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Healthcare Management: Improving Patient Outcomes and Service Quality

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A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: 30 January 2027 | Viewed by 19482

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Dr. Christos Ntais

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Healthcare Management Program, School of Economics & Management, Open University of Cyprus, Nicosia 2220, Cyprus
Interests: healthcare management; health economics; health technology assessment; health policy; public health; epidemiology
Special Issues, Collections and Topics in MDPI journals

Dr. Nikolaos Kontodimopoulos

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Department of Economics and Sustainable Development, Harokopio University, 17676 Athens, Greece
Interests: healthcare management; health economics; health technology assessment
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are pleased to invite you to contribute to our Special Issue, titled “Healthcare Management: Improving Patient Outcomes and Service Quality”. As the global demand for high-quality healthcare services continues to rise, healthcare institutions face mounting challenges, including resource constraints, the need for equitable access, and the integration of new technologies. Effective management strategies are pivotal in addressing these challenges and ensuring that healthcare systems are resilient, efficient, and patient-focused.

This Special Issue aims to highlight the importance of innovative approaches to healthcare management that prioritize patient outcomes and service quality, fostering more equitable and effective healthcare systems for all. By showcasing research that bridges theory and practice, this Special Issue seeks to provide actionable insights for practitioners, researchers, and policymakers. Contributions that propose evidence-based solutions, technological advancements, and strategies for operational excellence are particularly encouraged.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

Healthcare operation management.
Patient-centered care initiatives.
Quality improvement methodologies.
Health policy and governance.
Technological innovations in healthcare delivery.
Strategies for enhancing patient safety.
Equity and access in healthcare.

I look forward to receiving your contributions.

Dr. Christos Ntais
Dr. Nikolaos Kontodimopoulos
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

healthcare management
patient outcomes
service quality
healthcare delivery
quality improvement
patient-centered care
health policy
healthcare innovation
health service research

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Published Papers (9 papers)

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Research

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17 pages, 458 KB

Open AccessArticle

Public and Private Healthcare Service Quality in Trujillo, Peru: Evidence from a SERVQUAL Survey

by Pedro Oloya-Salazar, Ener Alayo-Ruiz, Katia Vallejos-Salas, María Ruiton-Castillo, Johanna Peña-López, Kiara Anicama-Ramirez and Walter Rojas-Villacorta

Healthcare 2026, 14(6), 738; https://doi.org/10.3390/healthcare14060738 - 13 Mar 2026

Viewed by 1772

Abstract

Background: Service quality and patient satisfaction are key indicators of healthcare performance, yet disparities remain between public hospitals and private clinics in Peru. Understanding these differences is essential for improving patient-centered care and advancing Sustainable Development Goal 3 (Good Health and Well-Being). The study examined how perceived service quality relates to user satisfaction in Trujillo’s private and public institutions. Methods: A cross-sectional study was conducted involving 480 users from public and private healthcare institutions. Service quality was assessed using the SERVQUAL model, and user satisfaction was measured with a validated Likert-scale instrument. Data did not follow a normal distribution (Kolmogorov–Smirnov test); thus, nonparametric statistics were applied. A two-step cluster analysis was additionally performed to identify user profiles based on the five quality dimensions of quality. Results: Participants from both health centers exhibited a range of sociodemographic profiles with regard to age, gender and income. Private clinics reported high levels of perceived service quality (95.8%) and user satisfaction (89.3%), whereas the public hospital showed moderate ratings in both dimensions. In the public setting, empathy and tangible elements emerged as significant predictors of satisfaction, while in private clinics, these same dimensions exhibited negative associations. The cluster analysis identified two distinct user profiles, with tangibles and reliability being the most influential predictors. Conclusions: Significant differences were observed between private and public institutions. Although service quality was positively associated with satisfaction, its explanatory power was limited, suggesting the influence of additional unmeasured factors. This study opens avenues for future research on how differentiated strategies can be scaled and adapted to strengthen public healthcare delivery in Peru, ensuring alignment with equitable and patient-centered care principles promoted by SDG 3. Full article

(This article belongs to the Special Issue Healthcare Management: Improving Patient Outcomes and Service Quality)

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12 pages, 258 KB

Open AccessArticle

Knowledge, Attitudes, and Clinical Preparedness of Dentists for Medical Emergencies: A Nationwide Cross-Sectional Survey

by Suzan Cangül, Makbule Taşyürek, Özkan Adıgüzel and Fırat Aşır

Healthcare 2026, 14(6), 732; https://doi.org/10.3390/healthcare14060732 - 13 Mar 2026

