IDENTIFYING PRACTICE GAPS FOR QUALITY IMPROVEMENT NURS 8302
Walden University IDENTIFYING PRACTICE GAPS FOR QUALITY IMPROVEMENT NURS 8302-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University IDENTIFYING PRACTICE GAPS FOR QUALITY IMPROVEMENT NURS 8302 assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for IDENTIFYING PRACTICE GAPS FOR QUALITY IMPROVEMENT NURS 8302
Whether one passes or fails an academic assignment such as the Walden University IDENTIFYING PRACTICE GAPS FOR QUALITY IMPROVEMENT NURS 8302 depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for IDENTIFYING PRACTICE GAPS FOR QUALITY IMPROVEMENT NURS 8302
The introduction for the Walden University IDENTIFYING PRACTICE GAPS FOR QUALITY IMPROVEMENT NURS 8302 is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
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How to Write the Body for IDENTIFYING PRACTICE GAPS FOR QUALITY IMPROVEMENT NURS 8302
After the introduction, move into the main part of the IDENTIFYING PRACTICE GAPS FOR QUALITY IMPROVEMENT NURS 8302 assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for IDENTIFYING PRACTICE GAPS FOR QUALITY IMPROVEMENT NURS 8302
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for IDENTIFYING PRACTICE GAPS FOR QUALITY IMPROVEMENT NURS 8302
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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IDENTIFYING PRACTICE GAPS FOR QUALITY IMPROVEMENT NURS 8302
IDENTIFYING PRACTICE GAPS FOR QUALITY IMPROVEMENT NURS 8302
The need for healthcare organizations to enhance quality of their service provision is at the core of the discovery of initiatives as well as reforms in the health industry. Through the reforms and initiatives, these organizations can achieve their goals and objectives in care provision, especially patient-focused care. Adoption and use of technology continues to help hospitals deal with occurrence of adverse events and quality improvement (Saver et al., 2015). Through a case study of a health organization, this paper explores a quality improvement issue and provides a proposal on how this entity can address the problem. The paper uses the “road to evidence-based practice” model in exploring and addressing the issue.
Overview of the Issue
The changes in service delivery, management of health information and records as well as cost-containment measures are the main drivers of patient seeking care from non-hospital settings. Health records are a critical component of effective care delivery in many health facilities, including assisted living settings as they increase accessibility, integrity and accuracy. These records are used for reimbursement and provision of quality patient care and attainment of an organization’s quality initiatives and goals. The need for technology in managing health records in organizations cannot be overemphasized when considered from a quality improvement perspective (Saver et al., 2015). Evidence demonstrates that protection of patient’s data is critical to provision of quality health care services.
Atrium Health is one of the country’s leading healthcare providers and connects patients who need on-demand care and links them to world-class care specialists (Atrium Health, 2020). The provider has continued to attain successes for several years because of applying different healthcare technologies that include electronic health records (EHR), and electronic management system among others. Medication errors lead to over 1.1 million deaths in the country’s healthcare system. These errors are attributed to different causes, including insufficient knowledge and utilization of technology system by healthcare workers like nurses. Healthcare organization use close to $15 million each year in addressing the issue and seeking remedies. Atrium Health Organization is no exception as it deals with many cases of patients affected by medication errors.
Need for Quality Improvement
Technology and its application is critical to healthcare organizations in provision of quality as well as affordable care focused on patients. The implementation of quality improvement initiatives is essential for Atrium Health Organization in efforts to address quality measures and reduce medication errors. these errors are experienced in the healthcare system prompting initiatives focused on utilizing new technologies that improve accuracy and minimize potential errors (Aloini et al., 2018). These technologies also improve clarity in patient’s information as well as collegiality in diagnosis and treatment interventions. The development of medical technologies like the electronic health records has allowed organizations to optimize health outcomes for different patients and populations. These systems are essential for effective functioning of an organization’s information technology unit due to their ability to improve the receipt and sending of treatment intervention guidelines and ordering medication electronically using an organization’s computer system.
Research on Quality Improvement
Studies demonstrate that at the heart of quality improvement initiatives is the need to incorporate medical technologies through applications like electronic health records, telehealth, and artificial intelligence (AI Manca, 2015; Curtis et al., 2018). The demand for quality care services continues to rise due to an aging population as well as increase in emergence of chronic health conditions that require close care. Use of technologies like electronic health records, telehealth and artificial intelligence has the potential to promote quality health care services in medical facilities and thereby enhance patient outcomes. Quality improvement initiatives will allow patient to access useful information as well as efficient medical services (Silver et al., 2015). These technologies impact patients’ health status and enable them to boost immunity (Aloini et al., 2018). The initiative will also alter the cost of care by reducing the expenses associated with medication errors. Through this initiatives, more patients access care using medical centers.
