MEASURING SERVICE QUALITY IN PRIVATE HEALTHCARE …SERVPERF scale was used to gather information regarding service quality from the respondents. Total respondents were 183 out of which

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MEASURING SERVICE QUALITY IN PRIVATE HEALTHCARE USING

SERVPERF SCALE

Byju K.P.M, Research Scholar & Dr.Y.Srinivasulu, Associate professor

Department of International Business, School of Management, Pondicherry University

Abstract

Measuring service quality is one of the most researched area in services marketing context.

Researchers over the past three decades have developed various measurement instruments to

measure service quality and its relationship with that of customer satisfaction leading to future

purchase intentions. SERVQUAL and SERVPERF are the two widely used instruments across the

globe by the service sector for measuring service quality. The expectations minus perception

approach by Parasuraman and others has got serious critics even though it is the most adopted

one till date. Many felt that expectations have multiple dimensions hence it is hard to measure.

Cronin and Taylor then came up with SERVPERF as they strongly believed that performance

model is more convenient in measuring service quality. Further research showcased its

superiority in terms of better reliability, convergent and discriminant validity and less bias than

SERVQUAL. Incorporation of SERVPERF in Indian service segment especially in healthcare is in its

nascent stage only. This article intends to measure the service quality determinants in a private

hospital using SERVPERF scale, both from patients and their attendant’s perspective. The results

show that there is no major difference in service quality perceptions between patients and their

attendants. Responsiveness, Empathy and Tangibility are the three main factors associated with

overall customer satisfaction.

Key words: Service quality, Customer satisfaction, SERVQUAL, SERVPERF, Private hospital

Introduction

Service quality as described by Parasuraman, Zeithmal and Berry (1988) is a global judgment

(or) attitude, relating to the superiority of the service (Urban, 2013). Managing service quality is

one of the most important tool an organization needs to posses in order to have a long term

satisfied customers (Cronin & Taylor, 1994). Cronin and Taylor (1992) argued that service




quality has a positive influence on customer satisfaction. Service quality is in fact an antecedent

to customer satisfaction. Many researchers came to a common consensus that its service

quality and customer satisfaction which will have a long term impact in customer relationship

(Irfan, Ijaz, & Farooq, 2012). Customer satisfaction is a leading criterion for determining the

quality that is actually delivered to the customers (Vavra, 1997). According to Shierdan (1998)

companies have a competitive advantage with better service quality as they can differentiate

effectively from the competition with enhanced customer service.

Quality has been used to describe diverse phenomenon. Service quality is usually considered

mostly as a cognitive construct while satisfaction has been considered a more complex concept

that includes cognitive and affective components (Oliver,1997).The argument of taking service

quality as a mere cognitive thing (or) having an emotional influence attached to it depends

upon the service sector understudy (Kettinger & Lee, 1997) .In the past few decades service

quality has become a major area of attention to practitioners, managers and researchers awing

to its strong impact on business performance, lower costs, customer satisfaction, customer

loyalty and profitability .For an organization to remain competitive in the market it is necessary

to grab and channelize information for the purpose of enhancing service quality (Kettinger &

Lee, 1997).

Service quality needs to be monitored constantly in order to gain a competitive advantage.

Service quality becomes even more important in sectors like healthcare where the information

regarding technical aspect of the service offered is often limited or unknown to the patient. In

these circumstances the functional aspect becomes more important because the patients

evaluate the entire service based on how it was provided to them.

Objectives of the study

1. To analyze various models used for measuring quality of service across all service

sectors.

2. To find whether there is any significant difference in mean scores of patients and

attendants with respect to service quality determinants.




3. To find out the relation between the five factors of service quality and the customer

satisfaction.

4. To analyze whether there is any significant difference is service quality perception with

respect to gender, Income level and no of visits to the hospital.

Measuring Service quality

Service quality as mentioned by Parasuraman and co as an attitude (or) judgment towards a

service rendered, is hard to measure because of its highly qualitative nature. Many authors

came out with different methods and measured service quality using their own constructs

(Carrillat, Carrillat, Jaramillo, & Muliki, 2007).

Gronroos (1984) came out with three components of service quality (i.e.) 1. Technical quality 2.

Functional quality and 3. Image of the organization. It is the former two qualities which impacts

the latter one and the latter one having a considerable impact on perceived service quality.

