usefulness of data depends not only on the correctness of received data, but also the time that data are received. In other words, these new classes of applications require networks to provide guaranteed services or quality of service (QoS). Quality of service can be defined by a set of parameters and reflects a user's expectation about the underlying network's behavior. Traditionally, distinct services are provided by different kinds of networks. Voice services are provided by telephone networks, video services are provided by cable networks, and data transfer services are provided by computer networks. A single network providing different services is called an integrated-services network.

Improving the Service with the Servqual Method

NASA Astrophysics Data System (ADS)

Midor, Katarzyna; Kučera, Marian

2018-03-01

At the time when economy is growing, there is strong competition in the market, and customers have increasingly higher expectations as regards quality of service and products. Under such conditions, organizations need to improve. One of the areas of improvement for an organization is to research the level of customer satisfaction. The article presents results of customer satisfaction surveys conducted by the Servqual method in a pharmaceutical service company. Use of this method allowed to improve the services provided by that pharmaceutical wholesaler, identify areas that need to be improved as soon as possible in order to improve the level of service provided.

Measuring Inpatient Rehabilitation Facility Quality of Care: Discharge Self-Care Functional Status Quality Measure.

PubMed

Pardasaney, Poonam K; Deutsch, Anne; Iriondo-Perez, Jeniffer; Ingber, Melvin J; McMullen, Tara

2018-06-01

To describe the calculation and psychometric properties of the discharge self-care functional status quality measure implemented in the Centers for Medicare & Medicaid Services' (CMS) Inpatient Rehabilitation Facility (IRF) Quality Reporting Program on October 1, 2016. Medicare fee-for-service (FFS) patients from 38 IRFs that participated in the CMS Post-Acute Care Payment Reform Demonstration were included in this cohort study. Data came from the Continuity Assessment Record and Evaluation Item Set, IRF-Patient Assessment Instrument, and Medicare claims. For each patient, we calculated an expected discharge self-care score, risk-adjusted for demographic and baseline clinical characteristics. The performance score of each IRF equaled the percentage of patient stays where the observed discharge self-care score met or exceeded the expected score. We assessed the measure's discriminatory ability across IRFs and reliability. IRFs. Medicare FFS patients aged ≥21 years (N=4769). Not applicable. Facility-level discharge self-care quality measure performance score. A total of 4769 patient stays were included; 57% of stays were in women, and 12.1% were in patients aged <65 years. Stroke was the most common diagnosis (21.8%). The mean±SD performance score was 55.1%±16.6% (range, 25.8%-100%). About 54% of IRFs had scores significantly different from the percentage of stays that met or exceeded the expected discharge self-care score in the overall demonstration sample. The quality measure showed strong reliability, with intraclass correlation coefficients of .91. The discharge self-care quality measure showed strong discriminatory ability and reliability, representing an important initial step in evaluation of IRF self-care outcomes. A wide range in performance scores suggested a gap in quality of care across IRFs. Future work should include testing the measure with nationwide data from all IRFs. Published by Elsevier Inc.

Productivity and patient satisfaction in primary care--conflicting or compatible goals?

PubMed

Glenngård, Anna Häger

2013-07-01

Following recent reforms in Swedish primary care, providers are accountable to both citizens and county councils, in their role as payers. Productivity and quality measurement is fundamental for ensuring health care providers accountability to payers and that resources are spent as intended. The purpose was to study productivity and patient satisfaction in Swedish primary care. One measure of productivity capturing volume of visits and one measure capturing individual's judgment about the quality of services in relation to allocated resources was estimated. The potential conflict between the two measures and variation with respect to different factors was analyzed. There was a great variation in both measures of productivity. No conflict between the two measures of productivity was found. Thus, most providers could increase their volume of services without adverse effects for the quality and vice versa. Providers are however faced with different conditions. Traditional productivity measures are not enough to assess whether allocated resources are used according to set priorities and generates value for money. Information about the length and content of visits and the distribution of services produced is also needed, in particular to assess if resources allocated based on expected great needs among certain groups actually benefits those individuals. Effects of services produced are also needed. This is particularly important to assess if resources allocated based on expected great needs among certain groups actually benefits those individuals. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

41 CFR 102-76.10 - What basic design and construction policy governs Federal agencies?

Code of Federal Regulations, 2012 CFR

2012-01-01

... basic design and construction policies: (a) Provide the highest quality services for designing and... requirements. (See 40 U.S.C. 3310 and 3312.) (d) Design Federal buildings to have a long life expectancy and...

41 CFR 102-76.10 - What basic design and construction policy governs Federal agencies?

Code of Federal Regulations, 2013 CFR

2013-07-01

... basic design and construction policies: (a) Provide the highest quality services for designing and... requirements. (See 40 U.S.C. 3310 and 3312.) (d) Design Federal buildings to have a long life expectancy and...

Service Quality Management Systems: An Annotated Bibliography

DTIC Science & Technology

1992-05-01

customers, Fortune, 122, 38-48. Key words: Consumer preferences , customer expectations Abstract: Rice presents a profile of the 1990 U.S. consumers...business process, 16 competitive advantage, 6, 10 consumer, 5 consumer affairs department, 19 consumer preferences , 30 consumer research, 10,24

Validation of Medical Tourism Service Quality Questionnaire (MTSQQ) for Iranian Hospitals.

PubMed

Qolipour, Mohammad; Torabipour, Amin; Khiavi, Farzad Faraji; Malehi, Amal Saki

2017-03-01

Assessing service quality is one of the basic requirements to develop the medical tourism industry. There is no valid and reliable tool to measure service quality of medical tourism. This study aimed to determine the reliability and validity of a Persian version of medical tourism service quality questionnaire for Iranian hospitals. To validate the medical tourism service quality questionnaire (MTSQQ), a cross-sectional study was conducted on 250 Iraqi patients referred to hospitals in Ahvaz (Iran) from 2015. To design a questionnaire and determine its content validity, the Delphi Technique (3 rounds) with the participation of 20 medical tourism experts was used. Construct validity of the questionnaire was assessed through exploratory and confirmatory factor analysis. Reliability was assessed using Cronbach's alpha coefficient. Data were analyzed by Excel 2007, SPSS version18, and Lisrel l8.0 software. The content validity of the questionnaire with CVI=0.775 was confirmed. According to exploratory factor analysis, the MTSQQ included 31 items and 8 dimensions (tangibility, reliability, responsiveness, assurance, empathy, exchange and travel facilities, technical and infrastructure facilities and safety and security). Construct validity of the questionnaire was confirmed, based on the goodness of fit quantities of model (RMSEA=0.032, CFI= 0.98, GFI=0.88). Cronbach's alpha coefficient was 0.837 and 0.919 for expectation and perception questionnaire. The results of the study showed that the medical tourism SERVQUAL questionnaire with 31 items and 8 dimensions was a valid and reliable tool to measure service quality of medical tourism in Iranian hospitals.

Training And Supervision Did Not Meaningfully Improve Quality Of Care For Pregnant Women Or Sick Children In Sub-Saharan Africa.

PubMed

Leslie, Hannah H; Gage, Anna; Nsona, Humphreys; Hirschhorn, Lisa R; Kruk, Margaret E

2016-09-01

In-service training courses and supportive supervision of health workers are among the most common interventions to improve the quality of health care in low- and middle-income countries. Despite extensive investment from donors, evaluations of the long-term effect of these two interventions are scarce. We used nationally representative surveys of health systems in seven countries in sub-Saharan Africa to examine the association of in-service training and supervision with provider quality in antenatal and sick child care. The results of our analysis showed that observed quality of care was poor, with fewer than half of evidence-based actions completed by health workers, on average. In-service training and supervision were associated with quality of sick child care; they were associated with quality of antenatal care only when provided jointly. All associations were modest-at most, improvements related to interventions were equivalent to 2 additional provider actions out of the 18-40 actions expected per visit. In-service training and supportive supervision as delivered were not sufficient to meaningfully improve the quality of care in these countries. Greater attention to the quality of health professional education and national health system performance will be required to provide the standard of health care that patients deserve. Project HOPE—The People-to-People Health Foundation, Inc.

QaaS (quality as a service) model for web services using big data technologies

NASA Astrophysics Data System (ADS)

Ahmad, Faisal; Sarkar, Anirban

2017-10-01

Quality of service (QoS) determines the service usability and utility and both of which influence the service selection process. The QoS varies from one service provider to other. Each web service has its own methodology for evaluating QoS. The lack of transparent QoS evaluation model makes the service selection challenging. Moreover, most QoS evaluation processes do not consider their historical data which not only helps in getting more accurate QoS but also helps for future prediction, recommendation and knowledge discovery. QoS driven service selection demands a model where QoS can be provided as a service to end users. This paper proposes a layered QaaS (quality as a service) model in the same line as PaaS and software as a service, where users can provide QoS attributes as inputs and the model returns services satisfying the user's QoS expectation. This paper covers all the key aspects in this context, like selection of data sources, its transformation, evaluation, classification and storage of QoS. The paper uses server log as the source for evaluating QoS values, common methodology for its evaluation and big data technologies for its transformation and analysis. This paper also establishes the fact that Spark outperforms the Pig with respect to evaluation of QoS from logs.

Assessing the physical service setting: a look at emergency departments.

PubMed

Steinke, Claudia

2015-01-01

To determine the attributes of the physical setting that are important for developing a positive service climate within emergency departments and to validate a measure for assessing physical service design. The design of the physical setting is an important and contributing factor for creating a service climate in organizations. Service climate is defined as employee perceptions of the practices, procedures, and behaviors that get rewarded, supported, and expected with regard to customer service and customer service quality. There has been research conducted which identifies antecedents within organization that promotes a positive service climate which in turn creates service-oriented behaviors by employees toward clients. The antecedent of the physical setting and its impact on perceptions of service climate has been less commonly explored. Using the concept of the physical service setting (which may be defined as aspects of the physical, built environment that facilitate the delivery of quality service), attributes of the physical setting and their relationship with service climate were explored by means of a quantitative paper survey distributed to emergency nurses (n = 180) throughout a province in Canada. The results highlight the validity and reliability of six scales measuring the physical setting and its relation to service. Respondents gave low ratings to the physical setting of their departments, in addition to low ratings of service climate. Respondents feel that the design of the physical setting in the emergency departments where they work is not conducive to providing quality service to clients. Certain attributes of the physical setting were found to be significant in influencing perceptions of service climate, hence service quality, within the emergency department setting. © The Author(s) 2015.

Balanced scorecard as a framework for driving performance in managed care organizations.

PubMed

Sahney, V K

1998-01-01

Managed care organizations in a highly competitive environment constantly face the pressure of improving their financial performance. At the same time, customers of the organization expect the organization to deliver high-quality outcomes and improve customer service. Payers expect the organization to develop innovative new products to meet their needs. This article presents an approach called "Balanced Scorecard" for measurement, development of strategy, and performance improvement in a managed care organization.

Applying the expectancy disconfirmation and regret theories to online consumer behavior.

PubMed

Liao, Chechen; Liu, Chuang-Chun; Liu, Yu-Ping; To, Pui-Lai; Lin, Hong-Nan

2011-04-01

This study synthesizes the expectancy disconfirmation theory with empirical theories pertaining to customer regret in an e-commerce environment. The study begins by examining the roles that information quality (IQ), system quality (SYQ), and service quality (SEQ) play in determining customer regret and satisfaction. Then the consequences of regret and satisfaction on reuse intention are examined. Survey data collected from 445 respondents are analyzed using structural equation modeling with partial least squares (PLS-Graph 3.0) to provide support for the hypothesized links. Results show that IQ disconfirmation, SYQ disconfirmation and SEQ disconfirmation are related to regret and satisfaction. Both regret and satisfaction are related to reuse intention. In addition, satisfaction mediates the effect of regret on reuse intention. Based on these results, implications for theory and practice are discussed.

Pay-for-performance: too much of a good thing? A conversation with Martin Roland. Interview by Robert Galvin.

PubMed

Roland, Martin

2006-01-01

As the United States moves down the road of pay-for-performance (P4P), concerns about unintended consequences are foremost in the minds of policymakers. Initial results from the world's most ambitious P4P program, the United Kingdom's Quality and Outcomes Framework (QOF), indicate that while quality improvements exceeded expectations, so too did the amount of funds paid out, straining the National Health Service (NHS) budget. Martin Roland, one of the leading U.K. health services researchers and an adviser to the QOF, gives his views on what went right and what went wrong, and he offers his advice to the United States about using financial incentives to improve quality.

Patients' Expectations and Perceptions of Service Quality in the Selected Hospitals.

PubMed

Nadi, Aliasghar; Shojaee, Jalil; Abedi, Ghassem; Siamian, Hasan; Abedini, Ehsan; Rostami, Farideh

2016-04-01

Hospital's success depends on patients' expectations, perceptions, and judgment on the quality of services provided by hospitals. This study was conducted to assess the patients' perceptions and expectations from the quality of inpatient health care in Vali-Asr hospital, Ghaemshahr, and Imam Khomeini and Shafa Hospitals, Sari. This study is applied regarding the objective of the study. Considering the research methodology, it is a descriptive - analytical study. The sample of this study consists of 600 patients with at least 24 hours of being hospitalized in internal, surgery, women, and children sectors of Vali-Asr, Ghaemshahr, Imam Khomeini, and Shafa Hospitals. Using random sampling method, the classifications relevant to the size of each class were selected. The data required was collected through the standard SERVQUAL questionnaire and then it was analyzed using the SPSS software. The overall mean value and standard deviation of expectations were equal to 10.4 and 28, respectively. The mean value for the field of perception was 69.2 and the relevant standard deviation was 26. In terms of patients and hospital visits in concrete cases, the highest priority is related to empathy. The second priority is related to physical appearance, the third priority is related to responsiveness, the fourth priority is related to assurance, and the lowest priority is related to the reliability of the SERVQUAL approach. Examining the gap between patients' perceptions and expectations, the widest gap was observed in the Vali-Asr Hospital with the mean and SD (-92.0±39.0) and the lowest gap was observed in Shafa Hospital with the mean value of (-39.9±44.0). According to The Kruskal-Wallis test, the difference observed in these three hospitals were significant. The results showed that patients' expectations had not been met in any of the examined dimensions and their consent has not been achieved. It seemed that necessary for managers and relevant authorities to plan and pay special attention to this important issue.

Support of NASA quality requirements by defense contract administration services regions

NASA Technical Reports Server (NTRS)

Farrar, Hiram D.

1966-01-01

Defense Contract Administration Services Regions (DCASR) quality assurance personnel performing under NASA Letters of Delegation must work closely with the assigned technical representative of the NASA centers. It is realized that technical personnel from the NASA Centers cannot make on-site visits as frequently as they would like to. However, DCASR quality assurance personnel would know the assigned NASA technical representative and should contact him when problems arise. The technical representative is the expert on the hardware and should be consulted on any problem area. It is important that the DCASR quality assurance personnel recommend to the delegating NASA Center any new or improved methods of which they may be aware which would assist in achieving the desired quality and reliability in NASA hardware. NASA expects assignment of competent personnel in the Quality Assurance functional area and is not only buying the individual's technical skill, but also his experience. Suggestions by field personnel can many times up-grade the quality or the hardware.

Service Quality and Patient Satisfaction: An Exploratory Study of Pathology Laboratories in Jaipur.

PubMed

Agarwal, Anuradha; Singh, Maithili R P

2016-01-01

One of the most important parts of healthcare system is diagnostics. Nowadays, Indians have become more aware of their health, due to improved and better availability of health related information, increase in medical tourism, and expanding health insurance. The demand for better diagnostic facilities have increased with the increase in lifestyle related diseases, excesses use of chemicals in agriculture practices and change in food habits. It is expected that the Indian diagnostic market will grow from USD $5 billion in the year 2012 to USD $32 billion by the year 2020 with 20% CAGR (India Brand Equity Foundation 2015 ). Today patients have easy access of information regarding the health services and they have become more concerned about it as they look forward to receiving the maximum value for their money. To win the confidence of the patients and to maintain that trust, it is required to deliver the right services to the right person at the right time. The purpose of this study was to develop a scale to measure the service quality at pathology laboratory. A thorough review of literature revealed that there are studies related to healthcare service quality but there is no such established scale to measure service quality of pathology laboratory. Thus, the authors strived to develop a reliable and valid instrument to measure the patients' perception toward pathology laboratory service quality. For this exploratory study was conducted on the sample of 80 patients of the laboratories in Jaipur city. The reliability and factor structures were tested to purify the scale. The findings revealed 13 items, comprising of three dimensions of service quality: responsiveness, tangibility, and reliability.

Using Creative Problem Solving (TRIZ) in Improving the Quality of Hospital Services

PubMed Central

LariSemnani, Behrouz; Far, Rafat Mohebbi; Shalipoor, Elham; Mohseni, Mohammad

2015-01-01

TRIZ is an initiative and SERVQUAL is a structured methodology for quality improvement. Using these tools, inventive problem solving can be applied for quality improvement, and the highest quality can be reached using creative quality improvement methodology. The present study seeks to determine the priority of quality aspects of services provided for patients in the hospital as well as how TRIZ can help in improving the quality of those services. This Study is an applied research which used a dynamic qualitative descriptive survey method during year 2011. Statistical population includes every patient who visited in one of the University Hospitals from March 2011. There existed a big gap between patients’ expectations from what seemingly is seen (the design of the hospital) and timely provision of services with their perceptions. Also, quality aspects of services were prioritized as follows: keeping the appearance of hospital (the design), accountability, assurance, credibility and having empathy. Thus, the only thing which mattered most for all staff and managers of studied hospital was the appearance of hospital as well as its staff look. This can grasp a high percentage of patients’ satisfaction. By referring to contradiction matrix, the most important principles of TRIZ model were related to tangible factors including principles No. 13 (discarding and recovering), 25 (self-service), 35 (parameter changes), and 2 (taking out). Furthermore, in addition to these four principles, principle No. 24 (intermediary) was repeated most among the others. By utilizing TRIZ, hospital problems can be examined with a more open view, Go beyond The conceptual framework of the organization and responded more quickly to patients ’ needs. PMID:25560360

Manufacturing Bms/Iso System Review

NASA Technical Reports Server (NTRS)

Gomez, Yazmin

2004-01-01

The Quality Management System (QMS) is one that recognizes the need to continuously change and improve an organization s products and services as determined by system feedback, and corresponding management decisions. The purpose of a Quality Management System is to minimize quality variability of an organization's products and services. The optimal Quality Management System balances the need for an organization to maintain flexibility in the products and services it provides with the need for providing the appropriate level of discipline and control over the processes used to provide them. The goal of a Quality Management System is to ensure the quality of the products and services while consistently (through minimizing quality variability) meeting or exceeding customer expectations. The GRC Business Management System (BMS) is the foundation of the Center's ISO 9001:2000 registered quality system. ISO 9001 is a quality system model developed by the International Organization for Standardization. BMS supports and promote the Glenn Research Center Quality Policy and wants to ensure the customer satisfaction while also meeting quality standards. My assignment during this summer is to examine the manufacturing processes used to develop research hardware, which in most cases are one of a kind hardware, made with non conventional equipment and materials. During this process of observation I will make a determination, based on my observations of the hardware development processes the best way to meet customer requirements and at the same time achieve the GRC quality standards. The purpose of my task is to review the manufacturing processes identifying opportunities in which to optimize the efficiency of the processes and establish a plan for implementation and continuous improvement.

Wrapping the COTS Dilemma

DTIC Science & Technology

2000-12-01

security services for its transactions, notably e-commerce both business to customer (B2C) and business to business ( B2B ). Already the e4: Wrapping...is cos-oms s the continuity of its function in replacement" cost-competitiveness products? "• customer expectation of quality * are the implications...of new functionality on previous "* customer tolerance to shortfalls in quality assurances "* lifetime in the marketplace "* commercial through-life

The determinations of remote sensing satellite data delivery service quality: A positivistic case study in Chinese context

NASA Astrophysics Data System (ADS)

Jin, Jiahua; Yan, Xiangbin; Tan, Qiaoqiao; Li, Yijun

2014-03-01

With the development of remote sensing technology, remote-sensing satellite has been widely used in many aspects of national construction. Big data with different standards and massive users with different needs, make the satellite data delivery service to be a complex giant system. How to deliver remote-sensing satellite data efficiently and effectively is a big challenge. Based on customer service theory, this paper proposes a hierarchy conceptual model for examining the determinations of remote-sensing satellite data delivery service quality in the Chinese context. Three main dimensions: service expectation, service perception and service environment, and 8 sub-dimensions are included in the model. Large amount of first-hand data on the remote-sensing satellite data delivery service have been obtained through field research, semi-structured questionnaire and focused interview. A positivist case study is conducted to validate and develop the proposed model, as well as to investigate the service status and related influence mechanisms. Findings from the analysis demonstrate the explanatory validity of the model, and provide potentially helpful insights for future practice.

Courageous leaders. The integral force behind organizational excellence.

PubMed

Snyder, N H

1995-01-01

For more than a decade, Total Quality Management (TQM) has been used as a powerful instrument in shaping the competitive strategies of businesses, and producing quality products and services has become the credo of firms trying to defend or expand their markets. During this time, we have come to realize that without effective leadership no quality program can succeed. That is why the quality guru, W. Edwards Deming, refused to work in any organization unless he could begin with the CEO. That is why the first criterion examined for the Malcolm Baldridge National Quality Award is leadership. Focusing on quality will not guarantee success in today's rapidly changing markets. Increasingly discriminating consumers have come to expect quality in the products and services they buy, and businesses that fail to deliver it will not survive. In a very real sense, quality performance is the price you must pay simply to play the game. But consumers want more, and satisfying their expectations will determine tomorrow's winners and losers. Building organizations capable of producing superior results that consistently meet the needs of customers is the responsibility of leaders. For this reason, leaders are more important today than they have ever been before. Leaders in successful businesses must show the way for their employees by nurturing "cultures" that encourage and reward superior performance and by exhibiting personal characteristics that inspire excellence. Great leaders possess three crucial characteristics--vision, strong values and beliefs, and the courage to do the job despite seemingly insurmountable obstacles. These characteristics make the difference between excellence and "business as usual."

Use of national surgical quality improvement program data as a catalyst for quality improvement.

PubMed

Rowell, Katherine S; Turrentine, Florence E; Hutter, Matthew M; Khuri, Shukri F; Henderson, William G

2007-06-01

Semiannually, the National Surgical Quality Improvement Program (NSQIP) provides its participating sites with observed-to-expected (O/E) ratios for 30-day postoperative mortality and morbidity. At each reporting period, there is typically a small group of hospitals with statistically significantly high O/E ratios, meaning that their patients have experienced more adverse events than would be expected on the basis of the population characteristics. An important issue is to determine which actions a surgical service should take in the presence of a high O/E ratio. This article reviews case studies of how some of the Department of Veterans Affairs and private-sector NSQIP participating sites used the clinically rich NSQIP database for local quality improvement efforts. Data on postoperative adverse events before and after these local quality improvement efforts are presented. After local quality improvement efforts, wound complication rates were reduced at the Salt Lake City Veterans Affairs medical center by 47%, surgical site infections in patients undergoing intraabdominal surgery were reduced at the University of Virginia by 36%, and urinary tract infections in vascular patients were reduced at the Massachusetts General Hospital by 74%. At some sites participating in the NSQIP, notably the Massachusetts General Hospital and the University of Virginia, the NSQIP has served as the basis for surgical service-wide outcomes research and quality improvement programs. The NSQIP not only provides participating sites with risk-adjusted surgical mortality and morbidity outcomes semiannually, but the clinically rich NSQIP database can also serve as a catalyst for local quality improvement programs to significantly reduce postoperative adverse event rates.

Determining Level of Service for Multilane Median Opening Zone

NASA Astrophysics Data System (ADS)

Ali, Paydar; Johnnie, Ben-Edigbe

2017-08-01

The road system is a capital-intensive investment, requiring thorough schematic framework and funding. Roads are built to provide an intrinsic quality of service which satisfies the road users. Roads that provide good services are expected to deliver operational performance that is consistent with their design specifications. Level of service and cumulative percentile speed distribution methods have been used in previous studies to estimate the quality of multilane highway service. Whilst the level of service approach relies on speed/flow curve, the cumulative percentile speed distribution is based solely speed. These estimation methods were used in studies carried out in Johor Malaysia. The aim of the studies is to ascertain the extent of speed reduction caused by midblock U-turn facilities as well as verify which estimation method is more reliable. At selected sites, road segments for both directional flows were divided into free-flow and midblock zones. Traffic volume, speed and vehicle type data for each zone were collected continuously for six weeks. Both estimation methods confirmed that speed reduction would be caused by midblock u-turn facilities. However level of service methods suggested that the quality of service would improve from level F to E or D at midblock zone in spite of speed reduction. Level of service was responding to traffic volume reduction at midblock u-turn facility not travel speed reduction. The studies concluded that since level of service was more responsive to traffic volume reduction than travel speed, it cannot be solely relied upon when assessing the quality of multilane highway service.

Effective Schools. What Makes a Public School Work Well?

ERIC Educational Resources Information Center

Our Children, 1998

1998-01-01

Most effective schools share a number of key characteristics, including clear-cut goals and objectives, adequate funding and financial management, quality academic programs, valid assessment programs, parent and family involvement, teacher and staff development, high expectations for students, community involvement, comprehensive support services,…

Assessing physician/patient relationships in the presence of HIV/AIDS: an exploratory study.

PubMed

Taylor, S A; Madrigal, C

1998-01-01

The following study investigates the nature of the relationship between physicians and HIV/AIDS patients within the context of the rapidly evolving services/relationship marketing literatures. The emerging evidence suggests that service providers generally play a critical role in the development of positive consumer attitudes and behaviors, and that relationship marketing practices can contribute to the delivery of health services. However, to date, there appears little evidence supporting the efficacy of employing relationship marketing practices in relation to a target market of HIV/AIDS patients. This exploratory study contributes to the body of knowledge by more closely investigating the nature of the patient-physician relationship relative to HIV/AIDS patients' attitudes, marketing-related behaviors, and overall quality-of-life/life satisfaction judgments. The results of this study first suggest that HIV/AIDS patients use the expectancy disconfirmation model when evaluating the performance of their physician. A reliance on expectancy disconfirmation suggests the likely prevalent role of service quality perceptions and satisfaction judgments in evaluating their relationship with their physician. Second, the results appear to support the conclusion that the patient's evaluation of their physician relationship and subsequent behaviors (e.g., word-of-mouth) are directly related to the patient's general perception of received health services. Thus, the patient/physician relationship may play a particularly powerful role in determining patient (marketing related) outcomes relative to other health service settings. Third, a direct influence is supported between negative affective reactions by patients and subsequent outcome behaviors. This finding lends support for the potential efficacy of service recovery efforts when rendering treatment to HIV/AIDS patients. Finally, evidence is presented demonstrating the effect of positive perceptions of the patient/provider relationship on these patients' overall evaluation of their quality-of-life/life satisfaction. The managerial and research implications of this study are presented and discussed.

Assessing the performance of mental health service facilities for meeting patient priorities and health service responsiveness.

PubMed

Bramesfeld, A; Stegbauer, C

2016-10-01

The World Health Organisation has defined health service responsiveness as one of the key-objectives of health systems. Health service responsiveness relates to the ability to respond to service users' legitimate expectations on non-medical issues when coming into contact with the services of a healthcare system. It is defined by the areas showing respect for persons and patient orientation. Health service responsiveness is particularly relevant to mental health services, due to the specific vulnerability of mental health patients but also because it matches what mental health patients consider as good quality of care as well as their priorities when seeking healthcare. As (mental) health service responsiveness applies equally to all concerned services it would be suitable as a universal indicator for the quality of services' performance. However, performance monitoring programs in mental healthcare rarely assess health service performance with respect to meeting patient priorities. This is in part due of patient priorities as an outcome being underrepresented in studies that evaluate service provision. The lack of studies using patient priorities as outcomes transmits into evidence based guidelines and subsequently, into underrepresentation of patient priorities in performance monitoring. Possible ways out of this situation include more intervention studies using patient priorities as outcome, considering evidence from qualitative studies in guideline development and developing performance monitoring programs along the patient pathway and on key-points of relevance for service quality from a patient perspective.

Quality of psychiatric care in the general hospital: referrer perceptions of an inpatient liaison psychiatry service.

PubMed

Solomons, Luke C; Thachil, Ajoy; Burgess, Caroline; Hopper, Adrian; Glen-Day, Vicky; Ranjith, Gopinath; Hodgkiss, Andrew

2011-01-01

To explore the experience of senior staff on acute medical wards using an established inpatient liaison psychiatry service and obtain their views on clinically relevant performance measures. Semistructured face-to-face interviews with consultants and senior nurses were taped, transcribed and analyzed manually using the framework method of analysis. Twenty-five referrers were interviewed. Four key themes were identified - benefits of the liaison service, potential areas of improvement, indices of service performance such as speed and quality of response and expanded substance misuse service. Respondents felt the liaison service benefited patients, staff and service delivery in the general hospital. Medical consultants wanted stepped management plans devised by consultant liaison psychiatrists. Senior nurses, who perceived themselves as frontline crisis managers, valued on-the-spot input on patient management. Consultants and senior nurses differed in their expectations of liaison psychiatry. Referrers valued speed of response and regarded time from referral to definitive management plan as a key performance indicator for benchmarking services. Copyright © 2011 Elsevier Inc. All rights reserved.

Validation of Medical Tourism Service Quality Questionnaire (MTSQQ) for Iranian Hospitals

PubMed Central

Qolipour, Mohammad; Torabipour, Amin; Khiavi, Farzad Faraji; Malehi, Amal Saki

2017-01-01

Introduction Assessing service quality is one of the basic requirements to develop the medical tourism industry. There is no valid and reliable tool to measure service quality of medical tourism. This study aimed to determine the reliability and validity of a Persian version of medical tourism service quality questionnaire for Iranian hospitals. Methods To validate the medical tourism service quality questionnaire (MTSQQ), a cross-sectional study was conducted on 250 Iraqi patients referred to hospitals in Ahvaz (Iran) from 2015. To design a questionnaire and determine its content validity, the Delphi Technique (3 rounds) with the participation of 20 medical tourism experts was used. Construct validity of the questionnaire was assessed through exploratory and confirmatory factor analysis. Reliability was assessed using Cronbach’s alpha coefficient. Data were analyzed by Excel 2007, SPSS version18, and Lisrel l8.0 software. Results The content validity of the questionnaire with CVI=0.775 was confirmed. According to exploratory factor analysis, the MTSQQ included 31 items and 8 dimensions (tangibility, reliability, responsiveness, assurance, empathy, exchange and travel facilities, technical and infrastructure facilities and safety and security). Construct validity of the questionnaire was confirmed, based on the goodness of fit quantities of model (RMSEA=0.032, CFI= 0.98, GFI=0.88). Cronbach’s alpha coefficient was 0.837 and 0.919 for expectation and perception questionnaire. Conclusion The results of the study showed that the medical tourism SERVQUAL questionnaire with 31 items and 8 dimensions was a valid and reliable tool to measure service quality of medical tourism in Iranian hospitals. PMID:28461863

[A survey about quality of care and user’s' rights in Chilean psychiatric services].

PubMed

Minoletti, Alberto; Toro, Olga; Alvarado, Rubén; Carniglia, Claudia; Guajardo, Alejandro; Rayo, Ximena

2015-12-01

Quality of care and respect for the rights of users are critical to achieve positive health outcomes and respond appropriately to the expectations of people, particularly if they have mental illnesses. To carry out a baseline diagnosis of quality of care and respect for rights in public outpatient psychiatric services. Quality of care and respect for patients'’ rights was assessed by a mental health professional and a trained psychiatric service user in 15 ambulatory psychiatric services. The WHO QualityRights instrument was used, reviewing documentation and making observations in each facility, as well as interviewing 146 patients, 148 health care workers and 64 relatives of patients. A high level of achievement was accomplished in terms of discrimination-free health care, availability of psychotropic medications, lack of abuse or neglect and use of informed consents. A low level of achievement was found in terms of user support to cope with community living, access to education or work and participation in community activities, respect for user treatment preferences and preventive measures to avoid maltreatment and cruelty. Chile could improve the performance of psychiatry services having laws based on the “Convention of Rights of Persons with Disabilities” and standards of the World Health Organization, having national policies about quality of care and rights of users, reinforcing the community work of mental health care teams, reinforcing and informing users about their rights and promoting research on interventions to improve the respect of their rights.

Apportioning our time and energy: oral presentation, poster, journal article or other?

PubMed

Cleary, Michelle; Walter, Garry

2004-09-01

There is a general expectation for health service employees to present their work in oral or written format to showcase clinical ideas, innovations, service developments, and quality and research initiatives. This research note outlines the types of forums where work can be presented and highlights their relative merits. It is anticipated that this discussion will be of interest to clinicians, managers and researchers when considering where best to present their work.

Implementation Of Quality Management System For Irradiation Processing Services

NASA Astrophysics Data System (ADS)

Lungu, Ion-Bogdan; Manea, Maria-Mihaela

2015-07-01

In today's market, due to an increasing competitiveness, quality management has set itself as an indispensable tool and a reference point for every business. It is ultimately focused on customer satisfaction which is a stringent factor for every business. Implementing and maintaining a QMS is a rather difficult, time consuming and expensive process which must be done with respect of many factors. The aim of this paper is to present a case study for implementing QMS ISO 9001 in a gamma irradiation treatment service provider. The research goals are the identification of key benefits, reasons, advantages, disadvantages, drawbacks etc for a successful QMS implementation and use. Finally, the expected results focus on creating a general framework for implementing an efficient QMS plan that can be easily adapted to other kind of services and markets.

Achieving the integrated and smart health and wellbeing paradigm: a call for policy research and action on governance and business models.

PubMed

Stroetmann, Karl A

2013-04-01

To assure sustainability of our health systems and improve quality, implementing integrated wellness, health and social care service models have been proposed. They will need the enabling power of Health ICT facilitated systems and applications. Such solutions support the efficient coordination of service provision across provider and jurisdictional boundaries, the sharing of data, information and knowledge, and the streamlining as well as individualisation of care. Achieving such change in health systems with limited resources requires refocusing the trend of medico-technical progress. Health ICT innovations must be scrutinised for their potential to indeed contribute not only to decreasing costs, but - at the same time - improving the quality of life and ability to cope with challenges like the increasing prevalence of certain chronic diseases or new expectations from healthy people and patients alike. This paper argues that decision-oriented governance models leading to focused policy interventions are needed at several levels: Governments should provide for comprehensive Health ICT infrastructures to enable provider market success. At the individual actor level, sustainable business models reflecting in their value propositions the expectations of their clients (patients and funders) need to be developed. Health policy should design intelligent reimbursement systems providing incentives to indeed optimise services. Smart health innovations should only be implemented where they help achieve the goal of increasing the productivity of health value chains and the quality of overall service delivery value systems. To assure allocational efficiency, regulatory impact analyses (RIA) can support evidence based policy making. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Incentive payments are not related to expected health gain in the pay for performance scheme for UK primary care: cross-sectional analysis

PubMed Central

2012-01-01

Background The General Medical Services primary care contract for the United Kingdom financially rewards performance in 19 clinical areas, through the Quality and Outcomes Framework. Little is known about how best to determine the size of financial incentives in pay for performance schemes. Our aim was to test the hypothesis that performance indicators with larger population health benefits receive larger financial incentives. Methods We performed cross sectional analyses to quantify associations between the size of financial incentives and expected health gain in the 2004 and 2006 versions of the Quality and Outcomes Framework. We used non-parametric two-sided Spearman rank correlation tests. Health gain was measured in expected lives saved in one year and in quality adjusted life years. For each quality indicator in an average sized general practice we tested for associations first, between the marginal increase in payment and the health gain resulting from a one percent point improvement in performance and second, between total payment and the health gain at the performance threshold for maximum payment. Results Evidence for lives saved or quality adjusted life years gained was found for 28 indicators accounting for 41% of the total incentive payments. No statistically significant associations were found between the expected health gain and incentive gained from a marginal 1% increase in performance in either the 2004 or 2006 version of the Quality and Outcomes Framework. In addition no associations were found between the size of financial payment for achievement of an indicator and the expected health gain at the performance threshold for maximum payment measured in lives saved or quality adjusted life years. Conclusions In this subgroup of indicators the financial incentives were not aligned to maximise health gain. This disconnection between incentive and expected health gain risks supporting clinical activities that are only marginally effective, at the expense of more effective activities receiving lower incentives. When designing pay for performance programmes decisions about the size of the financial incentive attached to an indicator should be informed by information on the health gain to be expected from that indicator. PMID:22507660

Stuck in the middle: the impact of collaborative interprofessional communication on patient expectations.

PubMed

Stewart, Michael Adrian

2018-01-01

A central aim of modern day healthcare is to deliver a high quality, patient-centred service that addresses the expectations of its service users. However, mounting research evidence highlights a lack of patient satisfaction across a range of healthcare settings, with an overwhelming proportion of complaints relating to interprofessional communication. The link between interprofessional miscommunication and poor patient outcomes has been well documented. All too often, patients are left feeling stuck in the middle between opposing opinions, differing diagnoses and conflicting clinical outlooks. This article aims to highlight the issues surrounding interprofessional communication in healthcare, at the same time as addressing the potential facilitators and barriers for developing improved collaborative links between healthcare providers. Several key questions will be considered: (i) what are the underlying causes of interprofessional miscommunication; (ii) what do patients expect from healthcare professionals; and (iii) how might we reduce the risk of miscommunication and develop interprofessional collaboration?

Vouchers in Fragile States: Reducing Barriers to Long-Acting Reversible Contraception in Yemen and Pakistan

PubMed Central

Boddam-Whetham, Luke; Gul, Xaher; Al-Kobati, Eman; Gorter, Anna C

2016-01-01

ABSTRACT In conflict-affected states, vouchers have reduced barriers to reproductive health services and have enabled health programs to use targeted subsidies to increase uptake of specific health services. Vouchers can also be used to channel funds to public- and private-service providers and improve service quality. The Yamaan Foundation for Health and Social Development in Yemen and the Marie Stopes Society (MSS) in Pakistan—both working with Options Consultancy Services—have developed voucher programs that subsidize voluntary access to long-acting reversible contraceptives (LARCs) and permanent methods (PMs) of family planning in their respective fragile countries. The programs focus on LARCs and PMs because these methods are particularly difficult for poor women to access due to their cost and to provider biases against offering them. Using estimates of expected voluntary uptake of LARCs and PMs for 2014 based on contraceptive prevalence rates, and comparing these with uptake of LARCs and PMs through the voucher programs, we show the substantial increase in service utilization that vouchers can enable by contributing to an expanded method choice. In the governorate of Lahj, Yemen, vouchers for family planning led to an estimated 38% increase in 2014 over the expected use of LARCs and PMs (720 vs. 521 expected). We applied the same approach in 13 districts of Punjab, Khyber Pakhtunkhwa (KPK), and Sindh provinces in Pakistan. Our calculations suggest that vouchers enabled 10 times more women than expected to choose LARCs and PMs in 2014 in those areas of Pakistan (73,639 vs. 6,455 expected). Voucher programs can promote and maintain access to family planning services where existing health systems are hampered. Vouchers are a flexible financing approach that enable expansion of contraceptive choice and the inclusion of the private sector in service delivery to the poor. They can keep financial resources flowing where the public sector is prevented from offering services, and ensure that alternative sources are available for reproductive health services such as family planning. Programs should consider using vouchers in fragile states to facilitate access to family planning services and support the countries’ health systems. PMID:27540129

Assessment of the quality of medical care among patients with early stage prostate cancer undergoing expectant management in the United States.

PubMed

Ritchey, Jamie; Gay, E Greer; Spencer, Benjamin A; Miller, David C; Wallner, Lauren P; Stewart, Andrew K; Dunn, Rodney L; Litwin, Mark S; Wei, John T

2012-09-01

Given the increased attention to the quality and cost of medical care, the Institute of Medicine and Centers for Medicare and Medicaid Services have called for performance measurement and reporting. The clinical management of prostate cancer has been outlined, yet is not intended to describe quality prostate cancer care. Therefore, RAND researchers developed quality indicators for early stage prostate cancer. The ACoS (American College of Surgeons) used these indicators to perform the first national assessment to our knowledge of the quality of care among men with early stage prostate cancer undergoing expectant management. Information from medical records was abstracted for evidence of compliance with the RAND indicators (structure and process). Weighted and stratified proportions were calculated to assess indicator compliance. Logistic regression models were fit and evaluated by hospital type and patient factors. A weighted and stratified total of 13,876 early stage prostate cancer cases on expectant management in 2000 to 2001 were investigated. Compliance with structural indicators was high (greater than 80%) and compliance with process indicators varied (19% to 87%). Differences in process indicators were observed from models by hospital type and comorbid conditions, but not for age, race or insurance status. Using the RAND quality indicators this study revealed several process areas for quality improvement among men with early stage prostate cancer on expectant management in the United States. Efforts to improve the quality of early stage prostate cancer care need to move beyond the paradigm of age, race and insurance status. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Child Welfare Worker Caseload: What's Just Right?

ERIC Educational Resources Information Center

Yamatani, Hide; Engel, Rafael; Spjeldnes, Solveig

2009-01-01

This study was designed to establish a caseload standard for child welfare workers. Understanding reasonable workload expectations for child welfare workers is a cornerstone of quality service provision and the recruitment and retention of qualified workers. Because of the analytic complexity of this question, qualitative and quantitative methods…

Contagious Ideas from Health Care

ERIC Educational Resources Information Center

Chaffee, Ellen

2009-01-01

Financial problems plague both higher education and health care, two sectors that struggle to meet public expectations for quality services at affordable rates. Both higher education and health care also have a complex bottom line, heavy reliance on relatively autonomous professionals, and clients who share personal responsibility for achieving…

Measurement-Driven Characterization of the Mobile Environment

ERIC Educational Resources Information Center

Soroush, Hamed

2013-01-01

The concurrent deployment of high-quality wireless networks and large-scale cloud services offers the promise of secure ubiquitous access to seemingly limitless amount of content. However, as users' expectations have grown more demanding, the performance and connectivity failures endemic to the existing networking infrastructure have become more…

[User's perceived quality in an internal medicine service after a five-year period application of a user's satisfaction survey].

