The Gaps of Healthcare Service Quality in Nurse Practitioner Practice and Its Associated Factors From the Patients’ Perspective

Abstract

Purpose This study investigates the expectations, perceptions, and gaps of the healthcare service quality (HSQ) from the patients’ perspective, and explores the significant demographic and clinical factors associated with the HSQ in nurse practitioner practice (NPP). Design A cross‐sectional design was carried out, with convenience sampling performed under the NPP in Taiwan, from June to November 2016. Methods The Nurse Practitioner Healthcare Service Quality Scale was used to assess the expectations, perceptions, and gaps of the HSQ. The demographics, clinical characteristics, and symptom severity of patients were collected, and the Importance‐Performance Analysis was applied to identify the priority of ranking items for the improvement of nurse practitioners (NPs). The Generalized Estimating Equation was used to explore the factors associated with the HSQ in NPP. Findings A total of 200 patients completed the questionnaires. The results revealed that the patients had overall high expectations (M = 6.35, SD = 0.46), moderate perceptions (M = 4.21, SD = 0.95), and a mild HSQ gap (M = ‐2.14, SD = 0.69), with statistically significant differences (p < .001). In NPP, the largest gap in the HSQ dimensions was reliable responsiveness, followed by empathy, assurance, and tangibility. Patients with greater symptom severity and a longer in‐hospital stay were associated with larger HSQ gaps; however, patients who were transferred from the emergency department had smaller gaps than those in the outpatient department. Conclusions The patients’ expectations were not fully satisfied in the NPP, especially for the dimensions of reliable responsiveness and empathy. The patients’ symptom severity was a significant factor related to the gaps in the HSQ. The awareness of unmet needs, from the patients’ perspective, could guide the convergence of a rational policy to promote healthcare delivery in the NPP. Clinical Relevance The managers of NPP need to pay attention to increasing NPs’ reliable responsiveness and empathy, by setting the appropriate scope of practice, regulating the NP‐to‐patient ratio, applying for certification programs in prescribing training, and cultivating patient‐centered care with shared decision making. In addition, building up the knowledge and competency of symptom management is also suggested for NP training.

A Grey Simulation-Based Fuzzy Hierarchical Approach for Diagnosing Healthcare Service Quality

“…Healthcare Staff had a significant effect on healthcare service quality. These findings align with prior studies [30][31][32].…”

A scale for measuring healthcare service quality incorporating patient-centred care and using a psychometric analytics framework

“…These include Tob on and Arias (2018; n 5 51) and Asiamah et al (2021;n 5 610); the latter extended SERVQUAL by adding items relating to hospital hygiene and sanitation in Ghana. Others have adapted traditional items to new contexts, for instance, Almuhanadi et al (2020) in Bahrein (n 5 520); Lin et al (2021), in Taiwan (n 5 200); and Hou et al (2019), in Datuan (n 5 350). Moreover, given that the PQ dimension comprises items relating to timeliness, effectiveness, security, tangibles, and equity, and the PCC dimension addresses patient-centred care, we have addressed Arboleda-Arango et al's (2018) call for Colombian surveys that take users' viewpoints into consideration.…”

“…Others have adapted traditional items to new contexts, for instance, Almuhanadi et al. (2020) in Bahrein ( n = 520); Lin et al. (2021), in Taiwan ( n = 200); and Hou et al.…”

“…Islam and Muhamad (2021) have extended the concept of healthcare service quality by incorporating patient-centred communication. Additionally, recent studies (Behmane et al, 2021;Carter et al, 2021;Jeon et al, 2010;Lin et al, 2021;Makubalo et al, 2020;Skog€ o Nyvang et al, 2019) argue that patient-centred care is needed to address current problems of poor user satisfaction, limited understanding of patient needs, lack of patient autonomy/engagement/proactivity in care and clinical services/solutions, and the dehumanization of medical care (Miles and Mezzich, 2011;Ornstein and Kay, 2021).…”

Gap analysis of service quality and associated factors at the oncology center of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2022: a cross-sectional study

“…In some studies, patients age and gender were found to be significant factors affecting the level of the gap in service quality14–16; however, in another studies, those factors did not have any influence on the level of the gap in service quality 17–19. A study conducted in Taiwan to analyse the gaps in healthcare service quality in nurse practitioner practice has found that the source of admission has an association with the level of gap in quality, with admissions from the emergency department recording lower gaps compared with those from outpatient setups 20…”