Track: Healthcare Operations and Services

Abstract

Delivering high-quality services is crucial in service industry success. That is the reason why patient satisfaction in hospitals is an important research topic. Health services in developing countries are no exception, with high demand and significant budgetary restrictions. The widely accepted quality of service dimensions - tangibility, empathy, reliability, responsiveness, and assurance - have been studied to understand their impact on patient satisfaction; however, its application in every context is debatable, especially in circumstances where the patient cannot choose widely between different services. The military health care facilities in developing countries are one of those contexts; therefore, it is necessary to identify the specific dimensions of a quality service that contributes to patient satisfaction in them. This study aims to reveal factors associated with patient satisfaction that may be useful for military organizations in developing countries. To meet the objective of the study, the authors collected surveys of 2,606 users of military health care facilities. The analysis was performed in two phases.  First, confirmatory factor analysis is carried out to validate the goodness of the proposed measurement model. Second, the effects of the variables of the measurement model on an overall satisfaction variable are analyzed. For the first phase, a structural equation model analysis based on covariance (CB-SEM) is used, and for the second phase, a structural equation model based on variance (PLS-SEM) is applied.  In total, seven indicators are included in the measurement model. The results of CB-SEM propose that the data are adjusted to three components, namely: appointment scheduling service, human resources quality, and medical support services. Regards the global adjusted of the model, the quality measures of the exact fit show that the Chi² statistic is significant (92.0, df = 11, p-value < .001), and all indexes show a satisfactory fit. The values of GFI (.986), TLI (.974),  and RMSEA (.054) are satisfactory (their values tend to 1 and > .5); additionally, the index SRMR (.025) indicates the acceptable fit (<.08). The analysis with PLS-SEM indicates the constructs measurement reliability  (all composite reliabilities > .8) as well as convergent validity (all AVE > .5) and discriminant validity (HTMT < .9 for all relationships between variables).  Moreover, the result of the analysis of the structural model indicates that the three latent variables of the model explain the variance of the overall satisfaction (R² = .34); the path coefficients for appointment scheduling service, human resources quality, and medical support services are .13, .40, and .15, respectively. A bootstrapping procedure indicated that all these effects are significant (p-values < .001). In conclusion, on the one hand, these findings highlight the assessment of the patient concerning the human dimensions in military health care facilities; on the other hand, the results indicate that it is necessary to continue exploring new variables that explain the overall satisfaction of the patient in this context.