Communities and population will be impacted by quality improvement initiatives. Use of electronic health records allows patients to access their information and spend less time and money in treating certain conditions due to errors like misdiagnoses. Electronic health records enhance transactional accuracies compared to manual records. These records are critical in provision of value-based care as opposed to offering care based on volume (Liss et al., 2020). The implication is that through the implementation of EHR, health care organizations can reduce their operational costs and expenses, especially those linked to the occurrence of adverse events like medication errors.
The implementation of EHR protocols is critical in quality care since it allows organizations to develop evidence-based interventions for different conditions and carry out studies to find the most optimal ways of addressing cost containment in their operations. According to HealthIT.gov (2020), electronic health records offer a host of benefits to organizations that include secure sharing of electronic data with both patients and healthcare providers, provides accurate and current as well as complete data concerning patients at the point of care. EHRs also enhance patient and provider interaction as well as communication and enables safer and more reliable prescribing of medications. More fundamentally, these records enhance privacy and security of patient information and assists in promoting eligibility, documentation and accurate, streamlined coding for billing and reimbursement purposes.
Steps in Implementing Quality Improvement Model
The optimal and effective implementation of quality improvement models in the organization requires following essential steps to guarantee success. Imperatively, the management and other stakeholders must start with proper planning as well as management of human and financial resources. These steps entail developing a comprehensive budget for the process and aligning it with the overall organizational expenses to ascertain the ability of the organization to finance the initiative. Secondly, the organization’s change agents should use the accepted change models like Lewin’s to attain a buy-in from the staff. The implication is that the management should educate the employees and involve them in the implementation of the initiative (Liss et al., 2020). Thirdly, the organization should cultivate a change culture that will implore the staff to adopt the new system.
Fourthly, it is critical for the organization to offer and highlight the essential benefits that will be derived from the project. Fifthly, before implementation, the organization should test the working of an electronic health record (EHR) system through a prototype. Lastly, through the application of Lewin’s model, the healthcare provider should institutionalize the changes in its culture and processes.
Evaluating the Improvement
It is essential to evaluate the implementation of the project proposed to understand and ascertain its effectiveness to the health organization. The implementation of the initiative will lead to significant change at the organization in delivery of quality patient services. Therefore, to evaluate the successful implementation of the project, different measures will be used. Quality measures assess and compare the quality of service delivery in health care organizations. These include structure, process, and outcome measures. In this instance, the evaluation will use the three types of measures. Structural measures offer consumers a sense of the organization’s capacity, processes, and system in providing high-quality care outcomes (AHRQ, 2015). For instance, the implementation of electronic health records will demonstrate to patients that the entity has effective system to offer high-quality care. Process measures show what a health care provider implements to maintain or enhance health, both for healthy individuals and those with medical conditions. In this case, the facility should use process measures to ascertain if consumers will attain better services through the use of electronic health records (EHRs).
According to the Agency for Healthcare Research and Quality (AHRQ) (2015), most of health care quality measures in public health organizations are process measures. These measures also contribute toward enhancing outcomes. In this instance, process measures will evaluate the impact of using EHRs in enhancing better outcomes through reduced time, costs, and security as well as patient safety. Thirdly, outcome measures can be used to evaluate the effectiveness of using the electronic health records since the mirror the effect of health service or intervention on the overall health status of consumers (AHRQ, 2015). In this case, the outcome measures will be used to know the number of reported medication errors after implementing this initiative. The facility can also use key performance index, KPI, to evaluate the overall performance of nurses in care provision. Through the application of these criteria, the management will monitor the level of success of the quality improvement initiatives.
Test, Hypotheses & Explanation
The quality improvement initiative centers on experimental implementation of hypothesized solutions to the organization’s challenges. Imperatively, the effectiveness of this process will be ascertained by the size as well as complexity of quality improvement efforts by the entity (Aloini et al., 2018). For example, the organization can conduct certain tests to get answers based on the implementation process. For instance, it can decide to use different patients with similar diagnoses to test the hypothesized solution as well as statistical tests to ascertain the success of the quality improvement initiative. In this case, it can choose ten patients from various units or sections and then analyze the results using sample test and null hypothesis. Through such interventions, the facility will determine the effectiveness of the quality improvement model in comparison to patients who did not use the new system.
