Health care quality in NHS hospitals

Fayek N. Youssef
  • International Journal of Health Care Quality Assurance, February 1996, Emerald
  • DOI: 10.1108/09526869610109125

Health care quality in hospitals

What is it about?

The quality of service in hospitals is variable - as patients are often well aware. This study reports results from a patient satisfaction research project designed to explore the factors which patients identify as necessary in providing error‐free service quality with NHS hospitals. SERVQUAL, the internationally‐used market research technique, was used to measure patients’ satisfaction with NHS hospitals, comparing patients’ expectations before admission with their perceptions after discharge from the hospital, throwing light on how this gap might be closed. SERVQUAL compares expectations with perceptions of service received across five broad dimensions of service quality, namely; tangibility; reliability: responsiveness; assurance; and empathy. This study covered 174 patients who completed the SERVQUAL questionnaire, including patients who had had treatment in surgical, orthopaedic, spinal injury, medicinal, dental and other specialties in the West Midlands region. It recorded the average weighted NHS service quality score overall for the five dimensions as significantly negative.

Why is it important?

This research found that hospital services, as perceived by patients, failed to meet expectations in all dimensions, except for those patients (32%) who found that the “tangibles” exceeded their expectations. In particular, it was found that 100% of patients perceived reliability to be the worst feature of NHS hospital services, and it was apparent that failures in reliability had a detrimental effect on perception of the overall quality of NHS hospitals. To have service problems reported by 25% of patients is serious. These problems affected the perception of every dimension. For almost half of patients (42%), the problems were not resolved. This represents 11% of all patients who participated. In particular, the results of the orthopaedic, medicinal and dental specialties were below average.


Professor Tony Bovaird (Author)
University of Birmingham

NHS hospitals have to ask themselves: “What business are we in?” Are they prepared to continue offering inadequate service with a 25% quality failure rate to their customers? The answer should be that NHS hospitals will seek to provide error-free service quality and to have continuous quality improvement. SERVQUAL is one useful instrument to evaluate results regularly, to design continuous quality improvement throughout NHS hospitals and to compare service quality changes between NHS hospitals. The NHS quality challenge should be to meet or exceed customer expectations. There are no specific answers to this challenge. Part of the solution is recognition by management that high quality can contribute significantly to bottom line performance. Part is recognition that delivering high quality service touches everyone in the NHS and is not limited to a quality assurance team. Another part is the recognition that many steps can be taken to improve quality but that they need to be moulded into a cohesive whole. Improving service quality requires planning and co-ordination. Most of all, it requires total commitment: anything less is not enough.

The following have contributed to this page: Professor Tony Bovaird