Quality of medical services

Medical service is a complex process that consists of medical examination, consultation, treatment and the aspects which cannot be noted tangibly. The aim of the service is to meet the properly determined needs of the customer, which should always be clearly defined. The problem, however, is the fact that the client reports to the medical facility with his subjective feelings which should be defined by the professional medical staff in terms of needs (necessary for the implementation of the actions improving the patient’s condition). It is an extremely important moment, because properly defined, necessary medical activities, presented to the patient or his authorized relatives, will be the object of the customer satisfaction evaluation during the further stages of the therapeutic-diagnostic process. If, at the very beginning, a doctor, a nurse or other member of the medical staff defines clearly all the necessary activities to the patient, he will observe and evaluate them. If a patient as the client does not receive information about the actions of the medical staff, he will not be able to make an objective assessment but he will subjectively express his concerns, sense of chaos, lack of sensitivity and coherence. The whole service, despite its effectiveness and substantive advantages, may be assessed negatively in the eyes of the patient since he has not felt an important part of the process whereas he should be its subject.

Medical service

In evaluation of the service, it is important for the customer to be satisfied which means the product meets the his expectations. Satisfaction is the variable and elusive experience so the assessment of the service is very subjective. Medical service is a health benefit, “which aim is to maintain, restore or improve the health together with other medical actions resulting from the treatment process or separate laws regulating the rules of their implementation” [the law of 15 April 2011].

Medical service is specific because of the insecurity and risk connected with the medical needs [Detyna 2011]. “In health care services, the offer is a declaration (identified with a particular contractor) readiness and willingness to reduce the sense of insecurity of the patient in the area of his health” [Bukowska-Piestrzyńska 2009]. Medical services differ in terms of the possibilities of using them, because every Polish citizen has the right to use financial benefits covered by the state budget if he has health insurance. The nature and number of the services in particular facility is often dictated by the terms of its contract with the National Health Fund. The demand for certain benefits is large and for certain – small. That is why the role of management is to match the range of services to the local market so the number of patients in need of treatment was as big as possible. The local market should be monitored in terms of morbidity and prevalence as well as epidemiological data and statistics of the population on a given area. For both residents and medical institutions it should be important to look for the niches and implement services in the field of health care. These niches can result from demographic changes as well as previously unrecognized needs of the community for medical care. The examples might be the growing population of the obese youth, a group of patients suffering from diabetes and its complications (particularly type II diabetes), as well as lower demand for specialized pediatric health care in small centres due to the small population growth, etc.

The quality of service depends on the staff

A doctor should support the patient, he specifies the treatment, decides what will bring greater advantages to the patient (is his agent). If the patient’s condition is so serious that he cannot make independent decisions, in the ideal situation it is a medic who makes decisions taking the best benefits, payment preferences and time into account. The role of the agent might lead to a conflict of interest, because the doctor as an entrepreneur also runs a business and his goal is to maintain high demand for his services. In some cases, a doctor may encourage his patient to use health benefits excessively, which does not improve the patient’s condition, but only boosts the profits of a doctor; in this way, a doctor has the possibility to take advantage of the patient, in order to increase his profits. Such phenomenon is called supply-induced demand and is not desirable in medical care facilities [Dobska 2008]. The demand is accompanied by the asymmetry of information between a healthcare provider and patient. The doctor uses a specific language, in contact with which the patient is illiterate.

In the study, it has been found that 75% of patients want to be informed about their health condition, regardless of whether this information is positive or negative, 91% of respondents want to know the diagnosis of the disease, 97% of patients want to know what are the next steps in the treatment process. A patient remembers 30% of the information provided by the doctor. To sum up, the physician should provide the most important information to the patient and his family (both positive and negative) [Laskowska and  Tulińska 2006]. In Poland the National Health Fund  is a monopolist in the market of payers for medical services from the public funds. The type of service depends primarily on the availability of medical staff (doctors, nurses, hospital porters,  medical attendants), specialization of doctors, as well as infrastructure, socio-technical facilities, supply of medical surgeries and operating rooms, sanitary requirements obeying. Compliance with the law and safety standards is inherent in the provision of medical services.

Various factors affect the quality

The service is not the product of a specified size, it is a variable, and intangible product. In medical practice, certain part of the services requires the presence of the client (the operation), while part of the service can be made from a distance or indirectly, telemedicine or the extension of drug therapy through the prescription writing.

Impermanence of the service disenables buying it in advance, as well as the quality of implementation depends on the potential of employees and their involvement [Bukowska-Piestrzyńska 2009]. The realization of the service is undurable and meets the needs of a patient only for a limited time, depending on the attitude, examination findings, genetics, lifestyle and underwent illnesses. Treatment techniques are changing. The service, despite the same name and description of the procedure, may be different due to the knowledge and experience of a particular doctor, the use of available technology and also because of the patient and the cultural conditions.The service cannot be sold ahead, because it is consumed at the time of the performing, it consists of both intangible and tangible elements, and it is one-of-a-kind, since each time it is performed differently. There exist many factors that influence a particular service: patient’s feelings and mood, his attitude towards the doctor, the opinions about the medical facility and general information about the treatment, awareness of the possible complications, as well as the stress associated with the service realization and uncertainty about the effectiveness of the service. From the doctor, the service will vary, too, because each man is an individual of different characteristics to which you need to adjust the program of the service. The procedure can be one, however the way of realization can be totally different.

To sum up “the provision of medical care is one of a kind due to the attention which everybody pays to the health and its loss and the market of medical services is different from all other markets of goods and services because the value of the individual and social health is one of the most important issues” [Bukowska-Piestrzyńska 2009].

