Quality of outpatient care and its gaps in a public hospital in southeastern Mexico: an analysis using the servqual model
DOI:
https://doi.org/10.71068/hs000107Keywords:
quality of health care, outpatient care, patient experience, SERVQUAL, MexicoAbstract
The quality of outpatient care requires consideration of both service organization and the expectations of people using the services. This study examined gaps between expectations and perceptions in General Medicine at Dr. Agustín O’Horán General Hospital, Mérida, Yucatán. To assess perceived outpatient care quality using SERVQUAL and identify priority dimensions and attributes for improving patients’ experiences. An observational, descriptive, cross-sectional study was conducted between September and October 2025. A total of 328 adults provided valid questionnaires. Twenty-two pairs of seven-point Likert items covered reliability, responsiveness, assurance, empathy, and tangibles. The gap was defined as expectations minus perceptions. Dimensional means and associations reported using chi-square tests were described. The mean of the five dimensional gaps was 0.7412. Empathy showed the largest difference (1.576), followed by reliability (1.120) and tangibles (1.010). The main concerns were delays relative to scheduled appointments (2.22), failure to respect arrival order (2.16), and interpersonal treatment (2.06). Assurance showed a negative gap (−0.310), whereas responsiveness reached 0.310. Associations of age and educational attainment with selected ratings of care were reported. The main opportunities for improvement concern punctuality, clinical communication, and physical conditions. The findings describe experiences reported by users of this outpatient service and can guide institutional actions whose effectiveness requires subsequent evaluation.
References
1. de la Garza-Carranza MT, Calderón-Pérez A, Reyes-Berlanga ML, García-Torres MA. Calidad en el servicio mediante la metodología Servqual y satisfacción en pacientes hospitalizados. Horiz Sanitario. 2024;23(1):73-81. https://doi.org/10.19136/hs.a23n1.5697.
2. World Health Organization, Organisation for Economic Co-operation and Development, World Bank Group. Delivering quality health services: a global imperative for universal health coverage. Geneva: WHO; 2018. https://doi.org/10.1787/9789264300309-en
3. Organisation for Economic Co-operation and Development. Health at a Glance 2023: OECD Indicators. Paris: OECD Publishing; 2023. https://doi.org/10.1787/7a7afb35-en
4. Donabedian A. The quality of care: how can it be assessed? JAMA. 1988;260(12):1743-1748. https://doi.org/10.1001/jama.1988.03410120089033
5. Parasuraman A, Zeithaml VA, Berry LL. A conceptual model of service quality and its implications for future research. J Mark. 1985;49(4):41-50. https://doi.org/10.1177/002224298504900403.
6. Parasuraman A, Zeithaml VA, Berry LL. SERVQUAL: a multiple-item scale for measuring consumer perceptions of service quality. J Retail. 1988;64(1):12-40. https://doi.org/10.5281/zenodo.14579730.
7. Doubova SV, Leslie HH, Pérez-Cuevas R, Kruk ME, Arsenault C. Users’ perception of quality as a driver of private healthcare use in Mexico: insights from the People’s Voice Survey. PLoS One. 2024;19(6):e0306179. https://doi.org/10.1371/journal.pone.0306179.
8. Gilavand A, Torabipour A. The quality of services of Iran university hospitals based on SERVQUAL’s evaluation model: a systematic review and meta-analysis. Front Public Health. 2022;10:838359. https://doi.org/10.3389/fpubh.2022.838359.
9. Bustamante U MA, Tello M, Carvache-Franco M, Carvache-Franco O, Carvache-Franco W. Statistical determination of service quality gaps in primary health care in Guayas, Ecuador. PLoS One. 2024;19(3):e0299994. https://doi.org/10.1371/journal.pone.0299994.
10. Owusu AA, Boakye K, Boateng D, Osei-Mensah C, et al. Patient satisfaction with quality of care at out-patient departments in selected health facilities in Kumasi, Ghana. BMC Health Serv Res. 2024;24:1027. https://doi.org/10.1186/s12913-024-11399-w.
11. Chitha WW, Mnyaka OR, Ncinitwa A, Giwu O, et al. Assessing patients’ experience of care in four referral hospitals: a cross-sectional survey of outpatients in two South African rural provinces. BMC Health Serv Res. 2024;24:1566. https://doi.org/10.1186/s12913-024-12002-y.
12. León-García M, Wieringa TH, Espinoza Suárez NR, et al. Does the duration of ambulatory consultations affect the quality of healthcare? A systematic review. BMJ Open Qual. 2023;12(4):e002311. https://doi.org/10.1136/bmjoq-2023-002311.
13. McAvoy S, Toth-Peter A, Jagdish N, Nguyen BH, Arnott A, et al. Timely access to specialist outpatient care: can applying systems thinking unblock our waiting lists? BMC Health Serv Res. 2025;25:121. https://doi.org/10.1186/s12913-024-11981-2
14. Herath M, Reid JL, Ting YY, Bradshaw EL, Edwards S, Bruening M, et al. Patient focused interventions and communication in the surgical clinic: a systematic review and meta-analysis. eClinicalMedicine. 2023;57:101893. https://doi.org/10.1016/j.eclinm.2023.101893.
15. Huynh K, Brito JP, Bylund CL, Prokop LJ, Singh Ospina N. Understanding diagnostic conversations in clinical practice: a systematic review. Patient Educ Couns. 2023;116:107949. https://doi.org/10.1016/j.pec.2023.107949.
16. Asare AA, Otchi E, Manu A. Relevance of meeting general outpatients’ information needs to their perceptions of healthcare quality in a hospital in Ghana: a Healthcare Quality Survey using modified SERVQUAL analysis. BMJ Open Qual. 2024;13(2):e002683. https://doi.org/10.1136/bmjoq-2023-002683.
17. Östensson S, Acuña Mora M, Darcy L, Saarnio Huttu L, Van Dulmen S, Sundler AJ. Patient–registered nurse communication: exploring patients’ expectations and experience in primary care consultations. Health Expect. 2025;28(4):e70353. https://doi.org/10.1111/hex.70353.
18. Ekberg K, Beach WA, Jones D. Communication in outpatient secondary care: a state-of-the-art literature review of conversation-analytic research. Res Lang Soc Interact. 2024;57(1):38-54. https://doi.org/10.1080/08351813.2024.2305042.
19. Qiu Y, Xiao C, Li J. Service quality evaluation of county-level public hospitals in Chongqing under smart healthcare. BMC Health Serv Res. 2024;24:1492. https://doi.org/10.1186/s12913-024-11976-z.
20. Aljohani M. Three-year trends and seasonal variation in patient satisfaction with primary health care services in Saudi Arabia: results from the national patient experience measurement program (2022–2024). Front Public Health. 2026;13:1727345. https://doi.org/10.3389/fpubh.2025.1727345.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Roberto Abraham May Pérez, Gael García Quinto, Myrna Nataly Durán Fajardo, Elidé de los Ángeles Moreno Pacheco, Luisa Guadalupe Villanueva Herrera
This work is licensed under a Creative Commons Attribution 4.0 International License.
Articles published in this journal are available under the Creative Commons Attribution 4.0 International (CC BY 4.0) licence. This licence authorises third parties to download, copy, distribute, adapt and reuse the contents, including for commercial purposes, provided that credit is given to the original author of the work.
