Transcription
Research ArticleiMedPub Journalswww.imedpub.comJournal of Hospital & Medical ManagementISSN 2471-97812018Vol.4 No.1:4DOI: 10.4172/2471-9781.100048The Impact of Service Quality Dimensions onPatient Satisfaction in the Private HealthcareIndustry in PakistanAbstractThe present study examines the “The impact of service quality dimensions onpatient satisfaction in the private health sector located in district Sargodha,Pakistan. Service quality is considered to be as one of the significant factor tokeep people safe and health from diseases. The study has been carried out byemploying questionnaire as data collection techniques by designing 21 items on afive point likert scale. The sample size of the study is composed of 380 respondentsfrom district Sargodha. The results of the study reveals that the most importantfactor that impact on service quality dimension is tangible “(Physical facilities,equipment, and appearance of personnel)” and empathy “(Caring, individualizedattention the firm provides its customers)” so these are the most important factorsof SERVQUAL model that impact on service quality. Future research may explorethe service quality in various sectors in Pakistan in general and in the Sargodharegion in particular.Keyword: Patient satisfaction; Service quality dimensions; SERVQUAL modelReceived: May 18, 2018; Accepted: May 30, 2018; Published: June 06, 2018IntroductionIn the last three decades, there has been incrementing the interestinternationally in the quality of health care services, as standardsof living have transmuted and there is an ordinant dictation forbetter medical care to amend lifestyles. Amending the quality ofmedical care accommodations has become a primary concernfor patients so in order to provide better accommodation topatients service quality has become increasingly paramount forhospitals in reverence of gratifying and retaining patients [1].As Quality of Life is badly affected in health care services morethan of any other service sector [2] so health care providers thatfail to understand the importance of delivering service qualityand customer satisfaction may be inviting a possible loss ofpatients [3,4]; Patients are becoming more and more consciousabout the quality of health care accommodations provided byhospitals [5,6]. Consumers of health care accommodations haveexceptionally higher prospects and authoritatively mandate ahigh caliber of precision, reliability, responsiveness and empathyfrom accommodation providers [7-9].Service quality is defined as the difference between customerperceptions and their expectations, according to customers;Rehaman B 1*andHusnain M21 Department of Management Sciences,University of Lahore, Sargodha Campus,Pakistan2 Department of Management Sciences,Islamic International UniversityIslamabad, Pakistan*Corresponding author: Rehaman B bushra rehman65@yahoo.comMPhil, Department of ManagementSciences, University of Lahore, SargodhaCampus, Pakistan.Tel: 92 (0)42 111-865-865Citation: Rehaman B, Husnain M (2018)The Impact of Service Quality Dimensionson Patient Satisfaction in the PrivateHealthcare Industry in Pakistan. J Hosp MedManage Vol.4 No.1:4quality is satisfactory if performance meets with expectations[10]. We can also identify about satisfaction from the feedbackof customers [11-13]. Satisfied customers shows long termrelationship with their service provider which result in higherlevel of compliance that leads to better health outcomes [1416]. Customer satisfaction is an important aspect for serviceorganizations and is highly related to service quality [17-20].When service quality improves, the probability of customersatisfaction increases. Increased customer satisfaction leads tobehavioral outcomes such as commitment, customer retention,and creation of a mutually rewarding relationship with theservice provider and the user, increased customer tolerance forservice failures and positive word-of-mouth advertising about theorganization [21-24]. In order to measure international servicequality there is two school of thought, the 1st one is Nordic schoolof thought [25] and second is American school view, Nordicschool of thought explain service quality in two ways such asfunctional and technical quality whereas the American schoolof thought define about service quality in five dimensions “(1)Tangibles (Physical facilities, equipment, and appearance ofpersonnel); (2) Reliability (Ability to perform the promised servicedependably and accurately); (3) Responsiveness (Willingness Under License of Creative Commons Attribution 3.0 License This article is available in: hive.php1