Cited by 1 | Viewed by 615

Abstract

Background: Medical emergencies in dental practice are uncommon but may have serious consequences if not promptly recognized and managed. Dentists are expected to identify and initiate appropriate interventions during such events; however, the extent to which theoretical knowledge translates into clinical confidence and preparedness remains unclear. Methods: This nationwide cross-sectional survey evaluated dentists’ knowledge, attitudes, and preparedness regarding medical emergencies encountered in routine dental practice. A total of 300 dentists practicing in Türkiye completed two structured questionnaires: a scenario-based single-best-answer multiple-choice questionnaire assessing knowledge of medical emergencies and a Likert-scale questionnaire evaluating attitudes and clinical preparedness. Of the 450 dentists invited to participate, 300 completed the survey (response rate: 66.6%). Overall knowledge scores were calculated from 16 emergency scenarios, and participants were categorized into knowledge-level groups. Associations between knowledge, attitudes, and availability of emergency resources were analyzed using chi-square tests with effect size estimation. Results: The median overall knowledge score was 11 (IQR: 9–13). While high correct response rates were observed for commonly encountered emergencies such as syncope and intraoral bleeding, lower accuracy was noted for high-risk conditions including hypertensive crisis, anaphylaxis, and epileptic seizures. Only 40% of dentists reported feeling sufficiently competent to manage medical emergencies, and avoidance of treating high-risk patients was common. Higher knowledge levels and availability of emergency equipment and medications were significantly associated with greater self-perceived competence and reduced avoidance behavior. Conclusions: Although dentists demonstrate adequate theoretical knowledge of medical emergencies, significant gaps persist in clinical confidence, preparedness, and management of high-risk scenarios. Strengthening emergency preparedness in dental practice requires structured, hands-on training and improved access to essential emergency resources to ensure patient safety and support effective clinical decision-making. Full article

(This article belongs to the Special Issue Healthcare Management: Improving Patient Outcomes and Service Quality)

21 pages, 306 KB

Open AccessArticle

Patient Satisfaction Measurement: A Comparison of Likert and Item-Specific Response Options Scales

by Vassilis Aletras, Stavros Chatzopoulos, Maria Kalouda, Dimitris Niakas and Angeliki Flokou

Healthcare 2025, 13(23), 3017; https://doi.org/10.3390/healthcare13233017 - 21 Nov 2025

Cited by 9 | Viewed by 3304

Abstract

Background/Objectives: Patients’ reports on their satisfaction with the care received often have been seen as a key quality indicator of hospital performance. However, the potential effect of different approaches to its measurement has not been adequately assessed in the health care setting. This study therefore aimed to methodologically compare two different response formats in patient satisfaction questionnaires—Likert scales and Item-Specific Response Options (ISRO)—within a Greek public hospital context. The aim was to comparatively explore resulting item- and scale-level score values, ceiling effects, acquiescence bias, and psychometric properties, including reliability and validity. Methods: An overall sample of 400 hospitalized patients at a National Health Service general university hospital was randomly assigned to two groups during February–March 2025. One group completed a Likert-scale questionnaire and the other a questionnaire, with the same content, that employed an ISRO format instead. The questionnaire items covered two aspects of the hospital experience, these being the satisfaction with doctors/nurses as well as the organization and planning of care. Statistical analysis involved Kolmogorov–Smirnov tests for normality, descriptive statistics, chi-square and Fisher’s exact test, t-tests, Mann–Whitney tests, ceiling effects, regressions, Cronbach’s alpha coefficients, and confirmatory factor analysis (CFA), with measures of composite reliability and average variance extracted and model fit indices. Results: Our analysis identified differences in the distributions of patient responses for many items, including variations in median values and the proportion of positive answers. ISRO items tended to produce higher ratings for nursing care and overall satisfaction, whereas Likert items yielded higher scores in organizational aspects. However, the magnitude of these differences was generally small. Regression analysis, adjusting for length of stay, confirmed statistically significant but modest differences in scale scores between formats. Neither format was superior in terms of ceiling effects, whereas no consistent evidence of acquiescence bias was found. Psychometric testing showed that Likert scales had somewhat higher internal consistency reliability and convergent validity, while ISRO exhibited a better model fit in CFA. Conclusions: The item response format seems to affect reported satisfaction scores, yet the impact is rather limited in practical terms for decision-making. Since neither format is consistently superior, the choice between them should depend on study aims, respondent burden, and the intended use of satisfaction scores by policy makers. Moreover, concerns about acquiescence bias may have been overstated in the health care context. Future research should extend these comparisons with other instruments and larger and more diverse samples, as well as employ complementary methods to clarify how response format affects patient satisfaction measurement. Full article

