Quality gaps and priorities for improvement of healthcare service for patients with prolonged mechanical ventilation in the view of family

Background: Little is known about the gaps between expectation and the perception of service quality in the care setting of prolonged mechanical ventilation (MV). Methods: We conducted this prospective study at the Respiratory Care Center (RCC) of a medical center from February 2017 to January 2018. Family members of the patients admitted to the RCC completed a questionnaire based on the SERVQUAL instrument in two sections-expectation and perception, consisting of 22 questions each in five dimensions. We analyzed the gaps between paired items, used important-performance analysis (IPA) to identify priority items for improvement, and performed multivariate logistic regression analysis. Results: A total of 167 respondents participated in the survey. The average length of patient stay in the RCC was 19.4 days, and 70.7% were successfully liberated from MV. The overall mean SERVQUAL scores for the two sections were similar (4.50 +/- 0.52 and 4.51 +/- 0.54 for expectation and perception, respectively; p = 0.808). IPA identified four items, including one "tangible," one "reliability" and two "empathy" with an undesired expectation/perception gap indicating a priority for improvement. Multivariate logistic regression analysis showed that male respondents, patients older than 75 years, tracheostomy, and the need for physical training or dialysis were associated with an increased gap in these priority items. Conclusion: Gaps exist between expectation and perception in multiple dimensions of the quality of healthcare service in the care setting of prolonged MV, indicating unmet needs and priorities for improvement. Copyright (C) 2018, Formosan Medical Association. Published by Elsevier Taiwan LLC.