Conclusion
The case study demonstrates that health care organizations can enhance quality delivery of services using different technologies like the EHR which ensures security and privacy of patients. Further, the use of quality measures and implementation of quality interventions are pre-requisites to increasing accessibility, and reducing medication errors. through the use of health care technologies like EHR, health organizations like Atrium can respond effectively and promptly to information and orders with a view of addressing medication errors. they should also use metrics system to ascertain the credibility of their quality improvement initiatives. Using these initiatives, they will reduce the overall cost of care, improve accessibility and address medication errors.
References
Agency for Healthcare Research and Quality (AHRQ) (2015). Types of Health Care Quality
Measures. Retrieved from https://www.ahrq.gov/talkingquality/measures/types.html
Aloini, D., Cannavacciuolo, L., Gitto, S., Lettieri, E., Malighetti, P., & Visintin, F. (2018).
Evidence-Based Management for Performance Improvement in HealthCare. Management Decision, 56(10), 2063-2068. https://doi.org/10.1108/MD-10-2018-004
Atrium Health (2020). About Atrium Health. Retrieved from https://atriumhealth.org/about-us
Atrium Health (2020b). World-Class Care. Retrieved from https://atriumhealth.org/
Curtis, J. R., Sathitratanacheewin, S., Starks, H., Lee, R. Y., Kross, E. K., Downey, L., … &
Lindvall, C. (2018). Using electronic health records for quality measurement and accountability in care of the seriously ill: opportunities and challenges. Journal of Palliative Medicine, 21(S2), S-52.
HealthIT.gov (2019). What are the advantages of electronic health records? Retrieved from
Liss, D. T., Peprah, Y. A., Brown, T., Ciolino, J. D., Jackson, K., Kho, A. N., … & Persell, S. D.
(2020). Using Electronic Health Records to Measure Quality Improvement Efforts: Findings from a Large Practice Facilitation Initiative. The Joint Commission Journal on Quality and Patient Safety, 46(1), 11-17.
Manca, D. P. (2015). Do electronic medical records improve quality of care?
Yes. Canadian Family Physician, 61(10): 846-847.
Saver, B. G., Martin, S. A., Adler, R. N., Candib, L. M., Deligiannidis, K. E., Golding, J.,
Mullin, D. J., Roberts, M., & Topolski, S. (2015). Care that Matters: Quality Measurement and Health Care. PLos Med, 12(11): e1001902.
Silver, S. A., McQuillan, R., Harel, Z., Weizman, A. V., Thomas, A., Nesrallah, G., & Chertow,
G. M. (2016). How to sustain change and support continuous quality improvement? Clinical Journal of the American Society of Nephrology, 11(5), 916-924. DOI: https://doi.org/10.2215/CJN.11501015
Week 3 Discussion
Top of Form
Identifying a practice problem in an organization can either be simple and obvious or more complex and hidden. When identifying a problem it is important to talk with those in an organization who may be witnessing it more often. This means that if there is a problem on the floor of the unit you will be more successful talking with nurses on the floor than with nurses who are in the back office of the unit. Involving stakeholders in identifying problems can also be a successful way in recognizing where a quality improvement project can take place. These ways can be considered collection of information through surveys.
A potential quality improvement practice gap in my organization could be getting the residents at the long term care facility that I work at to all get a shower at least 2 times a week. It is a 125 bed facility and at the moment we have 96 residents. Many residents are not getting bathed or even given the opportunity to shower. This is a right that needs to be taken care of. The care of the residents are so important and sometimes something as simple as a shower can change how a person feels. There is a lack of communication when it comes to who is responsible for what at my facility. Changing the narrative and really assigning and then holding people accountable for what they have been assigned could help in getting all residents the opportunity to shower. This is an example of improving the processes in order to improve the quality of the organization which is one of the main reasons for research (Nash, Joshi, Ransom and Ransom, 2019).
Implementing a morning huddle about showers is a method that could be used to address the practice gap. Huddles in healthcare improve communication and collaboration between different levels and areas of care and can include improvement in team outcomes and clinical outcomes (Pimentel, Snow, Carnes, Shah, Loup, Vallejo-Luces, Madrigal and Hartmann, 2021). Huddles can help with communicating the needs of the residents and it will also help with the accountability of staff. The second method that could be effective in improving this quality problem is to teach staff the importance of informing residents about what is happening with cue cards or other items in order to reduce the amount of anxiety a resident may experience from bathing (Novotney, 2013). This communication with the resident allows the resident to feel like they are in control and that what is going on is not just happening to them, but that they are an active participant in it. Allowing residents to make decisions can help them feel included and empowered. Teaching these appropriate communication techniques to the staff can help them feel more comfortable approaching residents and helping them bathe. Having both parties be more comfortable with showering and/or bathing can help increase the amount that it happens at the facility.
