IOSR Journal of Business and Management (IOSRJBM) ISSN: 2278-487X Volume 1, Issue 4 (July-Aug. 2012), PP 01-06 www.iosrjournals.org www.iosrjournals.org 1 | Page Setting agenda for quality improvement in a public hospital in Nigeria using the consumers’ judgement D.S. Ogaji 1 , A.J. Etokidem 2 1. Dr Daprim Ogaji, Department of Community Medicine, Niger Delta University, Amassoma, Nigeria 2. Dr Aniekan Etokidem, Department of Community Medicine, University of Calabar, Calabar, Nigeria ABSTRACT Background: The paradigm shift in the locus of control in many health systems brought about by consumerism, makes it imperative for consumers of health services to be involved in setting agenda for quality improvement.. This study sought to identify service quality gaps in a public hospital using the clients’ judgement. Methodology: Sixty-eight consenting clients attending the State House Hospital, Yenagoa, were administered an adapted version of the SERVQUAL instrument to rate their expectation before and perception after the encounter with the practice. Negative gap scores indicated that the actual service (the perceived score) was less than what was expected (the expectation score) and thus requires some form of quality improvement. Criteria having high expectation scores from the clients were also of importance to the administrators of the facility. Result: Majority of the raters were married (71.2%) and female (55.9%). Significant gaps were elicited in clients’ desire for up-to-date equipment for patient care (-1.15); desire to be able to trust staff (-1.06) and feel safe with hospital’s employees (-1.11). All 5 dimensions showed some degree of inadequacies but none crossed the pre-set critical line. Majority of the clients showed general satisfaction with the performance of the hospital (88.4%), a likelihood of return (76.3%) and recommending to others (81.0%) Conclusion: The identification of symptoms of dysfunction in this organization through this instrument provided a starting point for the examination of underlying problems that inhibit the provision of quality service. Keywords: Quality improvement, SERVQUAL, clients’ expectation, clients’ perception, quality gap, Yenagoa. INTRODUCTION Quality of Care is the level of performance or accomplishment that characterizes the health care provided, and its ultimate measure always depending upon value judgements on various ingredients and determinants which have been classified into measures of structure, process and outcome. [1] Pertinent however, in any meaningful assessment of the functional quality of health service delivery are the views and feelings of the health care consumer. Functional quality refers to the manner in which the health care service is delivered to the patients who are often unable to accurately assess technical quality and therefore, functional quality is the primary determinant of patients’ quality perception. [2], [3] The current focus on consumerism and accountability in the delivery of health services is forcing hospitals to address whether (or not) patients are satisfied with the care they receive and as a result of this paradigm shift, reforms in many health systems have sought to strengthen the role of health service users and patients in ensuring accountability, particularly for quality assurance and for improving performance. [4], [5] The utilization of patients’ assessment is based on the notion that if patients are truly satisfied, they have in fact received good care. This notion carries with it a guarded validity, as many of the surveys carried out are organized around theories of human judgement, which are highly subjective. In current health care context, nonetheless, patients’ evaluation is seen to have both practical and political relevance – practically long waiting times and/or unsatisfactory relationships with health care professionals are potential barriers to seeking treatment. Patient satisfaction with an apparent emphasis on the viewpoints of individual patients is a way of eliciting how responsive the health service is to the public politically and closing the identified gaps that exist between clients’ expectation before service encounter and their perception of the actual services after the encounter has the potential of improving service quality as well as utilization of these services. [6], [7] Health professionals now realise the need to demonstrate that their services are truly client-focused and that continuous performance improvement is being made through the judgement of their clients. The various reasons for assessing patient perception from the hospital’s perspective, stem from the fact that patient satisfaction is considered to be a desired outcome of care at a time when the technical aspects of medicine are overtaking humanistic factors; patient perception is also predictive of future behaviour (compliance with recommended treatments); and lastly, patient perception is related to the quality of care, in interpersonal and organizational areas as well as in technical domains. [8], [9] Earlier works that had been published gave credence to the benefits