The quality of service is an important aspect of management in the medical industry. The quality in Latin is ‘qualitas’ so  ‘a certain degree of excellence’ [Detyna 2011]. J. Oakland claimed that “quality as all the other complex issues needs to be constantly subject to observation in the light of the ongoing changes” [Detyna 2011]. Starting from quality, one should be careful not to commit one of the most common mistake, that is, defining quality in a way, which will be convenient for the company, but will not match the expectations of the client [Blikle 2011].

The ambiguity in understanding of the quality has let us to choose the most appropriate definition of the health services. According to “A guide for quality assurance in the hospital” there is an area of benefits “where the quality of the medical facility activity is the sum of the qualities of particular benefits” what allows to compare the quality assessments of several sectors or wards of the hospital.

Another perception of quality is the one perceived by the patient, according to his own experiences – a subjective perception [Dobska 2008]. External client-can assess the quality of medical services in relation to simple determinants – the actual features like: surgery time, waiting time, a sense of security and by the illusory characteristics such as: the environment in which the patient finds himself i.e. the building of the medical facility (generally speaking, infrastructure), access to the hospital, conversation with the staff – a receptionist and a doctor, the appearance of the employees and also the possibility of consultation for the patient’s family and reliability so the assurance that the service will be provided in agreed time. Each person reacts differently to therapy, and the effects of the therapy also vary, there is no 100% certainty to the techniques and methods of the treatment, so the reliability of the service is very subjective. A very important issue in medicine is the responsibility for the treatment process and examination using the medical competence and experience. A patient by choosing a particular medical facility shall aim at the sum of the service benefits [Detyna 2011].

The concept of quality in health services in Europe began to evolve in the second half of the 1980s [Dobska 2008]. Quality management is about taking actions to improve the quality of health benefits. It is based on the analysis of the health services quality, considering the opinions of the patients-customers on this topic, searching for effective and efficient methods of quality management. Quality provision is a certain philosophy of work that determines the activities in cases of any inconsistency, adverse events or mistakes since the medical processes, expenditures and time devoted to a patient are permanently monitored. Quality assessment is a detailed research on the quality of service, medical treatment and the effectiveness of the treatment. The tools that can be used are: patient satisfaction surveys, employee satisfaction surveys or direct interviews which will bring more information than mere filling out the survey [Dobska 2008].

To effectively work on the quality of medical services improving, you need to know the characteristics of the services and characteristics of the medical entities. The character of the medical service is the fact that it does not have a physical standard for evaluation. Quality consists of a  certain degree of customer satisfaction and the fulfilment of his conscious and unconscious needs – the client will be satisfied when the quality of the actual and expected service is the same. According to Taguchi, quality is a loss handed over to the community, the lower is this loss the higher is the quality. Since time when some medical institutions were privatised, the increase in quality, as well as in the expectations of patients have been noted. This is the trend in the world economy –  progress in product, technical and process innovations, new legislation such as the sanitary-epidemiological requirements, pharmaceutical progress, the rights of a patient, safety of data, the requirements of the payer (in Poland this is the National Health Fund, which works according to the Law of 27 August 2004, on the benefits of health care), the regulations on civil liability for quality of services and products. When the borders of the European Union have been opened, more residents migrated to other countries for medical purposes: to undergo a surgery, use the services of a dentist, be dialyzed. The experience of patients, awareness of other offices, hospitals and medical equipment condition, have made the customer conscious of the possible quality and he has experienced it once he now requires care on the same or even higher level of quality. In 2011  approximately 300 thousand. foreigners have benefited from medical services of a total value of 800 million PLN [OSOZ 2012].  Medical facilities are convinced that good quality improves the image of a company, improves its reputation, increases competitiveness in the local market. Work on the quality of medical services is a long-lasting process, whose effects are not immediately visible and sometimes they are intangible but still can be noticeable.

“No improvement can almost immediately be a real improvement, it becomes so only after certain time from the practical application” [Martyniak 2002].

The medical unit is trying to eliminate weak points, to improve quality standards and to mind reducing the costs of quality. It is important to collaborate with the staff, its motivation and awareness that poor quality costs more than good one. According to Edward Deming, work should be properly done “in the first place” so the staff should contribute to the reducing of the costs and to the quality by solid work taking the law, requirements and ethic into account. Such an attitude can reduce the number of complaints, boost the patient’s satisfaction and to improve the possibilities to extend the National Health Fund contract for medical services.

1. The law of 15 April 2011 about the medical services, Dz.U. 15 February 2013, nr 217
2. Detyna B., Detyna J.: Jakość Usług Medycznych, Ocena statystyczna Podstawy metodyczne, Warszawa 2011, Delfin
3. Bukowska-Piestrzyńska A.: Pozytywna atrybucja usług zdrowotnych, University of  Łódź 2009, http://uslugi.ue.poznan.pl/file/129_237561536.doc,
4. Dobska M., Rogoziński K.: Podstawy zarządzania zakładem opieki zdrowotnej, Warszawa 2008, wydawnictwo naukowe PWN
5. Laskowska E., Tulińska M.: Jakość relacji lekarz- pacjent i jej wpływ na proces zdrowienia in: Miscellanea, Neuroskop 2006, nr 8, pp 163-166
6. Blikle A.: Doktryna Jakości, Warszawa 2011, http://www.firmyrodzinne.pl/konwersatorium-tqm/doktryna-jakosci.html
7. Martyniak Z.: Nowe metody i koncepcje zarządzania, Kraków 2002, Wydawnictwo Akademii Ekonomicznej w Krakowie