PubMed

García-Aparicio, J; Herrero-Herrero, J; Corral-Gudino, L; Jorge-Sánchez, R

2010-01-01

To evaluate the quality perceived by users of the 'Los Montalvos' Internal Medicine Service (Salamanca, Spain), over its first five years of operation. A cross-sectional study was carried out from February 2004 to January 2009. All in-patients (6,997) were given a survey model SERVQHOS at the time of discharge, which was anonymous and voluntary. We collected 2,435 surveys. Participation was 34.8%. Except for the item regarding accessibility, the other questions of the survey were perceived "as expected" or above expectations by over 85% of the users. A total of 90.6% of patients who completed the survey were satisfied with the care received, and 83.9% would recommend the hospital to others. The variables with higher predictive capability, in relation to overall satisfaction, were "personalised care', and the interests of staff to solve problems. The easy access to the hospital' was seen by 33.6% as below expectations. After introducing several improvement measures, the percentage of dissatisfaction regarding accessibility was 24.8% (p=0.02). Nine out of ten patients surveyed were satisfied or very satisfied with the care received, and would recommend the hospital to others. The variables more strongly associated with overall satisfaction were those related to service personnel. After identifying deficiencies and implementing measures to improve, the survey detected an increase in the level of satisfaction. Copyright 2009 SECA. Published by Elsevier Espana. All rights reserved.

Maintaining quality of health services after abolition of user fees: A Uganda case study

PubMed Central

Nabyonga-Orem, Juliet; Karamagi, Humphrey; Atuyambe, Lynn; Bagenda, Fred; Okuonzi, Sam A; Walker, Oladapo

2008-01-01

Background It has been argued that quality improvements that result from user charges reduce their negative impact on utilization especially of the poor. In Uganda, because there was no concrete evidence for improvements in quality of care following the introduction of user charges, the government abolished user fees in all public health units on 1st March 2001. This gave us the opportunity to prospectively study how different aspects of quality of care change, as a country changes its health financing options from user charges to free services, in a developing country setting. The outcome of the study may then provide insights into policy actions to maintain quality of care following removal of user fees. Methods A population cohort and representative health facilities were studied longitudinally over 3 years after the abolition of user fees. Quantitative and qualitative methods were used to obtain data. Parameters evaluated in relation to quality of care included availability of drugs and supplies and; health worker variables. Results Different quality variables assessed showed that interventions that were put in place were able to maintain, or improve the technical quality of services. There were significant increases in utilization of services, average drug quantities and stock out days improved, and communities reported health workers to be hardworking, good and dedicated to their work to mention but a few. Communities were more appreciative of the services, though expectations were lower. However, health workers felt they were not adequately motivated given the increased workload. Conclusion The levels of technical quality of care attained in a system with user fees can be maintained, or even improved without the fees through adoption of basic, sustainable system modifications that are within the reach of developing countries. However, a trade-off between residual perceptions of reduced service quality, and the welfare gains from removal of user fees should guide such a policy change. PMID:18471297

Maternity-care: measuring women's perceptions.

PubMed

Clark, Kim; Beatty, Shelley; Reibel, Tracy

2016-01-01

Achieving maternity-care outcomes that align with women's needs, preferences and expectations is important but theoretically driven measures of women's satisfaction with their entire maternity-care experience do not appear to exist. The purpose of this paper is to outline the development of an instrument to assess women's perception of their entire maternity-care experience. A questionnaire was developed on the basis of previous research and informed by a framework of standard service quality categories covering the spectrum of typical consumer concerns. A pilot survey with a sample of 195 women who had recent experience of birth was undertaken to establish valid and reliable scales pertaining to different stages of maternity care. Exploratory factor analysis was used to interpret scales and convergent validity was assessed using a modified version of the Client Satisfaction Questionnaire. Nine theoretically informed, reliable and valid stand-alone scales measuring the achievement of different dimensions of women's expectancies of public maternity care were developed. The study scales are intended for use in identifying some potential areas of focus for quality improvement in the delivery of maternity care. Reliable and valid tools for monitoring the extent to which services respond to women's expectations of their entire maternity care form part of the broader toolkit required to adequately manage health-care quality. This study offers guidance on the make-up of such tools. The scales produced from this research offer a means to assess maternity care across the full continuum of care and are brief and easy to use.

How the Kano model contributes to Kansei engineering in services.

PubMed

Hartono, Markus; Chuan, Tan Kay

2011-11-01

Recent studies show that products and services hold great appeal if they are attractively designed to elicit emotional feelings from customers. Kansei engineering (KE) has good potential to provide a competitive advantage to those able to read and translate customer affect and emotion in actual product and services. This study introduces an integrative framework of the Kano model and KE, applied to services. The Kano model was used and inserted into KE to exhibit the relationship between service attribute performance and customer emotional response. Essentially, the Kano model categorises service attribute quality into three major groups (must-be [M], one-dimensional [O] and attractive [A]). The findings of a case study that involved 100 tourists who stayed in luxury 4- and 5-star hotels are presented. As a practical matter, this research provides insight on which service attributes deserve more attention with regard to their significant impact on customer emotional needs. STATEMENT OF RELEVANCE: Apart from cognitive evaluation, emotions and hedonism play a big role in service encounters. Through a focus on delighting qualities of service attributes, this research enables service providers and managers to establish the extent to which they prioritise their improvement efforts and to always satisfy their customer emotions beyond expectation.

Fishing for ecosystem services.

PubMed

Pope, Kevin L; Pegg, Mark A; Cole, Nicholas W; Siddons, Stephen F; Fedele, Alexis D; Harmon, Brian S; Ruskamp, Ryan L; Turner, Dylan R; Uerling, Caleb C

2016-12-01

Ecosystems are commonly exploited and manipulated to maximize certain human benefits. Such changes can degrade systems, leading to cascading negative effects that may be initially undetected, yet ultimately result in a reduction, or complete loss, of certain valuable ecosystem services. Ecosystem-based management is intended to maintain ecosystem quality and minimize the risk of irreversible change to natural assemblages of species and to ecosystem processes while obtaining and maintaining long-term socioeconomic benefits. We discuss policy decisions in fishery management related to commonly manipulated environments with a focus on influences to ecosystem services. By focusing on broader scales, managing for ecosystem services, and taking a more proactive approach, we expect sustainable, quality fisheries that are resilient to future disturbances. To that end, we contend that: (1) management always involves tradeoffs; (2) explicit management of fisheries for ecosystem services could facilitate a transition from reactive to proactive management; and (3) adaptive co-management is a process that could enhance management for ecosystem services. We propose adaptive co-management with an ecosystem service framework where actions are implemented within ecosystem boundaries, rather than political boundaries, through strong interjurisdictional relationships. Published by Elsevier Ltd.

Fishing for ecosystem services

USGS Publications Warehouse

Pope, Kevin L.; Pegg, Mark A.; Cole, Nicholas W.; Siddons, Stephen F.; Fedele, Alexis D.; Harmon, Brian S.; Ruskamp, Ryan L.; Turner, Dylan R.; Uerling, Caleb C.

2016-01-01

Ecosystems are commonly exploited and manipulated to maximize certain human benefits. Such changes can degrade systems, leading to cascading negative effects that may be initially undetected, yet ultimately result in a reduction, or complete loss, of certain valuable ecosystem services. Ecosystem-based management is intended to maintain ecosystem quality and minimize the risk of irreversible change to natural assemblages of species and to ecosystem processes while obtaining and maintaining long-term socioeconomic benefits. We discuss policy decisions in fishery management related to commonly manipulated environments with a focus on influences to ecosystem services. By focusing on broader scales, managing for ecosystem services, and taking a more proactive approach, we expect sustainable, quality fisheries that are resilient to future disturbances. To that end, we contend that: (1) management always involves tradeoffs; (2) explicit management of fisheries for ecosystem services could facilitate a transition from reactive to proactive management; and (3) adaptive co-management is a process that could enhance management for ecosystem services. We propose adaptive co-management with an ecosystem service framework where actions are implemented within ecosystem boundaries, rather than political boundaries, through strong interjurisdictional relationships.

Preferences for home- and community-based long-term care services in Germany: a discrete choice experiment.

PubMed

Lehnert, T; Günther, O H; Hajek, A; Riedel-Heller, S G; König, H H

2018-04-06

Most people prefer to "age in place" and to remain in their homes for as long as possible even in case they require long-term care. While informal care is projected to decrease in Germany, the use of home- and community-based services (HCBS) can be expected to increase in the future. Preference-based data on aspects of HCBS is needed to optimize person-centered care. To investigate preferences for home- and community-based long-term care services packages. Discrete choice experiment conducted in mailed survey. Randomly selected sample of the general population aged 45-64 years in Germany (n = 1.209). Preferences and marginal willingness to pay (WTP) for HCBS were assessed with respect to five HCBS attributes (with 2-4 levels): care time per day, service level of the HCBS provider, quality of care, number of different caregivers per month, co-payment. Quality of care was the most important attribute to respondents and small teams of regular caregivers (1-2) were preferred over larger teams. Yet, an extended range of services of the HCBS provider was not preferred over a more narrow range. WTP per hour of HCBS was €8.98. Our findings on preferences for HCBS in the general population in Germany add to the growing international evidence of preferences for LTC. In light of the great importance of high care quality to respondents, reimbursement for services by HCBS providers could be more strongly linked to the quality of services.

Healthcare Leaders' Intention to Serve as Organizational Teachers

ERIC Educational Resources Information Center

Aggarwal, Sushma Kumari

2014-01-01

Today's organizational leaders are expected to actively participate and facilitate learning. A highly engaged and knowledgeable workforce, inspired by leaders, may increase the quality of service, and aid in maintaining and attracting loyal employees and customers. These leaders are now being asked to serve as organizational teachers. However,…

Online Searching in the Small College Library--Ten Years Later.

ERIC Educational Resources Information Center

Smith, Scott; Smith, Jane B.

1991-01-01

Reviews experiences with online searching at the Nazareth College library. Topics discussed include user expectations; actual and perceived search quality; the impact of laser printers; growth in online searching; increases in other reference services; the use of CD-ROM technology; and costs and pricing policies. (LRW)

Spatialised Metaphors of Practice: How Teacher Educators Engage with Professional Standards for Teachers

ERIC Educational Resources Information Center

Ryan, Mary; Bourke, Terri

2018-01-01

Pre-service teacher educators, both nationally and internationally, must negotiate a plethora of expectations including using Professional Standards to enhance teacher quality. In Australia, the recent Teacher Education Ministerial Advisory Group (TEMAG) report highlighted weak application of Standards in Initial Teacher Education (ITE). However,…

Essential basic and emergency obstetric and newborn care: from education and training to service delivery and quality of care.

PubMed

Otolorin, Emmanuel; Gomez, Patricia; Currie, Sheena; Thapa, Kusum; Dao, Blami

2015-06-01

Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries with a high burden of maternal and newborn mortality. Jhpiego and its consortia partners have implemented three global programs to build provider capacity to provide comprehensive EmONC services to women and newborns in these resource-poor settings. Providers have been educated to deliver high-impact maternal and newborn health interventions, such as prevention and treatment of postpartum hemorrhage and pre-eclampsia/eclampsia and management of birth asphyxia, within the broader context of quality health services. This article describes Jhpiego's programming efforts within the framework of the basic and expanded signal functions that serve as indicators of high-quality basic and emergency care services. Lessons learned include the importance of health facility strengthening, competency-based provider education, global leadership, and strong government ownership and coordination as essential precursors to scale-up of high impact evidence-based maternal and newborn interventions in low-resource settings. Copyright © 2015. Published by Elsevier Ireland Ltd.

Using the critical incident survey to assess hospital service quality.

PubMed

Longo, B; Connor, G; Barnhart, T

1993-01-01

This survey was designed to determine "standards of excellence" in hospital services as defined by (a) former patients, (b) physicians, (c) hospital employees, and (d) corporate insurance subscribers. One hundred forty-seven (147) patients, 188 employees, and 20 corporate subscribers were interviewed by telephone, and 52 physicians were interviewed in their offices. The interview consisted of a single question: "Can you think of a time when, as a patient/employee/employer/physician, you had a particularly satisfying or dissatisfying experience with a local hospital?" Reported incidents were reviewed, and 239 "critical incidents" were identified. These incidents were classified into 12 descriptive categories relating to the underlying factors in the incident reports. Six focus groups were later held with participants segregated by the population pool they represented. These groups were asked to develop definitions of "excellence" in hospital service quality and standards for service which would "exceed expectations." The focus groups created 122 standards of excellence, which were classified into 43 categories. Overall, the largest percentages of corporate, physician, and employee critical incidents were classified as "Administrative Policy" issues. Patients most often reported "Nurturing" incidents as critical to their perceptions of hospital service quality.

Community health centers tackle rising demands and expectations.

PubMed

Hurley, Robert; Felland, Laurie; Lauer, Johanna

2007-12-01

As key providers of preventive and primary care for underserved people, including the uninsured, community health centers (CHCs) are the backbone of the U.S. health care safety net. Despite significant federal funding increases, community health centers are struggling to meet rising demand for care, particularly for specialty medical, dental and mental health services, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. Health centers are responding to these pressures by expanding capacity and adding services but confront staffing, resource and other constraints. At the same time, CHCs are facing other demands, including increased quality reporting expectations, addressing racial and ethnic disparities, developing electronic medical records, and preparing for public health emergencies.

Website Quality, Expectation, Confirmation, and End User Satisfaction: The Knowledge-Intensive Website of the Korean National Cancer Information Center

PubMed Central

Koo, Chulmo; Wati, Yulia; Park, Keeho

2011-01-01

Background The fact that patient satisfaction with primary care clinical practices and physician-patient communications has decreased gradually has brought a new opportunity to the online channel as a supplementary service to provide additional information. Objective In this study, our objectives were to examine the process of cognitive knowledge expectation-confirmation from eHealth users and to recommend the attributes of a “knowledge-intensive website.”. Knowledge expectation can be defined as users’ existing attitudes or beliefs regarding expected levels of knowledge they may gain by accessing the website. Knowledge confirmation is the extent to which user’s knowledge expectation of information systems use is realized during actual use. In our hypothesized research model, perceived information quality, presentation and attractiveness as well as knowledge expectation influence knowledge confirmation, which in turn influences perceived usefulness and end user satisfaction, which feeds back to knowledge expectation. Methods An empirical study was conducted at the National Cancer Center (NCC), Republic of Korea (South Korea), by evaluating its official website. A user survey was administered containing items to measure subjectively perceived website quality and expectation-confirmation attributes. A study sample of 198 usable responses was used for further analysis. We used the structural equation model to test the proposed research model. Results Knowledge expectation exhibited a positive effect on knowledge confirmation (beta = .27, P < .001). The paths from information quality, information presentation, and website attractiveness to knowledge confirmation were also positive and significant (beta = .24, P < .001; beta = .29, P < .001; beta = .18, P < .001, respectively). Moreover, the effect of knowledge confirmation on perceived usefulness was also positively significant (beta = .64, P < .001). Knowledge expectation together with knowledge confirmation and perceived usefulness also significantly affected end user satisfaction (beta = .22 P < .001; beta = .39, P < .001; beta = .25, P < .001, respectively). Conclusions Theoretically, this study has (1) identified knowledge-intensive website attributes, (2) enhanced the theoretical foundation of eHealth from the information systems (IS) perspective by adopting the expectation-confirmation theory (ECT), and (3) examined the importance of information and knowledge attributes and explained their impact on user satisfaction. Practically, our empirical results suggest that perceived website quality (ie, information quality, information presentation, and website attractiveness) is a core requirement for knowledge building. In addition, our study has also shown that knowledge confirmation has a greater effect on satisfaction than both knowledge expectation and perceived usefulness. PMID:22047810

Marketing and commercialization of computational research services.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Toevs, J. W.

Physical and computational scientists and mathematicians in Russia's nuclear cities are turning their work toward generating profits from Western markets. Successful ventures require an understanding of the marketing of contract research as well as Western expectations regarding contract execution, quality, and performance. This paper will address fundamentals in business structure, marketing, and contract performance for organizations engaging in the marketing and commercialization of research services. Considerable emphasis will be placed on developing adequate communication within the organization.

Identifying role of perceived quality and satisfaction on the utilization status of the community clinic services; Bangladesh context.

PubMed

Karim, Rizwanul M; Abdullah, Mamun S; Rahman, Anisur M; Alam, Ashraful M

2016-06-24

Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients' perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic services. This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 community clinics. Since most of the outcome indicators focus mainly on women and children, women having children less than 2 years of age were randomly assigned and interviewed for the study purpose. Data were collected through FGD, Key informants interview and a pretested semi- structured questionnaire. About 95 % of the respondents were Muslims and 5 % were Hindus. The average age of the respondents was 23.38 (SD 4.15) and almost all of them are home makers. The average monthly expenditure of their family was 95US $ (SD 32US$). At the beginning of the study, two psychometric research instruments; 24 items perceived quality of primary care services PQPCS scale (chronbach's α = .89) and 22 items community clinic service satisfaction CCSS scale (chronbach's α = .97), were constructed and validated. This study showed less educated, poor, landless mothers utilized the community clinic services more than their educated and wealthier counterpart. Women who lived in their own residence used the community clinic services more frequently than those who lived in a rental house. Perceptions concerning skill and competence of the health care provider and satisfaction indicating interpersonal communication and attitude of the care provider were important predictors for community clinic service utilization. Perception related to the quality of management, administration, physical environment of the service point and satisfaction addressing health promotion and women health issues played significant role on community clinic's services utilization. Besides parental education and income, client's perception and satisfaction played significant role in community clinic service utilization. Provider's perception of service quality should be studied. The study findings will enable policy-makers to improve quality of primary health care services, realizing providers' and patients' ideas of community clinic service quality.

Food production and service in UK hospitals.

PubMed

Ahmed, Mohamed; Jones, Eleri; Redmond, Elizabeth; Hewedi, Mahmoud; Wingert, Andreas; Gad El Rab, Mohamed

2015-01-01

The purpose of this paper is to apply value stream mapping holistically to hospital food production/service systems focused on high-quality food. Multiple embedded case study of three (two private-sector and one public-sector) hospitals in the UK. The results indicated various issues affecting hospital food production including: the menu and nutritional considerations; food procurement; food production; foodservice; patient perceptions/expectations. Value stream mapping is a new approach for food production systems in UK hospitals whether private or public hospitals. The paper identifies opportunities for enhancing hospital food production systems. The paper provides a theoretical basis for process enhancement of hospital food production and the provision of high-quality hospital food.

Traffic model for the satellite component of UMTS

NASA Technical Reports Server (NTRS)

Hu, Y. F.; Sheriff, R. E.

1995-01-01

An algorithm for traffic volume estimation for satellite mobile communications systems has been developed. This algorithm makes use of worldwide databases for demographic and economic data. In order to provide for such an estimation, the effects of competing services have been considered so that likely market demand can be forecasted. Different user groups of the predicted market have been identified according to expectations in the quality of services and mobility requirement. The number of users for different user groups are calculated taking into account the gross potential market, the penetration rate of the identified services and the profitability to provide such services via satellite.

A Regional Multi-permit Market for Ecosystem Services

NASA Astrophysics Data System (ADS)

Bernknopf, R.; Amos, P.; Zhang, E.

2014-12-01

Regional cap and trade programs have been in operation since the 1970's to reduce environmental externalities (NOx and SOx emissions) and have been shown to be beneficial. Air quality and water quality limits are enforced through numerous Federal and State laws and regulations while local communities are seeking ways to protect regional green infrastructure and their ecosystems services. Why not combine them in a market approach to reduce many environmental externalities simultaneously? In a multi-permit market program reforestation (land offsets) as part of a nutrient or carbon sequestration trading program would provide a means to reduce agrochemical discharges into streams, rivers, and groundwater. Land conversions also improve the quality and quantity of other environmental externalities such as air pollution. Collocated nonmarket ecosystem services have societal benefits that can expand the crediting system into a multi-permit trading program. At a regional scale it is possible to combine regulation of water quality, air emissions and quality, and habitat conservation and restoration into one program. This research is about the economic feasibility of a Philadelphia regional multi-permit (cap and trade) program for ecosystem services. Instead of establishing individual markets for ecosystem services, the assumption of the spatial portfolio approach is that it is based on the interdependence of ecosystem functions so that market credits encompasses a range of ecosystem services. Using an existing example the components of the approach are described in terms of scenarios of land portfolios and the calculation of expected return on investment and risk. An experiment in the Schuylkill Watershed will be described for ecosystem services such as nutrients in water and populations of bird species along with Green House Gases. The Philadelphia regional market includes the urban - nonurban economic and environmental interactions and impacts.

QoE collaborative evaluation method based on fuzzy clustering heuristic algorithm.

PubMed

Bao, Ying; Lei, Weimin; Zhang, Wei; Zhan, Yuzhuo

2016-01-01

At present, to realize or improve the quality of experience (QoE) is a major goal for network media transmission service, and QoE evaluation is the basis for adjusting the transmission control mechanism. Therefore, a kind of QoE collaborative evaluation method based on fuzzy clustering heuristic algorithm is proposed in this paper, which is concentrated on service score calculation at the server side. The server side collects network transmission quality of service (QoS) parameter, node location data, and user expectation value from client feedback information. Then it manages the historical data in database through the "big data" process mode, and predicts user score according to heuristic rules. On this basis, it completes fuzzy clustering analysis, and generates service QoE score and management message, which will be finally fed back to clients. Besides, this paper mainly discussed service evaluation generative rules, heuristic evaluation rules and fuzzy clustering analysis methods, and presents service-based QoE evaluation processes. The simulation experiments have verified the effectiveness of QoE collaborative evaluation method based on fuzzy clustering heuristic rules.

The Turkish adaptation of scale to measure patient perceptions of the quality of nursing care and related hospital services: A validity and reliability study

PubMed Central

Oren, Besey; Zengin, Neriman; Yildiz, Nebahat

2016-01-01

OBJECTIVE: This study aimed to test the validity and reliability of a version of the tool developed in Sri Lanka in 2011 to assess patient perceptions of the quality of nursing care and related hospital services created for use with Turkish patients. METHODS: This methodological study was conducted between November 2013 and November 2014 after obtaining ethical approval and organizational permission. Data was collected during discharge from 180 adult patients who were hospitalized for at least 3 days at a medical school hospital located in Istanbul. After language validation, validity and reliability analyses of the scale were conducted. Content validity, content validity index (CVI), construct validity, and exploratory factor analysis were assessed and examined, and reliability was tested using the Cronbach’s alpha coefficient and item-total correlations. RESULTS: Mean CVI was found to be 0.95, which is above expected value. Exploratory factor analysis revealed 4 factors with eigenvalues above 1, which explained 82.4% of total variance in the Turkish version of the tool to measure patient perceptions of nursing care and other hospital services. Factor loading for each item was ≥.40. Cronbach’s alpha coefficient of sub-dimensions and total scale were found to be 0.84-0.98 and 0.98, respectively. Item-total correlations ranged from 0.56 to 0.83 for the entire group, which was above expected values. CONCLUSION: The Turkish version of the scale to assess patient perceptions of the quality of nursing care and related hospital services, which comprised 4 sub-dimensions and 36 items, was found to be valid and reliable for use with the Turkish population. PMID:28275750

The Turkish adaptation of scale to measure patient perceptions of the quality of nursing care and related hospital services: A validity and reliability study.

PubMed

Oren, Besey; Zengin, Neriman; Yildiz, Nebahat

2016-01-01

This study aimed to test the validity and reliability of a version of the tool developed in Sri Lanka in 2011 to assess patient perceptions of the quality of nursing care and related hospital services created for use with Turkish patients. This methodological study was conducted between November 2013 and November 2014 after obtaining ethical approval and organizational permission. Data was collected during discharge from 180 adult patients who were hospitalized for at least 3 days at a medical school hospital located in Istanbul. After language validation, validity and reliability analyses of the scale were conducted. Content validity, content validity index (CVI), construct validity, and exploratory factor analysis were assessed and examined, and reliability was tested using the Cronbach's alpha coefficient and item-total correlations. Mean CVI was found to be 0.95, which is above expected value. Exploratory factor analysis revealed 4 factors with eigenvalues above 1, which explained 82.4% of total variance in the Turkish version of the tool to measure patient perceptions of nursing care and other hospital services. Factor loading for each item was ≥.40. Cronbach's alpha coefficient of sub-dimensions and total scale were found to be 0.84-0.98 and 0.98, respectively. Item-total correlations ranged from 0.56 to 0.83 for the entire group, which was above expected values. The Turkish version of the scale to assess patient perceptions of the quality of nursing care and related hospital services, which comprised 4 sub-dimensions and 36 items, was found to be valid and reliable for use with the Turkish population.

Building a learning organisation in a child and adolescent mental health service.

PubMed

Birleson, P

1998-01-01

In recent business literature, the model of the learning organisation has been proposed as a solution to the problem of continually changing environments and increasing consumer expectations of maximum quality and value for money. The model seems highly appropriate for health services, which are staffed by educated professional staff who must become more adaptive and concerned with improving consumer outcomes. This case study describes how the principles of learning organisations have been applied to the design of a new structure and the creation of a learning culture within a mental health service for children and adolescents.

Using willingness to pay to investigate regressiveness of user fees in health facilities in Tanzania.

PubMed

Bonu, Sekhar; Rani, Manju; Bishai, David

2003-12-01

The study uses data from the Tanzania Human Resources Development Survey (1994) on willingness to pay (WTP) for desired quality of health care at lower-level health facilities to assess potential regressiveness of user fees - a disproportionately higher negative effect of user fees on utilization of health services among the poor compared with the rich. Despite reports of extensive bypassing of the lower-level health facilities in Tanzania, the WTP for quality health care at these health facilities is surprisingly large. WTP was lower among the poor, female and elderly respondents. Almost one-quarter of the poorest 40% of the population was not willing to pay even when the quality of services met their expectations. The results suggest that: the utilization of health services at lower-level health facilities can be increased by improving the quality of care; and the implementation of uniform user charges in the public facilities may be regressive, adversely affecting utilization among the poor, women and the elderly. An effective system of exemptions and waivers will be required for the very poor who may not be able to pay even when quality of services is improved. The findings of the study have policy implications for the Tanzanian government's recent attempts to expand cost-sharing through community health funds at lower-level health facilities, being introduced since 1998.

Understanding organizational and cultural premises for quality of care in nursing homes: an ethnographic study.

PubMed

Nakrem, Sigrid

2015-11-13

Internationally, there are concerns about the quality of care in nursing homes. The concept of 'corporate culture' as an internal variable could be seen as the means to improve quality of care and quality of life for the residents. The aim of this article was to describe the nursing home culture from the staff's perspective and to include how the residents describe quality of care. An ethnographic design was employed. A purposive sample of four municipal public nursing homes in Norway with long-term care residents was included in the study. Data were collected by participant observation including informal conversation with the staff, and in-depth interviews with 15 residents using a narrative approach. The main findings were that organizational cultures could be seen as relatively stable corporate cultures described as 'personalities' with characteristics that were common for all nursing homes (conformity) and typical traits that were present in some nursing homes, but that they were also like no other nursing home (distinctiveness). Conformity ('Every nursing home is like all other nursing homes') meant that nursing home organizations formed their services according to a perception of what residents in general need and expect. Trait ('Every nursing home is like some other nursing homes') expressed typologies of nursing homes: residency, medical, safeguard or family orientation. The distinctness of each nursing home ('Every nursing home is like no other nursing home') was expressed in unique features of the nursing home; the characteristics of the nursing home involved certain patterns of structure, cultural assumptions and interactions that were unique in each nursing home. Nursing home residents experienced quality of care as 'The nursing home as my home' and 'Interpersonal care quality'. The resident group in the different types of nursing homes were unique, and the experience of quality of care seemed to depend on whether their unique needs and expectations were met or not. In order to create a sustainable nursing home service the service needs to be characterized by learning and openness to change and must actually implement practices that respond to the resident and his or her family's values.

Quality of antenatal care in Zambia: a national assessment

PubMed Central

2012-01-01

Background Antenatal care (ANC) is one of the recommended interventions to reduce maternal and neonatal mortality. Yet in most Sub-Saharan African countries, high rates of ANC coverage coexist with high maternal and neonatal mortality. This disconnect has fueled calls to focus on the quality of ANC services. However, little conceptual or empirical work exists on the measurement of ANC quality at health facilities in low-income countries. We developed a classification tool and assessed the level of ANC service provision at health facilities in Zambia on a national scale and compared this to the quality of ANC received by expectant mothers. Methods We analysed two national datasets with detailed antenatal provider and user information, the 2005 Zambia Health Facility Census and the 2007 Zambia Demographic and Health Survey (DHS), to describe the level of ANC service provision at 1,299 antenatal facilities in 2005 and the quality of ANC received by 4,148 mothers between 2002 and 2007. Results We found that only 45 antenatal facilities (3%) fulfilled our developed criteria for optimum ANC service, while 47% of facilities provided adequate service, and the remaining 50% offered inadequate service. Although 94% of mothers reported at least one ANC visit with a skilled health worker and 60% attended at least four visits, only 29% of mothers received good quality ANC, and only 8% of mothers received good quality ANC and attended in the first trimester. Conclusions DHS data can be used to monitor “effective ANC coverage” which can be far below ANC coverage as estimated by current indicators. This “quality gap” indicates missed opportunities at ANC for delivering effective interventions. Evaluating the level of ANC provision at health facilities is an efficient way to detect where deficiencies are located in the system and could serve as a monitoring tool to evaluate country progress. PMID:23237601

The Effect of Field Specialization Variation on Technological Pedagogical Content Knowledge (TPACK) among Malaysian TVET Instructors

ERIC Educational Resources Information Center

Chua, Junnaina Husin; Jamil, Hazri

2014-01-01

Technological Knowledge is directly related to productivity, enhanced performance and service quality. Technology integration in the Technical and Vocational Education and Training (TVET) curriculum is expected due to high application of technical knowledge and technology applications. TPACK is a professional knowledge framework that gives…

Quality Outcomes in Group Home Dementia Care for Adults with Intellectual Disabilities

ERIC Educational Resources Information Center

Janicki, M. P.

2011-01-01

Background: Dementia, as a public health challenge, is a phenomenon vexing many care organisations providing specialised residential and family supports for older adults with intellectual disabilities. With increasing survivorship to ages when risk is greatest, expectations are that many more adults in service will present with cognitive decline…

Unfulfilled expectations to services offered at primary health care facilities: experiences of caretakers of underfive children in rural Tanzania.

PubMed

Kahabuka, Catherine; Moland, Karen Marie; Kvåle, Gunnar; Hinderaker, Sven Gudmund

2012-06-14

There is growing evidence that patients frequently bypass primary health care (PHC) facilities in favour of higher level hospitals regardless of substantial additional time and costs. Among the reasons given for bypassing are poor services (including lack of drugs and diagnostic facilities) and lack of trust in health workers. The World Health Report 2008 "PHC now more than ever" pointed to the importance of organizing health services around people's needs and expectations as one of the four main issues of PHC reforms. There is limited documentation of user's expectations to services offered at PHC facilities. The current study is a community extension of a hospital-based survey that showed a high bypassing frequency of PHC facilities among caretakers seeking care for their underfive children at two district hospitals. We aimed to explore caretakers' perceptions and expectations to services offered at PHC facilities in their area with reference to their experiences seeking care at such facilities. We conducted four community-based focus group discussions (FGD's) with 47 caretakers of underfive children in Muheza district of Tanga region, Tanzania in October 2009. Lack of clinical examinations and laboratory tests, combined with shortage of drugs and health workers, were common experiences. Across all the focus group discussions, unpleasant health workers' behaviors, lack of urgency and unnecessary delays were major complaints. In some places, unauthorized fees reduced access to services. The study revealed significant disappointments among caretakers with regard to the quality of services offered at PHC facilities in their areas, with implications for their utilization and proper functioning of the referral system. Practices regarding partial drugs administrations, skipping of injections, unofficial payments and consultations by unskilled health care providers need urgent action. There is also a need for proper accountability mechanisms to govern appropriate allocation and monitoring of health care resources and services in Tanzania.

Service quality and corporate social responsibility, influence on post-purchase intentions of sheltered employment institutions.

PubMed

Chen, Chao-Chien; Lin, Shih-Yen; Cheng, Chia-Hsin; Tsai, Chia-Ching

2012-01-01

The main purpose of this study is to investigate the impact of service quality and corporate social responsibility (CSR) on customer satisfaction, and customer satisfaction toward post-purchase intentions from sheltered employment institutions. Work experience plays an important role in career development for those people with intellectual disabilities. When they are not yet capable of obtaining a job in the open market, they must receive job training and daily care in sheltered employment institutions. If the sheltered employment institutions cannot operate properly, they will greatly affect intellectual disabilities. From the study of "Children Are Us Bakeries and Restaurants" sheltered employment institutions are one kind of food service business that has been found to request and improve service quality and execution of CSR. These are two main factors which can enhance brand value and create a good reputation for sheltered employment institutions. The questionnaire results indicate that perceived service quality has a positive relationship with customer satisfaction and the reliability dimension is the most important factor for customers to assess service quality. Meanwhile, correlation analysis shows that customer satisfaction regarding service quality influences post-purchase intentions, indicating that friendly and helpful employees can please customers and enhance their satisfaction level and also induce positive post-purchase intentions of consumers. Regarding the CSR of "Children Are Us Bakeries and Restaurants" sheltered employment institutions, the analysis reveals a statistical significance: the greater customer satisfaction of CSR, the higher the post-purchase intention. In addition, in the work, paired-sample t test analysis reveals there is a significant difference (p<.05) in service quality and CSR in terms of "perceived" and "expected" responses. In summary, since those with intellectual disabilities usually are enthusiastic at work and do their best to provide good service and execute CSR well, the value of sheltered employment institutions establishments should be recognized by all should receive continued support and there should be a willingness to hire these intellectually disabled citizens. Copyright © 2012 Elsevier Ltd. All rights reserved.

Outcomes sensitive to nursing service quality in ambulatory cancer chemotherapy: Systematic scoping review.

PubMed

Griffiths, Peter; Richardson, Alison; Blackwell, Rebecca

2012-07-01

There is long standing interest in identifying patient outcomes that are sensitive to nursing care and an increasing number of systems that include outcomes in order to demonstrate or monitor the quality of nursing care. We undertook scoping reviews of the literature in order to identify patient outcomes sensitive to the quality of nursing services in ambulatory cancer chemotherapy settings to guide the development of an outcomes-based quality measurement system. A 2-stage scoping review to identify potential outcome areas which were subsequently assessed for their sensitivity to nursing was carried out. Data sources included the Cochrane Library, Medline, Embase, the British Nursing Index, Google and Google scholar. We identified a broad range of outcomes potentially sensitive to nursing. Individual trials support many nursing interventions but we found relatively little clear evidence of effect on outcomes derived from systematic reviews and no evidence associating characteristics of nursing services with outcomes. The purpose of identifying a set of outcomes as specifically nurse-sensitive for quality measurement is to give clear responsibility and create an expectation of strong clinical leadership by nurses in terms of monitoring and acting on results. It is important to select those outcomes that nurses have most impact upon. Patient experience, nausea, vomiting, mucositis and safe medication administration were outcome areas most likely to yield sensitive measures of nursing service quality in ambulatory cancer chemotherapy. Copyright © 2011 Elsevier Ltd. All rights reserved.

The costs and benefits of getting the ISO 9000 certification in the manufacturing sector in Saudi Arabia.

PubMed

Mezher, T; Ramadan, H

1998-01-01

Many Saudi companies, in their journey to improve quality, efficiency and competitiveness, are pursuing and obtaining the ISO 9000 certificate. Many studies have evaluated how to implement ISO 9000 in different sectors, but none have analyzed the effectiveness of ISO 9000 certification (costs and benefits) on improving the overall quality and on meeting expectations. This study addressed these issues by investigating manufacturing organizations in Saudi Arabia that have the ISO 9000 certification. A survey questionnaire was distributed to firms throughout the kingdom. Thirty-two firms participated in the study. Results indicate that increased consistency of operations, improved service, and product quality are among the top motivators for pursuing the ISO certificate. The benefits most often experienced were improved awareness of procedural problems, better management control, keeping existing customers, increased customer satisfaction, and improved customer service. Difficulties experienced during the certification process involved time and cost, but these were not considered to be major problems. A high volume of paperwork was the main problem experienced following initial certification. Respondents in general said that the ISO 9000 certification met their expectations and that their level of satisfaction regarding the impact of ISO 9000 was high. Most recommended that other organizations pursue the certificate.

Client satisfaction with reproductive health-care quality: integrating business approaches to modeling and measurement.

PubMed

Alden, Dana L; Do, Mai Hoa; Bhawuk, Dharm

2004-12-01

Health-care managers are increasingly interested in client perceptions of clinic service quality and satisfaction. While tremendous progress has occurred, additional perspectives on the conceptualization, modeling and measurement of these constructs may further assist health-care managers seeking to provide high-quality care. To that end, this study draws on theories from business and health to develop an integrated model featuring antecedents to and consequences of reproductive health-care client satisfaction. In addition to developing a new model, this study contributes by testing how well Western-based theories of client satisfaction hold in a developing, Asian country. Applied to urban, reproductive health clinic users in Hanoi, Vietnam, test results suggest that hypothesized antecedents such as pre-visit expectations, perceived clinic performance and how much performance exceeds expectations impact client satisfaction. However, the relative importance of these predictors appears to vary depending on a client's level of service-related experience. Finally, higher levels of client satisfaction are positively related to future clinic use intentions. This study demonstrates the value of: (1) incorporating theoretical perspectives from multiple disciplines to model processes underlying health-care satisfaction and (2) field testing those models before implementation. It also furthers research designed to provide health-care managers with actionable measures of the complex processes related to their clients' satisfaction.

Patient safety and quality improvement: civil money penalty inflation adjustment. Direct final rule.

PubMed

2009-08-25

The Department of Health and Human Services amends the Patient Safety and Quality Improvement Rule by adjusting for inflation the maximum civil money penalty amount for violations of the confidentiality provisions of the Rule. We are amending the penalty amount to comply with the Federal Civil Penalties Inflation Adjustment Act of 1990. We are using direct final rulemaking for this action because we expect that there will be no significant adverse comment on the rule.

Medical Data GRIDs as approach towards secure cross enterprise document sharing (based on IHE XDS).

PubMed

Wozak, Florian; Ammenwerth, Elske; Breu, Micheal; Penz, Robert; Schabetsberger, Thomas; Vogl, Raimund; Wurz, Manfred

2006-01-01

Quality and efficiency of health care services is expected to be improved by the electronic processing and trans-institutional availability of medical data. A prototype architecture based on the IHE-XDS profile is currently being developed. Due to legal and organizational requirements specific adaptations to the IHE-XDS profile have been made. In this work the services of the health@net reference architecture are described in details, which have been developed with focus on compliance to both, the IHE-XDS profile and the legal situation in Austria. We expect to gain knowledge about the development of a shared electronic health record using Medical Data Grids as an Open Source reference implementation and how proprietary Hospital Information systems can be integrated in this environment.

The Quality Imperative for Palliative Care

PubMed Central

Kamal, Arif H.; Hanson, Laura C.; Casarett, David J.; Dy, Sydney M.; Pantilat, Steven Z.; Lupu, Dale; Abernethy, Amy P.

2015-01-01

Palliative medicine must prioritize the routine assessment of the quality of clinical care we provide. This includes regular assessment, analysis, and reporting of data on quality. Assessment of quality informs opportunities for improvement and demonstrates to our peers and ourselves the value of our efforts. In fact, continuous messaging of the value of palliative care services is needed to sustain our discipline; this requires regularly evaluating the quality of our care. As the reimbursement mechanisms for health care in the United States shift from fee-for-service to fee-for-value models, palliative care will be expected to report robust data on quality of care. We must move beyond demonstrating to our constituents (including patients and referrers), “here is what we do,” and increase the focus on “this is how well we do it” and “let’s see how we can do it better.” It is incumbent on palliative care professionals to lead these efforts. This involves developing standardized methods to collect data without adding additional burden, comparing and sharing our experiences to promote discipline-wide quality assessment and improvement initiatives, and demonstrating our intentions for quality improvement on the clinical frontline. PMID:25057987

[IMPLEMENTATION OF A QUALITY MANAGEMENT SYSTEM IN A NUTRITION UNIT ACCORDING TO ISO 9001:2008].

PubMed

Velasco Gimeno, Cristina; Cuerda Compés, Cristina; Alonso Puerta, Alba; Frías Soriano, Laura; Camblor Álvarez, Miguel; Bretón Lesmes, Irene; Plá Mestre, Rosa; Izquierdo Membrilla, Isabel; García-Peris, Pilar

2015-09-01

the implementation of quality management systems (QMS) in the health sector has made great progress in recent years, remains a key tool for the management and improvement of services provides to patients. to describe the process of implementing a quality management system (QMS) according to the standard ISO 9001:2008 in a Nutrition Unit. the implementation began in October 2012. Nutrition Unit was supported by Hospital Preventive Medicine and Quality Management Service (PMQM). Initially training sessions on QMS and ISO standards for staff were held. Quality Committee (QC) was established with representation of the medical and nursing staff. Every week, meeting took place among members of the QC and PMQM to define processes, procedures and quality indicators. We carry on a 2 months follow-up of these documents after their validation. a total of 4 processes were identified and documented (Nutritional status assessment, Nutritional treatment, Monitoring of nutritional treatment and Planning and control of oral feeding) and 13 operating procedures in which all the activity of the Unit were described. The interactions among them were defined in the processes map. Each process has associated specific quality indicators for measuring the state of the QMS, and identifying opportunities for improvement. All the documents associated with requirements of ISO 9001:2008 were developed: quality policy, quality objectives, quality manual, documents and records control, internal audit, nonconformities and corrective and preventive actions. The unit was certified by AENOR in April 2013. the implementation of a QMS causes a reorganization of the activities of the Unit in order to meet customer's expectations. Documenting these activities ensures a better understanding of the organization, defines the responsibilities of all staff and brings a better management of time and resources. QMS also improves the internal communication and is a motivational element. Explore the satisfaction and expectations of patients can include their view in the design of care processes. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Perceptions of quality in primary health care: perspectives of patients and professionals based on focus group discussions

PubMed Central

2014-01-01

Background The EUprimecare project-team assessed the perception of primary health care (PHC) professionals and patients on quality of organization of PHC systems in the participating countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania and Spain. This article presents the aggregated opinions, expectations and priorities of patients and professionals along some main dimensions of quality in primary health care, such as access, equity, appropriateness and patient- centeredness. Methods The focus group technique was applied in the study as a qualitative research method for exploration of attitudes regarding the health care system and health service. Discussions were addressing the topics of: general aspects of quality in primary health care; possibilities to receive/provide PHC services based on both parties needs; determinant factors of accessibility to PHC services; patient centeredness. The data sets collected during the focus group discussions were evaluated using the method of thematic analysis. Results There were 14 focus groups in total: a professional and a patient group in each of the seven partner countries. Findings of the thematic analysis were summarized along the following dimensions: access and equity, appropriateness (coordination, continuity, competency and comprehensiveness) and patient centeredness. Conclusions This study shows perceptions and views of patients in interaction with PHC and opinion of professionals working in PHC. It serves as source of criteria with relevance to everyday practice and experience. The criteria mentioned by patients and by health care professionals which were considered determining factors of the quality in primary care were quite similar among the investigated countries. However, the perception and the level of tolerance regarding some of the criteria differed among EUprimecare countries. Among these dissimilar criteria we especially note the gate-keeping role of GPs, the importance of nurses' competency and the acceptance of waiting times. The impact of waiting time on patient satisfaction is obvious; the influence of equity and access to PHC services are more dependent on the equal distribution of settings and doctors in urban and rural area. Foreseen shortage of doctors is expected to have a substantial influence on patient satisfaction in the near future. PMID:24974196

The political economy of decentralization of health and social services in Canada.

