Graduation Year


Document Type




Degree Granting Department

Industrial Engineering

Major Professor

Kingsley Reeves, Ph.D.


Service quality, Outpatient, Health care, Patient perspective, Continuous improvement


The 2001 Institute of Medicine's (I.O.M.) landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century observes that, "[though] medical science and technology have advanced at a rapid pace,...the health care delivery system has floundered in its ability to provide consistently high-quality care" (I.O.M. 2001). The report recommended six quality aims for a twenty-first century health care system; one of them being patient-centered care. It explains patient-centered care as "providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions" (I.O.M. 2001). This research is aimed at directly addressing this I.O.M. recommendation and seeks to understand quality care in the context of the I.O.M. guideline which clearly states that to achieve quality "the patient is the source of control of interactions" with the provider system.

The objectives of this project are: (i) to gain a deeper and clearer understanding of the ways patients as customers of an outpatient clinic evaluate health care providers, and (ii) to determine if varying definitions of service quality exist with in a clinic containing a complex constituency. The project site chosen was the set of outpatient clinics at USF Health that makes for a complex site (e.g. eighty different specialties, outpatient surgical units, practicing and academic environment, multi-disciplinary teams at work involving multiple levels of health care professionals and complex inter-personal relationships) to carry out this research. The formal hypothesis can be stated as follows: H1: There exist identifiable differing classes of patients with varying perceptions of Service Quality in an outpatient setting.

The subsequent research questions that the research aims to address are that, given that differing patient classes can be identified, do they have an impact on the overall patient-perceived quality and how significant is the impact? The project will contribute to a change in the approach at the clinic from a profession-centered to a patient-centered effort. It will raise the awareness among clinicians about how patients view quality care which can then be integrated into the system, institutionalized over time and thus help them improve their ability to provide quality care as preferred by patients. It will also serve to educate and empower the patients by increasing their participation and strengthening their role as partners with clinicians in a health care system. According to a review of the consumer health literature (Hibbard 2003), patients who collaborate with their health care providers and play an active role in their health care have improved health outcomes.

It also enables future work in metric identification to promote continuous improvement in care provision. Though the research was conducted at a specific outpatient setting, it will have wider applicability as it can be a model worth emulating more broadly. The study also contributes to the academic literature that clearly indicates that there is a recognized need for more research on the delivery of outpatient care (Hammons 2003). Additionally, the study can be applicable and useful in other environments with complex constituencies (e.g. university classrooms, public transportation and travel industry).