SERVICE QUALITY IN HOSPITAL CARE: THE DEVELOPMENT OF AN IN-PATIENT QUESTIONNAIRE
Service quality in hospital care:
the development of an in-patient
questionnaire
Anne E. Tomes and Stephen Chee Peng Ng
Describes the development of a multi-item scale for assessing in-patient perceptions of service quality
in an NHS or NHS trust hospital
Introduction
It has been said that the USA is currently on the wave of
the third revolution in health care, “The era of assessment
and accountability”. The first revolution was the era of
rapid expansion in medicine and technology. This was
followed by the second revolution, “The era of cost
containment”[1].
Although the above was written in an American context,
the same trend can be seen in the UK health care system.
The Government’s efforts at restricting pay rises for
health care professionals[2] and the move towards
making doctors prescribe generic medication instead of
branded products[3] can be seen as attempts at cost
containment. At the same time the Government’s efforts
at restructuring the entire NHS by making GPs and
hospitals accountable for managing their own funds, and
documents such as Working for Patients[4] and The
Patients’ Charter [5], which require health care providers
to become more responsive to patients’ needs, are clear
indicators that we have reached the era of assessment and
accountability in the NHS[1].
Health care professionals and managers must thus
address the issue of improving the quality of service they
provide[6-8]. However, this “quality” movement is not
taking place without certain resistance[9-12]. Some
managers we spoke with view the work involved as yet
another piece of bureaucratic paper work and some
doctors expressed the view that, while the concept of
quality management may work well in the
manufacturing industry, it may not be appropriate in the
health care setting. Terms like “zero defect” and
techniques like “statistical process control” are offensive
to many doctors and nurses. “To health care
International Journal of Health Care Quality Assurance, Vol. 8 No. 3, 1995,
pp. 25-33 © MCB University Press Limited, 0952-6862
25
professionals, providing competent service in a caring
and personal environment is the only important element,
and it cannot be measured in terms of defect nor
statistically controlled…measurements should be
presented in terms of patient satisfaction”[9].
The degree of satisfaction will become increasingly
important since the recent NHS reforms give GPs the
right to purchase services from any hospital which
provides quality services for their patients. Patients
discharged from hospital will provide feedback to their
GPs. This feedback will then form the basis of the GP’s
decision to continue buying services from that hospital or
to switch to another. Hence, the patient becomes the focus
of both the GP and the hospital. As such, hospitals are
being required to concentrate not only on providing
excellent medical care, the technical aspects of the
service, but on the functional aspects of care as well, such
as communication between patients and staff[13].
This need to focus on the patient as the customer requires
a fundamental change in NHS culture[14]. Only when we
start to recognize the patient as the customer will we
really seek to find out about the patient’s needs. And only
when we find out about their needs will the quality of
service be improved, since we might define quality as
“meeting the needs of the customer in a consistent and co-
ordinated way”[15]. But how do we know if we are
meeting these needs? This is only possible by obtaining
feedback from the patients themselves, that is,
developing measurement scales which will allow the
patients to assess the quality of care[16].
This brings us to the purpose of this study, which is to
develop a service quality measurement scale for use in
the NHS hospital context. Before embarking on a
description of the study, it is necessary to elucidate some
terminology.
26 IJHCQA 8,3
The two aspects of quality in service organizations,
technical and functional quality[17], need to be explained
in the hospital context. Technical quality refers to the
competence of the staff as they go about performing their
routines. These include the clinical and operating skills of
the doctors, the nurses’ familiarity with the
administration of drugs, and the laboratory technicians’
expertise in conducting tests on blood samples. Hospitals
run internal audits to monitor the quality of this technical
work. Doctors hold morbidity and mortality meetings in
order to learn from the cases under care, and thereby
improve their diagnosis and clinical management
skills[18,19].
Internal checks on quality
are not evident to
patients
Laboratory equipment is calibrated constantly to ensure
that it is functioning according to specifications.
However, these internal checks on quality are not evident
to patients. Patients cannot judge the technical
competence of the hospital and its staff[20]. Hence, the
patient makes a judgement on a hospital based on the
functional quality which he receives, the manner in which
medical care is delivered to him. Examples include the
communication skills of the staff and the empathy shown
by them to the patients[21]. Although a patient cannot
pass judgement on the technical competence of the staff,
he/she can still pass judgement on the way in which the
technical procedures are performed.
In this study, we are concerned, therefore, with patients’
judgements concerning the functional quality of a
hospital.
Objective of this study
The objective of this study was to develop a measurement
scale to assess the quality of service provided in NHS and
NHS trust hospitals and identify the basic constructs
underlying patients’ perceptions of quality of service
provided by these hospitals.
Methodology
Several authors have derived measurement scales which
attempt to quantify the quality of service provided by a
hospital[22-24]. Most of these scales are straightforward
satisfaction measures, placed in questionnaires
completed by patients just before or after discharge.
These satisfaction surveys have used a variety of
dimensions. Hulka et al.[22] used statements based on
just three dimensions: personal relationship, convenience
and professional competence. Thompson[25] based his
work on seven dimensions: tangibles, communications,
relationships between staff and patients, waiting time,
admission and discharge procedures, visiting procedures
and religious needs, while Baker[26] concentrated on
consultation time, professional care and depth of
relationship. Reidenbach and Sandifer-Smallwood[27]
used ten dimensions which were reduced to seven after a
factor analysis: patient confidence, empathy, quality of
treatment, waiting time, physical appearance, support
services and business aspects.
However, it is widely recognized that one’s perception of
the quality of service received is based on a comparison
with what was expected of that service[28-30]. Hence the
