For experiences where the quality of service is critical or where service cannot be obtained elsewhere, convenience is less of an issue. In the case of medical care, many people are willing to fly across the country to speak with a top neurosurgeon and avoid the more conveniently located Dr. Nick. Convenience becomes a critical factor in saturated industries where the services are often too similar to distinguish. In these cases, convenience can be your major differentiator and a key customer decision-making attribute.
Methods:Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations.
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Results:Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers.
Healthcare service quality is even more difficult to define and measure than in other sectors. Distinct healthcare industry characteristics such as intangibility, heterogeneity and simultaneity make it difficult to define and measure quality. Healthcare service is an intangible product and cannot physically be touched, felt, viewed, counted, or measured like manufactured goods. Producing tangible goods allows quantitative measures of quality, since they can be sampled and tested for quality throughout the production process and in later use. However, healthcare service quality depends on service process and customer and service provider interactions (19,20). Some healthcare quality attributes such as timeliness, consistency, and accuracy are hard to measure beyond a subjective assessment by the customer.
This study represents an exploratory effort in understanding factors affecting healthcare services quality in the Iranian context. A qualitative approach is appropriate to answer the research question. A qualitative research typically produces detailed and in-depth information about a much smaller number of people and cases. This increases understanding of the cases and situations studied and enhances the validity of the data obtained (33). It is often inductive, with propositions emerging at the end of the study rather than being hypothesis driven. However, the qualitative research is labour-intensive, costly, time consuming, and demands the highest level of expertise to undertake the research and interpret the findings (34). It also suffers the limitations in generalising the results to a larger population.
The findings suggest that healthcare quality can be improved by supportive leadership, proper planning, education and training, and effective management of resources, employees, and processes. If policy-makers and managers intend to improve healthcare services quality, they should apply techniques and tools to operationalise these quality management constructs. However, there are some obstacles that prevent the successful introduction of quality management models. Some of these organisational morbidities are explained below.
Several ministries, organisations, and institutions are involved in the provision of healthcare services in Iran, which make the healthcare system less efficient. They pay differently to their employees. It resulted in a feeling of inequity, de-motivation and dissatisfaction among employees. The quality and tariff of services are also different in these healthcare organisations, leading to patient dissatisfaction. Nationalisation of healthcare services decreases the feeling of inequity among healthcare providers and clients. Many Iranians cannot afford the costs of healthcare services on their own. There are many public and private medical insurance programmes in Iran. A national (Universal) programme of comprehensive health insurance helps to decrease the inequity in access to services for patients.
Successful quality management implementation requires a significant change in mindsets, attitudes, and beliefs of individuals with regard to quality. Teamwork and collaboration should be fostered. Good communication, cooperation, and collaboration among healthcare providers support providing effective and efficient healthcare services, and promote shared responsibility for patient care. In Iranian healthcare, decision-making is centralized, the workforce is not empowered and there is a lack of trust amongst managers and employees. Mistakes bring blame seeking and dismissal and teamwork is thought to be unnecessary. Changing established behaviour and practices of an organisation is not easy (56). Education of the next generation in schools and universities on participation and teamwork concepts and skills, continuous improvement, and customer focus by the national TV or radio, ISIRI, etc. could be helpful. The increasing complexity of healthcare services, treatment options and care pathways requires a more knowledgeable and participative customer to achieve the most satisfactory outcomes. More active informed customer involvement reduces inappropriate use of healthcare services and errors and improves the quality of services through constructive criticism. However, customers lack knowledge about their rights in Iranian healthcare organisations (57,58). The media and education system must play an active role in increasing public knowledge about healthcare services. Customer advocate institutions like the National Council for Quality Healthcare and the patients association should be established at the national level to make sure healthcare organisations are accountable enough in providing high-quality services. Healthcare organisations should also establish a patient relations department to provide patient advice and liaison service.
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