When researching user satisfaction at the University
Hospital of USP related to the attributes of care, and comparing
it to the perception that the management team had
of satisfaction, there was a big difference between what
the user identified as quality and what the manager considered
to be quality, demonstrating divergences between
the two perceptions. The rate of satisfaction manifested
by users was higher than that perceived by the managers
and they, in turn, had a higher expectation than the actual
performance of the operational area. As to the attributes
of the care, it became clear that the user considered the
initial care and treatment outcome as the important attributes
for his satisfaction, portrayed predominantly in
the dimensions of empathy and reliability. The study also
identified that the quality of services of the nursing team
was a positive difference in the institution(9).
The quality of an ambulatory ophthalmological service
provided to users of the National Health System in
the city of Belo Horizonte (MG) was evaluated using two
structured questionnaires, adapted from the modified
SERVQUAL scale. A slight general dissatisfaction was detected
regarding the quality of care, and safety and reliability
were the attributes of greatest importance; the
authors concluded there was a need for planning and
implementation of actions to improve this service(10).
The quality of health services in the public and private
networks in Ribeirão Preto-SP was analyzed focusing on
analysis of the time for the medical consultation. The study
identified fragility in the system of scheduling appointments,
especially in public institutions, and delays in waiting
for medical care. Institutions that presented shorter
times of medical consultation also received a lower score
on the quality assessment in relation to others(11).
The expectations and perceptions of chronic renal
patients, in relation to the dialysis treatment programs,
were measured using the SERVQUAL scale, in the city of
Taichung, in Taiwan, and demonstrated that elderly users
had a level of perception of the service that was lower
than younger people. With regard to education, users with
higher levels of education demonstrated lower expectations
and perceptions in relationship to the programs.
A positive correlation was present between expectations
and perceptions, loyalty and perceptions of the service;
however there was no positive correlation between expectation
and loyalty(12).
Levels of satisfaction in a private hospital the city of São
Paulo were analyzed and the attributes that reached the highest
levels of satisfaction corresponded to education and
commitment of medical and nursing staff, the explanations
and guidance about the health problem of the user, respect
for privacy and guidance for continuing care after hospital
discharge. Assurance and reliability were the dimensions that
most influenced satisfaction, followed by responsiveness
and empathy. There was also the need to adopt strategies
in the nutrition service and in the initial care of the users(2).
Another study employing the SERVQUAL was conducted
at a university hospital in the interior of the state
of São Paulo, with the objectives of verifying the levels
of user satisfaction and knowing the factors involved in
their satisfaction . Findings indicated that the dimensions
of reliability and assurance represented the attributes
with the highest degree of satisfaction and that
the dimensions of responsiveness and empathy were the
attributes with lower levels of satisfaction(13).
In the cited studies, an elevated level of user satisfaction
was observed in relationship to the respective health
services. The authors mentioned above iterated the importance
of health services counting on assessment tools
that enabled managers to plan improvements, and indicated
the need for enhancement of such instruments.
Despite the recognition that every theoretical model is
always partial and approximate, it is necessary to recognize
the relevance of the criticism that indicates important
theoretical and conceptual inconsistencies within the area
of user satisfaction studies. Finally, the establishment of a
consensus of experts should be encouraged, to seek a validation
for the concept of user satisfaction and operationalization
for its measurement(14).
Consequently, on the option of a particular model of
evaluation, it is necessary to remember that, depending on
the type of assessment to be developed, one can choose or
adapt one or more approaches in the design process. However,
the success of the evaluation process is conditional
on effective planning that meets the specifics of each organization
and the context in which it operates.
FINAL CONSIDERATIONS
The absence of objective measures to assess the
quality of services increases the degree of complexity
in relation to its assessment. There are several models
proposed in the literature to evaluate such an attribute,
during and after the experience of acquisition, ranging
in numerical representation, principle characteristics
and conclusions about their applicability.
In this article, the employment of an evaluation model
developed in the context of marketing and applied
to the area of health demonstrates the growing concern
of health institutions and professionals themselves regarding
user satisfaction. Furthermore, it reinforces the
possibility of using existing models, adapting them to
the the health segment, in order to obtain a model that
most closely approximates the reality of these services.
The monitoring of the quality of services, according
to the various existing models, not only permits
the planning of assertive, highly effective strategies of
intervention, but also the monitoring of the responses
to these actions, contributing to scientific and technological
advances.