EVIDENCE FOR THE APPLICABILITY AND USE AREAS OF THE KANO MODEL IN THE HEALTH SECTOR: A SYSTEMATIC REVIEW

Year 2023, Volume: 26 Issue: 3, 871 - 894, 26.09.2023

Zehra Özge Çandereli

Abstract

This study examined the Kano model, which focuses on the nonlinear relation between service quality performance and customer satisfaction and has been used in the field of health in recent years. In order to understand how it is applied in the field of health, to determine its basic features and to reveal the opportunities and difficulties with current application examples, research articles made in the international arena were examined through systematic review. In this context, application examples of the Kano model in the field of health published in the WoS, Pubmed and Scopus databases in the last five years (2018-2022) were included and 23 research articles were examined with certain criteria. It has been determined that the Kano model is used both in various fields of the health sector and in different units of health services. The model provided input to the identification, monitoring and improvement strategies of patients' expectations from different service characteristics related to health institutions. It has been seen that the model is also used in the design, definition and prioritization of service features that may have the most impact on customer satisfaction in emerging new technology-based service delivery such as mobile health applications and tele-nursing. Thanks to the dynamic and flexible nature of the Kano model, it is used together with other quality and performance tools such as Servqual, MUSA, and IPA. Furthermore, it is recommended that they be used together to reduce the limitations of these tools and thus integrated models aid in providing a more comprehensive response to the complex nature of patient needs. This provides a perspective for healthcare managers and healthcare providers to create more effective improvement strategies taking into account the voice of patient.

Keywords

Healthcare, Kano model, Patient satisfaction, Service quality

KANO MODELİNİN SAĞLIK SEKTÖRÜNDE UYGULANABİLİRLİĞİNE VE KULLANIM ALANLARINA İLİŞKİN KANITLAR: SİSTEMATİK BİR DERLEME

Abstract

Bu çalışmada son yıllarda sağlık alanında kullanımı artan ve hizmet kalite performansı ile müşteri tatmini arasındaki doğrusal olmayan ilişkiye odaklanan Kano modeli incelenmiştir. Sağlık alanında nasıl uygulandığını anlamak, temel özelliklerini belirlemek ve güncel uygulama örnekleri ile fırsat ve zorluklarını ortaya koymak amaçlanmıştır. Bu kapsamda günümüz hasta ihtiyaçlarının karmaşık doğasını ortaya koymada tercih edilen Kano modeline ilişkin sistematik derleme yoluyla uluslararası alanda yapılan bilimsel makaleler ele alınmıştır. Belirli kriterler ile son beş yıllık (2018-2022) süreçte WoS, PubMed ve Scopus veri tabanlarında yayınlanan sağlık alanındaki uygulama örneklerine yer verilmiş ve 23 araştırma makalesi incelenmiştir. Kano modelinin hem sağlık sektörünün çeşitli alanlarında hem de sağlık hizmetlerinin farklı birimlerinde kullanıldığı belirlenmiştir. Modelin, hastaların sağlık kurumlarına ilişkin farklı hizmet özelliklerinden beklentilerinin tanımlanması, izlenmesi ve iyileştirme stratejileri için girdi sağladığı bulunmuştur. Ayrıca mobil sağlık uygulamaları ve tele-hemşirelik gibi ortaya çıkan yeni teknoloji tabanlı hizmet sunumunda müşteri tatmini üzerinde en fazla etkiye sahip olabilecek hizmet özelliklerinin tasarımında, tanımlanmasında ve önceliklendirilmesinde kullanıldığı görülmüştür. Kano modelinin dinamik ve esnek yapısı sayesinde Servqual, Çok Kriterli Memnuniyet Analizi (MUSA) ve Önem-Performans Analizi (IPA) gibi diğer kalite ve performans iyileştirme araçları ile birlikte kullanıldığı ve bu araçların sınırlılıklarının azaltılmasında birlikte kullanılmasının önerildiği saptanmıştır. Entegre modeller hasta/kullanıcı ihtiyaçlarının karmaşık doğasının daha bütüncül olarak ele alınmasında yardımcı olmaktadır. Bu yaklaşımlar ise yöneticilere ve sağlık hizmeti sunucularına hastanın sesini dikkate alarak daha etkin iyileştirme stratejileri oluşturması için bir bakış açısı sunmaktadır.

