Gap analysis developed by Parasuraman, Zeithaml, and Berry (PZB), followed by a SERVQUAL scale assessment is commonly used to quantify the functional quality of various health care service departments, however, few studies have investigated the service quality of inpatient cancer patients. In this study, we applied gap analysis and assessment by the SERVQUAL scale to investigate the service quality of inpatient cancer patients being cared for by physicians and nurses. In addition, the assessment was analyzed by Importance-Performance Analysis (IPA) and customer orientation was measured.
Expectations and perceptions of service quality of 52 physicians and 96 nurses caring for inpatient cancer patients and those of 182 inpatient cancer patients were assessed by a 21-item SERVQUAL instrument of PZB. We found that both physicians and nurses underestimate patient expectations (gap 1). Differences in gap scores between physician perceptions and patient expectations in all five dimensions of quality (tangibles, reliability, responsiveness, assurance, and empathy) were statistically significant (P<0.05). Additionally, with the exception of tangibles, differences in gap scores between nurse perceptions and patient expectations in the five dimensions of quality were statistically significant (P<0.05).
We found that the expectations of inpatient cancer patients were higher than their perceptions in all five dimensions of quality (gap 5); those differences between expectations and perceptions were statistically significant (P<0.05). Furthermore, the differences in expectations and perceptions in all 21-items except ?physician-and-nurse appear neat? of the tangibles were statistically significant (P<0.05).
According to multiple regression analysis, both education level (Master degree and Ph.D. degree) (P=0.043) and the measure of customer orientation of physicians (P<0.001) had a different effect on gap 1; in addition, only measures of customer orientation of nurses had a different effect on gap 1 (P<0.001). Finally, gender, age, commercial medical insurance coverage, duration of disease, and sites of cancer had a different effect on gap 5.
IPA revealed that the priority of patient satisfaction and patient assessment of importance in service quality were concordant; the same result was found between physician satisfaction and physician assessment of importance. The dimension of ?reliability? was ranked no. 1 by both patients and physicians in their satisfaction and assessment of importance. In addition, patients regarded no dimension of quality as being ?concentrate here? or ?possible overkill?; the dimensions of ?reliability?, ?responsiveness? and ?assurance? fell in ?keep up the good work?; and the dimensions of ?tangibles? and ?empathy? fell in ?low priority?. IPA of physicians revealed that ?responsiveness? fell in ?concentrate here?; whereas ?reliability? and ?assurance? fell in ?keep up the good work?. ?Tangibles? and ?empathy? were given in ?low priority?. The dimension of ?reliability? was ranked no. 1 in the assessment of importance of nurses; however, the dimension of ?assurance? was ranked no.1 in their satisfaction. IPA of nurses revealed that ?responsiveness? fell in ?concentrate here?, ?reliability? fell in ?keep up the good work?, ?tangibles? were ?low priority?, and ?assurance? and ?empathy? fell in ?possible overkill?.
Analysis of customer orientation showed that physicians regard ?close attention is given to after-sales service in our hospital? as the highest measure; however, the analysis revealed that nurses regard ?our hospital?s competitive strategy is based on a thorough understanding of our patients? needs? as the highest measure. Physicians had higher mean scores than nurses in all 6-items of the customer orientation analysis; however only the item ?close attention is given to after-sales service in our hospital? differed significantly between physicians and nurses (P<0.05).
?Patient-focused? care is the mainstream of the health care system. It is mandatory to strengthen closer communication between patients and caregivers, such as physicians and nurses. Caregivers should understand patients? perceptions and provide whole person understanding. Furthermore, physicians with higher education levels should provide better quality care for cancer patients based upon the best available evidence. It is important that the concept of customer orientation should be implanted in the minds of both physicians and nurses.