The Impact of State-Owned Hospital Consolidation on the Performance of Affiliated Hospitals: A Case Study of Krakatau Medika Hospital

The competitive and dynamic health care sector has spurred hospitals into delivering greater flexibility and quality of services while cutting the hospital cost at the same time. However, hospitals differ in the extent to which they achieve these strategic goals. This article explores the use of a new management tool-the balanced scorecard-which facilitates managers to meet multiple strategic goals. It also analyzes how nurse managers use the balanced scorecard in an interactive or diagnostic way and its subsequent effect on strategic goal achievement (cost reduction and flexibility). It also examines how "balanced" is the balanced scorecard in terms of financial versus nonfinancial measures. Data were collected from a mail survey sent to 218 nurse managers in Spanish public hospitals. A satisfactory response rate was achieved, with 114 (52.29%) useful answered questionnaires. The results show that younger, more tenured, and clinically trained nurse managers would be more likely to use the balanced scorecard in an interactive way. Conversely, older, less tenured, and administratively trained managers would use it diagnostically. The results also indicate that the balanced scorecard facilitates the cost reduction and flexibility in hospitals only when it is used interactively. This article provides evidence that not only the technical design of the balanced scorecard matters, but also an appropriate use of the balanced scorecard is paramount for achievement of multiple strategic goals. An effective use of the balanced scorecard requires managers to actively stimulate dialogue and agreement among hospital's staff about desirable financial and nonfinancial performance measures in alignment with multiple strategic goals.

A recurring problem in the service quality literature is measurement--knowing which quality aspects should be measured and in what ways. This article aims to assess service quality measurement by focusing on general practice appointment systems. The authors use a case study, integrating qualitative and quantitative methods, including interviews with stakeholders as well as data regarding appointment systems' temporal aspects. This study offers insights into service quality's subjective and context-dependent nature, as reflected in primary healthcare stakeholder perceptions and service quality's objective and quantifiable aspects, revealing its dynamic, process-based nature. The empirical approach to service quality measurement did not focus on all general practice service quality aspects, but instead focused on patient appointments with healthcare professionals. Broader applications to include other service quality aspects should be addressed by research. Using one approach, service operators could have a tool for obtaining a more complex and richer service quality picture, leading to a better understanding of the relationship between service delivery and its evaluations by different stakeholders. The service quality measurement method offers innovative insights into different theoretical abstractions, constructively challenges both measurement and service quality, whilst moving beyond managerial and user-based approaches, and is highly relevant to contemporary organisation practice.

Transferring and applying manufacturing principles and practices to improve both service efficiency and service quality is an important area of research in service operations. This paper advances this stream of research by examining the compatibility of operating efficiency and service quality. Specifically, our research addresses the following questions: (1) Do operating efficiency and service quality have to be traded off, or can they exist in unison (are they compatible)? and (2) What aspects of service quality have a stronger association with operating efficiency? In disentangling these important issues, we utilise a combination of data envelopment analysis (DEA) and survey-based empirical research methods. Additionally, our focus lies on a novel type of service industry where such research has been sparse. We evaluate the relative operating efficiencies of service driving agencies based on actual transaction data and subsequently analyse differences in service quality dimensions based on efficiencies. Overall, our analyses suggest important strategic decision-making implications for service operations managers and provide novel insights for academic research.

