How do patients perceive and expect quality of surgery, diagnostics, and emergency services in tertiary care hospitals? an evidence of gap analysis from Pakistan

Objectives: Service quality is one of the important gears to appraise services and determine the gray areas that need improvement. In countries with a resource-poor health system, the first step of measuring quality is yet to be taken. This study seeks to inform policy makers in developing contextual service quality models by identifying service quality gaps in tertiary care teaching hospitals using patients' perspective. Methods: A cross-sectional study was performed using multistage cluster sampling, and a modified version of the SERVQUAL [SERV-service, QUAL-quality] instrument was administered to determine patient's expectations and perceptions. A total of 817 completed questionnaires were obtained from patients and/or their attendants using convenience sampling

Results: Data analysis revealed statistically significant negative quality gaps between expectations and perceptions of tangibility, reliability, empathy, assurance, responsiveness, and communication. The difference in mean expectation and perception for responsiveness across the sexes was significant [p < 0.003;p < 0.037, respectively] as well as in perception of communication [p < 0.026]. Other dimensions and overall hospital expected and perceived quality were independent of sex. Educational status showed significant difference in expectation and perception in responsiveness [p < 0.005], but the perception of each dimension was significantly different in different educational categories [assurance:p < 0.001; empathy:p < 0.001; reliability:p < 0.001; tangibility:p < 0.001; responsiveness:p < 0.001; communication:p < 0.001; and for overall service quality:p < 0.001]. Age and service departments showed no relationship with any of the perceived or expected dimension of service quality of hospitals

Conclusions: Tertiary care hospitals failed to meet patients' expectations in all major areas of service quality, posing a question of how hospitals implement and evaluate their quality assurance policy

Conflict types and conflict management styles in public and private hospitals

Objective: To determine the conflict management styles and the relationship of conflict types and management from both the public and private hospitals

Study Design: Cross-sectional research design

Place and Duration of study: Data were collected from public and private hospitals in Lahore from June 2014 to January 2015

Methodology: The sample comprised of 160 doctors working in private [n=64] and public [n=96] sector hospitals, with Mean age=30.03 [SD=5.63]. Rahim Organizational Conflict Inventory-II and Rahim Organizational Conflict Inventory-III were used

Results: Results revealed that the two sectors differed in the use of conflict management styles after controlling for the conflict types. Obliging, integrating, compromising and avoiding conflict management style were used more by doctors in public sector hospitals than those in private hospitals. However, none of the conflict types predicted conflict management styles and the pattern of prediction was similar for doctors working in private and public sector hospitals

Conclusion: Affecting, transforming and substantive conflict types were more experienced in private sector and obliging, integrating, avoiding and compromising conflict management styles were used more by public sector hospitals conflict

Knowledge and attitude of older women towards menopause

To assess the knowledge and attitude towards menopause in postmenopausal women and to determine associated socio-demographic features such as the age, parity, social and educational status of such women. Descriptive, observational. January 2004 to November 2004. Out patient department, Sir Ganga Ram Hospital, Lahore. A total 200 postmenopausal women aged 50 and above were interviewed in the outpatient department to assess their knowledge about menopause and their attitude postmenopausally whether positive or negative. Mean age at menopause was 48.9 years. Sixty five percent women were satisfied with cessation of menstruation mostly because of religious background. However 3% desired to continue menstruation while 5% women were unhappy with their menopausal status. Twenty four percent women perceived no change in behavior. About 50% women had knowledge about menopause and its symptoms. Only a small percentage of women had knowledge about sequel of menopause and its treatment. The average age at menopause in Pakistan is around 49years. Most Pakistani women are multiparous or grand multiparous especially rural women. Knowledge about menopause, its sequel and treatment to improve quality of life is limited. Pakistani women take menopause positively on religious grounds. There is a need to conduct population based studies on the knowledge and awareness of women towards menopause, so as to formulate a countrywide health education strategy