Background to the Study
The ability of health institutions to continue and survive in the market depends on their ability to respond to the requirement of change and interact with the output of it. As the patients’ needs are shaped and formed in the light of their economic and societal conditions, there is a close relationship between the health institutions’ ability to continue and survive and their ability to provide service that fit in with the increasing and changing need of the patients.
Quality service is a means to establish, maintain and enhance relationships with customers and other partners, at a profit so that the objectives of both parties are met (Dhar & Kushwar, 2009). Ragavan and Megeh, (2013) stated that quality service as perceived by customers definitely indicates what was left of their previous perception of the service quality and the level of their satisfaction with the current performance of service. This means that satisfaction is an intermediary factor between the previous perception of the service quality and the present perception of it. Within this general framework, customers can assess the service actual quality provided to them. Hence, the customer’s satisfaction with the actual performance level of service has an impact on the formation of the customers’ perception of service quality. Once service is purchased, satisfaction becomes a major approach to the process of assessing service quality. Kimanzi, (2014) observed that service quality unlike product quality, is more abstract and elusive, therefore difficult to evaluate and measure. He also stated that quality in healthcare may comprise of newer technology, newer and effective medication, and higher staff to patient ratios, affordability, efficiency and effectiveness of service delivery. In the United States of America for instance, in the healthcare industry, service quality has become imperative in providing patient satisfaction, loyalty and financial profitability of service business. In healthcare service, quality can be broken down into two quality dimensions: technical quality and functional quality (Dean & Lang, 2008). While technical quality in healthcare sector is defined primarily on the basis of the technical accuracy of the medical diagnoses and procedures or the conformance to professional specification, functional quality refers to the manner in which the healthcare service is delivered to the patients.
Professional healthcare providers play a vital role in the provision of healthcare globally. In most of the European countries, the performance of healthcare workers including professional nurses, link closely to the productivity and quality of care provision within health care organizations. According to Kimanzi, (2014), in Latin America, human resource or the health workforce are the most important assets of the health system. There are many complex reasons for deterioration of health system in the African region; however, the main cause is the neglect of the health workforce (High Level Forum in MDGs 2009). Insufficient health personnel, in terms of number and level of performance, are one major constraint in achieving the millennium development goals (MDGs) for reducing poverty and diseases. (High Level Forum in MDGs 2009).
Quality healthcare is a subjective, complex and multi-dimensional concept. Mosadeghrad (2013) defined quality healthcare as “consistently delighting the patient by providing efficacious, effective and efficient healthcare services according to the latest clinical guidelines and standards, which meet the patient’s needs and satisfies providers”. He believes that quality healthcare is “providing the right healthcare services in a right way in the right place at the right time by the right provider to the right individual for the right price to get the right results”.
Many countries in sub-Saharan Africa are unable to provide adequate quality and coverage of health services because of economic factors and dwindling resources. This has prompted many countries to advocate for decentralization as a key factor to drive health sector reforms with a view to maximizing the use of available resources in improving access and quality of health care services provided.
Healthcare provision in Nigeria is a concurrent responsibility of the three tiers of government in the country (the Federal, State and Local government). The government health service is supplemented by privately owned and operated hospitals and clinics. Research in healthcare service quality is vital to ensure a high quality of care and patient satisfaction and to maximize the benefit of scarce resources. A central goal of healthcare quality improvement is to maintain what is good about existing healthcare system while focusing on the areas that need improvement. Improving the quality of care and reducing medical errors are priority areas for the Agency for Healthcare Research and Quality (Agency for Healthcare Research and Quality, 2015). Quality is considered as the cornerstone of success for any business, as it is a key factor for the sustainable competitive advantages (Tabassum, Rahman & Jahan, 2012). However, research results are still limited in determining the factors associated with patients’ satisfaction which is crucial for public healthcare providers in order to understand what is valued by patients, how the quality care is perceived by healthcare professionals and to know where, when and how service changes and improvement could be made. It is therefore necessary to empirically investigate factors influencing the provision of quality service in a public health sector such as Federal Medical Centre Yenagoa, Bayelsa State, Nigeria.