DE MEDICINAJournal of Hospital &ARCHIVOSMedical ManagementISSN1698-9465ISSN2471-9781to help customer and provide prompt service); (4) Assurance(Knowledge and courtesy of employees and their ability toinspire trust and confidence); (5) Empathy (Caring, individualizedattention the firm provides its customers)” in this paper we haveto use these five dimensions.The main objective of this paper is to determine factors thatinfluence on customer satisfaction that is intricate but we aregoing to simplify it by applying scientific study. In this study, weare going to identify the customer satisfaction on the healthsector, there is limited literature that related to this topic inPakistani context; we are going to fulfill this gap by contributingin limited Pakistani literature by applying empirical methodology.The aim of this study is to research in the field of service qualityin the health sector of district Sargodha to get customersatisfaction. For the Purpose to measure the service quality theSERVQUAL instrument and to see if a replication of the SERVQUALinstrument would result in a fit of the five-factor model; to testthe impact of the dimensions of the SERVQUAL instrument oncustomer satisfaction and the impact of customer satisfaction oncustomer recommendation of the health sector to others.Literature ReviewIf we explain the service quality into two different schools ofthought such as it is the Nordic school view [25] and the secondis the American school of thought from which the Nordic schooldefine the service quality in two dimensions such as functionaland technical, Whereas the American school define servicequality into five dimensions “(1) Tangibles (Physical facilities,equipment, and appearance of personnel); (2) Reliability (Abilityto perform the promised service dependably and accurately);(3) Responsiveness (Willingness to help customer and provideprompt service); (4) Assurance (Knowledge and courtesy ofemployees and their ability to inspire trust and confidence); (5)Empathy (Caring, individualized attention the firm provides itscustomer)”. In this study we have to use these fine dinensions.Service QualityIn order to achieve competitive advantage it is most important tofocus on service quality because customers are more consciousabout quality, so it’s important to deliver higher servicequality better than its competitors [26]. The service firm candifferentiate itself by delivering high quality service more thanthat of its competitors because ability of service firm dependon how consistently it provides value to its customers, whereasbest method to retain customers is depend on their quality [27].Service quality is defined as the difference between customerexpectation and their perception about the service experience[2].The most important work on such topic was the gap modeldeveloped by Parasuraman and his colleagues [28]. Manycontributions have been done on the measuring of servicequality that is considered around the SERVQUAL scale. In orderto easily understand about service quality this model is veryimportant [29]. It has many applications which are used andtested in a variety of sectors, like insurance restaurant in banking22018Vol.4 No.1:4and internet banking [30-33]. In order to access about the servicequality of health care some students have done their work onpublic sector health care [33-35] and some on the private sectorhealth care (Figure 1).Customer SatisfactionService quality is an important factor of customer satisfactionas well as word-of-mouth communication. There is a directrelationship between both service quality and satisfactionas service quality is the antecedent of satisfaction [36]. It wasobserved by Parasuraman et al. that their instrument (SERVQUAL)can be habituated to evaluate the relative paramountcy ofthe dimensions of quality in influencing customers’ overallperceptions of an accommodation. Reliability and empathy arethe significant dimensions the insignificant across a seeminglywide array of service types. According to Zeithaml et al. [2]demonstrated that, using a variation of SERVQUAL those tangiblesproves to be consistently unimportant. Barclay et al. [37] definedthe responsiveness as the faculty to react purposefully and withina felicitous timescale to paramount events, opportunities andthreats, especially from the external environment to establish ormaintain competitive advantage.According to research in marketing and sales, there have been hugedifferences in the approach of empathy. The former approach ofempathy have described empathy as a personal character [38,39]or as an capability [40] and it can be one of cognitive, affectiveor both. The perspective of cognitive about empathy, alsoreport as “perspective taking”, is the understanding of anotherperson’s direction at a cognitive level [41]. Perspective takingallows a person to cognitively gauge the situation from anotherperson’s point of view and assume their needs and motivations[42]. The emotive view of empathy is described as