Public Hospital Services Research Articles

The New European Society for Clinical Nutrition and Metabolism Definition of Malnutrition: Application for Nutrition Assessment and Prediction of Morbimortality in an Emergency Service.

Recently, the European Society for Clinical Nutrition and Metabolism (ESPEN) provided novel consensus criteria for malnutrition diagnosis. This study aimed to evaluate the applicability of this instrument in combination with different nutrition screening tools (1) to identify malnutrition and (2) to predict morbidity and mortality in hospitalized patients. Observational prospective study in 750 adults admitted to the emergency service of a tertiary public hospital. Subjective Global Assessment (SGA-reference method) and the new ESPEN criteria were used to assess nutrition status of patients, who were initially screened for nutrition risk using 4 different tools. Outcome measures included length of hospital stay, occurrence of infection, and incidence of death during hospitalization, analyzed by logistic regression. There was a lack of agreement between the SGA and ESPEN definition of malnutrition, regardless of the nutrition screening tool applied previously (κ = -0.050 to 0.09). However, when Malnutrition Screening Tool and Nutritional Risk Screening-2002 (NRS-2002) were used as the screening tool, malnourished patients according to ESPEN criteria showed higher probability of infection (relative risk [RR], 1.54; 95% confidence interval [CI], 1.02-2.31 and RR, 2.06; 95% CI, 1.37-3.10, respectively), and when the NRS-2002 was used, the risk for death was 2.7 times higher (hazard ratio, 2.69; 95% CI, 1.07-6.81) in malnourished patients than in well-nourished patients. Although the new ESPEN criteria had a poor diagnostic value, it seems to be a prognostic tool among hospitalized patients, especially when used in combination with the NRS-2002.

The experiences of patients with advanced cancer and caregivers presenting to Emergency Departments: A qualitative study

Background: Despite being a common event in the course of an advanced cancer illness, there is little understanding of patients’ perceptions of hospital Emergency Department presentations. Aim: To explore the experiences and perceptions of Emergency Departments held by patients with advanced cancer and their informal caregivers. Design: Cross-sectional study involving semi-structured interviews with advanced cancer patients and their informal caregivers. Qualitative data analysis was underpinned by a phenomenological approach utilising a data-driven inductive thematic frame. Setting/participants: In total, 19 patients with advanced cancer who presented to Emergency Departments in the previous 6 months and 10 informal caregivers from an Australian public hospital and community palliative care service were interviewed. Results: Patients reported that Emergency Department presentations were largely prompted by worsening symptoms or were a means to expedite hospital admission, with many instructed to attend by their health care provider. The experience in the Emergency Department was described as a time of anxiety and uncertainty with concerns over communication, the general environment and delays in the symptom management highlighted. Long waits were common. Despite this, patients described relief at receiving care. While the Emergency Department was viewed as a safety net for the health system, many believed advanced cancer patients should have alternative options. Conclusion: Relatively simple changes of regular communication updates and early symptom relief would improve patient experience of Emergency Department care. However, since an Emergency Department presentation is frequently serving as a default to access medical care, a significant re-orientation of the health care system is required to meet patient needs.

Public-on-private dual practice among physicians in public hospitals of Tigray National Regional State, North Ethiopia: perspectives of physicians, patients and managers

BackgroundPhysicians who work in the private sector while also holding a salaried job in a public hospital, known as “dual practice,” is one of the main retention strategies adopted by the government of Ethiopia. Dual practice was legally endorsed in Tigray National Regional State, Ethiopia in 2010. Therefore, the aim of this study was to explore the extent of dual practice, reasons why physicians engage in it, and its effects on public hospital services in this state in northern Ethiopia.MethodsA cross-sectional study using mixed methods was conducted from February to March 2011 in six geographically representative public hospitals of Tigray National Regional State. A semi-structured, self-administered questionnaire was distributed to all physicians working in the study hospitals, and an interviewer-administered, structured questionnaire was used to collect data from admitted patients. Focus group discussions were conducted with hospital governing boards. Quantitative and qualitative data were used in the analysis.ResultsData were collected from 31 physicians and 449 patients in the six study hospitals. Six focus group discussions were conducted. Twenty-eight (90.3%) of the physicians were engaged in dual practice to some extent: 16 (51.6%) owned private clinics outside the public hospital, 5 (16.1%) worked part-time in outside private clinics, and 7 (22.6%) worked in the private wing of public hospitals. Income supplementation was the primary reason for engaging in dual practice, as reported by 100% of the physicians. The positive effects of dual practice from both managers’ and physicians’ perspectives were physician retention in the public sector. Ninety-one patients (20.3%) had been referred from a private clinic immediately prior to their current admission-a circular diversion pattern. Eighteen (19.8%) of the diverted patients reported that health workers in the public hospitals diverted them.ConclusionsCircular diversion pattern of referral system is the key negative consequence of dual practice. Physicians and hospital managers agreed that health worker retention was the main positive consequence of dual practice upon the public sector, and banning dual practice would result in a major loss of senior physicians. The motive behind the circular diversion pattern described by patients should be studied further.

