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2012 14: 27Journal of Health ManagementSunil C. D'Souza and A.H. Sequeira

Measuring the Customer-Perceived Service Quality in Health Care Organization: A Case Study

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Impact on Stock Price by the Inclusion to and Exclusion from CNX Nifty Index 27Article

Measuring the Customer-Perceived Service Quality in Health Care Organization: A Case Study

Sunil C. D’SouzaA.H. Sequeira

Abstract

In today’s highly competitive environment, health care organizations are increasingly realizing the need to focus on service quality as a measure to improve their competitive position. While there has been a plethora of conceptual and empirical research regarding the many complexities involved in services marketing, few endeavours have been directed towards integrating the customer’s assessment into models to improve overall service quality. This article examines service quality through a case study of a health care organization in Mangalore, Karnataka, India with a tertiary health provision. The population consisted of patients aged 18–65 years and 45 patients were considered through a purposive sampling technique. The study basically started off using the grounded theory for patient of service quality and this exploration was enabled to formulate a hypothesis; to test the specific hypothesis, the descriptive approach was used. The grounded theory indentified service quality dimensions through open coding, axial coding and selective coding. The analysis was done for the assessment of overall service quality by ‘doctors’, ‘quality of care,’ ‘nursing quality of care’ and ‘operative quality of care’ and the proportion of statistically significant variance. The service quality in which operative quality of care yielded 79 per cent; doctor quality of care yielded 45.6 per cent; and nursing quality of care yielded 63.8 per cent of explanatory power.The results also indicated there is need to improve doctors’ care in the case of this organization. Service attributes related to this dimension requires management attention to improve the doctors’ care of quality. The article concludes by highlighting the dearth in services marketing research for service quality measurement through patient perspective in health care organizations.

Keywords

Dimensions, health care organization, patient-perceived quality, service quality

Introduction

Patient-perception of health care quality is critical to the success of a health care organization because of their influence on patient satisfaction and hospital profitability (Donabedian 1996). Patients demand

Journal of Health Management 14(1) 27–41

© 2012 Indian Institute of Health Management Research

SAGE PublicationsLos Angeles, London,

New Delhi, Singapore, Washington DC

DOI: 10.1177/097206341101400103http://jhm.sagepub.com

Sunil C. D’Souza, Department of Humanities, Social Sciences and Management, National Institute of Technology Karnataka, India. Email: [email protected]. Sequeira, Department of Humanities, Social Sciences and Management, National Institute of Technology Karnataka, India.

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28 Sunil C. D’Souza and A.H. Sequeira

Journal of Health Management, 14, 1 (2012): 27–41

more information than ever and do not hesitate to switch to other health care providers if they do not obtain satisfaction (Ramsaran-Fowdar 2008). In the new age of health care, the need is to shift the medi-cal paradigm away from the traditional perception that the accepted standard is just to deliver health care in a scientific and caring manner. Health care systems are a fundamental interest to all societies, as they become more advanced and as standards of living rise due to economic development. Quality of life becomes essential in a global context. The Indian health care industry is going through a transition and the future is likely to see significant changes in the nature of provision of health care and roles of various players in the industry. Health care organizations are considered the focal points for health services delivery and consume nearly 30 per cent of the national health care budget (Pestonjee et al. 2005). A hospital is an institution suitably located, constructed, organized and staffed to supply scientifically, eco-nomically, efficiently and unhindered, all or any recognized part of the complete requirements for the prevention, diagnosis and treatment of physical, mental and medical aspects of social ills, with function-ing facilities, training the new workers in many special professional, technical and economical fields, essential to the discharge of its proper function and adequate contacts with physicians, other hospitals, medical schools and accredited health agencies engaged in better health programmes (Dorland Medical dictionary).