an emotionalimpression that increments the understanding of anotherperson’s perception [43]. The emotive view merges differentaspects such as emotional concern and emotional contamination[44]. Empathic involvement occurs when an individual respondsto the emotional state of someone else without experiencing theemotion themselves [45]. Empathic concern is associated withaltruistic comportments, due to feelings of congruency with aperson who is in need [46]. Empathic matter is correlated withhuman behaviors, due to feelings of congruency with a personwho is in need [46]. Emotional behavior result when a personsimultaneously shares the emotion experienced by anotherperson [41]. As emotional behavior involves the transfer ofemotions from one person to another, it can lead to imitationof expressions and gesture [47]. We conceptualize empathy as apersonality trait that are consist of cognitive as well as affectivecomponents and explain as “the ability to identify and understandanother person’s feelings, thoughts and situation” [48,49].Service Quality and Patient SatisfactionService quality impact on consumer loyalty have beenconcentrated in numerous fields [49,50] and have turned into adubious issue in advertising writing. A few analysts and scholasticssaw that service quality is a forerunner of consumer loyalty[2,7,51]. In the clinic business, [52] found that the relationshipThis article is available in: hive.php
DE MEDICINAJournal of Hospital &ARCHIVOSMedical ManagementISSN1698-9465ISSN2471-9781among human service quality and patient satisfaction is great. Apatient is fulfilled at the point when healing center service qualitymatches with their desires and prerequisites, thusly, the morenoteworthy the patient fulfillmen [53]. Be that as it may, patientshave their rights and decision, and on the off chance that theyare not fulfilled by their healing facility, they have the chance tochange to another healing facility [54]. Besides there is no accordconcerning the relation between service quality and patientsatisfaction in the healing facility industry, as various specialists ofsocial insurance industry are more direct on measuring specializedand utilitarian quality as opposed to patient fulfillment [55], andquietsatisfaction keeps on being measured as an intermediaryfor the patient's appraisal of administration quality [56].MethodologyIt was a quantitative research in which primary data werecollected by using a questionnaire. It was a causal study, whichdone in a natural environment, i.e. in a non-contrived setting.The purpose of this study was to find out satisfaction levelabout health sector located in District Sargodha. Variables usedin this study were such as the dependent variable was patientsatisfaction in health sector and the independent variables arereliability, responsiveness, assurance, empathy and tangibles.It was a field study in which data were gathered by using aquestionnaire. The Population used in this study was peoplebelong to District Sargodha.The sampling used in this study was non-probability samplingdesign. Respondent were those people, who belong to DistrictSargodha, convenient sampling was used to collect data.The Sample size used in this study was 380, data gathered bydistributing questionnaires in different private and publicorganizations as well as by using an online survey. This study triesto focus on 21 “quality characteristics” these characteristics foundsignificant in the previous studies. Our selected respondentswere those people who are using the services of the privatehospitals situated in District Sargodha.A part of demographics also used in the questionnaire in whichquestions related to gender, marital status, age, Income level,education level were included. All measures were obtained byusing “Self-report” questionnaire except the demographic part allthe items were measured on a five point Likert scale through 1 to 5in which 1 indicate strongly disagree and 5 indicate strongly agree[57]. For the analysis of data, software used is SPSS and Amos. TheOLS regression model is used to test the relationship betweendependent and independent variable. Patient satisfaction is usedas the dependent variable and the dimension of service qualityare namely reliability, responsiveness, assurance, empathy andtangibles as the independent variable.The OLS model is as follows:Basically, CSHSCustomer satisfaction in hospital sector,CSHS α β1 x 1 β2 x 2 β3 x 3 β4 x 4 β5 x 5 eX1 Reliability, X2 Responsiveness, X3 assurance, X4 empathy,X5 Tangibles. Under License of Creative Commons Attribution 3.0 License2018Vol.4 No.1:4In this regression line α is constant and βs are coefficients, ande is the error term. Customer satisfaction in hospital sector isdependent variable and reliability, responsiveness, assurance,empathy, and