Gap model – (Parasuraman, Zeithamal and Berry, 1985)

The gap model proposed by Parasuraman et.al is a function of differences between expectation

and performance along the quality dimensions. It is developed on the basis of gap analysis

which includes five, stated as

1. Customer expectations minus management perceptions of those expectations.

2. Difference between management perceptions of consumer’s expectations and service

quality specifications.

3. Difference between service quality specifications and the actual service delivered.

4. Difference between the actual service quality and the communications to consumers

about service quality.

5. Difference between consumer’s expectation and perceived service quality.

Performance only model (Cronin and Taylor, 1991)

The authors conceptualized the measurement of service quality and its relationship with

customer satisfaction and future purchase intentions. The argument put forward for

performance only measurement (SERVPERF) is that service quality is a form of customer

attitude and performance only measure of service quality is an enhanced means of measuring




service quality. They maintained that performance instead of performance minus expectations

determines service quality.

And there are many other models such as

1. Attribute and overall affect model by Dabholkar (1996) which is mainly framed for self

service options.

2. PCP attribute model by Philip and Hazlett (1997) where three main classes of attributes

where taken into consideration namely pivotal, core and peripheral attributes.

3. Synthesized model of service quality by Brogowicz et.al (1990), the purpose of the

model is to identify the dimensions associated with service quality in planning,

implementation and control process. The synthesized model of device quality

considered three factors viz., company image, external influences and traditional

marketing activities as the factors influencing technical and functional quality

expectations to name a few (Carrillat, Carrillat, Jaramillo, & Muliki, 2007).

Study area & construct used

Study was conducted in a service oriented 1200 bedded hospital in Pondicherry region.

SERVPERF scale was used to gather information regarding service quality from the respondents.

Total respondents were 183 out of which 103 -patients and 80 - attendants.

The questionnaire had two parts.

1. A total of 10 questions dealing with the Geographical and Demographical data of the

respondents.

2. A total of 27 questions (Psychometric) focusing on the five latent factors of service

quality and the overall customer satisfaction.

The five factors taken for the study are:

1. Tangibility (Measured by 5 constructs)

Tangibility represents the service physically. It is defined as the appearance of physical

facilities, staff appearance and communication materials that are used to provide services for

them. Often firms use tangibility to highlight their image and quality.

2. Reliability (Measured by 4 constructs)




It is the ability to perform promised service accurately on time. It generally means the company

delivers on its promises regarding delivery, service provision and problem resolution.

3. Responsiveness (Measured by 4 constructs)

Being willingness to help, it is the willingness or readiness to help customers and to provide

prompt service. This dimension emphasizes attentiveness and promptness in dealing with

customer requests, questions, complaints and problems.

4. Empathy (Measured by 4 constructs)

Treating customers as individuals is defined as empathy. Caring, individual attention a firm

provides to its customers.

5. Assurance (Measured by 4 constructs)

Inspiring trust and confidence is defined as Assurance. The employees knowledge and courtesy

and the ability of the firm and its employees to inspire trust and confidence.

Hypothesis

1. H01: There is no significant difference in service quality perception between male and

female.

2. H02: There is no significant difference in service quality perceptions with respect to

income levels of the respondents.

3. H03: There is no significant difference in service quality perceptions with respect to

number of visits to the hospital.

4. H04: There is no significant relation between all the five service quality factors and

overall customer satisfaction.

All the statistical measures mentioned below were computed using SPSS 20.0 version. All

the following analyses are done at 5% level of significance. Hence the cutoff p value to accept

null hypothesis is .05 for all the subsequent analysis.

The reliability value of the scale items are computed using Cronbach’s alpha. The Cronbach’s

alpha value is .893 which is consistent with the values obtained from research using the same

scale (Narang, 2010).




Analysis and Discussion

Demographics

Of the total 183 respondents 179 were male and 161 female. 56% of the patients were from

Puducherry union territory and 19% from Cuddalore district, while the remaining from nearby

districts of puducherry. 38% of the respondents had a minimum of three visits to the hospital

before as inpatients while 33% of the respondents were using the facility for more than four

times. So the major junk of the patients (79%) had repeated visits to the hospital facility

before. Hence they were in much better position to evaluate the quality of service provided.

