Primary health care services quality in Spain : A formative measurement approach using PLS path modeling

Purpose – Service quality is an elusive and abstract construct, so that particular effort is required to establish a valid measure. Patients' perceptions of health services seem to have been largely ignored by health care providers. The purpose of this paper is to propose a modified approach to the measurement of service quality in a primary health care setting. Design/methodology/approach – Through the use of the HEALTHQUAL scale adapted from the SERVQUAL scale to the context of primary health care centres, the authors measure the perceptions of service quality reported by both users and health centre managers in Spain. Taking service quality to be a construct of a formative nature, the authors propose a modification for its measurement using partial least squares (PLS) path modelling, as recommended in the literature for the modeling of formative constructs. Findings – It is found that the model provides health centre managers with a tool for the measurement of functional quality in their organization. The results reveal the importance of health staff attributes and efficiency measures for the perception of health centre quality. Research limitations/implications – The model can also be used to measure how health care centre managers believe that patients perceive the quality of their service. This allows the potential gap between the provider's view and the customer's view to be assessed and monitored. Originality/value – The paper extends the previous literature in two directions. First, based on SERVQUAL, it presents a general framework for measuring primary health care service quality as a construct of a formative nature. Second, it is the first application of PLS path modeling to the simultaneous examination of both users' and health centre managers' perceptions in a European context.