Report on Association Servqual and Nursing Sensitivity Quality Indicators

This chapter provides the detailed overview of the results and analysis that are conducted in this study for measuring the response of the medical staff to solving the various problems as well as to attain the research objectives in effective manners. This chapter also provides the answers of the respondents to attaining the objective of the research study. In this research, the findings of the research study are evaluated, focusing on the research questions of the study.

The discussion would contain the detailed study and knowledge of the research topic, and the future project would also be given in the discussion section for the research study. The findings of the analysis will be provided in this research in details along with the justification of several other studies that are conducted on a similar topic for supporting this concept. The quantitative analysis is discussed in this study in details for providing accurate details and exploring the concepts of materials and methods in the research study. The mixed, methods are used in this research study because the mixed method is a good approach to exploring both concepts as quantitative and qualitative in this study. This chapter discusses the demographic profile of the respondents in details [1].  

Summary of Main Finding of Association Servqual and Nursing Sensitivity Quality Indicators

By analyzing the whole research study about the association servqual and nursing sensitivity quality indicators, it is examined that less than half sample population possessed experience around 6-10 years 41.8 percent. The t-test indicated the gap between observed and expected declaration was statistically importance, and the magnitude of that alteration was large. In-depth analysis, each statement, and domain were analyzed to establish the differences of priority perceived and expected by nurses. In the analogous method, the nurse's overall expectation on E12 employees of excellent HCO will always be willing to help customers was rated with 6.1 points which are significantly greater than their observed perception of this aspect on the grounds, according to a paired samples t-test. The nurses anticipated perception of E14 the behavior of employees in excellent HCO's will instill confidence in customers.

However, the multivariate linear analysis has also indicated that experience of the nurses years correlated significantly, but destructively, with their perceived hospital quality gap score, t= -3.02, p=0.003, since all of the variables as accounted for, this signifies that  as experience of the nurses tended to increase their  supposed  gap in quality  inclined to meaningfully decline. Nevertheless, the Nurses reported management effort of these patient falls when they have occurred, highlighting the admin handling of patient falls as between very good to excellent. The preventability of medication errors was rated with a collective mean rated high, denoting that the nurses believed in general that meds errors are usually preventable [2]

Accidental Central IV access removal was rated with an overall frequency of 1.6 points out of seven. Therefore they jointly believe this event is among rarely to rarely observe at work. Furthermore, with their collectively perceived preventability of Accidental Peripheral IV access Removal equal to 5.5 out of 7 points. To sum up, the top occurring patient opposing events are IV site complications and removals monitored by pressure ulcers, then CVC and Ventilator-associated infections according to Nurses [3].

On the other hand,  the nurses perceived weighted empathy score was significantly but inversely connected to  NSQI on average, These variables, although their effect on Nurses NSQI not likely to reach the statistical significance level of 0.05, they could be practically important, with greater age nurses perceive better NSQI. The findings of the quantitative phase established the gaps in all domain of the service quality and highlighted the items with the biggest differences. The results evidenced that all the 22 items the differences from expected to perceived/observed. The indicators of the sensitive nursing quality revealed that frequency of incidence of these indicators as seldom occurring on average, and the collective preventability of these indicators was possibly preventable and their management is highlighting the management at this institution with a very good effort at talking the quality indicators.

The qualitative research, consequently, becomes a powerful way of identifying what happens, abstracting findings and providing precise definitions of fundamental issues in nurse’s view on service quality. An interview guide was used as a framework to guide areas of exploration, probing, and questioning to elucidate and illuminate the particular issue.  The nurse’s responses were examined using thematic points, for example, the nurses’ understanding and associations of service quality meanings, frequently mentioned dimensions and sub-dimensions in service quality and the most important paraphrase in patient safety. The interview was introduced by exploring the meaning of quality by respondents [4].

 When the nurses were asked to explain what they recognize about service quality, most of them had trouble initially to express attributes of service quality. Policy and procedures seen as the tools for standardizing the care and it can be applied as general standard care for most of treatment, procedures, and care provided to patients.  One nurse defined service quality as Meeting expectation of the customer is described as service quality. Customer is seen as patients' families and healthcare professionals.

The patient expectation of care they will accept has a significant impact on their overall satisfaction. The nurses initiate that meeting or failing to meet the care patients expecting for is an important indicator of patient and families satisfaction. Though, there were few of the respondents feel like the organization still can be better to meet the patient's expectation [5]. The nurses were asked to identify the dimensions that might offer to measure service quality. In many cases, the nurses linked service quality to hospital performance, patient’s complaints, and indicators measurements done in the hospital. The administration performance decides either the organization will be able to able to provide quality care.  

