| The recent Ghanaian population is around 32,268,187.The population of Ghana is just 0.4%of the total world population.Kumasi,the place where the data was collected for this research,is an urban area in Ghana.The urban area in Ghana,of which Kumasi is part,has around 56.1%of Ghana’s population.The metro area of Kumasi as of 2021 could boast of a population of 3,490,000.This represents an increase from 2020.In 2020,the metro population of Kumasi was around3,348,000,which is a 4.43%increase from 2019.Kumasi that has had this increased population for the past years can currently claim over 530 healthcare facilities,of which the Ghana Health Service operated 170.The mission hospitals also operate about 71 of these healthcare facilities.Private individuals or organizations operate about 281 private hospitals in Kumasi as shown in the Ghana Health Service report of 2021,which showed a relatively low number of about 43 private hospitals in Kumasi in the 2008 Kumasi Metro Health Directorate report.The increase in the number of private hospitals in recent times has had a negative effect on the retention of patients in Kumasi.This is because there is no improvement in the delivery of quality health services.This does not encourage a patient to go to the same hospital for the second time.The problem with many private hospitals lies in the fact that they are established for-profit and for that matter,they concentrate so much on profit margins without actually focusing on quality health delivery.The overall deduction is that even though there is a considerable upsurge in the number of private hospitals in Kumasi,however,there is a steady decline of about 20-25%in patient retention due to poor delivery of health services.Researchers have used different models in determining the dimensions of service quality delivery at healthcare facilities that can lead to patient retention but none of them has proven to be effective.One such model used in measuring service quality delivery at hospitals was the HEALTHQUAL model that comprises five factors.These factors include empathy,safety,tangibility,improvement of care,and efficiency.What could be deduced from this previous model is that it focused mainly on quality health delivery in respect of a particular health facility.Available studies reveal that the HEALTHQUAL Model has many flaws,which do not ensure a great improvement in the delivery of quality service to warrant retention of patients.It is against this background that this research seeks to improve upon this existing model by developing the EXPANDED HEALTHQUAL Model,which is the main focus of this paper and has the propensity to create an avenue,which would ensure that there would be an appreciable level of quality delivery of health services regarding the private hospitals in Ghana that would lead to patient retention.The EXPANDED HEALTHQUAL Model adds two important dimensions,which include Corporate Social Responsibility and collaborative networking.These two factors can retain patients because the communities within the Kumasi enclave premise their judgment of service quality delivery on the relationship between the private hospitals and the community.Patient retention is also dependent on the relationship between a private hospital and other healthcare facilities.The EXPANDED HEALTHQUAL Model has been put into two mechanisms that are the intrinsic mechanism of service quality(IMSQ),which is made up of apathy,safety,improvement of care and efficiency,and extrinsic mechanisms of service quality(EMSQ)that entail tangibility,corporate social responsibility and collaborative networking.This has led to the proposition of this research study that seeks to determine the expectations and perceptions of patients through the EXPANDED HEALTHQUAL model in determining the dimensions of intrinsic and extrinsic mechanisms in service quality delivery and its impact on patient retention in Ghana,specifically Kumasi.This study also proposes the mediating role of trust and patient satisfaction in the relationship between service quality delivery and patient retention.Furthermore,this research seeks to determine the moderation effect of price/charges on the relationship between IMSQ and patient retention.Lastly,the moderating effect of effective treatment between the relationship of EMSQ and patient retention was also examined.The main objective of this study is to analysis the intrinsic and extrinsic mechanism of the EXPANDED HEALTHQUAL model of quality service delivery,its impact on patient retention and the mediating role of trust and patient satisfaction in private hospitals in Ghana.This study will also explore the moderating effect of charges/price and effective treatment.This is a cross-sectional descriptive survey of a quantitative study;that is,a mixed-social survey where the researchers translated the research problem into questionnaires using the Healthcare Service Quality Scale(HCSQS)instrument with 57 items which include four demographics.The researcher adopted five-point Likert scales that express how much a patient is satisfied or dissatisfied with a particular statement in the questionnaire.The study also adopted judgment sampling in selecting the four private hospitals,while on the other hand;a simple random sampling technique was used in the selection of 880 respondents from the four sampled private hospitals.The researcher analyzed the answered questionnaire using Statistical Package for Social Science(SPSS version 23)and Partial Least Square Structural Equation Modeling(PLS-SEM)Software.The researcher adopted a two-way approach in assessing the results:assessment of the measurement model,and assessment of the structure model.To examine the relationship between the latent variables and