A systematic review and meta-analysis of healthcare service quality in Iran using the SERVQUAL model: a comparison before and after the Health Transformation Plan

Background: The quality of service constitutes a crucial element in achieving patient satisfaction and population health. The Health Transformation Plan (HTP) represented a pivotal initiative within the Iranian health system, aimed at enhancing the quality of health services. Therefore, this study aimed to determine the effect of Iran’s HTP on the quality of health services based on the SERVQUAL model. 

Methods: This systematic review and meta-analysis was conducted in 2023, following the PRISMA guidelines. A comprehensive search was performed in national and international databases, including Web of Science, PubMed, Scopus, SID, and MagIran. The quality of the studies was assessed using the 22-item STROBE checklist. Overall expectation and overall perception scores were calculated as the pooled mean values across the five SERVQUAL dimensions. The data analysis was conducted using Comprehensive Meta-Analysis software. 

Results: A total of 51 studies, comprising a total sample size of 19,679, were included in the analysis. The pooled estimate of the mean for overall expectation before and after the HTP was 4.646 (95% CI: 4.48–4.81, P < 0.001) and 4.678 (95% CI: 4.29–5.06, P < 0.001), respectively. Moreover, the pooled estimate of the mean for overall perception before and after the HTP was 3.785 (95% CI: 3.56–4.01, P < 0.001) and 3.806 (95% CI: 3.53–4.07, P < 0.001), in that order. After the HTP, the highest and lowest gap was related to empathy (Gap = -0.9) and tangibles (Gap = -0.852), respectively. Additionally, there was a 0.176 decrease in the quality gap for inpatient services, a 0.02 increase for outpatient services, and a 0.24 rise for primary health care (PHC) services. 

Conclusion: Our study shows that although patients’ expectations and perceptions improved slightly after the HTP, the overall quality gap widened, with the greatest deterioration occurring in primary healthcare. These findings underscore the need for more balanced resource allocation, stronger support for the PHC workforce, and enhanced patient-centered practices, particularly communication, empathy, and responsiveness. Prioritizing these areas may help improve service quality across all levels of Iran’s health system.