measure used in this work is a gap measure based on the
SERVQUAL measure of Parasuraman et al.[28-30].
Despite recent criticisms of this technique[31],
Parasuraman et al.[32] have provided a stern defence of
the theoretical basis of their gap methodology and its
success in a host of applications suggests that it has
validity.
There have been, however, only a few published
applications of SERVQUAL in the health care context;
two in a US hospital context[33,34] and a third in the UK
general practice context[35]. All three studies used the ten
generic dimensions and statements recommended by
Parasuraman et al.[29]. In this study, however, the
backgrounds of the authors enabled a bespoke set of
statements to be developed for the UK context using both
medical and marketing insights.
Hence, taking into consideration the concepts within The
Patients’ Charter[5] and a content analysis of in-depth
interviews with 25 patients, five hospital managers, seven
nurses and eight doctors in NHS and NHS trust hospitals,
a total of eight dimensions emerged, six relating to the
intangibles of hospital care and two covering the tangible
aspects. These we named empathy/understanding,
relationship between patients and health care staff,
communications, reliability, courtesy, dignity, food and
physical environment.
It could be argued that to assess satisfaction with a
service the importance of each aspect should be taken
into account. However, this is a problem. First, consider
the tangible dimensions. It would appear initially that the
physical environment and food should not be important
considerations to patients. However, our interviews with
patients and hospital staff revealed that these tangibles
are important. The primary reason seems to be that a
hospital stay can be a rather boring experience and
except for the relatively short periods of time when the
patient is being attended to by staff the patient is left
 SERVICE QUALITY IN HOSPITAL CARE: THE DEVELOPMENT OF AN IN-PATIENT QUESTIONNAIRE
wondering how to pass the rest of the day. About the only
thing the patient can look forward to is the meals to break
the monotony. Hence food becomes an important factor.
Likewise, most patients are confined within the
boundaries of the ward, or at best a trip to the hospital
restaurant. Hence the physical environment and the
facilities take on an inflated role.
However, while food and environment play an important
role during the stay in hospital, these soon fade from the
patients’ minds on leaving hospital. In our interviews
with hospital managers complaints by patients actually
in hospital related to these tangible aspects whereas
letters of complaint received after discharge related
almost exclusively to the intangible aspects of care
received during their stay in hospital. It also proved
difficult to rank the individual factors within the
intangibles. Patients found great difficulty in doing this
when we tried to encourage them to make such
evaluations during our interviews. A good doctor or
nurse is expected simultaneously to be competent,
courteous, show empathy, communicate and relate well to
the patients. A failure in any one aspect portrays to the
patient an image of poor quality.
Development of the questionnaire
Using the eight dimensions discussed earlier in this
article two questionnaires were developed based on the
SERVQUAL principle. The expectation questionnaire
asked patients what they felt hospitals and their staff
should do and provide. The same questions formed the
basis of the perception questionnaire. A seven-point
Likert[36] response format, ranging from “strongly
disagree”, which scored 1, to “strongly agree”, which
scored 7, was used for this study and all questions were
phrased positively.
The two questionnaires were piloted on 20 patients in
medical wards of a large NHS hospital. After the
elimination, addition and rephrasing of several questions
the final questionnaires were prepared consisting of 49
statements. The expectations statements took the
following form: “The nurses should get to know me better
by spending time talking to me whenever they can”. The
corresponding perception statement is therefore: “The
nurses got to know me better by spending time talking to
me whenever they could”. The full 49 expectation
statements are presented in Table I.
The survey was conducted over a period of three months
in autumn 1993, in the medical wards of a large general
hospital in the east of England. During this period, every
patient admitted was included in the survey. A total of
196 patients were admitted during this time. Out of these,
12 were too ill to participate, while another 52 refused to
complete the questionnaires for one reason or another,
27
giving a response rate of 67.3 per cent. The expectation
questionnaires were given to all the patients within 24
hours of being admitted to the wards. The perception
questionnaires were given to the patients as soon as they
were informed of their discharge.
Analysis of findings
The SPSS for Windows computer package[37] was used
to analyse the findings. The reliability of the scale was
tested using Cronbach’s α. A high alpha value of 0.959
was achieved indicating good internal consistency for the
49-item scale. The mean scores for the 49 expectation and
perception statements are also presented in Table I as are
the mean service quality gaps between the corresponding
statements. The gaps were calculated using the
SERVQUAL principle:
Service quality (Q) = Perception (P) – Expectation (E)
Expectation scores
The mean scores of expectations were high, ranging from
5.06 to 6.42. The lowest expectations score related to the
question which asked if doctors should present patients
with choices when deciding on their medical care
(statement 33). This is a particularly interesting finding
because the concept of choice for the patients is a
fundamental concept in The Patients’ Charter. Our
interpretation of this apparent discrepancy is as follows.
Most patients regard medical care as a highly technical
matter and would not want to take such decisions on
themselves. They expect the doctors and nurses to decide
their care. This finding is supported by Waterworth and
Luker[38], who conducted in-depth interviews with
patients pre-Patients’ Charter and came to a similar
conclusion. However, a related statement asking if
doctors and nurses should involve the patients when
plans are made regarding their medical care (statement
34) resulted in a higher score of 5.67.
Doctors should be
thorough in their dealings
with patients
Hence, keeping the patients informed is of greater
concern to patients than presenting them with a set of
treatment options. This is reinforced by the finding that
the three highest expectation scores (statements 8, 9 and
27) indicated that the patients felt strongly that doctors
should be thorough in their dealings with patients,
demonstrate competence in clinical skills and be able to
 28 IJHCQA 8,3

