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International Journal of Management (IJM)
Volume 8, Issue 6, Nov–Dec 2017, pp. 33–43, Article ID: IJM_08_06_004
Available online at
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ISSN Print: 0976-6502 and ISSN Online: 0976-6510
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CRITICAL ANALYSIS ON INCLUSION OF
HEALTHCARE QUALITY DIMENSIONS
Varsha Agarwal
Assistant Professor, Jain University, Centre for Management Studies, Bangalore
PhD Research Scholar, Christ University, Bangalore
Dr. Ganesh. L
Associate Professor & HOD (General Management),
Institute of Management, Christ University, Bangalore
ABSTRACT
(Starr, 1982) defined Social Transformation of American Medicine and found that
medicine has disappeared from a supreme profession to a massive industry. For
decades, quality was taken for granted and Institute of Medicine (IOM), 2000 report
showed, up to 98,000 deaths happened per year due to inevitable medical errors. The
Institute of Medicine’s “Crossing the Quality Chasm” report recommended six aims
for upgrading healthcare quality.” Those aims were safety, equity, patient-
centeredness, timeliness, effectiveness, and efficiency. According to India’s 12th Five
Year Plan at present, India’s health care system consists of private sector providers.
Inspite of private providers the Indian healthcare system suffers from many
weaknesses such as quality of health care. This study focuses on the healthcare quality
based on Institute of Medicine’s six aims to assess their relevance with healthcare
quality. This research study was designed as descriptive research study. The closed
ended questionnaire was given to outpatients, inpatients or to the accompanying
persons of 4 hospitals chosen for the study. Location of study was Karnataka. In this
study multistage sampling was used for data collection. Sample size taken was 290. 5
point Likert’s scale was used to collect responses for statement questions. While
taking the IOM reports under consideration, this study has focused on health care
quality aims and analyzed relationship among them in context of private hospitals in
India. Findings of the study revealed that among all healthcare quality dimensions
patient centeredness followed by safety showed highest correlation with healthcare
quality. Hence these were the most important healthcare dimensions where healthcare
providers can focus for healthcare quality improvement.
Key words: Healthcare, Healthcare Quality, Patients, Private Hospitals.
Cite this Article: Varsha Agarwal and Dr. Ganesh. L Critical Analysis on Inclusion
of Healthcare Quality Dimensions. International Journal of Management, 8 (6), 2017,
pp. 33–43. http://www.iaeme.com/IJM/issues.asp?JType=IJM&VType=8&IType=6
Varsha Agarwal and Dr. Ganesh. L
http://www.iaeme.com/IJM/index.asp 34 editor@iaeme.com
1. INTRODUCTION
Health care is the diagnosis, treatment, and prevention of illness, injury, disease and other
types of physical and mental loss in human beings. Healthcare refers to services provided in
primary, secondary, tertiary and public healthcare. In present world, all governments,
healthcare service providers, insurers and patients are involved in a continuous tug of war in
balancing priorities: meeting increased demand of healthcare services, cost reduction of
services and improvement in healthcare quality. (Starr, 1982) defined Social Transformation
of American Medicine and found that medicine has disappeared from a supreme profession to
a massive industry.
From decades there is no clear definition available for quality and it was taken for granted.
It was first revealed by (Institiue of Medicine, 2000), in their report titled “To Err is Human”
and it opened the entire reality of the best healthcare provided by the world. This report
highlighted that 98,000 deaths happened every year was the result of inevitable or preventable
errors. Suddenly quality as well as safety of care provided became a question for everyone.
The main promise of medicine was at risk. To solve this issue of healthcare quality IOM
improved the definition of healthcare quality in context with 21st century‟s healthcare system
and suggested six dimensions of healthcare quality. These dimensions were safety, timeliness,
patient centeredness efficiency, effectiveness, and equitability.
According to (Planning Commission Government of India, 2013) at present, India‟s health
care system consists of private sector providers of health services. Quality of health care
services varies considerably in private sector. Many practitioners in the private sector are
actually not qualified doctors. Private healthcare sector covers entire range from doctors to
clinics, general hospitals, multi-speciality hospitals and super specialty hospitals. But the
system suffers from weakness such as quality of care provided.
(Tandon, Murray, Lauer, & Evans, n.d.) found that France is on number one position in
World Health Organization Ranking of the World‟s Health Systems among total 191
countries of the world and India ranks 112 in world for its health systems. Other countries like
USA, UK, Japan and Bangladesh are ahead of India in this ranking.
Healthcare quality is an important issue. (Institiue of Medicine, 2000) report revealed
44,000 to 98,000 deaths happened because of preventable errors and approximately
1,000,0000 additional injuries each year in U.S. hospitals. Another report (Institute of
Medicine, 2001) found that medication errors were the most common error and harmed 1.5
million patients each year.
