review andhra good

8/17/2019 Review Andhra Good

1/37

1.5. REVIEW OF CURRENT LITERATURE:

Paper by Syed Muhammad Irfan et al. (2011) aimed to evaluate the service quality delivered by

the private hospitals in Paistan !hich !as literally based on patient perception. " questionnaire

!as developed based on S#$%&'" model comprised of 22 variables representin five service

quality dimensions* empathy+ tanible+ assurance+ timeliness and responsiveness. ,he taret

population of this study !as the employees !orin at officer level in the service orani-ations

and availin healthcare services includin consultation and inpatient from the best private

hospitals in the city+ ahore of Paistan. " total /20 respondents considered for the study. ,he

results of the study indicate that service quality in private hospitals is meetin patients

satisfactions i.e. private hospitals are deliverin better healthcare services. $esults of the five

factors sho!ed that the measurement model for service quality constructs had a ood fit and the

model is valid and reliable.

$esearch !as conducted by aith "lrubaiee+ eras "laaida (2011) to study healthcare quality

of patient perception+ satisfaction+ and patient trust. It also aims to test the socio demoraphic

variables in determinin healthcare quality. S#$%&'" model !as used to measure and the

results indicate its reliability. ,he study indicates that Sociodemoraphic variables play a vital

role in determinin patient perception of healthcare quality+ satisfaction+ and trust. n the other

hand the study indicates better quality in private hospitals compared to public hospitals.

Patient contentment is sinificant pointer of the quality of care and service in the emerencydepartment (#3). ,his study by Soleimanpour et al. (2011) !as to evaluate patients satisfaction

!ith the #merency 3epartment (#3) of Imam $e-a 4ospital in ,abri-+ Iran. Patients !ere

ased to complete the questionnaire prior to dischare. ive hundred patients !ho attended !ere

included in this study. ,he hihest satisfaction rates !ere observed in the terms of physicians

communication !ith patients (52.67)+ security uards courtesy (85./7) and nurses

communication !ith patients (857). ,he study findins indicated the need for evidencebased

interventions in emerency care services in areas such as medical care+ nursin care+ courtesy of

staff+ physical comfort+ and !aitin time. ,he study suested that efforts should focus on

shortenin !aitin intervals and improvin patients perceptions about !aitin in the #3+ and

also improvin the overall cleanliness of the emerency room.

,he sample collected by Mohsin Muhammad 9utt+ #rnest :yril de $un+ (2010) consisted of /;0

random participants over a period of / months to study private healthcare quality applyin


2/37

S#$%&'" model. 4ere the data !ere analy-ed to establish the modified S#$%&'" scale


3/37

the doctor in P3 of SCIMS has to see at least /6;0 patients per hour !hereas literature says a

doctor should see /; ne!+ A5 old patients per hour+ on an averae a doctor should see B12

patients per hour only. ,he study found that the service time to patient is less compared to

literature. ,he patient service time may be ma=imi-e by developin ne! polices+ procedures and

P3 time schedulin+ ne! procedures of reistration and to set up "@ (ocal "rea @et!or)

system.

,he study by Minsoo Dun et al. (200B) !as to evaluate the perception and the satisfaction of

outpatients those !ho made use of clinics and hospitals are structurally connected !ith their

readiness to approach the same institution in the future. /10 responses !ere collected via

convenient samplin from 6 hospitals and 20 clinics located in Seoul listed in the Corea @ational

4ospital 3irectory 2006. Service quality !as utili-ed as the satisfaction measurement tool. ,he

structural equation model sho!ed that the satisfaction of outpatients !ith the quality of medical

services !as influenced by a fe! subdimensional satisfaction factors. "mon these sub

dimensional satisfaction factors+ the satisfaction !ith medical staff and payment !ere determined

to e=ert a sinificant effect on overall satisfaction !ith the quality of medical services. ,he

structural relationship in !hich overall satisfaction perceived by patients sinificantly influences

their !illinness to use the same institution in the future !as also verified.

,his round!or evaluation paper by :osun 9aar et al. (2005) tests the attitude of the patients

in service aspect by means of S#$%&'". ,he 'niversity of 9asent made survey to!ards the

periodic patients satisfaction so as to no! the !eaness+ strenth+ problems and also issues

!ith reard to the quality improvement. ,his particular study !as conducted for randomly

selected patients in the year 200A bet!een the months of Danuary and ebruary. ,he patients

!ere of both inpatients and outpatients. ,he readin says that the scores !ere hiher than

anticipated for a reular hospital but lo!er than anticipated for a hih quality hospital. ?oun

and hihly educated sho! hihe=pected service !hen compared !ith uninsured patients !ho

have fe!er e=pectations.

,he study conducted by "ter et al. (2005) to identify the service quality of the suburban public

hospital of 9analadesh and to determine the service quality ap bet!een the e=pectation and

perception based on a field survey. 110 intervie!s !ere planned from upto!n (suburban) 3haa

city (east+ !est+ north+ and south) alone. #valuations !ere obtained from patients on several

dimensions of perceived service quality includin responsiveness+ assurance+ communication+


4/37

discipline+ and basheesh. S#$%&'" Eap analysis reveals that Mean perception score of

responsiveness is hiher than mean e=pectation score of responsiveness in all dimensions. It !as

proposed that four more incentives be considered to promote hiher quality in hospitals in

9anladesh. ,hese include competitive+ social+ internal and reulatory incentives.

