Quality of Medical Services in the UAE - Research Paper Example

Executive Summary Service quality for patients and internal customers is significantly important in the healthcare sector especially due to the involvement of high risk and stakes in the field. The UAE healthcare sector has been invested in by the government and this development is reflected in how the sector has changed in the last decade. The objective of the paper is to highlight the issues of management of service quality that are inherent in the UAE healthcare organization specifically for SKMC, Abu Dhabi. For the purpose of the paper secondary and primary research in the form of literature review, academic research, industry research and interviews were undertaken. The analysis of the data as per a customized SERVQUAL highlighted four main issues of service quality. The issues highlighted were however not just limited to SKMC, but can be generalized to an extent to the UAE healthcare sector due to applicability. The issues highlighted pertained to the issue of trust from the perspective of the patients in terms of the medical professionals and their capabilities. The medical professionals and the patients also faced a communication barrier which was aggravated because of the incompatible languages and the conflicting cultural background and orientations. Their existed a management issue pertaining to the style of management and leadership being bureaucratic which was not well received by the medical professionals and affected their working capability and job satisfaction. The image of SKMC has also suffered lately with inconsistent provision of value added services to the patients. Index Executive Summary 1 Introduction 4 Literature Review 6 Service Quality Management and Competitive Advantage 7 Importance of Service Quality Management in the Healthcare Sector 8 Elements of Healthcare Service Quality 9 Factors Effecting Service Quality and Management 10 Methodology 13 Analysis and Findings 14 Technological Innovation, Physical Environment and Infrastructure 14 Medical Personnel and Professionals Quality 15 Image and Perception of the Customers 15 Trustworthiness as Depicted by Patients 16 Process of Clinical Care 16 Communication 17 Relational Conflict 17 Organizational Culture, Management Style and Leadership 18 Issues not Addressed 18 Conclusion 19 References 21 Management of Service Quality Report Management of Service Quality in SKMC General Hospital, Abu Dhabi (UAE Healthcare Organization) Introduction The UAE region has been seeing significant growth in the recent years. The area is a hub of business activity in the region, especially with the development of Dubai as a tax-free business zone. Similarly, the region has been experiencing growth in terms of destination tourism. The increasing importance of the region amongst travelers as well as a destination for the purpose of career growth and the opportunity it provides to people makes it an attractive region. The public administration in the region as a result is influenced by these changes in the recent years (Latham and Watkins LLP). Fields such as education, hospitality and healthcare have also seen significant growth and development with the highlighted changes. The local government in the region has been significantly investing in the region to bring the standard of living in the region at par with the developed western countries. In this regard the government has focused its attention to the hospitality and airline sector, the construction of recreational, business as well as housing facilities in the region as well as the healthcare programs. The healthcare sector as a result has been directly influenced due to the demand presented by the people for professional medical facilities and services. The government has been steadily increasing its spending and budget for healthcare with formalized policies and plans for long term sustainability and standardization of operations of medical facilities that can run at par with those in Europe and the United States (Abbas, 2012). The healthcare provision to the public is a form of service provided by the government with the general public being the customers. The management of service quality in the healthcare sector as a result becomes important for the development of a competitive and sustainable healthcare sector that satisfies the requirements of the customers while also striving to surpass them through continuous improvement. The healthcare sector in the region has faced major issues in the past with lack of proper facilities in the 1980s when only 7 establishments present in the region to cater to the needs of the population (Abbas, 2012). Now hundreds of healthcare facilities like hospitals and clinics are hosted in the region to cater to the growing population and their changing healthcare needs. The types of epidemics and diseases in the region have also changed over the years with the changes in living standards for the population and its changing characteristics. Diseases that are influenced by the changes in the lifestyle of the population have taken precedence in the region and same goes for life style based injuries. The treatment of these requires professionals in the field, who have experience dealing with such problems. UAE as a result is host to some of the most dynamic and diverse work force in the region. Most of the medical professionals that work in the healthcare sector are expatriates of other countries that have migrated to the region seeking career growth opportunities. However most of the development has been focused in the cosmopolitan regions of Dubai and Abu Dhabi, with the smaller cities being remote to investments in healthcare. The UAE healthcare sector RNCOS forecast report highlights that while the government has been increasing government spending on