Keywords

Hasta tatmini, Hizmet kalitesi, Kano modeli, Sağlık hizmetleri

References

• Al Deheshi, A., Hejaili, F., Binsalih, S., & Al Sayyari, A. (2016). Application of the Kano Model for determining service attributes preferences of hospital inpatients. International Journal of Business and Social Science, 7(5), 85-92.
• Baki, B., Basfirinci, C. S., AR, I. M., & Cilingir, Z. (2009). An application of integrating SERVQUAL and Kano's model into QFD for logistics services: a case study from Turkey. Asia Pacific Journal of Marketing and Logistics, 21(1), 106-126.
• Barrios-Ipenza, F., Calvo-Mora, A., Criado-Garcia, F., & Curioso, W. H. (2021). Quality Evaluation of Health Services Using the Kano Model in Two Hospitals in Peru. International Journal of Environmental Research and Public Health, 18(11), 6159.
• Berger, C., Blauth, R., & Boger, D. (1993). Kano’s methods for understanding customer-defined quality. Center for Quality of Management Journal, 2, 3-35.
• Chang, W. J., & Chang, Y. H. (2013). Patient satisfaction analysis: Identifying key drivers and enhancing service quality of dental care. Journal of Dental Sciences, 8(3), 239-247.
• Cheng Lim, P., Tang, N. K. H., & Jackson, P. M. (1999). An innovative framework for health care performance measurement. Managing Service Quality: An International Journal, 9(6), 423-433.
• Čufar, A., Mrhar, A., & Robnik-Šikonja, M. (2015). Assessment of surveys for the management of hospital clinical pharmacy services. Artif Intell Med, 64(2), 147-158.
• Çınar, N. (2021). İyi Bir Sistematik Derleme Nasıl Yazılmalı? Online Türk Sağlık Bilimleri Dergisi, 6(2), 310-314.
• de Vasconcelos, C. R., de Carvalho, R. S. M. C., de Melo, F. J. C., & de Medeiros, D. D. (2022). Improving quality in public health service: an integrated approach to the Kano model and the balanced scorecard. Journal of Nonprofit and Public Sector Marketing. 1-27, https://doi.org/10.1080/10495142.2022.2066598
• Dinulescu, R., & Dobrin, C. (2022). Applying the fuzzy analytical hierarchy process for classifying and prioritizing healthcare quality attributes. Management and Marketing, 17(1), 15-40.
• Ferreira, D. C., Marques, R. C., Nunes, A. M., & Figueira, J. R. (2018). Patients’ satisfaction: The medical appointments valence in Portuguese public hospitals. Omega, 80, 58-76.
• Ferreira, D. C., Marques, R. C., Nunes, A. M., & Figueira, J. R. (2021). Customers satisfaction in pediatric inpatient services: A multiple criteria satisfaction analysis. Socio-Economic Planning Sciences, 78, 101036.
• Gimpel, H., Manner-Romberg, T., Schmied, F., & Winkler, T. J. (2021). Understanding the evaluation of mHealth app features based on a cross-country Kano analysis. Electron Mark, 31(4), 765-794.
• Göral, R., & Topuz, Ç. (2018). Otel hizmetlerine dair konuk beklentilerinin Kano Modeli ile sınıflandırması ve önceliklendirilmesi. Manas Sosyal Araştırmalar Dergisi, 7(3), 823-842.
• Gustavsson, S., Gremyr, I., & Kenne Sarenmalm, E. (2016). Using an adapted approach to the Kano model to identify patient needs from various patient roles. The TQM Journal, 28(1), 151-162.
• Howsawi, A. A., Althageel, M. F., Mohaideen, N. K., Khan, M. S., Alzahrani, A. S., Alkhadir, M. A., Alaqeel, S. M., Alkathiri, M. A., & Hawsawi, R. A. (2020). Application of the Kano model to determine quality attributes of patient's care at the primary healthcare centers of the Ministry of Health in Saudi Arabia, 2019. J Family Community Med, 27(3), 178-185.
• Huang, J. C. (2018). Application of Kano model and IPA on improvement of service quality of mobile healthcare. International Journal of Mobile Communications, 16(2), 227-246.
