Quality of hospital service: The impact of formalization and decentralization

Purpose - To investigate the relationship between two structural dimensions (formalization and decentralization) and two quality dimensions (design and conformance). Design/methodology/approach - A total sample of 758 staff members and patients in five hospitals completed a questionnaire composed of four scales designed to measure the main variables in our study. Correlation and regression analysis were used to measure and confirm the study's hypotheses. Findings - It was found that higher levels of decentralization are related to higher levels of design quality while higher levels of formalization are related to higher levels of conformance quality. Practical implications - The results suggest that hospital managers need to skillfully handle the structural conflict between decentralization and formalization, and use both dimensions simultaneously to improve hospital performance and patients' service quality. Originality/value - Previous studies are advanced by clarifying the impact of structural variables on total quality. A positive relationship between decentralization and design quality; and between formalization and conformance quality is empirically confirmed. The study points out the necessity of simultaneously achieving high levels of both formalization and decentralization in order to improve hospital performance in general and both components of total quality in particular.