Customer evaluations of service quality may exhibit variation at the individual customer level, or in the aggregate level, over time. This study investigated three types of aggregate-level variation in customer evaluations of service quality. Using multiple data sets, it examined (1) the relationship between the mean score for an aspect of service quality and its variance; (2) the amount of variation in service quality scores given to an organization over time; (3) the degree to which scores for aspects of service quality are stable relative to scores for other aspects of service for the same organization and (4) the extent to which a mean score is related to the proportion of responses that fall below the neutral point on the scale (e.g. below 5/10). The study finds the following: (1) Service quality aspects that receive high mean scores have low variance, and those that receive lower scores have higher variance. (2) Scores for aspects of service quality are very stable over time (for the three organizations with repeated cross-sectional data). (3) There is also considerable stability in the relative ranking of service quality aspects over time. Aspects of service quality that have higher average scores than other aspects of service quality tend to retain this relative position over time. (4) There is a strong association between mean score for a service aspect and the proportion of responses that fall at or below 5/10. The relationship can be expressed simply as Proportion of responses at or below 5/10 = 122 - 13 x Mean Score. (R2 = 0.90). The results suggest that service quality surveys may not need to be conducted very often. They also suggest that aspects of service quality that receive lower scores are due to more heterogeneity in responses, rather than a large number of customers perceiving that aspect of service to be poorer. This result implies that when managers notice that some aspects of service score less highly than others, that the challenge for remedial action is to identify and remedy causes of variability in service quality rather than trying to lift performance ‘across the board’. Lastly, the results help contextualize mean scores - ‘7 out of 10’ means that (in these datasets, at least) approximately (122 - 13 x 7 = 31) 31% of respondents gave at best a neutral score.

Purpose – The purpose of this paper is to report on aspects of service quality at the London 2012 Paralympic Games, from a rather unusual perspective, the athletes. To date there has been little evidence captured about athlete’s satisfaction at sporting events, and specifically about their perceptions of the service quality provided. Design/methodology/approach – Unique “full” access to the London 2012 Paralympics allowed to the collection of data directly from the athletes. The study reports the questionnaire findings from a sample of 250 respondents. Findings – From this study an operational assessment and performance framework has been generated composed of ten criteria and 73 items or sub-criteria, which can be used as a benchmarking tool to plane, design and compare future sport mega-event. Moreover, the study evidence based the high quality of the 2012 Paralympics Games, as he athletes rated, on a five point Likert scale, 64 items in the “very satisfied” category, a very positive set of feedback for the Games organisers. Research limitations/implications – The methodology applied was appropriate, generating data to facilitate discussion and draw specific conclusions from. A perceived limitation is the single case approach; however, this can be enough to add to the body of knowledge where very little evidence has been captured so far and where the objectives were to explore the Paralympics games service quality and performance. Practical implications – This research provides a tangible evidence base to support future sport event decision makers, planners and designers in this highly complex “arena”. In any system there are always areas for improvement, these are highlighted within the paper for further investigation. Originality/value – This is the first paper to identify and synthesize aspects of sport mega event service quality from the athletes viewpoint and informs how well designed, organised and managed the London 2012 Games were from a primary user perspective. The paper makes a defined contribution by developing evidence based recommendations for this important yet under researched area.

This study aims to determine the performance of Sultan Hospital Dg. King of Bulukumba when measured using the Balanced Scorecard approach. The analytical method used is descriptive analysis with a quantitative approach using hospital performance indicators in performing performance measurements. The results of the study show generally that 1) Sultan Hospital Dg. Raja Bulukumba allows to apply the Balanced Scorecard to measure organizational performance, because with the Balanced Scorecard all aspects can be measured. The application of the Balanced Scorecard is possible because the Sultan Hospital Dg. The King of Bulukumba has formulated his vision, mission and strategy and the results of the research show that the performance of Sultan Hospital Dg. The King of Bulukumba is said to be quite good when using the Balanced Scorecard. And 2) performance measurement of Sultan Hospital Dg. The King of Bulukumba using the Balanced Scorecard for a period of 2 years shows good results