• Hussain, A. B., & Mkpojiogu, E. O. C. (2018). An application of Kano method in the elicitation of stakeholder satisfying requirements for an e-ebola awareness system. WSEAS Transactions on Business and Economics, 15, 80-92.
• Johnson, P. A., & Johnson, J. C. (2021). Kano and other quality improvement models to enhance patient satisfaction in healthcare settings. Journal of Family and Community Medicine, 28(2), 139-140.
• Kano, N., Seraku, K., Takahaski, F., & Tsuji, S. (1984). Attractive quality and must-be quality. The Journal of Japanese Society for Quality Control, 14(2), 39-48.
• Kuo, Y. F., Chen, J. Y., & Deng, W. J. (2012). IPA–Kano model: A new tool for categorising and diagnosing service quality attributes. Total Quality Management & Business Excellence, 23(7-8), 731-748.
• Lacerda, A. B., Souza, A. S. S., Da Silva, G. K. L., Azevedo, E. H. M. D., & Melo, F. J. C. D. (2021). Basic Health Units services quality assessment through Kano and SERVQUAL models. Benchmarking: An International Journal, 29(9), 2858-2880.
• Liang, Y. W., Wang, J., Yu, S. P., Lin, J. K., & Chung, A. L. (2022). Creating a healthy life for the elderly through participation in self-media: a study on the demands of the elderly in self-media. International Journal of Environmental Research and Public Health, 19(19),
• Lin, F., Chen, Q., Lin, M., He, A., Chen, H., Chen, Y., Chen, H., He, W., Hu, Y., Wang, J., Lin, X., & Wang, X. (2022). Clinical effect of nursing based on the Kano model in emergency multiple ınjuries. Evidence-based Complementary and Alternative Medicine, 2022, 3586290. https://doi.org/10.1155/2022/3586290
• Luor, T., Lu, H. P., Chien, K. M., & Wu, T. C. (2012). Contribution to quality research: A literature review of Kano's model from 1998 to 2012. Total Quality Management & Business Excellence, 26(3-4), 234-247.
• Malinka, C., von Jan, U., & Albrecht, U. V. (2022). Prioritization of quality principles for health apps using the Kano model: survey study. JMIR Mhealth Uhealth, 10(1), e26563.
• Mao, J. Y., Xie, L. L., Zhao, Q. H., Xiao, M. Z., Tu, S. T., Sun, W. J., & Zhou, T. T. (2022). Demand analysis of an intelligent medication administration system for older adults with chronic diseases based on the Kano model. International Journal of Nursing Sciences, 9(1), 63-70.
• Martin, C. G., Morato, R. A. G., Cortes, N. D., Fernandez-Canamaque, J. L., & Holguin, P. (2019). Patient satisfaction in a Spanish burn unit. Burns, 45(2), 341-347.
• Materla, T., Cudney, E. A., & Antony, J. (2017). The application of Kano model in the healthcare industry: a systematic literature review. Total Quality Management & Business Excellence, 30(5-6), 660-681.
• Materla, T., Cudney, E. A., & Hopen, D. (2019). Evaluating factors affecting patient satisfaction using the Kano model. Int J Health Care Qual Assur, 32(1), 137-151.
• Materla, T., & Cudney, E. A. (2020). An integrated methodology for evaluating patient service quality. Total Quality Management and Business Excellence, 31(15-16), 1738-1759.
• Matzler, K., & Hinterhuber, H. H. (1998). How to make product development projects more successful by integrating Kano's model of customer satisfaction into quality function deployment. Technovation, 18(1), 25-38.
• Meng, Q., & Dong, J. (2018). Future direction and visual analysis of Kano model: a literature review. Journal of Service Science and Management, 11(04), 399.
• Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Group, P. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine, 151(4), 264-269.
• Momani, A., Al-Hawari, T., Al-Shebami, H., & Al-Araidah, O. (2014). Classifying and ranking healthcare quality attributes using integrated Kano-Fuzzy Analytical Hierarchy Process Model. Engineering Management Research, 3(1).