The respondents highlighted that the quality of service provided portray by the facilities of the organization. They highlight the image of the hospital quality kept between the infrastructure buildings and facilities of the organization. Patients and family may feel frustrated about visiting the organization and unable to accept the particular service needed, such some special treatment, diagnostics machine, and care needed.

Some laboratory examination could not be done because of the needed test neither is available nor limited, also categorized as the organization fails to meet the demands and requirement of the patients. The respondents accentuated the prominence to have accredited hospital which promising standard care to patients’ families and staff. Quality and accreditation are understood as strongly interrelated on the organization image and performance.

This response from the interviewer is supported by the staff of the organization to guarantee the best quality in their educational growth was also seen as one of the best service quality factors. Respondent raises the willingness of the organization to unceasingly ensure the update of information among all staff to ensure the best care.  

 The best service quality provided will increase the families, patients trust and the HCP. In case the organization able to preserve the mission, vision, objectives manifestly as brought out, then the organization is supposed to have the greatest service quality. Consequently, language training found to be significant, especially in the international situation with multicultural staff and patients. Upholding professional ethics within the employee and employer were also explored by the respondent.

Respondents found patients feel protected when facing with competent and knowledgeable staff. The aptitude of the organization to offer employees with equivalent and fair treatment from the superior, administration and the human resource is recognized as one of the major factors in manipulating the distinctive service quality

Quantitative Findings

The quantitative phase data analysis was using the descriptive statistics to analyze on the nurses’ socio-demographic characteristics and described the categorical and binary variables with frequencies and percentage. The result which comes up as the Continuous variables is included the nurses’ perceptions on expected and observed service empathy, tangibles, reliability, responsiveness, and assurance besides the service weighting of organization with those perceived sensitive nursing quality indicators and satisfaction and stress level perceptions [6]. 

Based on the total of 400 questionnaires that delivered to the respondents which included the inpatients medical-surgical, isolation, critical care, and pediatric and Obstetrics and gynecology units, the result was calculated for about 78 nurses or 87% were responded to the questionnaire from the total of 378 respondents. The variables that we used for this quantitative phase data analysis [7] are divided by socio-demographic and work-related variables.

Then, with using Pearson’s correlation as a bivariate effect size statistic, and also Spearman’s association during the testing of ordinal variables [8], we associated the continuous variables and the other different metric variables as well. The next step, to determine the main effects of the characteristics of nurses along with their attributes, the quantitative phase data analysis was using one-way ANOVA and also t-tests.

Discussion on Sociodemographic variables of Association Servqual and Nursing Sensitivity Quality Indicators

Questionnaires were distributed to the 400 respondents for conducting this study from which only 378 questionnaires were returned in the filled form.  Most of the respondents of the research study were female who has participated in this research study. The percentage of the male respondents is only 2.9% but the remaining 97 % are female respondents. Because the research study was conducted from the medical staff of the health care department that is included as the nurses and doctors. Most of the nurses are the female that’s why the majority respondents of the study are female. All of these nurses are youngsters who are performing their duties that’s why most of the respondent of this study are lies in the age group of the 31-40 years. From these entire respondents, the majority of these are married respondents. It means young married female respondents are the major parts of this study that are earning roundabout 7000 SAR and playing the role of the registered nurse.

These nurses are performing their services on the Pediatric Floors [9]. The sample size that is used in this study was not too large neither it was too small this was an accurate sample size for conducting the research study based upon the actual data. Most of the studies that are conducted on this topic such as the study of the (Liza & Sai), 2014 used the sample size 300-400 [10].  It also shows that there is limited scholarly feedback for the topic of the “the association servqual and nursing sensitivity quality” that’s why this sample size is considered as the best for conducting this research study [11].

 From the work-related variables, we can see in Table 4.2 that the current experience of nurses is ranged from 1 year to above than 20 years. The finding reported that for 158 nurses or 41.8%, which is not more than half a sample of nurses have attained the experience between 6 to 10 years. The finding also mentioned that for 130 nurses or 34% of them have attained the experience in current hospital for below than 5 years, 83 nurses or 22% of them have the experience for 11 to 19 years in the current hospital, and the rest, for 7 nurses or only 1% of the respondents have the experience for more than 20 years in the current hospital.

