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

Faculty development ---- looking through different lenses

To understand how the faculty and students perceive the needs, barriers and possible solutions for instructional, professional and organizational development of faculty in context of a medical school. Mixed method sequential study. Shaikh Khalifa Bin Zayed Al-Nahyan Medical College [SKZMC] Lahore from September 2013 to March 2014. Five-point Likert scale, focus group discussions [FGDs] and in-depth, face-to-face interviews [IDI] were used to collect data. Using convenience sampling, 2lfaculty members for Likert scale forms,lO for FGD and 12 for ID1 were selected along with93 students for Likert scale and20 students for 2 FGDs. Scale data summarized using mean +/- SD and categorized using median score. Thematic analysis was done on interview and focus group data and findings were triangulated. Triangulation showed lack of motivation, poor time management, deficiencies in curriculum understanding and alignment with instruction and assessment, unawareness of innovative instruction and assessment tools, lack of feedback use and reflection, poor learning environment, and almost no rewards and recogrution of excellence in teaching. Weak institutional leadership and unsupportive administration were impediments too. Enhanced motivation by incentives, rewards and institutional support along with a robust faculty development program, training faculty and improving instructional, professional and organizational structure were identified as context specific solutions to address the needs and barriers. Innovative instructional training, development of research, leadership and scholarship, with organizational restructuring and support, are the main elements for faculty development in this specific context