Purpose To investigate the health-care providers’ perceptions of patient safety culture in Shenzhen hospitals and to compare 2019 with 2015 data. Methods This cross-sectional study adopted a questionnaire survey and targeted hospital staff fitting the sampling criteria (physicians, nurses, technicians, and managers). A total of 5490 staff from 13 Shenzhen hospitals were surveyed using the Hospital Survey on Patient Safety Culture (HSOPSC). Results The average positive response rates of this study were generally higher than the data from the 2018 Agency for Healthcare Research and Quality (AHRQ) survey and the 2015 HSOPSC Shenzhen survey. Bivariate and multivariate regression showed that respondents who had direct contact with patients were less likely to report high overall patient safety grade. The probability of high overall patient safety grade was rated higher by men than by women. Compared with nurses, the probability of high overall patient safety grade was higher for both physicians and technicians. Conclusion The overall results of the patient safety culture in Shenzhen hospitals were relatively good and have improved significantly in recent years, but some areas of weakness still need improvement. Our recommendations are to develop training programs for various positions, recruit more employees, provide management support, and establish a just culture to promote a strong patient safety culture. Regular assessment is also needed to provide valuable information to hospital leaders on areas requiring improvement and to evaluate the quality improvement plan that has been implemented.

Background Outpatient services account for a large part of healthcare in China, and to survive in the competition with other hospitals, the management needs to understand and measure outpatient services quality for healthcare improvement and patient retention. There is a lack of comprehensive standardized outpatient healthcare quality measurement tools from patients’ perspective in China. This study aimed to develop and test a quality indicator system for outpatient services assessment in the Chinese healthcare sector. Methods Twenty-nine indicators were generated using literature review and focus group interviews. A modified Delphi process with the analytic hierarchy process (AHP) was conducted to screen and determine the final indicators with 13 interdisciplinary panelists through two-round email surveys. A two-level and three-column questionnaire was distributed to 250 outpatients in Shenzhen to pretest the indicator system. The validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient, and degree of concentration of opinions. The reliability of the questionnaire was assessed using Cronbach's alpha coefficient and inter-subscale correlation. Results Of the two rounds of Delphi consultation, the active coefficients were 76.92% and 80%, and the authoritative coefficients were both 0.88. An assessment system for the Chinese outpatient services quality was constructed with six first-level dimensions and 23 second-level indicators. The weights of safety, tangibility, reliability, responsiveness, assurance, and empathy were 0.286, 0.096, 0.088, 0.135, 0.226, and 0.169, respectively. For the pretest, Cronbach’s alpha values for the importance of the indicator, perception of quality of service, and expected quality of service were 0.96, 0.94, and 0.96, respectively. The values of the KMO test were 0.94, 0.93, and 0.95. All Bartlett’s test results showed that the correlation matrix was significant (p<0.001). Conclusion A multidimensional quality indicator system from patients’ perspective was developed for the outpatient services assessment in China’s healthcare sector. It has good validity and reliability and can be applied as a standardized tool by healthcare managers and policymakers in China to measure patients’ perceptions and expectations.

Background:Outpatient services plays a large and critical part in China’s hospitals. Quality improvements can be achieved through patients’ perspective, especially the patient experience. There is no consensus on assessment methods and procedures on patient to provide fair and accurate assessments of patient experience. This study was aimed to evaluate hospitals’ outpatient service quality from patients’ perspective.Methods:This study evaluates hospitals’ outpatient service quality from patients’ perspective among 1876 outpatients in 13 Shenzhen tertiary hospitals from June to July, 2019 using a self-established questionnaire.Relative importance of the quality indicators, perceived and expected quality of service rated by outpatients were obtained by analytic hierarchy process. Factors associated with patients’ experience was examined by optimal scaling regression.Results:Assurance was most expected, the dimensions patient perceived best and worst were Assurance and Safety, and the widest two gaps exist in Reliability and Empathy. Negative gaps were found existing in all dimensions and indicators. Background characteristics and hospital natural were found significantly different in each dimension of outpatient service quality. Overall impression and willingness to recommend both significantly correlate with age, education level, visits frequency, source of cost,region and visiting forms.Conclusions:Our research evaluated outpatient service quality from the outpatients’ perspective and focused on their experiences. The indicator system passed reliability and validity test, and its findings are partly consistent with many satisfaction surveys done in China. The overall patient experience in our study is not ideal, but overall impression and willingness to recommend are high. Service quality can be improved according to the relative importance of each indicator, patient expectation and perception, and associated factors. Patient experience should be used for hospital managers to drive patient-centered care.

In China, most ambulatory care is provided by public hospitals. However, many public hospitals’ outpatient services fall short of meeting patients’ demands. This study aimed to assess the quality gap of outpatient service in public hospitals by using an indicator system developed based on the SERVQUAL model. This cross-sectional study was conducted from June to July 2019 at 13 public hospitals in Shenzhen. In total, 1876 outpatients were included in the study, and participants were asked to fill out the modified SERVQUAL questionnaire. The scale consists of 23 items scattered in 6 dimensions, including Safety, Reliability, Responsiveness, Tangibles, Assurance, and Empathy. Descriptive analysis, t-test or F-test, and optimal scale analysis were performed. The patients’ expectation of outpatient services exceeded the hospitals’ services they perceived and resulted in negative gaps between the mean expectation and perception scores for each indicator. The gaps were as follows: Reliability =  Empathy >  Responsiveness >  Safety >  Assurance >  Tangibles. Quality gaps differed significantly between age, education, and hospital type. The overall impression mean scores are 7.45 ± 1.18 (out of 9 points) and 7.27 ± 1.23 for general and specialized hospitals. And the willingness to recommend the hospital to others mean scores are 4.06 ± 0.62 (out of 5 points) and 3.92 ± 0.65 for general and specialized hospitals. Patients’ impression of the hospital and willingness to recommend the hospital were significantly correlated with age, citizenship, health insurance, referral type, frequency of visits, Safety, Tangibles, Reliability, and Assurance. The outpatient service provided by Shenzhen’s public hospitals did not meet patients’ needs. Hospital administrators should evaluate the quality gap of outpatient services to identify the flaws within the delivery of ambulatory care and make improvements according to the findings to drive patient-centered care.