Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346) ORIGINAL ARTICLE Patients’ Expectations and Perceptions of Services Provided by Primary Health Clinics in Kota Bharu, Kelantan, Malaysia Ahmad Badruridzwanullah Zun1, Mohd Ismail Ibrahim1, Anees Abdul Hamid2 1 Department of Community Medicine, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan. 2 Kelantan State Health Department, 15590, Kota Bharu, Kelantan ABSTRACT Introduction: Primary health care plays an important role in healthcare systems. In Malaysia, One (1) Malaysia Clinic (now known as Community Clinic since 2018) was established in 2010 aims to increase healthcare services accessibility within the poor urban population. The aim was to look at the effectiveness of One (1) Malaysia Clinic as a new form of public primary health clinic by looking at expectations and perceptions of the quality of the provided services by the patients. Method: It applied a cross sectional study involving nine clinics in of the busiest district in Kelantan namely, Kota Bharu district. 386 respondents which were Malaysian citizen, 18 years old and above were involved in this study. The survey used Malay validated SERVQUAL questionnaire. The Service Quality (SQ) gap was calculated. Result: The empathy dimension obtained the highest expectation and perception score, while the tangi- ble dimension has the lowest expectation and perception score. In all SERVQUAL dimension, the expectations and perceptions of the service provided was significantly different with P < 0.001. The most critical dimension identified was tangible dimension as it has the largest negative SQ gap score. Conclusion: Negative gaps for all SERVQUAL dimensions and individual items indicated that provided services at One (1) Malaysia Clinic still could not fulfilled the patient’s expectation. A continuous improvement program is needed especially on tangible dimension in deliv- ering a quality healthcare services. Keywords: SERVQUAL dimensions, Primary Health Clinic, Expectation, Perception Corresponding Author: Service Quality (SERVQUAL) Model was proposed by Mohd Ismail Ibrahim, MPH Parasuraman, Zeithaml (7) with the concept of satisfaction Email: [email protected] will achieve when patients’ expectations towards services Tel: +609-7676625 / +60129898604 are met. Understanding the perceptions of clients and narrowing the gap between their expectations and what INTRODUCTION the organization can actually provide should be a major operational goal of an organization. For service quality, Globally, primary health care plays an important role in this realignment can be regarding either the technical health care systems. It is the first contact of care for an or functional aspects of organizations (8). It focuses on individual and community within the health care system, the functional aspect of a service which can be assessed providing preventive care, curative treatment along with based on a number of dimensions namely reliability of rehabilitative care. Patient feedback such as satisfaction provider, the responsiveness of provider, the assurance survey is crucial for evaluation and monitoring of and empathy by the provider, the physical facilities healthcare provide an opportunity for the improvement available, and the equipment. The model allows one to strategies (1-3). Besides that, it also can help patients to assess the holistic satisfaction of the customer regarding choose better health care services and finally influence the services by comparing customer expectations against their compliance with treatment, as well as their customer perceptions (7). Satisfaction is understood as continuity of care (4). Satisfied patients tend to involve being achieved when patients’ perceptions meet their in their own clinical management. Satisfaction level can expectations; this is seen numerically as an equal or be assessed through the identification of quality gaps positive SQ gap (9). The SERVQUAL model was found between expectation and perception level (5). As people to be most appropriate in assessing satisfaction levels nowadays are more educated and aware of alternatives in most of the health care environment with some being offered, assessing patient satisfaction becomes modifications (5, 10). importance (5). The expectation levels of patients are also depending on the individual’s experiences on the The primary care services in Malaysia were both provided services (6). by public and private institutions. The public clinics are Mal J Med Health Sci 16(3): 225-230, Sept 2020 225 Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346) managed directly by the Ministry of Health (MOH) of emergency care were excluded. We also excluded Malaysia, and approximately 60 percent of these clinics relatives