In the case of health care services, the service providers are doctors, nurses, hospitals, nursing homes, clinics, etc., because they offer health services for patients. The buyer is the client or a patient who receives these health services at stipulated charges from government or private hospitals. The buyer wants acceptable quality services, which must satisfy the predetermined norms. Customers being an integral part of the health care system are becoming aware of the same. In the competitive world of health care it becomes more difficult to satisfy a customer (patient). In a situation like this, it is necessary to understand that one of the key factors satisfying a patient in a hospital is its service quality. It may also include quality of performance that is directly connected and closely related to the health care such as food, accommodation, safety, security, attitude of employees and other factors that arise in connection with hospitals services. It may also include quality of performance that is directly connected and closely related to the health care such as food, accommodation, safety, security, attitude of employees and other factors that arise in connection with hospital services. Today, medical standards of all types define the content and quality of health care in variety of contexts. A continual quality improvement is the basic mantra of health care providers and there is need to get motivated towards improving the quality stand-ards. Improving health care quality includes the doctors’ care of quality, nursing care of quality and operational-care quality. What is needed for those involved in such medical systems is to realize the true nature of quality of health care and to be motivated towards improving the quality; that is the greater concern of this article in the dynamic health care environment.

Review of Literature

The literature on service quality has given various models around the world. Cronin et al. (2000) com-mented that the literature in evaluating service quality, satisfaction and value is conflicting and confus-ing. The inter-relationships between quality, value and satisfaction have recent focus of the research to explain how they relate to each other and how they drive consumer behaviour (Cronin et al. 2000). Consensus seems to be growing around the opinion that positive perceptions of service quality lead to



Customer-Perceived Service Quality in Health Care Organization 29


increased customer satisfaction and acknowledgement of value. Past research indicates that the value of service was primarily measured by consumer perception of quality. The significant role that service qual-ity plays in achieving customer satisfaction and importance of satisfying customers to gain loyalty and increase profitability, indicates that focus on service quality is beneficial to organizations. Over the years there has been significant progress noted in the measurement of the perceptions of external service qual-ity (Cronin and Taylor 1992; Zeithaml et al. 1996). The perceived quality of given service will be the outcome of an evaluation process where consumers compare their expectations with service they get (Gronroos 1984). Perceived quality is a form of attitude, long-run overall evaluation where satisfaction is a transaction-specific measure (Parasuraman et al. 1988). An evaluation of ‘what’ the customer receives in interactions with the service firm is technical quality; ‘how’ the customer receives a service a called functional quality (Gronroos 1984). Corporate image results from how consumers perceive the firm (technical quality and functional quality) in addition to external factors (traditions, ideology, word-of-mouth) and marketing activities (advertising, pricing and public relation) (Gronroos 1984). Parasuraman et al. (1985, 1988 and 1991) define perceived quality as a gap between consumers’ expecta-tions and consumers’ perceptions regarding the service. Arnauld et al. (2002) define perceived quality, ‘whether in reference to a product or service’, as ‘the consumer’s evaluative judgment about an entity’s overall excellence or superiority in providing desired benefits’. The quality of service—both technical and functional—is a key ingredient in the success of service organizations (Gronroos 1984; Sadiq Sohail 2003). Technical quality in health care is defined primarily on the basis of technical accuracy of the diagnosis and procedures. Functional quality relates to the manner of delivery of health care services. Patients are often unable to assess the technical quality of medical services accurately; functional quality is usually the primary determinant of patients’ perception of quality (Donabedian 1982; Sadiq Sohail 2003). There is growing evidence to suggest that perceived quality is the single most important vari-able influencing consumers’ perception of value and that this, in turn, affects their intentions to purchase products or services (Bolton and Drew 1991; Zeithamal et al. 1988). Service quality has also become recognized as a driver of corporate marketing and financial performance (Buttle 1996). Although it is widely acknowledged that there is a need for quality indicators of patients’ perception of the quality and some research in this area exist, Parasuraman et al. (1985) identified five dimensions of service quality which includes responsiveness, reliability, assurance, empathy and tangibility for various services set-tings. Based on these dimensions, the SERVQUAL instrument was developed. The SERVQUAL has widely been used (Buttle 1996) and criticized for its empirical application failure to recover the five dimensions and to suggest modifying them (Carman 1990; Cronin and Taylor 1992). The latter devel-opment is in the modification and refinement of dimensions of various service settings. Specific to health care organizations, the eight dimensions are identified as tangibles, reliability, responsiveness, compe-tence, courtesy, communication, access and understanding customers (Parasuraman et al. 1988). Dabholkar (1996) developed the retail service-quality scale in taking into account retailing service qual-ity dimensions and five dimensions, which are personal interaction, policy, physical aspects, reliabil-ity and problem solving. G.S. Sureshchandar et al. (Sureshchandar et al. 2001) identified 12 dimensions of quality management for service organizations which includes top management commitment and visionary leadership, human resource management, technical system, information and analysis system, benchmarking, continuous improvement, customer focus, employee satisfaction, union intervention, social responsibility, service-scapes and service culture. The enrichment of service quality literature is observed in the form of dimensions as given by various researchers in changing business environments.