Mean value of all the Factors

The following table shows the mean value of all the factors taken for the study both the

patients, attendants and overall perspective. The mean score consistently above 4.10 for all

the factors shows that both attendants as well as patients as highly satisfied with the service

outcomes.

Factor

Overall

Patients

Attendants

1. Tangibility 4.13 4.18 4.08

2. Reliability 4.08 4.06 4.11

3. Responsiveness 4.14 4.18 4.24

4. Assurance 4.22 4.22 4.23

5. Empathy 4.24 4.21 4.27

6. Customer Satisfaction 4.32 4.31 4.33




H01: There is no significant difference in service quality perception between male and female.

Table: 2

Independent Samples Test

Levene's

Test for

Equality of

Variances

t-test for Equality of Means

F Sig. t df Sig.

(2-

tailed)

Mean

Difference

Std. Error

Difference

95%

Confidence

Interval of the

Difference

Lower Upper

Customer

sat sum

Equal

variances

assumed

2.283 .133 -

2.090 181 .038 -.10353 .04954

-

.20128

-

.00578

Equal

variances

not

assumed

-

2.204 178.041 .029 -.10353 .04696

-

.19621

-

.01085

To identify whether there is any significant difference in perceptions of overall customer

satisfaction between male and female respondents, Independent sample T Test was performed.

The Leven’s test for equality of variances is .133 which is higher than .05 (at 5% level of

significance) which states that there is inequality in variances among two groups. The p value

under equal variance not assumed is .029 which is less than .05 (at 5% level of significance). H01

is rejected. There is significant difference between male and female with respect to perceptions

of overall customer satisfaction.

H02: There is no significant difference in service quality perceptions with respect to income

levels of the respondents.

Anova Table Table: 3

Sum of Squares df Mean Square F Sig.

Between Groups 2.600 4 .650 6.491 .000

Within Groups 17.824 178 .100

Total 20.424 182




To determine whether there is any significant difference in respondent’s perceptions towards

overall customer satisfaction with respect to the income levels of the respondents, one way

analysis of variance measure was employed. The p value which denotes the significance level of

the test used is .000 which is lesser than .05 (at 5% level of significance).hence the null

hypothesis stands rejected which states that there is significant difference in respondent’s

perceptions towards overall customer satisfaction with respect to the income levels of the

respondents. Post-Hoc analysis was done to examine the groups in detail to have multiple

comparisons between them. Turkey HSD the preferred method for Post Hoc analysis was

employed. The following table reveals that the 5 types of income groups can be clubbed into

three subsets but will have overlapping between them.

Table: 4

Customer sat sum

Monthly income N Subset for alpha = 0.05

1 2 3

25,001-30,000 16 4.1000

<10,000 110 4.2673 4.2673

10,001-15,000 15 4.3867 4.3867

15,001-20,000 22 4.4545 4.4545

20,001-25,000 20 4.5500

Sig. .419 .302 .444

H03: There is no significant difference in service quality perceptions with respect to number of

visits to the hospital

Table: 5

Anova Table

Customer sat sum

Sum of Squares df Mean Square F Sig.

Between Groups .868 4 .217 1.975 .100

Within Groups 19.556 178 .110

Total 20.424 182




To measure whether there is any significant difference in based on number of visits they had to

the hospital before, one way analysis of variance measure was employed.

The p value which denotes the significance of the measure used is .100 higher than .05 (at 5%

significance level). Hence the null hypothesis H03 is accepted that there is no significant

difference in respondents perception towards the overall customer satisfaction based on the

number of visits they had to the hospital before.

H04: There is no significant relation between all the five service quality factors and overall

customer satisfaction

Table: 6

Correlations

Customer sat sum

Tangibility sum

Pearson Correlation .663**

Sig. (2-tailed) .000

N 183

Reliability sum



N 183

Responsiveness sum



N 183

Empathy sum



N 183

Assurance sum



N 183

Customer sat sum

Pearson Correlation 1

Sig. (2-tailed)

N 183

**. Correlation is significant at the 0.01 level (2-tailed).

Correlation matrix

Correlation analysis was performed to identify the relationship between all the five factors

contributing towards service quality with that of overall customer satisfaction. All the five

correlation coefficients are positive and statistically significant at 1% level of significance.




