HEALTHCARE SERVICE QUALITY AND PATIENT SATISFACTION IN OMANI PUBLIC HOSPITALS THROUGHOUT COVID-19 ERA: AN EMPIRICAL INVESTIGATION

By Ghaliya Salah Al Atar and Abu Bakar Abdul Hamid

Healthcare quality (HQ) became eminent during the COVID-19 crisis. Despite the efforts made by the Ministry of Health in Oman, the country faced several challenges, such as a lack of available funds and patients perceived in a negative manner which hindered their treatment experience. The study examines factors affecting HQ using the SERVQUAL model; patient satisfaction in Omani public hospitals, including healthcare quality, resources availability (RA), and healthcare facility preparedness (HFP); and the moderation effect of the perceived risk of COVID-19 pandemic. This research uses a mixed method with a sample size of 387 patients (quantitatively) selected using probability random sampling of 8 patients (qualitatively) who visited public hospitals The findings from the quantitative analysis reveals that the tangibility and RA had insignificant effect on the HQ. The moderation effect of perceived risk of COVID-19 between HQ, RA, HFP and patient satisfaction was insignificant. The results of the qualitative analysis indicated other factors that affected patient satisfaction, including communication, helpfulness, compassion, physician professionalism, patient-doctor contact, waiting time, atmosphere, and cleanliness. The study proposed a strategy for technical categories that include professional skills, service outcomes and concrete quality aspects, and functional categories. The study has also recommended implications for further investigation.

• Language: English
• Publisher: Partridge Publishing Singapore
• Release date: Sep 7, 2023
• ISBN: 9781543780765

Ghaliya Salah Al Atar

Ghaliya Al Atar Dr Ghaliya Al Atar works in the Directorate of Quality in Oman College of Health Sciences (OCHS). She has PhD from Infrastructure University Kuala Lumpur (IUKL), Malaysia on quality in public health care. She has a dental degree from OCHS and a Master in Business Administration from the University of Hull, UK. Prior to her current role, she worked as dental assistant in several hospitals including Al-Nahda Hospital and the Royal Hospital in Oncology Centre. She has also worked in primary health centres, secondary healthcare centres and special care needs school health programs. Ghaliya has trained a number of dental students in clinics and has worked as a superintendent for the dental education program and has contributed to the preparation of the five-year plans for dentistry from 2005-2010 in Directorate General Health Services, Muscat. She has also worked with the inspection teams of private and public dental clinics as part of the quality assurance program applied by the Ministry of Health. She has done a number of researches on evaluation of oral health program in public schools and quality of health system during Covid-19. She has applied Kaison approach in quality in the Health Sciences Programs from 2018 and has presented at a number of international business conferences. Abu Bakar Abdul Hamid Dr. Abu Bakar holds a BBA, MBA from Northrop University (USA), PhD from University of Derby (UK, 2003) and now attached as Professor at Infrastructure University Kuala Lumpur (IUKL), Malaysia. He has demonstrated an excellent record of teaching and supervision for more than 30 years in the academic field. His achievement in graduating more than 60 PhD candidates and 30 post-doc fellowships proves his ability, capability and passion in supervisions. He has shown excellent records of impactful research and publications which directly has strengthened his expertise in the area of his interest. He managed to secure several competitive national grants and consultant for various projects and later profoundly published in more than 350 articles in competitive international journals, proceedings, books and book chapters. Such commitment is truly an academician landmark.

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Copyright © 2023 by Ghaliya Salah Al Atar; Abu Bakar Abdul Hamid.