SATISFACTION OF PATIENTS WHO USE MEDICAL SERVICES IN PUBLIC HOSPITALS IN CAN THO CITY

Objectives: To assess patients’ satisfaction with using public health services in public hospitals in Can Tho city according to the new 2016 criteria and compare the patient satisfaction in 7 public hospitals in Can Tho and Can Tho city according to the Health Ministry’s 2016 patient satisfaction survey. Materials and Methods: A cross-sectional study was applied to assess the service quality of 7 general public hospitals in Can Tho City with the study subjects included 1069 outpatient and 882 inpatient. Results: The average of patients’ satisfaction with outpatient and residential services in 7 hospitals at the district and provincial levels was only at 4 (satisfied or good). Most hospitals meet about 80% of patients’ expectations. More than 95% of the patients are likely to return, or will come back or refer others to the hospitals. However, there are still some patients who rate some very dissatisfactory or very poor and unhappy or poor criteria, and some patients are unlikely to return or refuse to come back. The difference in satisfaction between hospitals is statistically significant (p<0.001). Conclusion: In order to improve patients’ satisfaction with public hospitals in Can Tho city, interventions should be developed to improve the quality of hospitals. Attention should be paid to the implementation of hospital training sessions on improving service quality and patient satisfaction. Key words: Satisfaction, inpatient, outpatient, Service, Medical, Can Tho

Equating the expected and perceived service quality

PurposeThe purpose of this paper is to investigate patients’ views toward the perceived service quality of public and private healthcare service providers. Determinants of healthcare service quality were compared by carrying out a GAP analysis to equate perceived and expected services and examined differences in the service quality.Design/methodology/approachThe study sample comprises 310 inpatients of public and private healthcare service providers. Self-administered questionnaires were used along a five-point Likert scale and analyzed through the Statistical Package for Social Sciences. GAP analysis was used to observe the difference between expectations and perceived service quality.FindingsA cross-sectional study revealed significant quality gaps between the expected and perceived services of public and private healthcare service providers; conversely patients’ expectations are not fully met in both types of hospitals. Private hospitals surpassed in terms of overall perceived service quality from their counterparts. Perceived services were found better in terms of physician medical services in public sector hospitals, while rooms and housekeeping services were found better in terms of private sector hospitals.Practical implicationsThe result can be used by both public and private healthcare service providers to restructure their quality management practices which could only be possible through effective management commitment, regular patients’ feedback and translucent complaint procedures.Originality/valueThe study conceptualizes the expected and perceived hospital service quality dimensions as an eight-dimensional framework. A comparison between public and private sector hospitals is made to get a better understanding about the differences in the perceived healthcare services among two sectors. Consequences of the study will aid hospital managers and policy makers to get a fuller picture of healthcare services in order to contrive enhancement practices.

The development and practical application of a simulation model to inform musculoskeletal service delivery in an Australian public health service

Timely access to orthopaedic and neurosurgery services in public hospitals is difficult to achieve due to constrained resources and rising demand with the result that waiting time targets are often not met. Advanced physiotherapy-led clinics can assist in managing demand by directly assessing and managing many patients without the need for consultation with a medical specialist. The purpose of this study was to develop and apply simulation modelling to determine the scale and mix of services required to efficiently manage demand from patients with musculoskeletal conditions in one health district. DesignWe designed a simulation model to estimate service demand over five years and test different service configurations (medical specialist-led or advanced physiotherapy-led) to meet waiting time targets and reduce waiting lists in orthopaedic and neurosurgery services. ResultsWithout intervention, the combined orthopaedic and neurosurgical outpatient waiting list is predicted to grow from 11,000 to over 15,000 patients over a five year period. To achieve waiting time targets within 2 years the scale of services would need to approximately double and the most efficient combination would be to direct approximately 50% of referrals to medical specialist clinics and 50% to advanced physiotherapy-led clinics. ConclusionsIn the health system modelled, a significant gap was identified between future demand and current provision of services. Simulation modelling was able to assist service planners understand the demand and identify effective management strategies.

