Patient-centered care is considered to be one of the essential pillars of a modern healthcare system. Thus, quality assessment based on patients’ perceptions, views and experiences in their journey through the healthcare system is recognized as one of the key principles for quality improvement initiatives. Measuring patient satisfaction can be confounded by expectations and prior experiences, which can be at least partly overcome by evaluating patient-perceived healthcare quality (PPHQ). Understanding the principal constituents of PPHQ may aid healthcare professionals and decision makers in the healthcare management process and help in creating instruments to meaningfully measure patient feedback. Herein, we aimed to analyze the primary determinants of PPHQ and their interactions, with a focus on patient experiences and healthcare accessibility, using the example of Lithuanian primary healthcare. For this purpose, we conducted a cross-sectional representative telephone survey that included a total of 1033 respondents (48% male) who had encountered primary healthcare during last 3 years. Survey questions consisted of sociodemographic characteristics, patient perceptions of healthcare service provision, patient experiences, self-reported health status and overall PPHQ ranked with a 5-point Likert scale as the primary outcome. The classification-regression tree (CRT) technique was used to analyze the relationship between different explanatory variables and PPHQ, as well as their relative importance and interactions. The majority of respondents (89%) evaluated PPHQ as acceptable or good. CRT analysis identified staff behavior, organizational accessibility and financial accessibility as the most important factors affecting PPHQ. Importantly, the latter factors surpassed the effect of other known PPHQ determinants, such as sociodemographic characteristics or health status. Further analysis has revealed that the relative importance of staff behavior, including understanding, attention and empathy, increased when more problems with organizational accessibility were encountered. In conclusion, our study suggests that PPHQ in primary healthcare may primarily be determined by organizational and financial accessibility and staff behavior, which may also act as an important mediating factor.

Improving health care quality is a continuous goal that requires constant attention and innovative solutions. One of the sources from which we can learn about what quality changes are needed is patient experience. "Collaboration" is one way to develop instruments and use them to gather knowledge about patient needs related to the patient journey and measures to improve the quality of services, such as service collaboration. The direction, in terms of the identification of patient needs and relatively urgent changes to the system, depends on the organizational culture determined by leadership. Different approaches towards leadership initiate different outcomes and consequences. Collaborative health care leadership comes with the decision to strengthen collaboration between health professionals and patients, thus addressing service quality gaps. Therefore, it becomes important to understand patients’ expectations in terms of such cooperation. The study aim is to investigate whether patient satisfaction barriers can be linked to shortages in collective leadership. All three dimensions of collaborative leadership (horizontal collaboration, interorganizational (vertical) collaboration, and collaboration with patients) demonstrate the link between leadership and accepted health care quality.