Nurses ‘perceptions and expectations on the service quality of healthcare

As has been noted previously, this study breaks new ground by providing the various concepts about the association between servqual and nursing sensitivity quality. As a result, the above rough outline of demographic characteristics provides an insight into this population that may be of use in two distinct ways. Firstly, it provides organizations with an insight into who is more likely to become a medical volunteer for measuring the service quality of the health care department. By using this knowledge and all of the information provided in this study can be used to hiring the candidates for recruitment [12].

Since the main objective of this study is to determine the nurses’ perceptions and also their expectations on the service quality of healthcare, the entire findings of data were analyzed to make sure that the objective has been achieved. The complete gaps then again were calculated for every single concept by averaging those gaps [13].

 The descriptive statics are applied to measure the mean mod and median for the perceptions of the respondents. Particular this analysis has been conducted to measure the level of the expectation and perception of the Nurses for the service quality of health care departments. There are several scales that are selected for measuring the expected quality of the health care departments. These scales are; Reliability, Tangibles, responsiveness, assurance, Overall SERVQUAL, and empathy. The values of the descriptive static for all of this variable are showing that the significance level of the all driver quality is much higher than the expected values because the value of the “P” for all indicators is less than or equal to 0.001. It shows that the expected quality is much higher than the observed quality. The T statics are also greater than 10 for all variables it shows the expected quality is much accurate as compared observed. The mean values are also discussed in this study from a good perspective.

The difference between expected and perceived gap for each item

to calculate an inclusive mean for the five main concepts that included the SERVQUAL the findings from Table 4.4 using the SPSS program [14] by summing each items and then separate them by the numbers that contain for every single concept, and result in mean (expected and  observed: empathy, reliability,  responsiveness , assurance and  tangibles). The gap score was calculated and weighted with using the suggestion from the author of the SERVQUAL [15], in which for every single item of 22 indicators. Firstly, we separated the Observed from the Expected (O-E), then we weighted them with increasing the gap score with the weighted quality ratings for the specified concept which is altering them rendering to the quality rating items.

In other demonstration about the difference among the expected and perceived gap for every single item from the highest to the lowest gap by domains and the statements, the finding was mentioned that for the entire 22 items presented someway were recognized to have certain negative gaps, in which the differences from the expected to the observed or perceived were reported at -0.2 to -0.06. [16]

Three other statements explained in the finding which the statement employees of excellent HCO will give prompt service to customers has presented the expected value for 0.87 and get the actual value for 0.72. The statement which mentioned employees of excellent HCO will always be willing to help customers with its expected value of 0.88 presented for its actual value of 0.73. And another finding, the statement which mentioned employees of excellent HCO will tell customers exactly when services will be performed which its expected value of 0.85 had shown its actual value of 0.71.

The finding from the research also showed for the different statements which had smaller gaps, particularly from the Assurance and Tangibles domains, as well as certain of Empathy and Reliability domains. We can see from the statement that mentioned excellent HCO will provide the service at the time they promise to do so which had its expected value of 0.82 presented its actual value of 0.68. Then, the statement of excellent HCO will have operating hours convenient to all their customers had its expected value of 0.85, and showing its actual value of 0.71. The statement which stated that customers of excellent HCO will feel safe in transactions had its expected value of 0.88 and then got its actual value of 0.75.

Moreover, we also could see the finding for the statement employees of excellent HCO will be consistently courteous with customers with its expected value of 0.87 presented its actual value of 0.74. In addition to this, the statement of excellent HCO will perform the service right the first time which had its expected value of 0.82 showed its actual value of 0.69. The behavior of employees in excellent HCO will instill confidence in customers which previously had its expected value of 0.86, presented its actual value of 0.74. Meanwhile, the statement that mentioned employees at excellent HCO will be neat appearing which an expected value of 0.87 had showed its actual value of 0.75.

By conducting the PCA like analysis the difference has been calculated among the expected service quality and observed service quality for all of the Items that are taken as the scales of the quality of the service. This difference lies between the 0.06-0.2. There is the highest difference occurs for the item E22 which is “the employees of excellent HCO will understand the specific needs of their customers” the highest difference among the expected and observed quality is 0.2.  Meanwhile the lowest difference among the expected RELATIVE IMPORTANCES and observed RELATIVE IMPORTANCES is 0.06 for the variables “Excellent HCO will have the modern looking equipment”. There is too much gap among the expected RELATIVE IMPORTANCES and observed RELATIVE IMPORTANCES so the medical staff has a need to improve it.

