ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Salarian   A. (1*)
Mohammadi   H.R. (1)
Dargahi   H. (1)






(1*) Health Care Administration Department, Management Faculty, Electronic Branch, Islamic Azad University, Tehran, Iran

Correspondence

Article History

Received:  May  21, 2018
Accepted:  October 9, 2018
ePublished:  March 16, 2019

BRIEF TEXT


... [1-13]. The main mission of hospitals is to provide quality care to patients and meet their needs and expectations.

... [14-22]. Expectations are one of the most important determinants of customer evaluation of service quality, and accurate recognition of customer expectations is the most important step in defining and delivering high quality services. In fact, how to respond to patient expectations is one of the current challenges of health systems [23]. The patient's expectations arise from the patient's perception of the ideal care standards or previous experience of using the service [24]. The results of various studies indicate that meeting patient expectations is associated with his high satisfaction with the service, and unmet expectations are also associated with dissatisfaction [25]. Several methods have been developed to determine patients' expectations and how to meet them, but SERVQUAL model developed by Parasuraman et al. (1988) is one of the best and most used models to assess the expectations and perceptions of customers for the quality of services [26, 27]. Since most patients lack the knowledge needed to evaluate the quality of the services, their evaluation of quality is based on the care process [28]. Unfortunately, limited research has been done on assessing the satisfaction of health services in veterans [29].

The aim of this study was to determine the difference in expectations and perceptions of the injured and chemical veterans from the quality of health care services.

The present descriptive study is an applied research based on its objective and has a descriptive cross sectional survey method.

This study was carried out on 900 injured and chemical veterans of the Iran-Iraq war in Kashan in 2017.

The Cochran formula according to the study population was used to determine the sample size and it was calculated 270 subjects. They were selected through purposive sampling and entered the study. The inclusion criteria included veterans with more than 25% of injury, residence in Kashan city, veterans of the Iran-Iraq war. Exclusion criteria included being veterans after Iran-Iraq war as well as veterans referred from other cities and non-residents of Kashan.

The standard SERVQUAL questionnaire [26-29] and in the case of ambiguity, purposeful interviews were used for data collection. The questionnaire consisted of two sections; the first part included questions about demographic and social characteristics of patients and chemical veterans. In the second part, to assess the expectations and perceptions of chemical patients and veterans about the quality of services the SERVQUAL tool for assessing the customer view about quality of service was used. This section has 30 questions which are designed in two groups of 15 questions (expectations and perceptions). The first 15 questions of SERVQUAL (expectations) questions 1 to 3 assessed tangibility, questions 4 to 6 reliability, questions 7 to 9 accountability, questions 10 to 13 assurance, and questions 14 and 15 evaluated empathy. The last two questions (31 and 32) assessed service quality. Validity and reliability of this questionnaire have been confirmed [26-29]. In this study, content validity was used to assess the validity. The questionnaire was provided to 10 faculty members and experts in health services management and they confirmed validity of the questionnaire. Cronbach's alpha was used to evaluate reliability of the scale. Accordingly, it was calculated 0.77 for tangibility, 0.78 for reliability, 0.81 for accountability, 0.73 for assurance, and 0.77 for empathy. Ethical considerations were observed, including essential permission from the Foundation of Martyrs and Veterans Affairs of Kashan Province, participation in research voluntarily, confidentiality of information, coordination with the authorities of the studied hospitals, and human dignity as an important ethical principle. Kolmogorov test and Shapiro test could not be used to determine the normalization of the research variables, since the number of samples was less than 3000 and the variables were not basically quantitative. Skewness and elongation of variables and questions of the research were the best test for the Likert scale. According to Hire, all skewness coefficients for questions and research variables obtained between 3 and -3 and all elongation coefficients between 5 and -5, so the distribution of data was normal. Therefore, parametric inferential tests were used. SERVQUAL dimensions were measured using the mean difference test and there was a gap in all dimensions. Paired t-test was used and also Skewness and elongation were used to check the normality of the variables. Data was analyzed by SPSS 24.

64.4% of veterans aged 51-60 years. 72.6% were married, 26.3% had diploma and 3.0% had PhD. 84.4% of veterans have been treated for 30 and 35 years and 13% of them over 35 years. Nearly half of the veterans and chemical injured subjects had Medical Services Insurance and the other half were insured by the Armed Forces Medical Services Insurance. Most veterans and chemical injured subjects had Complementary Insurance (Table 1).Reliability showed the highest mean and empathy had the lowest mean among the dimensions of expected quality. In addition, tangibility had the highest mean and assurance showed the lowest mean among the dimensions of perceived quality (Table 2).There was a significant gap for all dimensions of perceptions and expectations (p=0.0001; Table 3).

The obtained findings of the main hypothesis indicate that there was a gap between all studied dimensions. The results of most studies have shown that there are gaps in all five dimensions of service quality. These findings are consistent with the results of studies by Shojaei Baghini & Nakhaee [30], Mohebbifar et al. [31], Ayoubian et al. [32], Mohammadnia et al. [17], Zarei Matin et al. [34], Lee et al. [35] and Butt et al. [36]. This means that the expectations and perceptions of injured subjects and veterans hospitalized in the studied hospitals have not been met. .... [37].

In terms of assurance and reliability dimensions, training psycho-psychological methods of communication with patient is suggested to improve companionship of the hospital staff with the patients

The present study was conducted in Kashan hospitals and the results should be its generalized cautiously to all hospitals in Iran.

Veterans and chemical injured subjects have a high expectation of the quality of health care and despite the high quality of services, in all aspects of the quality of service, there is a significant difference between patient expectations and existing quality (perception), which requires the authorities to improve the quality in all respects, especially the dimension of tangibility and assurance.

The research was not possible without the support of the Foundation of Martyrs and Veterans Affairs of Kashan and the Holy Defense Museum. Therefore, the authors are grateful to the to the cooperation and support of the participated veterans.

None declared.

None declared.

The research was funded by the Holy Defense Museum research center.

TABLES and CHARTS

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