Fith lots of care+ a cross sectional study !as conducted by 9.,. Shaih et al. (2005) for

a year bet!een 200; and 2006 March at a secondary level hospital in Carachi of Paistan. or

this+ data !as collected on a quarterly basis throuh S#$%&'" tool+ !ith intervie!s and it !as

taen on 16// patients and found /;.;7 of patients !ere satisfied !ith the medical services

offered by the secondary level hospitals. "part from this they also conducted !orshops to!ards

the quality improvement based on the results of the four phases. ,his in turn !ithin a year

resulted in the improvement of patients satisfaction level from /;.;7 to 52.0 7( over a year).

,he study by Chalid arooq 3anish et al. (2005) aims to no! the deree of patients

contentment !ith different aspects of care in Islamic International Medical :ollee ,rust (IIM:

,) $ail!ay 4ospital+ $a!alpindi. Patients !ere iven a questionnaire form at the time of

dischare. eedbac concernin various aspects of services at the hospital and suestions for

improvement of services !as collected !hich formed the data.

$esponses !ere raned as e=cellent+ ood+ and unsatisfactory. ut of 2+80B responses+ /;7 !ere

e=cellent+ A07 ood+ and A7 unsatisfactory. ,he best part of service !as the accessibility of

doctors in !ards (5;7 e=cellent and ood) and !orst part !as cleanliness of !ards (127

unsatisfactory). ,he researcher concluded that IIM:, $ail!ay 4ospital !as providin services

to patients !ith a reasonable deree of patient satisfaction.

,he ob>ective of the study by 4eather et al. (2005) !as to develop and e=amine the psychometric

properties of a measure that !ould meet the need+ the Patient :ontinuity of :are &uestionnaire

(P::&). ,he P::& !as administered after ; !ees of dischare to 20; inpatients. ,he

questionnaire !as assessed by item and principal components analysis. " principal components

analysis resulted in si= subscales includin perceptions ofG (1) relationships !ith providers in

hospital+ (2) information transfer to patients+ (/) relationships !ith providers in community+ (;)

mt. of !ritten forms+ (6) manaement of follo!up and (A) manaement of communication

amon providers. ,he conclusions of the study !ere the initial study supports the reliability and

validity of the P::& for measurin patient perceptions of factors central to continuity of care.


5/37

,he subscales may be of value for identifyin problems in continuity of care and for evaluatin

interventionsaimed at improvin continuity of care for patients after hospital dischare.

MullerStaub M et al. (2005) has conducted a comprehensive study e=aminin ambulatory

patients< satisfaction !ith nursin care in a S!iss emerency department. Patient contentment

involves the follo!in three dimensionsG Hinteraction interpersonal dimensionH+

Hinformationpatient participationH+ and Hnurses< no!ledeH. "n e=planatory crosssectional

study scrutini-ed patient fulfillment to!ards nursin care by usin !ell thouht outpatient

contentment questionnaire. Sample selection !as convenience and 11; patients have been !ell

thouhtout for the study. ,he psychometric characteristics of the measurement instrument !ere

also e=amined. @o patient attained the utmost total score and the mar values for HInteraction

interpersonal dimensionH+ informationpatient participation+ and Hnurses< no!ledeH !as not

attained. n the !hole results !ere not enerally lo!+ but reveal prospective for quality

improvement.

,he aim of "charyulu et al. (2008) !as to sho! that the usefulness of S#$%&'" for

measurin patients< perceptions of quality healthcare. ,he study has been conducted in selected

areas of Southern part of India+ !hich include 9analore+ :hennai+ and 4yderabad. ,he study

!as further restricted to three corporate hospitals operated by same manaement roup one from

each city havin bed capacity of /60 plus. ,he name of the study roup !as mased by

researchers due to confidentiality. "ll important demoraphic characteristics lie ae+ education+

income !ere taen into consideration. ,he study concluded that the sinificant aps and

importance !as associated to reliability+ responsiveness+ and empathy implyin that the health

center is still only Hcure centreH and not Jcare centreK. It !as suested that Indian hospitals need

to concentrate on $eliability and $esponsiveness and the remainin dimensions of service

quality+ and allocate resources to provide better service to their patients.

"ccordin to Siru $aninen (2008)/0 the study aimed at the surical patients< acquaintance at

admission !ith the no!lede they received durin their hospital stay and also discoverin the

association bet!een demoraphic variables and patients< no!lede e=pectations and no!lede

received. ,he sample consisted of /A2 surical patients and the study !as conducted at a

university hospital in inland. ,he data !ere collected in t!o questionnaires (patients

perceptions and e=pectations) !ith forty item instruments !hich !ere made as a distinction

bet!een various aspects lie social+ ethical+ e=periential+ financial etc. 'ltimately the conclusion


6/37

of the study !as based on the need for better patient learnin !hile the surical patients e=pect to

receive more understandin than they actually et on all proportions. ,he most difficult areas in

the learnin of surical patients are the pramatic+ moral+ social and economic dimensions of

a!areness. f all+ the youner+ female less educated need more attention.