tangibles are independent variables. In order tocheck out inter-correlation among variable bivariate correlationanalysis was used. In order to check the internal consistencyamong items factor analysis also performed.HypothesisH1: Responsiveness has a significantly positive influence onpatient satisfaction.H2: Empathy has a significantly positive influence on patientsatisfaction.H3: Assurance has a significantly positive influence on patientsatisfaction.H4: Reliability has a significantly positive influence on patientsatisfaction.H5: Tangible has a significantly positive influence on patientsatisfaction.AnalysisGiven below the Table 1 represents the mean and standarddeviation of the respondent. The result indicates that the meanof the variables ranged from 2.9302 to 3.6306 and the standarddeviation ranged from .97947 to 1.15916.Results also indicate that the mean of “Neat appearance ofemployees” are µ 3.6306, “Say positive things about the hospitalto other people” µ 3.5293 and the mean of Ability to handlepatients’ problems µ 3.500 these are the factors which have thehighest mean score (Table 2).Descriptive statistics of all the dimensions are calculated in whichhighest mean 3.450 and 3.4107 which are the mean of tangibleand assurance. Cranbach’s α value of each dimension is alsocalculated in which highest value is .807 and .753 that is the valueof patient satisfaction and tangible.Factor analysisWe thoroughly analyzed the results this section that werecollected from 380 respondents. Application of principalcomponent analysis using SPSS was employed to investigatethe latent factors linked to these 21 items. The Kaiser-MayerOlkin and Bartlett's Test of Sphericity were carried out to checkthe strength and sufficiency of sample and relationship amongvariables. KMO is used to find whether data are suitable forapplying the factor analysis or not?. And tells us which variablesshould be drop to overcome the multicollinearity problem. Itsvalue ranges from 0 to 1 where higher value greater the 0.60indicates the significance of the data and factor analysis can beemployed. If its value is less than 0.60 then several items shouldbe deleted which are unnecessary variables based on the antiimage values. Results of KMO and Bartlett’s test reveal thatvariables are highly significant and principal component analysiswas suitable (Table 3).3
DE MEDICINAJournal of Hospital &ARCHIVOSMedical ManagementISSN1698-9465ISSN2471-97812018Vol.4 No.1:4Table 1: Descriptive statistics of variables.VariablesMaintains error free recordsA sincere interest in solving problemsProviding services as promisedResponding quicklyWilling to help patientsOffering prompt services to patientsConstantly courteousAbility to instill confidence in the patientHaving the knowledge to answer patients’ questionsAbility to handle patients’ problemsGiven individual attentionConvenient consultation hoursUnderstand the specific needs of patientNeat appearance of employeesVisual appealing facilitiesNeat appearance of polyclinic serviceProfessional appearance of employeesModern equipmentsSay positive things about the hospital to other peopleEncourage friends and relatives to use the services of this hospitalIntend to continue using the services of this hospitalHave strong preference in this 923.32883.42343.43243.52933.41673.25453.3491Std. 55555Table 2: Resulting dimension and their reliability coefficients.Service quality dimensions (items)ReliabilityMaintains error free recordsA sincere interest in solving problemsProviding services as promisedResponsivenessResponding quicklyWilling to help patientsOffering prompt services to patientsAssuranceAbility to instill confidence in the patientHaving the knowledge to answer patients’ questionsAbility to handle patients’ problemsEmpathyGiven individual attentionConvenient consultation hoursUnderstand the specific needs of patientTangiblesNeat appearance of employeesVisual appealing facilitiesNeat appearance of polyclinic serviceProfessional appearance of employeesModern equipmentsPatient SatisfactionSay positive things about the hospital to other peopleEncourage friends and relatives to use the services of this hospitalIntend to continue using the services of this hospitalHave strong preference in this hospital.4Mean3.0015Variance0.713Cranbach’s 0.6643.45090.6060.7533.38740.7200.807This article is available in: hive.php
