The Gaps of Healthcare Service Quality in Nurse Practitioner Practice and Its Associated Factors From the Patients’ Perspective

Chia Hung Lin, Shu Fen Siao, Heng Hsin Tung, Kuo Piao Chung, Shiow Ching Shun*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Purpose: This study investigates the expectations, perceptions, and gaps of the healthcare service quality (HSQ) from the patients’ perspective, and explores the significant demographic and clinical factors associated with the HSQ in nurse practitioner practice (NPP). Design: A cross-sectional design was carried out, with convenience sampling performed under the NPP in Taiwan, from June to November 2016. Methods: The Nurse Practitioner Healthcare Service Quality Scale was used to assess the expectations, perceptions, and gaps of the HSQ. The demographics, clinical characteristics, and symptom severity of patients were collected, and the Importance-Performance Analysis was applied to identify the priority of ranking items for the improvement of nurse practitioners (NPs). The Generalized Estimating Equation was used to explore the factors associated with the HSQ in NPP. Findings: A total of 200 patients completed the questionnaires. The results revealed that the patients had overall high expectations (M = 6.35, SD = 0.46), moderate perceptions (M = 4.21, SD = 0.95), and a mild HSQ gap (M = -2.14, SD = 0.69), with statistically significant differences (p <.001). In NPP, the largest gap in the HSQ dimensions was reliable responsiveness, followed by empathy, assurance, and tangibility. Patients with greater symptom severity and a longer in-hospital stay were associated with larger HSQ gaps; however, patients who were transferred from the emergency department had smaller gaps than those in the outpatient department. Conclusions: The patients’ expectations were not fully satisfied in the NPP, especially for the dimensions of reliable responsiveness and empathy. The patients’ symptom severity was a significant factor related to the gaps in the HSQ. The awareness of unmet needs, from the patients’ perspective, could guide the convergence of a rational policy to promote healthcare delivery in the NPP. Clinical Relevance: The managers of NPP need to pay attention to increasing NPs’ reliable responsiveness and empathy, by setting the appropriate scope of practice, regulating the NP-to-patient ratio, applying for certification programs in prescribing training, and cultivating patient-centered care with shared decision making. In addition, building up the knowledge and competency of symptom management is also suggested for NP training.

Original languageEnglish
Pages (from-to)378-386
Number of pages9
JournalJournal of Nursing Scholarship
Issue number3
StatePublished - May 2021


  • advanced nursing practice
  • healthcare service quality
  • nurse practitioner
  • quality of care


Dive into the research topics of 'The Gaps of Healthcare Service Quality in Nurse Practitioner Practice and Its Associated Factors From the Patients’ Perspective'. Together they form a unique fingerprint.

Cite this