(This article belongs to the Special Issue Healthcare Management: Improving Patient Outcomes and Service Quality)

20 pages, 1541 KB

Open AccessArticle

Implementing a Mixed Health Service Model as an Informed Modality to Enhance Prevention and Promote Workplace Health in the Greek Regional Public Sector: A Pilot Study in Crete

by Nikos Frantzeskakis, Maria Tziraki, Marios Spanakis, Spyridoula D. Katsarou, Nikolaos Papadopoulos, Manolis Linardakis, Charikleia Vova-Chatzi, Apostolos Kamekis, George Pitsoulis, Antonios Papadakis and Emmanouil K. Symvoulakis

Healthcare 2025, 13(18), 2337; https://doi.org/10.3390/healthcare13182337 - 17 Sep 2025

Cited by 2 | Viewed by 1474

Abstract

Background/Objectives: Preventive care in Greece remains underdeveloped, especially in workplace settings. To address this, a mixed service model was piloted to integrate preventive and occupational health for public sector employees in Region of Crete. Methods: Between January and July 2025, 180 employees enrolled for a 30 min consultation including medical history review, lifestyle assessment, and evaluation of vaccination and screening status according to age, risk factors, and national guidelines. Standardized tools (PSS-14, PHQ-9) assessed perceived stress and mental well-being. Participants rated satisfaction and perceived care quality on a 10-point Likert scale. Results: Of 180 enrolled, 154 completed the evaluation. The majority of participants were female (68.8%), with a mean age of 54 years, and 42.9% held a higher education degree. Common lifestyle characteristics included current smoking (24.7%), regular alcohol consumption (9.8%), and insufficient sleep (mean 6.5 h/night). Overweight (40.3%) and obesity (29.2%) were prevalent. Chronic conditions were reported in 87.0% of participants, with dyslipidemia (54.5%), allergies (35.8%), and hypertension (26.9%) being the most frequent. Criteria for metabolic syndrome were found in 33.1% of participants with a higher prevalence in men (50.0% vs. 25.0%; p = 0.029). Mental health assessments revealed moderate stress levels (mean PSS-14: 23.7) and mostly minimal depressive symptoms (mean PHQ-9: 4.3). Preventive screening was variable, with higher adherence for mammography (79.2%) and lower for colonoscopy (40.2%). Service satisfaction was high, with significant increases in perceived usefulness (8.96 to 9.80, p < 0.001) and satisfaction (9.08 to 9.87, p < 0.001) after the intervention. Conclusions: This pilot revealed critical gaps in vaccination, cardiometabolic risk, and stress management among public employees. It was also shown that integrated workplace-based health models are both feasible and acceptable. These models can effectively deliver preventive actions on a scale and represent a promising strategy for strengthening occupational health in employed adult population. Full article

(This article belongs to the Special Issue Healthcare Management: Improving Patient Outcomes and Service Quality)

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18 pages, 614 KB

Open AccessArticle

Job Satisfaction Among Healthcare Professionals in Community-Based Care for Older People: Evidence from Greece

by Eirini Michaela Foukaki, Argyroula Kalaitzaki, George Markakis, Athanasios Alegakis and Sofia Koukouli

Healthcare 2025, 13(18), 2299; https://doi.org/10.3390/healthcare13182299 - 13 Sep 2025

Viewed by 2014

Abstract

Objectives: This study aimed to investigate the level of job satisfaction and the associated factors among health and social care employees of the public sector providing services in open care community settings and home-based care for the older people in Greece. Method: The self-administered questionnaire, Job Satisfaction Survey (JSS), was distributed to personnel across all four prefectures in the Region of Crete (Greece). In total, 228 valid responses were received. Results: Overall job satisfaction was moderate (mean = 134, SD = 24). Employees reported greater satisfaction with the supervision (mean = 19.3), nature of work (mean = 19.2), and coworkers (mean = 19.0). Lower satisfaction was observed in relation to promotion (mean = 9.7). Women scored significantly higher satisfaction than men in pay (mean = 10.9) and fringe benefits (mean = 12.3), while age was associated with differences in pay and promotion satisfaction. Variations were also found according to service unit and contract type, with permanent staff reporting higher satisfaction (mean = 11.3) in the Promotion scale than temporary staff (mean = 9.2) (p < 0.001). Conclusions: Findings emphasize the need to institute targeted short- and long-term measures to improve job satisfaction in community-based care for older people. Short-term actions should include the introduction of fair and competitive pay structures, improvements in fringe benefits, and the implementation of supportive leadership practices. Meanwhile, long-term strategies should focus on transparent promotion systems, structured professional development and continuing education opportunities, and the provision of stable contracts to retain skilled personnel. Full article

