Delivered health care can be measured, and identified customer needs can be met and exceeded.
The patient is not only interested in what he or she receives, but also how the care is delivered.
This dimension is called functional quality. It is perceived in a very subjective way.
This is the result of a patient’s view of service dimensions, some of which are technical and others functional.
When this is compared with the expected service, one then gets the perceived service quality.
In the context of healthcare, perception of quality is thus a function of both the process and outcome.
Core to health care is the performance of the clinician, including that of physicians, nurses, nutritionists, physiotherapists, and other professionals in patient care.
Technical quality assessment is easier to measure as it is fairly standardised.
Quality care is deemed to have been achieved to the highest level if knowledge and practice have been applied even if the outcome is adverse.
If a patient with a heart attack is treated, the highest level of quality is deemed to have been achieved even if he dies.
Quality is the driver of customer satisfaction. Poor quality has a large negative impact and likelihood of non-return (69.5 per cent) as well as to inform others (one customer informs nine others) about an adverse experience.
Quality is a driver for future patronage either directly or through influencing others.
Patients’ intention to revisit a hospital or to inform others favourably about their experience is determined by their own satisfaction level.
This is determined by the perceived value of the care received, which, in turn, is determined by the quality of medical care received as perceived by the patient.
Understanding patient satisfaction is important in gaining a better insight and influencing health care delivery.
Patient satisfaction is a complex phenomenon involving clinical outcome, empathy of the clinician, physical ambience, financial and geographical access and efficacy.
This means that knowing the needs of the patients is imperative.
Technical quality, once present, does not contribute further to patient satisfaction.
Absence of positive treatment outcome is a cause of dissatisfaction but its presence (positive treatment outcomes) does not guarantee satisfaction.
Patient satisfaction must include the other components of quality, namely functional quality.
The interpersonal interaction must be tailored to enhance delivery of technical quality and must be within cultural contexts and in an acceptable format that includes privacy, confidentiality, informed choice, concern, empathy, honesty, tact and sensitivity.
The interpersonal relationship between clinician and patient may hamper or enhance technical quality.
There is clearly a hierarchical dimension when patients are choosing a hospital or recommending one to others.
These are interpersonal, environment of care and hospitality, administrative processes and access.
Patients infer quality of care from the physical environment.
A well-maintained and pleasant physical environment infers attention to detail and better technical quality.
It is important that the environmental of care is not the sole focus of the organisation.
It is not necessary to go to extremes. A deficient environment can be compensated for by excellent technical quality.
Administrative processes are the third most important dimension of quality.
The attributes of importance to patients are discharge, billing and admission.
Waiting time is a major source of dissatisfaction among patients.
Instead of patients going to sort out issues, it makes more sense for the services to come to where they are.
There is financial as well physical access within the hospital.
Access dimension contribution to the future behaviour of the patient is modest compared to the three discussed earlier (interpersonal, environment of care and administrative process).
However, there is a trade-off of quality over distance.
Patients are willing to travel longer distance to get superior quality.
Perception of quality by the patient is affected by quality dimensions that are hierarchical – interpersonal attributes, environment of care and hospitality, administrative and access.
Clinical outcomes are more important when the expectations of pre-hospital clinical expectations are realised.
Patients’ education and counselling on clinical expectations is thus important at admission.
Dr Twahir is an associate dean and the chief of staff, Aga Khan University Hospital, Nairobi