healthcare with government bodies controlling and standardizing the provision of medical services and their quality to the public, the focus in developments has been restricted to the most cosmopolitan cities (Abbas, 2012). Moreover the demand for the over the counter drugs in the region also is very high despite investment in their provision. This is mostly because of the low level of locally generated medical facilities and services. The purpose of this report is to identify the underlying service quality issues present in SKMC General Hospital, Abu Dhabi. Abu Dhabi is one of the cosmopolitan cities in the region and has seen significant growth and development in the healthcare sector. In this regard the quality if service and the related issues faced by medical professionals as well as the patients are explored. The reasons for the problems and disparity in the service quality in the sector are also highlighted to provide a conclusive recommendation as a solution for the issues present in the UAE healthcare sector. Literature Review Service Quality Management and Competitive Advantage With the increase in the level of competition it becomes harder for businesses to be competitive and retain a position of priority in the minds of the customers. This is particularly true where many service providers exist in the market (Couthard, 2004). The presence of many service providers offering similar services for the utilization of the customers gives them the buying power and increases the level of competition in the market. In such dynamics, organizations that cannot cater to the demands and the requirements of the customers are overlooked by them and lose their strategic position of importance in the market as well as in terms of customer perception. The proper management of service quality in service oriented organizations can play a major role in preventing the negative effects of a competitive marketplace (Douglas and Judge Jr., 2001). Firms and organizations can attain competitive advantage by employing techniques of service quality management to provide relevant and up to date services to the customers in order to create value offerings (Woodruff, 1997). The relationship between service quality management and competitive advantage is significantly strong, with the implementation of service quality strategies like Total Quality Management (TQM) resulting in increasing advantages for businesses. These advantages do not only stem from financial streamlining or profitability, but instead can arise from the tacit changes in the environmental culture, and business process reengineering for service quality management (Powell, 1995). Aside from this the management of service quality can also enable the healthcare institutions to reduce their operating cost (Ghobadian et al., 1994) and can help them in meeting the demands and the needs of the patients effectively. Importance of Service Quality Management in the Healthcare Sector Service quality management is an important aspect in firms that have a high level of customer involvement and interaction. Particularly for those service providers that have their employees interacting face to face with the customers, the management of service quality and its measures becomes more important. The healthcare sector is labor intensive with the presence of qualified and skilled professionals that deal with the patients while providing diagnosis and treatments as services for the institutions in the sector. There is high context of patient involvement as well as two way communication and interaction between the patients and the physicians and medical professionals (Douglas and Ryman, 2003). This justifies the management of service quality strategies application in the healthcare industry. The management of service quality involves managing for customer satisfaction to create value of service offering for the customers while enabling profitable business for the organization. In terms of the healthcare sector, the business entities are the medical institutions, while the patients as well as the medical professionals can be treated as customers and stakeholders. The management of service quality in the healthcare sector as a result involves creating value for the patients while managing for the satisfaction of the patients, the physician and surgeons as well as the other medical professionals in the sector (Kenagy et al., 1999). The healthcare sectors have generally changed markedly with the increasing awareness in the public regarding health and related issues (Belek, 2007) as well as due to the development of numerous healthcare facilities to cater to the demands of the patients and customers in the market. The healthcare sector in the gulf countries has also significantly developed with small institutions forming large healthcare systems and organizations like hospitals and healthcare facilities. With the changing dynamics of the healthcare sector, the need for the management of appropriate level of customer service quality arises. With the changing dynamics in the healthcare sector, competition in the sector has increased with increasing number of institution, both private and public competing with each other. In such cases, the relevance of service quality management becomes more important in the healthcare sector (Ennis and Harrington, 2001). The aim of the institutions is to attract more patients by providing them with value added service offerings and increasing their satisfaction level (Johns et al, 2004). The trend in the industry is to employ service quality measurement techniques like balanced scorecard, benchmarking and dashboard reports (Curtright et al., 2000). While financial performance indicators are a good source of service quality management, the complex nature of the customers and the healthcare provision through the facilities