,he study by 9ayram Sahin et al. (2008) !as aimed to identify factors affectin patient

satisfaction. ,he study !as conducted at a trainin hospital in ,urey. ,he final sample consisted

of /02 inpatients. In this study+ patient satisfaction !as e=amined usin a survey questionnaire

!ith 22 questions collected under five dimensions. Structural #quation Model (S#M) !as

performed to determine the influence of patient characteristics on patient satisfaction. ,he S#M

analysis found that variables of education and type of clinic (surical vs nonsurical) !ere

sinificant on patient satisfaction. Persons !ith a hiher level of education !ere less satisfied

!hen compared to those !ith a lo!er level of education. Surical patients are more satisfied !ith

the care they received !hen compared to nonsurical patients. ,he study concluded that

education level of patients and the type of clinics had a sinificant influence on patient

satisfaction. ,he analysis sho!ed the questionnaire has an appropriate reliability and validity.

,he researcher i- Eill+ esley Fhite (200A) evaluates studies of service quality in healthcare+

reconi-in e=tra ey domains. ,otal of /A related studies of service quality have been evaluated+

only three have one !ell beyond the S#$%&'" model and five have deployed entirely

diverse approaches. 9ased on considerations from the evaluated studies a model is proposed to

include those reconi-ed ey domains to measure service quality of healthcare. In the public

health sector the independent variables !hich are suested to determine service quality are

$eliability+ $esponsiveness+ "ssurance+ Doint 3ecision Main+ :arin+ $is+ :ontinuity+

:ollaboration+ utcome+ #mpathy+ and ,anibles.

,he aim of this article by ,ola ,aner+ Di>u "ntony (200A) !as to study the variation in service

quality bet!een public and private hospitals in ,urey. S#$%&'" method !as used to study

service quality offered by them. ,he sample consisted of a total of 200 patients. ,he outcome

point to inpatients in the private hospitals !as more contented !ith service quality than those in

the public hospitals. ,he outcome also proposes that inpatients in the private hospitals !ere more

contented !ith doctors+ nurses and supportive services than that of the public hospitals. In

conclusion+ the outcome sho!s that contentment !ith doctors and reasonable costs is the ma>or


7/37

determinants of service quality in the public hospitals. ,he research proves that S#$%&'"+ as

a standard instrument for measurin functional service quality+ is trust!orthy and applicable in a

hospital environment.

,he ob>ectives of the research by Crishna 3ipanar $ao (200A) !ere to develop a dependable

and applicable scale to measure inpatient and outpatient perceptions of quality in India and to

reconi-e aspects of perceived quality !hich have lare effects on patient contentment. ,he

study has been conducted in primary health centers+ community health centers+ district hospitals+

and female district hospitals in the state of 'ttar Pradesh in @orth India. "n assessment !as

conducted on health facilities and patients at hospitals. " 1Aitem scale havin ood

dependability and validity !as developed. ive dimensions of perceived quality !ere identified

Lmedicine availability+ medical information+ staff behaviour+ doctor behaviour+ and hospital

infrastructure.

Multivariate reression analysis results indicate that for outpatients+ doctor behaviour has the

larest effect on eneral patient contentment follo!ed by medicine availability+ hospital

infrastructure+ staff behaviour+ and medical information. or inpatients+ staff behaviour has the

larest effect follo!ed by doctor behaviour+ medicine availability+ medical information+ and

hospital infrastructure. Perceived quality at public facilities is only marinally favorable+ leavin

much scope for improvement. 9etter staff and physician interpersonal sills+ facility

infrastructure+ and accessibility of drus have the ma>or effect in improvin patient contentment

at public health facilities.

,he #yptians hospitals service and its quality !ere tested by Mohamed M. Mostafa (2006)

throuh this paper. or this they considered both public and private hospitals. S#$%&'"

model !as adopted for the study. " crosssectional questionnaire survey carried out in 2006 too

a random sample of //2 patients from 12 hospitals of #ypt !as chosen. actor analysis revealed

three factor solutions and did not support the five factor model of S#$%&'". ,he three factors

!ere empathy+ tanibles and reliability confidence. In all the mentioned three factors the private

hospitals have lesser aps !hen compared !ith public hospitals. Patients may have a

multifaceted set of sinificant vie!point that cannot be confined in the opinion poll.

"ccordin to Eon-ale-%alentn et al. (2006) the quality of hospital service is seen clearly

throuh the Patient satisfaction. 4ence an assessment !as conducted at the reional university

hospital in southern Spain and resolute the applicable sociodemoraphic and attendance


8/37

distinctiveness. or this the tests !ere conducted usin S#$%&'" !ith a crosssectional

questionnaire survey. $eliability and validity of the S#$%&'" instrument !as established.

,he only communication measured !as ender and education level. Scrutiny of covariance

demonstrated for lo!er patients satisfaction !ere female ender+ hiher educational level+ and

lesser overall satisfaction !ith the hospital.

,he aim of the study conducted by "lMailam+ aten ahad (2006)/8 !as to establish the

e=tent of patient contentment !ith care provided in a 110bed private hospital in Cu!ait.

