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The scope of this study is to explore and summarize the pool of dimensions, models and measurement techniques of service quality used in healthcare services and to propose a comprehensive conceptual model for practitioners and researchers.

This research employs a comprehensive review of available literature by using multiple keywords on different electronic repositories using the recommendations of the PRISMA approach for the selection of articles. A critical analysis of available studies helped in compiling a list of core service quality dimensions in healthcare services.

This paper presents a comprehensive account of different dimensions and their measurement items used by various researchers to assess service quality in healthcare systems. Most of the researchers have used SERVQUAL model either in its original or modified form while the others have proposed and used totally different dimensions to assess the service quality in healthcare. Many dimensions are just an existing dimension of SERVQUAL that has undergone a name change while others are completely new. The dimensions used by many researchers have items drawn from more than one dimension of SERVQUAL model. The availability of so many dimensions and models adds to the confusion that researchers and practicing managers experience when determining the appropriate model to be used in their work. To mitigate this confusion, there is a need to develop a comprehensive model; the current work is an attempt to meet this need. Through our analysis, we identify four major service quality dimensions: clinical quality, infrastructural quality, relationship and managerial quality and propose a model named CIRMQUAL.

After exploring all available models in the domain of healthcare, this research presents the best possible areas to enhance the quality of healthcare services. It also enhances the research insights for academicians and working professionals by developing and proposing a comprehensive model for measuring healthcare service quality. The proposed model covers almost all of the service quality dimensions used by other researchers and will make the choice of dimensions/model easy for the future researchers/practitioners interested in measuring and improving the quality of services offered by their healthcare units. Such a comprehensive model has not been developed by any researcher thus far.

The mental healthcare is experiencing an ever-growing surge in understanding the consumer (e.g., patient) engagement paradox, aiming to vouch for the quality of care. Despite this surge, scant attention has been given in academia to conceptualize and empirically investigate this particular aspect. Thus, drawing on the Stimulus-Organism-Response (S-O-R) paradigm, the study explores how patients engage with healthcare service providers and how they perceive the quality of the healthcare services.

Data were collected from 279 respondents, and the derived conceptual model was tested by using Smart PLS 3.2.7 and PROCESS. To complement the findings of partial least squares (PLS)-based structural equation modeling (SEM), the present study also applied fuzzy set qualitative comparative analysis (fsQCA) to identify the necessary and sufficient conditions to explore substitute conjunctive paths that emerge.

Findings show that patients’ perceived intimacy (PI), cohesion and privacy enhance the quality of mental healthcare service providers. The results also suggest that patients’ PI, cohesion and privacy have indirect effects on the perceived quality of care (PQC) by the service providers through consumer engagement. The fsQCA results derive that the relationship among conditions leading to patients’ perception of the quality of care in regard to mental healthcare service providers is complex and is best reflected as multiple and conjectural causation configurations.

The findings from this research contribute to the advancement of studies on patients’ experiences by empirically examining the unique dynamics of interaction between consumers (patients) and mental healthcare service providers, thereby enriching both the literature on social interactions and the understanding of the consumer–provider relationship.

The results of this study provide practical implications for mental healthcare service providers on how to combine the study variables to enhance the quality of care and satisfy more patients.

A significant research gap has ascertained the inter-relationship between PI, cohesion, privacy, engagement and PQC from the perspective of mental healthcare service providers. This research is one of the primary studies from a managerial and methodological standpoint. The study contributes by combining symmetric and asymmetric statistical tools in service marketing and healthcare research. Furthermore, the application of fsQCA helps to understand the interactions that might not be immediately obvious through traditional symmetric methods.

The current study aims at developing a conceptual framework containing original dimensions of SERVQUAL and adding two modified dimensions: patient safety and medical professionalism in healthcare service quality (HSQ) model.

An extensive review of HSQ literature pertaining to its dimensions and models with respect to content analysis and bibliometric studies of service quality in healthcare and SERVQUAL in healthcare were performed on 47 relevant studies, 4,689 and 529 documents after applying inclusion and exclusion criteria. Google Scholar and Scopus were the primary sources to find the relevant documents.

The content analysis was conducted to group HSQ dimensions into seven themes. Co-occurrence analysis of author keywords was performed in VOSviewer to find the links between service quality, SERVQUAL and proposed dimensions. Organization and analysis of different HSQ models and dimensions emerged from the literature result in a comprehensive conceptual framework comprising modified dimensions of healthcare service quality – medical professionalism and patient safety.

SERVQUAL is a widely accepted, tested and validated model in perceiving HSQ from the lenses of patients. But it does not cover the complex nature of healthcare service, thus requiring modification and the addition of new contextual dimensions. Therefore, a comprehensive conceptual framework is developed to validate and test quantitatively.