can provide biased and restricted results through this technique. Instead the strategies that take into account customer perceptions, and the environmental elements are more useful to employ in such settings. Elements of Healthcare Service Quality Service quality is an intangible artifact in the healthcare industry, however there do exist some arbitrary dimensions, through which the perceptions of the patients and the internal and external stakeholders can be determined for the assessment of service quality and its management. These take the form of observed dimensions that are considered important by medical professionals as well as the patients in healthcare organizations. Concisely the SERVQUAL model for quality of customer service can be employed in the healthcare industry as well, with slight customizations for industry specific elements. The available SERVQUAL model for health care customer service provides that the customer service level is formed through a combination of experiences and perceptions of the customers (Reynoso and Moores, 1995). The customers assess the healthcare service in terms of the physical and tangible environment provided to the patients, the quality of the medical professionals that deal with the patients, the image that the institution has earned over time, the trustworthiness of the medical professionals and the services being provided, the additional support and aid provided to the patients, the actual process involved in clinical care as well as the ease of effective communication between the medical professionals, the facility staff and patients. Aside from these the administration of the institution as well as the relationship that the institution develops with the patients are additional dimensions through which the service quality in the health care sector can be assessed. Factors Effecting Service Quality and Management There exist other factors aside from the above highlighted elements of service quality that impact service quality in healthcare organizations. These factors include the inherent culture of the organization, the attitude of the employees in the organization, the management style employed as well as dynamics of the different medical professionals that work cohesively on projects in the organizations. The issues associated with leadership, technology and innovation as well as the management of work based teams in the healthcare organizations also significantly impacts the level of customer service in the organization. Quality management in the healthcare sector is of significant importance as the processes involved are high risk oriented with significant involvement of the stakeholders (Mostafa, 2005). As a result governments have paid significant attention to the development of healthcare policies and the management of service quality in the sector (Sorensen et al., 2005). Service quality by nature cannot be tabulated as its intangible and often cannot be seen in computable terms. Therefore accounting for service quality can become difficult for healthcare organization. The elements or dimensions of service quality for healthcare firms as highlighted previously can provide a basis for the assessment of service quality, however some attributes like customer satisfaction and customer perception remain arbitrary and therefore difficult to manage. In order to create value for the customers and increase customer service quality in the institution, the healthcare firms seek to identify the internal and external customer satisfaction level and change their perception of favorability (Verho and Artnez, 2003). When it comes to management of service quality where transactions of physical items are involved, the management becomes easy due to the tangible nature of the services provided (Chiu and Wu, 2002). However in the healthcare sector, the high risk and sensitive nature of the services provided as well as the intangibility of the services along with their heterogeneous nature makes the assessment and service quality more complex and difficult (Parasuraman et al., 1985). This however does not undermine the significance of service quality management in the field; instead it highlights the importance of its management. The organizational culture and the attitudes of the employees in the healthcare organizations greatly impact the level of service quality for services delivered to the patients (Davies et al., 2000). This is because the orientation of the employees, their attitudes and their opinions are directly as well as indirectly projected in the way they deal with the patients and the importance that they associate with them and the sensitive nature of the services delivered to them. For healthcare organizations, there exist two types of customers, the internal customers and the external customer. The physicians, surgeon, technicians and medical professionals are the internal customers of the organization while the patients take the role of the external customers. Both have their respective stakes when dealing with the healthcare organization and its service provision. In this regard the management style and the leadership strategies used by the healthcare organization and its management greatly affect the customer service level through an indirect route. The internal customer satisfaction is based on learning opportunities, responsibility, credit and job satisfaction which can be threatened where conflicting management styles and autocratic leadership approaches exist (Ferlie and Shortell, 2001). This also effects the perceptions of the customers regarding the image and the reputation of the healthcare facilities. Similarly the way in which the different medical professionals work together to provide the services to the patients also affects the service quality (Degeling et al., 2003). Where there exist conflicts