PubMed

Tsalikis, G

1989-01-01

A trend to decentralization in Canada's 'welfare state' has received support from the Left and from the Right. Some social critics of the Left expect decentralization to result in holistic services adjusted to local needs. Others, moreover, feel we are in the dawn of a new epoch in which major economic transformations are to bring about, through new class alliances and conflict, decentralization of power and a better quality of life in communities. These assumptions and their theoretical pitfalls are discussed here following an historical overview of the centralization/decentralization issue in Canadian social policy. It is argued that recent proposals of decentralization are a continuation of reactionary tendencies to constrain social expenditures, but not a path to better quality of life.

Teleradiology in Singapore--taking stock and looking ahead.

PubMed

Cheng, Lionel T E; Ng, Samuel E S

2006-08-01

Teleradiology will have a significant impact on the delivery of healthcare and the practice of medicine. In order to ensure a positive outcome, the expected benefits, limitations and potential pitfalls of teleradiology must be carefully considered. For Singapore, teleradiology can be used to facilitate a quantum leap in the standards of radiological services. This can be achieved through the development of an integrated, nationwide, high-speed radiology network which will allow patients to have access to high-quality and responsive subspecialty radiology expertise located throughout the country. If judiciously implemented, teleradiology has the potential to propel Singapore radiology to an unprecedented level of professional quality and service delivery, and will provide the framework for sustainable radiological insourcing from other countries.

Voice of the customer---a roadmap for service improvement.

PubMed

Uberoi, Ravinder S; Nayak, Yogamaya; Sachdeva, Pritindira; Sibal, Anupam

2013-01-01

Patient satisfaction surveys help a great deal in identifying ways of improving a hospital's services. Ultimately, that translates into better care and happier patients. Moreover, it shows the staff and the community that the hospital is serious about quality and is looking for ways to improve. This article describes how the Voice of the Customer (VOC) Survey can be used as a tool for improving services. Regular monitoring of VOC scores is essential for minimizing the gaps between service delivery and patient expectations. The present study showcases the various initiatives undertaken to improve the VOC scores from an original 4.40 to 4.77 (on a 5 point scale) at the hospital under study.

The feasibility of BRT corridor VI shelters in Semarang City

NASA Astrophysics Data System (ADS)

Purnomo, Andi; Setiawan, Moch Fathoni

2018-03-01

Like other big cities in Indonesia, Semarang City as the capital of Central Java Province also has various city problems, one of them is the transportation problem. Transportation problems arise due to increased mobility of society that is not in balanced with the public transportation facilities and infrastructure availability. In order to create a better transportation system, the local government of Semarang City held Trans Semarang bus rapid transit (BRT) which began operating in 2010. This study aims to analyze the feasibility of BRT Trans Semarang corridor VI shelters. This research uses descriptive critique technique. The results are expected to be considered in determining the right policy in creating a better transportation system. Based on observations made, the majority of BRT Trans Semarang corridor VI uses non-permanent shelters and is less feasible to be a BRT shelter. Thus, the local government is expected to improve the feasibility of BRT Trans Semarang shelter so that the sense of security and comfort can be obtained by users of BRT. In addition, the local government is also expected to maintain the quality of services provided. These services include ticket service, the condition of buses, speed and waiting time, as well as the placement and condition of shelters.

Creating a new class of pharmaceutical services provider for underserved areas: the Tanzania accredited drug dispensing outlet experience.

PubMed

Rutta, Edmund; Senauer, Katie; Johnson, Keith; Adeya, Grace; Mbwasi, Romuald; Liana, Jafary; Kimatta, Suleiman; Sigonda, Margareth; Alphonce, Emmanuel

2009-01-01

In developing countries, the most accessible source of treatment for common conditions is often an informal drug shop, where drug sellers are untrained and operations are unmonitored. We sought to describe a public-private initiative in Tanzania that created a new class of provider in government-accredited drug outlets, which improved the quality of medicines and pharmaceutical services in previously underserved areas. The accredited drug-dispensing outlet program combines changing behavior and expectations of community members who use, own, regulate, and work in drug shops. Success resulted from including community stakeholders from the beginning of the process. Addressing shortages in qualified health care providers by training and accrediting private sector drug dispensers to recognize common conditions and provide quality pharmaceutical products and services is feasible in a developing country, when supported by an appropriate policy and regulatory environment. Scaling up and sustaining the program will be a challenge.

Resilience and Professional Quality of Life in Staff Working with People with Intellectual Disabilities and Offending Behavior in Community Based and Institutional Settings.

PubMed

Søndenaa, Erik; Lauvrud, Christian; Sandvik, Marita; Nonstad, Kåre; Whittington, Richard

2013-01-02

Staff in forensic services for people with intellectual disabilities (ID) are expected to deal with a wide range of emotional challenges when providing care. The potential impact of this demanding work has not been systematically explored previously. This article explores the professional quality of life (QoL) and the resilience (hardiness) of the staff in this setting. The Professional QoL questionnaire and the Disposional Resilience Scale were completed by staff (n=85, 80% response rate) in the Norwegian forensic service for ID offenders. Responses from staff working in institutional settings were compared to those from staff in local community services. Staff in the local community services had higher resilience scores compared to the staff in the institutional setting, (t=2.19; P<0.05). However in the other QoL and resilience domains there were no differences between the staff in the two settings. The greater sense of resilient control among community staff may be a function of both the number of service users they work with and the institutional demands they face. Even though these participants worked with relatively high risk clients, they did not report significantly impaired quality of life compared to other occupations.

Factors Influencing Utilization of Primary Health Care Services in Patients with Chronic Respiratory Diseases.

PubMed

Kurpas, D; Bujnowska-Fedak, M M; Athanasiadou, A; Mroczek, B

2015-01-01

The purpose of our study was to determine the factors affecting the level of services provided in primary health care among patients with chronic respiratory diseases. The study group consisted of 299 adults (median age: 65, min-max: 18-92 years) with mixed chronic respiratory diseases, recruited from patients of 135 general practitioners. In the analysis, in addition to the assessment of the provided medical services, the following were used: Patient Satisfaction Questionnaire, Camberwell Assessment of Needs Short Appraisal Schedule, Acceptance of Illness Scale, and WHO Quality of Life Instrument Short Form. Variables that determined the level of services were the following: age, place of residence, marital status, number of chronic diseases, and level of disease acceptance, quality of life, and health behaviors. The level of provided services correlated with variables such as gender, severity of somatic symptoms, level of satisfied needs, and satisfaction with health care. We concluded that in patients with mixed chronic respiratory diseases a higher level of health care utilization should be expected in younger patients, those living in the countryside, those having a partner, with multimorbidity, a low level of disease acceptance, those satisfied with their current quality of life, with positive mental attitudes, and maintaining health practices.

Resilience and Professional Quality of Life in Staff Working with People with Intellectual Disabilities and Offending Behavior in Community Based and Institutional Settings

PubMed Central

Søndenaa, Erik; Lauvrud, Christian; Sandvik, Marita; Nonstad, Kåre; Whittington, Richard

2013-01-01

Staff in forensic services for people with intellectual disabilities (ID) are expected to deal with a wide range of emotional challenges when providing care. The potential impact of this demanding work has not been systematically explored previously. This article explores the professional quality of life (QoL) and the resilience (hardiness) of the staff in this setting. The Professional QoL questionnaire and the Disposional Resilience Scale were completed by staff (n=85, 80% response rate) in the Norwegian forensic service for ID offenders. Responses from staff working in institutional settings were compared to those from staff in local community services. Staff in the local community services had higher resilience scores compared to the staff in the institutional setting, (t=2.19; P<0.05). However in the other QoL and resilience domains there were no differences between the staff in the two settings. The greater sense of resilient control among community staff may be a function of both the number of service users they work with and the institutional demands they face. Even though these participants worked with relatively high risk clients, they did not report significantly impaired quality of life compared to other occupations. PMID:26973892

[Nursing motivation leadership].

PubMed

Chen, Ia-Ling; Hung, Chich-Hsiu

2007-02-01

The concept of "patients treated as guests" is emphasized in today's medical service and patient-center nursing care. However, with rapid changes in health insurance and hospital accreditation systems as well as increasing consumer awareness, the nurse manager must both efficiently relieve the working pressure of nurses and motivate them. However, it would be an extreme challenge for nurse managers to build a team in which each member works in a self-fulfilling work environment and achieves a high quality of care. This article presents several theories and techniques that relate to motivation strategies. These strategies can serve as a guide and a reference for nurse managers to inspire teamwork and raise morale. It can be expected that increasing nurse satisfaction, performance, and care quality will decrease turnover and desertion rates. Hopefully, this article will assist nurse managers to become better leaders and to achieve success in providing efficient services and good of nursing care quality.

The World Health Organization's water safety plan is much more than just an integrated drinking water quality management plan.

PubMed

Viljoen, F C

2010-01-01

South Africa is a country of contrasts with far ranging variations in climate, precipitation rates, cultures, demographics, housing levels, education, wealth and skills levels. These differences have an impact on water services delivery as do expectations, affordability and available resources. Although South Africa has made much progress in supplying drinking water, the same cannot be said regarding water quality throughout the country. A concerted effort is currently underway to correct this situation and as part of this drive, water safety plans (WSP) are promoted. Rand Water, the largest water services provider in South Africa, used the World Health Organization (WHO) WSP framework as a guide for the development of its own WSP which was implemented in 2003. Through the process of implementation, Rand Water found the WHO WSP to be much more than just another integrated quality system.

Assessing performance enhancing tools: experiences with the open performance review and appraisal system (OPRAS) and expectations towards payment for performance (P4P) in the public health sector in Tanzania.

PubMed

Songstad, Nils Gunnar; Lindkvist, Ida; Moland, Karen Marie; Chimhutu, Victor; Blystad, Astrid

2012-09-10

Health workers' motivation is a key determinant of the quality of health services, and poor motivation has been found to be an obstacle to service delivery in many low-income countries. In order to increase the quality of service delivery in the public sector in Tanzania, the Open Performance Review and Appraisal System (OPRAS) has been implemented, and a new results-based payment system, Payment for performance (P4P) is introduced in the health sector. This article addresses health workers' experiences with OPRAS, expectations towards P4P and how lessons learned from OPRAS can assist in the implementation of P4P. The broader aim is to generate knowledge on health workers' motivation in low-income contexts. A qualitative study design has been employed to elicit data on health worker motivation at a general level and in relation to OPRAS and P4P in particular. Focus group discussions (FGDs) and in-depth interviews (IDIs) have been conducted with nursing staff, clinicians and administrators in the public health sector in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania. Health workers evaluated OPRAS and P4P in terms of the benefits experienced or expected from complying with the tools. The study found a general reluctance towards OPRAS as health workers did not see OPRAS as leading to financial gains nor did it provide feedback on performance. Great expectations were expressed towards P4P due to its prospects of topping up salaries, but the links between the two performance enhancing tools were unclear. Health workers respond to performance enhancing tools based on whether the tools are found appropriate or yield any tangible benefits. The importance placed on salary and allowances forms the setting in which OPRAS operates. The expected addition to the salary through P4P has created a vigorous discourse among health workers attesting to the importance of the salary for motivation. Lessons learned from OPRAS can be utilized in the implementation of P4P and can enhance our knowledge on motivation and performance in the health services in low-income contexts such as Tanzania.

Assessing performance enhancing tools: experiences with the open performance review and appraisal system (OPRAS) and expectations towards payment for performance (P4P) in the public health sector in Tanzania

PubMed Central

2012-01-01

Background Health workers’ motivation is a key determinant of the quality of health services, and poor motivation has been found to be an obstacle to service delivery in many low-income countries. In order to increase the quality of service delivery in the public sector in Tanzania, the Open Performance Review and Appraisal System (OPRAS) has been implemented, and a new results-based payment system, Payment for performance (P4P) is introduced in the health sector. This article addresses health workers’ experiences with OPRAS, expectations towards P4P and how lessons learned from OPRAS can assist in the implementation of P4P. The broader aim is to generate knowledge on health workers’ motivation in low-income contexts. Methods A qualitative study design has been employed to elicit data on health worker motivation at a general level and in relation to OPRAS and P4P in particular. Focus group discussions (FGDs) and in-depth interviews (IDIs) have been conducted with nursing staff, clinicians and administrators in the public health sector in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania. Results Health workers evaluated OPRAS and P4P in terms of the benefits experienced or expected from complying with the tools. The study found a general reluctance towards OPRAS as health workers did not see OPRAS as leading to financial gains nor did it provide feedback on performance. Great expectations were expressed towards P4P due to its prospects of topping up salaries, but the links between the two performance enhancing tools were unclear. Conclusions Health workers respond to performance enhancing tools based on whether the tools are found appropriate or yield any tangible benefits. The importance placed on salary and allowances forms the setting in which OPRAS operates. The expected addition to the salary through P4P has created a vigorous discourse among health workers attesting to the importance of the salary for motivation. Lessons learned from OPRAS can be utilized in the implementation of P4P and can enhance our knowledge on motivation and performance in the health services in low-income contexts such as Tanzania. PMID:22963317

Development of Family Medicine training in Botswana: Views of key stakeholders in Ngamiland.

PubMed

Ogundipe, Radiance M; Mash, Robert

2018-08-31

Family Medicine training commenced in Botswana in 2011, and Maun was one of the two sites chosen as a training complex. If it is to be successful there has to be investment in the training programme by all stakeholders in healthcare delivery in the district. The aim of the study was to explore the attitudes of stakeholders to initiation of Family Medicine training and their perspectives on the future roles of family physicians in Ngami district, Botswana. Maun and the surrounding Ngami subdistrict of Botswana. Thirteen in-depth interviews were conducted with purposively selected key stakeholders in the district health services. Data were recorded, transcribed and analysed using the framework method. Participants welcomed the development of Family Medicine training in Maun and expect that this will result in improved quality of primary care. Participants expect the registrars and family physicians to provide holistic health care that is of higher quality and expertise than currently experienced, relevant research into the health needs of the community, and reduced need for referrals. Inadequate personal welfare facilities, erratic ancillary support services and an inadequate complement of mentors and supervisors for the programme were some of the gaps and challenges highlighted by participants. Family Medicine training is welcomed by stakeholders in Ngamiland. With proper planning introduction of the family physician in the district is expected to result in improvement of primary care.

Hospitality Major Vocational High School Students' Expectations on University Education

ERIC Educational Resources Information Center

Chung, Ya-Ting; Yang, Cheng-Cheng

2013-01-01

Hospitality is not a new industry in Asia, but high quality hospitality industry has become more and more important in the trend of questing service-based economy and the increasing number of tourists in Asia. Thus there are more universities opened hospitality degree programs in Asia, Taiwan is no exception. In this context, why high school…

2010 Mississippi Curriculum Framework: Postsecondary Clothing and Textile Services. (Program CIP-19.0905)

ERIC Educational Resources Information Center

Redfield, Verlene

2010-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

Pre-Service Education for Primary School English Teachers in Indonesia: Policy Implications

ERIC Educational Resources Information Center

Zein, Subhan

2016-01-01

Although English is only an extra-curricular subject at primary level in Indonesia, expectations over the improved quality of the teachers are exceptionally high. This is the case in the past few years in which the low proficiency of primary English teachers and their lack of teaching competencies have repeatedly been pointed out as major…

Economic aspects of a therapy and support service for people with long-term stroke and aphasia.

PubMed

van der Gaag, Anna; Brooks, Richard

2008-01-01

This paper considers some economic aspects of a therapy and support service for people with stroke and aphasia. This material was part of a broader evaluation of the service, which is reported elsewhere (van der Gaag et al. 2005, van der Gaag and Mowles 2005). The purpose of this part of the study was to investigate the feasibility of undertaking economic appraisal in a voluntary sector service providing therapy for people with aphasia and their families. The costs of delivering therapy and support services were calculated. These costs were compared with the costs of equivalent services in the National Health Service (NHS). The EQ-5D health-related quality of life instrument was used to calculate quality-adjusted life years (QALYs). The cost of delivering therapy was lower than expected for a customized service of this nature. The study generated cost data for delivering therapy services, allowing some comparisons to be made with equivalent services in NHS settings. QALY data were generated for a sample of 25 clients on one of the programmes. The economics of speech and language therapy service delivery have received scant attention in the published literature. The paper argues that decision-making about methods of service delivery can be aided by the explicit consideration of the costs and consequences of different programmes.

[Quality management in pathology--an executive function and political implications].

PubMed

Turzynski, A

2013-09-01

Quality management (QM) is primarily an in-house executive function. It conduces to ensure a high quality service and has the external object to satisfy customer expectations. In Germany the implementation of quality management systems (QMS) is made compulsory for all medical facilities by law. However, details are not regulated and there is no need to certify the in-house QMS. Within the last 10 years many pathology institutions have become certified or accredited and have implemented voluntary measures of external quality assurance, such as quality circles and round robin trials. For non-certified institutions it might be helpful to be guided by established QM standards like the ISO 9001:2008. The fundamental concepts of QM, some pathology-specific aspects and some implications for the professional associations are discussed in this article.

Measuring the patient experience.

PubMed

Lees, Carolyn

2011-01-01

This paper examines the complex issues of measuring the patient experience and evaluating the quality of health care. It discusses the use of surveys, patient stories and narrative methods of data collection in an attempt to define quality and how it should be measured. A recent Department of Health (DH) document insists that patients will be at the heart of decision making in the NHS by having greater control in informing strategic commissioning decisions (DH 2010c). The government aims to improve patient experience, enabling patients to rate services according to the quality of care they receive. This will be carried out using information generated by patients. This paper discusses the advantages and disadvantages of using surveys in gathering patient satisfaction data. It considers the value of surveys in measuring quality of care and appraises their usefulness in strengthening patients' collective voice. The paper investigates the use of another source of feedback - it examines the design of qualitative data collection methods as a means of gaining feedback from service users in encouraging providers of health care to be more responsive to their needs. Too often, patients are expected to fit the services, rather than services meeting the patients' needs. The most effective way of exploring and representing the patient's experience is by using a mixed-method approach. In other words, an integrated approach with the use of surveys and more narrative methods, such as patient stories, will effectively define quality and how it should be measured, ensuring that the focus is always on what matters most to patients.

Support as a complement, intrusion and right--evidence from ageing and disability support service users in Sweden and Australia.

PubMed

Laragy, Carmel; Fisher, Karen R; Cedersund, Elisabet; Campbell-McLean, Carolyn

2011-12-01

How service users conceptualise their personal support services is under researched, even though this understanding is important for responsive policy development and service implementation. This paper tests the proposition that service users understand formal support in three ways: support is a complement to their other arrangements, an intrusion into their personal life and a right. These three concepts were identified using discourse analysis in a Swedish study of older people wanting in-home support services. To test generalisability of these concepts, they were applied to data from an Australian study of people using disability personal support. The analysis found that the three concepts were core to people's views of their support, although the construction of the concepts differed in the two countries. Service users in Sweden asserted their right to services more forcefully than those in Australia, and they had higher expectations that their support needs would be met. These differences reflect the impact of each country's social policy environment on service users' expectations. The analysis suggests that service users and their families want to control their formal support arrangements to complement their informal care and their life preferences and to minimise the intrusive aspects of formal support. The findings imply that the three concepts have utility for theorising service users' perspectives, informing policy and developing implementation strategies which enhance peoples' quality of life. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

The Association between Freedom of Choice and Effectiveness of Home Care Services.

PubMed

Steffansson, Marina; Pulliainen, Marjo; Kettunen, Aija; Linnosmaa, Ismo; Halonen, Miikka

2016-03-31

The aim of this paper is to study home care clients' freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors. A structured postal survey was conducted among regular home care clients (n = 2096) aged 65 or older in three towns in Finland. Freedom of choice was studied based on clients' subjective experiences. The effectiveness of the services was evaluated by means of changes in the social-care-related quality of life. Regression analyses were used to test associations. As much as 62% of home care recipients reported having some choice regarding their services. Choosing meals and visiting times for the care worker were associated with better effectiveness. The basic model, which included needs and other factors expected to have an impact on quality of life, explained 15.4% of the changes in quality of life, while the extended model, which included the freedom-of-choice variables, explained 17.4%. The inclusion of freedom-of-choice variables increased the adjusted coefficient of determination by 2%. There was a significant positive association between freedom of choice and the effectiveness of public home care services. Freedom of choice does not exist for all clients of home care who desire it. By changing social welfare activities and structures, it is possible to show respect for clients' opinions and to thereby improve the effectiveness of home care services.

The Association between Freedom of Choice and Effectiveness of Home Care Services

PubMed Central

Pulliainen, Marjo; Kettunen, Aija; Linnosmaa, Ismo; Halonen, Miikka

2016-01-01

Objectives: The aim of this paper is to study home care clients’ freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors. Methods: A structured postal survey was conducted among regular home care clients (n = 2096) aged 65 or older in three towns in Finland. Freedom of choice was studied based on clients’ subjective experiences. The effectiveness of the services was evaluated by means of changes in the social-care-related quality of life. Regression analyses were used to test associations. Results: As much as 62% of home care recipients reported having some choice regarding their services. Choosing meals and visiting times for the care worker were associated with better effectiveness. The basic model, which included needs and other factors expected to have an impact on quality of life, explained 15.4% of the changes in quality of life, while the extended model, which included the freedom-of-choice variables, explained 17.4%. The inclusion of freedom-of-choice variables increased the adjusted coefficient of determination by 2%. There was a significant positive association between freedom of choice and the effectiveness of public home care services. Conclusion: Freedom of choice does not exist for all clients of home care who desire it. By changing social welfare activities and structures, it is possible to show respect for clients’ opinions and to thereby improve the effectiveness of home care services. PMID:27616949

Efficiency of antenatal care and childbirth services in selected primary health care facilities in rural Tanzania: a cross-sectional study.

PubMed

Saronga, Happiness P; Duysburgh, Els; Massawe, Siriel; Dalaba, Maxwell A; Savadogo, Germain; Tonchev, Pencho; Dong, Hengjin; Sauerborn, Rainer; Loukanova, Svetla

2014-02-28

Cost studies are paramount for demonstrating how resources have been spent and identifying opportunities for more efficient use of resources. The main objective of this study was to assess the actual dimension and distribution of the costs of providing antenatal care (ANC) and childbirth services in selected rural primary health care facilities in Tanzania. In addition, the study analyzed determining factors of service provision efficiency in order to inform health policy and planning. This was a retrospective quantitative cross-sectional study conducted in 11 health centers and dispensaries in Lindi and Mtwara rural districts. Cost analysis was carried out using step down cost accounting technique. Unit costs reflected efficiency of service provision. Multivariate regression analysis on the drivers of observed relative efficiency in service provision between the study facilities was conducted. Reported personnel workload was also described. The health facilities spent on average 7 USD per capita in 2009. As expected, fewer resources were spent for service provision at dispensaries than at health centers. Personnel costs contributed a high approximate 44% to total costs. ANC and childbirth consumed approximately 11% and 12% of total costs; and 8% and 10% of reported service provision time respectively. On average, unit costs were rather high, 16 USD per ANC visit and 79.4 USD per childbirth. The unit costs showed variation in relative efficiency in providing the services between the health facilities. The results showed that efficiency in ANC depended on the number of staff, structural quality of care, process quality of care and perceived quality of care. Population-staff ratio and structural quality of basic emergency obstetric care services highly influenced childbirth efficiency. Differences in the efficiency of service provision present an opportunity for efficiency improvement. Taking into consideration client heterogeneity, quality improvements are possible and necessary. This will stimulate utilization of ANC and childbirth services in resource-constrained health facilities. Efficiency analyses through simple techniques such as measurement of unit costs should be made standard in health care provision, health managers can then use the performance results to gauge progress and reward efficiency through performance based incentives.

Nature and determinants of customer expectations of service recovery in health care.

PubMed

Dasu, S; Rao, J

1999-01-01

Service recovery refers to the service provider's response to a dissatisfied customer. This article proposes a model of customer expectations of service recovery in health care services. The model discusses two types of service recovery expectations: will and should. An exploratory study indicates that industry reputation and personal experiences drive customers' "will-expectations" of service recovery while "should-expectations" can be explained via norm, fairness, social contract and hospitality theories.

Contracting for directorships.

PubMed

Knapp, Donna K

2013-05-01

Hospitals are required to have a medical director of respiratory care as a condition of their participation in the Federal Medicare and Medicaid programs. This gives physicians opportunities to improve the quality of care for the patients in their community, to diversify income streams, and to assist hospitals to meet regulatory requirements for quality. The contracts for these positions are usually provided by the hospital, so it is imperative that physicians know how to protect their interests, what is expected of them, if they are being paid fairly, and that the contract is compliant with all regulatory issues. The directorship relationship with the hospital that provides designated health services and the "stand in the shoes" definition of direct compensation also gives physicians and physician practices guidance to determine if their group and individual physicians are compliant with Stark and antikickback regulations. This article guides physicians through the process of reviewing a contract for medical directorship or service line management services. Information on compensation in the directorship market can be found in at least two standard surveys. Duties and compensation vary among entities and frequently include incentive-based compensation for improving quality measures and operations. Directorships are evolving to service line management as more of the hospital's reimbursement is linked to clinical quality and patient satisfaction. This article does not offer legal advice, nor is it meant to be all inclusive. Physicians should consult a health-care attorney for any questions before signing any contract.

[Community perception on the quality of public health services delivery in the Norte and Ichilo districts of Bolivia].

PubMed

Gattinara, B C; Lbacache, J; Puente, C T; Giaconi, J; Caprara, A

1995-01-01

The current study identifies the people perception on the quality of public health services in Norte and Ichilo health districts (Bolivia), with a particular emphasis on the relationship between heath workers and patients. Both qualitative and quantitative methods were utilised such as: survey, focus groups, participatory observation, unstructured interviews to Key informants and open discussions with the community. Results show that the public health services reputation is affected by elements as discriminatory attitude towards people belonging to a low socio-economic strata, lack of communication between health workers and patients, perceived insufficient technical skills and recognition of a low therapeutic efficacy. The people who are coming from highlands (collas) appear as the most disappointed by the health service provision structured on the western predominant pattern with a top-bottom approach ignoring its potential users' expectations and needs. A low capability of the public health services to accept and recognise the inter-cultural features of the region, makes that the challenge to be undertaken by the district health personnel should focus on the establishment of intercultural bridges between the public health service providers and the potential patients, as well as among the different co-existing medical systems.

Quality assurance: Importance of systems and standard operating procedures

PubMed Central

Manghani, Kishu

2011-01-01

It is mandatory for sponsors of clinical trials and contract research organizations alike to establish, manage and monitor their quality control and quality assurance systems and their integral standard operating procedures and other quality documents to provide high-quality products and services to fully satisfy customer needs and expectations. Quality control and quality assurance systems together constitute the key quality systems. Quality control and quality assurance are parts of quality management. Quality control is focused on fulfilling quality requirements, whereas quality assurance is focused on providing confidence that quality requirements are fulfilled. The quality systems must be commensurate with the Company business objectives and business model. Top management commitment and its active involvement are critical in order to ensure at all times the adequacy, suitability, effectiveness and efficiency of the quality systems. Effective and efficient quality systems can promote timely registration of drugs by eliminating waste and the need for rework with overall financial and social benefits to the Company. PMID:21584180

Quality assurance: Importance of systems and standard operating procedures.

PubMed

Manghani, Kishu

2011-01-01

It is mandatory for sponsors of clinical trials and contract research organizations alike to establish, manage and monitor their quality control and quality assurance systems and their integral standard operating procedures and other quality documents to provide high-quality products and services to fully satisfy customer needs and expectations. Quality control and quality assurance systems together constitute the key quality systems. Quality control and quality assurance are parts of quality management. Quality control is focused on fulfilling quality requirements, whereas quality assurance is focused on providing confidence that quality requirements are fulfilled. The quality systems must be commensurate with the Company business objectives and business model. Top management commitment and its active involvement are critical in order to ensure at all times the adequacy, suitability, effectiveness and efficiency of the quality systems. Effective and efficient quality systems can promote timely registration of drugs by eliminating waste and the need for rework with overall financial and social benefits to the Company.

The use of quantile regression to forecast higher than expected respiratory deaths in a daily time series: a study of New York City data 1987-2000.

PubMed

Soyiri, Ireneous N; Reidpath, Daniel D

2013-01-01

Forecasting higher than expected numbers of health events provides potentially valuable insights in its own right, and may contribute to health services management and syndromic surveillance. This study investigates the use of quantile regression to predict higher than expected respiratory deaths. Data taken from 70,830 deaths occurring in New York were used. Temporal, weather and air quality measures were fitted using quantile regression at the 90th-percentile with half the data (in-sample). Four QR models were fitted: an unconditional model predicting the 90th-percentile of deaths (Model 1), a seasonal/temporal (Model 2), a seasonal, temporal plus lags of weather and air quality (Model 3), and a seasonal, temporal model with 7-day moving averages of weather and air quality. Models were cross-validated with the out of sample data. Performance was measured as proportionate reduction in weighted sum of absolute deviations by a conditional, over unconditional models; i.e., the coefficient of determination (R1). The coefficient of determination showed an improvement over the unconditional model between 0.16 and 0.19. The greatest improvement in predictive and forecasting accuracy of daily mortality was associated with the inclusion of seasonal and temporal predictors (Model 2). No gains were made in the predictive models with the addition of weather and air quality predictors (Models 3 and 4). However, forecasting models that included weather and air quality predictors performed slightly better than the seasonal and temporal model alone (i.e., Model 3 > Model 4 > Model 2) This study provided a new approach to predict higher than expected numbers of respiratory related-deaths. The approach, while promising, has limitations and should be treated at this stage as a proof of concept.

The Use of Quantile Regression to Forecast Higher Than Expected Respiratory Deaths in a Daily Time Series: A Study of New York City Data 1987-2000

PubMed Central

Soyiri, Ireneous N.; Reidpath, Daniel D.

2013-01-01

Forecasting higher than expected numbers of health events provides potentially valuable insights in its own right, and may contribute to health services management and syndromic surveillance. This study investigates the use of quantile regression to predict higher than expected respiratory deaths. Data taken from 70,830 deaths occurring in New York were used. Temporal, weather and air quality measures were fitted using quantile regression at the 90th-percentile with half the data (in-sample). Four QR models were fitted: an unconditional model predicting the 90th-percentile of deaths (Model 1), a seasonal / temporal (Model 2), a seasonal, temporal plus lags of weather and air quality (Model 3), and a seasonal, temporal model with 7-day moving averages of weather and air quality. Models were cross-validated with the out of sample data. Performance was measured as proportionate reduction in weighted sum of absolute deviations by a conditional, over unconditional models; i.e., the coefficient of determination (R1). The coefficient of determination showed an improvement over the unconditional model between 0.16 and 0.19. The greatest improvement in predictive and forecasting accuracy of daily mortality was associated with the inclusion of seasonal and temporal predictors (Model 2). No gains were made in the predictive models with the addition of weather and air quality predictors (Models 3 and 4). However, forecasting models that included weather and air quality predictors performed slightly better than the seasonal and temporal model alone (i.e., Model 3 > Model 4 > Model 2) This study provided a new approach to predict higher than expected numbers of respiratory related-deaths. The approach, while promising, has limitations and should be treated at this stage as a proof of concept. PMID:24147122

The implementation of a quality assurance procedure for the Veterinary Services of France.

PubMed

Gerster, F; Guerson, N; Moreau, V; Mulnet, O; Provot, S; Salabert, C

2003-08-01

Due to the increasing complexity of food production systems and the concerns that these systems raise, there has been increasing demand from the general public for more State control of these processes. In France, it is the official Veterinary Services who are responsible for food safety and who must respond to these demands. The Veterinary Service is formulating a quality assurance procedure in accordance with standard EN 45004-ISO 17020, which determines the requirements that inspection bodies must follow to be recognised, at national, European and international level, as competent and reliable. As part of this procedure, the Veterinary Service will review requirements in terms of organisation, functions, qualifications and resources. The progress of inspection service orders, from their conception by the Central Administration, to their implementation by decentralised services, must be carefully managed. It is essential that service orders be implemented effectively and systematically by using recognised methods and issuing adequate inspection reports. The training and qualifications of inspectors are very important: their skills must remain up-to-date so that there is always a network of qualified staff, that is, staff who have an understanding of production processes and who have recognised competences in terms of initial training, continuous professional development and adequate experience. The quality systems implemented will only meet expectations if they are continuously monitored by means of regular evaluations. For this reason, both internal and external audits are performed. These new practices contribute to establishing a basis for the improvement of internal evaluation. In order to facilitate the implementation of a quality assurance procedure for inspection services, several tools, that are linked with the information system of the government department responsible for food, are, or will be, at the disposal of the decentralised Veterinary Services, i.e. a national database, mail and service order processing software, and inspection procedures.

Seeking perfection in healthcare. A case study in adopting Toyota Production System methods.

PubMed

Kaplan, Gary S; Patterson, Sarah H

2008-01-01

Virginia Mason Health System's vision to be the quality leader in healthcare means continually adopting new ways of thinking. One change has been shifting from believing defects are to be expected to believing zero defects in healthcare is not only possible, but also necessary. Generally, healthcare has advanced in technology and understanding of disease, but its business and management systems have changed little since the 1950s. Virginia Mason realized it needed a management method to help make real and measurable improvements in safety, quality, service and staff satisfaction.

Attending to physical health in mental health services in Australia: a qualitative study of service users' experiences and expectations.

PubMed

Young, Sarah J; Praskova, Anna; Hayward, Nicky; Patterson, Sue

2017-03-01

Evidence is unequivocal: the premature death of people with severe mental health problems is attributable primarily to cardiovascular disease, and healthcare provided is often suboptimal. With the overarching aim of improving outcomes, policies and guidelines oblige mental health services and psychiatrists to monitor cardio-metabolic health of patients and intervene as appropriate. Practice is highly variable; however, with ongoing debate about resourcing and responsibilities dominated by clinicians who have identified disinterest among patients as influencing practice. Seeking to balance discussion, we posed the question 'what do patients experience and expect of mental health services in relation to their physical health?' To answer it, we interviewed a convenience sample of 40 service users recruited from a mental health service in Australia, early in 2015. Data were analysed using the framework approach. With few regarding themselves as healthy, participants were commonly concerned about side effects of medication, weight and fitness but rarely mentioned tobacco smoking. Participants' accounts reinforce extensive research demonstrating variability in attention to physical health in mental health services. Reports by some participants of comprehensive care are encouraging, but widespread uncertainty about reasons for various assessments and denial of requests for management of medication side effects, including weight gain, gives cause for concern. Although participants in this study wanted to improve their health and health-related quality of life, they acknowledged that their motivation and ability to do so fluctuated with mental health. They expected clinicians to work proactively, especially when symptoms compromised capacity for self-care, and mental health services to provide or enable access to health-promoting interventions. Attention should be given, as a matter of priority, to creating conditions (culture and infrastructure) needed to support sustained attention to physical health within services and, importantly, to full engagement of service users in management of their physical health. © 2016 John Wiley & Sons Ltd.

2008 Mississippi Curriculum Framework: Postsecondary Irrigation Management Technology. (Program CIP:01.0699 - Applied Horticulture/Horticultural Business Services, Other)

ERIC Educational Resources Information Center

Oliver, Michael L.

2008-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2005 Mississippi Curriculum Framework: Postsecondary Banking and Finance Technology. (Program CIP: 52.0803 - Banking and Financial Support Services)

ERIC Educational Resources Information Center

Gullett, Janet; Thigpen, Herbert

2005-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2010 Mississippi Curriculum Framework: Postsecondary Banking and Finance Technology. (Program CIP: 52.0803 - Banking and Financial Support Services)

ERIC Educational Resources Information Center

Gullett, Janet; Dinkins, Shivochie

2010-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

Further Choice and Quality: The Charter for Further Education.

ERIC Educational Resources Information Center

Department for Education and Employment, London (England).

This charter explains what is being done to promote high standards of service for all who use technical colleges in the new further education (FE) sector in England--students, employers, and other members of the local community. It sets out the standards one has a right to expect from colleges in the FE sector and other organizations involved in…

[Nursing managers: study to assess the expectations of nursing coordinators in a Northern Italian Hospital].

PubMed

Curti, Tiziana; Scaffidi, Maria Carmela; Basso, Anna Maddalena; Garrino, Lorenza

2011-01-01

In modern health-care , nursing managers play a strategic role in improving the quality of care and the skills of carers, since management and leadership strategies are known to be decisive in the deployment of resources and professional development. The aim of this study is to present the opinions and expectations of nursing coordinators regarding their managerial role. During the creation of a nursing service unifying the management of 3 local health authorities in Northern Italy, with different organizational and professional features, nursing coordinators were asked to fill in a questionnaire. Results showed that a priority aspect of the managerial role is to assess the appropriateness of care and the use of resources Their answers showed that they hoped for a style of management founded on aspects related to clinical government. For the style of leadership, they emphasized dedication to work, participation of staff in decision-making, group information and providing support in areas needing improvement. Although the study was territorial , it confirmed international guide-lines regarding the policies which give value to investments in the quality of organization and can be considered a point of reference for planning and creating future nursing services.

Monitoring quality of care at dialysis facilities: a case for regulatory parsimony--and beyond.

PubMed

Stivelman, John C

2012-10-01

With the issuance of the new Conditions for Coverage in 2008 and the implementation of the Prospective Payment System in 2011, the Centers for Medicare & Medicaid Services has fundamentally altered the regulatory landscape of quality in the ESRD program. Although these changes-largely through use of tools comparing individual facility performance to regional and national quality expectations-have increased facility accountability for the quality of patient care in many quarters, they have also complicated both substance and process of facility adherence to quality rules in that component of the program. This editorial critically assesses the main quality tools now in use for dialysis facilities and reviews the issues arising from their conjoint use. A scheme for improving the effectiveness of each quality tool is proposed, and an assessment of their future value and effectiveness in quality improvement is offered.

Baseline data for evaluating development trajectory and provision of ecosystem services of created fringing oyster reefs in Vermilion Bay, Louisiana

USGS Publications Warehouse

La Peyre, Megan K.; Schwarting, Lindsay; Miller, Shea

2013-01-01

Understanding the time frame in which ecosystem services (that is, water quality maintenance, shoreline protection, habitat provision) are expected to be provided is important when restoration projects are being designed and implemented. Restoration of three-dimensional shell habitats in coastal Louisiana and elsewhere presents a valuable and potentially self-sustaining approach to providing shoreline protection, enhancing nekton habitat, and providing water quality maintenance. As with most restoration projects, the development of expected different ecosystem services often occurs over varying time frames, with some services provided immediately and others taking longer to develop. This project was designed initially to compare the provision and development of ecosystem services by created fringing shoreline reefs in subtidal and intertidal environments in Vermilion Bay, Louisiana. Specifically, the goal was to test the null hypothesis that over time, the oyster recruitment and development of a sustainable oyster reef community would be similar at both intertidal and subtidal reef bases, and these sustainable reefs would in time provide similar shoreline stabilization, nekton habitat, and water quality services over similar time frames. Because the ecosystem services hypothesized to be provided by oyster reefs reflect long-term processes, fully testing the above-stated null hypothesis requires a longer-time frame than this project allowed. As such, this project was designed to provide the initial data on reef development and provision of ecosystem services, to identify services that may develop immediately, and to provide baseline data to allow for longer-term follow up studies tracking reef development over time. Unfortunately, these initially created reef bases (subtidal, intertidal) were not constructed as planned because of the Deepwater Horizon oil spill in April 2010, which resulted in reef duplicates being created 6 months apart. Further confounding the project were additional construction and restoration projects along the same shorelines which occurred between 2011 and June 2012. Because of constant activity near and around the reefs and continuing construction, development trajectories could not be compared among reef types at this time. This report presents the data collected at the sites over 3 years (2010–2012), describing only conditions and trends. In addition, these data provide an extensive and detailed dataset documenting initial conditions and initial ecosystem changes which will prove valuable in future data collection and analyses of reef development at this site. Data collection characterized the local water quality conditions (salinity, temperature, total suspended sediments, dissolved oxygen, chlorophyll a), adjacent marsh vegetation, soils, and shoreline position along the project shoreline at Vermilion Bay. During the study, marsh vegetation and soil characteristics were similar across the study area and did not change over time. Shoreline movement indicated shoreline loss at all sites, which varied by reefs. Water quality conditions followed expected seasonal patterns for this region, and no significant nonseasonal changes were measured throughout the study period. Despite oyster recruitment in fall 2010 and 2011, few if any oysters survived from the 2010 year class to 2012. At the last sampling of this project, some oysters recruited in fall 2011 survived through 2012, resulting in an on-reef density of 18.3 ± 2.1 individuals per square meter (mean size: 85.6 ± 2.2 millimeters). Because project goals were to compare reef development and provision of ecosystem services over time, as well as many of the processes identified for monitoring reflect long-term processes, results and data are presented only qualitatively, and trends or observations should be interpreted cautiously at this point. Measurable system responses to reef establishment require more time than was available for this study. These data provide a valuable baseline that can be ultimately used to help inform site selections for future restoration projects as well to further investigate the development trajectories of ecosystem provision of created reefs in this region.