The phenomenon of contribution to service quality dimensions in health care was given by Parasuraman et al. in 1988. Keeping the reference point of the eight dimensions (see column 1 of Table 1), the amount of variation on service quality dimensions by key researchers was presented (Table 1). The identification of service quality dimensions is becoming increasingly important in health care, as providers seek to meet the challenges inherent in a more competitive health care environment. It is evident that the service quality dimensions are seen as the criteria to assess the service quality in health care organizations.

Research Questions

1. What are the key attributes of patient-perceived service quality?2. How to evaluate the service quality in health care organizations?

Research Objectives

1. To identify the key attributes of patient-perceived service quality2. To analyze doctors’ care of quality in health care organization3. To analyze nursing care of quality in health care organization4. To analyze operational care of quality in health care organization5. To suggest model for patient-perceived service quality

Hypothesis

H1: Doctors’ care of quality has a relationship with overall service quality.H2: Nursing care of quality has a relationship with overall service quality.H3: Operational-care quality has a relationship with overall service quality.

Research Methodology

The research used qualitative and quantitative methods so that the resultant mixture has complementary strengths and non-overlapping weakness. The population consists of patients from a case health care organization of South India and 50 patients were considered using purposive sampling technique. Potential subjects who met the following inclusion criteria were selected from the roster of case health care organization with the input from the senior nursing supervisor: (a) 18–65 years of age, (b) ability to speak Kannada or English, (c) hospitalised for at least three days, (d) not to be suffering from severe mental or cognitive disorders, (e) willing to participate, ( f ) communicable and (g) to be well enough to participate in the interview. The average length of an interview was 25–30 minutes. For two interviews,



Impact on Stock Price by the Inclusion to and Exclusion from CNX Nifty Index 31

Tab

le 1

. Com

pari

son

of S

ervi

ce Q

ualit

y D

imen

sion

s in

Hea

lth C

are

Org

aniz

atio

n by

Key

Res

earc

hers

Para

sura

man

et

al. (

1988

)(1

)

Pick

er/M

HQ

P (1

988)

(2)

Jun

et a

l. (1

988)

(3)

Bow

ers

et a

l. (1

994)

(4)

Mitt

al e

t al

. (1

996)

(5)

Ree

s (1

998)

(6)

Ovr

etve

it (2

000)

(7

)Sc

ott

(200

6)

(8)

Tan

gibl

es∗

∗∗

Rel

iabi

lity

∗∗

R

espo

nsiv

enes

s∗

∗∗

∗∗

C

ompe

tenc

e∗

∗∗

∗ P

rovi

der’

s re

puta

tion

Cou

rtes

y∗

∗∗

∗∗

C

omm

unic

atio

n∗

∗C

arin

g∗

A

cces

s∗

∗∗

U

nder

stan

ding

cus

tom

er∗

∗Pa

tient

out

com

e∗

∗∗ (

Clie

nt q

ualit

y)∗

Con

tinui

ty o

f car

eC

olla

bora

tion

∗∗

∗ (Pr

ofes

sion

al q

ualit

y)M

edic

al n

eces

sity

∗ (M

anag

emen

t qu

ality

)D

eter

min

atio

ns∗

Rep

ortin

gD

ocum

enta

tion

Clin

ical

pro

cess

Util

izat

ion

revi

ewS

our

ce:

Lite

ratu

re R

evie

w.





the researcher remained as a listener and he was just taking notes and believed in the importance of acquired experience as a listener. After each of these two interviews, he took time to exchange opinions and to keep focus on the research problem. This method assures quality of classification and coding as part of Grounded theory developed for patient service quality to indentify the service quality attributes. Grounded theory methodology explains the area under investigation based around a ‘core category’ which is in turn supported by sub-core categories (Glaser 1978). The core category is the important gen-eral level behaviour performed in a specific situation, which is then supported by more specific behav-iours called sub-core categories. The core category is able to explain the majority of the behaviours observed/reported in the area under study (Glaser 1978).

The study basically started off using the grounded theory for patient of service quality and this explo-ration was enabled to formulate hypotheses; to test the specific hypothesis, the descriptive approach was used. The initial study was conducted through personal interview using open-ended questions for grounded theory. These interview transcripts were open coded for core categories; it was then supported by more specific behaviours called sub-categories or axial coding and listing on core category items by selective coding. Finally, the self-administered questionnaire was designed to capture data on the basis of objectives and the levels of data to be captured. The survey questionnaire consisted of 38 statements on the Likert scale, where 1 = ‘strongly disagree’, 2 = ‘disagree’, 3 = ‘neither agree nor disagree’, 4 = ‘agree’ and 5 = ‘strongly agree’. The validity of the instrument was obtained by experts and piloted for a small group of respondents. The reliability was obtained by computing Cronbach Alpha that measures the internal consistency of the items.

Out of 50 questionnaires, 45 were obtained in complete with a response rate of 90 per cent. In con-formity with the ethical requirements of the study, formal consents for conducting research were obtained. The model fit was determined through regression analysis and the significance by Pearson’s correlation. The model fit was determined through regression analysis (R, R2) and the significance by Pearson’s correlation.

Results and Discussion

Grounded Theory for Patient-Perceived Service Quality

After going through all the interview transcripts, the researcher identified three categories that were open coded as ‘doctors’ quality of care,’ ‘nursing quality of care,’ and ‘operative quality of care.’ This was the first-level of categorization (see Table 2).

Axial Coding

Second-level categorization was done by axial coding based on the patients’ feelings regarding each of the three dimensions and sub-categories of previous categories. The recorded feelings were positive, negative and neutral (see Tables 3, 4 and 5).



Impact on Stock Price by the Inclusion to and Exclusion from CNX Nifty Index 33T

able

2. O

pen

Cod

ing:

Pat

ient

-Per

ceiv

ed S

ervi

ce Q

ualit

y

Inte

rvie

w T

rans

crip

tC

ore

Cat

egor

y

‘All

doct

ors

are

very

kin

d w

ith m

e…’;

‘I do

not

wan

t to

kno

w t

he t

ruth

abo

ut m

y he

alth

con

ditio

n…’;

‘Doc

tors

kno

w w

hat

is g

ood

for

me.

’D

octo

rs’ q

ualit

y of

car

e‘D

octo

rs h

ere

are

alw

ays

help

ful a

nd s

uppo

rtiv

e; s

omet

imes

the

y m

ake

us w

ait

long

hou

rs…

’; ‘Y

ou s

ee t

he p

eopl

e he

re a

re c

row

ded.

’D

octo

rs’ q

ualit

y of

car

e‘T

hey

also

tre

at m

y fa

mily

and

frie

nds

nice

ly.’