$andom sample of ;20 inpatients !as collected to establish the deree of their contentment !ith

the overall care offered at the hospital. ,he patient contentment !ith the quality of care provided

at the hospital !as found to be quite hih (#=cellent+ 8;.87* %ery ood+ 2/.87). Individually+

nursin care received the ma=imum patient satisfaction ratins (#=cellent+ B1.B7* %ery ood+

/.B7). ,he researcher concluded that the overall patient contentment is connected !ith quality

nursin care+ !hich in turn depends on the quality of leadership practiced at the institution.

,ransformational leadership behavior promotes nurse satisfaction+ !hich adds to their !or

efficiency and inspires them to provide quality patient care.

,he research study by Fisnie!si et al. (2006)+ aims to apply the S#$%&'" measurement

instrument in a Scottish colposcopy clinic. Patient outloo of service !ere acquired on first

attendance at the clinic. Patient opinion of service !as acquired at the end of treatment. ,houh

patient contentment on the !hole !ith the service offered !as by and lare hih+ the instrument

offered proof of !here precise service enhancements !ere considered necessary. ,he larest

service quality ap !as for the trust!orthiness of service. $esearch concluded that the

S#$%&'" instrument has a useful investiative role in measurin and supervisin service

quality in nursin+ facilitatin nursin staff to reconi-e !here upradin !as needed from the

patients point of vie!.

,his article by Sivabrovornvatana @ et al. (2006) intends to investiate the connection stuc

bet!een technoloy and quality manaement for improvin ,hai hospital service quality. 9ased

on the intervie!s carried out !ith respondents in ,hai hospitals+ the first roup consisted of

professionals as internal customers in direct contact !ith e=ternal customers+ !hile the second

roup consisted of e=ternal customers of the same hospitals. ,he findins propose that hospitals

can build up a suitable method+ !hich can improve in service quality as perceived by patients

and professionals. ,hey can also mae enhanced quality choices based on planned measurement


9/37

and no!lede. ,he study recommends that manaers relate this no!lede for triumphant

accomplishment of actions related to service quality in their orani-ations.

,he aim of the study by @erea Eon-ale- (2006);0 !as to develop a psychometrically

sound+ hospital patient contentment questionnaire. $andom samples of A60 patients had

been considered for the study and study !as conducted at 9asque 4ealth Service+ Spain.

,he results of factor analysis sho!ed si= dimensions i.e. information+ nursin care+

comfort+ cleanliness+ visitin and privacy that enerally had ood internal consistency.

@o sociodemoraphic differences !ere found bet!een respondents and nonrespondents.

:omfort !as the dimension !ith the lo!est level of patient contentment+

!hereas privacy !as the most areeable. ,he results obtained from the development and

validation of the questionnaire provided proof of its psychometric properties+ thouh it

!ould be useful to carry out further analyses to assess timebased properties of

16 Syed Muhammad Irfan+ "amir I>a-+ Saman Shahba- (2001)+ J"n assessment of Service

&uality of Private 4ospitals in PaistanG " patient perspectiveK+ Indian Journal of Commerce &

Management Studies, %olN2+ Issue 2.

aith "lrubaiee+ eras "laaida (2011)+ J,he mediatin effect of patients satisfactions of

4ealthcare &uality N Patient trust relationshipK+ International Journal of Marketing Studies,

%ol./+ @o.1.

18 4assan Soleimanpour+ :hani- Eholipouri+ Shaer Salarila+ payam $aoufi+ $e-a Eholi

%ahidi+ "mirhossein Dafari $ouhi+ $ou-beh $a>aei hafouri+ Maryam Soleimanpour (2011)+

J#merency department patients satisfaction survey in Immam $e-a 4ospital+ ,abri-+ IranK+

International Journal of Emergency Medicine, %ol.;G2.

15 Mohsin Muhammad 9utt+ #rnest :yril de $un (2010)+ HPrivate healthcare qualityG applyin a

S#$%&'" modelH+ International Journal of Health Care Quality Assurance, %ol. 2/ IssueG 8+

pp.A65 N

A8/.

1B ien ?esilada and #bru 3iretor (2010)+ J4ealth service qualityG " comparison of public and

private

hospitalsK+ African Journal of Business Management, %ol. ;(A)+ pp. BA2B81.

1;

20 "li "nbori+ Sira>oon @oor Ehani+ 4ematram ?adav+ "qil Mohammad 3aher (2010)+ JPatient


10/37

satisfaction and loyalty to the private hospitals in Sana


11/37

SatisfactionG "n #=perience at IIM:, $ail!ay 4ospital+ $a!alK+ $he Journal of %akistan

Medical

Association, #aalindi'Islama"ad, %ol. //Gpp. 2;62;5.

15

28 4eather 4ad>istavropoulos+ 4enry 9iem+ 3onald Sharpe+ Michelle 9ouraultanou 1 and

Dennifer

Dan-en (2005)+ JPatient perceptions of hospital dischareG reliability and validity of a Patient

:ontinuity of

:are &uestionnaireK+ International Journal for Quality in Health care, %ol. 20+ issue 6+ pp. /1;

/2/.