Forward view: advancing health library and knowledge services in England.

PubMed

Lacey Bryant, Sue; Bingham, Helen; Carlyle, Ruth; Day, Alison; Ferguson, Linda; Stewart, David

2018-03-01

This article is the fourth in a series on New Directions. The National Health Service is under pressure, challenged to meet the needs of an ageing population, whilst striving to improve standards and ensure decision making is underpinned by evidence. Health Education England is steering a new course for NHS library and knowledge services in England to ensure access to knowledge and evidence for all decision makers. Knowledge for Healthcare calls for service transformation, role redesign, greater coordination and collaboration. To meet user expectations, health libraries must achieve sustainable, affordable access to digital content. Traditional tasks will progressively become mechanised. Alongside supporting learners, NHS librarians and knowledge specialists will take a greater role as knowledge brokers, delivering business critical services. They will support the NHS workforce to signpost patients and the public to high-quality information. There is a need for greater efficiency and effectiveness through greater co-operation and service mergers. Evaluation of service quality will focus more on outcomes, less on counting. These changes require an agile workforce, fit for the future. There is a bright future in which librarians' expertise is used to mobilise evidence, manage and share knowledge, support patients, carers and families, optimise technology and social media and provide a keystone for improved patient care and safety. © 2018 Health Libraries Group.

The role of patient experience surveys in quality assurance and improvement: a focus group study in English general practice.

PubMed

Boiko, Olga; Campbell, John L; Elmore, Natasha; Davey, Antoinette F; Roland, Martin; Burt, Jenni

2015-12-01

Despite widespread adoption of patient feedback surveys in international health-care systems, including the English NHS, evidence of a demonstrable impact of surveys on service improvement is sparse. To explore the views of primary care practice staff regarding the utility of patient experience surveys. Qualitative focus groups. Staff from 14 English general practices. Whilst participants engaged with feedback from patient experience surveys, they routinely questioned its validity and reliability. Participants identified surveys as having a number of useful functions: for patients, as a potentially therapeutic way of getting their voice heard; for practice staff, as a way of identifying areas of improvement; and for GPs, as a source of evidence for professional development and appraisal. Areas of potential change stimulated by survey feedback included redesigning front-line services, managing patient expectations and managing the performance of GPs. Despite this, practice staff struggled to identify and action changes based on survey feedback alone. Whilst surveys may be used to endorse existing high-quality service delivery, their use in informing changes in service delivery is more challenging for practice staff. Drawing on the Utility Index framework, we identified concerns relating to reliability and validity, cost and feasibility acceptability and educational impact, which combine to limit the utility of patient survey feedback. Feedback from patient experience surveys has great potential. However, without a specific and renewed focus on how to translate feedback into action, this potential will remain incompletely realized. © 2014 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Understanding the perspectives of health service staff on the Friends and Family Test.

PubMed

Leggat, Sandra G

2016-06-01

Objectives The present study was designed to determine what staff consider when asked to respond to the Friends and Family Test question. Methods Over 300 health service staff responded to an online questionnaire exploring whether they would recommend treatment at their organisation to friends and family (Friends and Family Test). Results Staff identified staff attitudes and behaviours, the busyness of the health service and quality of care as themes that affected their recommendation. A considerable number of staff also identified factors largely outside the control of the health service as influencing their response. Conclusions Majority of respondents based their perceptions on personal expectations, with smaller numbers citing personal experience and hearsay. Staff would need to see changes both in the quality of care and management practice to amend their recommendation on the Friends and Family Test. What is known about the topic? The Friends and Family Test is seen as a useful tool to gather the opinions of patients and staff on the patient experience, yet there has been little validation of this question. What does this paper add? The present study suggests that, as currently worded, the question does not reliably report staff perceptions regarding patient experience. The study illustrates that the relationship with the organisation and perceptions of effective management are linked to staff responses. What are the implications for practitioners? The Family and Friends Test question may need to be more clearly focused to gather the desired information. Improvement on this indicator is only likely to be seen when management teams are meeting the expectations of staff for good management practice.

Using cost-effectiveness estimates from survey data to guide commissioning: an application to home care.

PubMed

Forder, Julien; Malley, Juliette; Towers, Ann-Marie; Netten, Ann

2014-08-01

The aim is to describe and trial a pragmatic method to produce estimates of the incremental cost-effectiveness of care services from survey data. The main challenge is in estimating the counterfactual; that is, what the patient's quality of life would be if they did not receive that level of service. A production function method is presented, which seeks to distinguish the variation in care-related quality of life in the data that is due to service use as opposed to other factors. A problem is that relevant need factors also affect the amount of service used and therefore any missing factors could create endogeneity bias. Instrumental variable estimation can mitigate this problem. This method was applied to a survey of older people using home care as a proof of concept. In the analysis, we were able to estimate a quality-of-life production function using survey data with the expected form and robust estimation diagnostics. The practical advantages with this method are clear, but there are limitations. It is computationally complex, and there is a risk of misspecification and biased results, particularly with IV estimation. One strategy would be to use this method to produce preliminary estimates, with a full trial conducted thereafter, if indicated. Copyright © 2013 John Wiley & Sons, Ltd.

Value Assessment Study for Air quality in Regulation Services of Ecosystems Services target on NO2 using Remote sensing data

NASA Astrophysics Data System (ADS)

Jeon, S. W.; Ryu, J.; Choi, Y.; Jung, H. I.; Jang, R.; Lee, J.

2017-12-01

The purpose of this study is to evaluate the value of green space that regulates the air quality in the regulatory service classification of ecosystem services. In this study, statistical data and satellite images (GOME) were used to construct data and evaluate the control functions of the whole country. In order to evaluate the value, national economic activities are evaluated and typified based on national GDP. This is because the amount of No2 emissions and the damage caused by them are different depending on the speed and characteristics of national development. After that, regression models were made using land cover, change in urban green area ratio, NDVI (Normalised Difference Vegetation Index), increase or decrease in population, increase in urban area, altitude and slope, cardiovascular due to NO2 and respiratory population. After that, the value of green space was evaluated by applying the scenario of NO2 increase or decrease for each type. The value of green space was converted into economic value by increasing or decreasing the number of affected people and the damage amount when NO2 increased. The results of this study are expected to provide a basis for conservation of forests by assessing the value of greenery to control air quality globally.

Interacting coastal based ecosystem services: recreation and water quality in Puget Sound, WA

USGS Publications Warehouse

Kreitler, Jason; Papenfus, Michael; Byrd, Kristin; Labiosa, William

2013-01-01

Coastal recreation and water quality are major contributors to human well-being in coastal regions. They can also interact, creating opportunities for ecosystem based management, ecological restoration, and water quality improvement that can positively affect people and the environment. Yet the effect of environmental quality on human behavior is often poorly quantified, but commonly assumed in coastal ecosystem service studies. To clarify this effect we investigate a water quality dataset for evidence that environmental condition partially explains variation in recreational visitation, our indicator of human behavior. In Puget Sound, WA, we investigate variation in visitation in both visitation rate and fixed effects (FE) models. The visitation rate model relates the differences in annual recreational visitation among parks to environmental conditions, park characteristics, travel cost, and recreational demand. In our FE model we control for all time-invariant unobserved variables and compare monthly variation at the park level to determine how water quality affects visitation during the summer season. The results of our first model illustrate how visitation relates to various amenities and costs. In the FE analysis, monthly visitation was negatively related to water quality while controlling for monthly visitation trends. This indicates people are responding to changes in water quality, and an improvement would yield an increase in the value of recreation. Together, these results could help in prioritizing water quality improvements, could assist the creation of new parks or the modification of existing recreational infrastructure, and provide quantitative estimates for the expected benefits from potential changes in recreational visitation and water quality improvements. Our results also provide an example of how recreational visitation can be quantified and used in ecosystem service assessments.

Interacting Coastal Based Ecosystem Services: Recreation and Water Quality in Puget Sound, WA

PubMed Central

Kreitler, Jason; Papenfus, Michael; Byrd, Kristin; Labiosa, William

2013-01-01

Coastal recreation and water quality are major contributors to human well-being in coastal regions. They can also interact, creating opportunities for ecosystem based management, ecological restoration, and water quality improvement that can positively affect people and the environment. Yet the effect of environmental quality on human behavior is often poorly quantified, but commonly assumed in coastal ecosystem service studies. To clarify this effect we investigate a water quality dataset for evidence that environmental condition partially explains variation in recreational visitation, our indicator of human behavior. In Puget Sound, WA, we investigate variation in visitation in both visitation rate and fixed effects (FE) models. The visitation rate model relates the differences in annual recreational visitation among parks to environmental conditions, park characteristics, travel cost, and recreational demand. In our FE model we control for all time-invariant unobserved variables and compare monthly variation at the park level to determine how water quality affects visitation during the summer season. The results of our first model illustrate how visitation relates to various amenities and costs. In the FE analysis, monthly visitation was negatively related to water quality while controlling for monthly visitation trends. This indicates people are responding to changes in water quality, and an improvement would yield an increase in the value of recreation. Together, these results could help in prioritizing water quality improvements, could assist the creation of new parks or the modification of existing recreational infrastructure, and provide quantitative estimates for the expected benefits from potential changes in recreational visitation and water quality improvements. Our results also provide an example of how recreational visitation can be quantified and used in ecosystem service assessments. PMID:23451067

Digital contract approach for consistent and predictable multimedia information delivery in electronic commerce

NASA Astrophysics Data System (ADS)

Konana, Prabhudev; Gupta, Alok; Whinston, Andrew B.

1997-01-01

A pure 'technological' solution to network quality problems is incomplete since any benefits from new technologies are offset by the demand from exponentially growing electronic commerce ad data-intensive applications. SInce an economic paradigm is implicit in electronic commerce, we propose a 'market-system' approach to improve quality of service. Quality of service for digital products takes on a different meaning since users view quality of service differently and value information differently. We propose a framework for electronic commerce that is based on an economic paradigm and mass-customization, and works as a wide-area distributed management system. In our framework, surrogate-servers act as intermediaries between information provides and end- users, and arrange for consistent and predictable information delivery through 'digital contracts.' These contracts are negotiated and priced based on economic principles. Surrogate servers pre-fetched, through replication, information from many different servers and consolidate based on demand expectations. In order to recognize users' requirements and process requests accordingly, real-time databases are central to our framework. We also propose that multimedia information be separated into slowly changing and rapidly changing data streams to improve response time requirements. Surrogate- servers perform the tasks of integration of these data streams that is transparent to end-users.

Development of a business plan for women's health services, using Malcolm Baldrige Performance Excellence Criteria.

PubMed

Caramanica, L; Maxwell, S; Curry, S

2000-06-01

A new process for business planning at Hartford Hospital was needed to achieve critical business results. This article describes the Hospital's use of the Malcolm Baldrige Performance Excellence Criteria as a way to standardize and improve business planning. Women's Health Services is one of Hartford Hospital's "centers for excellence" and one of the first to use these criteria to improve its service. Staff learned how to build their business plan upon a set of core values and concepts such as customer-driven quality, leadership that sets high expectations, continuous improvement and learning, valuing employees, faster response to market demands, management by fact, and a long-range view of the future.

Multi-stakeholder perspectives in defining health-services quality in cataract care.

PubMed

Stolk-Vos, Aline C; van de Klundert, Joris J; Maijers, Niels; Zijlmans, Bart L M; Busschbach, Jan J V

2017-08-01

To develop a method to define a multi-stakeholder perspective on health-service quality that enables the expression of differences in systematically identified stakeholders' perspectives, and to pilot the approach for cataract care. Mixed-method study between 2014 and 2015. Cataract care in the Netherlands. Stakeholder representatives. We first identified and classified stakeholders using stakeholder theory. Participants established a multi-stakeholder perspective on quality of cataract care using concept mapping, this yielded a cluster map based on multivariate statistical analyses. Consensus-based quality dimensions were subsequently defined in a plenary stakeholder session. Stakeholders and multi-stakeholder perspective on health-service quality. Our analysis identified seven definitive stakeholders, as follows: the Dutch Ophthalmology Society, ophthalmologists, general practitioners, optometrists, health insurers, hospitals and private clinics. Patients, as dependent stakeholders, were considered to lack power by other stakeholders; hence, they were not classified as definitive stakeholders. Overall, 18 stakeholders representing ophthalmologists, general practitioners, optometrists, health insurers, hospitals, private clinics, patients, patient federations and the Dutch Healthcare Institute sorted 125 systematically collected indicators into the seven following clusters: patient centeredness and accessibility, interpersonal conduct and expectations, experienced outcome, clinical outcome, process and structure, medical technical acting and safety. Importance scores from stakeholders directly involved in the cataract service delivery process correlated strongly, as did scores from stakeholders not directly involved in this process. Using a case study on cataract care, the proposed methods enable different views among stakeholders concerning quality dimensions to be systematically revealed, and the stakeholders jointly agreed on these dimensions. The methods helped to unify different quality definitions and facilitated operationalisation of quality measurement in a way that was accepted by relevant stakeholders. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Ethical Perceptions of Customers Towards the Services of Foreign Branch Banks in Northern Cyprus

NASA Astrophysics Data System (ADS)

Veli Safakli, Okan

Nowadays, the ethical principles, which are institutionalized as generally accepted principles like the human rights, have become very popular in the banking sector like in many other sectors. The implementation of these principles provides public trust and reputation as well as competitive edge to the banks. The branches of the foreign banks, which have their head offices in foreign countries, are expected to be in harmony with the ethical principles more than the local banks. Therefore, ethical perceptions of customers towards the services of the foreign branch banks in Northern Cyprus have been researched in this study. According to this survey, it was found out that the foreign branch banks, generally, respect the ethical principles as expected. However, there is a necessity of institutional and administrative restructuring in the direction of improving the quality of the ethic standards used in these banks.

HEALTH WORKERS' PERCEPTIONON THE QUALITY OF SERVICE AND CORPORATE CULTURE OF A TEACHING HOSPITAL IN NIGERIA.

PubMed

Akpan, Etukumana Etiobong; Bassey, Orie Jacob

2015-01-01

Quality of service delivery remains the most important issue in hospitals since patients expect higher standard care and services. This quality service is rooted in the culture of the health care organization. Therefore,this study seeks to determine health workers' perception on the quality of service and corporate culture at University of Uyo Teaching hospital, Uyo, Nigeria. A cross-sectional descriptive study was carried out. Using structured questionnaire and convenient sampling technique, data were collected from 250 hospital workers.The responses on questions to elicit the hospital's quality of service and corporate culture were rated on a five-point Likert Scale as follows; Strongly Agree (SA), Agree (A), Neutral(N), Disagree (D) and Strongly Disagree (SD). Data entry and analysis were performed using Epi Info 3.2.2 (CDC, Atlanta, Georgia, USA). The minimum and maximum ages of the respondents were 21 years and 60 years respectively. The mean, median and mode ages in the respondents were 34.6 (± 7.88) years, 33 years, and 30 years respectively. Majority of the study respondents were in the age group of 31-40 years (30%), female (56.8%) and Doctors (36%). The respondents' positive perception on quality of service offered by the hospital was 69.2% (OR 5.05, 95% CI 3.39-7.52, P < 0.00001). The subjects' positive perception on the organization values for the individual worker was 54.4% (OR 1.42, 95% CI 0.99- 2.06, P = 0.049). However, only 43.2% of the subjects accepted that the management of the hospital was flexible and understands the important of balancing their work/personal life (OR 0.58, 95%CI 0.40-0.84), P = 0.002).Thirty-eight percentages (38%) accepted that top management of the hospital communicates changes in decisions that affect employees (OR 0.38, 95% CI 0.26-0.55), P < 0.00001). Majority of the workers in the various professions accepted that the hospital offer quality services as obtained in other hospitals. Majority of the workers in all the professions except Medical Doctors accepted that the hospital values the individual workers. Majority of the Pharmacists and Non-clinical staff accepted that the hospital management was flexible and understands the importance of balancing their work and personal life. Majority of the Doctors, Pharmacists and laboratory/image scientists did not accept that top management communicates changes in decisions that affect employees. The perception of health workers on the quality of service rendered by the University of Uyo Teaching Hospital was satisfactory. However, the hospital needs to improve on its corporate culture to achieve a higher quality of service.

Urban poor program launched.

PubMed

1991-01-01

The government of the Philippines has launched a program to deal with the rapidly growing urban poor population. 60 cities (including Metro Manila) are expected to increase their bloated population by 3.8% over 1990 which would be 27.7 million for 1991. Currently there is an exodus of people from the rural areas and by 2000 half the urban population will be squatters and slum dwellers. Basic services like health and nutrition are not expected to be able to handle this type of volume without a loss in the quality of service. The basic strategy of the new program is to recruit private medical practitioners to fortify the health care delivery and nutrition services. Currently the doctor/urban dweller ration is 1:9000. The program will develop a system to pool the efforts of government and private physicians in servicing the target population. Barangay Escopa has been chosen as the pilot city because it typifies the conditions of a highly populated urban area. The projects has 2 objectives: 1) demonstrate the systematic delivery of health and nutrition services by the private sector through the coordination of the government, 2) reduce mortality and morbidity in the community, especially in the 0-6 age group as well as pregnant women and lactating mothers.

What are the preferred characteristics of a service robot for the elderly? A multi-country focus group study with older adults and caregivers.

PubMed

Bedaf, Sandra; Marti, Patrizia; De Witte, Luc

2017-11-10

This multi-perspective study focuses on how a service robot for the elderly should behave when interacting with potential users. An existing service robot and a scenario were used as a concrete case, which was discussed and analyzed during focus group sessions with older adults (n = 38), informal caregivers (n = 24), and professional caregivers (n = 35) in the Netherlands, France, and the United Kingdom. A total of seven topics-privacy, task execution, environment, appearance, behavior, visitors, and communication-were explored. The results showed that some of the characteristics mentioned were unique to a user group, but several were cross-cutting. Overall, potential users expected the service robot to be customizable in order to match the users' needs and preferences. Also, high expectations concerning its functioning and behavior were expressed, which sometimes could even be compared to the qualities of a human being. This emphasizes the complexity of service robot development for older adults, and highlights the need for a personalized and flexible solution. One size does not fit all, and specific attention should be paid to the development of the robot's social behavior and skills beyond a mere functional support for the person.

Incentives in Rheumatology: the Potential Contribution of Physician Responses to Financial Incentives, Public Reporting, and Treatment Guidelines to Health Care Sustainability.

PubMed

Harrison, Mark; Milbers, Katherine; Mihic, Tamara; Anis, Aslam H

2016-07-01

Concerns about the sustainability of current health care expenditure are focusing attention on the cost, quality and value of health care provision. Financial incentives, for example pay-for-performance (P4P), seek to reward quality and value in health care provision. There has long been an expectation that P4P schemes are coming to rheumatology. We review the available evidence about the use of incentives in this setting and provide two emerging examples of P4P schemes which may shape the future of service provision in rheumatology. Currently, there is limited and equivocal evidence in rheumatology about the impact of incentive schemes. However, reporting variation in the quality and provision of rheumatology services has highlighted examples of inefficiencies in the delivery of care. If financial incentives can improve the delivery of timely and appropriate care for rheumatology patients, then they may have an important role to play in the sustainability of health care provision.

Patients need a strong voice in how NHS is run.

PubMed

Scott, Graham

2016-03-23

Politicians, professionals and the public would surely all agree that patients must have a say in the way they access and receive NHS care, and the opportunity to provide feedback easily on their experience. However, the reality is that patients and other service users often struggle to be heard, not least if they seek redress when the quality of care does not meet their expectations.

Early Head Start Program Strategies: Responding to the Mental Health Needs of Infants, Toddlers and Families.

ERIC Educational Resources Information Center

Zero to Three: National Center for Infants, Toddlers and Families, Washington, DC.

Each year, Early Head Start (EHS) and migrant and seasonal Head Start grantees are invited to share their experiences in providing high-quality services for expectant parents and families with infants and toddlers. This report highlights how 10 Early Head Start and Migrant and Seasonal Head Start grantees respond to mental health needs of infants,…

Information vs advertising in the market for hospital care.

PubMed

Montefiori, Marcello

2008-09-01

Recent health care reforms have introduced prospective payments and have allowed patients to choose their preferred providers. The expected outcome is efficiency in production and an increase in the quality level. The former objective should be obtained by the prospective payment scheme; the latter by the demand mechanism, through the competition between providers. Unfortunately, because of asymmetry of information, patients are unable to observe the true quality and the demand for health care services depends on a perceived quality as influenced by the hospital advertising. Inefficiency in the resource allocation and social welfare loss are the two likely effects. In this paper we show how the purchaser can implement effective policies to overcome these undesired effects.

Evaluating natural flood management measures using an ecosystem based adaptation framework: a meta-analysis

NASA Astrophysics Data System (ADS)

Iacob, Oana; Rowan, John; Brown, Iain; Ellis, Chris

2014-05-01

Climate change is projected to alter river flows and the magnitude/frequency characteristics of floods and droughts. As a result flood risk is expected to increase with environmental, social and economic impacts. Traditionally flood risk management has been heavily relying on engineering measures, however with climate change their capacity to provide protection is expected to decrease. Ecosystem-based adaptation highlights the interdependence of human and natural systems, and the potential to buffer the impacts of climate change by maintaining functioning ecosystems that continue to provide multiple societal benefits. Natural flood management measures have the potential to provide a greater adaptive capacity to negate the impacts of climate change and provide ancillary benefits. To understand the impacts of different NFM measures on ecosystem services a meta-analysis was undertaken. Twenty five studies from across the world were pulled together to assess their effectiveness on reducing the flood risk but also on other ecosystems services as defined by the UK National Ecosystem Assessment, which distinguishes between provisioning, regulating, cultural and supporting services. Four categories of NFM measures were considered: (i) afforestation measures, (ii) drainage and blocking the drains, (iii) wetland restoration and (iv) combined measures. Woodland expansion measures provide significant benefits for flood protection more pronounced for low magnitude events, but also for other services such as carbon sequestration and water quality. These measures however will come at a cost for livestock and crop provisioning services as a result of land use changes. Drainage operations and blocking the drains have mixed impacts on carbon sequestration and water quality depending on soil type, landscape settings and local characteristics. Wetland and floodplain restoration measures have generally a few disbenefits and provide improvements for regulating and supporting services. Mixed measures are expected to have cumulative benefits which are likely to outweigh disbenefits and packages of actions are recommended rather than individual or localised actions for an integrated catchment management approach. NFM measures have the potential to provide significant environmental gains, however the time lags between the moment these measures are set in place until they become effective must be considered especially in flood vulnerable communities where there is already a stakeholders demand to decrease the risk of flooding even for the current level of exposure.

Analysis of Optimal Jitter Buffer Size for VoIP QoS under WiMAX Power-Saving Mode

NASA Astrophysics Data System (ADS)

Kim, Hyungsuk; Kim, Taehyoun

VoIP service is expected as one of the key applications of Mobile WiMAX, but the speech quality of VoIP service often suffers deterioration due to the fluctuating transmission delay called jitter. This is commonly ameliorated by a de-jitter buffer, and we aim to find the optimal size of de-jitter buffer to achieve speech quality comparable to PSTN. We developed a new model of the packet drops at the de-jitter buffer and the end-to-end packet delay which takes account of the additional delay introduced by the WiMAX power-saving mode. Using our model, we analyzed the optimal size of the de-jitter buffer for various network parameters, and showed that the results obtained by analysis accord with simulation results.

Online Sellers’ Website Quality Influencing Online Buyers’ Purchase Intention

NASA Astrophysics Data System (ADS)

Shea Lee, Tan; Ariff, Mohd Shoki Md; Zakuan, Norhayati; Sulaiman, Zuraidah; Zameri Mat Saman, Muhamad

2016-05-01

The increase adoption of Internet among young users in Malaysia provides high prospect for online seller. Young users aged between 18 and 25 years old are important to online sellers because they are actively involved in online purchasing and this group of online buyers is expected to dominate future online market. Therefore, examining online sellers’ website quality and online buyers’ purchase intention is crucial. Based on the Theory of planned behavior (TPB), a conceptual model of online sellers’ website quality and purchase intention of online buyers was developed. E-tailQ instrument was adapted in this study which composed of website design, reliability/fulfillment, security, privacy & trust, and customer service. Using online questionnaire and convenience sampling procedure, primary data were obtained from 240 online buyers aged between 18 to 25 years old. It was discovered that website design, website reliability/fulfillment, website security, privacy & trust, and website customer service positively and significantly influence intention of online buyers to continuously purchase via online channels. This study concludes that online sellers’ website quality is important in predicting online buyers’ purchase intention. Recommendation and implication of this study were discussed focusing on how online sellers should improve their website quality to stay competitive in online business.

Principles of data collection applied to customer knowledge.

PubMed

Quinn, D

1992-01-01

Are customers becoming more demanding or is the state of excellence in service in the United States in decline? With the dawning of the Age of the Global Marketplace and its attendant competition, American consumers have come to expect a higher standard in products and services. They naturally choose to purchase products that have proved to be well made and reliable. In brief, they require satisfaction. Yet business and medical journals, newspapers, and books all have been eager to tell the story of the sad state of customer service. The "demands of American consumers for high-quality service are higher than ever and businesses that ignore the new realities of customer satisfaction can jeopardize not only their future sales but also their very survival" (Szabo, 1989, p. 16).

The impact of complaint management and service quality on organizational image: A case study at the Malaysian public university library

NASA Astrophysics Data System (ADS)

Tan, Pei Kian; Mohd Suradi, Nur Riza; Saludin, Mohamad Nasir

2013-04-01

Service failure frequently occurs. This affects customer expectations which lead to complaint. However, not all dissatisfied customers actually complain. Without customer feedback, it would be impossible for a company to know whether they needed a change for improvement. Thus, complaint management brings a learning experience to organization in order to provide better service. Therefore, it is important to identify customer dissatisfaction through a systematic complaint handling or management. The study proposes a model of systematic complaint management which applied to academic library as a tool of service recovery. As such, the main purpose of this study is to investigate the critical success factors of complaint management towards service quality, customer satisfaction, customer loyalty and the impact to organizational image at academic library. Three academic libraries have been identified and selected for this project, the Library of Tun Sri Lanang, UKM, UTeM and UNIMAS. Using the justice theory, this study investigates the perception of customers on complaint management in terms of outcomes they receive, procedures used by organization and interpersonal treatment. In this study, there are five factors of complaint management identified, which includes speed of recovery, management system, empowerment, culture and psychology and tangible compensation. A questionnaire was designed and used as the data gathering instrument. A total of 600 respondents participated in this study. Ten hypotheses were used to test the relationships between complaint management, service quality, customer satisfaction, customer loyalty and organizational image. To measure the construct relationships, Structural Equation Model (SEM) approach was used. The results show that management system (b = 0.210; p < 0.05) exerts the highest positive impact on service quality. It followed by psychology and culture (b = 0.188; p < 0.05), empowerment (b = 0.179; p < 0.05) and tangible compensation (b = 0.175; p < 0.05). However, the empirical results suggest that speed of recovery (b = -0.009; p > 0.05) do not influence service quality. The second part of this study uses confirmatory factor analysis (CFA) to analyze and confirm the conceptual model proposed in this research. The result shows that all the values obtained in this study fits the data reasonably well.

The psychological contract: is the UK National Health Service a model employer?

PubMed

Fielden, Sandra; Whiting, Fiona

2007-05-01

The UK National Health Service (NHS) is facing recruitment challenges that mean it will need to become an 'employer of choice' if it is to continue to attract high-quality employees. This paper reports the findings from a study focusing on allied health professional staff (n = 67), aimed at establishing the expectations of the NHS inherent in their current psychological contract and to consider whether the government's drive to make the NHS a model employer meets those expectations. The findings show that the most important aspects of the psychological contract were relational and based on the investment made in the employment relationship by both parties. The employment relationship was one of high involvement but also one where transactional contract items, such as pay, were still of some importance. Although the degree of employee satisfaction with the relational content of the psychological contract was relatively positive, there was, nevertheless, a mismatch between levels of importance placed on such aspects of the contract and levels of satisfaction, with employees increasingly placing greater emphasis on those items the NHS is having the greatest difficulty providing. Despite this apparent disparity between employee expectation and the fulfilment of those expectations, the overall health of the psychological contract was still high.

Investigating the use of patient involvement and patient experience in quality improvement in Norway: rhetoric or reality?

PubMed Central

2013-01-01

Background Patient involvement in health care decision making is part of a wider trend towards a more bottom-up approach to service planning and provision, and patient experience is increasingly conceptualized as a core dimension of health care quality. The aim of this multi-level study is two-fold: 1) to describe and analyze how governmental organizations expect acute hospitals to incorporate patient involvement and patient experiences into their quality improvement (QI) efforts and 2) to analyze how patient involvement and patient experiences are used by hospitals to try to improve the quality of care they provide. Methods This multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews and non-participant observation of key meetings and shadowing of staff at the meso and micro levels in two purposively sampled Norwegian hospitals. Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011–2012). Results Governmental documents and regulations at the macro level demonstrated wide-ranging expectations for the integration of patient involvement and patient experiences in QI work in hospitals. The expectations span from systematic collection of patients’ and family members’ experiences for the purpose of improving service quality through establishing patient-oriented arenas for ongoing collaboration with staff to the support of individual involvement in decision making. However, the extent of involvement of patients and application of patient experiences in QI work was limited at both hospitals. Even though patient involvement was gaining prominence at the meso level − and to a lesser extent at the micro level − relevant tools for measuring and using patient experiences in QI work were lacking, and available measures of patient experience were not being used meaningfully or systematically. Conclusions The relative lack of expertise in Norwegian hospitals of adapting and implementing tools and methods for improving patient involvement and patient experiences at the meso and micro levels mark a need for health care policymakers and hospital leaders to learn from experiences of other industries and countries that have successfully integrated user experiences into QI work. Hospital managers need to design and implement wider strategies to help their staff members recognize and value the contribution that patient involvement and patient experiences can make to the improvement of healthcare quality. PMID:23742265

Ontology Based Quality Evaluation for Spatial Data

NASA Astrophysics Data System (ADS)

Yılmaz, C.; Cömert, Ç.

2015-08-01

Many institutions will be providing data to the National Spatial Data Infrastructure (NSDI). Current technical background of the NSDI is based on syntactic web services. It is expected that this will be replaced by semantic web services. The quality of the data provided is important in terms of the decision-making process and the accuracy of transactions. Therefore, the data quality needs to be tested. This topic has been neglected in Turkey. Data quality control for NSDI may be done by private or public "data accreditation" institutions. A methodology is required for data quality evaluation. There are studies for data quality including ISO standards, academic studies and software to evaluate spatial data quality. ISO 19157 standard defines the data quality elements. Proprietary software such as, 1Spatial's 1Validate and ESRI's Data Reviewer offers quality evaluation based on their own classification of rules. Commonly, rule based approaches are used for geospatial data quality check. In this study, we look for the technical components to devise and implement a rule based approach with ontologies using free and open source software in semantic web context. Semantic web uses ontologies to deliver well-defined web resources and make them accessible to end-users and processes. We have created an ontology conforming to the geospatial data and defined some sample rules to show how to test data with respect to data quality elements including; attribute, topo-semantic and geometrical consistency using free and open source software. To test data against rules, sample GeoSPARQL queries are created, associated with specifications.

[The concept of quality of life in medicine: its history and current relevance].

PubMed

Bullinger, Monika

2014-01-01

This paper attempts to review 40 years of quality-of-life research. The increasing recognition of the topic is obvious from the number of publications and its representation in academic discussions. Despite a rather weak theoretical foundation, methods of quality-of-life assessment have been developed successfully. Both the number and the quality of assessment tools have increased over the years so that there is now a broad spectrum of instruments for adults and children available, which is used from epidemiological studies to health services research, and especially in quality assurance and comparative benchmarking. Assessment is still underrepresented in clinical trials, which is why only few meta-analyses and reviews are available. Also, implementation of results in recommendations for treatment and in guidelines has just started. Implications for clinical practice also relate to the patient orientation in the physician-patient communication. A future perspective is the widespread use of available instruments, provided that relevant information is gained, which depends on the study design as well as the interpretation and dissemination of results. Consequences for the healthcare systems are expected if improvements in quality of life can be attributed to benefits of treatment and surrounding services. Copyright © 2014. Published by Elsevier GmbH.

Quality-based financial incentives in health care: can we improve quality by paying for it?

PubMed

Conrad, Douglas A; Perry, Lisa

2009-01-01

This article asks whether financial incentives can improve the quality of health care. A conceptual framework drawn from microeconomics, agency theory, behavioral economics, and cognitive psychology motivates a set of propositions about incentive effects on clinical quality. These propositions are evaluated through a synthesis of extant peer-reviewed empirical evidence. Comprehensive financial incentives--balancing rewards and penalties; blending structure, process, and outcome measures; emphasizing continuous, absolute performance standards; tailoring the size of incremental rewards to increasing marginal costs of quality improvement; and assuring certainty, frequency, and sustainability of incentive payoffs--offer the prospect of significantly enhancing quality beyond the modest impacts of prevailing pay-for-performance (P4P) programs. Such organizational innovations as the primary care medical home and accountable health care organizations are expected to catalyze more powerful quality incentive models: risk- and quality-adjusted capitation, episode of care payments, and enhanced fee-for-service payments for quality dimensions (e.g., prevention) most amenable to piece-rate delivery.

Mexican immigrant mothers' expectations for children's health services.

PubMed

Clark, Lauren; Redman, Richard W

2007-10-01

Women of Mexican descent living in the United States raise children who use health care services. What do immigrant Mexican mothers expect from children's health care services? And how do their expectations for children's health services compare to acculturated Mexican American mothers' expectations? This focused ethnographic study, based on repeated interviews with 28 mothers of varying acculturation levels, describes their expectations and experiences with children's health care services in the United States. Findings support a shared core of expectations for both Mexican immigrant and Mexican American mothers, and differences in health care access and financing, time spent in health care encounters, and cultural and linguistic expectations for care. Health care providers can use this information to approach Mexican-descent mothers and children with their expectations in mind, and craft a negotiated plan of care congruent with their expectations.

Design and development of a tele-healthcare information system based on web services and HL7 standards.

PubMed

Huang, Ean-Wen; Hung, Rui-Suan; Chiou, Shwu-Fen; Liu, Fei-Ying; Liou, Der-Ming

2011-01-01

Information and communication technologies progress rapidly and many novel applications have been developed in many domains of human life. In recent years, the demand for healthcare services has been growing because of the increase in the elderly population. Consequently, a number of healthcare institutions have focused on creating technologies to reduce extraneous work and improve the quality of service. In this study, an information platform for tele- healthcare services was implemented. The architecture of the platform included a web-based application server and client system. The client system was able to retrieve the blood pressure and glucose levels of a patient stored in measurement instruments through Bluetooth wireless transmission. The web application server assisted the staffs and clients in analyzing the health conditions of patients. In addition, the server provided face-to-face communications and instructions through remote video devices. The platform deployed a service-oriented architecture, which consisted of HL7 standard messages and web service components. The platform could transfer health records into HL7 standard clinical document architecture for data exchange with other organizations. The prototyping system was pretested and evaluated in a homecare department of hospital and a community management center for chronic disease monitoring. Based on the results of this study, this system is expected to improve the quality of healthcare services.

The influence of personal belief, agency mission and city size on open space decision making processes in three southwestern cities

Treesearch

Megan Friggens; Carol Raish; Deborah Finch; Alice McSweeney

2015-01-01

The southwest has experienced dramatic population increases over the last 30 years, a trend that is expected to continue. Open space conservation is important both from the standpoint of preserving ecosystem services as well as maintaining quality of life for urban populations. Federal agencies manage a large proportion of the public land in the Southwestern U.S. We...

Factors Concerning Veterans With Dementia, Their Caregivers, and Coordination of Care: A Systematic Literature Review.

PubMed

Mileski, Michael; Scott Kruse, Clemens; Brooks, Matthew; Haynes, Christine; Collingwood, Ying; Rodriguez, Rachel

2017-11-01

Military veterans diagnosed with dementia compose a large portion of our population. Often ignored are their caregivers and their plight as well as the availability, quality, and accessibility of health care for this demographic. The purpose of this systematic literature review is three fold: to identify opportunities available to increase public awareness on the subject; to identify areas of improvement in the level of care and quality of life for our nation's veterans; and to identify if adequate resources are available to veterans with dementia and their caregivers. The authors conducted systematic searches of three databases: PubMed via The National Center for Biotechnology Information, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete via Ebson B. Stephens Company (EBSCO Host), and Google. Data were collected regarding providing care to veterans who are suffering from dementia or Alzheimer's disease and their caregivers between 2008 and June 2016. Search results were filtered by date range, full text, English language, Boolean operators, and academic journals (n = 14). The review confirmed there are many facilitators and barriers in the coordination of care offered to veterans with dementia. Facilitators of quality care include veteran's expectations, family support, program development, and the availability of services. These positive aspects are aided by several community-based support services, new technology, and preventative care. Barriers are caregiver expectations, coordination of care, providers, and informal and formal costs. These negative facets are due to lack of educational resources, an increased veteran population diagnosed with dementia, limited knowledge of resources, and limited medical service in rural areas. Overall, there are a number of community programs that want to, and can, help veterans with dementia. There are also a number of ways to help veterans with dementia cope with their issues, which include technology and preventative care. Veterans are hindered from receiving help with their dementia concerns due to most veteran's dependence on the Veterans Affairs (VA) for health services, a lack of education about possible treatments and programs, and a lack of services in rural areas. This review will prove useful to providers when evaluating the expansion of VA services and caregiver interventions. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

[Points of view: the role of quality measurement from the Federal Joint Committee's perspective].

PubMed

Klakow-Franck, Regina

2014-01-01

The Federal Joint Committee (G-BA) is a central decision-making body that issues binding directives to ensure the quality of both inpatient and outpatient health care services within the German Statutory Health Insurance system. Quality measurement on the basis of quality indicators has proceeded furthest in the field of external quality assurance (QA) of inpatient services. Originally designed for quality development in a "protected environment" through learning from better practices, it has been faced with new expectations since competitive elements have been introduced into the health care system. The economisation of medicine is de facto the driving force of the development of QA measures. In terms of health policy, the 2013 coalition agreement includes "a renaissance of the concept of quality competition". In particular, this is meant to strengthen the decision-making options of insured persons by creating more transparency into the quality of not only inpatient but also outpatient care and, if necessary, to support the possibility of selective agreements with individual health insurance funds. The campaign planned to improve the quality of hospitals also provides for a quality-oriented advancement of hospital planning and funding; and the Federal Joint Committee, supported by the new Institute for Quality Assurance and Transparency in the Healthcare System in accordance with Section 137a of Book V of the Social Code (SGB V) in the GKV-FQWG version will be assigned new tasks within this context, too. On the whole, the measures already agreed upon in the Act to Improve the Financial Structure and Quality of the Statutory Health Insurance System (GKV-FQWG) and—as far as can now be anticipated—the proceedings of the working group set up between the German government and the German federal states indicate that there is a high need to improve the methods and tools of external quality assurance available, starting with questions about the validity of the quality indicators used and their relevance to patient care. Special issues and tasks require the development of new methods and tools. The need for paying more attention to the patient perspective will pose a particular challenge to future quality measurement. Additional information about the QA documentation of health care providers and the basis of social data that should be used preferentially can be gained from patient surveys. Despite the high political expectations (for example, concerning the development of online charts comparing the quality of inpatient care delivery), the Federal Joint Committee should not overlook the necessity of embedding quality measurement and public reporting into a comprehensive quality framework which can be used to promote continuous quality improvement through a structured feedback of the results to health care providers. In addition, we need a consistent patient orientation and a systematic evaluation of the QA measures employed. By networking more closely with evidence-based medicine and health services research, quality assurance may give rise to a systematic quality research from which genuine quality and care objectives can be derived and which, as an integral part of a "learning care", supports a patient-oriented advancement of care structures. Copyright © 2014. Published by Elsevier GmbH.

Non-Hodgkin's lymphomas: clinical governance issues.

PubMed

Fields, P A; Goldstone, A H

2002-09-01

Every patient in every part of the world has the right to expect the best possible quality of care from health care providers. Non-Hodgkin's lymphomas (NHL) are an extremely heterogeneous group of conditions which require important decisions to be taken at many points along the treatment pathway. To get this right every time requires that high-quality standards are instituted and adhered to, so that the best possible outcome is achieved. In the past this has not always been the case because of the failure of clinicians sometimes to adhere to an optimal management plan. In 1995, the UK government commissioned an inquiry into the running of cancer services in the United Kingdom, which culminated in a series of recommendations to improve them. Subsequently, these recommendations were implemented as objectives of the NHS Cancer Plan which is the framework by which the UK government wishes to improve cancer services. Concurrently another general concept has emerged which is designed to ensure that the highest quality standards may be achieved for all patients across the whole National Health Service (NHS). This concept, termed 'clinical governance', brings together a corporate responsibility of all health care workers to deliver high quality standards, in the hope that this will translate into better long-term survival of patients with malignant disease. This chapter focuses on the issues surrounding clinical governance and how the principles of this concept relate to non-Hodgkin's lymphomas.