The paper aims to investigate the practices facilitating the transformation of healthcare services, understanding the resulting outcomes in terms of well-being and uplifting changes. a systematic literature review (SLR) focusing on analyzing the healthcare sector under the transformative service research (TSR) theoretical domain is conducted to achieve this goal.

Employing a structured SLR developed based on the PRISMA protocol (Pickering and Byrne, 2014; Pickering et al., 2015) and using Scopus and WoS databases, the study identifies and analyzes 49 papers published between 2021 and 2022. Content analysis is used to classify and analyze the papers.

The SLR reveals four transformative practices (how) within the healthcare sector under the TSR domain, each linked to specific well-being outcomes (what). The analysis shows that both practices and outcomes are mainly patient-related. An integrative framework for transformative healthcare service is presented and critically examined to identify research gaps and define the trajectory for the future development of TSR in healthcare. In addition, managerial implications are provided to guide practitioners.

This research is among the first to analyze TSR literature in the context of healthcare. The study critically examines the TSR’s impact on the sector’s transformation, providing insights for future research and offering a roadmap for healthcare practitioners to facilitate uplifting changes.

Lean Six Sigma in public and private healthcare organisations has received considerable attention over the last decade. Nevertheless, such process improvement methodologies are not generalizable, and their effective implementation relies on contextual variables. The purpose of this study is to explore the readiness of Italian hospitals for Lean Six Sigma and Quality Performance Improvement (LSS&QPI), with a focus on gender differences.

A survey comprising 441 healthcare professionals from public and private hospitals was conducted. Multivariate analysis of variance was used to determine the mean scores on the LSS&QPI dimensions based on hospital type, gender and their interaction.

The results showed that public healthcare professional are more aware of quality performance improvement initiatives than private healthcare professionals. Moreover, gender differences emerged according to the type of hospital, with higher awareness for men than women in public hospitals, whereas for private hospitals the opposite was true.

This study contributes to the Lean Six Sigma literature by focusing on the holistic assessment of LSS&QPI implementation.

This study informs healthcare managers about the revolution within healthcare organisations, especially public ones. Healthcare managers should spend time understanding Lean Six Sigma as a strategic orientation to promote the “lean hospital”, improving processes and fostering patient-centredness.

This is a preliminary study focussing on analysing inter-relationship between perceived importance of soft readiness factors such as gender dynamics as a missing jigsaw in the current literature. In addition, the research advances a holistic assessment of LSS&QPI, which sets it apart from the studies on single initiatives that have been documented to date.

The authors compare perspectives on external evaluation of health service provision between Norway and the USA. External inspection and accreditation are examples of internationally wide-spread external evaluation methods used to assess the quality of care given to patients. Different countries have different national policy strategies and arrangements set up to do these evaluations. Although there is growing attention to the impact and effects on quality and safety from external evaluation, there is still a gap in knowledge to how structures and processes influence these outcomes. Accordingly, the purpose of this article is to describe the structures and processes in external evaluation designed to promote quality improvement in Norway and the USA with attention to comparison of enablers and barriers in external evaluation systems.

Data collection consisted of documentary evidence retrieved from governmental policies, and reviews of the Joint Commission (the US), international guidelines, recommendations and reports from the International Society for Quality in Health Care, and the World Health Organization, and policies and regulations related to Norwegian governmental bodies such as the Ministry of Health and Care Services, the Norwegian Directorate of Health, and the Norwegian Board of Health Supervision . Data were analyzed inspired by a deductive, direct content analytical framework.

The authors found that both accreditation and inspection are strategies put in place to ensure that healthcare providers have adequate quality systems as well as contributing to the wider risk and safety enhancing management and implementation processes in the organizations subjected to evaluation. The US and the Norwegian external regulatory landscapes are complex and include several policymaking and governing institutions. The Norwegian regulatory framework for inspection has replaced an individual blame logic with a model which “blames” the system for inadequate quality and patient harm. This contrasts with the US accreditation system, which focuses on accreditation visits. Although findings indicate an ongoing turning point in accreditation, findings also demonstrate that involving patients and next of kin directly in adverse event inspections is a bigger part of a change in external inspection culture and methods than in processes of accreditation.

The message of this paper is important for policymakers, and bodies of inspection and accreditation because knowledge retrieved from the comparative document study may contribute to better understanding of the implications from the different system designs and in turn contribute to improving external evaluations.

Although there is a growing attention to the impact and effects on quality and safety from external evaluation, the implications of different regulatory strategies and arrangements for evaluation on quality and safety remain unclear.

The purpose of this paper is to explore and describe the perspectives and reasoning of senior development leaders in healthcare organizations, when reflecting on design as theory and practice in relation to more traditional methods and tools for improving quality and support innovation.