25 MullerStaub M+ Meer $+ 9riner E+ Probst M,+ @eedham I+ (Measuring atient satisfaction

in an

emergency unit of a Siss uni!ersity hosital) concet clarification and results*, Pflee+ 2005+

21(/)G

pp.182B.

1B

2B "charyulu+ E.%.$.C.+ $a>ashehar+ 9+ Journal of International Business and Economics,

International

Academy of Business and Economics+ 2008+ %ol. 8+ issue 2.

20

/0 Siru $aninen+ Sanna Salanter+ Cat>a 4eiinen+ Cirsi Dohansson+ "nne Cal>onen+ 4eli

%irtanen and 4elena einoCilpi (2008)+ J#=pectations and received no!lede by surical

patientsK+

International Journal for Quality in Health Care, %ol. 1B+ issue 2+ pp.11/11B.

/1 9ayram Sahin+ atma ?ilma-+ Ceon N 4yun ee (2008)Jactors "ffectin Inpatient

SatisfactionG

Structural #quation ModelinK+ Journal of Medical Systems, Plenum Press @e! ?or+ @?+ 'S"+

%ol./1+

Issue 1+ pp. B N 1A.

21


12/37

/2 i- Eill+ esley Fhite (200A)+ J" proposed model for measurin service quality in the public

healthcare

sectorK+ ,he School of "dvertisin+ Maretin and Public $elations&ueensland 'niversity of

,echnoloy+

9risbane+ "ustralia+ International conference+ ;A 3ec. 200A.

// ,ola ,aner+ Di>u "ntony (200A)+ J:omparin public and private hospital care service quality

in ,ureyK+

+eadershi in Health Ser!ices, %ol. 1B IssueG 2+ pp. 1 N 10.

22

/; Crishna 3ipanar $ao + 3avid 4. Peters and Caren 9andeen$oche (200A)+ J,o!ards patient

centered

health services in IndiaLa scale to measure patient perceptions of qualityK+ International

Journal for

Quality in Health care, %ol. 15+ issue A+ pp. ;1;21.

2/

/6 Mohamed M. Mostafa (2006)+ H"n empirical study of patients< e=pectations and satisfactions

in #yptian

hospitalsH+ International Journal of Health Care Quality Assurance, %ol. 15 IssueG 8+ pp. 61A N

6/2.

/A Eon-ale-%aletin+ "raceli+ Padinope-+ Susana+ 3e $amonEarrido+ #nrique (2006)+

JPatient

Satisfaction !ith @ursin care in a $eional 'niversity 4ospital in Southern SpainK+ Journal of

ursing

Care Quality, %ol.20+ Issue 1+ pp. A/82.

2;

/8 "lMailam+ aten ahad (2006)+ J,he effect of @ursin care on overall patient satisfaction

and its

predictive value on returntoprovider behaviorG " survey studyK+ Quality Management in Health

Care,

%ol.1;+ Issue 2+ pp. 11A120.


13/37

/5 Fisnie!si+ Mi* Fisnie!si+ 4a-el (2006)+ JMeasurin service quality in a hospital

colposcopy

clinicK+ International Journal of Health Care Quality Assurance, #merald Eroup Publishin

td.+

%ol.15+ @o./+ pp.218225(12).

26

/B Sivabrovornvatana @+ Sienthai S+ Crairit 3+ Paul 4 (2006)+ J,echnoloy usae+ quality

manaement

system+ and service quality in ,hailandK+ International -ournal of healthcare .uality assurance

incororating +eadershi in health ser!ices, 15(A8)G pp. ;1/2/.

;0 @erea Eon-ale-+ Dose M. &uintana+ "maia 9ilbao+ "ntonio #scobar+ elipe "i-puru+ "ndre!

,hompson+ :ristobal #steban+ Dose "ntonio San SebastiQn and #milio de la Sierra (2006)+

J3evelopment

and validation of an inpatient satisfaction questionnaireK+ International Journal for Quality in

Health care,

%ol. 18+ issue A+ pp. ;A682.

2A

dependability. ,he inpatient contentment questionnaire could become a useful

instrument in quality care assessment.

"ccordin to D. %eillard+ et al. (2006);1 for the quality upradin in hospitals the Forld

4ealth rani-ation (F4) has launched in the year 200/+ a fle=ible and complete tool

!hich intended at sustainin hospitals in evaluatin their performance+ questionin their

o!n consequences+ and convertin them into procedures for upradin+ by

ivin hospitals !ith tools for routine assessment and by enablin colleial support and

net!orin amon participatin hospitals. In turn this has also developed from four

!orshops by meetin specialists+ a !ide revie! of the literature on hospital performance

pro>ects+ more than 100 performance pointers !ere inspected and a revie! !ere

conceded out over t!enty #uropean countries. ,hus+ it resulted in various concepts and

implementation of various tailor made strateies of the performance assessment

frame!or for hospitals (P",4 frame!or). P",4 is at present bein steer

e=ecuted in eiht countries and evaluates the viability and e=pediency of the approach


14/37

used to assess and refine for additional development.

