Testing the Strength of Hospital Accreditation as a Signal of the Quality of Care in Romania: Do Patients' and Health Professionals' Perceptions Align?

Hospital accreditation, as a quality signal, is gaining its popularity among low- and middle-income countries, such as Romania, despite its costly nature. Nevertheless, its effectiveness as a quality signal in driving patients' choice of hospital services remains unclear. In this study, we intend to empirically explore the perceptions of both healthcare professionals and patients toward Romanian hospital accreditation and identify perception gaps between the two parties. Exploratory and confirmatory factor analyses were carried out to extract the latent constructs of health professionals' perceived effects of hospital accreditation. The Wilcoxon rank-sum test and Kruskal-Wallis test were used to identify correlations between patients' sociodemographic characteristics and their behavioral intentions when confronted with low-quality services. We found that health professionals believe that hospital accreditation plays a positive role in improving patient satisfaction, institutional reputation, and healthcare services quality. However, we found a lack of awareness of hospital accreditation status among patients, indicating the existence of the perception gap of the accreditation effectiveness as a market signal. Our results suggest that the effect of interpersonal trust in current service providers may distract patients from the accreditation status. Our study provides important practical implications for Romanian hospitals on enhancing the quality of accreditation signal and suggests practical interventions.

Combining Direct and Indirect Measurements to Assess Patients' Satisfaction with the Quality of Public Health Services in Romania: Uncovering Structural Mechanisms and Their Implications.

Introduction: Patients' satisfaction was extensively researched over the last decades, given its role in building loyalty, compliance to treatment, prevention, and eventually higher levels of wellbeing and improved health status. Patients' feedback on the perceived quality of health services can be incorporated into practice; therefore, understanding factors and mechanisms responsible for patients' satisfaction allows providers to tailor targeted interventions. Method: A questionnaire assessing patients' perception of the quality of health services was administered to a country-representative sample of 1500 Romanian patients. Using a partial least squares-path modeling approach (PLS-PM), with cross-sectional data, we developed a variance-based structural model, emphasizing the mediating role of trust and satisfaction with various categories of health services. Results: We confirmed the mediating role of trust in shaping the relationship between the procedural accuracy of health professionals, along with the perceived intensity of their interaction with patients, and patients' experienced quality of the health services. We confirmed the mediating role of satisfaction by the categories of services in the relationship between waiting time on the premises, attention received, and the perceived reliability of the information received, as predictors, and the experienced quality of the health services. In addition, indirect assessment of patients' satisfaction is a good predictor for direct assessment, thereby affirming the idea that the results of the two types of evaluations converge. Discussions: One of the most efficient solutions to increase both patients' satisfaction and their compliance is to empower the communication dimension between patients and health practitioners. Given the non-linear relationships among variables, we advocate that, unless the nature of the relationships between satisfaction and its predictors is understood, practical interventions could fail. The most relevant variable for intervention is the degree of attention patients perceive they received. We suggest three methods to turn waiting time into attention given to patients.