The frequency of wearing protective eyewear and face shield at educational hospital and public service Hospital in Makassar

Objective: The aim of this study is to explore the comparison of frequency of wearing a protective eyewear and face shield at educational hospital and public service hospital in Makassar.Material and Method: This study is a descriptive research. It was conducted in March 2017 at dental hospital Hasanuddin University and at the dental and oral health service center (PPKGM) in Makassar. The subjects of the study are clinical students, dental professionals (resident), and dentist at department of periodontics and conservative at dental hospital Hasanuddin University and PPKGM. This research was done under direct observation on the subject of research. A descriptive analysis was done.Results: Number of operators at dental hospital Hasanuddin University who wore a protective eyewear were as many as 6 operators (5%) and none of the operators wore face shields while working. While in PPKGM the number of operators who wore a protective eyewear were as much as 4 operators (19%) and 11 operators (52%) wore face shields while working.Conclusion: The frequency of wearing protective eyewear and face shields at dental hospital Hasanuddin University is minimal and much lower than in PPKGM.

Service Quality in Public Hospitals in Gauteng Province, South Africa: an Ethical Approach to Translate Current Practices Into ‘People’ Strategy

It is not easy for all South Africans to access health services and it is often the case that public healthcare facilities are often undersupplied and offer poor quality service to outpatients. The expectations and experiences of outpatients vary considerably and the perception of many is that they would rather not bother to visit a facility. This in itself is highly problematic since those who keep away and who are afflicted with communicable diseases will in all likelihood spread their disease, with what could be dire outcomes. This paper is based on a literature exploratory overview and suggests an ethics paradigm infused with quality excellence, for public service hospitals which it is proposed, require greater moral intensity, leadership, design with strategic focus, effective change management and above all, a culture of engagement with all stakeholders especially outpatients. The postulations in this paper may serve as a basis for building better ethically driven quality into the provision of services in public hospitals in South Africa. The guidelines which are proposed could be used practically in health care provision so as to identify quality gaps and offer concrete solutions for quality improvement in public hospitals.

HealthLinks: Incentivising better value chronic care in Victoria

Introduction: As the system manager for Victoria’s acute care system, the Department of Health and Human Services recognises the benefits of integrated approaches for patients with chronic and complex conditions. However, Victoria’s current hospital funding model is not particularly well suited to supporting integrated care for these patients.Health links: Chronic Care is a funding-neutral reform that aims to support Victoria’s Public Health Services in adopting approaches that better identify patients at risk of becoming frequent users and responds to their chronic care needs earlier.Description of policy context and objectives: In Victoria, activity based funding has been the preferred approach to funding public hospital services. However, the acute inpatient activity based model is often cited as a barrier to the delivery of integrated hospital-wide care for some groups of highly complex patients.Over the past decade, Victorian hospitals have put in place service responses to help reduce the risk of hospitalisation for these patients, such as those delivered through substitution and diversion programs such as the Health Independence Program. However, there has been little concurrent development of the funding models underpinning this shift in healthcare. For many complex and chronic disease patients, their journey through the hospital system is funded via many different funding streams.While discrete funding streams offer ways to account for, and cost, different types of services they can also lead to artificial boundaries being created between service streams. These funding streams lack the flexibility providers are seeking to deliver integrated care across the continuum of the patient’s journey.In order to test if it is possible to deliver better value care for these complex patients, from within existing resources, Victoria will trial the use of a capitation funding model in 2016-17.Target Population: Patients with chronic care needs who are at risk of multiple acute admissions in a 12 month period.Highlights: Using Victorian linked data (Victorian Admitted Episode Dataset and Victorian Emergency Minimum Dataset) a prediction algorithm has been developed that identifies patients who are at risk of three or more admissions in the next 12 months (positive predictive value =32%). The predicted average resource utilisation of the group prescribes a capitation payment for each identified patient. Health services will build on existing, or define new, clinical and service interventions to be implemented.Transferability: The approach is being formally evaluated over a two year period with patient monitoring continuing for a further 12 months. Early observational findings will be available by November 2016.Conclusions: The Department of Health and Human Services (DHHS) is working with a small group of Public Health Services to test if the use of a capitation funding model, based on the average acute inpatient resource utilisation of this group, will drive alternate models of care, including better integration across service streams. Ultimately the aim is to deliver better patient value from within existing acute care funding resources.