• Müller, S. D., Lauridsen, K. G., Palic, A. H., Frederiksen, L. N., Mathiasen, M., & Løfgren, B. (2021). Mobile app support for cardiopulmonary resuscitation: development and usability study. JMIR Mhealth Uhealth, 9(1), e16114.
• Müller, S. D., Tsirozidis, G., Mathiasen, M., Nordenhof, L., Jakobsen, D., & Mahler, B. (2022). Eliciting information needs of child patients: adapting the Kano model to the design of mhealth applications. Methods Inf Med, 61(3-04), 123-138.
• Nordin, N., & Razak, R. C. (2014). The concept of Kano-QFD integration for non-linear customer needs in product and service design. Advanced Review on Scientific Research, 4(1), 1-6.
• Ömürgönülşen, M., Eryiğit, C., Tektaş, Ö. Ö., & Soysal, M. (2020). Enhancing the quality of a higher education course: quality function deployment and Kano model integration. Yükseköğretim Dergisi, 10(3), 312-327.
• Plehn, N., Folkert, L., Meissner, A., & Plehn, G. (2016). Expectations of Russian medical tourists on German health care services: a Kano model-based analysis. Journal of Tourism and Hospitality, 5(2).
• Priyono, A., & Yulita, A. (2017). Integrating Kano Model and Quality Function Deployment for designing service in hospital front office. Intangible Capital, 13(5), 923-945.
• Tan, K. C., & Pawitra, T. A. (2001). Integrating SERVQUAL and Kano’s model into QFD for service excellence development. Managing Service Quality: An International Journal, 11(6), 418-430.
• Tontini, G., & Silveira, A. (2007). Identification of satisfaction attributes using competitive analysis of the improvement gap. International Journal of Operations & Production Management, 27(5), 482-500.
• Vassiliadis, C. A., Fotiadis, A. K., & Tavlaridou, E. (2014). The effect of creating new secondary health services on patients' perceptions: a Kano service quality analysis approach. Total Quality Management and Business Excellence, 25(7-8), 897-907.
• Wang, C. C., & Hsin-Hao, C. (2018). Identifying the key factors of service quality in a traditional Chinese medicine clinic-based Kano-IPA model and case study. TEM Journal, 7(2), 301.
• Wang, Z., Yang, Y., Zhu, Y., Liu, M., Zhao, X., Xiao, L., Zhang, Y., Liang, F., Pang, X., Yang, Z., & Weng, H. (2022). Spiritual care needs among Chinese elders hospitalized for severe chronic heart failure: An observational study. Palliat Support Care, 1-10. https://doi.org/10.1017/s1478951522001237
• Witell, L., Löfgren, M., & Dahlgaard, J. J. (2013). Theory of attractive quality and the Kano methodology – the past, the present, and the future. Total Quality Management and Business Excellence, 24(11-12), 1241-1252.
• Wongrukmit, P., & Thawesaengskulthai, N. (2014). Hospital service quality preferences among culture diversity. Total Quality Management & Business Excellence, 25(8), 908–922.
• Yeboah, M. A., Ansong, M. O., Appau-Yeboah, F., Antwi, H. A., & Yiranbon, E. (2014). Empirical validation of patient’s expectation and perception of service quality in Ghanaian hospitals: an integrated model approach. American International Journal of Social Science, 3(3), 143–160.
• Yuan, Y., Liu, Y. L., Gong, L., Chen, H. M., Zhang, S., Kitayama, A., Takashi, E., & Liang, J. Y. (2021). Demand analysis of telenursing for community-dwelling empty-nest elderly based on the Kano model. Telemedicine and E-Health, 27(4), 414-421.
• Yuan, Y., Tao, C., Yu, P., Wang, Y., Kitayama, A., Takashi, E., Yanagihara, K., & Liang, J. (2022). Demand analysis of telenursing among empty-nest elderly individuals with chronic diseases based on the Kano model. Frontiers in Public Health, 10, 990295. https://doi.org/10.3389/fpubh.2022.990295