Table I. Statements from the final questionnaire

Mean Mean Mean

Factor expectation perception quality
Statement loadings score score gap score

Intangibles
Factor 1: Empathy
(% variance explained = 43.9 %; Cronbach’s α = 0.918)

29. The nurses should get to know me better by spending time talking to me
whenever they can 0.889 5.45 5.88 0.42
34. Doctors and nurses should involve me when plans are made regarding my
medical care 0.872 5.79 5.58 –0.21
25. On my arrival at the ward, the doctor should attend to me quickly 0.761 5.70 6.03 0.33
3. Doctors should spend time with me discussing my fears and concerns about
my condition 0.750 5.82 5.55 –0.27
16. Even if a doctor cannot cure me right away, he should make me feel more
comfortable 0.749 6.18 6.21 0.03
18. The nurses should attend to me quickly, whenever I ask for help 0.715 5.18 6.30 1.12
4. My doctors should discuss with me my medical care following discharge
from hospital 0.711 6.12 5.82 –0.30
15. Doctors should do their best to make me feel better emotionally 0.671 5.58 5.76 0.18
14. Doctors should do their best to keep me from worrying 0.659 5.85 5.67 –0.18
33. My doctors should present me with choices when deciding my medical care 0.552 5.06 5.30 0.24

Factor 2: Relationship of mutual respect

(% variance explained = 15.0%; Cronbach’s α = 0.897)

23. Nurses should be polite when speaking to me and my family 0.824 6.15 6.27 0.12
12. Doctors should be competent when performing tests and procedures on me 0.812 6.24 5.97 –0.27
26. My doctors should treat me with respect 0.782 6.12 5.88 –0.24
21. Doctors should be courteous when speaking to me and my family 0.702 6.09 6.09 0.00
28. A patient should have enough confidence in his doctor to discuss very personal
matters, should the need arise 0.688 5.94 5.70 –0.24
27. I should be able to place complete trust in my doctor 0.631 6.39 6.15 –0.24
24. A doctor should not appear to be in a hurry when he is with me 0.578 5.82 5.85 0.03
19. The hospital should have my best interest at heart 0.557 6.21 6.33 0.12
30. The nurses should treat me as a person not just a bed number 0.549 5.82 6.12 0.30