Doc

tors

’ qua

lity

of c

are

‘Doc

tor

answ

ers

my

quer

ies

satis

fact

orily

.’D

octo

rs’ q

ualit

y of

car

e‘I

had

unea

sine

ss t

o w

alk

afte

r th

e ul

tras

ound

and

the

y co

mm

unic

ated

with

nur

ses

very

wel

l to

get

me

a w

heel

cha

ir…

’.D

octo

rs’ q

ualit

y of

car

e‘D

octo

rs e

xpla

in c

lear

ly a

bout

the

tre

atm

ent.’

Doc

tors

’ qua

lity

of c

are

‘Doc

tors

com

mun

icat

e w

ith n

urse

s ve

ry w

ell.’

Doc

tors

’ qua

lity

of c

are

‘My

doct

or is

alw

ays

avai

labl

e on

tim

e…’;

‘He

liste

ns t

o m

e pa

tient

ly’;

‘…I g

ot d

isch

arge

d ea

rly.

’D

octo

rs’ q

ualit

y of

car

e‘D

octo

r sp

oke

to m

y br

othe

r ve

ry n

icel

y’; ‘

I am

ver

y ha

ppy

abou

t th

e tr

eatm

ent…

’D

octo

rs’ q

ualit

y of

car

e‘D

octo

rs a

re h

ones

t.’D

octo

rs’ q

ualit

y of

car

e‘N

urse

s he

re a

re a

lway

s he

lpfu

l and

sup

port

ive.

’N

ursi

ng q

ualit

y of

car

e‘I

was

a li

ttle

unc

omfo

rtab

le t

o se

ttle

my

bills

…’;

‘Unu

sed

drug

s ar

e re

turn

ed t

o ph

arm

acy…

’N

ursi

ng q

ualit

y of

car

e‘…

sudd

enly

I ha

d a

drug

rea

ctio

n…T

hey

com

mun

icat

ed w

ith d

octo

rs v

ery

wel

l and

doc

tors

app

roac

hed

in a

few

min

utes

’; ‘N

urse

s he

re r

eally

al

ert

the

doct

ors…

Gre

at jo

b!’

Nur

sing

qua

lity

of c

are

‘Nur

ses

are

avai

labl

e at

any

tim

e of

nee

d.’

Nur

sing

qua

lity

of c

are

‘Nur

ses

are

alw

ays

help

ful a

nd s

uppo

rtiv

e.’

Nur

sing

qua

lity

of c

are

‘Nur

ses

com

mun

icat

e w

ith s

uppo

rtiv

e st

aff v

ery

wel

l.’N

ursi

ng q

ualit

y of

car

e‘M

y fr

iend

has

to

go o

n a

call…

’; ‘N

o at

tend

ant

is t

here

at

my

side

…ev

en t

hen

they

car

ed fo

r m

e…I n

ever

felt

lone

ly.’

Nur

sing

qua

lity

of c

are

‘Her

e th

e su

rrou

ndin

gs a

re c

alm

and

gre

en…

Inte

rnal

atm

osph

ere

is a

ttra

ctiv

e.’

Ope

rativ

e qu

ality

of c

are

‘Adm

issi

on p

roce

ss is

sim

ple…

No

need

to

wai

t in

que

ue…

I got

my

files

ver

y qu

ickl

y!’

Ope

rativ

e qu

ality

of c

are

‘Acc

ount

s st

aff c

lear

ed m

y bi

lls a

nd a

rran

ged

me

a ta

xi…

’; ‘B

illin

g sy

stem

is v

ery

good

.’O

pera

tive

qual

ity o

f car

e‘B

lood

ban

k se

rvic

e is

ver

y go

od.’

Ope

rativ

e qu

ality

of c

are

‘Sur

gery

ope

ratio

n sc

hedu

le w

as w

ell p

lann

ed.’

Ope

rativ

e qu

ality

of c

are

‘Lab

orat

ory

faci

litie

s ar

e ve

ry g

ood.

’ O

pera

tive

qual

ity o

f car

e‘C

ante

en fa

cilit

y is

goo

d.’

