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Understanding dimensionality in health care

Hyde, Susan Margaret (2014) Understanding dimensionality in health care. Doctoral thesis (PhD), Manchester Metropolitan University.


Available under License Creative Commons Attribution Non-commercial No Derivatives.

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In recent years, the quality of non-clinical elements of health care has been challenged in the UK. While dimensions such as the environment, communications, reliability, access, etc., all contribute to making patients feel more at ease during a time when they are at their most vulnerable, they often fall short of what they should be. This paper supports the shift towards greater emphasis on understanding the functional elements of health services in an effort to improve patient experience and outcomes. While there is an abundance of literature discussing the evaluation of service quality, much of this focuses on the SERVQUAL model and, although there is increasing debate about its relevance across sectors, no alternative has been offered. This paper argues that the model lacks substance as a tool to evaluate quality in the complex environment of health care. The study embraced multiple methods to acquire a greater understanding of service quality constructs within the health care sector. It was carried out in three phases. The first comprised critical incident interviews with service users, which highlighted both successes and failings in their care. This was followed by staff interviews and focus groups representing a cross section of the public, providing an insight into how different groups perceive quality. The data was used in the design of a detailed questionnaire which attracted in excess of 1,000 responses. Factor analysis was then used to develop a framework of key elements relevant both to hospital settings and to those services provided in the community such as general practice. The findings provide a four-factor model comprising: trust, access, a caring approach and professionalism, three of which are comprised primarily of human interactions. These findings suggest that although the original SERVQUAL ten-item model does have some relevance, with the adapted five-item model being far too simplistic, neither fully addresses the needs of a sector as unique and high contact as health care. The results point the way for further research to develop a detailed model to evaluate service quality in health care settings.

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