or companions of patients and patients known are concentrated in rural areas. In 2010, the One (1) to have psychiatric problems. Malaysia Clinic (now known as Community Clinic since July 2018) was established in 2010 by Malaysia’s SERVQUAL assessment MOH as an innovation in delivering public primary care This study applied a validated Malay version of the services that is focusing more on poor urban populations SERVQUAL questionnaire with the Cronbach’s alpha (11). This One (1) Malaysia Clinic is categorize as type reliability for expectations between 0.63 and 0.89 6 and 7 where the average daily attendance range and for perceptions between 0.69 and 0.92 (12). The between 50 to 100 patients per day, with the service questionnaire contained 20 matching items to assess provided is only cover for minor illnesses and simple patients’ expectations (taken before treatment given) procedures for the outpatient services meanwhile for and their perceptions (taken after received treatment) Non Communicable Disease services and Maternal and on the five SERQVUAL dimensions. The five dimensions Child Health services, only uncomplicated and simple are as follows: 1) Tangibles: Related to equipment, case is manage here (11). physical facilities, and the appearances of personnel; 2) Reliability: the ability to conduct the service accurately; In Kota Bharu District, as of 31 December 2016, there 3) Responsiveness: the willingness to provide prompt were nine One (1) Malaysia Clinic besides 17 public service and helping the consumers; 4) Assurance: health clinics and 25 community clinics that provide related to the competence, courtesy, and security; and public primary health care services under the Kota Bharu 5) Empathy: related to individualized attention and District Health Office administration. There were about caring. The 20 questions were analyzed according to 107 private primary care clinics in Kota Bharu District the five SERVQUAL dimension as below: in a similar period. Kota Bharu District is one of the 10 districts in Kelantan. It has 15 sub-districts. This region a) Tangible dimension: Q1, Q2, Q3, and Q17 contains approximately 564,400 people, 33 percent of b) Reliable dimension: Q4, Q5, and Q6 its total population. The majority is Malay, followed by c) Responsiveness dimension: Q7, Q8, and Q9 the Chinese population and small Indian and Siamese d) Assurance dimension: Q10, Q11, and Q12 populations. e) Empathy dimension: Q13, Q14, and Q15 This study's objective was to assess the quality services The questionnaire applied a Likert scale starting from provided by primary health clinics, specifically the One 1:“strongly disagree” to 5: “strongly agree.” The Service (1) Malaysia Clinic in Kota Bharu District, by measuring Quality (SQ) gap score was obtained through a formula the SQ gap as a product of differences between patients’ SQ gap = P – E. SQ = overall service quality, P = expectation and perception. Since One (1) Malaysia perception of service, and E = expectation of service. Clinic is new, the feedback from clients is necessary for The expectations were exceeded or met if the SQ gap evaluating the quality of the provided services. score is 0 and more and it will be considered opposite (less satisfy) if the gap score is negative. As for each MATERIALS AND METHODS dimension, the overall SQ gap was obtained through a calculation from each individual paired item. A cross-sectional study was conducted between January until February 2017 in nine One (1) Malaysia Clinic in Data collection Kota Bharu District, Kelantan. These clinics are located The respondents were asked to complete the survey while in six sub-district including Kota Bharu, Kota, Panji, at the clinic after getting their verbal informed consent. Pengkalan Chepa, Kubang Kerian, and Pendek. The The clinic staff was informed and explained the study’s sample size was calculated by using single proportion objective. All particular related to the subject were kept formula with the proportion of patient satisfaction was confidential and anonymized. The respondents were 0.37 by John, Yatim (12) and additional 20% for drop asked to complete a self-administered questionnaire and rate make it estimated sample size was 430. 57% of then collected directly by the researcher. average daily patient attendances needed for the number of samples was determined proportionately based on Ethical approval average daily patient attendances that ranged from 50 to The study was ethically approved by by the Human 150 patients per day. Research Ethical Committee Universiti Sains Malaysia (USM/ JEPeM/17010019) and the Medical Research and Once the number of respondents identified from each Ethics Committee of National Medical Research Registry of the nine One (1) Malaysia