References
Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press.
Novotney, A. (2013, May 1). Flex bathing for all: being able to adapt bathing equipment, spaces and materials to a changing census is critical for long-term care providers and residents. McKnight’s Long-Term Care News, 34(5), 32.
Pimentel, C. B., Snow, A. L., Carnes, S. L., Shah, N. R., Loup, J. R., Vallejo-Luces, T. M., Madrigal, C., & Hartmann, C. W. (2021). Huddles and their effectiveness at the frontlines of clinical care: a scoping review. JGIM: Journal of General Internal Medicine, 36(9), 2772–2783.
Response
This is an exceptional work Barbie. You have clearly identified a potential quality improvement practice gap in your organization and provided methods that can be used to address the practice. This is a clear indication that you had a good grasp of the content. I agree with your post. Essentially, nursing students are expected to develop effective problem-solving skills and critical thinking to enable them to identify practice problems and create solutions (Ahmady & Shahbazi, 2020).
Problem solving is anchored on the ability recognize critical issues and develop solutions. Nursing profession merges science, research, art, and creativity. Therefore, having problem solving skills, thinking creatively by asking the appropriate questions, and exploring multiple options, nurses can identify and solve practice problem more effectively (Bordoll et al., 2021). The application of problem-solving skills starts with critical thinking. Critical thinking is important in identifying courses of action and creating clear answers to the practice problems (Chan, 2019). Integrating problem-solving skills, critical thinking, and creativity can enable nurses to address specific practice problems and system-wide issues.
References
Ahmady, S., & Shahbazi, S. (2020). Impact of social problem-solving training on critical thinking and decision making of nursing students. BMC nursing, 19(1), 1-8. https://doi.org/10.1186/s12912-020-00487-x
Bordoll, J. C., Leyva, J., & Gonzalez, M. P. A. (2021). Innovation in Nursing Care. Innovation, 2022. https://guies.uab.cat/guies_docents/public/portal/html/2021/assignatura/44459/en
Chan, Z. C. (2019). Nursing students’ view of critical thinking as ‘Own thinking, searching for truth, and cultural influences’. Nurse education today, 78, 14-18. https://doi.org/10.1016/j.nedt.2019.03.015
Week 3 Initial Post
Top of Form
The methodology I would utilize to identify a quality improvement gap in my current organization is the hospitals’ scorecard on Hospital Compare. “The Centers for Medicare & Medicaid Services (CMS), the federal agency that runs the Medicare program, created this tool in collaboration with organizations representing people with Medicare, hospice organizations, other stakeholders, and other federal agencies”. (Center for Medicare and Medicaid Services, n. d.). CMS’s website, hospital compare, is a website that allows participants/caregivers/others, to identify providers based on the criteria most relevant to them. In reviewing my current organizations’ scorecard via hospital compare, the hospitals’ rate for 30- day inpatient psychiatric readmissions is 21.1%, while the national average is 20.1, which is not statistically significant. However, the percentage of patients included in this data (Medicare only), are minimal, compared to the total number of patients discharged from the inpatient psychiatric unit.
To be sure that this data was accurate, I compared this data to the same statistics reported by some of our other payors via the Value-Based Purchasing (VBP) program. This is a method of provider payments, directly related to the providers’ performance. More specifically, providers are held accountable for the quality of care they provide, which is directly related to the organizations’ reimbursement (HealthCare.gov, n. d.). My organization currently has VBP agreements with two payors. As reported by these payors, our 30-day readmission rate for the inpatient psych unit is significantly higher than the local/state/national average. Thus, this is an opportunity for our department to address.
The method I would choose to address this gap in practice is a retrospective chart review. This is a review of a medical record after a patient has been discharged from the hospital. It is the most comprehensive method of data collection related to patient care. Additionally, a retrospective chart review “is the primary tool for answering the “why” of a given situation” (Nash, Joshi, Ransom, E. & Ransom, S., 2019, pg. 114). Following a patients’ discharge, a thorough review of a patients’ chart could help to provide some detail regarding the patients’ discharge plan, wrap-around services in the community and other factors, or lack thereof, that may have contributed to the patients’ readmission.
