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The objectives of this research are to investigate service quality expectation, perception and satisfaction in outpatient departments and to propose the priority nonconformity index (PNCI) to assess overall prioritization of efforts in relation to expectations.

SERVQUAL has five dimensions: tangibility, reliability, responsiveness, assurance and empathy. It was used to gather data from multiple-responding care providers in 220 Thai hospitals nationwide. Paired-samples t-test and importance-performance analysis (IPA) were used for analysis. The PNCI was initiated to evaluate the overall conformity between expectation and perception and to suggest strategies for improvement.

It was found that assurance is the most important and the best performed dimension with the least dissatisfaction. Tangibility is the least important and the least performed dimension with the most dissatisfaction. From gap analysis, there are significant negative gaps in overall service quality, all dimensions and all indicators. IPA found assurance and responsiveness as strengths, and this suggests transfer of excessive resources from empathy to enhance reliability. PNCI of Thai hospitals is 0.8 and this has suggested similar strategies to IPA.

Findings from this study can be employed to develop strategic policy to improve Thai hospitals as a whole. The newly developed PNCI can be used as an indicator to assess efficiency of resource allocation to fit better with customer requirements.

The purpose of this paper is to develop an instrument that measures the effectiveness of the ISO 9001 Quality Management System (QMS), based on its components, meaning the ISO 9001 objectives; and to validate this instrument in the food manufacturing sector.

Bearing in mind the definition of “ISO 9001 effectiveness”, the ISO 9001 objectives and their indicators are identified in the literature. Based on these indicators, a measurement instrument is developed and then empirically validated through collecting preliminary data from 335 Greek food manufacturing small and medium‐sized enterprises (SMEs). After testing the assumptions of multivariate analysis, exploratory factor analysis as well as first and second order confirmatory factor analysis are applied.

The data collected reveal, as identified in the literature, the three‐dimensional nature of the ISO 9001 objectives (continuous improvement, prevention of nonconformities and customer satisfaction focus). The responding food manufacturing SMEs demonstrate a high level of achievement of these objectives. Further analysis of the data also reveals a valid latent factor reflecting the successful achievement of the ISO 9001 objectives, namely “ISO 9001 effectiveness”.

The present study focuses on food manufacturing SMEs. Therefore, it is worth validating the measurement instrument on large food manufacturing companies, food service companies, companies of specific food sub‐sectors, non‐food companies and finally on companies operating in different economic conditions to Greece.

This measurement instrument can be used by a food manufacturing SME as a self assessment tool and a benchmarking tool. In doing so, suitable strategies can be selected in order for a food SME to improve quality, gain competitive advantage and overcome the current downturn.

In this paper, a measurement instrument is developed and validated in food manufacturing SMEs, based on measures describing the ISO 9001 objectives; in other words, ISO 9001 effectiveness.

The purpose of this study is to investigate the links between lean, service quality expectation (SQE) and service quality performance (SQP) in outpatient departments (OPD).

The measurement instruments were developed from a comprehensive literature review, then verified by experts and confirmatory factor analysis. Multiple responses were applied to improve the reliability of data obtained from 220 Thai hospitals. The hypotheses were tested with linear regression and path analysis of structural equation modeling.

It was found that lean has significant positive impacts on all SQP dimensions (i.e. tangibility, reliability, responsiveness, assurance and empathy) and on overall SQP. SQE has significant positive direct effects on lean and SQP, and has a significant positive indirect effect on SQP through lean.

This is one of the first examples of research to present insights into the relationships between lean, SQE and SQP in OPD.

The purpose of this research is to explore the differences across hospital characteristics (i.e. lean maturity, hospital size, hospital type and ISO 9001) on lean expectation, lean performance, service quality expectation and service quality performance.

The survey instruments were developed from an extensive literature review, validated by experts and tested by statistical techniques. Data was collected from the perspective of care providers in 220 outpatient departments of Thai hospitals with multiple respondents to improve reliability of data. Analysis of variance and independent sample t test were applied for analysis.

It was found that there are significant differences across lean maturity and hospital size on overall lean expectation and overall lean performance, and across ISO 9001 on overall service quality performance. Overall, service quality expectation and performance have higher mean scores than overall lean expectation and performance.

To the best of author’s knowledge, this is one of the first studies to present insights into the links between Thai hospital characteristics, expected lean and service quality and performance from the care provider viewpoint. Findings form this study can be used to improve individual hospitals or develop healthcare system at national level.

The purpose of this paper is to evaluate the hygienic design of a scalable unit for supercritical carbon dioxide drying of food.

For the purpose of this study, a checklist has been developed, covering requirements from sanitary standards and industry-tailored guidelines. Beyond hygienic design, failure mode and effects analysis of the results were performed to assess the potential food safety risks that may arise from failures to hygienic design requirements.

The overall score of the hygienic design was 46 percent. This kind of evaluation revealed two types of nonconformities. The first type was related to inadequate sanitary procedures. The second type was associated to design failures.

The highest risk was designated to problems related to cleaning and sanitation followed by risks associated with the formation of dead zones and biofilms.

This study provides valuable insight to engineers and food technologists on hygienic design issues.

Application of a similar methodology was used for evaluating hygienic design of other non-thermal food technologies.

This study aims to propose a service quality evaluation model for health-care services.