Ope

rativ

e qu

ality

of c

are

‘We

need

not

get

ten

sed

abou

t ge

ttin

g bl

ood

grou

p…’;

‘Blo

od b

ank

serv

ice

is g

ood.

’O

pera

tive

qual

ity o

f car

e‘T

here

is d

elay

in g

ettin

g m

y re

port

…’;

‘Lab

orat

ory

faci

litie

s ha

ve t

o sp

eed

up…

;’ ‘S

omet

imes

the

y ig

nore

my

quer

ies.

’O

pera

tive

qual

ity o

f car

e‘H

ouse

keep

ing

serv

ices

and

can

teen

faci

litie

s ar

e go

od.’

Ope

rativ

e qu

ality

of c

are

‘My

phys

icia

n is

rea

dy t

o sp

end

mor

e tim

e to

exp

lain

my

cond

ition

.’D

octo

rs’ q

ualit

y of

car

e‘I

have

no

com

plic

atio

ns a

fter

my

surg

ery.

’D

octo

rs’ q

ualit

y of

car

e‘M

y ho

spita

l roo

m is

cle

an a

nd p

leas

ant.’

Ope

rativ

e qu

ality

of c

are

‘The

nur

sing

sta

ff is

kin

d an

d ca

ring

.’N

ursi

ng q

ualit

y of

car

e‘A

n ac

cura

te d

iagn

osis

of m

y co

nditi

on w

as m

ade.

’D

octo

rs’ q

ualit

y of

car

e‘I

was

abl

e to

und

erst

and

the

bill

for

the

serv

ices

.’O

pera

tive

qual

ity o

f car

e‘P

rope

r qu

eue

man

agem

ent

is fo

llow

ed.’

Ope

rativ

e qu

ality

of c

are

‘Adm

issi

on p

roce

ss is

sim

ple.

’O

pera

tive

qual

ity o

f car

e‘I

belie

ve t

he e

quip

men

t at

the

hos

pita

l is

mod

ern.

’O

pera

tive

qual

ity o

f car

e‘B

illin

g sy

stem

is s

atis

fact

ory.

’O

pera

tive

qual

ity o

f car

e‘O

vera

ll cl

eanl

ines

s m

aint

aine

d.’

Ope

rativ

e qu

ality

of c

are

So

urce

: C

onde

nsed

Inte

rvie

w t

rans

crip

ts.





Table 3. Axial Coding: Doctors’ Quality of Care

Doctors’ Quality of Care Sub-Category

‘…doctors are here always helpful and they explain me clearly about the surgery expenses…’ Positive‘Doctor answered my queries satisfactorily.’ Positive‘Nobody cares for us…; ‘In these times there is no respect’…; ‘Our world has become a jungle.’

Negative

‘Listen to me my friend……. I am suffering from a kidney stone’. ‘Since now I have visited many hospitals, doctors here are the best I have ever seen…I do not feel pain.’

Positive

‘Doctors are honest.’ Positive‘They explain clearly about the treatment.’ Positive‘Doctors here say there is no cure or treatment for this…I do not believe this!’ Negative‘My doctor gave me worst advice.’ Negative

Source: Condensed Interview Transcripts.

Table 4. Axial Coding: Nursing Quality of Care

Nursing Quality of Care Sub-Code Category

‘Sometimes I feel caring is a curse…’; ‘I just asked about my diet…here nobody is bothering.’

Negative

‘Nurses are always helpful and supportive.’ Positive‘Nurses communicate with the doctors very well.’ Positive‘The nursing staff in this hospital is the best I have ever seen…’; ‘I do not feel pain….’ Positive‘Nurses communicate with supportive staff very well.’ Positive‘They communicate with doctors very well.’ Positive‘When I asked to call my doctors, she politely said, ‘He is on the rounds.’ positive


Table 5. Axial Coding: Operational Quality of Care

Operational Quality of Care Sub-Code Category

‘He has to seek opinion from superior it seems…’; ‘Nobody guides me….’ Negative‘Admission process is simple.’ Positive‘I waited for a long time…’; ‘Bill is not ready…’; ‘Now they are contacting the nursing station…!’