A report by (Agency for Healthcare Research and Quality , 2002) found that every year
7,000 patients die because of medication errors and it was 16% more than the predicted
number. Medical errors harm one in ten patients across the world.
(Numbeo, 2015) Presented Health Care Index for 105 Countries where Health Care Index
represents an estimation of the overall quality of the health care system, health care
professionals, equipment, staff, doctors, cost, etc. For survey purpose a scale of 0-100 was
used and according to their findings Japan secured highest score in this health care index with
87.07, whereas other countries‟ scores are as follows: Sri Lanka 74.29, United Kingdom
73.88, United States 67.75 and India 66.86.
(Sinha, Times of India, 2013) found that India records 5.2 million injuries every year
because of preventable errors and other adverse events. Across the world almost 43 billion
Critical Analysis on Inclusion of Healthcare Quality Dimensions
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people were injured sue to insecure medical care. For each 100 hospitalizations 14.2 adverse
events occurred in developed countries and 12.7 in developing and under developed countries.
Above statistics clearly represents the scenario of healthcare quality at global and Indian
level and arises the need to focus on healthcare quality improvement. In review of literature
section all healthcare quality dimensions and their relevance with healthcare quality has been
presented.
2. REVIEW OF LITERATURE
(Institute of Medicine, 1990) provided the most widely accepted definition for healthcare
quality as the degree to which health services for persons or populations increase the
occurrence of chosen health results and are reliable with the existing professional knowledge.
According to “Crossing the Quality Chasm” report published by (Institute of Medicine,
2001) six health care quality dimensions were given. These are dimensions were safety,
patient centeredness, efficiency, timeliness effectiveness and equitability. These dimensions
are helping in providing directions to policy makers, clinicians and healthcare providers to
adopt change and improving healthcare quality.
(Mitchell, 2008) found Patient safety and its importance in health care service quality.
This study revealed the role of nurses in improving healthcare quality in through providing
patient safety is very important. Findings of the study revealed that Patient safety was the
foundation of healthcare quality. (Aspden & Institute of Medicine (U.S.), 2004) considered
patient safety “indistinguishable from the delivery of quality health care. According to IOM
report “Crossing the quality chasm” safety is the basis upon which quality healthcare could be
built.
(Sower, Duffy, Kilbourne, Kohers, & Jones, 2001) Conducted a study on the dimensions
of the service quality for hospitals revealed that effectiveness was come out as the important
factor to improve the healthcare quality in hospitals. A report published by (Aston Centre for
Health Service Organization Resea, 2003) highlighted role of effectiveness in health care
quality and revealed that effectiveness in working processes contributed to the healthcare
quality improvement.
A discussion paper published by (Healthcare, 2010) investigated patient centered care and
improvement in safety and quality by focusing on care for patients and consumers and found
that Patient-centered care necessitated a change in the way policy makers and regulators think
about the quality of health care.
(Kenagy, Berwick, & Shore, 1999) Conducted a study on service quality in healthcare and
revealed that top health care services are increasing speed as well as efficiency of the
processes. By this way healthcare professionals would be able to interact more with the
patients and do not have to waste time in other complex processes. (HOPE Sub-Committee on
Coordination, 2001) studied about waiting time in healthcare and focused on role of
timeliness in healthcare delivery and association with quality could make it more effective.
(Gounaris, 2001) Conducted a study healthcare quality in Greece and studied efficiency
and effectiveness in context of NHS Secondary Health Care Units. Study suggested a model
for hospital operation based on efficiency measurement and responsiveness. (Sower, Duffy,
Kilbourne, Kohers, & Jones, 2001) studied healthcare quality dimensions and included
KQCAH scale for measurement. Findings of the study revealed that efficiency was the
important factor among others for determination of healthcare quality in hospitals.
Varsha Agarwal and Dr. Ganesh. L
http://www.iaeme.com/IJM/index.asp 36 editor@iaeme.com
(Mahadevan & McGininnis, 2013) Conducted a study on improving health care quality
and equity by building partnerships between providers and community organizations. Apart
from daily basis hurdles patients also face transportation problems, low awareness about
health, food scarcity and partnerships with local organisations can help in meeting their needs.
(Akatwijuka & Propper, 2012) Conducted a study on importance of equity in service quality
in health care. Findings of the study shows that introducing consumer heterogeneity where
agents are motivated makes the case for competition more nuanced, even where there is no
patient selection by providers.
