چارچوب ارزیابی کیفیت بیمار برای خدمات بهداشتی  Patient-centric quality assessment framework for healthcare services

1. Introduction It is imperative for all types of service providers, including healthcare providers to provide high-quality service to their customers, and to engage in continuous improvement efforts, to stay competitive. Such efforts require effective quality assessment instruments to help the service providers assess their own service quality and to identify areas for improvement. In developed nations, such as the European Union, services contribute 62% of the GDP whereas the traditional industry and agriculture contribute the remaining 38%. Further, services are being offered across national borders and in order to stay competitive, they must focus on quality (Blind and Hipp, 2003). Traditionally, service quality was evaluated on transaction based attributes such as price and outcome. More recently, quality assessment of services has been based on customer experience. As a result, over the last 25 years or so, there has been a stream of research on customer experience management (CEM) in service delivery systems. The term “quality” is difficult to define precisely and many definitions of “quality” are found in the literature. For the purposes of this paper, we use a customer-centric definition of quality, proposed by Deming (1993) as the degree to which customer’s expectations are met or exceeded. The “customer experience” alluded to in the CEM literature goes beyond simply customer satisfaction; it encompasses a holistic experience which includes emotional, social and personal fulfillment during the various touchpoints involved in a service (Gentile et al., 2007). Healthcare services distinguish themselves from other types of services such as insurance, financial, hospitality, entertainment and other services in many ways. For example, (i) they involve a high degree of personalized or individualized interactions with the customer (patient), (ii) there are many touchpoints from start to finish and (iii) in addition to the patient, the patient’s loved ones are also involved at an emotional level when receiving the services. Due to these differences, patient experience involves some emotional and social dimensions that may not be so critical in assessing the quality in other types of services. It is therefore critical that the quality assessment framework for healthcare services take into account these unique dimensions in assessing quality. While there is vast amount of literature on CEM in services in general, literature on CEM in healthcare services is somewhat sparse. This paper attempts to fill that gap. In this paper, we propose a patient-centric quality assessment framework especially designed for healthcare providers. Using the framework, a comprehensive quality score is generated which represents the degree to which the patient’s expectations are met at all the touchpoints. This generic framework for healthcare providers can be used to build appropriate instruments, rubrics or metrics for assessing specific types of healthcare services, such as dental, surgical, outpatient, emergency care etc. The patient perceives value on two dimensions, namely, extrinsic and intrinsic. The extrinsic value is derived from (i) utilitarian or functional value, such as how effective the treatment was, how clean the facilities were, etc. and (ii) extrinsic social value, such as how pleasant the personnel interactions were. The intrinsic value is derived from (i) emotional value, such as empathy received from health personnel and not being ignored by the personnel, (ii) epistemic value, such as whether the patient’s belief systems were honored and (iii) intrinsic social value such as being treated respectfully. It is important for an effective quality assessment framework to include all these value themes. The contribution of this paper is a proposed generic patient-centric framework for assessing the quality of healthcare services that captures and compares the patient’s expected and perceived quality on many dimensions, some of which are unique to health services, across all the touchpoints or stages during the service. It generates a quality score which is a measure of the degree to which the patient’s expectations were met or exceeded. To the best of our knowledge, no existing framework provides such a comprehensive quality assessment from the patient’s perspective.