The correlation between Responsiveness, Tangibility and Empathy are highly correlated with

that of overall satisfaction (r values - .690, .663 and .660 respectively). Whereas Reliability and

Assurance have a moderate correlation with overall customer satisfaction (r values- .557 and

.442 respectively).

Regression Table: 7

Model Summaryd

Model R R

Square

Adjusted

R Square

Std. Error of the

Estimate

Change Statistics

R Square

Change

F

Change

df1 df2 Sig. F

Change

1 .690a .476 .473 .24312 .476 164.548 1 181 .000

2 .739b .546 .541 .22698 .070 27.657 1 180 .000

3 .755c .570 .563 .22152 .024 9.975 1 179 .002

a. Predictors: (Constant), Responsiveness sum

b. Predictors: (Constant), Responsiveness sum, Empathy sum

c. Predictors: (Constant), Responsiveness sum, Empathy sum, Tangibility sum

Table 8 Coefficientsa

Model Unstandardized

Coefficients

Standardized

Coefficients

t Sig. Collinearity

Statistics

B Std.

Error

Beta Tolerance VIF

1

(Constant) 1.655 .208 7.947 .000

Responsiveness

sum .631 .049 .690 12.828 .000 1.000 1.000

2

(Constant) 1.250 .209 5.978 .000

Responsiveness

sum .411 .062 .449 6.603 .000 .546 1.833

Empathy sum .316 .060 .358 5.259 .000 .546 1.833

3

(Constant) 1.204 .205 5.887 .000

Responsiveness

sum .284 .073 .311 3.905 .000 .380 2.633

Empathy sum .261 .061 .295 4.265 .000 .501 1.995

Tangibility sum .194 .061 .242 3.158 .002 .409 2.447

a. Dependent Variable: Customer sat sum

The correlation shows strong and moderate relation between the independent variables (5

factors of service quality) and the dependent variable (overall customer satisfaction). In order

to know which of these variables predicts the customer satisfaction significantly a multiple

regression analysis was performed.




The Multiple regression analysis was done through stepwise method in order to determine the

best possible factors determining the overall customer satisfaction level. Three different

models are analyzed here

1. Taking Responsiveness only as the Independent variable.

2. Taking both Responsiveness and Empathy as Independent variables.

3. Taking Responsiveness, Empathy and Tangibles as Independent variables.

The other 2 factors Assurance and Reliability were ignored because of Non significant F values.

The table provides the model summary. The adjusted r square values of 3 models were

compared and the 3rd

model has the highest adjusted r square value - .563. The 3rd

model

explains 56.30 percent of the total variance in the dependent variable. Table provides the

coefficients of the Independent variables taken for the study here all the coefficients are

statistically significant at 1% level of significance. From this table the below regression equation

is framed. Overall customer satisfaction = 1.204 +.311*Responsiveness + .295* Empathy + .242

* Tangibility.

Conclusion

The incorporation of SERVPERF scale in Indian healthcare is at its nascent stage. The reliability

values shows that the scale is consistent as proven in other service sectors in India and other

healthcare sectors worldwide. This study took a 2 dimensional view of capturing the

perceptions of both the Attendants and Patients towards service quality and customer

satisfaction. The mean values of all the five factors and customer satisfaction reveals that there

is common consensus between the two groups towards the service offered. The difference in

perceptions towards customer satisfaction with respect to different income levels is mainly due

to lesser satisfaction levels with higher income groups as their expectations creeps up more.

Relation between five factors and the overall customer satisfaction is positive and further

analysis revealed that it’s only Responsiveness, Empathy and Tangibles that can predict the

customer satisfaction levels significantly. The overall model explains sufficient variance in the

dependent variable. Responsiveness and Empathy both handled by the nursing staff in a

healthcare organizations emerged as the two top factors in determining customer satisfaction




levels. It states the need of employee empowerment and increased internal marketing efforts

to have enhanced customer experience. Tangibility factor often lacks behind in developing

countries like India when compared with other developed ones. With the recent rapid increase

in Healthcare segment which is poised to reach USD 158 billion by 2017 hope this void gets

filled up.

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MEASURING SERVICE QUALITY IN PRIVATE HEALTHCARE …SERVPERF scale was used to gather information regarding service quality from the respondents. Total respondents were 183 out of which