Factor 3: Dignity
(% variance explained = 14.7%; Cronbach’s α = 0.867)

5. Nurses should explain to me the procedures and tests before they are done on me 0.908 5.91 5.55 –0.36
20. Doctors should ask me for permission before performing any tests on me 0.879 5.52 5.42 –0.09
1. My doctors should explain thoroughly to me the reasons for tests and procedures,
which are carried out on me 0.873 6.15 5.85 –0.30
22. Nurses should ask me for permission before performing any procedures on me 0.863 5.42 5.91 0.48
13. My doctors should take a real interest in me as a person and not just my illness 0.771 5.52 5.58 0.06
7. The nurses should spend time with me discussing my worries regarding my stay
in hospital 0.708 5.73 5.58 –0.15
6. Nurses should explain to me the rules and regulations in the ward 0.627 5.85 5.48 –0.36
31. I should be treated with dignity and given adequate privacy during my stay in
hospital 0.597 5.79 6.18 0.39
17. Nurses should be kind, gentle and sympathetic at all times 0.504 5.82 6.30 0.48

(Continued )
 SERVICE QUALITY IN HOSPITAL CARE: THE DEVELOPMENT OF AN IN-PATIENT QUESTIONNAIRE 29

Table I.

Mean Mean Mean

Factor expectation perception quality
Statement loadings score score gap score

Factor 4: Understanding of illness

(% variance explained = 9.0%; Cronbach’s α = 0.644)

10. Doctors should give me medical advice in layman’s language which I can
understand 0.901 6.24 5.85 –0.39
9. Doctors should be very thorough in their dealings with patients 0.796 6.42 5.79 –0.64
8. Doctors should be very careful to check everything when examining me 0.705 6.42 5.91 –0.52
11. I should have a clear understanding of my current illness during this stay in
hospital 0.579 6.18 5.52 –0.76
2. Doctors should go out of their way to make sure that I understand my condition
and its treatment 0.558 5.97 5.76 –0.21

Factor 5: Religious needs

(% variance explained = 3.4%)

32. I should have access to a religious leader of my choice while in hospital 0.831 5.30 5.79 0.49

Tangibles
Factor 1: Food
(% variance explained = 46.7%; Cronbach’s α = 0.906)

46. The meals should be well presented, i.e. the food should be nicely arranged 0.864 5.73 5.79 0.06
48. The meals should still be hot when they are served 0.843 6.21 5.94 –0.27
49. After each meal the plates should be cleared immediately 0.796 5.58 5.94 0.36
45. I should be given the food which I have ordered 0.782 6.00 5.94 –0.06
44. There should be a choice of food on the menu 0.771 5.52 5.58 0.06
47. When the meal is served, I should be asked the size of portion that I would like 0.684 5.55 5.55 0.00

Factor 2: The physical environment

(% variance explained = 24.9%; Cronbach’s α = 0.772)