The paper is based on a qualitative interview design with five development and innovation leaders from separate healthcare regions in Sweden. They have, to varying degrees, applied design theory and practice for quality improvement and innovation in their organizations. The interview transcript was analysed using a content analysis together with an interpretive approach.

The major findings are to be found in the balancing act for leadership and organizations in healthcare when it comes to introducing and combining different theories and practices for improving quality and support innovation. The balance is between the change in power dynamics and pushing traditional boundaries in a complex healthcare world.

The narratives from the leaders' experience of applying design theory and practice for improving healthcare quality can help us create readiness and knowledge about how we prevent and/or facilitate planning and implementing design theories, practices, methods and tools in a healthcare context.

The study provides a unique insight when it captures and illustrates five different organizations' experiences when applying design for developing healthcare quality.

Previous research has identified associations between quality management and employee health. This study's purpose was to (1) examine those associations in a public healthcare organisation and (2) explore and describe the association between digitalisation and employee health.

An online questionnaire including indices to measure quality management values, employee health and digitalisation was answered by 118 managers in Swedish public healthcare. Correlation analysis was used to analyse the data. Based on the survey results, 12 qualitative, in-depth interviews were conducted with healthcare managers.

The findings show that employee health is associated with quality management and digitalisation. Categories were defined to describe the managers' views of the relationship between digitalisation and health.

Causality was not explicitly tested and cannot be assumed. However, the results strengthen the body of research showing that quality management is related to employee health, and associations between health and digitalisation were identified.

The findings and model should be helpful for healthcare managers in a digitalising environment who aim to preserve or enhance employee health whilst ensuring high service quality.

The results were used to create an integrated conceptual model depicting the association between quality, digitalisation and health. This association has not previously been studied.

Lean Six Sigma (LSS) implementation follows a structured approach called define-measure-analyze-improve-control (DMAIC). Earlier research about its application in emergency healthcare services shows that it requires organizational transformation, which many healthcare setups find difficult. The Kotter change management model facilitates organizational transformation but has not been attempted in LSS settings till now. This study aims to integrate the LSS framework with the Kotter change management model to come up with an integrated framework that will facilitate LSS deployment in emergency health services.

Two-stage Delphi method was conducted by using a literature review. First, the success factors and barriers of LSS are investigated, especially from an emergency healthcare point of view. The features and benefits of Kotter's change management models are then reviewed. Subsequently, they are integrated to form a framework specific to LSS deployment in an emergency healthcare set-up. The elements of this framework are analyzed using expert opinion ratings. A new framework for LSS deployment in emergency healthcare has been developed, which can prevent failures due to challenges faced by organizations in overcoming resistance to changes.

The eight steps of the Kotter model such as establishing a sense of urgency, forming a powerful guiding coalition, creating a vision, communicating the vision, empowering others to act on the vision, planning for and creating short-term wins, consolidating improvements and producing still more change, institutionalizing new approaches are derived from the eight common errors that managers make while implementing change in the institution. The study integrated LSS principles and Kotter’s change management model to apply in emergency care units in order to reduce waste and raise the level of service quality provided by healthcare companies.

The present study could contribute knowledge to the literature by providing a framework to integrate lean management and Kotter's change management model for the emergency care unit of the healthcare organization. This framework guides decision-makers and organizations as proper strategies are required for applying lean management practices in any system.

The proposed framework is unique and no other study has prescribed any integrated framework for LSS implementation in emergency healthcare that overcomes resistance to change.

The complexity and uncertainty of healthcare operations increasingly require agility to safeguard a high quality of care. Using a microfoundations of dynamic capabilities perspective, this study investigates the effects of nurses' implicit voice theories (IVTs) on the behaviors that influence their individual agility.

This research uses quantitative survey data collected from 2,552 Canadian nurses during the fourth wave of the Covid-19 pandemic in the fall of 2021. Structural equation modeling is used to test a conceptual model that hypothesizes the effects of three different IVTs on nurses' creativity, spontaneity, agility and the quality of care they deliver to patients.

The results reveal that voice-inhibiting cognitions (like “suggestions are criticisms for higher-ups”, “I first need a solution or solid data”, and “speaking up has negative repercussions”) negatively impact nurses' creativity and spontaneity in crafting solutions to problems they face daily. In turn, this affects nurses' individual agility as they attempt to adapt to changing circumstances and, ultimately, the quality of care they provide to their patients.

Even if organizations have little control over employees' pre-held beliefs regarding voice, they can still reverse them by developing and nurturing a voice-welcoming culture to boost their workers' agility.

This study combines two theoretical frameworks, voice theory and dynamic capabilities theory, to study how individual-level factors (cognitions and behaviors) contribute to nurses' individual agility and the quality of care they provide to their patients. It answers the recent calls of scholars to study the mechanisms through which healthcare operations can develop and sustain dynamic capabilities, such as agility, and better face the “new normal”.