Epidemiological characteristics of Chinese paediatric traumatic brain injury inpatients

ABSTRACTPrimary objective: To investigate the epidemiological characteristics of paediatric inpatients with traumatic brain injury (TBI) in China. Research design: The Chinese Trauma Database (CTD), a nationwide register system based on hospital admission data, contains diagnosis and treatment information for trauma inpatients in over 200 military-managed public-service hospitals in China. Using the ICD-9 coding, the data for children with TBI aged 0–17 years between 2001 and 2007 were retrieved. Methods and procedures: The demographic characteristics, admission time, injury cause, severity and treatment outcomes of paediatric inpatients with TBI were analysed. Main outcomes and results: A total of 26,028 paediatric inpatients with TBI (69.52% male, 30.48% female) were included in the CTD. Motor vehicle traffic (MVT) accidents, falls and assaults were the primary causes of injury. Falls were the leading cause of TBI in children aged 0–4 years, and MVT was the leading cause of TBI in children aged 5–17 years. According to the abbreviated injury scale, 37.20% of the TBI cases were mild, 25.15% were moderate, 24.81% were severe and 12.84% were critically severe. Conclusion: Chinese authorities should develop targeted measures to reduce children injuries based on the leading causes of TBI in the different age groups, particularly MVT, falls and assaults.

The Invisibility of Disadvantage: Why Do We Not Notice?

Personal health records (PHRs) offer tantalising benefits for patients and healthcare providers, including improvements in patient-provider communication, patient empowerment, and access to data and information. A suspicion that disadvantaged patients are less likely to use or benefit from PHRs stimulated a research agenda that included: (a) a literature review; and (b) empirical analysis of eight years' hospital admission and discharge data linked to measures of patient social disadvantage. The results demonstrated an association between disadvantage, increased use of public hospital services and barriers to PHR use. These findings may appear self-evident, but dramatically highlight how disadvantaged patients continue to be overlooked in many e-health design processes, and are rarely a focus of user centred design. The paper concludes by briefly considering the implications of this invisibility.

Six years of national mental health seclusion data: the Australian experience.

Reducing or eliminating seclusion from mental health care settings has been a national priority for Australia since 2005. This paper describes Australia's national seclusion data collection, and summarises changes in seclusion rates in Australian public mental health services. Seclusion events per 1000 patient days were calculated from 2009-2010 to 2014-2015 utilising state and territory administrative data sources. Combined national data were used to calculate results for a number of service characteristics, such as target population and location of the service. The rate of seclusion events decreased by 43% over the 6 years. Child and adolescent services reported consistently higher rates of seclusion, but a shorter duration of seclusion episodes, compared with other service types. There is high variation in seclusion rates between individual services (range 0.0-53.0 seclusion events per 1000 bed days in 2014-2015). Seclusion event rates in Australia's specialised public acute mental health hospital services are declining. The use of existing administrative data was instrumental in establishing a national data source to facilitate the monitoring and reporting of progress of seclusion reduction strategies.

The costs and cost effectiveness of providing first-trimester, medical and surgical safe abortion services in KwaZulu-Natal Province, South Africa.

BackgroundDespite a liberal abortion law, access to safe abortion services in South Africa is challenging for many women. Medication abortion was introduced in 2013, but its reach remains limited. We aimed to estimate the costs and cost effectiveness of providing first-trimester medication abortion and manual vacuum aspiration (MVA) services to inform planning for first-trimester service provision in South Africa and similar settings.MethodsWe obtained data on service provision and outcomes from an operations research study where medication abortion was introduced alongside existing MVA services in public hospitals in KwaZulu-Natal province. Clinical data were collected through interviews with first-trimester abortion clients and summaries completed by nurses performing the procedures. In parallel, we performed micro-costing at three of the study hospitals. Using a model built in Excel, we estimated the average cost per medical and surgical procedure and determined the cost per complete abortion performed. Results are presented in 2015 US dollars.ResultsA total of 1,129 women were eligible for a first trimester abortion at the three study sites. The majority (886, 78.5%) were eligible to choose their abortion procedure; 94.1% (n = 834) chose medication abortion. The total average cost per medication abortion was $63.91 (52.32–75.51). The total average cost per MVA was higher at $69.60 (52.62–86.57); though the cost ranges for the two procedures overlapped. Given average costs, the cost per complete medication abortion was lower than the cost per complete MVA despite three (0.4%) medication abortion women being hospitalized and two (0.3%) having ongoing pregnancies at study exit. Personnel costs were the largest component of the total average cost of both abortion methods.ConclusionThis analysis supports the scale-up of medication abortion alongside existing MVA services in South Africa. Women can be offered a choice of methods, including medication abortion with MVA as a back-up, without increasing costs.