,he ob>ective of this study by 9eele :haa (2006);2 !as to assess quality of nursin

care as indicated by patients satisfaction. " :rossSectional Survey !as conducted at

Public 4ospitals in "ddis "baba+ namely ,iur "nbessa+ Saint Paul and Re!ditu

Memorial 4ospitals from Duly+ 200; to "pril+ 2006. " total of A/1 adult patients !ere

considered for this study. Participants !ho !ere females+ ae roup ;1 N 60 years of old+

;1 D. %eillard+ . :hampane+ @. Cla-ina+ %. Ca-and>ian+ . ". "rah and ".. Euisset (2006)+

J"

performance assessment frame!or for hospitalsG the F4 reional office for #urope P",4

pro>ectK+

International Journal for Quality in Health Care, %ol. 18+ issue A+ pp.;58 N BA.

;2 9eele :haa (2006)+ J"dult Patient Satisfaction !ith @ursin :areK+ "ddis "baba

'niversity+ School

of raduate studies+ #thiopia.

28

havin lo! income+ less educated+ patients !ho !ere admitted in third classes+ and have

no history of previous admission !ere more satisfied. ,he over all ratin of satisfaction

!as A87. ,he top aspects that patients scored hihest for their satisfaction !ith nursin

care !ere the amount of freedom iven+ nurses capability in their !or+ and nurses

treatment of patients as an individual. ,he aspects !ith !hich patients !ere least

satisfied !ere the amount and type of information they received reardin their condition

and treatment and also the amount nurses ne! about patients care. ,he need of

improvin interpersonal relationship of nurses !ith patients !as recommended.

,he aims of the study by C>ell I. Pettersen (200;);/ !ere to describe the development of

the Patient #=periences &uestionnaire (P#&) and to assess dependability and soundness

of constructed summed ratin scales. Postal based survey has been conducted in 1;

hospitals in @or!ay. Patients of 1A years and above dischared from medical and

surical departments received a questionnaire A !ees after dischare. &uestionnaires

!ere sent to /A5;6 patients and 1B685 patients (6/7) !ere further analy-ed. ,he

researcher constructed 10 summed ratin scales based on factor analysis and theoretical

considerationsG Information on future complaints+ @ursin services+ :ommunication+


15/37

Information e=aminations+ :ontact !ith ne=tofin+ 3octor services+ 4ospital and

equipment+ Information medication+ rani-ation and Eeneral satisfaction. ,he research

concluded that ,he P#& is a selfreport instrument coverin the most important sub>ects

of interest to hospital patients. $esults are presented as 10 scales !ith ood validity and

reliability.

;/ C>ell I. Pettersen+ Mari>e %eenstra+ 9>rn Euldvo and "rne Colstad (200;)+ J,he Patient

#=periences

&uestionnaireG development+ validity and reliabilityK+ International Journal for Quality in

Health Care,

%ol. 1A+ issue A+ pp. ;6/A/.

25

,his research by CuiSon :hoi et al. (200;);; proposes an interative model of healthcare

consumer satisfaction based on established relationships amon service quality+ value+

patient satisfaction and behavioural intention+ and tests it in the frame!or of South

Corean healthcare maret. $esults based on the data collected from 6/8 South Corean

healthcare consumers corroborated the causal sequence amon these constructs suested

by the multi attribute attitude model frame!or+ i.e. conition (service quality and

value)Taffect (satisfaction)Tconation (behavioural intention). 9et!een the t!o

conitive constructs+ service quality emered as a more important determinant of patient

satisfaction than value. $esults also sho!ed that both service quality and value have a

sinificant direct impact on behavioural intention !hile value assessment !as influenced

by perceived service quality.

,he Pain ,reatment Satisfaction Scale (P,SS) !as to assess patient satisfaction for those

receivin treatment for either acute or chronic pain. ,he initial questionnaire of the study

by #vans :. et al. (200;);6 included a comprehensive literature revie! and intervie!s

!ith patients+ physicians and nurses in the 'nited States+ Italy and rance. "fter initial

items !ere created+ psychometric validation !as performed on the participatin patients.

"nalyses on this survey included principal components factor analysis tests of reliability+

clinical validity+ and confoundin. "ll dimensions e=cept medical care discriminated

!ell accordin to pain severity. ,he P,SS survey has been proven a valid and

comprehensive instrument to assess and evaluate satisfaction !ith treatment of pain


16/37

;; CuiSon :hoi+ Foo4yun :ho+ Sunhee ee+ 4an>oon ee and :hanon Cim (200;)+ J,he

relationships

amon quality+ value+ satisfaction and behavioral intention in health care provider choiceG "

South Corean

studyK+ Journal of Business #esearch, %ol. 68+ Issue 5+ pp. B1/21.

;6 #vans :.+ ,rudeau #.+ Mert-anis P.+ Marquis P.+ PeUa 9.+ Fon D.+ Mayne , (200;)+

J3evelopment and

%alidation of the Pain ,reatment Satisfaction Scale (P,SS)G Patient Satisfaction &uestionnaire

for 'se in

Patients !ith :hronic or "cute PainK+ Pain+ %ol. 112+ Issue /+ pp 26;AA.

2B

based on independent modules that have demonstrated satisfactory psychometric

performance.