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Contents

Dedication

About The Authors

Chapter 1     Issues And Challenges

Chapter 2     Analysis And Assessment Of Current Knowledge

Chapter 3     Technique And Approach

Chapter 4     Results

Chapter 5     Discussion Conclusion And Recommendations

References

Appendix

DEDICATION

To my husband Abdullah and wonderful daughters

Hababah, Hawra, Noor and Lya for their support

Ghaliya Al Atar

To my lovely wife Fazila Said and princess Aysha

Abu Bakar Abdul Hamid

ABOUT THE AUTHORS

Ghaliya Al Atar

Dr Ghaliya Al Atar works in the Directorate of Quality in Oman College of Health Sciences (OCHS). She has PhD from Infrastructure University Kuala Lumpur (IUKL), Malaysia on quality in public health care. She has a dental degree from OCHS and a Master in Business Administration from the University of Hull, UK. Prior to her current role, she worked as dental assistant in several hospitals including Al-Nahda Hospital and the Royal Hospital in Oncology Centre. She has also worked in primary health centres, secondary healthcare centres and special care needs school health programs. Ghaliya has trained a number of dental students in clinics and has worked as a superintendent for the dental education program and has contributed to the preparation of the five-year plans for dentistry from 2005-2010 in Directorate General Health Services, Muscat. She has also worked with the inspection teams of private and public dental clinics as part of the quality assurance program applied by the Ministry of Health. She has done a number of researches on evaluation of oral health program in public schools and quality of health system during Covid-19. She has applied Kaison approach in quality in the Health Sciences Programs from 2018 and has presented at a number of international business conferences.

Abu Bakar Abdul Hamid

Dr. Abu Bakar holds a BBA, MBA from Northrop University (USA), PhD from University of Derby (UK, 2003) and now attached as Professor at Infrastructure University Kuala Lumpur (IUKL), Malaysia. He has demonstrated an excellent record of teaching and supervision for more than 30 years in the academic field. His achievement in graduating more than 60 PhD candidates and 30 post-doc fellowships proves his ability, capability and passion in supervisions. He has shown excellent records of impactful research and publications which directly has strengthened his expertise in the area of his interest. He managed to secure several competitive national grants and consultant for various projects and later profoundly published in more than 350 articles in competitive international journals, proceedings, books and book chapters. Such commitment is truly an academician landmark.

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CHAPTER 1

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Issues And Challenges

In public health system due to the spreading of Coronavirus

1.1    Background of the study

The world is in a difficult position that this generation has never seen before. COVID-19 is the most worldwide pandemic since the great Spanish flu pandemic of the 1920s, impacting the economy and public health system (Barro et al., 2020). Urbanisation and globalisation have brought the various areas and countries closer and more convivial than ever before; millions of people are likely to die due to the spreading of this epidemic. Coronavirus is responsible for thousands of deaths worldwide, showing the virus’s power even in this contemporary age of public health and medical science(Shermin & Rahaman, 2021).

The Middle East and North Africa (MENA) medical systems are being tested by the epidemic, and some are already creaking under the strain of being overburdened (Organisation for Economic Co-operation and Development (OECD), 2020). The situation does not apply to the wealthier Gulf countries, the developing economies in North Africa, or fragile and conflict-affected countries such as Iran, the Palestinian Authority, Yemen and Libya, where a dearth of hospital beds and testing facilities is a severe problem (OECD, 2020). In Lebanon, Morocco, and Tunisia, the initial wave has left public hospitals and their staff depleted, and public confidence in official numbers and crisis management has been seriously undermined (OECD, 2020). In contrast to Jordan’s flawless crisis management, the UAE’s use of virtual physicians and sanitizing robots, or Morocco’s ramped-up local mask and test manufacture, certain nations have taken quick, decisive and/or inventive efforts to limit the infection(Organisation for Economic Co-operation and Development (OECD), 2020). However, current studies have yet to examine the public healthcare response to COVID-19 in Oman Cooperation and innovation in healthcare, particularly in vaccine development, were also greatly encouraged (OECD, 2020). This demonstrates the wide disparities in healthcare reaction capabilities between countries (Organisation for Economic Co-operation and Development (OECD), 2020)

In Oman, from 3 January 2020 to December 2021, there have been 304,581 confirmed cases of COVID-19, with 4,113 deaths reported to World Health Organization (WHO).

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Figure 1.1 COVID-19 in Oman

Hospitals are significant primary care providers during outbreaks of pandemics such as Covid-19, access to patient satisfaction with service quality is critical, and understanding patients’ needs is a difficult job that can only be accomplished by evaluating customer satisfaction(ALADI, 2021; Issai & Jarmajo, 2021; Khezeli et al., 2021; Shermin & Rahaman, 2021; Shirazi et al., 2020).

