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Volume 8, Issue 2 (Summer 2022)                   JMIS 2022, 8(2): 152-167 | Back to browse issues page


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Alipoor V, Azimi H, Mirzaee Shiri Y, Tanha N. Investigating the Quality of Diagnostic Services Provided by Medical Centers During the Covid-19 Pandemic in Zanjan, Iran Using Parasuraman’ Quality Model. JMIS 2022; 8 (2) :152-167
URL: http://jmis.hums.ac.ir/article-1-376-en.html
Department of Management and Accounting, Faculty of Humanities, University of Zanjan. Zanjan, Iran.
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Introduction
Considering the current covid-19 pandemic, the quality of services in medical centers is very important. Meeting the needs of patients to whom the services are provided is one of the most important duties of medical centers. Patients’ perception of the quality of medical services affects their satisfaction. Perceived service quality shows the difference between a person’s expectations and perceptions of a specific service. Factors such as the way medical staff behave patients, how they respond, empathy, and the amount of trust patients have in medical services affect the quality of medical services. Establishing an empathic relationship between patients and medical staff makes patients have better conditions in terms of psychological, physical, social aspects. The trust means the realization of goals given to patients. Therefore, due to the sensitivity and importance of providing quality medical services to patients by the medical centers, it is of great importance to investigate the factors affecting the patients’ perception of the quality of medical services. Therefore, the present study aims to investigate the quality of diagnostic services provided by medical centers during the COVID-19 pandemic using the Parasuraman’s SERVQUAL model.
Methods
This is descriptive correlational study with structural equation modeling (SEM) based on partial least squares (PLS). The study population consists of the patients referred to medical centers in Zanjan province in 2020. Non-probability sampling method (convenience method) was used for sampling, and the sample size was calculated based on Cochran’s formula. Based on a preliminary study, the deviation of the initial sample variance was estimated as s2=0.241 and therefore, the sample size was determined 370.
The data collection tool was a standard service quality questionnaire with 29 items rated on a 5-point Likert scale and in two sections: perceived status and expected status. The validity of the questionnaire was evaluated by experts and its reliability was evaluated using the SEM and Cronbach’s alpha. The values of Cronbach’s alpha and composite reliability for five variables (tangibility, reliability, responsiveness, assurance and empathy) were higher than 0.7, indicating the acceptable reliability of the model. The average variance extracted was used to check convergent validity in the PLS model whose value was higher than 0.5. Therefore, the measurement model had acceptable convergent validity. Data analysis was done in PLS and SPSS applications. Hypotheses testing and model fitting were done by SEM, PLS, and importance-performance map analysis (IPMA).
Results
About 53% of participants were women and 47% were men. More than 78% had a university degree and the rest had junior high school education or diploma; 64% were married and 36% were single, and the most of them were at the age range of 30-40 years. In Figure 1, the model is drawn along with factor loads (For the perceived state), in Figures 2 and 3, the measurement model and the rescaled factor load of the indicators are shown by implementing the IPMA method (For current and expected status).

Results of IPMA are presented in Table 1.


The paired t-test showed a significant statistical difference between the current and expected status of the quality of diagnostic services in all dimensions. The highest gap between the perceived status and expected status of the quality was in the dimensions of empathy (-1.952) and assurance (-1.861) while the lowest difference was related to the dimension of tangibility (-1.727). The order of the gap from the highest to the lowest was as follows: Empathy, assurance, responsiveness, reliability, and tangibility.
Conclusion
According to the findings of this study, there was a negative quality gap in terms of all domains of the SERVQUAL model, and the mean of expectations was higher than the mean of perceptions. The negative gap indicates that the expectations of patients were beyond their perceptions of the current situation and there was a long way to gain their satisfaction and to reach the expected level.
Based on the first hypothesis, from the perspective of participants, there was a significant difference between the perceived and expected status of the quality of diagnostic services. Tangibility, as one of the five dimensions of the SERVQUAL model, was reported in this study which had a quality gap. therefore, the second hypothesis was confirmed. The participants’ expectations of the quality of diagnostic services in terms of reliability were higher than their perceptions; hence, the third hypothesis was then confirmed. The participants’ expectations of the quality of diagnostic services in terms of assurance were higher than their perceptions., therefore, the fourth hypothesis was confirmed. The participants’ expectations of the quality of diagnostic services in terms of responsiveness were higher than their perceptions. Hence, the fifth hypothesis was confirmed. This indicates that the most of the patients’ needs are not met and that they expect more in terms of responsiveness from the medical centers. Finally, the participants’ expectations of the quality of diagnostic services in terms of empathy were higher than their perceptions.

Ethical Considerations
Compliance with ethical guidelines

This study has ethical approval  from University of Zanjan (Code: IR.ZNU.REC.1400.015)

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
Conceptualization: Vahideh Alipoor; Supervision: Hossein Azimi; Data analysis: Yosef Mirzaee Shiri; writing: Nahid Tanha.

Conflicts of interest
The authors declared no conflict of interest.

 
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Type of Study: Research | Subject: General
Received: 2021/12/12 | Accepted: 2022/04/17 | Published: 2022/07/1

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