Analysis of Nursing Service Quality Gaps and Improvement Strategies in VIP General Wards Based on Patient-Reported Outcomes.

backgroundIn the context of patient-centered healthcare, VIP wards are becoming increasingly common due to their commitment to an excellent service experience. This study aimed to investigate the associations between nursing service quality, patient-reported health status, and patient satisfaction in VIP wards.

methodsA single-center retrospective cross-sectional secondary analysis was conducted from January 2025 to March 2026, involving 266 discharged patients from the VIP general ward of a tertiary hospital in China. All primary study outcomes were patient-reported. The five-dimensional service quality (SERVQUAL) scale was used to assess nursing service quality gaps, the patient-reported outcomes measurement information system 29-item profile (PROMIS-29) scale was used to evaluate patient-reported outcomes (PROs), and overall satisfaction, along with socio-demographic information, was collected. Data were analyzed using descriptive statistics, analysis of variance, correlation analysis, and multiple linear regression.

resultsAmong 266 participants, a significant gap existed between patients' expectations and perceptions of nursing service (overall gap score: -0.45 ± 0.61), with the largest gap found in assurance (-0.63 ± 0.85; paired Cohen's d_z = -0.74), indicating a moderate-to-large standardized discrepancy. Patients reported lower physical function and higher anxiety, fatigue, and sleep disturbance than the general population reference. Patients who opted for the VIP payment package reported significantly smaller gaps in reliability, responsiveness, and assurance than patients using other payment methods, but no significant differences were found among the three payment groups across the seven PROMIS-29 domains or pain intensity. Multiple regression analysis revealed that the empathy deficit (β = -0.447, 95% CI -0.562 to -0.333, p < 0.001) and anxiety level (β = -0.299, 95% CI -0.424 to -0.174, p < 0.001) had the largest standardized coefficients; the reliability deficit (β = -0.226, 95% CI -0.347 to -0.106, p < 0.001) and sleep disturbance (β = -0.124, 95% CI -0.223 to -0.024, p = 0.015) were also significant, whereas the remaining candidate variables were not. Importance-performance analysis (IPA) identified four high-importance, low-performance items including 'Individualized attention', 'Sufficient nursing knowledge', 'Nurses willingness to help', and 'Patient safety', as priority areas for improvement.

conclusionIn VIP wards, there is significant room for improvement in nursing service quality, particularly in the empathy and assurance dimensions. Use of the VIP payment package was associated with a more favorable service-process experience in selected dimensions but was not associated with better patient-reported health status in this cross-sectional study. Targeted improvement should focus on individualized communication and anxiety management, supported by appropriate nursing training and organizational resources. Because this was a single-center cross-sectional study, these findings should not be interpreted causally and should be generalized cautiously.