Middle School Teacher Misconceptions and Anxieties Concerning Space Science Disciplinary Core Ideas in NGSS

NASA Astrophysics Data System (ADS)

Larsen, Kristine

2017-01-01

The Disciplinary Core Ideas (DCI) of the Next Generation Science Standards (NGSS) are grouped into the broad disciplinary areas of Physical Sciences, Life Sciences, Earth and Space Sciences, and Engineering, Technology and Application of Science, and feature learning progressions based on endpoint targets for each grade band. Since the Middle School DCIs build on the expected learning achievements to be reached by the end of Fifth Grade, and High School DCI similarly build on the expected learning achievements expected for the end of Eighth Grade, the Middle School grade band is of particular importance as the bridge between the Elementary and High School curriculum. In states where there is not a special Middle School Certification many of these science classes are taught by teachers prepared to teach at the Elementary level (and who may have limited content background). As a result, some pre-service and in-service teachers have expressed reduced self-confidence in both their own science content knowledge and their ability to apply it in the NGSS-based classroom, while decades of research has demonstrated the pervasiveness of science misconceptions among teachers. Thus the adoption of NGSS has the potential to drive talented teachers out of the profession who feel that they are ill-prepared for this sweeping transition. The key is providing rigorous education in both content and pedagogy for pre-service teachers and quality targeted professional development for in-service teachers. This report focuses on the Middle School Space Sciences grade band DCIs and presents research on specific difficulties, misconceptions and uncertainties with the material demonstrated by pre-service education students over the past four years in a required university science content course, as well as two year-long granted workshop series for current Middle School teachers. This information is relevant to the development of both new content courses aligned with NGSS for pre-service teachers and professional development for in-service teachers.

A tripartite regulation of health networks.

PubMed

Weil, T P; Jorgensen, N E

1996-01-01

With the Republicans in power, market-driven forces of managed care plans, capitated payment, and the regional networks (alliances) are likely to serve as centerpieces for improving the organization, financing, and delivery of our nation's health services. These "voluntary" alliances of health providers and health insurance underwriters foreshadow the powerful, geographically linked regional health networks that are now becoming oligopolies. As a result of these providers developing monopolistic practices, state health services commissions will be formed to regulate market share, the scope of health services, reimbursement rates, and profits. State departments of public health will continue to focus on broader community health initiatives such as access and quality. Complexities of relationships among those regulated by these responsible agencies, and the interfacing of these state health services commissions and state departments of public health and insurance, with their potentially conflicting goals and political forces, are expected.

A proposed simulation optimization model framework for emergency department problems in public hospital

NASA Astrophysics Data System (ADS)

Ibrahim, Ireen Munira; Liong, Choong-Yeun; Bakar, Sakhinah Abu; Ahmad, Norazura; Najmuddin, Ahmad Farid

2015-12-01

The Emergency Department (ED) is a very complex system with limited resources to support increase in demand. ED services are considered as good quality if they can meet the patient's expectation. Long waiting times and length of stay is always the main problem faced by the management. The management of ED should give greater emphasis on their capacity of resources in order to increase the quality of services, which conforms to patient satisfaction. This paper is a review of work in progress of a study being conducted in a government hospital in Selangor, Malaysia. This paper proposed a simulation optimization model framework which is used to study ED operations and problems as well as to find an optimal solution to the problems. The integration of simulation and optimization is hoped can assist management in decision making process regarding their resource capacity planning in order to improve current and future ED operations.

Disease management: a leap of faith to lower-cost, higher-quality health care.

PubMed

Short, Ashley; Mays, Glen; Mittler, Jessica

2003-10-01

With managed care's promise to reduce costs and improve quality waning, employers and health plans are exploring more targeted ways to control rapidly rising health costs. Disease management programs, which focus on patients with chronic conditions such as asthma and diabetes, are growing in popularity, according to findings from the Center for Studying Health System Change's (HSC) 2002-03 site visits to 12 nationally representative communities. In addition to condition-based disease management programs, some health plans and employers are using intensive case management services to coordinate care for high-risk patients with potentially costly and complex medical conditions. Despite high expectations, evidence of both disease management and case management programs' success in controlling costs and improving quality remains limited.

Expectations of support among White British and Asian-Indian older people in Britain: the interdependence of formal and informal spheres.

PubMed

Sin, Chih Hoong

2006-05-01

Abstract The discourse surrounding community care characterises informal support being superior to and preferred over formal sources of support, with this distinction buttressed by policy changes. There is a lack of understanding of the interdependence of both spheres of support. This article argues that an individual's experience and expectation of one type of support is often made in relation to his or her understanding, expectation and experience of other sources of support. There is also an urgent need to understand how these associations operate in a cross-cultural context as it is naïve to assume that normative expectations will remain constant when the relationship between family, state and other sources of support are unstable. This article reports on findings emerging from part of a Growing Older study funded by the Economic and Social Research Council of Great Britain to explore the relationship between quality of life and the social networks and support of older people from different ethnic groups. Research involved the use of a questionnaire comprising closed- and open-ended questions. In addition, in-depth qualitative interviews covering the existence and nature of social networks and support, as well as perceptions and expectations of these, were also conducted. This article reports on data relating to a sample comprising seven White British men, 10 White British women, 12 Asian-Indian men, and nine Asian-Indian women aged 55 and over derived from the Family Resources Survey. Findings reveal that the high level of expectation for family support amongst Asian-Indian respondents coexists with a high level of expectation for state support and an acknowledgement that the ideal of family support may not always materialise. Amongst White British respondents, the high level of expectation for state support exists regardless of whether the respondent has satisfactory informal social networks. This expectation is commonly expressed in terms of rights and entitlement by White British respondents but not by Asian-Indians. Associated with this, Asian-Indian respondents display a consistently lower level of awareness and usage of a range of health and social care services. Regardless of the extent of current and past usage of services, however, respondents from both groups overwhelmingly indicate an expectation for the continued provision of such services as they would like to be able to use one or more of these at some stage.

Open Access Data Centers as an Essential Partner to a Data Publication Journal

NASA Astrophysics Data System (ADS)

Carlson, D.; Pfeiffenberger, H.

2016-12-01

The success of Earth System Science Data derives in part from key infrastructure: digital object identifiers (doi) and open access data centers. Our concept that a data journal should promote access and exchange through publication of reviewed data descriptions presupposed third parties to hold the data. As minimum criteria for those data centers we expected international reputation for quality of service and an active lifetime extending at least a decade into the future. We also expected modern access interfaces offering geographic, topical and parameter-based browsing - so that users could discover related holdings through an ESSD link or discover ESSD by way of links in data sets revealed through the center's browse tools - and true open access. True open access means one or two clicks from abstract in ESSD to the data itself without barriers. We started with Pangaea and CDIAC. Data providers already used these centers, the staff welcomed the ESSD initiative and all parties cooperated on doi. With this initial support ESSD proved the basic concept of data publication and demonstrated utility to a larger group of data providers, many of whom suggested additional centers. So long as those data centers met expectations for open access and quality and durability of service, ESSD agreed to collaborate. Through back-door collaborations - e.g. service on particular data sets - ESSD developed working partnerships with more than 30 data centers in 13 countries. Data centers ask to join our list. We encourage those centers to stimulate local providers to submit a data set to ESSD, thus preserving our practical data-set by data-set partnership mode. For a few data centers where national policies impose a registration step, center staff and ESSD editors created bypass access routes to facilitate anonymous reviews. For ESSD purposes, open access and doi cooperation leading to reliable curation allows a win, win, win partnership among centers, providers, and journal.

Quality of reproductive health services at commune health stations in Viet Nam: implications for national reproductive health care strategy.

PubMed

Ngo, Anh D; Hill, Peter S

2011-05-01

This paper presents a qualitative study conducted in 2009 of provider and patient perceptions of primary level reproductive health services provided by commune health stations (CHSs), and the implications for Viet Nam's 2011-2020 National Strategy for Reproductive Health Care. In the three provinces of Thai Nguyen, Thua Thien Hue, and Vinh Long, we interviewed the heads of CHSs, held focus group discussions with midwives and women patients, and observed facilities. Half the 30 CHSs visited were in poor physical condition; the rest were newly renovated. However, the model of service delivery was largely unchanged from ten years before. Many appeared to fall short in meeting patient expectations in terms of modern medical equipment and technology, range of drug supplies, and levels of staff expertise. As a result, many women were turning to private doctors and public hospitals, at least in urban areas, or seeking medication from pharmacies. To make CHS clinics sustainable, promotion of access to reproductive health services should be undertaken concurrently with quality improvement. A responsive payment scheme must also be developed to generate revenues. Efforts should be made to reduce the unnecessary use of more costly services from private clinics and higher level public facilities. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Developing an active emergency medical service system based on WiMAX technology.

PubMed

Li, Shing-Han; Cheng, Kai-An; Lu, Wen-Hui; Lin, Te-Chang

2012-10-01

The population structure has changed with the aging of population. In the present, elders account for 10.63% of the domestic population and the percentage is still gradually climbing. In other words, the demand for emergency services among elders in home environment is expected to grow in the future. In order to improve the efficiency and quality of emergency care, information technology should be effectively utilized to integrate medical systems and facilities, strengthen human-centered operation designs, and maximize the overall performance. The improvement in the quality and survival rate of emergency care is an important basis for better life and health of all people. Through integrated application of medical information systems and information communication technology, this study proposes a WiMAX-based emergency care system addressing the public demands for convenience, speed, safety, and human-centered operation of emergency care. This system consists of a healthcare service center, emergency medical service hospitals, and emergency ambulances. Using the wireless transmission capability of WiMAX, patients' physiological data can be transmitted from medical measurement facilities to the emergency room and emergency room doctors can provide immediate online instructions on emergency treatment via video and audio transmission. WiMAX technology enables the establishment of active emergency medical services.

Video teleconsultation service: who is needed to do what, to get it implemented in daily care?

PubMed

Visser, Jacqueline J W; Bloo, J K C; Grobbe, F A; Vollenbroek-Hutten, M M R

2010-05-01

In telemedicine, technology is used to deliver services. Because of this, it is expected that various actors other than those involved in traditional care are involved in and need to cooperate, to deliver these services. The aim of this study was to establish a clear understanding of these actors and their roles and interrelationships in the delivery of telemedicine. A video teleconsultation service is used as a study case. A business modeling approach as described in the Freeband Business Blueprint Method was used. The method brings together the four domains that make up a business model, that is, service, technology, organization, and finance, and covers the integration of these domains. The method uses several multidisciplinary workshops, addressing each of the four domains. Results of the four domains addressed showed that (1) the video teleconsultation service is a store and put-forward video teleconsult for healthcare providers. The service is accepted and has added value for the quality of care. However, the market is small; (2) the technology consists of a secured Internet Web-based application, standard personal computer, broadband Internet connection, and a digital camera; (3) a new role and probably entity, responsible for delivering the integrated service to the healthcare professionals, was identified; and finally (4) financial reimbursement for the service delivery is expected to be most successful when set up through healthcare insurance companies. Pricing needs to account for the fee of healthcare professionals as well as for technical aspects, education, and future innovation. Implementation of the video teleconsult service requires multidisciplinary cooperation and integration. Challenging aspects are the small market size and the slow implementation speed, among others. This supports the argument that accumulation of several telemedicine applications is necessary to make it financially feasible for at least some of the actors.

Lessons from bad general practice *

PubMed Central

Wilkes, Eric

1975-01-01

The paucity of resources for general practice correlates well with high losses through emigration and questions the expensive over-production of doctors now being undertaken. The variable quality of community care and the absence of a structure yet providing real planning or capital, leads to the uneconomic abuse of hospital facilities and to an excessive emphasis on institutionalisation. Medicine is becoming depersonalised because unrealistic expectations lead to an overloading of the service. Simultaneously we allocate a low priority to education in the use of the service, have little training in the sociological aspects of medical care, and even less in how best to use the skills of our non-medical professional colleagues. PMID:1177214

Physical soil quality indicators for monitoring British soils

NASA Astrophysics Data System (ADS)

Corstanje, Ron; Mercer, Theresa G.; Rickson, Jane R.; Deeks, Lynda K.; Newell-Price, Paul; Holman, Ian; Kechavarsi, Cedric; Waine, Toby W.

2017-09-01

Soil condition or quality determines its ability to deliver a range of functions that support ecosystem services, human health and wellbeing. The increasing policy imperative to implement successful soil monitoring programmes has resulted in the demand for reliable soil quality indicators (SQIs) for physical, biological and chemical soil properties. The selection of these indicators needs to ensure that they are sensitive and responsive to pressure and change, e.g. they change across space and time in relation to natural perturbations and land management practices. Using a logical sieve approach based on key policy-related soil functions, this research assessed whether physical soil properties can be used to indicate the quality of British soils in terms of their capacity to deliver ecosystem goods and services. The resultant prioritised list of physical SQIs was tested for robustness, spatial and temporal variability, and expected rate of change using statistical analysis and modelling. Seven SQIs were prioritised: soil packing density, soil water retention characteristics, aggregate stability, rate of soil erosion, depth of soil, soil structure (assessed by visual soil evaluation) and soil sealing. These all have direct relevance to current and likely future soil and environmental policy and are appropriate for implementation in soil monitoring programmes.

The role of Imaging and Radiation Oncology Core for precision medicine era of clinical trial

PubMed Central

Rosen, Mark

2017-01-01

Imaging and Radiation Oncology Core (IROC) services have been established for the quality assurance (QA) of imaging and radiotherapy (RT) for NCI’s Clinical Trial Network (NCTN) for any trials that contain imaging or RT. The randomized clinical trial is the gold standard for evidence-based medicine. QA ensures data quality, preventing noise from inferior treatments obscuring clinical trial outcome. QA is also found to be cost-effective. IROC has made great progress in multi-institution standardization and is expected to lead QA standardization, QA science in imaging and RT and to advance quality data analysis with big data in the future. The QA in the era of precision medicine is of paramount importance, when individualized decision making may depend on the quality and accuracy of RT and imaging. PMID:29218265

Evaluation of Spine Health and Spine Mechanics in Service Members with Traumatic Lower Extremity Amputation or Injury

DTIC Science & Technology

2016-10-01

LBP risk. Using a novel set of clinical, experimental, and computational methods, we expect to demonstrate a positive association between abnormal ...this will reduce the substantial economic costs associated with its treatment and promote enhancements in psychological health and overall quality of...implicit integration algorithm inside an FE software (ABAQUS, Version 6.13, Dassault Systemes Simulia, Providence, RI). The outputs of equations of

Generation Y in healthcare: leading millennials in an era of reform.

PubMed

Piper, Llewellyn E

2012-01-01

The healthcare workforce has grown with the addition of a new group of physicians, nurses, allied health professionals, administrators, and support staff who belong to America's youngest generation now in the workforce-generation Y, or the millennials. This generation consists of more than 70 million people, the oldest of whom are now in their late 20s and early 30s. With traits and workplace expectations that differ from those observed in other generations, and with a size that threatens to overtake the total number of baby boomers, generation Yers are positioned to influence (if not drastically change) current leadership approaches. The common traits that define or are associated with generation Y workers are often regarded as barriers yet provide healthcare leaders with a clear guide to understanding these employees and drawing out their best qualities and performance. For the organization to fulfill its social contract to provide high-quality, cost-effective, and safe healthcare, it must satisfy the needs and manage the expectations of those who directly deliver these services. This is especially important in today's environment, which is marked by the still-fluid stipulations of the Affordable Care Act (ACA), changed consumer expectations, and public demands for transparency and accountability.

Near Real Time Operational Satellite Ocean Color Products From NOAA OSPO CoastWatch Okeanos System:: Status and Challenges

NASA Astrophysics Data System (ADS)

Banghua Yan, B.

2016-02-01

Near real-time (NRT) ocean color (OC) satellite operation products are generated and distributed in NOAA Okeanos Operational Product System, by using the CWAPS including the Multi-Sensor Level (MSL) 12 and the chlorophyll-a frontal algorithms. Current OC operational products include daily chlorophyll concentration (anomaly), water turbidity, remote sensing reflectance and chlorophyll frontal products from Moderate-resolution Imaging Spectroradiometer (MODIS)/Aqua. The products have been widely applied to USA local and state ecosystem research, ecosystem observations, and fisheries managements for coastal and regional forecasting of ocean water quality, phytoplankton concentrations, and primary production. Users of the products have the National Ocean Service, National Marine Fisheries Service, National Weather Service, and Oceanic and Atmospheric Research. Recently, the OC products are being extended to S-NPP VIIRS to provide global NRT ocean color products to user community suh as National Weatrher Service for application for Global Data Assimilation System and Real-Time Ocean Forecast System. However, there remain some challenges in application of the products due to certain product quality and coverage issues. Recent efforts were made to provide a comprehensive web-based Quality Assurance (QA) tool for monitoring OC products quality in near real time mode, referring to http://www.ospo.noaa.gov/Products/ocean/color_new/color.htm. The new QA monitoring tool includes but not limited to the following advanced features applicable for MODIS/Aqua and NPP/VIIRS OC products: 1) Monitoring product quality in NRT mode; 2) Monitoring the availability and quality of OC products with time; 3) Detecting anomalous OC products due to low valid pixels and other quality issues. As an example, potential application and challenges of the ocean color products to oceanic oil spill detection are investigated. It is thus expected that the Okeanos ocean color operational system in combination with the new QA monitoring tool will more efficiently ensure availability and quality of satellite operational OC products from Okeanos system to the user community. The QA tool also will provide much useful information of OC products quality and statistics to the OC user community.

Prior health expenditures and risk sharing with insurers competing on quality.

PubMed

Marchand, Maurice; Sato, Motohiro; Schokkaert, Erik

2003-01-01

Insurers can exploit the heterogeneity within risk-adjustment classes to select the good risks because they have more information than the regulator on the expected expenditures of individual insurees. To counteract this cream skimming, mixed systems combining capitation and cost-based payments have been adopted that do not, however, generally use the past expenditures of insurees as a risk adjuster. In this article, two symmetric insurers compete for clients by differentiating the quality of service offered to them according to some private information about their risk. In our setting it is always welfare improving to use prior expenditures as a risk adjuster.

GPCRM: a homology modeling web service with triple membrane-fitted quality assessment of GPCR models.

PubMed

Miszta, Przemyslaw; Pasznik, Pawel; Jakowiecki, Jakub; Sztyler, Agnieszka; Latek, Dorota; Filipek, Slawomir

2018-05-21

Due to the involvement of G protein-coupled receptors (GPCRs) in most of the physiological and pathological processes in humans they have been attracting a lot of attention from pharmaceutical industry as well as from scientific community. Therefore, the need for new, high quality structures of GPCRs is enormous. The updated homology modeling service GPCRM (http://gpcrm.biomodellab.eu/) meets those expectations by greatly reducing the execution time of submissions (from days to hours/minutes) with nearly the same average quality of obtained models. Additionally, due to three different scoring functions (Rosetta, Rosetta-MP, BCL::Score) it is possible to select accurate models for the required purposes: the structure of the binding site, the transmembrane domain or the overall shape of the receptor. Currently, no other web service for GPCR modeling provides this possibility. GPCRM is continually upgraded in a semi-automatic way and the number of template structures has increased from 20 in 2013 to over 90 including structures the same receptor with different ligands which can influence the structure not only in the on/off manner. Two types of protein viewers can be used for visual inspection of obtained models. The extended sortable tables with available templates provide links to external databases and display ligand-receptor interactions in visual form.

Cell phone short messaging service (SMS) for HIV/AIDS in South Africa: a literature review.

PubMed

Mukund Bahadur, Khatry-Chhetry; Murray, Peter J

2010-01-01

The HIV/AIDS pandemic is one of the most serious threats to global health. HIV/AIDS is a chronic illness, requiring patient empowerment to enhance adherence to treatment regimes if it is to be managed effectively. While healthcare costs are rising, people still have expectations of high-quality care. This literature review-based study explored the use of cell phone (mobile phone) short messaging services (SMS) in health care, in particular for HIV/AIDS in South Africa. From an initial corpus of 212 papers, 28 were reviewed. The main findings include that SMS can improve service delivery through appointment reminders and improve communication between healthcare workers. It improves diagnosis, prevention, treatment and rehabilitation by supporting adherence to medication, and monitoring illness and medical interventions. SMS is useful in public health programmes, such as contact tracing and partner notification, therefore playing an important role in control of HIV/AIDS. As South Africa has one of the highest uptakes and demographic distributions of cellular technology in the world, SMS is feasible as a tool to deliver quality health care with low cost.

[The subjective quality of life of patients with schizophrenia: influence of psychopathology and patients' expectations. A comparative study].

PubMed

Salomé, F; Petitjean, F; Germain, C; Demant, J-C

2004-01-01

Most studies on the quality of life (Qol) of patients with schizophrenia deal with objective living conditions and how they are perceived by hospitalized patients. The few studies that compare Qol for patients treated in part time services with the Qol of ambulatory patients do not show any significant difference in terms of subjective Qol. Some stu-dies evaluate the influence of psychopathology and needs (or expectations) on the subjective Qol in these groups of patients. Available data indicate that the general well-being is influenced by psychopathology (positive, negative or depressive symptoms) and unmet needs in ambulatory patients. They also show that subjective Qol in certain life domains (social relations, family relations, leisure, health, law and security) is influenced by negative symptoms, anxiety and depression in patients treated in part-time services. The aim of this study is to compare the objective and subjective Qol of patients with schizophrenia treated in part time services (day hospital and day care center) to the Qol of out-patients treated on a purely ambulatory basis (out patient clinic). We studied the Qol of 2 groups of 30 patients with schizophrenia (ICD 10 criteria) treated in various centers. The first group was made of ambulatory patients, the second one was constituted of patients treated in a day hospital or a day care center. Patients were matched for age, duration of illness, number of hospitalizations. The instruments used for rating were the following: Clinical Global Impression (CGI), Global Assessment of Functioning (GAF), Positive And Negative Symptoms Scale (PANSS), Drug Attitude Inventory (DAI-10). The Qol was measured with a french version of the Lancashire Quality Of Life Profile (LQOLP) (Salomé, Germain, Petitjean, Demant and Boyer, 2000). This instrument measures the objective Qol as well as the subjective Qol. It does possess satisfying psychometric properties and offers the possibility to establish Qol profiles. All Qol ratings were carried out by a clinician who was not involved in the treatment of the patients. When the 2 groups are compared our results indicate that ambulatory patients are less symptomatic, have a better level of functioning and a better objective Qol in such domains as: finances, living situation, family relations and health. There is no significant difference in terms of anxiety and depression as measured by the respective items of the PANSS. Patients treated in part-time services present higher scores of positive symptoms. Our results indicate that there is no significant difference for subjective Qol variables between the two groups, except for general well-being, that tends to be higher in ambulatory patients. When exploring the influence of clinical data on the Qol in each group, we find negative correlations in ambulatory patients between various domains of subjective Qol and illness severity (law and security, family relations, social relations, general well-being), global functioning (family relations, social relation, health) and positive symptoms (living conditions, law and security, family relations, social relations, health). In this same group, the subjective Qol for family relations is significantly correlated with several expectations in terms of Qol improvement (leisure, social relations, family relations, transport, work). In these patients, the subjective Qol for social relations is also significantly correlated with their expectations in terms of Qol improvement (work, money, lodging, affective relations, transport). There is no significant correlation between subjective Qol and expectations in patients treated in part-time services. Our results indicate that part time services treat schizophrenic patients with a lower level of global functioning and a higher level of symptom severity compared with ambulatory patients. These results confirm other studies that show no significant difference between these 2 groups in terms of subjective Qol. The subjective Qol in the field of relations (family and social) in ambulatory patients seems particularly sensitive to illness severity, positive symptoms and global functioning level. This has also been reported by other studies. In patients treated in part-time services, the subjective Qol, particularly for living conditions and security, seems sensitive to anxiety and depression. This has also been shown by other studies. Finally, our results underline the importance of patients' expectations in terms of subjective Qol, particularly in the field of relations (family and social) for ambulatory patients.

Ethnicity matters: the experiences of minority groups in public health programs.

PubMed

Pardasani, Manoj; Bandyopadhyay, Subir

2014-01-01

The minority population in the US is expected to overtake the nonHispanic Caucasian population by 2050. Compounding this demographic shift are the significant disparities between Caucasian and non Caucasian groups especially with regard to income, living standards, health and access to healthcare and vital services. Thus, healthcare and social service programs are being charged with identifying barriers and providing effective, culturally competent care to reduce these disparities in health and quality of life. But the issue of poverty and access is global and disparities affect communities worldwide. The purpose of this cross-sectional study is to assess the service concerns of 137 low-income or poor consumers receiving healthcare and social services in publicly funded facilities. Utilizing a modified cultural competence assessment tool, this study evaluates the impact of race/ethnicity on the experiences of receiving vital services and identifies factors that impact the help-seeking decisions made by consumers. Recommendations for practitioners and organizations to help promote effective models of services for a vulnerable, diverse population are provided.

Use of hospital data for Safe Motherhood programmes in south Kalimantan, Indonesia.

PubMed

Ronsmans, C; Achadi, E; Sutratikto, G; Zazri, A; McDermott, J

1999-07-01

The evaluation of Safe Motherhood programmes has been hampered by difficulties in measuring the preferred outcomes of maternal mortality and morbidity. The need for adequate indicators has led researchers and programme managers alike to resort to indicators of utilization and quality of health services. In this study we assess the magnitude of four indicators of use of essential obstetric care (EOC) and one indicator of quality of care in health facilities in three districts in South Kalimantan, Indonesia. The general picture which emerges for South Kalimantan is that the use of obstetric services is low. Even in the more urban district of Banjar where facility-based coverage is highest, fewer than 14% of all deliveries take place in an EOC facility, 2% of expected births are admitted to such a facility with a major obstetric intervention (MOI), and 1% of expected births have an MOI for an absolute maternal indication. The use of facility-based EOC is consistently lower in Barito Kuala compared to the other districts, and the differences persist regardless of the indicators used. In this setting with low utilization rates, general rates of utilization of EOC facilities seem to be as satisfactory an indicator of relative access to EOC as more elaborate indicators specifying the reasons for admission. The inequalities in access to care revealed by the various indicators of use of EOC services may prove to be a more powerful stimulus for change than the widely reported and highly inaccurate accounts of the high levels of maternal mortality.

Postgraduate students experience in research supervision

NASA Astrophysics Data System (ADS)

Mohamed, Hazura; Judi, Hairulliza Mohamad; Mohammad, Rofizah

2017-04-01

The success and quality of postgraduate education depends largely on the effective and efficient supervision of postgraduate students. The role of the supervisor becomes more challenging with supervisory expectations rising high quality graduates. The main objective of this study was to examine the experiences of postgraduate students towards supervisory services for the duration of their studies. It also examines whether supervisory experience varies based on demographic variables such as level of study and nationality. This study uses a quantitative approach in the form of survey. Questionnaires were distributed to 96 postgraduate students of the Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia. Data collected were analyzed using Statistical Package for the Social Science (SPSS 23.0) to get the frequency, mean and standard deviation. T-test was used to find the difference between demographic variables and supervisory experience. The findings overall showed that postgraduate students gave positive response to the supervisory services. However, there were differences supervisory experiences based on the level of study and nationality. The results of this study hope the parties involved could provide a better support to improve the quality of supervision.

Using standard treatment protocols to manage costs and quality of hospital services.

PubMed

Meyer, J W; Feingold, M G

1993-06-01

The current health care environment has made it critically important that hospital costs and quality be managed in an integrated fashion. Promised health care reforms are expected to make cost reduction and quality enhancement only more important. Traditional methods of hospital cost and quality control have largely been replaced by such approaches as practice parameters, outcomes measurement, clinical indicators, clinical paths, benchmarking, patient-centered care, and a focus on patient selection criteria. This Special Report describes an integrated process for strategically managing costs and quality simultaneously, incorporating key elements of many important new quality and cost control tools. By using a multidisciplinary group process to develop standard treatment protocols, hospitals and their medical staffs address the most important services provided within major product lines. Using both clinical and financial data, groups of physicians, nurses, department managers, financial analysts, and administrators redesign key patterns of care within their hospital, incorporating the best practices of their own and other institutions. The outcome of this process is a new, standardized set of clinical guidelines that reduce unnecessary variation in care, eliminate redundant interventions, establish clear lines of communication for all caregivers, and reduce the cost of each stay. The hospital, medical staff, and patients benefit from the improved opportunities for managed care contracting, more efficient hospital systems, consensus-based quality measures, and reductions in the cost of care. STPs offer a workable and worthwhile approach to positioning the hospital of the 1990s for operational efficiency and cost and quality competitiveness.

A hybrid health service accreditation program model incorporating mandated standards and continuous improvement: interview study of multiple stakeholders in Australian health care.

PubMed

Greenfield, David; Hinchcliff, Reece; Hogden, Anne; Mumford, Virginia; Debono, Deborah; Pawsey, Marjorie; Westbrook, Johanna; Braithwaite, Jeffrey

2016-07-01

The study aim was to investigate the understandings and concerns of stakeholders regarding the evolution of health service accreditation programs in Australia. Stakeholder representatives from programs in the primary, acute and aged care sectors participated in semi-structured interviews. Across 2011-12 there were 47 group and individual interviews involving 258 participants. Interviews lasted, on average, 1 h, and were digitally recorded and transcribed. Transcriptions were analysed using textual referencing software. Four significant issues were considered to have directed the evolution of accreditation programs: altering underlying program philosophies; shifting of program content focus and details; different surveying expectations and experiences and the influence of external contextual factors upon accreditation programs. Three accreditation program models were noted by participants: regulatory compliance; continuous quality improvement and a hybrid model, incorporating elements of these two. Respondents noted the compatibility or incommensurability of the first two models. Participation in a program was reportedly experienced as ranging on a survey continuum from "malicious compliance" to "performance audits" to "quality improvement journeys". Wider contextual factors, in particular, political and community expectations, and associated media reporting, were considered significant influences on the operation and evolution of programs. A hybrid accreditation model was noted to have evolved. The hybrid model promotes minimum standards and continuous quality improvement, through examining the structure and processes of organisations and the outcomes of care. The hybrid model appears to be directing organisational and professional attention to enhance their safety cultures. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Physician clinical alignment and integration: a community-academic hospital approach.

PubMed

Salas-Lopez, Debbie; Weiss, Sandra Jarva; Nester, Brian; Whalen, Thomas

2014-01-01

An overwhelming need for change in the U.S. healthcare delivery system, coupled with the need to improve clinical and financial outcomes, has prompted hospitals to direct renewed efforts toward achieving high quality and cost-effectiveness. Additionally, with the dawn of accountable care organizations and increasing focus on patient expectations, hospitals have begun to seek physician partners through clinical alignment. Contrary to the unsuccessful alignment strategies of the 1990s, today's efforts are more mutually beneficial, driven by the need to achieve better care coordination, increased access to infrastructure, improved quality, and lower costs. In this article, we describe a large, academic, tertiary care hospital's approach to developing and implementing alignment and integration models with its collaboration-ready physicians and physician groups. We developed four models--short of physicians' employment with the organization--tailored to meet the needs of both the physician group and the hospital: (1) medical directorship (group physicians are appointed to serve as medical directors of a clinical area), (2) professional services agreement (specific clinical services, such as overnight admissions help, are contracted), (3) co-management services agreement (one specialty group co-manages all services within the specialty service lines), and (4) lease arrangement (closest in scope to employment, in which the hospital pays all expenses and receives all revenue). Successful hospital-physician alignment requires careful planning and the early engagement of legal counsel to ensure compliance with federal statutes. Establishing an integrated system with mutually identified goals better positions hospitals to deliver cost-effective and high-quality care under the new paradigm of healthcare reform.

Access to timely formal dementia care in Europe: protocol of the Actifcare (ACcess to Timely Formal Care) study.

PubMed

Kerpershoek, Liselot; de Vugt, Marjolein; Wolfs, Claire; Jelley, Hannah; Orrell, Martin; Woods, Bob; Stephan, Astrid; Bieber, Anja; Meyer, Gabriele; Engedal, Knut; Selbaek, Geir; Handels, Ron; Wimo, Anders; Hopper, Louise; Irving, Kate; Marques, Maria; Gonçalves-Pereira, Manuel; Portolani, Elisa; Zanetti, Orazio; Verhey, Frans

2016-08-23

Previous findings indicate that people with dementia and their informal carers experience difficulties accessing and using formal care services due to a mismatch between needs and service use. This mismatch causes overall dissatisfaction and is a waste of the scarce financial care resources. This article presents the background and methods of the Actifcare (ACcess to Timely Formal Care) project. This is a European study aiming at best-practice development in finding timely access to formal care for community-dwelling people with dementia and their informal carers. There are five main objectives: 1) Explore predisposing and enabling factors associated with the use of formal care, 2) Explore the association between the use of formal care, needs and quality of life and 3) Compare these across European countries, 4) Understand the costs and consequences of formal care services utilization in people with unmet needs, 5) Determine the major costs and quality of life drivers and their relationship with formal care services across European countries. In a longitudinal cohort study conducted in eight European countries approximately 450 people with dementia and informal carers will be assessed three times in 1 year (baseline, 6 and 12 months). In this year we will closely monitor the process of finding access to formal care. Data on service use, quality of life and needs will be collected. The results of Actifcare are expected to reveal best-practices in organizing formal care. Knowledge about enabling and predisposing factors regarding access to care services, as well as its costs and consequences, can advance the state of the art in health systems research into pathways to dementia care, in order to benefit people with dementia and their informal carers.

Small rural maternity units without caesarean delivery capabilities: is it safe and sustainable in the eyes of health professionals in Tasmania?

PubMed

Hoang, Ha; Le, Quynh; Kilpatrick, Sue

2012-01-01

In Australia, over 50% of small rural maternity units have been closed in the past two decades. Workforce shortages, safety and quality concerns and cost considerations are the three interrelated reasons that have led to these closures. Women and families face many challenges when these critical services are absent from their local communities. In an effort to continue to provide maternity services in rural areas, small maternity units without caesarean delivery capabilities have been established in a few rural communities in Tasmania. However, they have divided the opinions of Tasmanian health professionals. This article is part of a larger study which focused on maternity services for rural women and reports the views of the health professionals on this model of care. A qualitative study using semi-structured interviews was conducted with 20 maternity health providers across Tasmania to explore their experiences and views on the model of offering small rural maternity units without obstetric services. The data were analysed in NVivo v9 (www.qsrinternational.com) using grounded theory. Three main themes are grounded from interview data: (1) women's difficulties in rural areas; (2) women's expectations; and (3) maternity units without caesarean delivery capabilities. The results reveal that low-intervention style birthing services in rural areas could reduce women's difficulties that include access issues, disruption, anxiety and travel related issues, and address women's expectations in term of access to local services. However, this model is less likely to meet women's safety expectations, especially in emergency situations. The findings of this study offer insights for policy-makers and state government with regard to the future planning of this model of care. It is recommended that safety and sustainability issues should be considered when this model of care is to be implemented in other rural communities.

Introduction and comparison of next-generation mobile wireless technologies

NASA Astrophysics Data System (ADS)

Zaidi, Syed R.; Hussain, Shahab; Ali, M. A.; Sana, Ajaz; Saddawi, Samir; Carranza, Aparicio

2010-01-01

Mobile networks and services have gone further than voice-only communication services and are rapidly developing towards data-centric services. Emerging mobile data services are expected to see the same explosive growth in demand that Internet and wireless voice services have seen in recent years. To support such a rapid increase in traffic, active users, and advanced multimedia services implied by this growth rate along with the diverse quality of service (QoS) and rate requirements set by these services, mobile operator need to rapidly transition to a simple and cost-effective, flat, all IP-network. This has accelerated the development and deployment of new wireless broadband access technologies including fourth-generation (4G) mobile WiMAX and cellular Long-Term Evolution (LTE). Mobile WiMAX and LTE are two different (but not necessarily competing) technologies that will eventually be used to achieve data speeds of up to 100 Mbps. Speeds that are fast enough to potentially replace wired broadband connections with wireless. This paper introduces both of these next generation technologies and then compares them in the end.

Service Migration from Cloud to Multi-tier Fog Nodes for Multimedia Dissemination with QoE Support

PubMed Central

Camargo, João; Rochol, Juergen; Gerla, Mario

2018-01-01

A wide range of multimedia services is expected to be offered for mobile users via various wireless access networks. Even the integration of Cloud Computing in such networks does not support an adequate Quality of Experience (QoE) in areas with high demands for multimedia contents. Fog computing has been conceptualized to facilitate the deployment of new services that cloud computing cannot provide, particularly those demanding QoE guarantees. These services are provided using fog nodes located at the network edge, which is capable of virtualizing their functions/applications. Service migration from the cloud to fog nodes can be actuated by request patterns and the timing issues. To the best of our knowledge, existing works on fog computing focus on architecture and fog node deployment issues. In this article, we describe the operational impacts and benefits associated with service migration from the cloud to multi-tier fog computing for video distribution with QoE support. Besides that, we perform the evaluation of such service migration of video services. Finally, we present potential research challenges and trends. PMID:29364172

Service Migration from Cloud to Multi-tier Fog Nodes for Multimedia Dissemination with QoE Support.

PubMed

Rosário, Denis; Schimuneck, Matias; Camargo, João; Nobre, Jéferson; Both, Cristiano; Rochol, Juergen; Gerla, Mario

2018-01-24

A wide range of multimedia services is expected to be offered for mobile users via various wireless access networks. Even the integration of Cloud Computing in such networks does not support an adequate Quality of Experience (QoE) in areas with high demands for multimedia contents. Fog computing has been conceptualized to facilitate the deployment of new services that cloud computing cannot provide, particularly those demanding QoE guarantees. These services are provided using fog nodes located at the network edge, which is capable of virtualizing their functions/applications. Service migration from the cloud to fog nodes can be actuated by request patterns and the timing issues. To the best of our knowledge, existing works on fog computing focus on architecture and fog node deployment issues. In this article, we describe the operational impacts and benefits associated with service migration from the cloud to multi-tier fog computing for video distribution with QoE support. Besides that, we perform the evaluation of such service migration of video services. Finally, we present potential research challenges and trends.

Influence of land use on water quality in a tropical landscape: a multi-scale analysis

PubMed Central

Yackulic, Charles B.; Lim, Yili; Arce-Nazario, Javier A.

2015-01-01

There is a pressing need to understand the consequences of human activities, such as land transformations, on watershed ecosystem services. This is a challenging task because different indicators of water quality and yield are expected to vary in their responsiveness to large versus local-scale heterogeneity in land use and land cover (LUC). Here we rely on water quality data collected between 1977 and 2000 from dozens of gauge stations in Puerto Rico together with precipitation data and land cover maps to (1) quantify impacts of spatial heterogeneity in LUC on several water quality indicators; (2) determine the spatial scale at which this heterogeneity influences water quality; and (3) examine how antecedent precipitation modulates these impacts. Our models explained 30–58% of observed variance in water quality metrics. Temporal variation in antecedent precipitation and changes in LUC between measurements periods rather than spatial variation in LUC accounted for the majority of variation in water quality. Urbanization and pasture development generally degraded water quality while agriculture and secondary forest re-growth had mixed impacts. The spatial scale over which LUC influenced water quality differed across indicators. Turbidity and dissolved oxygen (DO) responded to LUC in large-scale watersheds, in-stream nitrogen concentrations to LUC in riparian buffers of large watersheds, and fecal matter content and in-stream phosphorus concentration to LUC at the sub-watershed scale. Stream discharge modulated impacts of LUC on water quality for most of the metrics. Our findings highlight the importance of considering multiple spatial scales for understanding the impacts of human activities on watershed ecosystem services. PMID:26146455

Assessing responsiveness of health care services within a health insurance scheme in Nigeria: users' perspectives.

PubMed

Mohammed, Shafiu; Bermejo, Justo Lorenzo; Souares, Aurélia; Sauerborn, Rainer; Dong, Hengjin

2013-12-01

Responsiveness of health care services in low and middle income countries has been given little attention. Despite being introduced over a decade ago in many developing countries, national health insurance schemes have yet to be evaluated in terms of responsiveness of health care services. Although this responsiveness has been evaluated in many developed countries, it has rarely been done in developing countries. The concept of responsiveness is multi-dimensional and can be measured across various domains including prompt attention, dignity, communication, autonomy, choice of provider, quality of facilities, confidentiality and access to family support. This study examines the insured users' perspectives of their health care services' responsiveness. This retrospective, cross-sectional survey took place between October 2010 and March 2011. The study used a modified out-patient questionnaire from a responsiveness survey designed by the World Health Organization (WHO). Seven hundred and ninety six (796) enrolees, insured for more than one year in Kaduna State-Nigeria, were interviewed. Generalized ordered logistic regression was used to identify factors that influenced the users' perspectives on responsiveness to health services and quantify their effects. Communication (55.4%), dignity (54.1%), and quality of facilities (52.0%) were rated as "extremely important" responsiveness domains. Users were particularly contented with quality of facilities (42.8%), dignity (42.3%), and choice of provider (40.7%). Enrolees indicated lower contentment on all other domains. Type of facility, gender, referral, duration of enrolment, educational status, income level, and type of marital status were most related with responsiveness domains. Assessing the responsiveness of health care services within the NHIS is valuable in investigating the scheme's implementation. The domains of autonomy, communication and prompt attention were identified as priority areas for action to improve this responsiveness. For the Nigerian context, we suggest that health care providers in the NHIS should pay attention to these domains, and the associated characteristics of users, when delivering health care services to their clients. Policy makers, and the insurance regulatory agency, should consider the reform strategies of monitoring and quality assurance which focus on the domains of responsiveness to lessen the gap between users' expectations and their experiences with health services.

Substitution of Assisted Living Services by Assistive Technology - Experts Opinions and Technical Feasibility.

PubMed

Schwartze, Jonas; Prekazi, Arianit; Schrom, Harald; Marschollek, Michael

2017-01-01

Ambient assisted living (AAL) may support ageing in place but is primarily driven by technology. The aim of this work is, to identifying reasons to move into assisted living institutions, their range of service and possible substitutability. We did semi-structured interviews with five experts from assisted living institutions and used results to design and implement assistive technologies in an AAL environment using BASIS, a cross domain bus system for smart buildings. Reasons for moving to assisted living institutions are expected benefits for chronic health problems, safety, social isolation and carefree living. We implemented six application systems for inactivity monitoring, stove shutdown, air quality monitoring, medication and appointment reminders, detection of unwanted situations before leaving and optical ringing of the doorbell. Substitution of selected assisted living services is feasible and has potential to delay necessity to move into assisted living institution if complement social services are installed.

An Academic-Service Partnership: A System-Wide Approach and Case Report.