DE MEDICINAJournal of Hospital &ARCHIVOSMedical ManagementISSN1698-9465ISSN2471-9781It was quite difficult to decide whether how many factors wouldbe used in the study, but based on initial eigenvalues 5 factorswere selected as shown in Table 4. To relate items to its coreconstructs with minimum loading advocated that factor loadinggreater the 0.30 should be noted, while values greater than 0.40were considered significant for the analysis.in current studyfactor with the loadings greater than 0.40 are accepted.We havedropped one variable on the basis of our results which have aloading of less than 0.40 (Tables 4-6).Regression analysisVol.4 No.1:4X2 EmpathyX3 Tangible.Analysis of regression coefficients explains about the relationshipbetween dependent and each independent variable. Accordingto Sig. Value assurance, empathy and tangible have a significantcorrelation with patient satisfaction level. Here table sig. Valueis. 05 which is greater than calculated sig. Value .011, .000respectively. Assurance, empathy and tangible shows significantso these factors have some impact on service quality.Here X1(Assurance) 0.141 I, e, 100% change in assurance leadsto 14.1% change in customer satisfaction level.Our results develop the regression model as follows.PS 3.259 0.164X1 0.271 X2 0.315X3X2 (Empathy) 0.317 i, e, 100% change in empathy leads to 31.1%change in customer satisfaction level.S.E (.722) (.057) (.041) (.067)T Values (4.515) (2.874) (6.534) (4.715)X3 (Tangible) 0.227 i, e, 100% change in tangible leads to 22.7%change in customer satisfaction level.R square (Adj) 0.338 F 46.154Bivariate correlation analysisSignificance at 99%Bivariate analysis for all variables was conducted and their resultindicates that all the variables have significant correlation withanother variable.PS Patient satisfactionX1 AssuranceTable 3: KMO and Bartlett's Test.Kaiser-Meyer-Olkin AdequacyBartlett's Test of Sphericity2018Measure of SamplingApprox. Chi-SquareDfSig.0.8512103.872910Reliability was positively correlated with patient satisfaction(r 0.282, p 0.1), positively correlated with responsiveness(r 0.392, p 0.1), positively correlated with assurance (r 0.433,p 0.1), positively correlated with tangible (r 0.508, p 0.1) andpatient satisfaction were positively correlated with empathy(r 0.445, p 0.01).Table 4: Total Variance Explained.Initial EigenvaluesTotal % of Variance Extraction Method: Principal Component Analysis.Component Under License of Creative Commons Attribution 3.0 LicenseExtraction Sums of Squared LoadingsTotal% of Variance .68545.9921.1515.23451.2251.1085.03656.262Rotation Sums of Squared LoadingsTotal% of Variance 11.35735.6602.39610.89246.5522.1369.71056.2625
DE MEDICINAJournal of Hospital &ARCHIVOSMedical ManagementISSN1698-9465ISSN2471-9781Conclusion of research hypothesisConsidering the results concerning the specific hypothesis, it isseen that all except reliability and responsiveness are supportedat the 0.05 levels (Table 7)In this study, we have to develop five hypothesis all the fivehypothesis except reliability and responsiveness were found tobe true, all the finding of hypothesis are as follows:H1 Reliability was found to have a negative impact on patientsatisfaction.Table 5: Model summary.R0.587R square0.345Adjusted R square0.338Std Error of the estimate2.76257Table 6: Regression coefficient analysis of the model coefficients.UnstandardizedCoefficientsModelBStd. -0.034-0.724 0.4690.0680.081.532 0.1260.0570.1412.874 0.0040.2710.0410.3176.53400.3150.0670.2274.7150T. 000.000Dependent Variable: P.SSource: SPSS is used to find the regression model.Table 7: Conclusion of research isfactionReliability-0.06Satisfaction 2018Vol.4 No.1:4H2 Responsiveness was found to have a positive impact onpatient satisfaction.H3 Assurance was found to have a positive impact on patientsatisfaction.H4 Empathy was found to have a positive impact on patientsatisfaction.H5Tangible was found to have a positive impact on patientsatisfaction.Figure 2 shows the structure and the result of the analysis of themodel.Conclusion and DiscussionSuccess of any country depends on its people if they were healthythen they will be active and can do better for their country byactively participating in their work, but if they were not healthy,they cannot actively participate in their work, so it is veryimportant to upgrade hospitals and improve their service qualityin order to satisfied patients. It is also important to identifywhether people are satisfied with their hospital or how muchthey are satisfied with the services of their hospital. In order tocheck the service quality of hospitals in district Sargodha we haveconducted an empirical research.The aim of this study was to identify the impact of servicequality dimension on patient satisfaction in district Sargodha.Furthermore, this research examined the relationship amongvariables and their significance. The main objective of this studywas to identify which variable impact more on the patientsatisfaction by using the SERVQUAL model. This model can alsoapply to the range of different service companies.This study suggests that most important factor that impact onthe service quality is tangible and empathy so these are themost important factors among other five factors of SERVQUALmodel. Similar results were found in the study [58], in that studythey examined patient satisfaction in the healthcare industry.Their study showed that empathy and assurance are importantantecedents of satisfaction. In this study results indicate ntsatisfactionTangiblesFigure 1 Conceptual model.6This article is available in: hive.php