Negative


Selective Coding

The third-level of categorization was done by selective coding; it finally gives the list of specific attributes related to doctors’ quality of care, nursing quality of care, and operative quality of care (see Figure 1).

Reliability Analysis

The reliability was obtained by computing Cronbach Alpha that measures the internal consistency of the items. Owing to the multi-dimensionality of service quality, Cronbach Alpha was computed separately





and it was ranged from 0.901 to 0.958 indicating higher level of internal consistency (see Table 6). Typically, reliability co-efficient of 0.7 or more is considered to be adequate (Cronbach 1951; Nunnally 1978).

Descriptive Statistics

It includes means and standard deviations, which were reported for all variables in the data set. Standard deviations (SDs) were used to indicate how far all of the scores in the distribution deviated or varied

Figure 1. Patient-Perceived Service Quality Using Grounded Theory

Source: Grounded Theory.





from the mean between each variable. Descriptive information regarding the means and standard devia-tions gave respondents’ attitudes toward these dimensions regarding the usefulness of patient-perceived quality in the health care organization. A five point Likert scale was used (1 = ‘strongly disagree’ and 5 = ‘strongly agree’), and respondents indicated their strong response to doctors’ care of quality with means ranging from 3.3 to 3.89, nursing care of quality with means ranging from 3.98 to 4.17, opera-tional care of quality with means ranging from 3.6 to 3.94 and overall service quality with means ranging from 3.77 to 4.06 (see Tables 7, 8, 9 and 10).

Table 6. Results of Reliability Analysis

Dimensions No. of Items Cronbach’s Alpha

Doctors’ care of quality 11 0.958Nursing care of quality 11 0.948Operational care of quality 10 0.933Overall service quality 6 0.901

Source: Author.

Table 7. Descriptive Statistics for Doctors’ Care of Quality

Questions P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11

Doctors care of quality

Mean 3.81 3.85 3.68 3.66 3.51 3.51 3.66 3.89 3.77 3.47 3.30SD 0.90 0.81 0.91 0.84 0.98 0.98 0.89 0.84 0.87 1.06 1.10

Source: Author.

Table 8. Descriptive Statistics for Nursing Care of Quality

Questions P12 P13 P14 P15 P16 P17 P18 P19 P20 P21 P22

Nursing Care of Quality

Mean 4.00 4.13 4.04 4.13 4.06 4.04 3.98 4.04 4.09 4.13 4.17SD 0.72 0.49 0.55 0.49 0.53 0.55 0.61 0.55 0.54 0.45 0.56

Source: Author.

Table 9. Descriptive Statistics for Operational Care of Quality

Questions P23 P24 P25 P26 P27 P28 P29 P30 P31 P32

Operational Care of Quality

Mean 3.94 3.74 3.91 3.89 3.77 3.70 3.70 3.74 3.74 3.60SD 0.79 0.85 0.58 0.67 0.70 0.75 0.78 0.77 0.79 0.90

Source: Author.

Table 10. Descriptive Statistics for Overall Service of Quality

P33 P34 P35 P36 P37 P38

Overall Service QualityMean 3.79 4.06 3.77 3.83 3.85 3.85SD 0.81 0.53 0.73 0.67 0.81 0.66

Source: Author.





Factor Analysis

The results of the factor analysis confirmed that attributes on scale were reliable in their measurement and most of them were found to be above the adequacy level. However, results suggested that doctors’ care of quality and nursing care of quality in the case organization requires improvement. The attri-butes related to these dimensions needs the management concerned to improve its service quality (see Tables 11, 12, 13 and 14).

Testing Hypotheses

In this study, default α of 0.05 was used to determine the level of significance. H1, H2 and H3 were statis-tically significant (p less than 0.05). Doctors’ care of quality (H1), nursing care of quality (H2) and opera-tional care of quality (H3) had a significant relationship with the overall service quality (see Table 15).