PubMed

Bay, Esther H; Tschannen, Dana J

2017-06-01

An academic-service partnership was formed to increase educational capacity, improve evidence-based nursing at the point of care, and engage staff nurses, clinical faculty, and students in patient and family care. This case report reflects an overview of the first year of full implementation, and survey results from nurse leaders and faculty at the 3-year time point. Following its third year of an academic-service partnership, the shared mission, vision, and values have resulted in stronger NCLEX-RN results, improved quality initiatives, and trends for improvements in patient outcomes. Alignment with faculty and mentors surrounding student expectations has improved, as well as shared evidence-based practices. Sustaining an academic-service partnership requires dedicated leaders, faculty, and mentors. This partnership continues to thrive and move toward excellence in patient- and family-centered outcomes and undergraduate clinical education. [J Nurs Educ. 2017;56(6):373-377.]. Copyright 2017, SLACK Incorporated.

The development of integrated service centre system for professional teachers empowerment in North Sumatera

NASA Astrophysics Data System (ADS)

Gultom, S.; Simanjorang, M. M.; Muchtar, Z.; Mansyur, A.

2018-03-01

Based on Act number 12 in year 2012 the function of higher education is related to individual, social community, knowledge and technology development. Hence, higher education providers need to think and develop policies in order to improve their service and fulfil the higher education function. As part of the effort to fulfil its function Universitas Negeri Medan (Unimed), which historically was a pre-service teacher training institute, should has a special interest on improving teachers’ professionalism. The Act number 14 in year 2005 described requirements for professional teacher, including academic qualification and set of competencies possessed by the teacher. The Act also guaranties teachers’ right to have opportunities for improving their competencies and academic qualification through training and other professionalism development programme. The question is how this guarantee can be implemented. In order to answer this question a developmental study has been done which aimed on developing an integrated service centre system for professional teachers empowerment. As the name implies, this integrated service centre system is expected to be a real manifestation of Unimed’s support towards the improvement of professional teachers quality, which in the end will boils down to the improvement of national education services quality. The result of this study is an integrated service centre system for professional teachers empowerment that fulfils the professionalism principles described in the Act number 14 in year 2005, which has been developed by considering problems faced by and also supports needed by teachers post certification programme.

Pygmalion in Media-Based Learning: Effects of Quality Expectancies on Learning Outcomes

ERIC Educational Resources Information Center

Fries, Stefan; Horz, Holger; Haimerl, Charlotte

2006-01-01

Two studies investigated how quality expectations affect students' outcomes of media-based learning. Experiment 1 (N=62) demonstrated that students expecting a high-end computer-based training programme learned most, whereas students expecting a programme of ambiguous quality learned least and students having no expectations performed in between.…

Centers for medicare and medicaid services: using an episode-based payment model to improve oncology care.

PubMed

Kline, Ronald M; Bazell, Carol; Smith, Erin; Schumacher, Heidi; Rajkumar, Rahul; Conway, Patrick H

2015-03-01

Cancer is a medically complex and expensive disease with costs projected to rise further as new treatment options increase and the United States population ages. Studies showing significant regional variation in oncology quality and costs and model tests demonstrating cost savings without adverse outcomes suggest there are opportunities to create a system of oncology care in the US that delivers higher quality care at lower cost. The Centers for Medicare and Medicaid Services (CMS) have designed an episode-based payment model centered around 6 month periods of chemotherapy treatment. Monthly per-patient care management payments will be made to practices to support practice transformation, including additional patient services and specific infrastructure enhancements. Quarterly reporting of quality metrics will drive continuous quality improvement and the adoption of best practices among participants. Practices achieving cost savings will also be eligible for performance-based payments. Savings are expected through improved care coordination and appropriately aligned payment incentives, resulting in decreased avoidable emergency department visits and hospitalizations and more efficient and evidence-based use of imaging, laboratory tests, and therapeutic agents, as well as improved end of life care. New therapies and better supportive care have significantly improved cancer survival in recent decades. This has come at a high cost, with cancer therapy consuming $124 billion in 2010. CMS has designed an episode-based model of oncology care that incorporates elements from several successful model tests. By providing care management and performance based payments in conjunction with quality metrics and a rapid learning environment, it is hoped that this model will demonstrate how oncology care in the US can transform into a high value, high quality system. Copyright © 2015 by American Society of Clinical Oncology.

A Sparse Representation-Based Deployment Method for Optimizing the Observation Quality of Camera Networks

PubMed Central

Wang, Chang; Qi, Fei; Shi, Guangming; Wang, Xiaotian

2013-01-01

Deployment is a critical issue affecting the quality of service of camera networks. The deployment aims at adopting the least number of cameras to cover the whole scene, which may have obstacles to occlude the line of sight, with expected observation quality. This is generally formulated as a non-convex optimization problem, which is hard to solve in polynomial time. In this paper, we propose an efficient convex solution for deployment optimizing the observation quality based on a novel anisotropic sensing model of cameras, which provides a reliable measurement of the observation quality. The deployment is formulated as the selection of a subset of nodes from a redundant initial deployment with numerous cameras, which is an ℓ0 minimization problem. Then, we relax this non-convex optimization to a convex ℓ1 minimization employing the sparse representation. Therefore, the high quality deployment is efficiently obtained via convex optimization. Simulation results confirm the effectiveness of the proposed camera deployment algorithms. PMID:23989826

International standards for tuberculosis care: relevance and implications for laboratory professionals.

PubMed

Pai, M; Daley, P; Hopewell, P C

2007-04-01

On World Tuberculosis (TB) Day 2006, the International Standards for Tuberculosis Care (ISTC) was officially released and widely endorsed by several agencies and organizations. The ISTC release was the culmination of a year long global effort to develop and set internationally acceptable, evidence-based standards for tuberculosis care. The ISTC describes a widely endorsed level of care that all practitioners, public and private, should seek to achieve in managing individuals who have or are suspected of having, TB and is intended to facilitate the effective engagement of all healthcare providers in delivering high quality care for patients of all ages, including those with smear-positive, smear-negative and extra-pulmonary TB, TB caused by drug-resistant Mycobacterium tuberculosis and TB/HIV coinfection. In this article, we present the ISTC, with a special focus on the diagnostic standards and describe their implications and relevance for laboratory professionals in India and worldwide. Laboratory professionals play a critical role in ensuring that all the standards are actually met by providing high quality laboratory services for smear microscopy, culture and drug susceptibility testing and other services such as testing for HIV infection. In fact, if the ISTC is widely followed, it can be expected that there will be a greater need and demand for quality assured laboratory services and this will have obvious implications for all laboratories in terms of work load, requirement for resources and trained personnel and organization of quality assurance systems.

Embedding systematic quality assessments in supportive supervision at primary healthcare level: application of an electronic Tool to Improve Quality of Healthcare in Tanzania.

PubMed

Mboya, Dominick; Mshana, Christopher; Kessy, Flora; Alba, Sandra; Lengeler, Christian; Renggli, Sabine; Vander Plaetse, Bart; Mohamed, Mohamed A; Schulze, Alexander

2016-10-13

Assessing quality of health services, for example through supportive supervision, is essential for strengthening healthcare delivery. Most systematic health facility assessment mechanisms, however, are not suitable for routine supervision. The objective of this study is to describe a quality assessment methodology using an electronic format that can be embedded in supervision activities and conducted by council health staff. An electronic Tool to Improve Quality of Healthcare (e-TIQH) was developed to assess the quality of primary healthcare provision. The e-TIQH contains six sub-tools, each covering one quality dimension: infrastructure and equipment of the facility, its management and administration, job expectations, clinical skills of the staff, staff motivation and client satisfaction. As part of supportive supervision, council health staff conduct quality assessments in all primary healthcare facilities in a given council, including observation of clinical consultations and exit interviews with clients. Using a hand-held device, assessors enter data and view results in real time through automated data analysis, permitting immediate feedback to health workers. Based on the results, quality gaps and potential measures to address them are jointly discussed and actions plans developed. For illustrative purposes, preliminary findings from e-TIQH application are presented from eight councils of Tanzania for the period 2011-2013, with a quality score <75 % classed as 'unsatisfactory'. Staff motivation (<50 % in all councils) and job expectations (≤50 %) scored lowest of all quality dimensions at baseline. Clinical practice was unsatisfactory in six councils, with more mixed results for availability of infrastructure and equipment, and for administration and management. In contrast, client satisfaction scored surprisingly high. Over time, each council showed a significant overall increase of 3-7 % in mean score, with the most pronounced improvements in staff motivation and job expectations. Given its comprehensiveness, convenient handling and automated statistical reports, e-TIQH enables council health staff to conduct systematic quality assessments. Therefore e-TIQH may not only contribute to objectively identifying quality gaps, but also to more evidence-based supervision. E-TIQH also provides important information for resource planning. Institutional and financial challenges for implementing e-TIQH on a broader scale need to be addressed.

Does enrollment status in community-based insurance lead to poorer quality of care? Evidence from Burkina Faso

PubMed Central

2013-01-01

Introduction In 2004, a community-based health insurance (CBI) scheme was introduced in Nouna health district, Burkina Faso, with the objective of improving financial access to high quality health services. We investigate the role of CBI enrollment in the quality of care provided at primary-care facilities in Nouna district, and measure differences in objective and perceived quality of care and patient satisfaction between enrolled and non-enrolled populations who visit the facilities. Methods We interviewed a systematic random sample of 398 patients after their visit to one of the thirteen primary-care facilities contracted with the scheme; 34% (n = 135) of the patients were currently enrolled in the CBI scheme. We assessed objective quality of care as consultation, diagnostic and counselling tasks performed by providers during outpatient visits, perceived quality of care as patient evaluations of the structures and processes of service delivery, and overall patient satisfaction. Two-sample t-tests were performed for group comparison and ordinal logistic regression (OLR) analysis was used to estimate the association between CBI enrollment and overall patient satisfaction. Results Objective quality of care evaluations show that CBI enrollees received substantially less comprehensive care for outpatient services than non-enrollees. In contrast, CBI enrollment was positively associated with overall patient satisfaction (aOR = 1.51, p = 0.014), controlling for potential confounders such as patient socio-economic status, illness symptoms, history of illness and characteristics of care received. Conclusions CBI patients perceived better quality of care, while objectively receiving worse quality of care, compared to patients who were not enrolled in CBI. Systematic differences in quality of care expectations between CBI enrollees and non-enrollees may explain this finding. One factor influencing quality of care may be the type of provider payment used by the CBI scheme, which has been identified as a leading factor in reducing provider motivation to deliver high quality care to CBI enrollees in previous studies. Based on this study, it is unlikely that perceived quality of care and patient satisfaction explain the low CBI enrollment rates in this community. PMID:23680066

Mutual benefits in academic-service partnership: An integrative review.

PubMed

Sadeghnezhad, Maliheh; Heshmati Nabavi, Fatemeh; Najafi, Fereshteh; Kareshki, Hossein; Esmaily, Habibollah

2018-05-30

Academic and service institutions involve with many challenges. Partnership programs are a golden opportunity to achieve mutual benefits to overcome these challenges. Identifying mutual benefits is the cornerstone of forming a successful partnership and guarantee to its continuity. There are definitions and instances of mutual benefits in the literature related to partnership programs, but there is no coherent evidence and clear picture of these benefits. This study is conducted to identify mutual benefits in academic-service partnership by analyzing the definitions and instances of it in the literature. An integrative review of key papers regarding mutual benefits in academic-service partnership was undertaken. This review was guided by the framework described by Whittemore and Knafl. Search of the following databases was conducted: MEDLINE, ERIC, Google Scholar, Emerald Insight and Science Direct. The search terms were mutual benefits, mutual gains, mutual interest, mutual expectations, mutual goals, mutual demand, partnership, collaboration, academic-service partnership and academic service collaboration. Cooper's five-stage integrative review method was used. Quality evaluation of articles was conducted. Data were abstracted from included articles. The analysis was conducted based on the qualitative content analysis of the literature suggested by Zhang and Wildemuth. 28 articles were included in this review. Mutual benefits are described in four categories include: synergy in training and empowerment of human resources, education improvement, access to shared resources, facilitate production and application of beneficial knowledge into practice. Mutual benefits in the academic-service partnership include a range of goals, interests, expectations, and needs of partner organizations that is achievable and measurable through joint planning and collaboration. We suggest academic and service policymakers to consider these benefits in the planning and evaluating partnership programs. Copyright © 2018 Elsevier Ltd. All rights reserved.

Architecture Design of Healthcare Software-as-a-Service Platform for Cloud-Based Clinical Decision Support Service.

PubMed

Oh, Sungyoung; Cha, Jieun; Ji, Myungkyu; Kang, Hyekyung; Kim, Seok; Heo, Eunyoung; Han, Jong Soo; Kang, Hyunggoo; Chae, Hoseok; Hwang, Hee; Yoo, Sooyoung

2015-04-01

To design a cloud computing-based Healthcare Software-as-a-Service (SaaS) Platform (HSP) for delivering healthcare information services with low cost, high clinical value, and high usability. We analyzed the architecture requirements of an HSP, including the interface, business services, cloud SaaS, quality attributes, privacy and security, and multi-lingual capacity. For cloud-based SaaS services, we focused on Clinical Decision Service (CDS) content services, basic functional services, and mobile services. Microsoft's Azure cloud computing for Infrastructure-as-a-Service (IaaS) and Platform-as-a-Service (PaaS) was used. The functional and software views of an HSP were designed in a layered architecture. External systems can be interfaced with the HSP using SOAP and REST/JSON. The multi-tenancy model of the HSP was designed as a shared database, with a separate schema for each tenant through a single application, although healthcare data can be physically located on a cloud or in a hospital, depending on regulations. The CDS services were categorized into rule-based services for medications, alert registration services, and knowledge services. We expect that cloud-based HSPs will allow small and mid-sized hospitals, in addition to large-sized hospitals, to adopt information infrastructures and health information technology with low system operation and maintenance costs.

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

PubMed

Lonial, Subash; Raju, P S

2015-01-01

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. 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. 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. 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. The study shows that organizations can benefit by identifying and focusing on critical attributes as part of their customer relationship management program. 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. 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.

Unintended Consequences of Evidence-Based Treatment Policy Reform: Is Implementation the Goal or the Strategy for Higher Quality Care?

PubMed

Park, Alayna L; Tsai, Katherine H; Guan, Karen; Chorpita, Bruce F

2018-02-14

This study examined patterns of evidence-based treatment (EBT) delivery following a county-wide EBT reform initiative. Data were gathered from 60 youth and their 21 providers, who were instructed to deliver therapy as they normally would under the EBT initiative. Results showed limited applicability of county-supported EBTs to this service sample, and that most youth did not receive traditional delivery of EBTs. Findings suggest that it may be unrealistic to expect providers to deliver EBTs with fidelity with all clients, and that EBT implementation may be best thought of as a strategy for improving mental health services rather than a goal.

Medicare Readmissions Policies and Racial and Ethnic Health Disparities: A Cautionary Tale

PubMed Central

McHugh, Matthew D.; Carthon, J. Margo Brooks; Kang, Xiao L.

2011-01-01

Beginning in 2009, the Centers for Medicare & Medicaid Services started publicly reporting hospital readmission rates as part of the Hospital Compare website. Hospitals will begin having payments reduced if their readmission rates are higher than expected starting in fiscal year 2013. Value-based purchasing initiatives including public reporting and pay-for-performance incentives have the potential to increase quality of care. There is concern, however, that hospitals providing service to minority communities may be disproportionately penalized as a result of these policies due to higher rates of readmissions among racial and ethnic minority groups. Using 2008 Medicare data, we assess the risk for readmission for minorities and discuss implications for minority-serving institutions. PMID:21531966

Investigations of VOCs in and around buildings close to service stations

NASA Astrophysics Data System (ADS)

Hicklin, William; Farrugia, Pierre S.; Sinagra, Emmanuel

2018-01-01

Gas service stations are one of the major sources of volatile organic compounds in urban environments. Their emissions are expected not only to affect the ambient air quality but also that in any nearby buildings. This is particularly the case in Malta where most service stations have been built within residential zones. For this reason, it is important to understand the dispersion of volatile organic compounds (VOCs) from service stations and their infiltration into nearby residences. Two models were considered; one to predict the dispersion of VOCs in the outdoor environment in the vicinity of the service station and another one to predict the filtration of the compounds indoors. The two models can be used in tandem to predict the concentration of indoor VOCs that originate from a service station in the vicinity. Outdoor and indoor concentrations of VOCs around a service station located in a street canyon were measured, and the results used to validate the models. Predictions made using the models were found to be in general agreement with the measured concentrations of the pollutants.

Toward a North American Standard for Mobile Data Services

NASA Technical Reports Server (NTRS)

Dean, Richard A.; Levesque, Allen H.

1991-01-01

The rapid introduction of digital mobile communications systems is an important part of the emerging digital communications scene. These developments pose both a potential problem and a challenge. On one hand, these separate market driven developments can result in an uncontrolled mixture of analog and digital links which inhibit data modem services across the mobile/Public Switched network (PSTN). On the other hand, the near coincidence of schedules for development of some of these systems, i.e., Digital Cellular, Mobile Satellite, Land Mobile Radio, and ISDN, provides an opportunity to address interoperability problems by defining interfaces, control, and service standards that are compatible among these new services. In this paper we address the problem of providing data services interoperation between mobile terminals and data devices on the PSTN. The expected data services include G3 Fax, asynchronous data, and the government's STU-3 secure voice system, and future data services such as ISDN. We address a common architecture and a limited set of issues that are key to interoperable mobile data services. We believe that common mobile data standards will both improve the quality of data service and simplify the systems for manufacturers, data users, and service providers.

Toward a North American standard for mobile data services

NASA Astrophysics Data System (ADS)

Dean, Richard A.; Levesque, Allen H.

1991-09-01

The rapid introduction of digital mobile communications systems is an important part of the emerging digital communications scene. These developments pose both a potential problem and a challenge. On one hand, these separate market driven developments can result in an uncontrolled mixture of analog and digital links which inhibit data modem services across the mobile/Public Switched network (PSTN). On the other hand, the near coincidence of schedules for development of some of these systems, i.e., Digital Cellular, Mobile Satellite, Land Mobile Radio, and ISDN, provides an opportunity to address interoperability problems by defining interfaces, control, and service standards that are compatible among these new services. In this paper we address the problem of providing data services interoperation between mobile terminals and data devices on the PSTN. The expected data services include G3 Fax, asynchronous data, and the government's STU-3 secure voice system, and future data services such as ISDN. We address a common architecture and a limited set of issues that are key to interoperable mobile data services. We believe that common mobile data standards will both improve the quality of data service and simplify the systems for manufacturers, data users, and service providers.

Approaches to quality management and accreditation in a genetic testing laboratory

PubMed Central

Berwouts, Sarah; Morris, Michael A; Dequeker, Elisabeth

2010-01-01

Medical laboratories, and specifically genetic testing laboratories, provide vital medical services to different clients: clinicians requesting a test, patients from whom the sample was collected, public health and medical-legal instances, referral laboratories and authoritative bodies. All expect results that are accurate and obtained in an efficient and effective manner, within a suitable time frame and at acceptable cost. There are different ways of achieving the end results, but compliance with International Organization for Standardization (ISO) 15189, the international standard for the accreditation of medical laboratories, is becoming progressively accepted as the optimal approach to assuring quality in medical testing. We present recommendations and strategies designed to aid genetic testing laboratories with the implementation of a quality management system, including key aspects such as document control, external quality assessment, internal quality control, internal audit, management review, validation, as well as managing the human side of change. The focus is on pragmatic approaches to attain the levels of quality management and quality assurance required for accreditation according to ISO 15189, within the context of genetic testing. Attention is also given to implementing efficient and effective quality improvement. PMID:20720559

Ethics and quality care in nursing homes: Relatives' experiences.

PubMed

Jakobsen, Rita; Sellevold, Gerd Sylvi; Egede-Nissen, Veslemøy; Sørlie, Venke

2017-01-01

A total of 71,000 people in Norway suffer from some form of dementia in 2013, of whom approximately 30,000 are in nursing homes. Several studies focus on the experiences of those who have close relatives and who are staying in a nursing home. Results show that a greater focus on cooperation between nursing staff and relatives is a central prerequisite for an increased level of care. Benefits of developing systematic collaboration practices include relief for nursing staff, less stress, and greater mutual understanding. Going through studies focusing on the experiences of nursing home patients' relatives, negative experiences are in the majority. In this study, relatives are invited to share positive experiences regarding the care of their loved ones; a slightly different perspective, in other words. The aim of the study is to investigate relatives of persons with dementia's experiences with quality care in nursing homes. The study is a part of a larger project called Hospice values in the care for persons with dementia and is based on a qualitative design where data are generated through narrative interviews. The chosen method of analysis is the phenomenological-hermeneutical method for the study of lived experiences. Participants and research context: Participants in the project were eight relatives of persons with dementia who were living in nursing homes, long-term residences. The sampling was targeted, enrolment happened through collective invitation. All relatives interested were included. Ethical considerations: The Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services approve the study. Findings show that relatives have certain expectations as to how their loved ones ought to be met and looked after at the nursing home. The results show that in those cases where the expectations were met, the relatives' experiences were associated with engagement, inclusion and a good atmosphere. When the expectations were not met, the relatives experienced powerlessness, distrust and guilt. The results are discussed considering the concepts of trust, power and asymmetry. When asked about experiences with quality care, the relatives spoke both of expectations met and of expectations not met. Results in this study are important knowledge for developing units where performing quality care is the overall aim.

No Magic Bullet: A Theory-Based Meta-Analysis of Markov Transition Probabilities in Studies of Service Systems for Persons With Mental Disabilities.

PubMed

Leff, Hugh Stephen; Chow, Clifton M; Graves, Stephen C

2017-03-01

A random-effects meta-analysis of studies that used Markov transition probabilities (TPs) to describe outcomes for mental health service systems of differing quality for persons with serious mental illness was implemented to improve the scientific understanding of systems performance, to use in planning simulations to project service system costs and outcomes over time, and to test a theory of how outcomes for systems varying in quality differ. Nineteen systems described in 12 studies were coded as basic (B), maintenance (M), and recovery oriented (R) on the basis of descriptions of services provided. TPs for studies were aligned with a common functional-level framework, converted to a one-month time period, synthesized, and compared with theory-based expectations. Meta-regression was employed to explore associations between TPs and characteristics of service recipients and studies. R systems performed better than M and B systems. However, M systems did not perform better than B systems. All systems showed negative as well as positive TPs. For approximately one-third of synthesized TPs, substantial interstudy heterogeneity was noted. Associations were found between TPs and service recipient and study variables Conclusions: Conceptualizing systems as B, M, and R has potential for improving scientific understanding and systems planning. R systems appear more effective than B and M systems, although there is no "magic bullet" system for all service recipients. Interstudy heterogeneity indicates need for common approaches to reporting service recipient states, time periods for TPs, service recipient attributes, and service system characteristics. TPs found should be used in Markov simulations to project system effectiveness and costs of over time.

What do clients expect of community care and what are their needs? The Community care for the Elderly: Needs and Service Use Study (CENSUS).

PubMed

Harrison, Fleur; Low, Lee-Fay; Barnett, Anna; Gresham, Meredith; Brodaty, Henry

2014-09-01

To investigate the relationship between objectively assessed care needs and expectations for care of older people and their carers, before commencement of community care services. Cross-sectional research on 55 community-dwelling older adults and carers, recruited after receiving approval for government-subsidised community care services. Care needs and expectations of care were assessed at interview. Participants' and carers' expectations for their pending community care package did not correspond with unmet participant needs. Instead, expectations corresponded with met needs, that is those for which they already received help, with the exception of expectations of domestic support and personal care. Participants' unmet needs were predominantly in social and recreational activities, eating, and physical and mental health. As community care in Australia becomes consumer-directed by 2015, care services will need to empower clients and carers through education about their needs and available services, as part of the assessment and service negotiation process. © 2013 ACOTA.

Clinical governance: bridging the gap between managerial and clinical approaches to quality of care

PubMed Central

Buetow, S. A.; Roland, M.

1999-01-01

Clinical governance has been introduced as a new approach to quality improvement in the UK national health service. This article maps clinical governance against a discussion of the four main approaches to measuring and improving quality of care: quality assessment, quality assurance, clinical audit, and quality improvement (including continuous quality improvement). Quality assessment underpins each approach. Whereas clinical audit has, in general, been professionally led, managers have driven quality improvement initiatives. Quality assurance approaches have been perceived to be externally driven by managers or to involve professional inspection. It is discussed how clinical governance seeks to bridge these approaches. Clinical governance allows clinicians in the UK to lead a comprehensive strategy to improve quality within provider organisations, although with an expectation of greatly increased external accountability. Clinical governance aims to bring together managerial, organisational, and clinical approaches to improving quality of care. If successful, it will define a new type of professionalism for the next century. Failure by the professions to seize the opportunity is likely to result in increasingly detailed external control of clinical activity in the UK, as has occurred in some other countries. PMID:10847876

Social support and actual versus expected length of stay in inpatient rehabilitation facilities

PubMed Central

Lewis, Zakkoyya H.; Hay, Catherine Cooper; Graham, James E.; Lin, Yu-Li; Karmarkar, Amol M.; Ottenbacher, Kenneth J.

2016-01-01

Objectives Describe impairment-specific patterns in shorter- and longer-than-expected lengths of stay in inpatient rehabilitation and examine the independent effects of social support on deviations from expected lengths of stay. Design Retrospective cohort study. Setting Inpatient rehabilitation facilities across the United States. Participants Medicare fee-for-service beneficiaries (N=119,437) who were discharged from inpatient rehabilitation facilities in 2012 following stroke, lower extremity fracture, or lower extremity joint replacement. Intervention Not applicable. Main Outcome Measure Relative length of stay (actual – expected). The Centers for Medicare and Medicaid Services posts annual expected lengths of stay based on patients’ clinical profiles at admission. We created a 3-category outcome variable: short, expected, long. Our primary independent variable (social support) also included 3 categories: family/friends, paid/other, none. Results Mean (SD) actual lengths of stay for joint replacement, fracture, and stroke were 9.8 (3.6), 13.8 (4.5), and 15.8 (7.3) days, respectively; relative lengths of stay were −1.2 (3.1), −1.6 (3.7), and −1.7 (5.2) days. Nearly half of patients (47–48%) were discharged more than 1 day earlier than expected in all 3 groups, whereas 14% of joint replacement, 15% of fracture, and 20% of stroke patients were discharged more than 1 day later than expected. In multinomial regression analysis, using family/friends as the reference group, paid/other support was associated (p<.05) with higher odds of long stays in joint replacement. No social support was associated with lower odds of short stays in all 3 impairment groups and higher odds of long stays in fracture and joint replacement. Conclusion Inpatient rehabilitation experiences and outcomes can be substantially impacted by a patient’s level of social support. More research is needed to better understand these relationships and possible unintended consequences in terms of patient access issues and provider-level quality measures. PMID:27373747

The keys to CERN conference rooms - Managing local collaboration facilities in large organisations

NASA Astrophysics Data System (ADS)

Baron, T.; Domaracky, M.; Duran, G.; Fernandes, J.; Ferreira, P.; Gonzalez Lopez, J. B.; Jouberjean, F.; Lavrut, L.; Tarocco, N.

2014-06-01

For a long time HEP has been ahead of the curve in its usage of remote collaboration tools, like videoconference and webcast, while the local CERN collaboration facilities were somewhat behind the expected quality standards for various reasons. This time is now over with the creation by the CERN IT department in 2012 of an integrated conference room service which provides guidance and installation services for new rooms (either equipped for videoconference or not), as well as maintenance and local support. Managing now nearly half of the 246 meeting rooms available on the CERN sites, this service has been built to cope with the management of all CERN rooms with limited human resources. This has been made possible by the intensive use of professional software to manage and monitor all the room equipment, maintenance and activity. This paper focuses on presenting these packages, either off-the-shelf commercial products (asset and maintenance management tool, remote audio-visual equipment monitoring systems, local automation devices, new generation touch screen interfaces for interacting with the room) when available or locally developed integration and operational layers (generic audio-visual control and monitoring framework) and how they help overcoming the challenges presented by such a service. The aim is to minimise local human interventions while preserving the highest service quality and placing the end user back in the centre of this collaboration platform.

Health services reform in Bangladesh: hearing the views of health workers and their professional bodies.

PubMed

Cockcroft, Anne; Milne, Deborah; Oelofsen, Marietjie; Karim, Enamul; Andersson, Neil

2011-12-21

In Bangladesh, widespread dissatisfaction with government health services did not improve during the Health and Population Sector Programme (HPSP) reforms from 1998-2003. A 2003 national household survey documented public and health service users' views and experience. Attitudes and behaviour of health workers are central to quality of health services. To investigate whether the views of health workers influenced the reforms, we surveyed local health workers and held evidence-based discussions with local service managers and professional bodies. Some 1866 government health workers in facilities serving the household survey clusters completed a questionnaire about their views, experience, and problems as workers. Field teams discussed the findings from the household and health workers' surveys with local health service managers in five upazilas (administrative sub-districts) and with the Bangladesh Medical Association (BMA) and Bangladesh Nurses Association (BNA). Nearly one half of the health workers (45%) reported difficulties fulfilling their duties, especially doctors, women, and younger workers. They cited inadequate supplies and infrastructure, bad behaviour of patients, and administrative problems. Many, especially doctors (74%), considered they were badly treated as employees. Nearly all said lack of medicines in government facilities was due to inadequate supply, not improved during the HPSP. Two thirds of doctors and nurses complained of bad behaviour of patients. A quarter of respondents thought quality of service had improved as a result of the HPSP.Local service managers and the BMA and BNA accepted patients had negative views and experiences, blaming inadequate resources, high patient loads, and patients' unrealistic expectations. They said doctors and nurses were demotivated by poor working conditions, unfair treatment, and lack of career progression; private and unqualified practitioners sought to please patients instead of giving medically appropriate care. The BMA considered it would be dangerous to attempt to train and register unqualified practitioners. The continuing dissatisfaction of health workers may have undermined the effectiveness of the HPSP. Presenting the views of the public and service users to health managers helped to focus discussions about quality of services. It is important to involve health workers in health services reforms.

Health services reform in Bangladesh: hearing the views of health workers and their professional bodies

PubMed Central

2011-01-01

Background In Bangladesh, widespread dissatisfaction with government health services did not improve during the Health and Population Sector Programme (HPSP) reforms from 1998-2003. A 2003 national household survey documented public and health service users' views and experience. Attitudes and behaviour of health workers are central to quality of health services. To investigate whether the views of health workers influenced the reforms, we surveyed local health workers and held evidence-based discussions with local service managers and professional bodies. Methods Some 1866 government health workers in facilities serving the household survey clusters completed a questionnaire about their views, experience, and problems as workers. Field teams discussed the findings from the household and health workers' surveys with local health service managers in five upazilas (administrative sub-districts) and with the Bangladesh Medical Association (BMA) and Bangladesh Nurses Association (BNA). Results Nearly one half of the health workers (45%) reported difficulties fulfilling their duties, especially doctors, women, and younger workers. They cited inadequate supplies and infrastructure, bad behaviour of patients, and administrative problems. Many, especially doctors (74%), considered they were badly treated as employees. Nearly all said lack of medicines in government facilities was due to inadequate supply, not improved during the HPSP. Two thirds of doctors and nurses complained of bad behaviour of patients. A quarter of respondents thought quality of service had improved as a result of the HPSP. Local service managers and the BMA and BNA accepted patients had negative views and experiences, blaming inadequate resources, high patient loads, and patients' unrealistic expectations. They said doctors and nurses were demotivated by poor working conditions, unfair treatment, and lack of career progression; private and unqualified practitioners sought to please patients instead of giving medically appropriate care. The BMA considered it would be dangerous to attempt to train and register unqualified practitioners. Conclusions The continuing dissatisfaction of health workers may have undermined the effectiveness of the HPSP. Presenting the views of the public and service users to health managers helped to focus discussions about quality of services. It is important to involve health workers in health services reforms. PMID:22375856

Understanding the responsibilities and obligations of the modern paediatric surgeon.

PubMed

Beasley, Spencer W

2015-02-01

The modern paediatric surgeon needs to be competent in multiple domains that extend well beyond their clinical and technical expertise. This article, based on the Journal of Pediatric Surgery Lecture at the BAPS Congress (2014), explores some of these less well understood responsibilities and obligations, including professionalism, leadership, effective clinical teaching, and research. The consequence of falling short in these areas includes risks to our profession as a whole as well as compromising our ability to provide our patients with the best clinical care. Paediatric surgeons have a responsibility to influence the configuration of services to improve the quality of care and equity of access to specialist services for all children in their region. Evidence presented shows how a well-organised and funded regional paediatric surgical service allows children to receive quality treatment closer to home and is reflected in better clinical outcomes, less unnecessary surgery, and fewer complications. A paradigm for support to emerging countries as they increase the capacity and infrastructure of their paediatric surgical services is proposed. The way we judge ourselves and others should relate to our performance across the full scope of roles that a responsible and committed paediatric surgeon is expected to display. Copyright © 2015 Elsevier Inc. All rights reserved.

Project officer's perspective: quality assurance as a management tool.

PubMed

Heiby, J

1993-06-01

Advances in the management of health programs in less developed countries (LDC) have not kept pace with the progress of the technology used. The US Agency for International Development mandated the Quality Assurance Project (QAP) to provide quality improvement technical assistance to primary health care systems in LDCs while developing appropriate quality assurance (QA) strategies. The quality of health care in recent years in the US and Europe focused on the introduction of management techniques developed for industry into health systems. The experience of the QAP and its predecessor, the PRICOR Project, shows that quality improvement techniques facilitate measurement of quality of care. A recently developed WHO model for the management of the sick child provides scientifically based standards for actual care. Since 1988, outside investigators measuring how LDC clinicians perform have revealed serious deficiencies in quality compared with the program's own standards. This prompted developed of new QA management initiatives: 1) communicating standards clearly to the program staff; 2) actively monitoring actual performance corresponds to these standards; and 3) taking action to improve performance. QA means that managers are expected to monitor service delivery, undertake problem solving, and set specific targets for quality improvement. Quality improvement methods strengthen supervision as supervisors can objectively assess health worker performance. QA strengthens the management functions that support service delivery, e.g., training, records management, finance, logistics, and supervision. Attention to quality can contribute to improved health worker motivation and effective incentive programs by recognition for a job well done and opportunities for learning new skills. These standards can also address patient satisfaction. QA challenges managers to aim for the optimal level of care attainable.

The "ARIANNA" Project: An Observational Study on a Model of Early Identification of Patients with Palliative Care Needs through the Integration between Primary Care and Italian Home Palliative Care Units.

PubMed

Scaccabarozzi, Gianlorenzo; Amodio, Emanuele; Pellegrini, Giacomo; Limonta, Fabrizio; Lora Aprile, Pierangelo; Lovaglio, Pietro Giorgio; Peruselli, Carlo; Crippa, Matteo

2018-05-01

The aim of this study was to illustrate the characteristics of patients with palliative care (PC) needs, early identified by general practitioners (GPs), and to analyze their care process in home PC services. Early identification and service integration are key components to providing quality palliative care (PC) services ensuring the best possible service for patients and their families. However, in Italy, PC is often provided only in the last phase of life and for oncological patients, with a fragmented service. Multicenter prospective observational study, lasting in total 18 months, implemented in a sample of Italian Home Palliative Care Units (HPCUs), enrolling and monitoring patients with limited life expectancy, early identified by 94 GPs. The study began on March 1, 2014 and ended on August 31, 2015. Nine hundred thirty-seven patients, out of a total pool of 139,071, were identified by GPs as having a low life expectancy and PC needs. Of these, 556 (59.3%) were nononcological patients. The GPs sent 433 patients to the HPCUs for multidimensional assessment, and 328 (75.8%) were placed in the care of both settings (basic or specialist). For all patients included in the study, both oncological and nononcological patients, there was a high rate of death at home, around 70%. This study highlights how a model based on early identification, multidimensional evaluation, and integration of services can promote adequate PC, also for noncancer patients, with a population-based approach.

Near-toll quality digital speech transmission in the mobile satellite service

NASA Technical Reports Server (NTRS)

Townes, S. A.; Divsalar, D.

1986-01-01

This paper discusses system considerations for near-toll quality digital speech transmission in a 5 kHz mobile satellite system channel. Tradeoffs are shown for power performance versus delay for a 4800 bps speech compression system in conjunction with a 16 state rate 2/3 trellis coded 8PSK modulation system. The suggested system has an additional 150 ms of delay beyond the propagation delay and requires an E(b)/N(0) of about 7 dB for a Ricean channel assumption with line-of-sight to diffuse component ratio of 10 assuming ideal synchronization. An additional loss of 2 to 3 dB is expected for synchronization in fading environment.

Measuring the perceived quality of ophthalmology services in private organizations. A marketing perspective.

PubMed

Gheorghe, Iuliana Raluca; Gheorghe, Consuela-Mădălina; Purcărea, Victor Lorin

2018-01-01

Nowadays, the competition registered on the Romanian markets regarding the activity of private ophthalmology organizations has raised their interest in developing consumer-oriented strategies. The key factor that assures a differentiation as well as a competitive advantage is the service quality from a marketing perspective. From a marketing perspective, service quality is measured as a perceived discrepancy between the consumers' expectations and was actually performed in health care services. The most widely and validated measurement is the SERVQUAL scale. However, a variety of SERVQUAL scales have been applied in different health care environments without taking into consideration the specialty of the health care service. Thus, the objective of this paper was to measure the service quality in the Romanian ophthalmology private organizations using the SERVQUAL measurement, by identifying the SERVQUAL dimensions, which register the highest and the lowest gap scores. The instrument for data collection was the SERVQUAL self-administered questionnaire that consisted of 22 items measured on a 5-point Likert scale. The sample size encompassed 100 participants and the sampling technique was the snowball. The internal consistency, validity and the reliability of the SERVQUAL scale was determined by the Cronbach's alpha coefficients and factor analysis. The SERVQUAL questionnaire focused on 5 dimensions (tangibles, reliability, assurance, empathy and responsiveness) and each dimension, in its turn, was characterized by different items. The mean age of the participants was 49.52 years, with a mean income of 3031 Romanian Currency and the mean period of wearing eyeglasses was 5 years (±2). Further, there were 47% females and 53% males. The overall internal consistency of the SERVQUAL scale, as well as the dimensions' internal consistency were all above 0.7 and the factor analysis revealed that the items loaded properly on each dimension. Moreover, the gap scores of the SERVQUAL scale's dimensions pinpointed that the highest gap score was registered by the Tangibles dimension and the lowest gap score was registered by the Reliability dimension. Performing the ophthalmology service right the first time, contributes significantly to the improvement of the marketing effectiveness and the operating efficiency.

Measuring the perceived quality of ophthalmology services in private organizations. A marketing perspective

PubMed Central

Gheorghe, Iuliana Raluca; Gheorghe, Consuela-Mădălina; Purcărea, Victor Lorin

2018-01-01

Nowadays, the competition registered on the Romanian markets regarding the activity of private ophthalmology organizations has raised their interest in developing consumer-oriented strategies. The key factor that assures a differentiation as well as a competitive advantage is the service quality from a marketing perspective. Objectives: From a marketing perspective, service quality is measured as a perceived discrepancy between the consumers’ expectations and was actually performed in health care services. The most widely and validated measurement is the SERVQUAL scale. However, a variety of SERVQUAL scales have been applied in different health care environments without taking into consideration the specialty of the health care service. Thus, the objective of this paper was to measure the service quality in the Romanian ophthalmology private organizations using the SERVQUAL measurement, by identifying the SERVQUAL dimensions, which register the highest and the lowest gap scores. Materials and methods: The instrument for data collection was the SERVQUAL self-administered questionnaire that consisted of 22 items measured on a 5-point Likert scale. The sample size encompassed 100 participants and the sampling technique was the snowball. The internal consistency, validity and the reliability of the SERVQUAL scale was determined by the Cronbach’s alpha coefficients and factor analysis. The SERVQUAL questionnaire focused on 5 dimensions (tangibles, reliability, assurance, empathy and responsiveness) and each dimension, in its turn, was characterized by different items. Results: The mean age of the participants was 49.52 years, with a mean income of 3031 Romanian Currency and the mean period of wearing eyeglasses was 5 years (±2). Further, there were 47% females and 53% males. The overall internal consistency of the SERVQUAL scale, as well as the dimensions’ internal consistency were all above 0.7 and the factor analysis revealed that the items loaded properly on each dimension. Moreover, the gap scores of the SERVQUAL scale’s dimensions pinpointed that the highest gap score was registered by the Tangibles dimension and the lowest gap score was registered by the Reliability dimension. Conclusions: Performing the ophthalmology service right the first time, contributes significantly to the improvement of the marketing effectiveness and the operating efficiency. PMID:29796435

Improving the quality of pressure ulcer care with prevention: a cost-effectiveness analysis.

PubMed

Padula, William V; Mishra, Manish K; Makic, Mary Beth F; Sullivan, Patrick W

2011-04-01

In October 2008, Centers for Medicare and Medicaid Services discontinued reimbursement for hospital-acquired pressure ulcers (HAPUs), thus placing stress on hospitals to prevent incidence of this costly condition. To evaluate whether prevention methods are cost-effective compared with standard care in the management of HAPUs. A semi-Markov model simulated the admission of patients to an acute care hospital from the time of admission through 1 year using the societal perspective. The model simulated health states that could potentially lead to an HAPU through either the practice of "prevention" or "standard care." Univariate sensitivity analyses, threshold analyses, and Bayesian multivariate probabilistic sensitivity analysis using 10,000 Monte Carlo simulations were conducted. Cost per quality-adjusted life-years (QALYs) gained for the prevention of HAPUs. Prevention was cost saving and resulted in greater expected effectiveness compared with the standard care approach per hospitalization. The expected cost of prevention was $7276.35, and the expected effectiveness was 11.241 QALYs. The expected cost for standard care was $10,053.95, and the expected effectiveness was 9.342 QALYs. The multivariate probabilistic sensitivity analysis showed that prevention resulted in cost savings in 99.99% of the simulations. The threshold cost of prevention was $821.53 per day per person, whereas the cost of prevention was estimated to be $54.66 per day per person. This study suggests that it is more cost effective to pay for prevention of HAPUs compared with standard care. Continuous preventive care of HAPUs in acutely ill patients could potentially reduce incidence and prevalence, as well as lead to lower expenditures.

Role concepts and expectations of physicians and nurses in hospitals.

