PURPOSE The advent and integration of technology have reshaped the interaction between customers and service providers across the customer journey. In the healthcare sector, chatbots are increasingly being adopted by service providers. Despite their growing usage, the perceived effectiveness of these tools depends on how users evaluate their customer-centricity. This paper investigates the user perceptions of customer-centricity in chatbot interactions. The study focuses on the healthcare sector. DESIGN/METHODOLOGY/APPROACH An exploratory sequential multi-method approach was adopted, combining Grounded Theory and Total Interpretive Structural Modelling for this study. FINDINGS The findings identify that perceived customer-centricity and customer satisfaction are driven by factors like digital empathy, trust, anthropomorphism, perceived usefulness, perceived control and perceived ease of use. The findings will help healthcare providers in designing more human-centric and emotionally intelligent chatbot systems. ORIGINALITY/VALUE The study contributes to the understanding of AI-mediated healthcare interactions by highlighting different aspects of chatbot experiences and their structural influence on customer-centricity.
Purpose This study explores how the sustainability of water and sanitation projects influences community health outcomes in rural Uganda. Design/methodology/approach A qualitative design was adopted, involving in-depth interviews with 18 purposively selected participants at saturation, including caregivers, LC1 chairpersons, water committee members, borehole caretakers and village health team members. Data were analysed thematically to identify patterns linking sustainability dynamics to hygiene practices and disease exposure. Findings Findings reveal that infrastructure breakdowns directly increase health risks, while weak leadership, limited accountability and low social trust undermine maintenance and community commitment. Coping strategies often involve health trade-offs, and environmental stress further intensifies system fragility. Strong participatory governance and community ownership were found to strengthen both sustainability and preventive health behaviours. Practical implications Practically, the study highlights the need for integrated governance reforms, climate-responsive planning, transparent financial management and strengthened community ownership mechanisms to safeguard health outcomes. The findings suggest that water infrastructure investments alone are insufficient without sustained institutional support and adaptive capacity building. Originality/value The study contributes an integrated sustainability–health perspective, demonstrating that achieving safe water and sanitation outcomes requires not only infrastructure provision but also accountable governance, social cohesion and climate-responsive management in rural contexts.
Purpose This study explains variation in healthcare service quality through an institutional and process-oriented lens rather than treating quality as a simple statistical comparison between hospitals. Drawing on institutional theory and Donabedian's structure-process-outcome logic, it examines whether Human Capital Development Activities (HCDA), Research Attitudes and Work Skills (RAWS) and workforce experience are associated with Service Handling Practices (SHP) in selected public hospitals in KwaZulu-Natal, South Africa. The study is positioned within Sustainable Development Goal 3, particularly target 3.8 on access to quality essential healthcare services, and African Union Agenda 2063 Goal 3 on healthy and well-nourished citizens. Design/methodology/approach A quantitative cross-sectional survey design was used. The respondent-level dataset contained 238 questionnaires. The analysis uses three measured constructs: HCDA (12 items), SHP (9 items) and RAWS (13 items), each assessed on 5-point Likert-type scales. Construct adequacy was examined using Kaiser–Meyer–Olkin statistics, Bartlett's tests, exploratory component analysis and Cronbach's alpha. Work-experience differences were assessed using one-way ANOVA with effect sizes. Multiple regression estimated SHP as the process-oriented service-quality outcome with HCDA and RAWS as predictors. Heteroscedasticity-consistent HC3 standard errors were used after diagnostic testing. Findings The regression was statistically significant overall, F(2, 231) = 4.35, p = 0.014, but explanatory power was modest (R2 = 0.036; adjusted R2 = 0.028). HCDA (B = 0.080, robust p = 0.376) and RAWS (B = 0.134, robust p = 0.152) were not independently significant after mutual adjustment. Work experience differed significantly across HCDA groups (F = 2.221, p = 0.042), but the practical effect was small (ω2 = 0.030); differences in SHP and RAWS were not significant. The results therefore do not support a simple claim that tenure or a single institutional attribute independently determines service quality. Rather, they refer to a more comprehensive institutional setting where governance procedures, organisational assistance, learning, coordination and service procedures all have a role to play. Research limitations/implications Cross-sectional, self-reported; does not suggest causality. Unfortunately, the de-identified analytic data set did not contain sufficient detail to assure reliable identification of hospitals, nor did it contain profession-specific respondent labels which would have enabled multilevel hospital effects and profession-specific comparisons. The SHP scale is a process-oriented scale and exploratory analysis indicates that the scales in the survey are multidimensional. Future studies should employ hospital-based longitudinal data and profession-stratified sampling in addition to confirmatory measurement models and objective clinical and patient-experience outcomes. Practical implications Managers must not put their trust in the age of employment of personnel as a proxy for organisational capacity. Continuous professional development should be embedded in supervision, patient-flow redesign, communication routines, accountability systems and resource-management processes. Quality-improvement dashboards should therefore combine workforce, process, governance and patient-experience indicators. Social implications Strengthening the organisational processes through which public hospitals convert staff capability and resources into reliable care supports the quality dimension of universal health coverage and the health-system aspirations of SDG 3 and Agenda 2063. Originality/value The study contributes by aligning measurable workforce and institutional conditions with a process-oriented quality outcome and by combining institutional theory with Donabedian's process logic. It shows that workforce development and work skills are enabling but insufficient conditions for service quality, supporting a systems-based rather than single-factor explanation of public-hospital performance.
