Comparison of answers to open-ended questions
We will now compare the responses obtained from open-ended questions from patients against responses obtained from staff for similar questions to uncover potential service gaps in the system.
What patients look for vs. what staff think patients want (Gap 1)
Comparing what patients look for in their healthcare and what staff thinks patients want in their healthcare (Q1 patients vs. staff) identifies shortcomings in Gap 1 of the SQG model. From the information collected, patients look for quality care, respect, and timely care. The staff’s top two responses were patients who wanted medication refills and a quality physician. In this simple side-by-side comparison, differences or gaps are already identified.
The biggest difference is that patients expect to be respected and receive timely care, whereas staff thinks patients are there merely for medication refills. The second difference is a little more subtle; while patients want quality care, the staff thinks that they only care about the quality of the physician. The difference here is that staff do not consider their interaction with patients as part of the patient’s healthcare experience. In contrast, patients look for an overall quality experience from the moment they enter the clinic. We believe that, at this clinic, staff might not be fully aware of the importance and magnitude their attitudes and behaviors have on the overall patient experience. Results show a disconnect between what patients are looking for in their service and what staff thinks patients want.
Our results align with Ostrov, Reynolds, and Scalzi , who assessed patient satisfaction between two healthcare units. Like our study, their questionnaire included what the physicians and nurses believed patients wanted. The survey found that the service the patients preferred was not the same service staff had thought would be preferred.
What staff think patients want vs. what staff think patients need (Gap 2)
Comparing what staff thinks patients want from their healthcare service and what staff thinks patients need from their healthcare provider (Q1 vs. Q2 for staff) aims to identify shortcomings in Gap 2 of the SQG model.
The staff thinks what patients want from their healthcare are medication refills and a quality physician from the information collected. The staff’s top two responses for patient needs were information communication and acknowledgment during the visit. In this side-by-side comparison, we can again identify the difference between what staff thinks patients look for in their service and what they think patients need. In this case, staff believes patients need to “hear and be heard,” as one of the staff members stated.
The answers from staff about patient needs are not surprising as “information and education” and “participation” are two core principles of PFCC . Acknowledgment or participation might still be related to quality physician, but it goes beyond the patient-physician interaction. Responses indicate that at this particular facility, the staff is still missing awareness of “Collaboration” and “Dignity and Respect,” which are also core principles of PFCC .
What patients look for vs. what staff think patients need (Gap 1 + Gap 2)
A third comparison is between what patients look for and what the staff thinks patients need from the healthcare visit (Q1 patients vs. Q2 staff). This comparison aims to identify any shortcomings in Gaps 1 and 2 in the SQG. Once again, from the information collected, patients look for quality care, respect, and timely care. The staff’s top responses for what they think the patient needs were the communication of information and acknowledged participation of the patient during their visit.
Results indicate a disconnect between what patients look for and what staff think they are looking for (Gap 1) and what staff believes patients look for versus what they need (Gap 2). If services are designed according to what providers believe patients need, there is still a disconnect from patient expectations. The Collaboration aspect of PFCC suggests patients, families, and healthcare providers “collaborate in policy and program development, implementation, and assessment; in health care facility design; and in professional education, and in the delivery of care” . The disconnect shown in Gaps 1 and 2 can lead to Gap 3 when healthcare providers design their services without patient input. All these gaps combine to increase the breach between patient expectations and perceptions of healthcare services.
What patients expect vs. what staff think patients need (Gap 1 + 2)
The comparison between what patients expect from their healthcare provider and what staff thinks patients need from their healthcare provider (Q2 patients vs. staff) aims to identify, once again, shortcomings in Gaps 1 and 2 of the SQG. From the information collected, the patient’s expectations from their healthcare include good customer service, a thorough diagnosis, and professionalism. The staff’s top responses for what they think patient needs were communication of information and acknowledged patient participation during their visit. Communication and acknowledgment are key components of good customer service, but other aspects, such as respect and empathy, make customer service a broader category. The expectation of a thorough analysis and professionalism were not considered by the staff. Ungureanu and Mocean  found that education, patience, and respect constitute a significant portion of what patients look for in their health service. Similarly, we find that patients look for respect and patience. Staff at this location agree on the importance of communication and information dissemination.
What patients look for vs. what patients expect (Expected Service)
Comparisons of what patients look for in the healthcare service versus what they expect from the provider (Q1 vs. Q2 patients) were done to study patients’ potential conditioning or bias. We were interested in uncovering if patients were setting their expectations differently from what they were anticipating. From the information collected, patients look for quality care, being respected, and timely care. Additional expectations were good customer service, a thorough diagnosis, and professionalism. Good customer service and thorough diagnosis are related to quality care and being respected is related to professionalism. Interestingly, even though patients look for timely care, they did not expect it. This was consistent with the results from question 3.
What patients didn’t like vs. what staff think patients did not like (Gap1)
Comparing what patients did not like and what staff thinks patients did not like (Q3 patients vs. staff) returns to explore Gap 1 further. From the information collected, the staff thinks patients do not like short visits with the provider or waiting to get an appointment. Other responses included not getting medications refilled, answering Government Performance and Results Act questions, and lack of explanation in medication, health education, and steps to improve health. Patients responded to this question with many stating the wait to get an appointment was a major dislike. The next two items that presented themselves were feeling mistreated and the wait to be seen. The two wait items differentiate because the former is an attempt to get an appointment and get in the system, while the latter is related to having obtained an appointment but waiting within the system to be seen by the provider. Both groups show that waiting to get an appointment is a dislike for people attempting to be seen. The staff’s first response of a short time with the provider did show up in one patient’s response. With many other items appearing more frequently than the staff’s top response, this appears not to be as important to the patient. A more significant item is the social treatment the patient receives.
Multiple-Choice questionnaire (Patients Only)
The multiple-choice section shows that there is room for improvement, particularly the appointment process, which is an issue for patients; however, many items came back rating slightly higher than average. This indicates there is room to improve as many areas were not close to the exceptional level.
Questions that showed poor performance were related to getting an appointment and lack of feedback or follow-up regarding x-ray or lab results. In both the Weidmer-Ocampo et al.  study and this study, individuals valued a high level of care and respect while being seen in their healthcare facility. In both studies, we can see a difference in what patients expect from their healthcare than those of the healthcare staff.
We also found that the HCAHPS constructs created by Weidmer-Ocampo et al.  aligned with the open question concerning patient expectations. The HCAHPS constructs, which assess service delivery against patients’ perceptions of the received services, align with the service expectations. In that case, it can then be implied that low HCAHPS scores are due to one or more of the four gaps previously discussed.
This study showed the existence of Gaps 1 and 2 in the SQG model at a Native American healthcare clinic. However, low HCAPHS scores at the Blackfeet reservation result from a compounding effect of the two gaps discussed and the Design gap (Gap 3) and Delivery Gap (Gap 4). Hyde and Hardy  argue there is a lack of shared understanding and communication regarding what PFCC means and how it is experienced from the patient perspective.