their measures,the internal consistency reliability,convergent and discriminant validity were tested.Results for constructs reliability and validity showed that most of the dimensions for both intrinsic and extrinsic mechanisms,trust,patient satisfaction,charges/price,effective treatment and patient retention had Cronbach’s alpha values higher than 0.7,except construct,tangibility which had Cronbach’s alpha values of 0.794.Additionally,the composite reliability values for all the constructs were greater than 0.7,except for patient satisfaction and trust which has composite reliability values of 0.667and 0.659 respectively.Convergent validity was evaluated for the model by using an average variance extracted(AVE)and the factor loadings of the constructs,which revealed AVE values were greater than 0.50 for almost all the constructs,in terms of the factors loadings,all items under the various constructs had values above 0.50.Results of the discriminant validity of the model were evaluated using the Fornell&Larcker criterion,Heterotrait-Monotrait Ratio of correlation(HTMT)and Cross Loadings.The square root of the AVE of the constructs was greater than their correlation with other constructs and the diagonal elements were also larger than the entries in the corresponding columns and rows thus,satisfying the criterion discriminant validity.This study revealed an HTMT value that is less than0.9,which reflects that the discriminant validity of constructs has been established.The various hypothesis posited were tested using the structural model to identify the relationships between the constructs in the research model.Path coefficient(β),coefficients of determination(R~2values),and predictive relevance(Q~2values)were used to test the strength of the relationship between the dependent and independent variables.In path analysis and structural equation modeling,a path coefficient is the direct effect of a correlation coefficient between the dependent variable and an independent variable,adjusted for another independent variable.Path coefficient analysis results show that the relationship between IMSQ→PR constructs was not supportive and it was revealed that the study had a Beta of-0.051 and a p-value of 0.195 indicating a weaker relationship between those two constructs.The results of the model also found that the relationship between EMSQ→PR had an of Beta 0.367 and a p-value of 0.000 that showed a statistically significant relationship.This explains that the good implementation of tangibility,corporate social responsibility and collaborating networking in a private hospital will promote patient retention.In determining the mediating role of trust and patient satisfaction in the relationship between service quality and patient retention,this study revealed that trust mediates positively between the relationship between extrinsic mechanisms of service quality and patient retention.The mediating role of trust has a negative effect on the relationship between the intrinsic mechanism of service quality and patient retention with an indirect effect of 0.025.Again,the mediating role of trust does not support the relationship between the extrinsic mechanism of service quality and patient retention with an indirect effect of 0.007.On the other hand,patient satisfaction mediates positively the relationship between the intrinsic mechanism of service quality and patient retention with an indirect effect of 0.289 and a p-value of 0.00.Furthermore,the mediating role of patient satisfaction does support the relationship between the extrinsic mechanism of service quality and patient retention with an indirect effect of 0.293 and a p-value of0.000.Results for the moderating effect of price/charges on intrinsic mechanism service quality and patient retention showed Beta 0.142 and p-value<0.000 thus,was significant,suggested that charge/price and for that matter the use of health insurance play a major role in retaining most of the patient who comes to these private hospitals for treatment.Again,the moderating effect of effective treatment on EMSQ and patient retention showed Beta-0.098 and a p-value<0.000 thus,support,also suggested that to retain most of the patients at the private hospital,hospital management should ensure that staff provide effective treatment.This study will equip private hospital administrators,healthcare policymakers,government agencies and other bodies with a valuable model for examining healthcare quality delivery on the use of the EXPANDED HEALTHQUAL model.This study will help policymakers and hospital administrators at private hospitals to know the areas to improve,and where they need to prioritize.It has been proven in the study that health quality services may not have any stronger impact on patient retention if proper policies are not made regarding the confidentiality of patients’information at private hospitals,most of the patients who visit the hospitals for treatment may not be retained.The study has suggested that if patients are provided with the needed healthcare quality delivery,they will be satisfied,and ultimately,most of the patients would come back to the same hospital when they need medical treatment.To get well-recognized healthcare for all,especially,people in third world countries like Ghana,this study has suggested to health policymakers and Ministries of Health(Mo H)in these countries to base their approval on giving accreditation to newly established private hospitals and healthcare centers based on the health quality service of the EXPANDED HEALTHQUAL model.Lastly,the outcome of this study has enriched the literature in this area and created an important awareness that will initiate further research,especially in developing countries. |
PDF Full Text Request