Purpose Efficient and contextually responsive resource utilisation is central to sustainable healthcare delivery, particularly in resource-constrained settings. Within South Africa's dual healthcare system, characterised by structural inequities, there is limited evidence on how practitioners operationalise resource use in practice. This study explored challenges associated with productive resource utilisation among audiology and speech therapy practitioners and identified strategies to enhance efficiency and sustainability across sectors. Design/methodology/approach A qualitative design was employed using semi-structured interviews with 92 practitioners across public and private sectors and urban, peri-urban, and rural contexts in four South African provinces (Gauteng, KwaZulu-Natal, Western Cape, and Limpopo). Data were analysed thematically using Braun and Clarke's framework, with exploratory inferential analyses examining sectoral differences. Qualitative codes were quantified at participant level to allow descriptive and exploratory statistical comparison across sectors. Findings Four themes emerged. First, public sector resource constraints included equipment shortages (80%), staffing limitations (75%) and budgetary constraints (85%), particularly in rural areas (χ2 = 17.89, p < 0.01). Second, private sector optimisation strategies emphasised efficiency through technology (70%) and staff training (60%), with higher digital tool use (t = 3.45, p < 0.01). Third, resource allocation priorities differed, with public practitioners prioritising equitable access and private practitioners personalised care (χ2 = 22.45, p < 0.001). Fourth, innovations included community partnerships, task-sharing and hybrid funding approaches. Originality/value This study provides novel insight into how resource optimisation is enacted within a dual healthcare system in an LMIC. It demonstrates how systemic inequities shape decision-making and service delivery, offering contextually grounded strategies to inform health system strengthening, including implications for public–private integration and South Africa's National Health Insurance. By integrating thematic analysis with exploratory quantitative comparisons, the study extends existing literature beyond descriptive accounts of resource scarcity to illustrate how practitioners adapt operationally within structurally unequal healthcare environments.
Purpose This study examines the influence of perceived calibration compliance (PCC) and risk-based maintenance (RBM) attitudes on perceived patient safety outcomes (PSO) among biomedical technicians and equipment operators. It further explores the mediating role of equipment accuracy (EA) and the moderating role of risk category awareness (RCA). Design/methodology/approach A structured questionnaire was used to collect responses from 415 biomedical staff across three NABH-accredited private hospitals in Kerala, using stratified purposive sampling. Data were analyzed using SPSS 26.0 for descriptive statistics and Smarts 4.0 for structural equation modeling, including path analysis, mediation and moderation testing. Findings Both PCC and RBM showed a significant positive impact on PSO. EA was found to mediate these relationships, indicating that calibration and maintenance practices contribute to safety through their effect on equipment performance. RCA was found to moderate the relationships, strengthening the impact of technical practices on safety outcomes when awareness of equipment risk levels was higher. Research limitations/implications This study was limited to three private hospitals in Kerala, so the findings might not apply to government or smaller healthcare settings. Since the data were collected at one point in time, it doesn't capture changes over time. Also, the responses were self-reported, so there's a chance of bias or overstatement by the participants. Practical implications The findings emphasize the need for regular calibration training, RBM protocols and staff awareness programs to promote a culture of safety in healthcare environments. Originality/value The study is novel in its investigation on how technical compliance and staff perception link to patient safety outcomes through equipment accuracy and risk awareness.
