A New Modelling Approach for Investigation of the Relationship between Quality of Health Care Services and Patient Satisfaction

Background: An important factor for the success of decentralization of health care is the provision high quality services at the regional level. The basic indicator for the level of quality of health services is the consensus of patients about the services provided, known as patient satisfaction. Health care organizations must deal with the dilemma of how to allocate their quality improvement resources in order to improve patient satisfaction to the degree that the local population no longer seeks other solutions in the central hospitals. The progress to this goal is usually monitored with the use of market research tools, whereby a statistical model of basic quality criteria is developed and the importance of the criteria for the formulation of patient satisfaction is analyzed using the importance-performance analysis. The basic principal of these models is that the relationship between the proposed quality criteria and total satisfaction is symmetric and linear. Several studies in other fields of service management have shown that there may be a different structure in the relationship in the health care sector which needs to be examined. The proposed model uses the three-factor theory proposed by Kano for identification of quality criteria in health care services, using a patient satisfaction research project in three regional hospitals in Northern Greece. Analysis of the resultant questionnaires identified four criteria for the characterization of the level of health care service quality, namely the quality level of the service provided by physicians and nurses, the quality level of the organizational procedures and the physical environment in which health care is delivered. The results demonstrated an asymmetrical relationship between the various quality criteria and total patient satisfaction that leads to differentiation of criteria importance assessment methodology and prioritization of decision-making steps for improvement of the quality of regional health care services.