The strategy implementation fidelity gap in transitional healthcare systems.

Purpose: Healthcare systems in transitional economies frequently fail to translate formally adopted strategies into consistent patient-centered care. This persistent disconnect between strategic intent and frontline execution is conceptualized in this study as the Strategic Implementation Fidelity Gap. This paper introduces the concept of whether differences in strategic implementation fidelity are associated with measurable variations in patient-perceived service quality in public healthcare organizations.

Design/methodology/approach: A comparative cross-sectional study was conducted in two state-owned healthcare institutions in Almaty, Kazakhstan: a hospital characterized by higher implementation fidelity and a polyclinic with lower fidelity. Service quality was assessed using the SERVQUAL model, reconceptualized here as a behavioral indicator of strategic execution. Non-parametric analysis was applied to compare service quality gaps across five dimensions.

Findings: The findings reveal significant negative service quality gaps in both institutions, with the largest deficiencies consistently observed in empathy and responsiveness. Crucially, the institution with higher implementation fidelity demonstrated a significantly smaller overall SERVQUAL gap (p = 0.003), indicating that differences in execution capacity translate directly into measurable differences in patient experience.

Research limitations/implications: This study provides compelling evidence; however, its findings should be interpreted in light of the following limitations. Cross-Sectional Design: The study employed a cross-sectional design, collecting data at a single point in time. While this allows for statistical comparison between institutions, it limits the ability to establish definitive cause-and-effect relationships or track the dynamic evolution of the Strategic Implementation Fidelity Gap over time. Future research should utilize longitudinal designs to assess the impact of implemented managerial protocols. Perceptual Data Dependency: The research relies primarily on patient-perceived quality data (SERVQUAL), which is inherently subjective. Although this is a crucial measure of service quality, the scope does not include the perspectives of healthcare providers or objective clinical outcome data. Generalizability: The sample was restricted to two public healthcare institutions in a single large city (Almaty, Kazakhstan). Therefore, the generalizability of the results to diverse regional healthcare settings or other transitional economies should be approached with caution.

Practical implications: Strategic Resource Rebalancing: The results offer a clear rationale for healthcare decision-makers to strategically rebalance investments. Priorities must shift from sole reliance on structural assets to rigorous development and control of managerial and staff protocols, placing a specific focus on the identified areas of weakness: Empathy and Responsiveness. Management Monitoring Tool: The statistically significant differences between institutions demonstrate that the SERVQUAL gap score can serve as a quantifiable management monitoring tool for supervisory bodies to audit the quality of strategic execution and compliance. Applicability in Transitional Systems: The findings provide an actionable governance model for all transitional and emerging economies seeking to modernize their health systems, demonstrating that reform success is predicated on the quality of Behavioral Governance.

Social implications: Restoring Public Trust: The identified gaps in Empathy and Responsiveness are primary drivers of eroded public trust in the healthcare system and government-led reforms. Addressing the Strategic Implementation Fidelity Gap through mandatory behavioral governance directly contributes to restoring citizens' trust in public institutions. Promoting Social Equity: Inconsistent service quality (low Implementation Fidelity) creates barriers to equitable access to effective care. Ensuring every facility adheres to standardized protocols (especially in behavioral aspects) promotes social equity and guarantees consistent quality of service for all population segments. Enhancing Patient Well-being: Directly addressing failures in Empathy and Responsiveness not only improves the clinical experience but also significantly enhances the psychological and emotional well-being of patients, increasing their adherence to treatment plans and overall satisfaction with state interaction.

Originality/value: The study provides the first empirical quantification of a Strategic Implementation Fidelity Gap in a transitional healthcare system and demonstrates that service quality deficits are not solely driven by resource constraints, but by failures in behavioral execution. By repositioning SERVQUAL as a diagnostic tool for strategic implementation, the study offers a novel framework for assessing how governance and execution shape frontline outcomes. The findings suggest that healthcare reforms should move beyond structural investment and prioritize behavioral governance, performance monitoring, and the standardization of frontline practices to ensure effective strategy implementation.