Hospitals in Oman strive to offer high-quality medical treatment. At the same time, Muscat is home to the majority of the country’s biggest and most sophisticated hospitals and health facilities, including the Royal Hospital and the Sultan Qaboos University Hospital (Al-Kalbani et al., 2020). The private sector is still emerging; there are only three private hospitals in the Sultanate. The private sector’s participation will need a greater effort to meet the population’s increasing wants and expectations (The Report Oman, 2019). The contribution of the private sector to health care is low, according to the Ministry of Health- Sultanate of Oman (2020). Only 7.5 percent of hospital beds are privately held, while 27 percent of clinics are privately operated (Ministry of Health- Sultanate of Oman, 2020a). Additionally, the public healthcare sector is assigned to the Sultanate’s vision in facing COVID-19 pandemic. Hence, this study will focus on the public sector only.

The healthcare sector is one of the fastest-growing service industries in the world. In recent years, different governments have made various initiatives to boost financing for the healthcare sector to enhance people’ quality of life. The persistent complaints about consumers’ unhappiness with the quality of healthcare services, on the other hand, provide a significant challenge to service providers (Mustaffa, 2021b). There is a connection between healthcare facilities and service seekers, and marketing research acknowledges the importance of service quality. The argument for service quality is becoming more important in the health sector due to the high levels of hazards associated with healthcare delivery (Issai & Jarmajo, 2021), with significant implications for humanity and long life (Amzat et al., 2020). (Ahmed et al., 2017; Kashif et al., 2016; Mustaffa et al., 2019; Mustaffa, 2021a) in Malaysia, and Fan et al. (2017) in China showed a strong positive connection between the quality of service and healthcare facilities. Quality of service has a significant impact on patients. Researchers found a connection between service quality and healthcare facilities in Jordan’s healthcare sector (Ajarmah et al., 2017; Al-Mhasnah et al., 2018b; Pakurár et al., 2019). Similar to this, several studies have stated that high-quality medical care entails more than only treating a pandemic sickness; it also includes other crucial elements like courtesy, compassion, doctor empathy, compassionate nurses, and comfortable surroundings (Fatima, Malik, & Shabbir, 2018; Ifijeh, 2020; Ihekweazu, 2020; Lucero-Prisno, Adebisi, & Lin, 2020).

The quality of service is recognised in marketing research, and there is a link between health care facilities and service seekers (patients). Due to the high levels of risks connected with healthcare delivery (Issai & Jarmajo, 2021), the argument for the quality of service takes increasing importance in the health sector, with far-reaching implications for humanity and long life (Amzat et al., 2020). Quality of service has a major effect on patients, according to (Ahmed et al., 2017; Kashif et al., 2016; Mustaffa, 2021a; Mustaffa et al., 2019) in Malaysia, and Fan et al. (2017) in China showed a strong positive connection between the quality of service and healthcare facility. In Jordan’s healthcare sector, (Ajarmah et al., 2017; Al-Mhasnah et al., 2018b; Pakurár et al., 2019) discovered a link between service quality and healthcare facilities. Similarly, some studies have suggested that excellent healthcare encompasses more than only curing a pandemic illness; it also includes other important aspects such as politeness, compassion, doctor empathy, caring nurses, and pleasant rooms (Fatima, Malik, & Shabbir, 2018; Ifijeh, 2020; Ihekweazu, 2020; Lucero-Prisno, Adebisi, & Lin, 2020).

