Measuring the Quality of Health Services Using SERVQUAL: Evidence From Portugal

Introduction

In times of acute economic, financial, and social crisis, the European Union (EU) member states have responded with a number of public administration reforms seeking more efficient organisational models regarding the provision of public services. Following an ideological path, these changes, focusing on the liberalisation of markets and the transition from the idea of a service user to a consumer/client logic, though not new from a political viewpoint, have been reinforced. The health sector is no different, becoming crucial to show that hospital services are ‘consumer-focused’ and heading for providing the best possible medical care to their ‘clients’ (Pakdil & Harwood, 2005). The need to continuously improve service quality has thus become an essential issue due to its significant association to cost saving and market share (Sirohi & Singh, 2016). Within this context, the importance of patient satisfaction in service quality assessment has been extensively recognized, being generally assumed that higher levels of service quality lead to higher levels of ‘consumer’ satisfaction (Pollack, 2008). In fact, literature argues that the quality of service can be measured by determining the difference between the patient’s expectations (what he/she wants) and his/her perceptions of the service (how he/she experiences it) (Pakdil & Harwood, 2005).

In Portugal, the increased pressure to reduce expenditures due to public budget shortfalls led to some health service reforms, such as the merging or closure of healthcare providers, the increase in patient fees, the reduction of wages and benefits for public servants and public service job cuts (Santinha, 2016a). Though the government discourse focused on the idea of an improvement of healthcare quality, with the launch of the National Strategy for Quality in Health 2009-2014, these reforms have engendered enough controversy amongst health professionals and former health decision-makers and have generated huge public discontent (Santinha, 2016b). Albeit the importance of this issue is acknowledged (see inter aliaRodrigues & Schulmann, 2014), to date, according to our knowledge, few studies have analysed the quality of health services in Portugal by assessing patient satisfaction using SERVQUAL. Moreover, the existing publications either focus on healthcare per se (e.g. Quintela, Joana, Correia, Anabela, & Antunes, 2011), or just make general observations on the level of satisfaction (e.g. Neves, 2008).

The aim of this chapter is to discuss the quality of health services in a Portuguese hospital by assessing the level of patient satisfaction, according to gender, age and medical specialty units, using SERVQUAL. In this sense, an exploratory study was conducted to one of the major hospital complexes in the North of Portugal – Centro Hospitalar Gaia/Espinho (CHVNG/E). Mixed methods were used to collect data. First, interviews were conducted to internal directors and healthcare professionals, to assess these stakeholders’ perceptions concerning the last satisfaction questionnaire conducted. Second, given that the results of the interviews showed some dissatisfaction with the existing questionnaire, a new one, based on SERVQUAL, was designed and delivered to hospital patients.

This chapter is structured in the following way: first, the theoretical grounds of quality management and patient satisfaction assessment are explained; second, the Portuguese health system is presented, as well as the reasons for ‘quality’ in healthcare to be a trending issue in this country from a public policy viewpoint; third, the research design and methods are introduced; fourth, results are analysed and discussed; and finally, conclusions are presented.