PubMed

Verschuren, P J; Masselink, H

1997-10-01

The social environment in which hospitals in the Netherlands have to function nowadays is greatly changing. Over the last 10 years the policy of the Dutch government has become less directive, market mechanisms are gaining weight and the demand for services by patients is changing. As a result of these changes hospitals formulate their strategic goals in terms of improvement of quality of care and efficacy. A basic assumption in this article is that quality of care is to be gained by collaborative practice between physicians and nurses. A necessary condition for this is that there is a correspondence in role concepts and expectancies of physicians and nurses in hospitals. The object of this research is to describe the role concepts and role expectations of nurses, physicians and patients in two Dutch hospitals. In general, the research revealed considerable differences between role behaviour and role concepts among nurses. In the long run these differences may not be favourable for good understanding between them and physicians, or for their own job satisfaction. This may also have negative consequences for collaboration between nurses and physicians and, finally, for the quality of care and cure within the ward. There is a need for discussion of the role concepts of nurses in relation to their actual regular tasks in order to resolve this. A second discrepancy exists between the role behaviour of physicians and the expectations of nurses about this behaviour. This may also lead to a lower job satisfaction for nurses. Taking into account the fact that patients are satisfied with the way physicians and nurses pay attention to most aspects of care and cure, a discussion between physicians and nurses could be recommended. The aim is revising either the role behaviour of physicians, especially as regards their attention to the psycho-social needs of patients, or the expectations of nurses, or both.

Teamwork in health care: opportunities for gains in quality, productivity, and competitive advantage. What works, what doesn't, and why.

PubMed

Montebello, A R

1994-01-01

Wholesale political, economic, and social change is pressuring health-care organizations to reinvent themselves as they enter a new arena of managed competition. Survival is at stake. Will belt-tightening efforts, combined with structural changes and strategic alliances, achieve the necessary improvements in efficiency and help to secure an adequate patient base? It seems reasonable to expect that health-care institutions can realize the major gains in quality, productivity, efficiency, and competitive edge that organizations in the manufacturing and service industries have enjoyed for the past several years. It seems like a logical next step for health-care organizations to deploy proven methods--such as work redesign, team-based structures, and empowered workforces--that have helped to restore competitiveness to many industrial and service firms. This article describes how to organize teams at all levels and accelerate their development to achieve important organizational objectives--such as improving quality, productivity, and efficiency--while increasing employee satisfaction. Pioneering workplace innovations are reviewed to demonstrate how high-involvement teams integrating strategic planning, research, and health-care delivery processes are not only possible but highly desirable. Enhanced quality, improved productivity, greater efficiency, and employee satisfaction all translate to an undeniable competitive advantage.

AGING & HEALTH Expectations About Future Use Of Long-Term Services And Supports Vary By CurrentLiving Arrangement

PubMed Central

Henning-Smith, Carrie; Shippee, Tetyana

2014-01-01

Most Americans know little about options for long-term services and supports and underestimate their likely future needs for such assistance. Using data from the 2012 National Health Interview Survey, we examined expectations about future use of long-term services and supports among adults ages 40–65 and how these expectations varied by current living arrangement. We found differences by living arrangement in expectations about both future need for long-term services and supports and who would provide such care if needed. Respondents living with minor children were the least likely to expect to need long-term services and supports and to require paid care if the need arose. In contrast, respondents living alone were the most likely to expect that it was “very likely” that they would need long-term services and supports and to rely on paid care. Overall, we found a disconnect between expectations of use and likely future reality: 60 percent of respondents believed that they were unlikely to need long-term services and supports in the future, whereas the evidence suggests that nearly 70 percent of older adults will need them at some point. These findings both underscore the need for programs that encourage people to plan for long-term services and supports and indicate that information about living arrangements can be useful in developing and targeting such programs. PMID:25561642

Informing primary care reform in Greece: patient expectations and experiences (the QUALICOPC study).

PubMed

Lionis, Christos; Papadakis, Sophia; Tatsi, Chrysanthi; Bertsias, Antonis; Duijker, George; Mekouris, Prodromos-Bodosakis; Boerma, Wienke; Schäfer, Willemijn

2017-04-05

Primary health care is the cornerstone of a high quality health care system. Greece has been actively attempting to reform health care services in order to improve heath outcomes and reduce health care spending. Patient-centered approaches to health care delivery have been increasingly acknowledged for their value informing quality improvement activities. This paper reports the quality of primary health care services in Greece as perceived by patients and aspects of health care delivery that are valued by patients. This study was conducted as part of the Quality and Costs of Primary Care in Europe (QUALICOPC) study. A cross-sectional sample of patients were recruited from general practitioner's offices in Greece and surveyed. Patients rated five features of person-focused primary care: accessibility; continuity and coordination; comprehensiveness; patient activation; and doctor-patient communication. One tenth of the patients ranked the importance of each feature on a scale of one to four, and nine tenths of patients scored their experiences of care received. Comparisons were made between patients with and without chronic disease. The sample included 220 general practitioners from both public and private sector. A total of 1964 patients that completed the experience questionnaire and 219 patients that completed the patient values questionnaire were analyzed. Patients overall report a positive experiences with the general practice they visited. Several gaps were identified in particular in terms of wait times for appointments, general practitioner access to patient medical history, delivery of preventative services, patient involvement in decision-making. Patients with chronic disease report better experience than respondents without a chronic condition, however these patient groups report the same values in terms of qualities of the primary care system that are important to them. Data gathered may be used to improve the quality of primary health care services in Greece through an increased focus on patient-centered approaches. Our study has identified several gaps as well as factors within the primary care health system that patient's perceive as most important which can be used to prioritize quality improvement activities, especially within the austerity period. Study findings may also have application to other countries with similar context and infrastructure.

Positive expectations encourage generalization from a positive intergroup interaction to outgroup attitudes.

PubMed

Deegan, Matthew P; Hehman, Eric; Gaertner, Samuel L; Dovidio, John F

2015-01-01

The current research reveals that while positive expectations about an anticipated intergroup interaction encourage generalization of positive contact to outgroup attitudes, negative expectations restrict the effects of contact on outgroup attitudes. In Study 1, when Blacks and Whites interacted with positive expectations, interaction quality predicted outgroup attitudes to a greater degree than when groups interacted with negative expectations. When expectations (Studies 2 and 3) and the actual interaction quality (Study 4) were manipulated orthogonally, negative expectations about the interaction predicted negative outgroup attitudes, regardless of actual interaction quality. By contrast, participants holding positive expectations who experienced a positive interaction expressed positive outgroup attitudes, whereas when they experienced a negative interaction, they expressed outgroup attitudes as negative as those with negative expectations. Across all four studies, positive expectations encouraged developing outgroup attitudes consistent with interaction quality. © 2014 by the Society for Personality and Social Psychology, Inc.

iCarer: AAL for the Informal Carers of the Elderly.

PubMed

Moreno, P A; Garcia-Pacheco, J L; Charvill, J; Lofti, A; Langensiepen, C; Saunders, A; Berckmans, K; Gaspersic, J; Walton, L; Carmona, M; Perez de la Camara, S; Sanchez-de-Madariaga, R; Pozo, J; Muñoz, A; Pascual, M; Gomez, E J

2015-01-01

In the context of the long-term care for older adults, informal carers play a key role. Daily competing priorities or a care-skills deficit may lead them to stress, anxiety and/or depression. The iCarer project (AAL-2012-5-239) proposes the design and implementation of a cloud-inspired personalised and adaptive platform which will offer support to informal carers of older adults with cognitive impairment. By means of a holistic approach comprising technologies and services addressing the intelligent and interactive monitoring of activities, knowledge management for personalised guidance and orientation, virtual interaction, e-learning, care coordination facilities and social network services, iCarer aims to reduce the informal carer stress and to enhance the quality of care they provide, thus improving their quality of life. The iCarer platform will be evaluated through a multi-centre non-controlled study (4 months; 48 homes located in England and in Slovenia). Currently the iCarer project is completing the development work. The evaluation trial is expected to start in August 2015.

Inpatient care of mentally ill people in prison: results of a year's programme of semistructured inspections

PubMed Central

Reed, John L; Lyne, Maggi

2000-01-01

Objective To investigate the facilities for inpatient care of mentally disordered people in prison. Design Semistructured inspections conducted by doctor and nurse. Expected standards were based on healthcare quality standards published by the Prison Service or the NHS. Setting 13 prisons with inpatient beds in England and Wales subject to the prison inspectorate's routine inspection programme during 1997-8. Main outcomes measures Appraisals of quality of care against published standards. Results The 13 prisons had 348 beds, 20% of all beds in prisons. Inpatient units had between 3 and 75 beds. No doctor in charge of inpatients had completed specialist psychiatric training. 24% of nursing staff had mental health training; 32% were non-nursing trained healthcare officers. Only one prison had occupational therapy input; two had input from a clinical psychologist. Most patients were unlocked for about 3.5 hours a day and none for more than nine hours a day. Four prisons provided statistics on the use of seclusion. The average length of an episode of seclusion was 50 hours. Conclusion The quality of services for mentally ill prisoners fell far below the standards in the NHS. Patients' lives were unacceptably restricted and therapy limited. The present policy dividing inpatient care of mentally disordered prisoners between the prison service and the NHS needs reconsideration. PMID:10764360

Joint Services Electronics Program: Electronics Research at the University of Texas at Austin

DTIC Science & Technology

1990-12-31

large area 2-dimensional phased arrays , and improved beam qualities . This device structure is expected to impact laser technology over a wide range...energy. In the following pages we report on two significant accomplishments. The first involves the influence oi mirror-quantum well optical coupling on... intensity enhancements in the normal direction to the mirror of a 24 (Research Unit SSE89-1, "Growth of Ill-V Compounds by Molecular Beam Epitaxy") factor of

Coverage and quality of antenatal care provided at primary health care facilities in the 'Punjab' province of 'Pakistan'.

PubMed

Majrooh, Muhammad Ashraf; Hasnain, Seema; Akram, Javaid; Siddiqui, Arif; Memon, Zahid Ali

2014-01-01

Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In 'Pakistan' antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to 'Divisions' and 'Districts'. By population 'Punjab' is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in 'Punjab' province of 'Pakistan'. Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers. The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage. The coverage and quality of the antenatal care services in 'Punjab' are extremely compromised. Only half of the expected pregnancies are enrolled and out of those 1/3 drop out in follow-up visits.

Current practice and perspectives in CRO oversight based on a survey performed among members of the German Association of Research-Based Pharmaceutical Companies (vfa)

PubMed Central

Hennig, Michael; Hundt, Ferdinand; Busta, Susanne; Mikus, Stefan; Sanden, Per-Holger; Sörgel, Andrea; Ruppert, Thorsten

2017-01-01

In recent years, the number and scope of outsourced activities in the pharmaceutical industry have increased heavily. In addition, also the type of outsourcing has changed significantly in that time. This raises the question of whether and how sponsors retain the capability to select and to control the contract research organizations (CROs) involved and what expertise still has to be present in the development department as well as other relevant departments to ensure adequate oversight, also in line with the expectations of regulators and health authorities. In order to answer these questions, a survey was conducted among the German vfa member companies. The survey describes the latest developments and experiences in outsourcing by 18 German vfa member companies. It concentrates on measures how to implement Quality Assurance (QA) when performing outsourced clinical studies. This study shows that the majority of companies apply a full-outsourcing, preferred-provider model of clinical trial services, with the clinical research department playing the major role in this process. A large amount of guiding documents, processes and tools are used to ensure an adequate oversight of the services performed by the CRO(s). Finally the guiding principles for all oversight processes should be transparent communication, a clearly established expectation for quality, a precise definition of accountability and responsibility while avoiding silo mentality, and a comprehensive documentation of the oversight’s evidence. For globally acting and outsourcing sponsors, oversight processes need to be aligned with regards to local and global perspectives. This survey shows that the current implementation of oversight processes in the participating companies covers all relevant areas to ensure highest quality and integrity of the data produced by the outsourced clinical trial. PMID:28163667

Current practice and perspectives in CRO oversight based on a survey performed among members of the German Association of Research-Based Pharmaceutical Companies (vfa).

PubMed

Hennig, Michael; Hundt, Ferdinand; Busta, Susanne; Mikus, Stefan; Sanden, Per-Holger; Sörgel, Andrea; Ruppert, Thorsten

2017-01-01

In recent years, the number and scope of outsourced activities in the pharmaceutical industry have increased heavily. In addition, also the type of outsourcing has changed significantly in that time. This raises the question of whether and how sponsors retain the capability to select and to control the contract research organizations (CROs) involved and what expertise still has to be present in the development department as well as other relevant departments to ensure adequate oversight, also in line with the expectations of regulators and health authorities. In order to answer these questions, a survey was conducted among the German vfa member companies. The survey describes the latest developments and experiences in outsourcing by 18 German vfa member companies. It concentrates on measures how to implement Quality Assurance (QA) when performing outsourced clinical studies. This study shows that the majority of companies apply a full-outsourcing, preferred-provider model of clinical trial services, with the clinical research department playing the major role in this process. A large amount of guiding documents, processes and tools are used to ensure an adequate oversight of the services performed by the CRO(s). Finally the guiding principles for all oversight processes should be transparent communication, a clearly established expectation for quality, a precise definition of accountability and responsibility while avoiding silo mentality, and a comprehensive documentation of the oversight's evidence. For globally acting and outsourcing sponsors, oversight processes need to be aligned with regards to local and global perspectives. This survey shows that the current implementation of oversight processes in the participating companies covers all relevant areas to ensure highest quality and integrity of the data produced by the outsourced clinical trial.

Identifying influence of perceived quality and satisfaction on the utilization status of the community clinic services; Bangladesh context.

PubMed

Karim, R M; Abdullah, M S; Rahman, A M; Alam, A M

2015-04-01

Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients' perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic (CC) services. This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 Community Clinics (CCs). Since most of the outcome indicators focus mainly on women and children, women having children less than two years of age were randomly assigned and interviewed for the study purpose. Data for the development of perceived service quality and satisfaction tools were collected through Focus Group Discussion (FGD), key informants interview and data for measuring the utilization status were collected by an interviewer administered pretested semi-structured questionnaire. About 95% of the respondents were Muslims and 5% were Hindus. The average age of the respondents was 23.38 (SD ± 4.15) years and almost all of them are home makers. The average monthly expenditure of their family was 7462.92 (SD ± 2545) BDT equivalent to 95 (SD ± 32) US$. To measure lay peoples' perception and satisfaction regarding primary health care service quality two scales e.g. Slim Haddad's 20-item scale for measuring perceived quality of primary health care services (PQPCS) validated in Guinea and Burkina Fuso and primary care satisfaction survey for women (PCSSW) developed by Scholle and colleagues 2004; is a 24-item survey tool validated in Turkey were chosen as a reference tools. Based on those, two psychometric research instruments; 24 items PQPCS scale (chronbach's α =0.89) and 22-items Community Clinic Service Satisfaction (CCSS) scale (chronbach's α = 0.97), were constructed and validated for measuring perceived service quality and satisfaction in Bangladesh context. This study showed mothers with preprimary education [(χ2 = 4.20, p = 0.04), AOR with 95% CI = 1.89 (1.03, 3.53)] utilized the limited curative care services more than educated mothers. On the contrary, higher income families [for income group 5000-10,000 BDT χ2 = 8.83, p = 0.003 and AOR with 95% CI = 0.37(0.19, 0.71)] and [for income group above 10,000 BDT χ2 = 5.02, p = 0.025 and AOR with 95% CI = 0.40 (0.18, 0.89)] and families having cultivable lands [for 5-10 decimal group χ2 = 5.51, p = 0.19, and AOR with 95% CI = 0.56 (0.35, 0.91)] and [for > 10 decimal group χ2 = 6.70, p = 0.010, and AOR with 95% CI = 0.50 (0.29, 0.84)] utilized the limited curative care services less than their poorer and landless counterpart. The same relationship was observed in case of health education and Antenatal Care (ANC) and Postnatal Care (PNC) services. Women who lived in their own residence used health education services more frequently than those who lived in a rental house [χ2 = 24.00, p = 0.000 and AOR with 95% CI = 1.21, (1.12, 1.30)] and they also increasingly used maternal and child health services χ2 = 27.49, p = 0.000 and AOR with 95% CI 1.61, (1.35, 1.93)]. Perceptions concerning skill and competence of the health care provider [χ2 = 16.90, p = 0.000 and AOR with 95% CI = 1.14, (1.07, 1.22)] and satisfaction indicating interpersonal communication and attitude of the care provider [χ2 = 7.07, p = 0.008 AOR with 95% CI = 1.08, (1.02, 1.15)] were found significant predictors for limited curative care service utilization of CC. Perception related to the quality of management, administration, physical environment of the service point and satisfaction addressing health promotion and women health issues also played significant role on CC's services utilization. Besides parental education and income, client's perception and satisfaction played significant role in CC service utilization. Provider's perception of service quality should be studied. The study findings will enable policy-makers .to improve quality of primary health care services, realizing providers' and patients' ideas of CC service quality.

Are We Monitoring the Quality of Cataract Surgery Services? A Qualitative Situation Analysis of Attitudes and Practices in a Large City in South Africa

PubMed Central

Haastrup, Oluwatosin O. O.; Buchan, John C.; Cassels-Brown, Andy; Cook, Colin

2015-01-01

Purpose: To evaluate the current quality “assurance” and “improvement” mechanisms, the knowledge, attitudes and practices of cataract surgeons in a large South African city. Methodology: A total of 17 in-depth semi-structured interviews were conducted with ophthalmologists in June 2012 at 2 tertiary institutions in the Republic of South Africa. Recruitment of the purposive sample was supplemented by snowball sampling. The study participants were 5 general ophthalmologists and 2 pediatric ophthalmologists; 4 senior and 4 junior registrars and a medical officer. Participants were interviewed by a trained qualitative interviewer. The interview lasted between 20 and 60 min. The interviews were recorded, transcribed verbatim and analyzed for thematic content. Results: Mechanisms for quality assurance were trainee logbooks and subjective senior staff observation. Clinicians were encouraged, but not obliged to self-audit. Quality improvement is incentivized by personal integrity and ambition. Poorly performing departments are inconspicuous, especially nationally, and ophthalmologists rely on the impression to gauge the quality of service provided by colleagues. Currently, word of mouth is the method for determining the better cataract surgical centers. Conclusion: The quality assurance mechanisms were dependent on insight and integrity of the individual surgeons. No structures were described that would ensure the detection of surgeons with higher than expected complication rates. Currently, audits are not enforced, and surgical outcomes are not well monitored due to concerns that this may lead to lack of openness among ophthalmologists. PMID:25949081

Are we monitoring the quality of cataract surgery services? A qualitative situation analysis of attitudes and practices in a large city in South Africa.

PubMed

Haastrup, Oluwatosin O O; Buchan, John C; Cassels-Brown, Andy; Cook, Colin

2015-01-01

To evaluate the current quality "assurance" and "improvement" mechanisms, the knowledge, attitudes and practices of cataract surgeons in a large South African city. A total of 17 in-depth semi-structured interviews were conducted with ophthalmologists in June 2012 at 2 tertiary institutions in the Republic of South Africa. Recruitment of the purposive sample was supplemented by snowball sampling. The study participants were 5 general ophthalmologists and 2 pediatric ophthalmologists; 4 senior and 4 junior registrars and a medical officer. Participants were interviewed by a trained qualitative interviewer. The interview lasted between 20 and 60 min. The interviews were recorded, transcribed verbatim and analyzed for thematic content. Mechanisms for quality assurance were trainee logbooks and subjective senior staff observation. Clinicians were encouraged, but not obliged to self-audit. Quality improvement is incentivized by personal integrity and ambition. Poorly performing departments are inconspicuous, especially nationally, and ophthalmologists rely on the impression to gauge the quality of service provided by colleagues. Currently, word of mouth is the method for determining the better cataract surgical centers. The quality assurance mechanisms were dependent on insight and integrity of the individual surgeons. No structures were described that would ensure the detection of surgeons with higher than expected complication rates. Currently, audits are not enforced, and surgical outcomes are not well monitored due to concerns that this may lead to lack of openness among ophthalmologists.

Preferred drug lists: potential impact on healthcare economics.

PubMed

Ovsag, Kimberly; Hydery, Sabrina; Mousa, Shaker A

2008-01-01

To analyze the implementation of Medicaid preferred drug lists (PDLs) in a number of states and determine its impact on quality of care and cost relative to other segments of healthcare. We reviewed research and case studies found by searching library databases, primarily MEDLINE and EBSCOHost, and searching pertinent journals. Keywords initially included "drug lists," "prior authorization," "prior approval," and "Medicaid." We added terms such as "influence use of other healthcare services," "quality of care," and "overall economic impact." We mainly used primary sources. Based on our literature review, we determined that there are a number of issues regarding Medicaid PDLs that need to be addressed. Some issues include: (a) the potential for PDLs to influence the utilization of other healthcare services, (b) criteria used by Medicaid for determining acceptance of drugs onto a PDL, (c) the effect of PDL implementation on compliance to new regimens, (d) the potential effects of restricting medication availability on quality of care, (e) administrative costs associated with PDLs, and (f) satisfaction rates among patients and medical providers. This review highlighted expected short-term cost savings with limited degree of compromised quality of PDL implementation, but raised the concern about the potential long-term decline in quality of care and overall economic impact. The number of concerns raised indicates that further studies are warranted regarding both short-term cost benefits as well as potential long-term effects of Medicaid PDL implementation. Objective analysis of these effects is necessary to ensure cost-effectiveness and quality of care.

Monitoring and root cause analysis of clinical biochemistry turn around time at an academic hospital.

PubMed

Chauhan, Kiran P; Trivedi, Amit P; Patel, Dharmik; Gami, Bhakti; Haridas, N

2014-10-01

Quality can be defined as the ability of a product or service to satisfy the needs and expectations of the customer. Laboratories are more focusing on technical and analytical quality for reliability and accuracy of test results. Patients and clinicians however are interested in rapid, reliable and efficient service from laboratory. Turn around time (TAT), the timeliness with which laboratory personnel deliver test results, is one of the most noticeable signs of laboratory service and is often used as a key performance indicator of laboratory performance. This study is aims to provide clue for laboratory TAT monitoring and root cause analysis. In a 2 year period a total of 75,499 specimens of outdoor patient department were monitor, of this a total of 4,142 specimens exceeded TAT. With consistent efforts to monitor, root cause analysis and corrective measures, we are able to decreased the specimens exceeding TAT from 7-8 to 3.7 %. Though it is difficult task to monitor TAT with the help of laboratory information system, real time documentation and authentic data retrievable, along with identification of causes for delays and its remedial measures, improve laboratory TAT and thus patient satisfaction.

Providing Our Fellows in Training with Education on Inflammatory Bowel Disease Health Maintenance to Improve the Quality of Care in Our Health Care System.

PubMed

Lee, Ann Joo; Kraemer, Dale F; Smotherman, Carmen; Eid, Emely

2016-01-01

Inflammatory bowel disease (IBD) quality measures were established in an effort to standardize IBD health care. Despite effort to improve clinical performance, considerable variations in practice still exist. To further improve IBD health care, we propose incorporating an in-service educational session on IBD health maintenance to provide trainees with increasing awareness and knowledge on IBD management. Fifty electronic medical charts were randomly selected, and the level of quality documentation was assessed for 15 core IBD quality measures. Data were reported as the percentage of charts meeting audit criteria (compliance score). Fellows then attended an in-service educational session to review IBD quality measures and reinforce practice expectations. A second audit was then performed on an additional 50 patient charts to determine whether documentation practices improved after the educational session. We found a positive correlation between an in-service educational session and fellows' compliance with IBD health maintenance. Overall, the fellows' compliance score increased by 18% (before intervention, 65%; after intervention, 83%; P < 0.0001). The intervention was equally beneficial irrespective of training level. Although the magnitude of improvement was comparable, the mean compliance score was highest in year 2 at 81% (year 1: 72% [P = 0.019] and year 3: 70% [P = 0.002]). Fellows expressed a high degree of satisfaction with the educational intervention and emphasized the value in reviewing the conceptual bases for IBD health maintenance. Incorporating a standard curriculum on IBD health maintenance provides fellows in training with increased awareness and guidance on managing the unique preventive care needs of patients with IBD.

Factors influencing private health providers' technical quality of care for acute respiratory infections among under-five children in rural West Bengal, India.

PubMed

Chakraborty, Sarbani; Frick, Kevin

2002-11-01

In many developing countries, private health practitioners provide a significant portion of curative care for diseases which are of public health importance. Currently, health sector reform efforts in these countries are fostering increased participation of private providers in the delivery of health services, including those of public health importance. Guaranteeing good technical quality of care is critical to the process. However, little is known about private providers' technical quality of care (disease management practices) and the factors influencing these services. The purpose of this study was to contribute information on this topic. The study was conducted among private providers in rural West Bengal, India and focused on providers' disease management practices for acute respiratory infections (ARI) among under-five children. World Health Organization (WHO) guidelines for ARI case management were used as the expected standard of care. Observations of patient-provider encounters and interviews with the providers and mothers were the main sources of data. The study found that private health providers in rural West Bengal have inadequate technical quality of care. The problem was related both to low levels of performance (limited potential) and inconsistency in performance (within-provider variation). Limited potential for good technical quality for ARI among the providers was related to lack of knowledge (technical incompetence). One of the important factors influencing within-provider variation was patient load. Since rural private providers operate on a fee-for-service payment system, there are incentives related to seeing many patients. The study concluded that to bring about sustainable improvements in private providers' ARI disease management practices, training programs and interventions that improved compliance were necessary.

Web-based magazine design for self publishers

NASA Astrophysics Data System (ADS)

Hunter, Andrew; Slatter, David; Greig, Darryl

2011-03-01

Short run printing technology and web services such as MagCloud provide new opportunities for long-tail magazine publishing. They enable self publishers to supply magazines to a wide range of communities, including groups that are too small to be viable as target communities for conventional publishers. In a Web 2.0 world where users constantly discover new services and where they may be infrequent patrons of any single service, it is unreasonable to expect users to learn the complex service behaviors. Furthermore, we want to open up publishing opportunities to novices who are unlikely to have prior experience of publishing and who lack design expertise. Magazine design automation is an ambitious goal, but recent progress with another web service, Autophotobook, proves that some level of automation of publication design is feasible. This paper describes our current research effort to extend the automation capabilities of Autophotobook to address the issues of magazine design so that we can provide a service to support professional-quality self publishing by novice users for a wide range of community types and sizes.

Improving the quality of care for mild to moderate dementia: an evaluation of the Croydon Memory Service Model.

PubMed

Banerjee, Sube; Willis, Rosalind; Matthews, David; Contell, Faith; Chan, Jeni; Murray, Joanna

2007-08-01

The large majority of people with dementia receive nothing in the way of specialist assessment and care at any stage of their illness. There is a particular lack of services focussed on early identification and intervention in dementia where there is the possibility of long-term harm reduction for people with dementia and their family carers. We have developed a model of care that is complementary to local systems of health and social care (The Croydon Memory Service Model [CMSM]). This is a low-cost, high-throughput, generic service to enable early identification and intervention in dementia. It is a multi-agency approach with joint ownership by health services, social services and the voluntary sector with embedded specifically-tailored approaches to primary care and minority ethnic communities. We completed a service evaluation of the introduction of the CMSM in a single borough in South London. Six predefined service goals were set: high acceptability; high appropriate referral rate; successful engagement with people from minority ethnic groups; successful engagement with people with young onset dementia; focus on engagement with mild cases to enable early intervention; and an increase in the overall number of new cases of dementia seen. Mixed qualitative and quantitative methodologies were used including a description and 6-month follow-up of a cohort of 290 consecutive referrals. All key predefined service goals were met: 95% acceptability; 94% appropriate referrals; successful engagement with minority ethnic groups (two-fold greater number compared with that expected from general population demographic data); 17% of referrals under 65 years of age; 68% referrals with mild or minimal dementia severity; and an estimated 63% increase in the number of new cases of dementia seen in Croydon. At 6-month follow up, those referred to the service had decreased behavioural disturbance and increased quality of life compared with baseline. Specific services for early dementia, which deliver diagnosis and care, can be established. These services can increase the numbers of people with early dementia identified and provided with care. Those receiving such services appear to improve in terms of quality of life and behavioural and psychological symptoms of dementia. Next steps should include the establishment of such services in other representative areas and evaluation of their effectiveness in comparison with other models of care.

How to Integrate HIV and Sexual and Reproductive Health Services in Namibia, the Epako Clinic Case Study

PubMed Central

Forster, Norbert; Campuzano, Pedro; Kambapani, Rejoice; Brahmbhatt, Heena; Hidinua, Grace; Turay, Mohamed; Ikandi, Simon Kimathi; Kabongo, Leonard; Zariro, Farai

2017-01-01

Introduction: During the past two decades, HIV and Sexual and Reproductive Health services in Namibia have been provided in silos, with high fragmentation. As a consequence of this, quality and efficiency of services in Primary Health Care has been compromised. Methods: We conducted an operational research (observational pre-post study) in a public health facility in Namibia. A health facility assessment was conducted before and after the integration of health services. A person-centred integrated model was implemented to integrate all health services provided at the health facility in addition to HIV and Sexual and Reproductive Health services. Comprehensive services are provided by each health worker to the same patients over time (longitudinality), on a daily basis (accessibility) and with a good external referral system (coordination). Prevalence rates of time flows and productivity were done. Results: Integrated services improved accessibility, stigma and quality of antenatal care services by improving the provider-patient communication, reducing the time that patients stay in the clinic in 16% and reducing the waiting times in 14%. In addition, nurse productivity improved 85% and the expected time in the health facility was reduced 24% without compromising the uptake of TB, HIV, outpatient, antenatal care or first visit family planning services. Given the success on many indicators resulting from integration of services, the goal of this paper was to describe “how” health services have been integrated, the “process” followed and presenting some “results” from the integrated clinic. Conclusions: Our study shows that HIV and SRH services can be effectively integrated by following the person-centred integrated model. Based on the Namibian experience on “how” to integrate health services and the “process” to achieve it, other African countries can replicate the model to move away from the silo approach and contribute to the achievement of Universal Health Coverage. PMID:28970759

Perceived quality of physiotherapy services among informal caregivers of children with cerebral palsy in Ibadan, Nigeria.

PubMed

Olaleye, Olubukola A; Hamzat, Talhatu K; Oloso, Modinat O

2015-01-01

Effective physiotherapy intervention for children with cerebral palsy (CP) requires that expectations of their caregivers be incorporated into treatment plans and strategies. This study explored the perceived Quality of Physiotherapy (QoP) for children with CP in Ibadan, Nigeria This cross-sectional survey explored the perceived QoP using the SERVQUAL instrument among informal caregivers of children with CP from two different healthcare facilities. Data was analysed using Mann Whiney U and Wilcoxon Signed Rank tests at p ≤ 0.05. Fifty-three informal caregivers (50 females, 3 males) of children with CP (32 males, 21 females) were surveyed. Fourth-fifths (81.13%) of the caregivers perceived the QoP service for their children as poor. The highest negative and positive ranks were in the tangible and responsiveness dimensions of the SERVQUAL respectively. The study demonstrated that caregivers of children with CP perceived the quality of physiotherapy provided for their children as poor. This poor perception is related more to the tangible dimension of care. Strategies to improve care environment for children with CP and their informal caregivers should be implemented to engender satisfaction with care.

Primary care clinician expectations regarding aging.

PubMed

Davis, Melinda M; Bond, Lynne A; Howard, Alan; Sarkisian, Catherine A

2011-12-01

Expectations regarding aging (ERA) in community-dwelling older adults are associated with personal health behaviors and health resource usage. Clinicians' age expectations likely influence patients' expectations and care delivery patterns; yet, limited research has explored clinicians' age expectations. The Expectations Regarding Aging Survey (ERA-12) was used to assess (a) age expectations in a sample of primary care clinicians practicing in the United States and (b) clinician characteristics associated with ERA-12 scores.  This study was a cross-sectional survey of primary care clinicians affiliated with 5 practice-based research networks, October 2008 to June 2009. A total of 374 of the 1,510 distributed surveys were returned (24.8% response rate); 357 analyzed. Mean respondent age was 48.6 years (SD = 11.6; range 23-87 years); 88.0% physicians, 96.0% family medicine, 94.9% White, and 61.9% male. Female clinicians reported higher ERA-12 scores; clinicians' age expectations decreased with greater years in practice. Among the clinicians, higher ERA-12 scores were associated with higher clinician ratings of the importance of and personal skill in administering preventive counseling and the importance of delivering preventive services. Agreement with individual ERA-12 items varied widely. Unrealistically high or low ERA could negatively influence the quality of care provided to patients and patients' own age expectations. Research should examine the etiology of clinicians' age expectations and their association with older adult diagnoses and treatment. Medical education must incorporate strategies to promote clinician attitudes that facilitate successful patient aging.

What are true community benefits?

PubMed

Trocchio, J

1996-01-01

Not-for-profit healthcare organizations have increasingly recognized the need to document their community benefit services, but not all healthcare services should be included in a community benefits report. Some services are reasonably expected of any high-quality healthcare organization, regardless of its tax status. Others are provided as part of a commitment to the community, but they cannot or should not be quantified. A third group of services, however, can be counted and reported in an inventory of benefits. To qualify as a true community benefit, an activity must respond to a particular health problem in the community, especially one involving special populations. In addition, it must be financed through philanthropic contributions, volunteer efforts, or an endowment; generate a low or negative margin; or be a service that would be discontinued if the decision were made on a purely financial basis. Once an organization has determined that an activity is a community benefit and not a basic service or promotional program, organizational leaders must decide whether to include the service in a quantitative inventory or in a more general narrative without assignment of specific financial benefit. The community benefit services might be further broken down according to the intended recipient, whether it is the poor or the broader community.

Electricity distribution industry restructuring, electrification, and competition in South Africa

DOE Office of Scientific and Technical Information (OSTI.GOV)

Galen, P S

1997-07-01

This paper reviews the status of the South African electricity supply industry (ESI) and proposals for reorienting and restructuring it. South Africa has been intensely examining its ESI for more than 4 years in an effort to determine whether and how it should be restructured to best support the country`s new economic development and social upliftment goals. The debate has been spirited and inclusive of most ESI stakeholders. The demands on and expectations for the ESI are many and varied. The debate has reflected this diversity of interests and views. In essence, however, there is a consensus on what ismore » expected of the industry, namely, to extend provision of adequate, reliable, and affordable electricity service to all citizens and segments of the economy. This means a large-scale electrification program to reach as many of the nearly 50% of households currently without electricity service as soon as possible, tariff reform to promote equity and efficiency, and the upgrading of service quality now being provided by some of the newly consolidated municipal authorities. The issues involved are how best to achieve these results within the context of the national Reconstruction and Development Program, while accounting for time and resource constraints and balancing the interests of the various parties.« less

Factors affecting the adoption of healthcare information technology.

PubMed

Phichitchaisopa, Nisakorn; Naenna, Thanakorn

2013-01-01

In order to improve the quality and performance of healthcare services, healthcare information technology is among the most important technology in healthcare supply chain management. This study sets out to apply and test the Unified Theory of Acceptance and Use of Technology (UTAUT), to examine the factors influencing healthcare Information Technology (IT) services. A structured questionnaire was developed and distributed to healthcare representatives in each province surveyed in Thailand. Data collected from 400 employees including physicians, nurses, and hospital staff members were tested the model using structural equation modeling technique. The results found that the factors with a significant effect are performance expectancy, effort expectancy and facilitating conditions. They were also found to have a significant impact on behavioral intention to use the acceptance healthcare technology. In addition, in Thai provincial areas, positive significance was found with two factors: social influence on behavioral intention and facilitating conditions to direct using behavior. Based on research findings, in order for healthcare information technology to be widely adopted and used by healthcare staffs in healthcare supply chain management, the healthcare organizational management should improve healthcare staffs' behavioral intention and facilitating conditions.

Factors affecting the adoption of healthcare information technology

PubMed Central

Phichitchaisopa, Nisakorn; Naenna, Thanakorn

2013-01-01

In order to improve the quality and performance of healthcare services, healthcare information technology is among the most important technology in healthcare supply chain management. This study sets out to apply and test the Unified Theory of Acceptance and Use of Technology (UTAUT), to examine the factors influencing healthcare Information Technology (IT) services. A structured questionnaire was developed and distributed to healthcare representatives in each province surveyed in Thailand. Data collected from 400 employees including physicians, nurses, and hospital staff members were tested the model using structural equation modeling technique. The results found that the factors with a significant effect are performance expectancy, effort expectancy and facilitating conditions. They were also found to have a significant impact on behavioral intention to use the acceptance healthcare technology. In addition, in Thai provincial areas, positive significance was found with two factors: social influence on behavioral intention and facilitating conditions to direct using behavior. Based on research findings, in order for healthcare information technology to be widely adopted and used by healthcare staffs in healthcare supply chain management, the healthcare organizational management should improve healthcare staffs' behavioral intention and facilitating conditions. PMID:26417235

Factorial validity of the Job Expectations Questionnaire in a sample of Mexican workers.

PubMed

Villa-George, Fabiola Itzel; Moreno-Jiménez, Bernardo; Rodríguez-Muñoz, Alfredo; Villalpando Uribe, Jessica

2011-11-01

The aim of this study was to examine the factorial validity of the Job Expectations Questionnaire (Cuestionario de Expectativas Laborales CEL) in a sample of Mexican workers. Following a cross validation approach, two samples were used in the study. The first sample consisted of 380 professionals who mainly performed administrative work in the Health Services in Puebla-Mexico. The second sample comprised 400 health professionals from the Hospital de la Mujer in Puebla-Mexico. Exploratory factor analysis yielded a three-factor solution, accounting for 51.8% of the variance. The results of confirmatory factorial analysis indicate that the three-factor model provided the best fit with the data (CFI = .96, GFI = .95, NNFI = .95, RMSEA = .04), maintaining the structure with 12 items. The reliability of the questionnaire and the diverse subscales showed high internal consistency. Significant correlations were found between job expectations and autonomy, vigor, dedication, and absorption, providing evidence of its construct validity. The evaluation of the psychometric qualities confirms this questionnaire as a valid and specific instrument to measure job expectations.

Improving the efficacy of healthcare services for Aboriginal Australians.

PubMed

Gwynne, Kylie; Jeffries, Thomas; Lincoln, Michelle

2018-01-16

Objective The aim of the present systematic review was to examine the enablers for effective health service delivery for Aboriginal Australians. Methods This systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Papers were included if they had data related to health services for Australian Aboriginal people and were published between 2000 and 2015. The 21 papers that met the inclusion criteria were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Seven papers were subsequently excluded due to weak methodological approaches. Results There were two findings in the present study: (1) that Aboriginal people fare worse than non-Aboriginal people when accessing usual healthcare services; and (2) there are five enablers for effective health care services for Australian Aboriginal people: cultural competence, participation rates, organisational, clinical governance and compliance, and availability of services. Conclusions Health services for Australian Aboriginal people must be tailored and implementation of the five enablers is likely to affect the effectiveness of health services for Aboriginal people. The findings of the present study have significant implications in directing the future design, funding, delivery and evaluation of health care services for Aboriginal Australians. What is known about the topic? There is significant evidence about poor health outcomes and the 10-year gap in life expectancy between Aboriginal and non-Aboriginal people, and limited evidence about improving health service efficacy. What does this paper add? This systematic review found that with usual health care delivery, Aboriginal people experience worse health outcomes. This paper identifies five strategies in the literature that improve the effectiveness of health care services intended for Aboriginal people. What are the implications for practitioners? Aboriginal people fare worse in both experience and outcomes when they access usual care services. Health services intended for Aboriginal people should be tailored using the five enablers to provide timely, culturally safe and high-quality care.

Ecosystem services: Urban parks under a magnifying glass.

PubMed

Mexia, Teresa; Vieira, Joana; Príncipe, Adriana; Anjos, Andreia; Silva, Patrícia; Lopes, Nuno; Freitas, Catarina; Santos-Reis, Margarida; Correia, Otília; Branquinho, Cristina; Pinho, Pedro

2018-01-01

Urban areas' population has grown during the last century and it is expected that over 60% of the world population will live in cities by 2050. Urban parks provide several ecosystem services that are valuable to the well-being of city-dwellers and they are also considered a nature-based solution to tackle multiple environmental problems in cities. However, the type and amount of ecosystem services provided will vary with each park vegetation type, even within same the park. Our main goal was to quantify the trade-offs in ecosystem services associated to different vegetation types, using a spatially detailed approach. Rather than relying solely on general vegetation typologies, we took a more ecologically oriented approach, by explicitly considering different units of vegetation structure and composition. This was demonstrated in a large park (44ha) located in the city of Almada (Lisbon metropolitan area, Portugal), where six vegetation units were mapped in detail and six ecosystem services were evaluated: carbon sequestration, seed dispersal, erosion prevention, water purification, air purification and habitat quality. The results showed that, when looking at the park in detail, some ecosystem services varied greatly with vegetation type. Carbon sequestration was positively influenced by tree density, independently of species composition. Seed dispersal potential was higher in lawns, and mixed forest provided the highest amount of habitat quality. Air purification service was slightly higher in mixed forest, but was high in all vegetation types, probably due to low background pollution, and both water purification and erosion prevention were high in all vegetation types. Knowing the type, location, and amount of ecosystem services provided by each vegetation type can help to improve management options based on ecosystem services trade-offs and looking for win-win situations. The trade-offs are, for example, very clear for carbon: tree planting will boost carbon sequestration regardless of species, but may not be enough to increase habitat quality. Moreover, it may also negatively influence seed dispersal service. Informed practitioners can use this ecological knowledge to promote the role of urban parks as a nature-based solution to provide multiple ecosystem services, and ultimately improve the design and management of the green infrastructure. This will also improve the science of Ecosystem Services, acknowledging that the type of vegetation matters for the provision of ecosystem services and trade-offs analysis. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Architecture Design of Healthcare Software-as-a-Service Platform for Cloud-Based Clinical Decision Support Service

PubMed Central

Oh, Sungyoung; Cha, Jieun; Ji, Myungkyu; Kang, Hyekyung; Kim, Seok; Heo, Eunyoung; Han, Jong Soo; Kang, Hyunggoo; Chae, Hoseok; Hwang, Hee

2015-01-01

Objectives To design a cloud computing-based Healthcare Software-as-a-Service (SaaS) Platform (HSP) for delivering healthcare information services with low cost, high clinical value, and high usability. Methods We analyzed the architecture requirements of an HSP, including the interface, business services, cloud SaaS, quality attributes, privacy and security, and multi-lingual capacity. For cloud-based SaaS services, we focused on Clinical Decision Service (CDS) content services, basic functional services, and mobile services. Microsoft's Azure cloud computing for Infrastructure-as-a-Service (IaaS) and Platform-as-a-Service (PaaS) was used. Results The functional and software views of an HSP were designed in a layered architecture. External systems can be interfaced with the HSP using SOAP and REST/JSON. The multi-tenancy model of the HSP was designed as a shared database, with a separate schema for each tenant through a single application, although healthcare data can be physically located on a cloud or in a hospital, depending on regulations. The CDS services were categorized into rule-based services for medications, alert registration services, and knowledge services. Conclusions We expect that cloud-based HSPs will allow small and mid-sized hospitals, in addition to large-sized hospitals, to adopt information infrastructures and health information technology with low system operation and maintenance costs. PMID:25995962

Problems and Expectations of University Students Attending Higher Education in Turkey: Orientation Services

ERIC Educational Resources Information Center

Kutlu, Mustafa

2005-01-01

The objective of this research is to find out the problems and expectations of the students in Inonu University (in Malatya, a city in east Turkey) concerning the orientation services. An additional objective is to ascertain whether students' expectations with regard to orientation services differ according to their sex, their place of origin, and…

[How much knowledge do health insurance companies need to make reimbursement decisions?].