In this study, a service quality evaluation model is proposed based on the service quality measurement (SERVQUAL) scale and machine learning algorithm. Primarily, items that affect the quality of service are determined based on the SERVQUAL scale. Subsequently, a service quality assessment model is generated to manage the resources that are allocated to improve the activities efficiently. Following this phase, a sample of classification model is conducted. Machine learning algorithms are used to establish the classification model.

The proposed evaluation model addresses the following questions: What are the potential impact levels of service quality dimensions on the quality of service practically? What should be prioritization among the service quality dimensions and Which dimensions of service quality should be improved primarily? A real-life case study in a public hospital is carried out to reveal how the proposed model works. The results that have been obtained from the case study show that the proposed model can be conducted easily in practice. It is also found that there is a remarkably high-service gap in the public hospital, in which the case study has been conducted, regarding the general physical conditions and food services.

The primary contribution of this study is threefold. The proposed evaluation model determines the impact levels of service quality dimensions on the service quality in practice. The proposed evaluation model prioritizes service quality dimensions in terms of their significance. The proposed evaluation model finds out the answer to the question of which service quality dimensions should be improved primarily?

The purpose of this paper is to propose a framework for the analysis of students’ ratings of teaching quality in higher education and the disclosure of risky issues undermining the quality of teaching and courses that require attention for continuous improvement. The framework integrates two decision-based methods: the standardized u-control chart and the ABC analysis using fuzzy weights. The control chart, using the students’ ratings, allows the identification of those courses requiring an improvement of teaching quality in the short-medium term. While the ABC analysis uses fuzzy weights to deal with the vagueness and uncertainty of students’ teaching evaluations and provides a risk map of the potential areas of teaching performances improvement in the long term. The proposed framework allows the identification of teaching and course quality aspects that need corrective actions in response to students’ criticisms in accordance with different levels of priority.

This study adopts two methods, commonly used in industrial applications, i.e. the u-control chart and ABC analysis. Combining the results of a literature review on teaching evaluation and the application of these two methods as building blocks for the assessment, a framework to detect potential risks reducing teaching quality in higher education is proposed. The application of the framework is shown through an action-based case study developed in an Italian public university.

The study proposes a framework that combines two methods, i.e. u-control chart and ABC analysis with fuzzy weights, to support the assessment of teaching and course quality. The framework is proposed as an assessment approach of the teaching performance in higher education with the purpose to continuously improve the quality of teaching and courses both in the short, medium and long term.

The study provides an original contribution to the understanding of how to analyze students’ evaluation of teaching performance in order to take proper and timely decisions on corrective actions in response to the need of continuously improving the level of teaching and course quality.

Both youngsters and adults with same-sex attraction are at greater risk for negative health outcomes. Despite mounting efforts to determine the biological background, a satisfactory conclusion has not been reached and there is a need to explore alternate factors like functioning of thyroid system during pregnancy. A retrospective chart review was undertaken of 790 eligible children and adolescents who had been admitted to child psychiatry between 2005 and 2013. This population consisted of 520 (65%) males and 270 (35%) females, aged 8 to 17 years. Fifteen mothers (1.8%) were found to have a history of thyroid dysfunction during pregnancy. Sixteen youngsters (2%) had a history of same-sex attraction. Twelve overlapping cases with both same-sex attraction and maternal thyroid dysfunction during pregnancy were identified, which was extremely significant (P<0.0001, by Fisher's exact test). The association was also significant for each sex (P<0.0001, by Fisher's exact test). There is evidence that thyroid gland plays a crucial and decisive role in determining sexual orientation in people. Maternal thyroid dysfunctions during pregnancy may result in homosexual orientation in the off-spring.

Quality systems are being adopted by the Swedish building industry to an increasing degree. The present paper examines two categories of specialist contractors — electrical contractors, and plumbing, heating and ventilation contractors — and the introduction of quality systems in these environments. The companies were assessed in terms of the ISO 9001 standard and the Crosby Quality Management Maturity Grid. The evaluation shows that much has been accomplished in efforts to ensure quality, but that much is yet to be done. Considering the investment in resources which the introduction of a quality system represented for these firms, it is noteworthy that none of them measured the effects of quality control in a concrete way. A specific instrument, based on ISO 9001 and the Crosby Grid, is seen as applicable. The importance of developing the evaluation of quality systems further is emphasized, an approach which can be used both by suppliers and by customers.

To make an improvement on a larger scale and continuing along the path of quality auditing, this paper aims to identify the steps taken towards excellence for patient care in Sultan Qaboos University Hospital (SQUH).

SQUH, in the Gulf country Sultanate of Oman, has enthusiastically entered the challenge of improving quality in healthcare while traveling towards healthcare excellence. It began with the successful achievement of ISO 9001:2000 certification (May 2005) and re‐certification (May 2008) and is now adopting accreditation standards.

Being a prominent 500‐bed teaching research hospital in the country offering general and distinguished specialized clinical services while adhering to continuing professional development, the source of motivation derives from the hospital's vision and mission, thus bringing the primary focus of auditing to a peak. By performing internal quality audit, proper monitoring of conformity by measuring the effectiveness to the stated intention in a cycle of continuous quality improvement (CQI) is ensured.

Traditionally, health prevention and cure have always been the aim for the healthcare industry. Consequently it is the one industry that faces continuous pressures to improve quality and the one with the fastest‐growing interest in quality.

The paper puts forward a model that incorporates the fundamentals of quality improvement through quality auditing step by step in a systematic manner and shows measurable results.