Calidad percibida del cuidado hospitalario

Mira Solves, J.J.; Buil Aina, J.A.; Rodríguez-Marín, J.; Aranaz Andrés, J.

doi:10.1016/S0213-9111(97)71296-2

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Resumen

Fundamento

SERVQUAL ha sido introducido en el sector sanitario como alternativa a las encuestas de satisfacción del paciente. SERVQUAL es uno de los cuestionarios más utilizados para medir la calidad percibida por los clientes de empresas de servicios dentro del denominado paradigma de la desconfirmación (diferencia entre expectativa y percepción del servicio). Pese a su pretendida utilidad no se ha estudiado la estructura, validez y fiabilidad de este cuestionario en el medio hospitalario de nuestro país.

Métodos

Este trabajo se diseñó con tres objetivos: 1) analizar la estructura factorial del SERVQUAL; 2) determinar la capacidad predictiva de las diferentes puntuaciones que de él pueden obtenerse (escala de percepciones, de expectativas, y diferencia entre expectativas y percepciones); 3) validar una versión del SERVQUAL adaptada al medio hospita lario (a la que denominamos SERVQHOS). Se diseñó un estudio descriptivo basado en encuestas con análisis multi-variante de los datos. Se entrevistó a 826 sujetos que habían sido atendidos en los hospitales de Alicante, Elche y Elda de la provincia de Alicante.

Resultados

La estructura factorial en cinco dimensiones del SERVQUAL no pudo ser confirmada. La escala de percepciones reunió mayor capacidad predictiva que la derivada de la puntuación de la diferencia entre expectativas y percepciones. Se identificaron cuatro factores en SERVQHOS (56% de varianza explicada). Alfa de Cronbach de 0,87, coeficiente Spearman-Brown 0,77. La escala de percepciones SERVQHOS mostró una mayor capacidad predictiva que las puntuaciones derivadas de la diferencia entre expectativas y percepciones con respecto a los criterios «satisfacción del paciente» (55% de varianza explicada) y «¿es recomendable el hospital?» (76,36% de clasificaciones correctas con respecto a los niveles de respuesta del criterio).

Conclusiones

El empleo de SERVQUAL requiere de un proceso de validación previo. En este sentido, SERVQHOS ha demostrado índices psicométricos adecuados, si bien algunos de los problemas metodológicos atribuidos a las mediciones basadas en SERVQUAL han quedado patentes, la principal que el valor predictivo de la escala de percepciones de la experiencia del servicio fue superior al de la magnitud de la diferencia entre expectativas y percepciones.

Palabras clave:

Calidad del Servicio

Calidad Percibida

Satisfacción del paciente

SERVQUAL

Summary

Introduction

SERVQUAL has been introduced in the healthcare sector as an alternative to the patient satisfaction measures. SERVQUAL is one of the most used questionnaires to measure the customers’ perceived quality. It is based on the disconfirmation paradigm (expectations-minus-perceptions). However, the structure, validity and reliability of this questionnaire have not been assessed in the Spanish hospital context.

Methods

Three main targets defined in this study: 1) analyze the SERVQUAL's factorial solution, 2) determine which of its scales (perceptions, expectations, and expectations-minus-perceptions) has higher predictive efficiency, and 3) develop a new version for hospital setting (which was called SERVQHOS). A descriptive study based on surveys with multivariate analysis of data was conducted. Eight-hundred-twenty-six subjects were interviewed. All were attended in the Alicante's, Elche's, or Elda's hospital.

Results

A five-factor solution of the SERVQUAL was not corroborated. The perceptions scale obtained a higher predictive efficiency than expectations and expectations-minus-perceptions scales. Four factors were identified using SERVQHOS (56% explained variance). Perceptions-SERVQHOS gathered a greater predictive capacity that the scores derived from the difference among expectations and perceptions. This result was obtained in both criteria: patient satisfaction (55% explained variance) and whether the respondents would recommend the hospital (76,36% right classifications with respect to response levels of the criterion).

Conclusions

Before using SERVQUAL is highly recommended to realize a validation procedure of this questionnaire. SERVQHOS has shown adequate reliability and validity. However, there were some methodological problems using it. The most important inconvenience was that perceptions' scores showed greater predictive capacity than expectations-minus-perceptions.

Key words:

Service quality

Perceived quality

Patient satisfaction

SERVQUAL

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