People-Centred Quality Indicators for Primary Care Centres

In Austria, the recent evolution of primary healthcare centres offers a new alternative to the people. In order to become attractive to the people the service quality dimension offers various opportunities for Primary Care Centres. Incorporating the principle of Integrated Care they offer more convenient opening times and a better continuity of care than practices working on an individual basis. Considering the fact that people have a free choice of visiting care providers the service dimension of care plays an important role in the decision-making process. In paying more attention to people`s expectations and needs and offering them better suited healthcare services primary care centres may be able to increase their attractiveness to the people. Exploring customers’ expectations and needs is a decisive issue from the services marketing viewpoint. The service quality model proposed by Parasuraman et al. (1985) serves as a conceptual framework for further research on service quality. Most studies on patient satisfaction have used a discrepancy approach implying that satisfaction results from comparing expected quality with perceived quality. This subjective element makes it extremely difficult to conceptualise a satisfaction model. Most studies on patient satisfaction focus on the patients’ perception of the quality of care by asking them to evaluate certain attributes of quality. More emphasis should be given to the exploration of patients expectations in order to receive better explanation on patients’ evaluation of the quality of care they receive. Starting to address patients’ expectations, we sought to conceptualize the expectations of people in a primary care setting. The main objective of the study was to systemize patient´s expectations according to Kano´s model of attractive quality (1984). The model distinguishes between must-be quality and attractive quality. The later refers to quality attributes which are not explicitly expected by the customer but have the potential to lead to high levels of satisfaction. Another aim of the study is to assess the impact of the research method used on the results received. In developing our research questions we were guided by the following two assumptions. The first assumption is that attributes of attractive quality have a high potential to be offered in particular by integrated care providers. Research work on patient satisfaction indicates that medical-competence is considered as a must-be quality whereas service quality attributes is suggested to lead to high levels of satisfaction. The second assumption is that people differ in their responses depending on the research method applied. Qualitative research methods start from the perspective of the people concerned and offer the interviewed person more freedom in choosing aspects which are important to him or herself. They are therefore more likely to provide a deeper insight in the needs and expectations of people receiving care. Quantitative research studies ask people to evaluate predetermined quality attributes thus providing limited space for individual contributions. Building on the two assumptions described above we hypothesized that quality attributes linked to technical competence are considered as must-be quality whereas quality attributes linked to the service dimension are considered as attractive quality. Since attractive quality attributes are often not clearly expressed by the people we hypothesized that qualitative research methods are better suited to reveal the elements of attractive quality. Our study presents a systematic review of research studies on patient expectations in primary care. Special attention was paid to the results obtained but also to the research methods used. The quality indicators identified can be used by primary care centres to increase attractiveness to the people. Literature search was conducted by using a combination search terms. The literature search was performed in databases covering management and health sciences. Literature considered was published in peer-reviewed journals and the research articles needed to meet pre-defined selection criteria. Reference lists of included papers and review articles revealed further literature. Research on patient satisfaction focuses on functional aspects of health care quality, also described as the caring dimension which refers to the process of service delivery. Perceived quality attributes include both individual as well as organisational aspects of service delivery. Access in terms of access to treatment was reported to have a great impact on patient satisfaction. Findings also highlighted the importance of interpersonal interaction and the quality of the patient – doctor relationship. However, general conclusions concerning attractive quality attributes can still only be hypothesized due to the limited number of research studies exploring patient’s expectations and needs in a primary care setting. The emphasis is on measuring perceived service quality and analysing the associations between patient satisfaction and other variables. A number of conceptual and methodological issues have been identified that induce challenges for researchers in gaining a deeper understanding of the processes involved in shaping expectations and perceptions in a health care setting. Due to the fundamental nature of the health care experience resulting in a subjective evaluation by an individual it may be impossible to arrive at a uniform concept of patient’s expectations and perceptions. Applying patient segmentation prior to exploring expectations and perceptions would allow for more individualisation. Focus groups and face-to-face interviews referring to critical incidents represent examples for alternative research methods that respect subjective interpretations and preferences. Case studies may indicate best practices and represent another valuable source for gaining insight into the people´s perspective, their expectations and needs. The present work highlights the importance of exploring people`s needs when designing primary care services. The work supports integrated research that combines findings from the services marketing sector with satisfaction constructs in health care.