The level of patient Satisfaction is widely recognised as an indicator of the quality of healthcare facilities. Among the many metrics used to evaluate the success of a healthcare provider, patient satisfaction ranks high (Akbar et al., 2020). Patients’ perspectives are increasingly being taken into account while making treatment decisions and providing care. As a result, public sector hospitals, in particular, have placed a premium on patient feedback about the quality of care they get, and patient feedback evaluations of health service delivery have become an integral part of any health system (Al-Harajin et al., 2019). The government exclusively supports public hospitals. Thus, they operate under government policy. In contrast, private sector organisations are legally recognised businesses with the potential to provide their consumers with more efficient treatment and services. Patients in private hospitals must pay extra to receive the same level of care provided in public hospitals. Accurate and comprehensive information is now expected from patients prior to receiving any services from a healthcare provider. Given that patients are now expected to spend more on treatments, any cause for discontent is likely to send them searching for alternatives elsewhere (Zhao et al., 2020); patients have grown more inquisitive and anticipate more services to acquire quality services beyond their expectations. However, the level of patient satisfaction with hospitals is expected to increase with improvements in the quality of services provided. Physicians and all hospital staff (medical and otherwise) have been urged to look in the same direction in order to improve and increase the quality of care they provide (Zhao et al., 2020). The patients are the hospital’s most valuable asset. Medical service delivery has become increasingly important in satisfying and keeping consumers. Patients may assess the process, outcomes, and structure of services Uzir et al. (2021) according to studies undertaken in industrialised countries. Patient satisfaction has been shown to correlate with the quality of treatment provided (Dam & Dam, 2021). According to the research of Singh and Dixit (2020), the quality of medical care greatly affects patient happiness. Patients’ perspectives on the evaluation and delivery of healthcare are crucial to the hospital experience, as Asnawi et al. (2019) noted. High relevance also requires attending to medical care standards and the demands of patients. The level of client satisfaction is often employed as a metric of health care quality.

Asif et al. (2019) found a connection between patient happiness and the quality of medical treatment they received. The results of their research demonstrated a strong correlation between patient happiness and the quality of care they received. Examining the differences between patients’ hopes and the care they actually receive might give insight into their level of satisfaction. A trust established via effective public learning can provide valuable feedback to hospital administration (Kurdi et al., 2020). Patient satisfaction with healthcare was discussed by (Afrashtehfar et al., 2020). The level of patient satisfaction helps mediate between patients’ goals and the quality of treatment they receive. The significance of service quality assessment, evaluation, and monitoring in the health sector is now undeniable(Al-Mhasnah et al., 2018a; Hanefeld et al., 2017; Khezeli et al., 2021; Rezaei et al., 2018; Tan et al., 2019; World Health Organization., 2018). Various studies aimed to comprehend the significance of collaborative connections between patients, satisfaction, and quality of life, modern medicine has progressively grasped and acknowledged the value of patients’ perceptions on health care (Tripathi & Siddiqui, 2018). Health care is a rapidly expanding industry that has attracted the attention of academics and physicians across the globe, and it requires careful study due to the sector’s shortcomings and difficulties to overcome because of rivalry between the public and private sectors (Kalaja et al., 2016).

Measuring the quality of service provided is critical in today’s changing marketing landscape (Hindarsah, 2021). Quality is a must for survival in this age of fierce competition and sophisticated demand. When it comes to services, the question of quality is paramount. The main goal is to obtain a competitive advantage by enhancing service quality perception (Khambhati et al., 2020; Qolipour et al., 2018). As a result, both practical managers and academics are interested in evaluating service quality in service settings (Mohtasham et al., 2017; Umoke et al., 2020; Vimla & Taneja, 2020). Service quality has gained momentum for healthcare professionals as well, taking a lesson from the present situation (Issai & Jarmajo, 2021). Researchers are especially interested in this field since the quality of the service provided is linked to the healthcare facility’s overall performance (Al-Mhasnah et al., 2018a; Alzaydi, 2021; Globenko & Sianova, 2012; Hanefeld et al., 2017; Khezeli et al., 2021; Rezaei et al., 2018; Tan et al., 2019; World Health Organization., 2018). To guarantee the long-term viability and profitability of healthcare institutions, perceived service quality must be good(Rezaei et al., 2018). The level of service provided will have a direct effect on patient satisfaction. Customer satisfaction, in turn, affects purchase intent, customer loyalty, and repeat business. As a result, healthcare providers aim to minimise wait times, have contemporary technology, aesthetically attractive facilities, and knowledgeable and courteous front-line personnel, among other things (Hanefeld et al., 2017; Khiavi et al., 2018; Orzeł & Horodecka, 2021; Ruchiwit et al., 2015).