between the different teams of medical professionals, the service quality is negatively influenced which is observed by the patients over time. The field of medicine and healthcare requires continuous improvement which has to be the orientation of the management of the organization. The medical professionals have to be highly skilled, and experienced enough to be capable to perform their tasks. In this regard the skills of the professionals along with the technology available significantly impact the perception of service quality of the healthcare facility as observed by the patients (Llosa et al., 1998). Healthcare organizations, that have the latest technology and equipment available at the disposal of the medical professionals who are highly skilled increase the reputation, image and the favorable perception of the patients regarding the level of service quality in the health care facilities. Methodology For the purpose of the report, a two way methodology was adopted for identifying issues of customer service quality in the healthcare institutes, specifically those in SKMC, Abu Dhabi. The literature review was performed in order to identify the main dimensions and factors that influence customer service in the healthcare industry and how they impact the service quality level. In addition to this, interviews were conducted from medical professionals employed in SKMC to provide an insider view on the prevalent issues that are present in the organization from the perceptions of quality of customer service. The interviews are kept open ended to allow for exploratory and unbiased information to be gathered. Leading questions were avoided sop interviewer bias would not be involved. In order to analyze the primary data collected through the interviews, the SERVQUAL dimensions provided by Parasuraman et al. (1985) and Reynoso and Moores (1995) were employed, The findings are presented using these dimensions, highlighting the issues and problems that exist in SKMC, Abu Dhabi. Analysis and Findings Particular to the UAE region, the healthcare provision is free of cost for UAE nationals with considerable subsidizing in the sector. However some key issues specific to the region remain, that became apparent through primary and secondary research on UAE healthcare sector and the SKMC. The following depict the findings and the issues that were observed. Technological Innovation, Physical Environment and Infrastructure Through research it was determined, that the government controls the healthcare sector significantly, and has been investing in the regional budget for healthcare to cater to the rising population levels, and the changing requirements of the population regarding healthcare. The establishment of healthcare facilities in the last 10 years is a testament to the importance the government associates with the field. In terms of SKMC, the respondents also provided, that the setup and infrastructure is very modern and at par with similar establishments in the western developed countries. The respondents went as far as to clearly highlight the level of hygiene and controlled hospital environment with commendations. The respondents also provided that the technology available at SKMC is that of the latest quality, making it a pleasure to work on the equipment. They also highlighted that the availability of the latest technology enables them to satisfy the requirements of the patients in a speedy and efficient manner, therefore increasing the level of service quality for the patients. Medical Personnel and Professionals Quality It has been observed through research that the medical professionals working in the field were mostly expatriates to the region. They were highly skilled professionals from UK, USA, Scotland, India, Philippines, Turkey, and Egypt. Their skill in the field was a positive point in the level of customer service in SKMC. However as SKMC is one of the big establishments in the UAE region, often patients from far flung northern regions of the state also visit the hospital for diagnosis and treatment. When the medical professionals had to deal with these patients, their skills and capabilities, and quality of services provided were hampered due to culture differences, and language barriers. Image and Perception of the Customers The perception of SKMC in UAE is held in high regard. The respondents provided that they were proud to be part of the recognized and reputed establishment as it provided them opportunities for growth and experience. The secondary research however revealed conflicting results. The public generally holds a favorable image regarding SKMC which is depicted as it being a sought after healthcare facility by the general population. However off late some bad experienced have been reported where the bed sheets in the facility were as per the expectations of the patients, and in some cases, the patients were not attended to on time causing trauma to them with degenerative adverse effects. Trustworthiness as Depicted by Patients The issue of trust is of significant importance in this case. The respondents reported that the patients coming in SKMC have problems in trusting the doctors and medical professionals. They do not open up about their problem, which hampers the diagnosis by the medical professionals. This adversely affects the service quality of the services provided to the patients. The issue however is not resident to only SKMC patients, but is generally the problem with the patients in the region. Process of Clinical Care The clinical care process as reported by the respondents is well above satisfactory in SKMC, and they had no issues of customer service quality regarding them. The secondary research however revealed that in the region the process of clinical care is not standardized. While the regulations and attempts have been