One of the provinces that have had a rise in MMR since 2019 is East Nusa Tenggara (NTT) Province. Southwest Sumba Regency saw an upsurge in maternal mortality cases in 2019, with ten cases; in 2020, there were nine cases; and as of October 2021, there were 14 MMR mothers. Having better antenatal care is one of the crucial measures to lower MMR and IMR. In order to perform their duties in accordance with the established standard operating procedures, midwives must be as prepared as feasible. One of them is raising the bar on several aspects of service quality, such as technical proficiency, service accessibility, effectiveness, efficiency, continuity, security, convenience, information, timeliness, and interpersonal relationships. This study has a cross-sectional design and is an analytical observational study. Using inclusion and exclusion criteria, a sample of 120 respondents was selected using the cluster random sampling technique. The information was gathered through the distribution of a questionnaire about midwives' knowledge of common antenatal care (ANC) examination services and the completion of a checklist to investigate the aspects of midwifery service quality and patient comfort during ANC visits. Chi-square analysis was used to examine the data. On the traits of the village midwives, the chi-square test and correlation test findings were obtained. Knowledge was the impacting factor (p-value 0.000; r = 0.599). With ANC visits, Polindes' distance from the houses of pregnant women had a p-value of 0.001 (r= 0.293). The p-value for the distance between Polindes and the residences of expectant women having quality ANC service is 0.027 (r=0.202). A p-value of 0.004 (r= 0.265) was obtained for the outcomes of the ANC visit test and the quality of ANC services. Knowledge and the geographic location of Polindes are the features of village midwives associated with the quality of ANC services in Southwest Sumba Regency. Keywords: Characteristics, of Village Midwives Distance to Village Maternity Post (Polindes) Quality of Antenatal Care (ANC)

The purpose of this research was to study the relationship between five aspects of service quality factor of low-cost airlines in Thailand. The population of the research was people who had experience traveling with low-cost airlines in Thailand. 380 respondents are the sample size of this research. Information is collected through social media such as Facebook, Line. The research tool was a questionnaire developed from a review of the relevant literature. The main descriptive statistical analysis was frequency, percentage, mean, standard deviation, skewness, and kurtosis and the researcher analyzed the inferential statistics by using the Structural equation model analysis. Firstly, the results of the general data analysis showed that most of the respondents were female (64.7%), aged 20-40 years (76.2%), had a bachelor's degree (50.8%), and had a monthly income of more than 900 US dollars (39.5%). Secondly, it was found that the overall mean of the service quality variables was considered the highest level. When considering each aspect of service quality, it was found that all five aspects of service quality were at the highest level as well. And finally, the results of the study revealed a significant correlation between the five factors of low-cost carrier service quality. The results suggest that low-cost airline executives need to focus on high service quality in all five aspects: tangibility, reliability, responsiveness, assurance, and empathy. Paying attention to the customer needs and five aspects of service quality will contribute to the good performance of low-cost airlines such as having good competitiveness, higher growth, better operating results, and better business sustainability.

Service quality is believed to influence the productive efficiency of firms, particularly in a service focused industry such as healthcare. However, there is mixed evidence in the literature of both positive and negative correlation (e.g., the cost drivers of care providers vis-à-vis capacity expansion for better quality of service) between quality and efficiency. To address this challenge, a two-phase data-driven analysis is undertaken. In the first stage, an output-oriented Data Envelopment Analysis is employed to model the interdependency between operational efficiency and service quality by assessing the allocation of the input resources for achieving these two objectives. While accounting for the external influences and avoiding the ‘best practice trap’ in the healthcare sector, a set of classification algorithms are used to quantify the impact of external factors on efficiency levels. The proposed model is empirically tested using healthcare data of 31 provinces of China for a period from 2013 to 2018. The results show that the efficiency scores in operational productivity and quality of service are 67% and 64%, respectively. The major source of inefficiency is the number of cases in observation rooms (almost 47%) followed by health examination (22%). The provinces are categorized into three classes (optimally chosen number of clusters) using K-means clustering. The second phase of the analysis starts with selecting a subset of relevant features from 33 explanatory variables using information gain and correlation analysis. The proposed two-phased integrated technique enhances the performance of healthcare services and provides a roadmap for improvement for inefficient regions.

Service quality is considered as a main domain of quality associ-ated with non-clinical aspect of healthcare. This study aimed to survey and im-proves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reli-able researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (P<0.001). Service quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers.