Description of Nurse’s Expectation and observation about Service Quality provided by each of the Domain

The finding for the perceptions of nurses about the organizational assurance among the SERVQUAL dimensions was presented in the research. The nurse's inclusive expected perception of E14 the behavior of employees in excellent HCO's will instill confidence in customers was rated with 6 points of 7 Likert points. In the other hand, their  observed  rating  for this rate was  rated with a United 5.2 points of 7, with the difference among the observed to expected  perceptions on this factor of confidence instilling to clients differed significantly  rendering to  paired samples t-test, p<0.001 with the Nurses  expecting significantly  further than observing this state on the ground.  Meanwhile, nurses overall expectation to whether E17 employees of excellent HCO will have the knowledge to answer customers’ questions was rated with a collective mean of 6.1 out of 7 points, which  is significantly bigger than their observed perception of this factor on the grounds (mean = 5.3), rendering to a paired samples t-test, p<0.001.

The finding that we can see from Table 4.9 presented that the nurses expected E18 excellent HCO will give customers individual attention was rated with 6 points from 7, their observed rating of this factor on the grounds was significantly minus (mean=4.8) if comparing the observed and expected values of attention to clients using a paired sample t-test, p<0.001. Similarly, the nurses expected the perception of E19 excellent HCO will have operating hours convenient to all their clients. was rated with significantly bigger points (mean = 5.9) than what the nurses really observed at work, p<0.001.

The finding showed that the nurses mentioned for their perceptions on the items that restrained about their sense of organizational tangibles. We can see the result of nurses’ expectation E1: excellent HCO will have the modern looking equipment which was rated with 5.8 points from the standard point of 7. In the meantime, the perceived equipment perception of nurses was rated with pointedly fewer points (mean= 5.4 out of 7), and a paired sample t-test proposed the difference was quite significant, which is p= 0.001. Next, the nurses gave their rate for e2: physical facilities at excellent HCO will be visually appealing. With 5.8 points out of 7. Meanwhile, their perceived expectation on the visual appearance of the physical facilities at this organization was rated significantly less (mean= 5.3).

Moreover, from the finding, we can see that the paired sample t-test illustrated that the difference was also quite significant for E3. Employment at excellent HCO will be a neat appearing, the nurses gave the rate of their expectation and perception with 6.1 points from the standard point 7, which is considered to present higher significant if compared to the ground observations. Within the same method, the nurses gave their rate for E4. Materials associated with the services will be visually appealing at an excellent HCO with 5.9 points from 7 on the Likert scale, in which their observed ratings for materials associated with services were significantly fewer (mean=5.2 out of maximum 7 points). Another finding from the research has presented that the paired sample t-test imitated that the difference was numerically significant, p<0.001.

The finding presented, which showed that the nurses expected and observed perceptions of the SERVQUAL items that dignified for the organizational responsiveness. In summarize, the nurses expected against the observed perception of E10 employees of excellent HCO will tell customers exactly when the service will be performed changed statistically when compared by a paired samples t-test, (Expected = 6 out of 7 points, Observed= 5 out of 7 points), p<0.001. Though, they're observed against expected perceptions to E11 employees of excellent HCO will give prompt service to customers changed quite significantly as well, the expected perception to prompt commands by the organization to excellent services (mean= 6.1) exceeded the observed (mean= 5) rendering to the paired samples t-test, p<0.001. From this table, we also could get the result that p<0.001 are presented and significant statistically.            

Nurses’ perceptions of the Nursing Sensitive Quality Indicators (NSQIs)

Now the discussion is about the perceived gap as well as the expected gap for each item. For this research study, by using the SPSS software the procedure of the result analysis is analyzed by computing the overall mean for the different five domain of the SERVQUAL through the division of the number as well as by summing the items which comprise of every concept, and the results will be in the observed and the expected means for the reliability, assurance, empathy is used in the results section of table 4.4. From the highest gap to the lowest by domains and the statements illustration of the difference between expected and the perceived gap is explained Invalid source specified.