(This article belongs to the Special Issue Healthcare Management: Improving Patient Outcomes and Service Quality)

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12 pages, 224 KB

Open AccessArticle

Workplace Gaslighting Is Associated with Nurses’ Job Burnout and Turnover Intention in Greece

by Ioannis Moisoglou, Aglaia Katsiroumpa, Olympia Konstantakopoulou, Ioanna V. Papathanasiou, Aggeliki Katsapi, Ioanna Prasini, Maria Chatzi and Petros Galanis

Healthcare 2025, 13(13), 1574; https://doi.org/10.3390/healthcare13131574 - 1 Jul 2025

Cited by 9 | Viewed by 3230

Abstract

Νurses often experience abusive behavior, such as gaslighting, which has a negative impact on their mental health and leads them to quit their jobs. Background/Objectives: We evaluate the impact of workplace gaslighting on nurses’ job burnout and turnover intention. Methods: We conducted a cross-sectional study with a convenience sample of 410 nurses in Greece. We used the Gaslighting at Work Scale (GWS) to measure levels of workplace gaslighting in our sample. Also, we used the single-item burnout measure to measure job burnout and a six-point Likert scale to measure turnover intention. We constructed multivariable regression models to estimate the independent effect of workplace gaslighting on job burnout and turnover intention. Results: We found positive correlations between GWS and job burnout (r = 0.298, p-value < 0.01) and turnover intention (r = 0.385, p-value < 0.01). We found that workplace gaslighting was associated with job burnout in our sample. Our multivariable linear regression model identified a positive association between the score on the GWS (adjusted b = 0.653, 95% CI = 0.436 to 0.869, p < 0.001) and burnout. Similarly, we found that a higher score on the GWS was associated with a higher turnover intention (adjusted b = 0.616, 95% CI = 0.466 to 0.765, p < 0.001). Conclusions: This study findings indicate that nurses encounter gaslighting behaviors that adversely impact their job burnout and turnover intentions. Healthcare institutions are urged to implement policies that raise awareness about this conduct, facilitate avenues for staff to report it, and exhibit zero tolerance for abusive behaviors, including gaslighting. Full article

(This article belongs to the Special Issue Healthcare Management: Improving Patient Outcomes and Service Quality)

12 pages, 363 KB

Open AccessArticle

Effect of Kinesiophobia and Social Support on Quality of Life After Total Hip Arthoplasty

by Panagio Marmouta, Lemonia Marmouta, Andreas Tsounis, Chara Tzavara, Maria Malliarou, Evangelos Fradelos, Maria Saridi, Aikaterini Toska and Pavlos Sarafis

Healthcare 2025, 13(12), 1366; https://doi.org/10.3390/healthcare13121366 - 6 Jun 2025

Cited by 3 | Viewed by 1755

Abstract

Background/Objectives: Total hip arthroplasty (THA) improves quality of life in patients with hip osteoarthritis (OA) by alleviating pain and restoring mobility. Kinesiophobia (i.e., fear of performing specific movements to avoid pain and re-injury) negatively affects the quality of life after THA, while social support impacts postoperative quality of life by influencing recovery and well-being. This cross-sectional study investigates the effects of kinesiophobia and social support, as well as their interaction, on the quality of life after THA. Methods: A total of 125 patients participated in the study, all of whom had undergone THA for end-stage hip OA. The Tampa Scale for Kinesiophobia (TSK), the Oslo Social Support Scale (OSSS), and the Total Quality of Life scale (T-QoL) were used for the assessment of the study variables. Multiple linear regression was conducted considering the T-QoL subscales (emotional and physical well-being, functional engagement, resilience, and peri-traumatic experience) as dependent variables. Results: Kinsesiophobia correlated negatively with physical and emotional well-being, peri-traumatic experience, and resilience. Social support was positively correlated with emotional well-being, functional engagement, and resilience; however, it also buffered the negative relationship between kinesiophobia and peri-traumatic experience. Age was negatively correlated with emotional and physical well-being, functional engagement, and resilience, while the patient being female also correlated negatively with emotional well-being and functional engagement. Finaly, self-perception of mental health problems was negatively correlated with resilience. Conclusions: Future studies may further investigate the pathway between kinesiophobia and social support on the one hand and quality of life on the other hand, as well as the interaction between social support and kinesiophobia. Full article