After a thorough review of a sampling of patients’ charts, collecting data, I would use a fishbone diagram to assist in sorting the data, identifying potential causes for patients’ readmissions. The fishbone diagram organizes possible causes, in a format that’s visual for ease in understanding (Nash et al., 2019). Although the reasons for readmission may be very individualized, my goal would be to ensure that, as an organization, we provided patients with all of the tools required to be successfully discharged to the community. Overall, in a review of this data, the focus would be on psychiatric readmissions, but would also consider patient outcomes. “Management strategies to reduce readmissions may influence indicators of well-being such as psychiatric symptomatology, functional status, quality of life, social adjustment, self-efficacy, service satisfaction, life skills, medication adherence, and ability to live independently” (RTI-UNC Evidence-based Practice Center, 2015, pg. 25). Improved quality of life is a goal for patients with severe and persistent mental illness.
References
Center for Medicare and Medicaid Services (n. d.). Hospital Compare. https://www.medicare.gov/care-compare/resources/about-this-tool
HealthCare.gov (n. d.). Value-Based Purchasing. https://www.healthcare.gov/glossary/value-based-purchasing-vbp/
Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.), (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press.
RTI-UNC Evidence-based Practice Center (2015). Effective health care program: Management strategies to reduce psychiatric readmissions. Technical Brief Number 21. https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/psychiatric-readmissions_technical-brief.pdf
What should be happening in practice? What is happening or observed in practice?
These two questions help to identify where quality improvement practice gaps might exist in nursing practice. If we know what should be happening does not coincide with what is happening, we know there is an issue, or more appropriately, a practice gap.
Photo Credit: Getty Images/iStockphoto
A practice gap is the difference between a desirable or achievable state of practice and current reality. For example, a common gap in practice in healthcare organizations today, are healthcare associated infections (HAIs), such as central line associated blood stream infections (CLABSIs), or catheter associated urinary tract infections (CAUTIs).
The ongoing identification of practice gaps is critical to quality improvement and involves identifying the current state, comparing that current state to the desired state, identifying the causes of the gaps in practice, and validating those gaps to develop a process for improvement.
For this Discussion, reflect on quality improvement practice gaps that may exist in your practice or organization. Consider what quality improvement methods and/or tools might be useful in improving this practice gap. Then, think about how you might address these challenges and what strategies you might implement as a future DNP-prepared nurse.
To Prepare:
- Review the Learning Resources on tools and methods for quality improvement.
- Reflect on a potential quality improvement practice gap, you have seen in your practice or organization, which you might consider using for your DNP project.
- Consider the tools and methods you might use to address this quality improvement practice gap.
By Day 3 of Week 3
Post a brief explanation of how you would identify a quality improvement practice gap in your practice or organization. Describe a potential quality improvement practice gap you might use for your DNP project, and explain why. Then, explain at least two types of tools and/or methods you might use to address this quality improvement practice gap, and explain why. Be specific and provide examples.
By Day 6 of Week 3
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding upon your colleague’s post and suggesting alternative tools and/or methods your colleague might consider using to address the quality improvement practice gap they selected.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
This is an outstanding work Andretta. The methodologies of identifying quality improvement gap in health care organization have been clearly identified. I concur with your post. Ideally, identification of quality improvement gap should be followed by addressing the gap and determination of quality of the service. However, evaluating the perceptions and expectations of patients concerning health care delivery and areas that need improvement remains a great challenge (Javed & Ilyas, 2018). Usually, surveys have been used to understand quality improvement gaps from the perspective of the patients and other stakeholders. However, another important methodology that organizations and providers can use is to compare the perceived and the expected quality of service and identify the gaps between them, utilize the feedback from the stakeholders to enhance quality, and evaluate the real experiences of health care (Lu et al., 2020). As service quality is increasingly becoming a critical aspect of corporate strategy in health care system, an approach of measuring the perception and understanding the gap between perception and expectation can be important in quality improvement initiatives (Dopeykar et al., 2018).
References
Dopeykar, N., Bahadori, M., Mehdizadeh, P., Ravangard, R., Salesi, M., & Hosseini, S. M. (2018). Assessing the quality of dental services using SERVQUAL model. Dental Research Journal, 15(6), 430. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6243813/
Javed, S. A., & Ilyas, F. (2018). Service quality and satisfaction in healthcare sector of Pakistan—the patients’ expectations. International journal of health care quality assurance. https://doi.org/10.1108/IJHCQA-08-2016-0110
Lu, S. J., Kao, H. O., Chang, B. L., Gong, S. I., Liu, S. M., Ku, S. C., & Jerng, J. S. (2020). Identification of quality gaps in healthcare services using the SERVQUAL instrument and importance-performance analysis in medical intensive care: a prospective study at a medical center in Taiwan. BMC Health Services Research, 20(1), 1-11. https://doi.org/10.1186/s12913-020-05764-8
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