Statement of Problem
Healthcare and quality are inextricable, therefore to provide healthcare without concern to quality is unprofessional and potentially deadly, (Adindu, 2010). According to Kimanze, (2014), provision of health services in hospitals lack the priority it should enjoy in relation to staff commitment, provision of required materials and equipment, technology and communication channels which translate to other health service delivery. There is a growing concern about the poor quality of health services rendered to the population, even though the Ministry of Health Policy advocates for improved quality of services to be provided at health facilities in the country. For instance in Federal Medical Centre Yenagoa, the researcher has observed poor customer care resulting in adverse patient outcomes, such as development of pressure ulcers/bed sore, wound breakdown and long waiting time / hospital stay. For instance, in postnatal ward, from January to June 2014 more than 60 wounds out of 340 caesarian sections were infected/ broken down leading to long hospital stay (post natal ward records, FMC Yenagoa); in Intensive Care Unit,12 out of 22 admissions died within February and June 2014(ICU admission and discharge records, 2014).Other problems include cancellation of booked/ elective surgeries in the theatre, missing patients clinical records leading to poor access to previous history resulting to medical errors; lack of basic amenities (such as light, water, and medical consumables) making the work environment un-conducive for both the care providers and patients. From management perspective, new units are created without recruiting required number of staff in the hospital leading to increasing workload. Determining factors associated with patients’ satisfaction is critical for public healthcare providers in order to understand what is valued by patients, how the quality of care is perceived by the healthcare providers and to know where, when and how service changes and improvement could be made. It is therefore necessary to empirically investigate factors influencing the provision of quality services in Federal Medical Centre Yenagoa, Bayelsa State, Nigeria.
Purpose of the study
The main purpose of this study is to investigate the factors influencing provision of quality services in Federal Medical Centre, Yenagoa, Bayelsa State.
Objectives of the Study
The objectives of this study are to:-
- examine the influence of personnel on quality service delivery in Federal Medical Centre, Yenagoa, Bayelsa State.
- determine the influence of financial resources on quality service delivery in Federal Medical Centre, Yenagoa, Bayelsa State.
- identify the organizational factors that influence the provision of quality service delivery in Federal Medical Centre Yenagoa, Bayelsa State
- determine the influence of application of Modern Technologies on quality service delivery in Federal Medical Centre Yenagoa, Bayelsa State
The study will be guided by the following research questions:
- What is the influence of personnel on quality service delivery in Federal Medical Centre Yenagoa, Bayelsa State?
- How do financial resources influence quality service delivery in Federal Medical Centre Yenagoa, Bayelsa State?
- To what extent do organizational factors affect the provision of quality service delivery in Federal Medical Centre, Yenagoa?
- What is the influence of application of modern technology on quality service delivery in Federal Medical Centre, Yenagoa.
Significance of the Study
The findings of this study will enable the hospital management to know the importance of employee capacity and human resource management on quality healthcare, ensure adequate staffing, motivation and effective monitoring of staff to meet required professional standard of healthcare. It would also help to improve job satisfaction among staff in public hospitals and as a result there will be better health and less death rate.
It would enable the management of the hospital to ensure sufficient allocation/equitable distribution of fund to departments, provide proper control mechanisms to curb corruption and mismanagement of funds.
The findings would enable management to ensure provision of adequate facilities/material/human resources, imbibe proper maintenance culture and create a safe and conducive working environment for both staff and consumers to influence quality healthcare.
It will make the management to see the need to adopt/ invest on modern technologies, ensure that staff are adequately trained in the use of ICT, electronic health record system in order to facilitate effective and efficient health care.
The study will serve as a source of secondary data for future research to students who intend to carry out a study on factors that influence provision of service quality in public health sector in Nigeria. Furthermore, the research findings will provide a means of bridging the knowledge gap in the area of quality service delivery in the public health sector thereby contributing to the existing body of knowledge.
Scope of the Study
This study is to examine the factors that influence the provision of service quality in Federal Medical Centre, Yenagoa, Bayelsa State. The study is confined to the health professionals (Nurses, Doctors, Pharmacists, Laboratory Scientists, Information Technologists/Medical Record Officers) in Federal Medical Centre, Yenagoa, Bayelsa State. The variables being considered in the study include influence of personnel, organizational factor, financial resources and application of modern technology.
Operational Definition of Terms
Quality Service Delivery: quality Service Delivery refers to service provided according to the latest clinical guidelines and standards, which meet the customers (patients) need and satisfies providers.
Factors Influencing Provision of Quality Service: refers to the variables that enhance or hinder provision of quality healthcare services. They include: organizational factors, personnel factors, financial factors and the influence of application of modern technologies.
Influence of Personnel: refers to the availability, quality and quantity of health professionals required to provide care in F.M.C. Yenagoa.
Influence of Financial Resources: refer to availability of funds, nation’s economy, financial planning, costing system, corruption, etc., that affect provision of quality care.
Healthcare Professionals: refers to doctors, nurses, pharmacists, laboratory scientists/technicians and information technologists/ medical record officers, etc.
Organizational Factors: refer to factors in the hospital organizational set up that affect healthcare delivery. Such factors include provision/ management of resources (man, materials and money), non-recruitment of staff, management policies, the physical hospital environment, mentainance culture etc.
Modern technologies: these refer to current ways or methods used in the delivery of healthcare services which meets patients need and care provider’s satisfaction. They include the electronic health record system, current information & communication technologies, telemedicine, laparoscopic surgeries, etc.