1.2    Problem Statement

The quality of healthcare services becomes more important during times of crisis (Lai et al., 2020). A country with abundant healthcare resources but insufficient delivery would suffer greatly in the event of a COVID-19 pandemic (Bhagavathula et al., 2020a). The availability of resources and the healthcare system’s readiness to deal with the current pandemic have a significant impact on the quality of healthcare services provided to patients (Anyanwu et al., 2020; Ihekweazu, 2020). The COVID-19 pandemic revealed inadequacies in health systems, which were especially difficult for the public healthcare sector, which must care for those affected by the disease (Deressa et al., 2021; Lai et al., 2020; Orlewska & Klusek, 2020; Shermin & Rahaman, 2021). Because of the random and unexpected spread of the pandemic, the healthcare scenario is chaotic and confusing, even with the use of vaccination, as scientists and researchers discover more and more about the different every day in the use of vaccination (Issai & Jarmajo, 2021).

In Oman, primary Healthcare Centers -level COVID-19 pandemic alleviation strategies focused on preventing the spread of infection among healthcare workers and patients, providing essential Primary Healthcare Centres -related services, and preventing the spread of infection in the community, amongst other things (Al Ghafri et al., 2021). These strategies were perceived by the patient as negatively hindering their treatment experience. In some cases, patients were denied service as the hospitals were serving only Covid 9 pandemic cases. This can greatly affect the patient satisfaction with the service provided.

Healthcare quality is frequently assessed by looking at the structure, technique, and outcome. Increasing the quality of patient care requires measuring the quality of hospital services (Goula et al., 2021). As long as there are effective public health response services, pandemics like Covid-19 can be avoided or reduced to a manageable level (Orlewska & Klusek, 2020). The quality of healthcare provided during the COVID-19 pandemic could be greatly improved by implementing changes to essential service characteristics like tangibility, dependability, assurance, responsiveness, and empathy (Gita & Kumar, 2021). Effective public health response services will almost certainly prevent or lessen the effects of pandemics like COVID-19 (Issai & Jarmajo, 2021). Most countries are limited to preventative measures like lockdowns and social isolation (Anyanwu et al., 2020). As the number of deaths approached record levels, the pandemic raised significant doubts about the reliability of health services offered throughout the globe (Gita & Kumar, 2021). It is now more important than ever to address these problems in order to enhance service mechanisms and reduce the number of people who die as a result of pandemics.

The quality of service in a healthcare facility is determined by the interactions between patients and doctors, as well as the frontline staff. As a result, healthcare institutions that focus on people are becoming increasingly popular (Afthanorhan et al., 2019; Kashif et al., 2016; Rezapour et al., 2019; Zun et al., 2018).

Through various stages, Oman worked with the WHO to develop and establish skills and a culture of healthcare quality in health facilities (Al Juma, 2017). The plan to enhance the quality of healthcare service quality is done by assisting workers in healthcare facilities and quality assurance departments with advice and assistance, along with promoting cooperation and recognising good conduct (Al Mahrouqi et al., 2021). The healthcare sector needs all innovations and information in the area of healthcare quality to workers, as well as the required training (Al-Kalbani et al., 2020). This will help in improving the quality system at healthcare facilities by assessing the structure of the quality assurance system, comparing it against national and international standards, assessing compliance with standards, and identifying and removing flaws (Ministry of Health- Sultanate of Oman, 2020b).

As a result, the Ministry of Health in Oman has seen a tremendous transformation in terms of the number of healthcare facilities and workers in those institutions, as well as the quantity and quality of healthcare services (Al Mahrouqi et al., 2021). However, it became essential to create a unit that is responsible for assessing healthcare services, human resources, and material resources, as well as working on ongoing performance and quality improvement at all levels and in different ministry divisions (Ministry of Health- Sultanate of Oman, 2020a).

Oman Health Vision 2050 is primarily concerned with improving Oman’s health system and attempting to envision the Omani health system over the next 30 years. Simultaneously, it is impossible to forecast how technological advancements and other elements of the fast-developing health sector will unfold throughout this time. As a result, Oman Health Vision 2050 will build the health system based on the resources and technology available during the period of development, and it needs to take into account patient satisfaction with the healthcare service provided. Increased specialised services and increased accessibility of the health services they want to see in the health system are among the major features that the Health Vision 2050 focused on, and this was given as the duty to subsequent development plans (Statistics & Information Health of Department., 2019).

The dimensions of the service quality affect the level of patients’ satisfaction with the service. According to the SERVQUAL model, both empathy and compassion are essential