The strategy implementation fidelity gap in transitional healthcare systems

Area of Science:

• Health Services Research
• Healthcare Management
• Transitional Economies

Background:

• Healthcare systems in transitional economies often struggle to implement strategies effectively, leading to a gap between strategic intent and patient-centered care.
• This disconnect is conceptualized as the Strategic Implementation Fidelity Gap, impacting patient-perceived service quality in public healthcare organizations.

Purpose of the Study:

• To investigate whether differences in strategic implementation fidelity are associated with measurable variations in patient-perceived service quality.
• To introduce and empirically quantify the Strategic Implementation Fidelity Gap in a transitional healthcare setting.

Main Methods:

• A comparative cross-sectional study was conducted in two public healthcare institutions in Almaty, Kazakhstan.
• Service quality was assessed using the SERVQUAL model, serving as a behavioral indicator of strategic execution.
• Non-parametric analysis compared service quality gaps across five dimensions between institutions with differing implementation fidelity.

Main Results:

• Both institutions exhibited significant negative service quality gaps, with empathy and responsiveness showing the largest deficiencies.
• The institution with higher implementation fidelity demonstrated a significantly smaller overall SERVQUAL gap (p=0.003).
• This indicates that differences in execution capacity directly translate into measurable differences in patient experience.

Conclusions:

• Strategic Implementation Fidelity Gap is empirically quantified in a transitional healthcare system, highlighting failures in behavioral execution over resource constraints.
• Healthcare reforms should prioritize behavioral governance and performance monitoring, using tools like the SERVQUAL gap score, to improve strategy implementation.
• Addressing this gap is crucial for restoring public trust, promoting social equity, and enhancing patient well-being in transitional economies.