3. NEED FOR THE STUDY
There are numerous significant motives why there is a need for inclusive study on healthcare
quality dimensions and healthcare quality. The key reason for this study is nonexistence of
any study on Institute of Medicine healthcare quality dimensions in relation with healthcare
quality for private hospitals in Indian context. There is a strong need to study for private
hospitals in Indian context with inclusion of healthcare quality dimensions. This study has
followed patient centric approach to understand the relationship among healthcare quality
dimensions. Hence, this study will have greater practical significance. The present study
therefore, aims to fill the gap in the in healthcare literature by reporting understandings gained
in an extensive study.
4. STATEMENT OF THE PROBLEM
Statistics presented above reflected India‟s extremely low rankings in healthcare quality index
and in various other healthcare parameters at global level and increased number of deaths due
to various medical errors has become an important problem. Hence providing quality in
healthcare has become priority. Low quality leads to dissatisfaction among patients. In this
study healthcare quality on the basis of IOM healthcare quality dimensions has been studied.
This study included patients‟ responses regarding healthcare quality dimensions at private
hospitals in Karnataka, India.
5. OBJECTIVES OF THE STUDY
The main objective of this study is to critically analyze inclusion of healthcare quality
dimensions.
Following are objectives of the study.
To analyze the important factors responsible for selection of hospital
To find the relationship among health care quality dimensions (safety, patient centeredness,
timeliness, effectiveness, efficiency and equitability) and healthcare quality.
To provide the suggestions for healthcare providers, policy makers, customers and others to
improve the health care quality in Karnataka, India.
6. HYPOTHESES
Following is the hypotheses for this study:
H1: Health care quality dimensions has a relationship with healthcare quality.
7. RESEARCH METHODOLOGY
This research study is a descriptive research. Primary data was collected from respondents
using structured questionnaire. A closed ended questionnaire was given to outpatients,
inpatients or to the accompanying persons of 4 hospitals chosen for the study on the basis of
highest ranking obtained by them in terms of number of beds. These hospitals were Fortis
Critical Analysis on Inclusion of Healthcare Quality Dimensions
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Health care, Apollo Hospitals, Manipal Hospitals and Narayana Health. Secondary data was
collected using websites, journals, books, reports, news etc. Sampling element was the patient
and patient party. Location of study was Karnataka. (V, 2012) found that Karnataka was
performing as better state in the country. Karnataka has surge of funds and therefore can
direct more resources for private healthcare. Findings revealed that Karnataka was leading
state in healthcare system reforms in India. In this study multistage sampling was used for
data collection. For this study sample size taken was 290. From each hospital equal number of
responses were collected randomly to avoid any unrepresentativeness. Primary data was
collected from patients and patient parties. To collect data from patients and patient parties,
questionnaire was administered. In total 300 questionnaire were given for data collection. Out
of which 290 were finally used for data analysis. The Questionnaire contained mainly three
parts. Part one was for capturing demographic details of respondents. Second part of the
questionnaire contained important statements related selection of hospital. In the end third
part was carrying statements related to healthcare quality dimensions (Safety, Patient
Centeredness, Effectiveness, Efficiency, Timeliness and Equitability) and healthcare quality.
5 point Likert‟s scale was used to collect responses for statement questions.
8. STATISTICAL ANALYSIS IN THE STUDY
The statistical tools used for data analysis in the study were: Frequency tables, Factor analysis
and Correlation Analysis. Frequency tables were used to analyse the demographic details of
respondents. Factor analysis was used to extract important factors responsible for selection of
hospitals. Further correlation analysis was used to find relationship among healthcare quality
dimensions and interrelationships among them.
9. ANALYSIS AND INTERPRETATION
9.1. Demographic Profile of Respondents
Table 1 gives information about gender, marital status, age, education, occupation and income
of respondents. Out of total 290 respondents majority 62.06% respondents are male followed
by 37.93% female. Most of the respondents 55.17% were single. Among all respondents
majority 20.68% respondents were 61 years above. 34.48% respondents were graduate in
total. Table 1 represents that most of the patients going for private hospitals were above 61
years old, educated and belonged to high income group. Hence private hospitals are the
preference for almost all kind of treatments and also related to patients‟ affordability. Private
hospitals have the opportunity to target all age groups and different income groups which will
help them to increase their market share and service more number of patients. They can adopt
specific pricing strategies to attract more number of patients for different types of treatments.
Table 1 Demographic Details of Respondents
Gender
Frequency
Percent
Male
180
62
Female
110
38
Total
290
100
Marital Status
Frequency
Percent
Single
160
55.2
Married
120
41.4
Divorced
5
1.7
Widow
2
0.7
Separated
3
1.0
Total
290
100
Age in years
Frequency
Percent
Below 20
30
10.4