42. The bathrooms and toilets should always be kept clean and pleasant to use 0.867 6.42 6.12 –0.30
38. At night, noises occurring inside the ward should be kept to a minimum,
e.g. TV, noisy equipment, staff talking 0.824 6.21 5.85 –0.36
39. The beds, pillows and mattresses should be comfortable 0.800 6.30 5.79 –0.52
43. The screens should be drawn around my bed, whenever medical procedures and
examinations are carried out 0.751 6.39 5.82 –0.39
41. The hospital should provide sufficient bathrooms and toilets in the ward 0.744 6.33 5.82 –0.52
37. Noises occurring outside the ward, e.g. ambulances, cars, should be kept to a
minimum 0.696 5.79 5.97 0.18
35. The ward should be clean at all times 0.682 6.27 5.97 –0.30
36. The ward should be kept well decorated 0.658 5.42 5.97 0.55
40. The ward should be well ventilated, i.e. always fresh and well aired 0.590 6.24 5.39 –0.85
30 IJHCQA 8,3
gain the trust of their patients. This finding correlates
well with the traditional view of the doctor-patient
relationship. It is a relationship which emphasizes the role
of the doctor as a technically competent and
knowledgeable professional who gains the trust of the
patients.
The second lowest expectation score related to the
question which asked if the patients felt that they should
have access to a religious leader of their choice (statement
32). This access to a religious leader is another “right”
stated in the The Patients’ Charter. Hence, two of the
basic concerns of The Patients’ Charter seem to be
concepts of which the patients themselves do not have
high expectations.
The physical environment expectation statements
(statements 35, 39, 40, 41 and 42) attracted high scores.
Obviously, physical comforts like bathroom facilities,
cleanliness, ventilation and bedding were of great
concern to the patients.
Perception scores
The mean scores of the perception statements ranged
from 5.55 to 6.33 for this particular hospital but it is not
the function of this article to present the results relating to
the quality of service provided by this hospital. However,
some of the findings may be of more general interest.
Twenty of the gap scores were positive, indicating that
this hospital exceeded patient expectations in almost half
of the variables tested and two were zero, indicating that
expectations were met. We have no reason to believe that,
although a good hospital, this hospital is particularly
exceptional and thus the areas of satisfaction are worthy
of mention.
The patients were happy that the hospital had their best
interest at heart. They were also happy that they were
treated with dignity and given adequate privacy during
their stay. The staff were thought to be courteous and
attended to the patients quickly. The patients felt that the
doctors made them feel more comfortable and better
emotionally. The patients also felt that the nurses had
spent time talking with them and that the doctors did not
appear to be in a hurry when attending them. The doctors
also had a positive score with regard to presenting the
patients with choices when decisions were taken,
possibly because the patients had low expectations in
this area. Also, the patients gave a positive score with
regard to access to a religious leader – again low
expectations were found in this area.
The hospital performed satisfactorily overall with regard
to food provision. The patients felt that the food was well
presented, served in the correct portion size and that the
plates were cleared quickly. The only significant negative
score was achieved when the patients were asked if the
food was still hot when it was served.
Although possibly not generalizable, the areas of under-
provision are also worthy of note. Among these were
several which indicated that the patients would like to
have more communication with their doctors. The
patients would like the doctors to spend time with them
discussing their fears, concerns, worries and even
personal matters. They would also like their doctors to
treat them with respect and to make more effort in
explaining medical matters in layman’s language, so that
they would have a clearer understanding of their illness
as well as treatment plans.
Are patients’ expectations
unrealistically
high?
Other sets of negative scores for the doctors were in the
areas of trust and the manner in which the patients
perceived the doctors’ technical competence. At first
glance, it would appear that these negative scores reflect
poorly on the doctors. However, closer examination
revealed that the doctors actually performed quite well in
these areas and were given high perception scores. But
these perception scores were counterbalanced by the high
expectations of the patients in these areas which achieved
some of the highest expectation scores. Perhaps, patients
expect their doctors to be perfect as far as technical
competence is concerned and would like to place absolute
trust in them.
This raises the question: are patients’ expectations
unrealistically high? Doctors are fallible beings working
under severe constraints[11]. Should we expect doctors to
strive to work even harder to improve on these areas?
Identification of the underlying factors of service quality
The data from the questionnaire provided us with an
opportunity to investigate the factors underlying patient
satisfaction with the quality of hospital service. By
carrying out a factor analysis of the expectations
questionnaire data we had an opportunity to extract
these underlying concepts from the large set of 49
variables.
Since two distinct sets of variables were developed
relating to the intangible aspects of hospital care, each of
these sets was factor-analysed separately.
Intangibles
A principal components analysis of the 34 intangible
expectation variables followed by a varimax rotation
 SERVICE QUALITY IN HOSPITAL CARE: THE DEVELOPMENT OF AN IN-PATIENT QUESTIONNAIRE
generated five factors as shown in Table I. These
accounted for 85.0 per cent of the variance in the original
data. Table I summarizes the results showing the
statements under the factors on to which each loaded
most heavily. The reliability of the factor scales was
assessed using Cronbach’s α[39]. As can be seen in Table
I, all factor scales are shown to be reliable.
Factor 1 has been labelled “empathy” and, looking at the
service gaps for the factor overall, expectations were
exceeded. On the whole, staff were given positive scores