DE MEDICINAJournal of Hospital &ARCHIVOSMedical ManagementISSN1698-9465ISSN2471-97812018Vol.4 No.1:4Figure 2 Empirically Validated Model.assurance, empathy and tangible are significant for patientsatisfaction, but reliability and responsiveness are insignificant.The findings of this study are important for public hospitalslocated in District Sargodha. The administration of the hospitalneed to modify their hospital and improved the service quality.There are also some limitations related to this study. The samplesize of this study was small and in order to get more reliableresults it is necessary to replicate the study by using larger samplesize it also can use Govt as well as foreign hospitals located inPakistan. This model can also use to check service quality in anyservice sector. We also can replicate it by using other contextsuch as Province level or country level.References1implications from the frontier. In: Rust RT, Oliver RL (eds.) ServiceQuality: New Directions in Theory and Practice, Sage Publications,Thousand Oaks, Canada.Anderson R, Weisman C, Camacho F, Scholle H, Henderson J, et al.(2007) Women’s satisfaction with their on-going primary health careservices: a consideration of visit-specific and period assessments.Health Serv Res 42: 663-681.92Parasuraman A, Zeithaml VA, Berry LL (1988) SERVQUAL: a multipleitem scale for measuring consumer perceptions of service quality. JRetailing 64: 12-40.10 Holder M, Berndt A (2011) The effect of changes in service escapeand service quality perceptions in a maternity unit. Int J Health CareQual Assur 24: 389-405.3Philips LW, Chang DR, Buzzell RD (1983) Product quality, costposition, and business performance: A test of some key hypotheses.J Mark 47: 26-43.11 Qatari GAL, Haran D (1999) Determinants of users satisfaction withprimary health care settings and services in Saudi Arabia. Int J QualHealth Care 11: 523-531.4Buzzell RD, Gale BT (1987) The PIMS Principles, New York, Free Press.5Carman JM (2000) Patient perceptions of service quality: combiningthe dimensions. J Serv Mark 14: 337-352.12 Bara A, van den Heuvel W, Maarse J, van Dijk J (2002) Userssatisfaction with the Romanian health care system: and evaluationof recent health care reforms. Eur J Public Health Suppl 12: 39-40.6Zineldin M (2006) The quality of health care and patient satisfaction:an exploratory investigation of the 5Q model at some Egyptian andJordanian medical clinics. Int J Health Care Qual Assur 19: 60-92.13 Brinkerhoff D, Wetterberg A (2013) Performance-based publicmanagement reforms: experience and emerging lessons from servicedelivery improvement in Indonesia. Int Rev Adm Sci 79: 433-457.7Parasuraman A, Zeithaml VA, Berry LL (1985) A Conceptual Modelof Service Quality and Its Implications for Future Research. J Mark49: 41-50.14 Margolis S, Al-Marzouqi S, Revel T, Reed RL (2003) Patient satisfactionwith primary health care services in the United Arab Emirates. Int JQual Health Care 15: 241-249.8Rust RT, Oliver R (1994) Service quality: insights and managerial15 Bleich S, Ozaltin E, Murray C (2009) How does satisfaction with the Under License of Creative Commons Attribution 3.0 LicenseBrady MK, Cronin JrJJ (2001) Some new thoughts on conceptualizingperceived service quality: a hierarchical approach. J Mark 65: 34-49.7
DE MEDICINAJournal of Hospital &ARCHIVOSMedical ManagementISSN1698-9465ISSN2471-97812018Vol.4 No.1:4health-care system relate to patient experience? Bull. World HealthOrgan 87: 271-278.37 Barclay I, Poolton J, Dann Z (1996) Improving competitiveresponsiveness via the virtual environment. IEEE IEMC 96: 52-62.16 Njong A, Tchouapi RPM (2014) Assessing User Satisfaction withthe Quality of Healthcare Services in Cameroon. African EconomicResearch Consortium, Nairobi, Kenya.38 Wispé L (1987) History of the concept of empathy. In: EisenbergN, Strayer J (eds.) Cambridge studies in social and emotionaldevelopment. Empathy and its development, New York, NY, US:Cambridge University Press.17 Bolton RN, Drew JH (1991) A multistage model of customers'assessments of service quality and value. J. Consum. Res. 17: 375-384.18
the service quality in various sectors in Pakistan in general and in the Sargodha region in particular. Keyword: Patient satisfaction; Service quality dimensions; SERVQUAL model Received: May 18, 2018; Accepted: May 30, 2018; Published: June 06, 2018 Introduction In the last three decades, there has been incrementing the interest
