Development and Validation of a Quality Indicator System for Outpatient Service in Shenzhen, China

Outpatient services account for a large part of healthcare in China, and to survive in the competition with other hospitals, the management needs to understand and measure outpatient services quality for healthcare improvement and patient retention. There is a lack of comprehensive standardized outpatient healthcare quality measurement tools from patients' perspective in China.This study aimed to develop and test a quality indicator system for outpatient services assessment in the Chinese healthcare sector.Twenty-nine indicators were generated using literature review and focus group interviews. A modified Delphi process with the analytic hierarchy process was conducted to screen and determine the final indicators with 13 interdisciplinary panelists through two-round email surveys. A two-level and three-column questionnaire was distributed to 250 outpatients in Shenzhen to pretest the indicator system. The validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient and degree of concentration of opinions. The reliability of the questionnaire was assessed using Cronbach's alpha coefficient and inter-subscale correlation.Of the two rounds of Delphi consultation, the active coefficients were 76.92% and 80%, and the authoritative coefficients were both 0.88. An assessment system for the Chinese outpatient services quality was constructed with six first-level dimensions and 23 second-level indicators. The weights of safety, tangibility, reliability, responsiveness, assurance and empathy were 0.286, 0.096, 0.088, 0.135, 0.226 and 0.169, respectively. For the pretest, Cronbach's alpha values for the importance of the indicator, perception of quality of service and expected quality of service were 0.96, 0.94 and 0.96, respectively. The values of the Kaiser-Meyer-Olkin test were 0.94, 0.93 and 0.95. All Bartlett's test results showed that the correlation matrix was significant (P < 0.001).A multidimensional quality indicator system from patients' perspective was developed for the outpatient services assessment in China's healthcare sector. It has good validity and reliability and can be applied as a standardized tool by healthcare managers and policymakers in China to measure patients' perceptions and expectations.