in respect of their efforts to be attentive and make
patients feel better. However, they did not perform as well
as when it came to discussing their fears and worries.
Staff perhaps do not sufficiently appreciate the very real
psychological needs of their patients. This is certainly an
area which is not emphasized during their training, nor
by their professional bodies.
Factor 2 was labelled “relationship of mutual respect” and
for this factor overall expectations were not met. While
patients seemed to have a satisfactory relationship with
nurses in this respect, the relationship between patients
and doctors was less clear. On close inspection of the
results it appears that the reason for this problem is the
very high expectations patients had of their doctors. It is
debatable if this level of expectation is reasonable. Many
of the doctors we spoke to felt that patients’ expectations
of them had risen considerably since the introduction of
The Patients’ Charter.
Looking at the gap scores relating to Factor 3, which we
labelled “dignity”, generally, the staff performed well.
However, the results indicated that the reasons for doing
particular tests and the rules of the ward might be better
explained.
Factor 4 related to the patient’s desire for the
“understanding of his/her illness” and the treatment. All
the service gaps relating to this factor were negative
implying that doctors might do more in this area.
Factor 5 contained only one variable, access to a religious
leader, and hence has been so named “religious needs”.
Expectations were exceeded in this respect.
Tangibles
A principal components analysis of the 15 tangibles
elements, followed by a varimax rotation, generated two
factors as shown in Table I. These factors were clear-cut
and labelled “food” and “the physical environment”. They
accounted for 71.6 per cent of the variance in the original
data and the Cronbach’s α calculations indicate that both
factor scales are reliable. While the patients were satisfied
with the food provision, dissatisfaction was expressed in
respect of the physical environment.
31
Discussion and conclusion
This study has identified seven factors relating to the
service quality of in-patient care – five intangible factors:
empathy, relationship of mutual respect, dignity,
understanding, religious needs, and two tangible factors:
food and physical environment, and a questionnaire has
been developed to evaluate hospitals to assess the quality
of service they provide encompassing all these factors.
The survey in the trial hospital indicated that patients’
expectations were met or exceeded in respect of four of
the seven factors. Dissatisfaction was expressed, not
unexpectedly, with the physical environment, a situation
which can only be remedied usually by a large injection of
cash, an unlikely scenario.
Hospitalization is more
than just a physical
experience
Of equal concern must be the unfulfilled expectations in
respect of the factors “relationship of mutual trust” and
“understanding of illness” and the individual variables
relating to the various communications between doctors
and patients. Such under-provisions raise several
important issues. When a patient is admitted, he/she
comes into the hospital with an obvious physical ailment.
The main duty of the hospital and its staff is to treat that
physical ailment. However, hospitalization is more than
just a physical experience. Patients come into the hospital
with a host of psychological burdens as well. It is not
surprising that they will come in with fears of physical
disability, fears of dying, fears about the side-effects of
treatment, worries about losing their jobs, worries about
family members left at home. These are just a few
examples of the many concerns which they may have.
Hospitalization is also a socially isolating event. Patients
carry with them all the above psychological burdens but,
since they have been isolated from their usual social
contacts, they have nobody on which to unburden their
fears and worries. So it is not surprising that the patients
look on their doctors and nurses as people on to whom
they can unload their psychological burdens. However,
these needs give rise to most of the negative service
quality scores.
It is debatable whether doctors and nurses are the
appropriate people to fulfil the psychological needs of the
patients because they have not been trained to do so. The
medical and nursing professions have to decide if their
members should learn to handle the psychological needs
32 IJHCQA 8,3
of the patients[23,24]. In order to do so, it would require a
major attitudinal change among the doctors and nurses
and training before they take this extra role of being a
counsellor. However, we are sceptical as to whether the
doctors and nurses would feel so inclined. In that case, we
must find other avenues which would allow the patients
to unburden themselves. Perhaps hospitals should
encourage and allow greater access to patients by their
own family members and friends, who would then be able
to play their usual social support roles.
Hospital managers must
also consider the needs of
their staff
This discussion remains incomplete without raising the
issue of the roles of the doctors and nurses in the quality
initiative programmes of their hospitals. The staff are an
integral part of any hospital’s quality initiative
programme. Just as hospital managers realized and
accepted the importance of finding out the needs of
patients, they must also consider the needs of their staff.
Our interviews with nurses revealed that most of them
are supportive of the quality programmes in their
hospitals. This is in agreement with the findings of other
authors[40]. However, many doctors interviewed felt
differently. They were concerned more with the technical
quality of hospital care, rather then the functional aspects
of quality.
It is perhaps time that top hospital management starts to
explore the staff ’s perceptions of quality initiatives
implemented in their hospitals. It is the role of top
management to convince and involve their staff in any
quality programmes[41], and to ensure that adequate
resources are made available for any quality
improvement[42,43]. Staff must be brought on-side if they
are to be expected to work even harder to provide a
quality service to patients in this new era of assessment
and accountability.
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