"nother study made by 'nni Crostad et al. (200;);A aimed at investiatin the doctors

and nurses insiht of interprofessional team!or and their contentment in hospitals. It

could also differ in manifestation of cultural diversity from the quality improvement point

of vie!. #ven for this they conducted a cross cultural data and collected from a sample

of 16 at @or!eian in 1BB5 !ith five hundred and fifty one doctors and t!o thousand

fifty nurses at different !ards. ,he overall response rate !as A67. ,he study discloses

that doctors !ere considerably more often than nurses contented !ith the interprofessional

cooperation of the t!o roups. Fell it !as based on various !or

situations for doctor and nurses. 'ltimately the study concluded that interprofessional

cooperation !as different for doctors and nurse+ for !hich the 4ospital manaement

ouht to brin about an understandin of cultural diversity to!ards quality improvement.

,he paper by M. Sadiq Sohail+ (200/);8 e=amines and measures the quality of services

provided by private hospitals in Malaysia. " modified version of S#$%&'" !as

adapted to measure service quality for the study. Survey questionnaire !as mailed to a

sample of a thousand people dra!n from patients !ho had been dischared from five

private hospitals across Malaysia. " total of 15A responses !ere obtained in !hich 160

!ere usable+ representin a response rate of 167. $esults based on testin the mean

differences bet!een e=pectations and perceptions indicate that patients perceived value


17/37

of the services e=ceed e=pectations for all the variables measured+ indicate that

;A 'nni Crostad+ 3a 4ofoss and Per 4>ortdahl (200;)+ J3octor and nurse perception of inter

professional

cooperation in hospitalsK+ International Journal for Quality in Health Care, %ol. 1A+ issue A+ pp.

;B1B8.

;8 M. Sadiq Sohail (200/)+ HService quality in hospitalsG more favourable than you miht thinH+

Managing

Ser!ice Quality+ M:9 'P td+ %ol. 1/ IssueG /+ pp.1B8 N 20A.

/0

Malaysians perceive the quality of service positively. 4o!ever+ the present findins

must be treated !ith caution because private hospitals have been mushroomin to cater

for the ro!in affluent population. 4ealth and medical service e=pectations are liely to

chane !ith time.

"ccordin to another study by ". ". D. 4endris (2002);5 the Satisfaction !ith 4ospital

:are &uestionnaire (S4:&) reliably establishes for calculatin the patient contentment

and assessment of quality care at hospital. ,he study !as conducted at "msterdam+ at an

"cademic Medical :enter. ,here they applied S4:& and used it for t!o measurement

purposes. ne of them is used for measurin patient satisfaction and the other one is

used by establishin hospital care quality. ,he study involved 286 Patients and 5/ staff

members !ith four hospital !ards. "ll this too 68item S4:& taclin thirteen features

of care. 'ltimately this research concluded that the S4:& reliably establishes both

patient satisfaction and in eneral quality of hospital care. 4o!ever+ results should

be understood more carefully as in most of the cases the patients usually cannot ive the

difference in quality of care.

,his article by '-un (2001);B reports the outcome of a survey on patient contentment

!ith nursin care+ from a university hospital in ,urey. In this study+ S#$%&'" scale

!as used for determinin patient satisfaction !ith nursin care by intervie! to ;22 adults

dischared from the same hospital. Sociodemoraphic characteristics of the patients

(ae+ ender+ education level) !ith reard to patient contentment !ere determined.

;5 ". ". D. 4endris+ . D. ort+ M. $. %rielin and #. M. ". Smets (2002)+ J$eliability and

validity of the


18/37

Satisfaction !ith 4ospital :are &uestionnaireK+ International Journal for Quality in Health

Care, %ol. 1;+

Issue A+ pp. ;8152.

;B '-un (2001)+ JPatient satisfaction !ith nursin care at a university hospital in ,ureyK+

Journal of

nursing care .uality+ %ol. A(1)G pp. 2;//.

/1

Sinificant differences !ere found bet!een the sociodemoraphic characteristics and

!eihted scores for dimensions of S#$%&'" (p V 0.6). "s per the results+ the service

quality ap scores for five dimensions !ere neative to meet e=pectations. ,he neative

scores for tanibles+ reliability+ responsiveness+ assurance+ and empathy indicate these

areas need improvement. In this hospital+ outcome of this study support necessitate for

nurses to plan strateies to improve patient satisfaction !ith nursin care as they are valid

indicators of quality nursin care.

,he article by ,enilimolu 3 et al. (2001)60 speas out the results of a patient

contentment survey directed for ;20 adults dischare from a chief public hospital in

,urey. " system !as considered alie to those available in the 'S and !as applied

durin an e=it intervie!. ,he analysis is concluded in three different areasG openness and

accessibility of services+ supposed quality of patient care and orani-ational and

administrative issues. 'ltimately+ the individuals !ere content !ith direct patient care+

thouh in it !as different in some areas. "bove all+ many reported unhappiness !ith

manaerial and directorial maintenance. ,he researcher also recommends that hospitals

in ,urey become accustomed to reular policies similar to those in the 'S for

accomplishin these types of assessments.

Patient contentment survey !as conducted by Prasanta Mahapatra et al. (2001)61 in 26

3istrict or "rea 4ospitals manaed by the "ndhra Pradesh %aidya %idhana Parishad

60 ,enilimolu 3+ Cisa "+ 3-ieiele!si S (2001)+ JMeasurement of patient satisfaction in a

public

hospital in "naraK+ Health ser!ices management research) an official -ournal of the Association

of

/ni!ersity rograms in Health Administration, %ol. 1;(1)G pp. 28/6.