Understanding quality and satisfaction in public hospital services: A nationwide inpatient survey in Greece

Health services compared to the most of other sectors' customer services present some special traits, such as extreme complexity, co-production, and intangibility, while financial and human consequences of low quality are high. This study reports on the findings of a nationwide HCAHPS questionnaire survey conducted in Greece after the implementation of the health system reform due to the financial crisis regarding the factors determining inpatient satisfaction in public hospitals. HCAHPS data were initially analysed by factor analysis followed by an ordinal regression analysis, which aimed to identify the determinants with significant impact on inpatient satisfaction. The study results are consistent with prior research which indicated that the communication with nurses is the most salient predictor of overall patients’ satisfaction followed by communication with doctors. Moreover, certain patient (age and health status) and hospital institutional (type and location) characteristics also contribute significantly to patients’ perceived overall satisfaction. Hence, health quality improvement activities should consider the critical differences among patient subgroups and hospital types in order to fulfil consumer needs and preferences more effectively.

Strategic Investment and Resource Allocation Model (SIRAM): Preventing and Managing Preventable Chronic Diseases in NT Australia

This paper presents a Strategic Investment and Resource Allocation Model (SIRAM) designed to facilitate health sector financing. This model is used to inform public policy on strategic investment and resource allocation to prevent and manage preventable chronic diseases (PCDs) viz. Diabetes Type II (NIDDM), Chronic Obstructive Airways Disease (COAD), Ischaemic Heart Disease (IHD), Hypertension and Renal Failure. The SIRAM enables forecast of future status of health and assessment of the gap between the projected and desired health status, future demand for health services and evaluate options for health intervention based on costs and a return (financial and health gains). The present phase of the study makes forecast of the future demands for public hospital services and costs of providing services by public hospitals in the Northern Territory (NT) of Australia to manage PCDs. The main findings are summarised here: •The base (2000) year hospital in-patient cost for management of PCDs is around $19 million and this accounts for 20 percent of the total hospital in-patient service cost of public hospitals in the NT. Without any strategic improvements to reduce the burden of PCDs, this cost will increase to $ 58 million by year 2025. •Out of the total hospital service cost for PCDs, about 75% ($ 15 million) was spent on treatment of PCDs among Indigenous Australians and the rest (25%) spent on providing hospital services to other Australians. Over the years there would be slight decrease (2%) in the percentage share of hospital service cost for PCDs for Indigenous population (73%) where as the percentage share of this cost would increase by 2% (27%) for other Australians. This is due to the higher proportion of expected ageing population of non-Indigenous population. •During the financial year 2000, hospital services cost for renal failure accounted for 55% of the total public hospital expenditure for PCDs followed by COAD (29%), NIDDM (9%), IHD (7%) and HT (0.5%). The projected cost for the next 25 years remains almost in the same proportion. During the financial year 2000, the number of public hospital separations and weighted inliers equivalence separations (WIES) were 20767 and 6099 respectively. By year 2025, these separations and WIES will increase to 39137 and 11275 respectively. •In the base year (2000), Indigenous Australians accounted for 85% PCDs related public hospital separations and this percentage might decline by 2% by 2025. This again must be due to higher proportion of ageing population of non-indigenous Australians who might be hospitalised due to PCD related illness. During the same period, the number of WIES for PCDs related hospital services provided to indigenous Australians accounted for 79% of the total PCDs related WIES and this proportion would remain the same until 2025. The next phase of the study will focus on simulation of the expected health when there is a change in the rate of incidence or prevalence of PCDs because of the changed health interventions viz. prevention, promotion and best practice clinical management. Note: A conference paper presented in the plenary session of the International Health Outcome Conference Held in Canberra, July 2002.

