Health Services Quality and Patient Satisfaction: A Review of the Literature

Introduction

Quality of care from the patient’s perspective and patient satisfaction are two major multidimensional concepts that are used several times interchangeably (Raftopoulos, 2005). There has been confusion and controversy in health care as to whether patients are in fact consumers. This confusion may be at the root of the overall service failing of hospitals (Fottler et al., 2002). Using a technical definition, a customer is anyone who has expectations about process operations or outputs (James, 2003); therefore all patients are customers, but not all customers are patients. According to Raftopoulos (2005), the quality of care has a subjective profile as it involves a cognitive evaluation process and an objective determinant which is “care” as an outcome, a process or a structure measure. On the other hand patient satisfaction tends to have an objective profile and determinant which is patient’s subjection. If we add the word perceived to both terms (quality and satisfaction) we conclude to an opposite meaning result: perceived quality of care and perceived satisfaction become a totally subjective concept as they are based on patients’ own feelings.

A competitive health market is usually quality-oriented, and improving the quality of care service is a continuing challenge to healthcare providers (Tzeng, 2002). According to Bleich et al. (2009), consumer satisfaction studies are challenged by the lack of a universally accepted definition of measure and by a dual focus: while some researchers focus on patient satisfaction with the quality and type of healthcare services received, others focus on people’s satisfaction with the health system more generally. The key to solving this problem may be for the health care sector to focus on perceived health service quality.

Quality was very popular in the marketing literature where the notion of satisfying the customer was a dominant model of quality of service provided and consumer satisfaction (“Satisfaction with Physician and Primary Care Scale”, Hulka et al., 1970; “Patient Satisfaction Questionnaire”, Ware and Snyder, 1975; “Client Satisfaction Questionnaire”, Larsen, 1979, later transformed to “Patient Satisfaction Scale”, e.tc.). Only a few researchers developed a conceptual framework for conceptualization of service quality and patient satisfaction, before validating their scale (Wilde et al., 1983). Measurement of patient satisfaction lacks a conceptual soundness as it reflects dimensions considered important by researchers and not by responders. Further, quality in healthcare has been studied largely from the clinical perspective, excluding the patient’s perception of service quality (Gill and White, 2009). The most frequently used theoretical model of consumers satisfaction is the one developed by Parasuraman et al. (1988). SERVQUAL was designed to accommodate measurement of service quality across a wide spectrum of services including health care services.

Figure 1.

Multi-dimensional hierarchical model of perceived service quality

Source: Dagger et al. (2007)