A crucial concern of both management information systems researchers and practitioners is improving user satisfaction with an organization's IS department. This study was undertaken in order to futher examine the relationship betwen user information satisfaction and service quality of organization's IS department, the facators contributed to better prediction of user information satisfaction and the variations of user's zone of tolerance for different service attributes/dimensions. To overcome the external validity problem, this study was held in real business environment setting and the respondents are users of IS departments from many different companies in Indonesia. There were several findings of this study. Firs, this study supported a significant positive relationship between user information satisfaction and service quality. Second, there were three significant predicors of user information satisfactions, the first two predictors are the original factors of the traditional user information satisfaction instrument (i.e., quality of information product and attitude towars IS department staff and services) and the third one is the aspect of service quality i.e. 'reliability'. Third, concerning the variation of users' zone of tolerance for different aspects of service quality, this study still can not reject the null hypothesis that there are no variation of users' zone of tolerance for different aspects of service quality. Implications for research and practice resulting from these findings are discussed.

This article presents the findings from an exploratory research study that assessed the content and impact of mission statements in 103 Canadian not-for-profit health care organizations. The study especially sought to determine if a relationship existed between selected mission statement components and various hospital performance indicators.

Purpose: To assess the service quality of care as perceived by people with Type 2 Diabetes (T2D). Methods: A cross-sectional study was carried out among 180 people with Type 2 diabetes in diabetes clinic using simple random sampling method in Tabriz, Iran in 2012. Service quality was calculated using: SQ=10 – (Importance ×Performance) based on importance and performance of non-health aspects from the patients' perspective. Validity of questionnaire was confirmed by 10 experts. Data analyzed by SPSS13 software. Results: From the participants' perspective, of12 aspects of service quality, communication and prevention had the highest score for importance. Dignity had the highest score for performance. But the highest service quality values were for continuity of care, dignity and confidentiality. There was no statistically significant relationship between service quality score, age and diabetes status. Conclusion: The findings revealed that there is a notable gap between patients' expectations and perceptions. Also overall service quality and all aspects of service quality with the exception of continuity of care, dignity and confidentiality achieved inadequate quality.

IntroductionDespite the critical importance of hospital performance measurement, empirically validated hospital performance frameworks lack. The balanced scorecard is considered one of the most influential contributions in the performance measurement literature. Since the introduction of the balanced scorecard in the early 90s, many scholars have used a balanced scorecard to enable hospital performance measurement and improvement. Therefore, this study aimed to construct and validate a balanced scorecard-based hospital performance framework. Additional to the original four perspectives, the quality of care is added as a perspective for the balanced hospital scorecard. It reflects one of the key strategic objectives in any healthcare organization.MethodsThe study adopted a two-phase model to validate the framework empirically. The first is the exploratory phase, where feedback from academicians and professionals helped finalize the framework in the form of scale. In the second phase, the scale was tested for dimensionality, reliability, and validity.ResultsA total of 200 (81 responded, RR= 40%) senior managers working in Hamad Medical Corporation (HMC), the largest healthcare provider in Qatar, were surveyed. The content, convergent, and discriminant validities were established. The study conducted composite reliability and Cronbach's alpha tests for the reliability, and all variables were found to have alpha and composite reliability higher than 0.7.ConclusionThe findings suggest that senior managers in HMC make a meaningful distinction between the five attributes of hospital performance. Findings, contributions, limitations, directions for future research, and managerial implications are all discussed.

THE QUALITY OF HOMELESSNESS SERVICES: AN OVERVIEW OF THE CURRENT SITUATION AND CHALLENGES IN CROATIA Although homelessness is a multifaceted phenomenon that has aroused interest in the Croatian scientific community over the last decade, the quality of homelessness services has not been explored so far. Based on a qualitative research that included key participants in the homelessness sector, this theme is problematized through various aspects of service quality. Following an introduction and a description of the method used, this paper describes the legal regulation of quality of services for homeless people, as well as the problems that homelessness services providers encounter in practice in relation to legal documents. More specifically, this paper analyses: the availability of services for homeless people, financing models, quality of accommodation facilities, quality of social services and quality control. All these aspects of service quality are supplemented by a number of first-hand practical experiences as well as some examples of good practice. Key words: homeless people, social services, (night) shelters, regulation, service quality.