According to the presented result, the data is analyzed, whereas the objective of the research study is to determine the perception as well as the expectation of the nurses on a service of the quality of the health care. By the method of the averaging, the complete gaps which are computed for each concept are calculated. In the result section, it is calculated the significance of the gap score, which is mentioned for the means, standard deviations for the five SERVQUAL. NSAIDs like the pressure ulcers and fall, and it’s impacted through nursing care. When the organization set the goal for the indication of the opportunities along with to create the captions plan which improves an NSQIs the needs of the learning assessment survey the revealed of the 62% of a clinical registered nurse Invalid source specified.

In the discussion of the nurse expected, the mean is around about the 6, and the standard de4viations is 1, whereas Responsiveness of the organization was significantly greater than their observed responsiveness (mean =5; SD = 1), a t-test indicated the difference in mean perceptions was significant too the effect size was large in magnitude, p<0.001, Cohens D= 0.76. And it is the nurses perceived assurance of the organization like the (mean = 6.1; SD = 0.9) and its exceed the expected perceived assurance  (mean = 5.2 SD = 1)  where the t-test indicated a gap among the  observed as well as expected assurance was statistically significant, along with  magnitude of that difference was large, p<0.001, Cohens D= 0.84The result which is presented the 22 items somehow were identified had a negative gap, the differences from expected to perceived/observed were within -0.2 to -0.06The expected value of 0.86 and perceived value of 0.65 is for the employees of excellent HCO which understand the needs of the customers by the highest gap, which falls under the domain of empathy as found in the above.  Among the statements that had higher gaps, in reliability domain item stating that follow up by three continuous statements of the domain and empathy, which are excellent HCO. Whereas the Excellent HCO will give customers individual attention had the expected value of 0.86 and actual value of 0.69.

 Demographic variables and nurses’ perceptions and expectations gap

Now the discussion is about the demographics of nurses as well as the variable of the expected and the perception of the gaps. Then calculating the connection among the characteristics of the nurses which is perceived the lower as well as higher gaps and it is expected and observed for the quality of the service that is assessed for the effects of nurses the demographic of the perceived then a gap is weighted the dependent variable. The one method is ANOVA, and its Independent samples t-test, which is employed to assess categorical variables levels for statistically significant differences in their recorded mean weighted service quality gap score. In the below table 4.13 the result mentioned that according to the One-way ANOVA test, there was a statistically significant difference on nurses perceived weighted quality gaps score across levels of their total experience years, f(3,374)=3.36, denoting that some nurse groups experienced with a various  number of years differed significantly with their perceptions of quality gaps.

Then the result of this research study which is presented the overall expectation for the score of the SERVQUAL dimension of the reliability, tangibles as well as the assurances of individual statements for the nursing care and it is the higher corresponding for the perceptions scores that gives the negative SERVQUAL gap scores. The gap scores showed that areas which need to be improved as well as the population study is felt strongly about the choices and needs which is especially for the responsiveness along with the reliability of items of the nursing services Invalid source specified. Now according to the result that data which is presented in table 4.15 has the post-hoc follow up pairwise comparison with Bonferroni adjustment to p-values suggested that only those  Nurses experienced (1-5 years )  significantly greater gaps than either nurses experienced (11-19   years), p=0.016, and also they perceived greater gaps than those nurses experienced with (>20years), p-value = 0.047. These finding which is revealed the study population and it has the large gap score for the care of nursing and it is regarding the information which is given for an explanation of the given conditions, and it is prior to initiating the nursing care. One-Way ANOVA  test, f(3,374)=4.3,p=0.005,   and a pairwise follow up post-hoc tests with Bonferroni adjustment showed that  Nurses  coming from Obstetric Floors perceived significantly  less gap score in quality than their peers coming from the  Pediatric Floors, p =0.002 and they also perceived  significantly less gap in quality in general than their peers working in General Floors, p= 0.005 is for the Those nurses with (1-5 years) experience and those experienced with (6-10) years do not differ statistically with their mean perceived gaps

Then the nurses communicate with the patients who give an honest as well as appropriate information by the clear explanation and the patient has fewer complaints and less stress. Whereas the ANOVA and t-tests suggested that Nurses marital status, age, income levels, current role, and experience years do not have a statistically significant effect on nurse’s perception on quality gaps, i.e. their levels do not differ statistically on the gap score when assessed. The smallest gap scores which are distributed between the 5 dimensions as mention in the above discussion, then it is notable empathy of the dimension which is obtained for the 2 of a 5 smallest gap scores. The result is indicated which is satisfied by the nursing care and it is provided probably due to the patient of the higher expectation which is prior for the admission, and it is more knowledgeable regarding their rights and needs.