PubMed

Pfeiffer, Doris

2009-01-01

Health insurance companies play a very significant role in the sociopolitical context. It is their responsibility to meet the demands of modern health services delivery, while at the same time limited financial resources need to be considered. Difficult decisions have to be made which must take into account the needs of the insured party as well as the healthcare situation and oncoming possibilities. Health insurance companies rely on secure knowledge with a high level of evidence to justify their decisions in a collectively funded healthcare system. Where the elimination of knowledge gaps is not related to the expectation of profit on the part of potential providers of medical services, procedures or products the funding of high-quality studies should be considered.

Poverty reduction by improving health and social services in Vietnam.

PubMed

Gien, Lan; Taylor, Sharon; Barter, Ken; Tiep, Nguyen; Mai, Bui X; Lan, Nguyen T

2007-12-01

This article describes the development and implementation of a five-year plan for the reduction of poverty and the enhancement of human development through improving public health and social services in rural Vietnam. This plan was achieved by training the trainers and building capacity for the social workers. The project was a collaborative effort between the Schools of Nursing and Social Work at Memorial University, Newfoundland and Labrador, Canada and the University of Labor and Social Affairs, Hanoi, Vietnam. The collaboration was also committed to improving the quality of social work education and training in Vietnam. All the project's objectives were achieved beyond original expectations. The actual outcomes are sustainable and in addition gender equality has been a cross-cutting theme.

Optical Fiber In The Loop: Features And Applications

NASA Astrophysics Data System (ADS)

Shariati, Ross

1986-01-01

It is expected that there would be various demands for digital capacity, from a few kilobits per second for such services as facsimile, data entry, and provision of audio and graphic for teleconferencing, to about 56Kb/sec for electronic mail and integrated work stations, and higher speeds for cable television, high resolution TV, and computer-aided engineering. Fiber optics has been proven-in from an economic standpoint to provide the above-mentioned services. This is primarily due to the fact that in less than five years optical line rates have leaped from 45Mb/s to gigabit rates, therefore reducing the cost per DS3 of capacity, and the price of high quality fiber cable has taken a nosedive.

Technical requirements for bioassay support services

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hickman, D.P.; Anderson, A.L.

1991-05-01

This document provides the technical basis for the Chem-Nuclear Geotech (Geotech) bioassay program. It includes information and details that can be used as a model in providing technical contents and requirements for bioassay laboratory support, either internally or in solicitations by Geotech to obtain subcontractor laboratory support. It provides a detailed summary and description of the types of bioassay samples to be expected in support of Geotech remedial projects for the US Department of Energy and the bioassay services and analytical requirements necessary to process such samples, including required limits of sensitivity. General responsibilities of the bioassay laboratory are alsomore » addressed, including quality assurance. Peripheral information of importance to the program is included in the appendices of this document. 7 tabs.« less

Do pneumonia readmissions flagged as potentially preventable by the 3M PPR software have more process of care problems? A cross-sectional observational study.

PubMed

Borzecki, Ann M; Chen, Qi; Restuccia, Joseph; Mull, Hillary J; Shwartz, Michael; Gupta, Kalpana; Hanchate, Amresh; Strymish, Judith; Rosen, Amy

2015-12-01

In the USA, administrative data-based readmission rates such as the Centers for Medicare and Medicaid Services' all-cause readmission measures are used for public reporting and hospital payment penalties. To improve this measure and identify better quality improvement targets, 3M developed the Potentially Preventable Readmissions (PPRs) measure. It matches clinically related index admission and readmission diagnoses that may indicate readmissions resulting from admission- or post-discharge-related quality problems. To examine whether PPR software-flagged pneumonia readmissions are associated with poorer quality of care. Using a retrospective observational study design and Veterans Health Administration (VA) data, we identified pneumonia discharges associated with 30-day readmissions, and then flagged cases as PPR-yes or PPR-no using the PPR software. To assess quality of care, we abstracted electronic medical records of 100 random readmissions using a tool containing explicit care processes organised into admission work-up, in-hospital evaluation/treatment, discharge readiness and post-discharge period. We derived quality scores, scaled to a maximum of 25 per section (maximum total score=100) and compared cases by total and section-specific mean scores using t tests and effect size (ES) to characterise the clinical significance of findings. Our abstraction sample was selected from 11,278 pneumonia readmissions (readmission rate=16.5%) during 1 October 2005-30 September 2010; 77% were flagged as PPR-yes. Contrary to expectations, total and section mean quality scores were slightly higher, although non-significantly, among PPR-yes (N=77) versus PPR-no (N=23) cases (respective total scores, 71.2±8.7 vs 65.8±11.5, p=0.14); differences demonstrated ES >0.30 overall and for admission work-up and post-discharge period sections. Among VA pneumonia readmissions, PPR categorisation did not produce the expected quality of care findings. Either PPR-yes cases are not more preventable, or preventability assessment requires other data collection methods to capture poorly documented processes (eg, direct observation). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Administrative review process for adjudicating initial disability claims. Final rule.

PubMed

2006-03-31

The Social Security Administration is committed to providing the high quality of service the American people expect and deserve. In light of the significant growth in the number of disability claims and the increased complexity of those claims, the need to make substantial changes in our disability determination process has become urgent. We are publishing a final rule that amends our administrative review process for applications for benefits that are based on whether you are disabled under title II of the Social Security Act (the Act), or applications for supplemental security income (SSI) payments that are based on whether you are disabled or blind under title XVI of the Act. We expect that this final rule will improve the accuracy, consistency, and timeliness of decision-making throughout the disability determination process.

Managing laboratory automation in a changing pharmaceutical industry

PubMed Central

Rutherford, Michael L.

1995-01-01

The health care reform movement in the USA and increased requirements by regulatory agencies continue to have a major impact on the pharmaceutical industry and the laboratory. Laboratory management is expected to improve effciency by providing more analytical results at a lower cost, increasing customer service, reducing cycle time, while ensuring accurate results and more effective use of their staff. To achieve these expectations, many laboratories are using robotics and automated work stations. Establishing automated systems presents many challenges for laboratory management, including project and hardware selection, budget justification, implementation, validation, training, and support. To address these management challenges, the rationale for project selection and implementation, the obstacles encountered, project outcome, and learning points for several automated systems recently implemented in the Quality Control Laboratories at Eli Lilly are presented. PMID:18925014

Risk and uncertainty.

PubMed

Carter, Tony

2010-01-01

Volatile business conditions have led to drastic corporate downsizing, meaning organizations are expected to do more with less. Managers must be more knowledgeable and possess a more eclectic myriad of business skills, many of which have not even been seen until recently. Many internal and external changes have occurred to organizations that have dictated the need to do business differently. Changes such as technological advances; globalization; catastrophic business crises; a more frantic competitive climate; and more demanding, sophisticated customers are examples of some of the shifts in the external business environment. Internal changes to organizations have been in the form of reengineering, accompanied by structural realignments and downsizing; greater emphasis on quality levels in product and service output; faster communication channels; and a more educated, skilled employee base with higher expectations from management.

The impact of web services at the IRIS DMC

NASA Astrophysics Data System (ADS)

Weekly, R. T.; Trabant, C. M.; Ahern, T. K.; Stults, M.; Suleiman, Y. Y.; Van Fossen, M.; Weertman, B.

2015-12-01

The IRIS Data Management Center (DMC) has served the seismological community for nearly 25 years. In that time we have offered data and information from our archive using a variety of mechanisms ranging from email-based to desktop applications to web applications and web services. Of these, web services have quickly become the primary method for data extraction at the DMC. In 2011, the first full year of operation, web services accounted for over 40% of the data shipped from the DMC. In 2014, over ~450 TB of data was delivered directly to users through web services, representing nearly 70% of all shipments from the DMC that year. In addition to handling requests directly from users, the DMC switched all data extraction methods to use web services in 2014. On average the DMC now handles between 10 and 20 million requests per day submitted to web service interfaces. The rapid adoption of web services is attributed to the many advantages they bring. For users, they provide on-demand data using an interface technology, HTTP, that is widely supported in nearly every computing environment and language. These characteristics, combined with human-readable documentation and existing tools make integration of data access into existing workflows relatively easy. For the DMC, the web services provide an abstraction layer to internal repositories allowing for concentrated optimization of extraction workflow and easier evolution of those repositories. Lending further support to DMC's push in this direction, the core web services for station metadata, timeseries data and event parameters were adopted as standards by the International Federation of Digital Seismograph Networks (FDSN). We expect to continue enhancing existing services and building new capabilities for this platform. For example, the DMC has created a federation system and tools allowing researchers to discover and collect seismic data from data centers running the FDSN-standardized services. A future capability will leverage the DMC's MUSTANG project to select data based on data quality measurements. Within five years, the DMC's web services have proven to be a robust and flexible platform that enables continued growth for the DMC. We expect continued enhancements and adoption of web services.

GP Practices as a One-Stop Shop: How Do Patients Perceive the Quality of Care? A Cross-Sectional Study in Thirty-Four Countries.

PubMed

Schäfer, Willemijn L A; Boerma, Wienke G W; Schellevis, François G; Groenewegen, Peter P

2017-12-29

To contribute to the current knowledge on how a broad range of services offered by general practitioners (GPs) may contribute to the patient perceived quality and, hence, the potential benefits of primary care. Between 2011 and 2013, primary care data were collected among GPs and their patients in 31 European countries, plus Australia, Canada, and New Zealand. In these countries, GPs are the main providers of primary care, mostly specialized in family medicine and working in the ambulatory setting. In this cross-sectional study, questionnaires were completed by 7,183 GPs and 61,931 visiting patients. Moreover, 7,270 patients answered questions about what they find important (their values). In the analyses of patient experiences, we adjusted for patients' values in each country to measure patient perceived quality. Perceived quality was measured regarding five areas: accessibility and continuity of care, doctor-patient communication, patient involvement in decision making, and comprehensiveness of care. The range of GP services was measured in relation to four areas: (1) to what extent they are the first contact to the health care system for patients in need of care, (2) their involvement in treatment and follow-up of acute and chronic conditions, in other words treatment of diseases, (3) their involvement in minor technical procedures, and (4) their involvement in preventive treatments. Data of the patients were linked to the data of the GPs. Multilevel modeling was used to construct scale scores for the experiences of patients in the five areas of quality and the range of services of GPs. In these four-level models, items were nested within patients, nested in GP practices, nested in countries. The relationship between the range of services and the experiences of patients was analyzed in three-level multilevel models, also taking into account the values of patients. In countries where GPs offer a broader range of services patients perceive better accessibility, continuity, and comprehensiveness of care, and more involvement in decision making. No associations were found between the range of services and the patient perceived communication with their GP. The range of GP services mostly explained the variation between countries in the areas of patient perceived accessibility and continuity of care. This study showed that in countries where GP practices serve as a "one-stop shop," patients perceive better quality of care, especially in the areas of accessibility and continuity of care. Therefore, primary care in a country is expected to benefit from investments in a broader range of services of GPs or other primary care physicians. © Health Research and Educational Trust.

Offering memorable patient experience through creative, dynamic marketing strategy

PubMed Central

Raţiu, M; Purcărea, T

2008-01-01

Creative, dynamic strategies are the ones that identify new and better ways of uniquely offering the target customers what they want or need. A business can achieve competitive advantage if it chooses a marketing strategy that sets the business apart from anyone else. Healthcare services companies have to understand that the customer should be placed in the centre of all specific marketing operations. The brand message should reflect the focus on the patient. Healthcare products and services offered must represent exactly the solutions that customers expect. The touchpoints with the patients must be well mastered in order to convince them to accept the proposed solutions. Healthcare service providers must be capable to look beyond customer's behaviour or product and healthcare service aquisition. This will demand proactive and far–reaching changes, including focusing specifically on customer preference, quality, and technological interfaces; rewiring strategy to find new value from existing and unfamiliar sources; disintegrating and radically reassembling operational processes; and restructuring the organization to accommodate new typess of work and skill. PMID:20108466

Offering memorable patient experience through creative, dynamic marketing strategy.

PubMed

Purcărea, Victor Lorín; Raţíu, Monica; Purcărea, Theodor; Davila, Carol

2008-01-01

Creative, dynamic strategies are the ones that identify new and better ways of uniquely offering the target customers what they want or need. A business can achieve competitive advantage if it chooses a marketing strategy that sets the business apart from anyone else. Healthcare services companies have to understand that the customer should be placed in the centre of all specific marketing operations. The brand message should reflect the focus on the patient. Healthcare products and services offered must represent exactly the solutions that customers expect. The touchpoints with the patients must be well mastered in order to convince them to accept the proposed solutions. Healthcare service providers must be capable to look beyond customer's behaviour or product and healthcare service aquisition. This will demand proactive and far-reaching changes, including focusing specifically on customer preference, quality, and technological interfaces; rewiring strategy to find new value from existing and unfamiliar sources: disintegrating and radically reassembling operational processes: and restructuring the organization to accommodate new types of work and skill.

The practice of neurology: Looking ahead by looking back.

PubMed

Ringel, Steven P

2015-05-19

Over the last 50 years, there have been many improvements in therapy for individuals with neurologic disorders. Simultaneously, the complexity and cost of care have increased. The delivery of neurologic services is inefficient. The needs of both patients and neurologists are not being optimally addressed. Although greater attention is on the quality, safety, and value of the care, there remains a need for fundamental redesign in the way neurologic services are provided. The future practice of neurology will likely be interdisciplinary and provide both easy access and efficient coordination of services. No matter what changes in financing of health care are adopted, focus needs to be on reducing health care costs. Patients seeking neurologic care will expect seamless, innovative, and cost-effective services and to be active participants in their care. The proposed modifications address current demands and advocate for prospective innovative solutions. The changes proposed to improve care for patients will simultaneously make the careers of neurologists more gratifying and less stressful. © 2015 American Academy of Neurology.

STS-103 MS Smith prepares to enter orbiter from White Room

NASA Technical Reports Server (NTRS)

1999-01-01

STS-103 Mission Specialist Steven L. Smith, in his orange launch and entry suit, waits for assistance from closeout crew members in the White Room before entering the orbiter. From left, they are NASA Quality Assurance Specialist Danny Wyatt, United Space Alliance (USA) Mechanical Technician Vinny Defranzo and USA Orbiter Vehicle Closeout Chief Travis Thompson. The White Room is an environmental chamber at the end of the orbiter access arm on the fixed service structure. It provides entry to the orbiter crew compartment. The mission, to service the Hubble Space Telescope, is scheduled to lift off at 7:50 p.m. EST Dec. 19 on mission STS-103, servicing the Hubble Space Telescope. Objectives for the nearly eight-day mission include replacing gyroscopes and an old computer, installing another solid state recorder, and replacing damaged insulation in the telescope. Discovery is expected to land at KSC Monday, Dec. 27, at about 5:24 p.m. EST.

KSC-99pp1480

NASA Image and Video Library

1999-12-19

KENNEDY SPACE CENTER, FLA. -- STS-103 Commander Curtis L. Brown Jr., in his orange launch and entry suit, enjoys a laugh with closeout crew members in the White Room before entering the orbiter. From left are United Space Alliance (USA) Mechanical Technician Rene Arriens, USA Orbiter Vehicle Closeout Chief Travis Thompson, and NASA Quality Assurance Specialist Danny Wyatt. The white room is an environmental chamber at the end of the orbiter access arm on the fixed service structure. It provides entry to the orbiter crew compartment. The mission, to service the Hubble Space Telescope, is scheduled to lift off at 7:50 p.m. EST Dec. 19 on mission STS-103, servicing the Hubble Space Telescope. Objectives for the nearly eight-day mission include replacing gyroscopes and an old computer, installing another solid state recorder, and replacing damaged insulation in the telescope. Discovery is expected to land at KSC Monday, Dec. 27, at about 5:24 p.m. EST

Mental health care reforms in Asia: the urgency of now: building a recovery-oriented, community mental health service in china.

PubMed

Tse, Samson; Ran, Mao-Sheng; Huang, Yueqin; Zhu, Shimin

2013-07-01

For the first time in history, China has a mental health legal framework. People in China can now expect a better life and more accessible, better-quality health care services for their loved ones. Development of a community mental health service (CMHS) is at a crossroads. In this new column on mental health reforms in Asia, the authors review the current state of the CMHS in China and propose four strategic directions for future development: building on the strengths of the "686 Project," the 2004 initiative that launched China's mental health reform; improving professional skills of the mental health workforce, especially for a recovery approach; empowering families and caregivers to support individuals with severe mental illness; and using information and communications technology to promote self-help and reduce the stigma associated with psychiatric disorders.

EIDA Next Generation: ongoing and future developments

NASA Astrophysics Data System (ADS)

Strollo, Angelo; Quinteros, Javier; Sleeman, Reinoud; Trani, Luca; Clinton, John; Stammler, Klaus; Danecek, Peter; Pedersen, Helle; Ionescu, Constantin

2015-04-01

The European Integrated Data Archive (EIDA; http://www.orfeus-eu.org/eida/eida.html) is the distributed Data Centre system within ORFEUS, providing transparent access and services to high quality, seismic data across (currently) 9 large data archives in Europe. EIDA is growing, in terms of the number of participating data centres, the size of the archives, the variability of the data in the archives, the number of users, and the volume of downloads. The on-going success of EIDA is thus providing challenges that are the driving force behind the design of the next generation (NG) of EIDA, which is expected to be implemented within EPOS IP. EIDA ORFEUS must cope with further expansion of the system and more complex user requirements by developing new techniques and extended services. The EIDA NG is being designed to work on standard FDSN web services and two additional new web services: Routing Service and QC (quality controlled) service. This presentation highlights the challenges EIDA needs to address during the EPOS IP and focuses on these 2 new services. The Routing Service can be considered as the core of EIDA NG. It was designed to assist users and clients to locate data within a federated, decentralized data centre (e.g. EIDA). A detailed, FDSN-compliant specification of the service has been developed. Our implementation of this service will run at every EIDA node, but is also capable of running on a user's computer, allowing anyone to define virtual or integrate existing data centres. This (meta)service needs to be queried in order to locate the data. Some smart clients (in a beta status) have been also provided to offer the user an integrated view of the whole EIDA, hiding the complexity of its internal structure. The service is open and able to be queried by anyone without the need of credentials or authentication. The QC Service is developed to cope with user requirements to query for relevant data only. The web service provides detailed information on the contents of the waveform data in an archive and in particular the following features and quality parameters are provided: gaps, statistical values, availability, overlaps, quality flags and more. It is a tool to be used for quickly exploring the contents of the waveform files before downloading them, or by clients to fulfill user specific requirements. The API reflects almost identically the FDSN dataselect service with some additional features. The characteristics are computed on fixed daily intervals (day boundaries) and in case of gaps the service can additionally provide the above features for each continuous data segment in the day interval. The newly developed services and the mediator service being designed and implemented in the near future, will facilitate interoperability and sustainability of the EIDA system and ensure a smooth integration with other Thematic (TCS) and Integrated (ICS) Core Services within EPOS.

Paying for quality not quantity: a wisconsin health maintenance organization proposes an incentive model for reimbursement of chiropractic services.

PubMed

Pursel, Kevin J; Jacobson, Martin; Stephenson, Kathy

2012-07-01

The purpose of this study is to describe a reimbursement model that was developed by one Health Maintenance Organization (HMO) to transition from fee-for-service to add a combination of pay for performance and reporting model of reimbursement for chiropractic care. The previous incentive program used by the HMO provided best-practice education and additional reimbursement incentives for achieving the National Committee for Quality Assurance Back Pain Recognition Program (NCQA-BPRP) recognition status. However, this model had not leveled costs between doctors of chiropractic (DCs). Therefore, the HMO management aimed to develop a reimbursement model to incentivize providers to embrace existing best-practice models and report existing quality metrics. The development goals included the following: it should (1) be as financially predictable as the previous system, (2) cost no more on a per-member basis, (3) meet the coverage needs of its members, and (4) be able to be operationalized. The model should also reward DCs who embraced best practices with compensation, not simply tied to providing more procedures, the new program needed to (1) cause little or no disruption in current billing, (2) be grounded achievable and defined expectations for improvement in quality, and (3) be voluntary, without being unduly punitive, should the DC choose not to participate in the program. The generated model was named the Comprehensive Chiropractic Quality Reimbursement Methodology (CCQRM; pronounced "Quorum"). In this hybrid model, additional reimbursement, beyond pay-for-procedures will be based on unique payment interpretations reporting selected, existing Physician Quality Reporting System (PQRS) codes, meaningful use of electronic health records, and achieving NCQA-BPRP recognition. This model aims to compensate providers using pay-for-performance, pay-for-quality reporting, pay-for-procedure methods. The CCQRM reimbursement model was developed to address the current needs of one HMO that aims to transition from fee-for-service to a pay-for-performance and quality reporting for reimbursement for chiropractic care. This model is theoretically based on the combination of a fee-for-service payment, pay for participation (NCQA Back Pain Recognition Program payment), meaningful use of electronic health record payment, and pay for reporting (PQRS-BPMG payment). Evaluation of this model needs to be implemented to determine if it will achieve its intended goals. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

A comparison of data obtained from service providers and service users to assess the quality of maternity care.

PubMed

Hundley, V; Penney, G; Fitzmaurice, A; van Teijlingen, E; Graham, W

2002-06-01

to compare data obtained from two sources, service providers and service users, regarding the maternity services in Scotland. an audit of maternity services involving site visits, staff interviews and a cross-sectional survey of service users. lead professionals in every consultant-led maternity unit in Scotland and all 1639 women giving birth in Scotland during a ten-day period. structured group interviews with service providers and a questionnaire survey of recently delivered women. professionals' and women's responses were cross-tabulated and differences in proportions were tested for statistical significance using the chi-square test. a total of 1137 women completed the questionnaire (response rate 69%). Overall, there was good agreement between professionals' and women's perceptions of the aspects of care studied. However, there were disparities in some areas. For example, staff in eight units reported mechanisms to ensure early distribution of a free national pregnancy book; however, in six of these units less than 75% of women actually received this book prior to their first hospital visit. Eighteen units reported that they offer a postnatal 'reunion meeting'; in ten of these units, less than 50% of women were aware of the reunion meeting. Eighteen units reported a policy of each woman having a lead professional or care co-ordinator; in three of these units, less than 50% of women perceived that they had a care co-ordinator and for most women, the profession (midwife, general practitioner or obstetrician) of their perceived co-ordinator differed from that expected on the basis of staff reports. There was some evidence overall that unit policies had a direct influence on women's responses. this study demonstrates the importance of using a range of complementary methods of data collection and of ascertaining both service users' and providers' views when assessing the quality of care. Further research is required to explore differences in service provider's and women's perceptions and how this information can be used to improve the quality of maternity care. The finding that service provision may influence women's preferences has important implications for service planning, in particular the introduction of new models of care, and this needs further exploration. Copyright 2002 Elsevier Science Ltd.

Client satisfaction and quality of health care in rural Bangladesh.

PubMed Central

Mendoza Aldana, J.; Piechulek, H.; al-Sabir, A.

2001-01-01

OBJECTIVE: To assess user expectations and degree of client satisfaction and quality of health care provided in rural Bangladesh. METHODS: A total of 1913 persons chosen by systematic random sampling were successfully interviewed immediately after having received care in government health facilities. FINDINGS: The most powerful predictor for client satisfaction with the government services was provider behaviour, especially respect and politeness. For patients this aspect was much more important than the technical competence of the provider. Furthermore, a reduction in waiting time (on average to 30 min) was more important to clients than a prolongation of the quite short (from a medical standpoint) consultation time (on average 2 min, 22 sec), with 75% of clients being satisfied. Waiting time, which was about double at outreach services than that at fixed services, was the only element with which users of outreach services were dissatisfied. CONCLUSIONS: This study underscores that client satisfaction is determined by the cultural background of the people. It shows the dilemma that, though optimally care should be capable of meeting both medical and psychosocial needs, in reality care that meets all medical needs may fail to meet the client's emotional or social needs. Conversely, care that meets psychosocial needs may leave the clients medically at risk. It seems important that developing countries promoting client-oriented health services should carry out more in-depth research on the determinants of client satisfaction in the respective culture. PMID:11436472

What is found positive in healthcare information and communication technology implementation?-the results of a nationwide survey in Finland.

PubMed

Winblad, Ilkka; Hämäläinen, Päivi; Reponen, Jarmo

2011-03-01

Considerable expectations have been placed on information and communication technology (ICT) in improving the processes and quality of healthcare. Our purpose was to find out which element is found positive in healthcare ICT implementation. An online questionnaire on e-Health implementation submitted to all Finnish public health service providers and a sample from the private sector included an open question about which the electronic working methods, systems, or applications have most positively influenced the fluency or quality of service processes. The electronic health record was mentioned as an item that has positive influence by 52% of the respondents from the hospital districts, 27% of those from the primary healthcare centers, and 38% of those from the private providers. Digital radiology systems (including teleradiology) were mentioned by 52% of the hospital districts and 27% of the primary healthcare centers. The figures for digital laboratory systems (including telelaboratory) were 5% and 11%, respectively. The figures for teleradiology itself were 5% for the hospital districts and 15% for the primary healthcare centers; the figures for telelaboratory systems were 5% and 9%, respectively. The specialized healthcare seem to experience intraorganizational electronic services integrated to the electronic health record, such as digital radiology and laboratory services as exerting a positive influence, whereas the primary healthcare find such influence from different functions such as interorganizational data exchange and telemedicine services. These might indicate where the efforts should be focused when implementing ICT in healthcare.

Ecosystem services altered by human changes in the nitrogen cycle: A new perspective for assessment

NASA Astrophysics Data System (ADS)

Compton, J. E.; Harrison, J.; Dennis, R. L.; Greaver, T.; Hill, B.; Jordan, S. J.; Walker, H.; Campbell, H. V.

2011-12-01

Human alteration of the nitrogen (N) cycle has produced benefits for health and well-being, but excess N has altered many ecosystems and degraded air and water quality. US regulations mandate protection of the environment in terms that directly connect to ecosystem services. Here, we review the science quantifying effects of N on key ecosystem services, and synthesize existing information concerning the costs of N-related impacts or mitigation using the metric of cost per unit of N. Damage costs to the provision of clean air, reflected by impaired human respiratory health, are well characterized and fairly high (e.g. costs of ozone and particulate damages of 28 per kg NOx-N). We also consider the impacts of nitrogen and climate interactions. Damage to services associated with productivity, biodiversity, recreation and clean water are less certain and although generally lower, these costs are quite variable (< 2.2-56 per kg N). In the current Chesapeake Bay restoration effort, for example, the collection of available damage costs clearly exceeds the projected abatement costs to reduce N loads to the Bay ($8-15 per kg N). Although few damage costs specifically consider climate-nitrogen interactions, changes in precipitation and temperature are expected to have synergistic impacts on drinking water quality and eutrophication in particular. Explicit consideration and accounting of effects on multiple ecosystem services provides decision-makers an integrated view of N sources, damages and abatement costs to address the significant challenges associated with reducing N pollution.

Patient Awareness and Expectations of Pharmacist Services During Hospital Stay.

PubMed

King, Philip K; Martin, Steven J; Betka, Eric M

2017-10-01

There are insufficient data in the United States regarding patient awareness and expectations of hospital pharmacist availability and services. The objective of this research is to assess patient awareness and expectations of hospital pharmacist services and to determine whether a marketing campaign for pharmacist services increases patient awareness and expectations. Eligible inpatients were surveyed before and after implementation of a hospital-wide pharmacist services marketing campaign (12 items; Likert scale of 1 [strongly disagree] to 4 [strongly agree]; maximum total score of 48) regarding awareness of pharmacist services. The primary outcome was the change in median total survey scores from baseline. Other outcomes included the frequency of patient requests for pharmacists. Similar numbers of patients completed the survey before and after the campaign (intervention, n = 140, vs control, n = 147). Awareness of pharmacist availability and services was increased (41 [interquartile ranges, IQRs: 36-46] vs 37 [IQR 31-43]; P < .001). Patients were 7 times more likely to request a pharmacist following the marketing campaign implementation. Awareness among inpatients of pharmacist services is low. Marketing pharmacist availability and services to patients in the hospital improves awareness and expectations for pharmacist-provided care and increases the frequency of patient-initiated interaction between pharmacists and patients. This could improve patient outcomes as pharmacists become more integrally involved in direct patient care.

Security Engineering FY17 Systems Aware Cybersecurity

DTIC Science & Technology

2017-12-07

11 Figure 4 A hierarchical controls model that defines the expected service of a UAV. Each level is...defined by a generic control structure. Inadequate control in each level can cause an adversarial action to degrade the expected service and produce a...and can completely violate the systems expected service by escalating their privileges by either using the attack vectors presented individually or

Parental expectations of maternal and child health services.

PubMed

Bradt, Lieve; Vandenbroeck, Michel; Lammertyn, Jan; Bouverne-De Bie, Maria

2015-01-01

This article reports on survey research (N = 1,418) aimed at examining whether parental expectations of maternal and child health (MCH) services are influenced by group characteristics (e.g., socioeconomic status [SES], ethnicity, at risk of poverty) and/or individual parenting context variables (e.g., received social support) in a context where these services are available to all. The findings reveal that parents have different expectations about the technical and relational expertise of MCH nurses. However, the authors found only very weak associations between family characteristics and parental expectations, suggesting that individual differences matter more than SES and other more traditional distinctions. Implications for MCH services are made.

Generating Expectations: What Pediatric Rehabilitation Can Learn From Mental Health Literature.

PubMed

Smart, Eric; Nalder, Emily; Rigby, Patty; King, Gillian

2018-04-03

Family-Centered Care (FCC) represents the ideal service delivery approach in pediatric rehabilitation. Nonetheless, implementing FCC as intended in clinical settings continues to be hindered by knowledge gaps. One overlooked gap is our understanding of clients' therapy expectations. This perspective article synthesizes knowledge from the mental health services literature on strategies recommended to service providers for generating transparent and congruent therapy expectations with clients, and applies this knowledge to the pediatric rehabilitation literature, where this topic has been researched significantly less, for the purpose of improving FCC implementation. Dimensions of the Measure of Processes of Care, an assessment tool that measures clients' perceptions of the extent a service is family-centered, inform the organization of therapy expectation-generating strategies: (1) Providing Respectful and Supportive Care (assessing and validating clients' expectations); (2) General and Specific Information (foreshadowing therapy journeys, explaining treatment rationale, and conveying service provider qualifications); (3) Coordinated and Comprehensive Care (socializing clients to roles and reflecting on past socialization); and (4) Enabling and Partnership (applying a negotiation framework and fostering spaces safe to critique). Strategies can help pediatric rehabilitation service providers work with families to reframe unrealistic expectations, establish congruent beliefs supporting effective partnerships, and prevent possible disillusionment with therapy over time.

Consumer Expectations of Online Services in the Insurance Industry: An Exploratory Study of Drivers and Outcomes.

PubMed

Méndez-Aparicio, M Dolores; Izquierdo-Yusta, Alicia; Jiménez-Zarco, Ana I

2017-01-01

Today, the customer-brand relationship is fundamental to a company's bottom line, especially in the service sector and with services offered via online channels. In order to maximize its effects, organizations need (1) to know which factors influence the formation of an individual's service expectations in an online environment; and (2) to establish the influence of these expectations on customers' likelihood of recommending a service before they have even used it. In accordance with the TAM model (Davis, 1989; Davis et al., 1992), the TRA model (Fishbein and Ajzen, 1975), the extended UTAUT model (Venkatesh et al., 2012), and the approach described by Alloza (2011), this work proposes a theoretical model of the antecedents and consequences of consumer expectations of online services. In order to validate the proposed theoretical model, a sample of individual insurance company customers was analyzed. The results showed, first, the importance of customers' expectations with regard to the intention to recommend the "private area" of the company's website to other customers prior to using it themselves. They also revealed the importance to expectations of the antecedents perceived usefulness, ease of use, frequency of use, reputation, and subjective norm.

Consumer Expectations of Online Services in the Insurance Industry: An Exploratory Study of Drivers and Outcomes

PubMed Central

Méndez-Aparicio, M. Dolores; Izquierdo-Yusta, Alicia; Jiménez-Zarco, Ana I.

2017-01-01

Today, the customer-brand relationship is fundamental to a company’s bottom line, especially in the service sector and with services offered via online channels. In order to maximize its effects, organizations need (1) to know which factors influence the formation of an individual’s service expectations in an online environment; and (2) to establish the influence of these expectations on customers’ likelihood of recommending a service before they have even used it. In accordance with the TAM model (Davis, 1989; Davis et al., 1992), the TRA model (Fishbein and Ajzen, 1975), the extended UTAUT model (Venkatesh et al., 2012), and the approach described by Alloza (2011), this work proposes a theoretical model of the antecedents and consequences of consumer expectations of online services. In order to validate the proposed theoretical model, a sample of individual insurance company customers was analyzed. The results showed, first, the importance of customers’ expectations with regard to the intention to recommend the “private area” of the company’s website to other customers prior to using it themselves. They also revealed the importance to expectations of the antecedents perceived usefulness, ease of use, frequency of use, reputation, and subjective norm. PMID:28798705

Perceived financial incentives, HMO market penetration, and physicians' practice styles and satisfaction.

PubMed

Hadley, J; Mitchell, J M; Sulmasy, D P; Bloche, M G

1999-04-01

To estimate the effects of physicians' personal financial incentives and other measures of involvement with HMOs on three measures of satisfaction and practice style: overall practice satisfaction, the extent to which prior expectations about professional autonomy and the ability to practice good-quality medicine are met, and several specific measures of practice style. A telephone survey conducted in 1997 of 1,549 physicians who were located in the 75 largest Metropolitan Statistical Areas in 1991. Eligible physicians were under age 52, had between 8 and 17 years of post-residency practice experience, and spent at least 20 hours per week in patient care. The response rate was 74 percent. Multivariate binomial and multinomial ordered logistic regression models were estimated. Independent variables included physicians' self-reported financial incentives, measured by the extent to which their overall financial arrangements created an incentive to either reduce or increase services to patients, the level of HMO penetration in the market, employment setting, medical specialty, exposure to managed care while in medical training, and selected personal characteristics. About 15 percent of survey respondents reported a moderate or strong incentive to reduce services; 70 percent reported a neutral incentive; and 15 percent reported an incentive to increase services. Compared to physicians with a neutral incentive, physicians with an incentive to reduce services were from 1.5 to 3.5 times more likely to be very dissatisfied with their practices and were 0.2 to 0.5 times as likely to report that their expectations regarding professional autonomy and ability to practice good-quality medicine were met. They were also 0.2 to 0.6 times as likely to report having the freedom to care for patients the way they would like along several specific measures of practice style, such as sufficient time with patients, ability to hospitalize, ability to order tests and procedures, and ability to make referrals. These effects were generally reinforced by practicing in an area with a high level of HMO penetration and were offset to some extent by having had exposure to HMOs and the practice of cost-effective medicine while in medical training. Although financial incentives to reduce services are not widespread, there is a legitimate reason to be concerned about possible adverse affects on the quality of care. More research is needed to investigate directly whether changes in patients' health are affected by their physicians' financial incentives.

Perceived financial incentives, HMO market penetration, and physicians' practice styles and satisfaction.

PubMed Central

Hadley, J; Mitchell, J M; Sulmasy, D P; Bloche, M G

1999-01-01

OBJECTIVE: To estimate the effects of physicians' personal financial incentives and other measures of involvement with HMOs on three measures of satisfaction and practice style: overall practice satisfaction, the extent to which prior expectations about professional autonomy and the ability to practice good-quality medicine are met, and several specific measures of practice style. DATA SOURCES: A telephone survey conducted in 1997 of 1,549 physicians who were located in the 75 largest Metropolitan Statistical Areas in 1991. Eligible physicians were under age 52, had between 8 and 17 years of post-residency practice experience, and spent at least 20 hours per week in patient care. The response rate was 74 percent. STUDY DESIGN: Multivariate binomial and multinomial ordered logistic regression models were estimated. Independent variables included physicians' self-reported financial incentives, measured by the extent to which their overall financial arrangements created an incentive to either reduce or increase services to patients, the level of HMO penetration in the market, employment setting, medical specialty, exposure to managed care while in medical training, and selected personal characteristics. PRINCIPAL FINDINGS: About 15 percent of survey respondents reported a moderate or strong incentive to reduce services; 70 percent reported a neutral incentive; and 15 percent reported an incentive to increase services. Compared to physicians with a neutral incentive, physicians with an incentive to reduce services were from 1.5 to 3.5 times more likely to be very dissatisfied with their practices and were 0.2 to 0.5 times as likely to report that their expectations regarding professional autonomy and ability to practice good-quality medicine were met. They were also 0.2 to 0.6 times as likely to report having the freedom to care for patients the way they would like along several specific measures of practice style, such as sufficient time with patients, ability to hospitalize, ability to order tests and procedures, and ability to make referrals. These effects were generally reinforced by practicing in an area with a high level of HMO penetration and were offset to some extent by having had exposure to HMOs and the practice of cost-effective medicine while in medical training. CONCLUSIONS: Although financial incentives to reduce services are not widespread, there is a legitimate reason to be concerned about possible adverse affects on the quality of care. More research is needed to investigate directly whether changes in patients' health are affected by their physicians' financial incentives. PMID:10199677

Quality of antenatal care services and completion of four or more antenatal care visits in Ethiopia: a finding based on a demographic and health survey.

PubMed

Muchie, Kindie Fentahun

2017-09-11

Antenatal care (ANC) is one of the core interventions for improving maternal outcomes. The average annual decline of maternal mortality rate from 1990 to 2013 was 5% in Ethiopia. This figure was below the least expected 5.5% to achieve the targeted 75% by 1990-2015. Moreover, completion of the recommended four or more ANC visits was only 32%. This study was aimed to examine individual, household and community level potential determinants of completing the recommended visits in the country. The 2014 Ethiopian Mini Demographic and Health Survey data were used. Among women aged 15-49 years 3694 who had given birth in the 5 years preceding the survey were included in the analysis. The robust standard error method of generalized estimation equations were used for binary outcome variable from the clustered data. Only 33.0% (95% CI 31. 5% 34.5%) of women completed the recommended visits. Out of the total women, 56.5% had at least one ANC visit. Out of those who had at least one ANC visit, 37.4% visited in their first trimester. Completing the recommended visits was negatively associated with women in the lower educational level, lower economic conditions, higher birth order, and rural residence. But, it was positively associated with the community level high quality ANC services received. Difference in age and region also affected the completion of the recommended visits. The finding revealed the need for improving the uptake of ANC services, early arrival in the first trimester for services, and motivating mothers that begin ANC to confirm continuity. Strategies to foster completing the recommended visits should focus on upgrading quality of care services at the community level. Women in low economic level, high birth order, rural residence, and low educational status should be given special attention. Early and late age groups should be given special attention regarding the services.

Avoiding Practice Shock: Using Teacher Movies to Realign Pre-Service Teachers' Expectations of Teaching

ERIC Educational Resources Information Center

Delamarter, Jeremy

2015-01-01

Pre-service teachers often have unrealistic expectations of teaching. They often create an inspiration/content dichotomy in which they expect relational activities to trump content delivery. Unchecked, these misaligned expectations can lead to practice shock, the disorienting and sometimes traumatic identity crisis that often occurs during the…

Exceeding parents' expectations in Ear-Nose-Throat outpatient facilities: the development and analysis of a questionnaire.

PubMed

Margaritis, Eleftherios; Katharaki, Maria; Katharakis, George

2012-05-01

The study attempts to develop an outpatient service quality scale by investigating the key dimensions which assess parental satisfaction and provides a recommendation on an improved health service delivery system. The survey was conducted in an Ear-Nose-Throat outpatient clinic of a Greek public pediatric hospital. A total of 127 parents in outpatient waiting areas were chosen; 74.8% of the sampled parents were under 40, and 78% were mothers. A factor analysis was performed; while a Fischer's exact test and multinomial logistic regression analysis was conducted. All Cronbach's α exceeded 0.70 and all factor loadings exceeded 0.50. Twenty-three items were retained through the scale development process and seven factors were formed that appear to be statistically valid and clinically meaningful: access and convenience, doctor's attention, customization, reliability, assurance, satisfaction and loyalty. Findings were discussed in relation to parents' overall satisfaction and intention of reusing and recommending outpatient clinic. Satisfaction was found to be positively affected by access and convenience and doctors' attention. Staff attitude and the telephone procedure of scheduling the child's examination found positively correlated to the likelihood of recommending services to friends and relatives. Time and communication in the waiting room influenced parents' satisfaction. Overall, results reveal the measures that need to be taken in order to improve outpatient service quality. Copyright © 2011 Elsevier Ltd. All rights reserved.