Table 11. Results of Factor Analysis for Doctors’ Care of Quality

Sl. No. Attributes Loadings

P1 Friendly 0.642P2 Answers your queries 0.617P3 Helpful and supportive 0.770P4 Listening 0.683P5 Explaining clearly 0.794P6 Care a lot 0.764P7 Treat your family and friends 0.831P8 Communication with nurses 0.730P9 Communication with supportive staff 0.639P10 Readily clear doubts 0.848P11 Available on time 0.533

Source: Author.

Table 12. Results of Factor Analysis for Nursing Care of Quality


P12 Sufficient care 0.643P13 Helpful and supportive 0.877P14 Listening 0.739P15 Friendly 0.852P16 Answers your queries 0.775P17 Treat your family and friends 0.813P18 Explaining clearly 0.819P19 Communication with supportive staff 0.911P20 Communication with doctors 0.689P21 Understanding needs 0.761P22 Available on time 0.862

Source: Author.





Table 13. Results of Factor Analysis for Operational Care of Quality


P23 Admission process 0.764P24 Billing system 0.800P25 Queue management 0.784P26 Internal atmosphere 0.836P27 Blood bank 0.744P28 Laboratory 0.852P29 Operation schedule 0.865P30 Change of bed sheets 0.835P31 Conducive interaction 0.672P32 House keeping 0.648

Source: Author.

Table 14. Results of Factor Analysis of Overall Service Quality


P33 Expectation with doctors 0.498P34 Expectation with nurses 0.485P35 Expectation with support staff 0.732P36 Overall administration 0.807P37 Overall cleanliness 0.698P38 Overall satisfaction 0.901

Source: Author.

Table 15. Hypotheses: Service Quality Dimensions

Hypothesis Test Value df Asymp.Sig. (2-sided)

H1 Pearson Chi-Square 29.769 12 0.003Likelihood Ratio 25.138 12 0.014Linear-by-Linear Association 12.058 1 0.001



Source: Author.

Using regression analysis, the extent to which independent variables accounted for variance in depend-ent variables was assessed. The analysis was done for the assessment of overall service quality by three independent variables and the proportion of variance statistically significant. In the three regression models, doctors’ care of quality yielded 45.6 per cent of explanatory power in the quality perception of patients, nursing care of quality yielded 63.8 per cent of explanatory power in the quality perception of





patients and operational care of quality yielded 79 per cent of explanatory power in the quality percep-tion of patients (see Table 16). The results indicated that there is need to improve doctor’s care in the case organization. Service attributes related to this dimension require management attention to improve the service quality.

Table 16. Regression Analysis of Service Quality

Dimensions RR

SquareAdjusted R Square

Std Error of the

Estimate

Change Statistics

R Square Change

F Change df1 df2

Sig. F Change

Doctors’ care of quality 0.675 0.456 0.444 0.60108 0.456 37.681 1 45 0.000Nursing care of quality 0.798 0.638 0.630 0.32117 0.638 79.171 1 45 0.000Operational care of quality

0.889 0.790 0.785 0.31029 0.790 169.360 1 45 0.000

Source: Author.

Figure 2. Customer-Perceived Service Quality Model for Health Care Organization

Limitations and Direction for Future Research

The study was limited for a case health care organization. The results are subject to a specific case and findings cannot be generalized. Factor analysis was used only to specify loadings on each attribute and considered for smaller sample size. The service attributes were limited for the customer assessment of service quality. To ensure representativeness, the study should be replicated for a bigger sampling size and results should be compared to those found in the study.





Conclusion

With the increasing awareness among consumers and with ever-increasing competition, medical services will have to focus on customer assessment to improve service quality. The Health care systems are required to decide whether they want to initiate change or adopt change that has been externally imposed upon them. Results from the study suggest that customer assessment provides inputs for the case health care organization to improve its service-quality attributes. The study suggests it was appropriate to iden-tify and improve the service performance through patients’ perception of service quality.

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