made by the UAE governing bodies and ADAAD but standardization between the different establishments has not been achieved till yet. This is one of the reasons, why customers seek SKMC as the perceived quality of the process of clinical care is high for the organization in the region. Communication The other most repeated issue as per the primary research is that of communication. UAE is host to people from diverse nationalities speaking different languages. This combined with the externally sourced migrant medial professionals in SKMC creates a communication barrier for the customers and the medical professionals when it comes to face to face communication. The patients often speak only Arabic or smatterings of French, both are languages which are sometimes foreign to the medical professionals. In these cases communication between the two gets significantly hampered therefore affecting the service quality. Relational Conflict The difference in the culture of the patients, and the medical professionals raises relational conflict pertaining to their perceptions, their orientation. The patients as a result hesitate to open up to the medical staff and do not trust them. The staff on the other hand is sometimes unable to relate to the perceptions and thinking of the patients, most of which come from conservative environments. The respondents provided that specific to regional taboo fields like gynecology, fertility, and family planning, it becomes difficult to communicate and treat the patient when they put up defensive tactics of not discussing their problems or seeking treatment. Another issue highlighted by the respondents was that of hygiene of patients in some cases which effects the work environment quality where the services are provided. These however have to be treated on the government scale rather than on the institution or organization level Organizational Culture, Management Style and Leadership The respondents provided that the organizational culture in SKMC is very professional, but the Arab culture of doing business is inherently visible in the way SKMC is managed. The bureaucratic guideline along with which the institution is run depicts the Arab orientation and related organizational culture. Some of the respondents complained about delays in availability of repaired or newly requisitioned equipment. While the delays reported were not substantial, the delayed were present and this need to be addressed. Aside from this the different in the management, the medical professionals and the customers creates a cultural conflict with the management and the customers generally of Arab orientation and background while the medical; staff composes of expatriates. The adherence to the management style and its comprehension becomes a problem for the medical staff which effects their motivation to work and job satisfaction. This is reflected adversely in the service quality provision to the patients by the medical staff. Also inconsistencies in comprehension create roadblocks in efficiency of the service provision to the customers, thus effecting quality. Issues not Addressed The issues that are not addressed are those which are not just specific to SKMC but can be generalized across the healthcare sector in UAE. The main problem that resides in the sector is that while the standard of services provided to the patients has been significantly improved and increased to be at par with similar western institutions, specialized treatment in UAE is still not possible. As a result for patients that require highly skilled or specialized treatment, the only option available is to cross the borders to other nations where such facilities are provided that can cater to the requirements of the patients. Only those patients that have the monetary feasibility can take this option. Conclusion Research into SKMC hospital and the UAE healthcare sector has revealed significant findings about service quality and management. The findings have revealed four main issues of service quality that are resident in SKMC. These are issues that have been noticed by critics, the general public as well as the medical professionals employed in the organization. These issue deal with the style of management involved, trustworthiness, the level of quality perceived by the patients specific to the medical professionals and their skills, the changing image of the establishment and its related perceptions in the minds of the general public as well as the communication barriers between the medical professionals and the hospital staff. The reasons for these discrepancies are mostly oriented towards the background and culture in the region and their working practices. Moreover these problems while highlighted for SKMC are also present in other healthcare establishments in the region as well. While identifying the management of quality of customer service issues inherent in SKMC Abu Dhabi, some issues specific to the region were also observed. In order to solve for these issues, governmental policies need to be developed while a gradual education of the general public can also be performed to help them trust the healthcare sector and its medical professionals. Similarly the SKMC General Hospital which employed migrant work force should invest in training the workforce in terms of the local language. This can greatly help in diffusing the issue of communication which is paramount when foreign medical professionals have to deal with local non English speaking Arabs. Addressing these issues can greatly improve SKMC as well as the healthcare sector in the UAE, to be at par with other well known establishments in the developed countries. References Abbas, W., April 8, 2012, UAE requires nearly 13,000 doctors in two years, Emirates 24/7, available at Belek, I. 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