The Roles of Infrastructure and Resources on Implementation of Free Maternal Healthcare Services in Machakos Level 5 Hospital, Machakos County, Kenya

Free maternal health care services in Kenya was introduced on 1st June, 2013 and has increased the number of skilled deliveries significantly. In this paper an attempt is made to examine the factors associated with the utilization of free maternal health care services in Kenya on the basis of data collected from Machakos Level 5 hospital. A descriptive cross-sectional study design was used. Using both probability and non-probability sampling techniques; purposive sampling and stratified sampling techniques, a sample of 398 participants who received free maternal services at Machakos level 5 were recruited. A survey questionnaire and interview schedule were administered to women who had delivered in the hospital and interview scheduled was administered to health workers. The findings of the study showed that there is a recognizable relationship between hospital infrastructure and implementation of free maternity services in public hospitals. The study established that there is a positive and significant relationship between patient level of awareness and utilization of free maternal healthcare services. Awareness was sighted as a major structural variable that could influence decision of women to deliver in public hospitals, such knowledge should highlight on requirement and various point of service delivery all of which determined to a great extent the quality of free maternal health services in Kenya.

Humanization in obstetric care: Psychodrama as an instrument in the learning processes

This article presents reports of a role-playing and sociodrama experience used in the development of teams in obstetric care, carried out between 2000 and 2002, as an integral part of the Ministry of Health program in Humanized Assistance to Women. The objective was to qualify, with the principles of Humanization, the mid- and senior-level professionals who worked in prenatal, childbirth and puerperium services in Brazilian public maternity hospitals in Recife, Joao Pessoa and Macapa.

Evaluating the Productive Efficiency of Jordanian Public Hospitals

Jordan is committed to providing healthcare services for more than a million refugees coming from bordering countries in the last five years and face increasing demand for the services of public hospitals. Their efficiency is a key success factor to manage the unique and complex context effectively. This research investigated the technical and scale efficiency of the Jordanian Public Hospitals. The study applied constant and variable returns to scale input-oriented DEA models to rank hospitals and allocate the factors associated with inefficient operations. The work tested 27 general public hospitals from 2010 to 2014, in total, 135 observations were examined with respect to four input-measures and three output-measures. The output-measures characterize three functional areas; inpatient, outpatient, and ambulance and emergency departments. Further, decomposing the technical efficiency allowed considering for scale effects. Findings revealed that 25 observations out of 135 ones were efficient and constructed the efficient frontier. Eight hospitals in 2014 were on the frontier, but weakly efficient and all suffered slacks. Targets and reference sets were identified to guide improvements. Hospitals were sorted into five performance patterns; promising, declining, stable good, stable poor, and unstable. The number of physicians and outpatient services recorded high slacks. On average, 2013 scored the best performance. Scale analysis shows that a capacity of 160 beds is an optimal production size in Jordan. Inefficient and weakly efficient hospitals can target areas of opportunities for performance improvements. The efficiency of Public hospitals in Jordan was not investigated since 1992. The study was limited to public hospitals from 2010 to 2014.

Measuring patient's satisfaction of healthcare services in the UAE hospitals: Using SERVQUAL

The purpose of this paper is to evaluate the quality of healthcare services by investigating the factors affecting patient satisfaction in private and public hospitals in the UAE based on five service quality dimensions of the SERVQUAL namely; tangibles, reliability, responsiveness, assurance, and empathy. A modified SERVQUAL questionnaire was used to gather the research data. The respondents of the study consisted of 127 patients who have been admitted within the last 6 months prior to the onset of the investigation. The results of the study revealed that the perceived healthcare services in private hospitals and public hospitals do not significantly vary. Although patients were more satisfied with nursing care, the perceived satisfaction of patients with the quality of services provided by physicians and nurses as well as the quality of the hospital environment do not significantly vary in both public and private hospitals. The dimension of assurance was rated the highest while responsiveness was perceived as the least important of the five SERVQUAL dimensions. The five dimensions of the SERVQUAL appeared to be a consistent and reliable scale for measuring healthcare service quality in the United Arab Emirates context. The modified SERVQUAL may be used to contribute in enhancing the quality of healthcare services in UAE and in other similar environments.

Secularism in hospital, between rights and obligations

Public hospitals are subject to specific regulations with regard to secularism, which must respect the nursing staff as well as the patients. The relevant legislation attempts to find a balance between freedom of belief and religious expression on the one hand, and the smooth running of the public hospital service on the other.