Quality of Service: An Investigation into United States and Saudi Arabian Health Care Systems - Report Example

Quality of Service: An Investigation into United s and Saudi Arabian Health Care Systems Introduction: Quality of service has different meaningsin different contexts. Some scientists argue that quality of service depends on different theoretical foundations and assumptions. For instance, quality of service is the consumer’s impression of inferior or superior service (Bitner and Hubbert ,1994, p 77). In addition, according to Parasuraman, Zeithaml, and Berry (1985) (p.16) quality service is a global judgment or a reaction to service excellence. They have suggested that the judgment on quality of service is a reflection of the degree of the consumers’ perceptions and expectations. Furthermore, some authors based these definitions on SERVQUAL -- a concept of five standards and models that include: receptiveness, compassion, assurance, reliability and tangibles. These models have been used widely in various industrial sectors (Zeithaml et al., 2006). According to (Angelopoulou et al., 1998) quality health service is multi-dimensional. Regardless of its medical service, patients expect comfortable rooms and friendly staff. Over the years many definitions have suggested a meaning for quality of health care. According to this healthcare research quality of health care means doing the right thing during the right time in the best way. Most definitions of health care service quality focus on the elements of clinical quality and effectiveness. Measurements help to record changes before and after the service, to discover problems and weaknesses and to establish clear standards of service. Edvardsen et al. (1994) report that the most important factors in the development of the quality of any service are to analyze and measure. To measure the quality of the service SERVQUAL is used. The key feature of SERVQUAL is that it is a measure and experiments can be employed for the purposes of comparison and benchmarking (Brysland and Curry, 2001). PRIMARY CARE: The World Health Organization (WHO, 1978) defined primary health care as an essential service provided to all members of the community. It relies on the latest scientific, medical and technological methods. In health systems around the world, healthcare plays a key role by providing immediate care to all people (Disease Control Priorities Project. 2007). Primary health care Holland’s (1983) view consists of basic care; for example, the initial diagnosis and treatment of cases. Additionally, it involves transferring some cases to hospitals and providing moral and psychological support to the community (Holland, 1983, p. 279). Five fundamentals are required to be a primary health care provider: comprehensiveness, coordination, access, accountability and continuity (AlTuwajri. K, 1986). According to Searl & Gallagher (1983) primary care should theoretically be employed as a substitute for medicine and technology tools. Development of health care must be consistent with the development of manpower. Various studies have shown that accessibility and availability are the most important elements that determine patient satisfaction in the health system. Additionally, studies found that traveling to get treatment and the waiting time could negatively impact patient satisfaction (Aday, Andersen and Fleming, 1980). Primary care in The United States: According to Harvard Medical School (2011), health care in the United States is the relatively expensive compared to other developed countries. However, this cost ensures relative quality of care. Sill, health care costs in the United States are a political issue because of their impact on the country economy. Harvard Medical School placed importance on the increase of service quality, safety and decreased costs. These elements could increase primary health care outcomes. Health care in America is in crisis (Harvard medical school 2011). The investment level in primary health care is low. In addition, the number of students going into primary care is low. Furthermore, a large number of primary care physicians are coming out of the retirement system. Difficulties in access to primary health care have led patients to use other medical sites; these include emergency departments. This causes the depletion of the budget of the health care system in United States. According to The New England Healthcare Institute (2005) the percentage of use of emergency departments for non-urgent care is high; this was 10% in 1997 and 15% in 2005. According to some experts, one of many problems is that doctors are forced to see the largest possible number of patients because of the doubling of financial returns; thus the quality of service is less than expected and hoped. There is also a problem with growing demand for service compared to the small number of service providers. Still, healthcare in America are struggling to provide high quality service at low costs. This is a model of health care that has been promised since its establishment 52 years ago. Primary Care in Saudi Arabia: Before 1979, The Ministry of Health, which is the agency of the health system in Saudi Arabia, relied on curative medicine. This agency is still seeking to develop primary health care as an essential part of the health system (Alnaif, M, 1995). People in Saudi Arabia are using the primary health care system and realize it as the essential gate to the health system. For this reason, primary health care systems are important, especially for those who have average or low incomes. The Ministry of Health has identified eight functions for primary health care services for all people: support proper nutrition, preservation of the environment and supporting healthy water, provide prevention of infectious diseases, organizing health plans for families, provide immunization against common and infectious diseases, provide early detection services of common and chronic diseases, and provide basic medications. In line with the policies of the World Health Organization to provide comprehensive and accessible health services, the Ministry of Health announced the establishment of primary health care in 1980. Health care centers in Saudi Arabia did not perform as expected and that reduced the importance of its purposes (Albaz, R, 1992). Primary health care problems in Saudi Arabia may be linked to poor quality of delivered services. Primary health care services are provided to ensure