(This article belongs to the Special Issue Healthcare Management: Improving Patient Outcomes and Service Quality)

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Review

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15 pages, 374 KB

Open AccessReview

Healthcare Quality Systems: International Frameworks, Evaluation and Improvement Strategies

by Christos Ntais and Michael A. Talias

Healthcare 2026, 14(11), 1510; https://doi.org/10.3390/healthcare14111510 - 29 May 2026

Viewed by 749

Abstract

Healthcare quality systems have evolved from narrow inspection and compliance mechanisms into broader, multi-level architectures that combine standards, measurement, organizational learning, patient safety, equity and patient-reported outcomes. Yet the field remains fragmented, with substantial variation in how quality is defined, measured and operationalized across countries and healthcare settings. This narrative review synthesizes major international quality systems and frameworks used in healthcare delivery, examines principal methods for evaluating and improving quality, and critically discusses organizational and policy conditions associated with successful implementation. A purposive review of the seminal conceptual literature and authoritative documents from major international organizations was undertaken to identify cross-cutting themes relevant to hospitals, ambulatory care and health systems. The review shows that influential approaches—including the World Health Organization’s quality and patient safety frameworks, Joint Commission International accreditation, NCQA/HEDIS, the EFQM model, ISO-based management systems, AHRQ quality indicators and OECD performance initiatives such as PaRIS—should be viewed as complementary rather than competing models. Their effectiveness depends less on formal adoption alone than on leadership commitment, workforce engagement, data infrastructure, patient involvement and alignment with financing and regulation. Evidence is strongest for gains in standardization, safety processes, teamwork and selected efficiency outcomes; direct causal effects on patient outcomes remain less consistent, particularly when quality systems become compliance-driven or are insufficiently adapted to local context. Future healthcare quality systems should integrate equity, digital interoperability, AI-enabled learning capabilities, patient-reported measures and continuous improvement while reducing measurement burden and indicator proliferation. Full article

(This article belongs to the Special Issue Healthcare Management: Improving Patient Outcomes and Service Quality)

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30 pages, 1679 KB

Open AccessReview

Patient-Centered Cardiac Surgery: Psychosocial Challenges, Evidence-Based Interventions, and Future Horizons

by Vasileios Leivaditis, Anastasios Sepetis, Francesk Mulita, Sofoklis Mitsos, Nikolaos G. Baikoussis, Efstratios Koletsis, Stelios F. Assimakopoulos, Andreas Antonios Maniatopoulos, Elias Liolis, Konstantinos Nikolakopoulos, Manfred Dahm and Nikolaos Kontodimopoulos

Healthcare 2025, 13(22), 2957; https://doi.org/10.3390/healthcare13222957 - 18 Nov 2025

Cited by 8 | Viewed by 2429

Abstract

Background: Psychosocial factors such as anxiety, depression, and lack of social support are increasingly recognized as critical determinants of outcomes in cardiac surgery. Up to 32% of patients experience preoperative anxiety, and nearly 20% experience depression, both of which have been associated in observational studies with delayed recovery, increased complications, and higher mortality. Objective: This study aimed to review current evidence on psychosocial aspects of cardiac surgery and evaluate patient-centered care strategies that address these challenges. Methods: A narrative literature review was performed using PubMed, Scopus, and ScienceDirect, focusing on recently published studies. The search covered studies published between January 2009 and June 2024, yielding 76 eligible studies after screening and thematic synthesis. Search terms included patient-centered care, psychosocial factors, cardiac surgery, anxiety, depression, rehabilitation, and telemedicine. Eligible studies included randomized controlled trials, cohort studies, qualitative studies, and systematic reviews. Results: Key themes included preoperative psychological preparation, management of anxiety and depression, promotion of quality of life, effective communication strategies, and integration of psychosocial support into rehabilitation programs. Evidence shows that psychological and social interventions reduce reported pain by up to 33%, as reported in pooled randomized controlled trials and meta-analyses; shorten hospital stay; improve adherence to treatment; and enhance long-term quality of life. Emerging tools such as telemedicine and digital platforms further expand access to psychosocial care. Conclusions: Integrating psychosocial care into cardiac surgery is essential for achieving holistic outcomes. Patient-centered models that emphasize communication, shared decision-making, family involvement, and digital support improve not only survival but also recovery, well-being, and patient satisfaction. Redefining success in cardiac surgery requires attention to both clinical results and the broader human experience of illness and recovery. Full article

(This article belongs to the Special Issue Healthcare Management: Improving Patient Outcomes and Service Quality)

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