Responsiveness in the context of a system can be defined as the outcome that can be achieved when institutions and institutional relationships are designed in such a way that they are cognisant and respond appropriately to the universally legitimate expectations of individuals. Responsiveness can be viewed from two angles. Firstly, the user of the health care system is often portrayed as a consumer, with greater responsiveness being perceived as a means of attracting consumers. Secondly, responsiveness is related to the safeguarding of rights of patients to adequate and timely care. Owens and Batchelor (1996) cite patients' charters as an attempt to lay down the manner in which to “treat those who use health services as consumers within a market based and people centred system”.
The use of the word patients is considered to underrate the status of the individual, as it implicitly crates a hierarchy. Owens and Batchelor (1996) suggest that the patient should be defined as a consumer, a rationale that originates from the emphasis on the market mechanism. Sitzia and Wood (1997) argue that the term consumer dignifies the professional/patient relationship in a way that the traditional term patient with its association of powerlessness against the medical establishment does not. Using the word client, customer or service user similarly moves away from the idea of the user of medical services being passive and dependent.
Carr-Hill (1992) argues that the term customer has the connotation of an individual where rights are concerned while consumer suggests that the individual is part of a group of users who can act together to safeguard rights. He suggests that the following seven principles should relate to consumers: access, choice, information, redress, safety, value for money and equity, but argues that their applicability in health may be limited, which results in the ability of consumers in the health system to act independently being restricted as well.
Among the words that are commonly used in the discussion of issues of responsiveness are satisfaction and quality of care. Patient satisfaction represents a complex mixture of perceived need, expectations and experience of care (Smith, 1992). Quality of care can cover a wide spectrum. Structural quality, can be defined as relating to dimensions such as continuity of care, costs, accommodation and accessibility while process quality involves the dimensions of courtesy, information, autonomy and competence (Campen et al, 1998). The terms ‘service quality’ are used by Kenagy, Berwick and Shore (1999) to refer to a set of issues including communication, sign posting, information provision and staff interaction with patients. Donabedian (1980) considers interpersonal aspects of quality and amenities of care along side the technical aspects of quality to be the three components of health care health care quality. The interpersonal component of quality is defined as the quality of interaction between the patient and provider or the responsiveness, friendliness, and attentiveness of the health care provider (Haas-Wilson, 1994). The