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Background <p>Taiwan is rapidly transitioning into a super-aged society, leading to an increased reliance on long-term care (LTC) institutions. High staff turnover remains a critical challenge for the industry globally. While internal service quality (ISQ) is recognized as a key driver of employee retention, there is a systemic lack of scientifically validated scales specifically tailored to the unique demands of LTC contexts, a research gap that persists both in Taiwan and internationally. This study aims to develop a validated ISQ scale that addresses this global empirical void and to identify strategic priorities for institutional management.</p> Methods <p>The study employed a multi-stage methodology. First, a Modified Delphi Method was conducted with a panel of 12 experts over two rounds to construct and validate the ISQ scale. Content Validity Ratio (CVR) and consensus thresholds were used for item selection. Second, a survey was administered to 364 LTC professionals (nurses, caregivers, social workers and Managers / Administrative Staff) across Taiwan. Data were analyzed using descriptive statistics, reliability/validity testing (Cronbach’s alpha, CR, and AVE), and Importance–Performance Analysis (IPA) to identify service gaps.</p> Results <p>The final validated ISQ scale consists of 29 items across five dimensions: Tangibles, Responsiveness, Reliability, Assurance, and Empathy. All dimensions showed high reliability (Cronbach’s α &gt; 0.80) and convergent validity. A significant service quality gap was identified, with an overall mean importance score of 4.24 compared to a satisfaction score of 3.13 (Gap = -1.11). IPA results revealed seven items in Quadrant II (“Concentrate Here”), highlighting critical weaknesses in soft management, including managers’ fairness in addressing issues, willingness to listen to staff feelings, and service enthusiasm. Conversely, salary payment and rotation systems were identified as core institutional strengths.</p> Conclusions <p>This study provides the first scientifically grounded ISQ measurement tool for the LTC sector in Taiwan. The findings suggest that while institutions perform well in tangible and financial aspects, a strategic shift toward empathetic leadership and organizational fairness is essential to improve staff morale. Policymakers and managers should integrate these qualitative ISQ indicators into evaluation frameworks to address workforce shortages and enhance external care quality.</p>

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From scale development to strategic action: internal service quality and importance-performance analysis findings in Taiwan’s long-term care

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月30日

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  • Che-Cheng Chang,
  • Shu-Hsien Huang

摘要

Background

Taiwan is rapidly transitioning into a super-aged society, leading to an increased reliance on long-term care (LTC) institutions. High staff turnover remains a critical challenge for the industry globally. While internal service quality (ISQ) is recognized as a key driver of employee retention, there is a systemic lack of scientifically validated scales specifically tailored to the unique demands of LTC contexts, a research gap that persists both in Taiwan and internationally. This study aims to develop a validated ISQ scale that addresses this global empirical void and to identify strategic priorities for institutional management.

Methods

The study employed a multi-stage methodology. First, a Modified Delphi Method was conducted with a panel of 12 experts over two rounds to construct and validate the ISQ scale. Content Validity Ratio (CVR) and consensus thresholds were used for item selection. Second, a survey was administered to 364 LTC professionals (nurses, caregivers, social workers and Managers / Administrative Staff) across Taiwan. Data were analyzed using descriptive statistics, reliability/validity testing (Cronbach’s alpha, CR, and AVE), and Importance–Performance Analysis (IPA) to identify service gaps.

Results

The final validated ISQ scale consists of 29 items across five dimensions: Tangibles, Responsiveness, Reliability, Assurance, and Empathy. All dimensions showed high reliability (Cronbach’s α > 0.80) and convergent validity. A significant service quality gap was identified, with an overall mean importance score of 4.24 compared to a satisfaction score of 3.13 (Gap = -1.11). IPA results revealed seven items in Quadrant II (“Concentrate Here”), highlighting critical weaknesses in soft management, including managers’ fairness in addressing issues, willingness to listen to staff feelings, and service enthusiasm. Conversely, salary payment and rotation systems were identified as core institutional strengths.

Conclusions

This study provides the first scientifically grounded ISQ measurement tool for the LTC sector in Taiwan. The findings suggest that while institutions perform well in tangible and financial aspects, a strategic shift toward empathetic leadership and organizational fairness is essential to improve staff morale. Policymakers and managers should integrate these qualitative ISQ indicators into evaluation frameworks to address workforce shortages and enhance external care quality.