that it’s acceptable and accessible. This created many problems in the health system including the length of the waiting period to see a doctor, the length of time inside the clinic, communication between health professional and patient, and the non-arrival of services. These problems reflect a negative image of services and generate a state of discontent and dissatisfaction between patients (Sebia, 1988; Altuwaijri, 1989; Noors, 1989; AI-Yamamah, 1988). Some studies have been conducted to assess the level of effectiveness and performance in Saudi Arabia primary health care. They found that the level is generally weak. A report by Saeed (1990) indicated that the percentage of Saudi doctors who work in primary health care centers are few. For example, a study conducted in 24 health centers found that less than 5% of the doctors were Saudis, while there are more than 96% foreign doctors. Some reports indicate the reason of this is because Saudi doctors prefer to work in hospitals rather than work in primary health care centers. In Saudi Arabia the expected average life of the people is 68 years, while life expectancy for people living in America is 77 years (U.S. Census Bureaus, 2004). From the ability to prevent some cases of death or to make lives longer, it seems that the quality of health care in America is better. American health providers sometimes ask the patient and families to attend health education sessions, while in Saudi Arabia this is not the case (American Bedu, 2009). Additionally, the culture in Saudi Arabia may have a negative impact on the delivery of services because female doctors wear the veil and this may cause difficulties in communication between the patient and the doctor; it may also generate dissatisfaction. In contrast, in the U.S. culture has very simple effect on the performance of health care services. Since the health care services in Saudi Arabia are free they may ease the impact of culture, in America, healthcare is not free and not easily accessible. Doctors and nursing staff, when satisfied with their work environment, could help improve health outcomes through their impact on the level of quality in primary health care. Physician satisfaction contributes to the appropriate prescription for the patient and thus effective impacts on patient satisfaction. Nursing staffs are also an important part of any health care setting; usually they are in the front lines and have direct contact with patients; thus the performance of their work is affected by the extent of their satisfaction with the work. This will have clearly affect the success of any health organization (Al Juhani AM, Kishk, NA., 2006). Saleem (2002) noted that the most important reasons for satisfaction of workers in primary health care rely on self-confidence, social advantage, self-expression and work style, in addition to work environment. PATIENT SATISFACTION: According to Palmer et al. (1991, p. 58) patient satisfaction measures the quality of service, level of outcomes and patient behavior. Furthermore, patient satisfaction is the rule issued by the beneficiary of the service. Whether the service is expected or not is a measure of the care, while output is measured by the effectiveness of care. Consumers are the patients, while the product is health care services. The satisfaction of the patient in health care services is not only the most important in the field of healthcare, but it is also the product goal. Consumer satisfaction is necessary as an outcome, no matter what the level of effectiveness. According to theorists (Linder-Pelz, 1982; Ross et al., 1981 al., 1983; Locker and Dunt, 1978) the level of satisfaction with the patient gives important information about the structure of any health organization and procedures in the delivering the service (McNeese, 1988; Ware et al., 1983; wagner, 1988). Patient satisfaction is a real measure of health services and is also a measure to the demands of patients and their expectations (Wagner, 1988; Ware et al., 1983; Locker and Dunt, 1978). Research shows that age increased with the greater extent of patient satisfaction. Researchers asserted that the older were more satisfied than younger people; however, by the scale and reach of services and therapeutic results, the elderly show that they are less satisfied than younger people (Kirscht et al., 1966; Ware et al., 1976). Ware et al. (1983) noted that patients who are younger than 55 years old are not satisfied with the level of health care services. On the other hand some research shows that elderly patients in Saudi Arabia are less satisfied than younger people (Sabry A. 2010). Research in Saudi Arabia indicates that the percentage of patient satisfaction in term of accessibility is very high and they do not face any difficulties in reaching health care centers. On the other hand, wait time was recorded as a key element of dissatisfaction among patients in Saudi Arabia. Thus any health organization must manage the waiting time to improve patient satisfaction and best outcomes. This will have a good affect on service quality. In America, according to Lovelock (1996), Americans spend the equivalent of 37 billion hours waiting in lines. Conclusion and recommendations: Ultimately, service quality is an important element of success and helps achieve goals in favor of the institution and the customer. Health care is the main entrance of the health system and therefore quality must be high. Health care in America is relatively high quality despite the difficulties faced by the shortage of doctors. If America wants the support and development of health care they must be careful to ensure the availability of a sufficient number of doctors and staff. Conversely, health care in Saudi Arabia is deteriorating, although it is somewhat of a developing country and looking to progress. If the Ministry of Health in Saudi Arabia wants to develop the quality of service in health care they must be concerned with the consent of the client and the search results, as these elements directly contribute to quality health care. References: Alnaif, M, 1995. An exploratory study of primary health centres and administrators in Saudi Arabia . Doctrate . The United State of America : University of South Carolnia . Albaz, R, 1992. Patient Satisfaction With Primary Health Care Services in Saudi Arabia. Doctorate. The United State of America : Washington University. AI-Tuwaijri, Fouzia (1989). 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