19/37

61 Prasanta Mahapatra+ Srilatha. S+ Sridhar.P (2001)+ J" Patient Satisfaction Survey in Public

4ospitalsK+

Journal of the Academy of Hosital Administration, %ol. 1/+ @o. 2.

/2

("P%%P). Patients feedbacs !ere collected usin a modified version of the Patient

Satisfaction &uestionnaireIII oriinally developed by Fare and others (4ays+ 3avies

and Fare* 1B58) from patients and from patient attendants if patients !ere not in a

position to ans!er. ,he study period !as May 1BBB to Duly 1BBB. In total 118B persons

!ere intervie!ed+ includin 2/8 attendants+ considered ;060 patients per hospital. n

the !hole+ the level of patient satisfaction in "P%%P !as about A67. ,he main reason

for displeasure !as corruption !hich !as rampant. ther sinificant areas of hospital

services contributin to patient displeasure !ere basic utilities lie !ater+ fans+ lihts+

etc.+ poor maintenance of toilets+ lac of cleanliness+ and poor interpersonal relationship.

1.3 Review of Literature

,houh there are various literatures available on the brand and maretin. 4o!ever+

fe! of them related to hospital industry has been selected !hich !ill provide the pedestal to my research.

Herstei a! "a#$ie$1%& ,he purpose of this research is to e=amine the potential

contribution of private brandin to the service sector+ and to interate private brandininto the S#$%&'" model. " total of /00 customers of a health maintenance

orani-ation (4M) !ere ased about the five dimensions of the servicequality

model and about several aspects of their 4Ms private brand. ,he study finds thatsatisfaction !ith service quality amon sub>ects !ho !ere a!are of the 4Ms

private brand !as hiher than that of una!are sub>ects !hen ased directly. In

addition+ a positive relationship !as found bet!een the perceptions of service qualityin the 4M and the evaluation of a private brand in the 4M those customers !ho

!ere a!are of the private brand. ,he data analysis suests that private brandinconstitutes an additional (si=th) dimension in the S#$%&'" model. ,his research

6 !as conducted durin the initial staes of the maret penetration of the 4Ms

private brand.

Curtis et a$.1' & ,here is evidence in the literature that orani-ations strule toformulate and implement their corporate brandin strateies. ,his paper aims to

provide an overvie! of the corporate brand buildin process in hiher education.


20/37

&ualitative methodoloy !as used in this study. " sinle case study of a private

"merican university !as used to ather information about their corporate brand

buildin process. 'niversity administrators and documents !ere used to ain insihtsinto their brand buildin process. ,he corporate brand buildin process addressed

three ey areas* !eb administration+ proram maretin and corporate brand

positionin. ,he corporate brand buildin process !as conducted in four phases and adescription of these phases is provided.

Tro(e a! )avas1*& ,his study sees to determine the relative importance of

factors nonprofit hospital administrators rely on in their decisions to >oin a nonprofitmultihospital orani-ation (M) and their assessments of an M in satisfyin these

motives. " related ob>ective of the study is to determine !hether or not the

administrators of different types of hospitals (i.e. eneral vs specialty+ member of a

national vs nonnational M and churchaffiliated vs nonchurch affiliated) differ intheir >udements. ,he analytical frame!or of the importanceperformance technique

is used in analy-in the data athered from the top administrators of a nation!ide

sample of hospitals in the 'S".

Hartwe$$ a! E!war!s+,& ,he purpose of this paper is to evaluate consumers perceptions to!ards descriptive menus and brandin in hospital foodservice. ,his

research is unique in its focus* earlier !or has tended to concentrate on palatabilityand the variety of the menu rather than on dish description. 3ata !ere collected by

means of a questionnaire in both medical and surical !ards (n W ;2). In addition+

qualitative comments !ere souht from patients and foodservice manaement toenhance and add !eiht to results and conclusions dra!n. Menu description !as

!elcomed !ith patients preferrin familiar foods. ,he eneral consensus !as that an

unfamiliar dish !ould not be selected on brand name alone. ,he potential impact of

the proposed !or could be sinificant !ith reard to hospital foodservice stratey A

particularly as reater emphasis has been iven to the role of food in clinical

outcomes. "ny initiative such as improved dish description or use of familiar branded products that alleviates patient concern and concurrently leads to reater acceptance

and consumption must be one that is rearded !ith favour.

-a!#a et a$.+1 & ,he purpose of this paper is to conceptuali-e hospital service quality(S&) into its component dimensions from the perspectives of patients and their

attendants* and to analy-e the relationship bet!een S& and customer satisfaction (:S)

in overnment and private hospitals in India. ,he study employs questionnairesurvey

approach to obtain the perceptions of patients and attendants. ,he instrumentsdeveloped have been validated usin tests for reliability+ validity and unidimensionality.

3ata collected have been analy-ed by usin statistical techniques such

as bivariate correlation and multiple reression. Patients and attendants treat theinterpersonal aspect of care as the most important one+ as they cannot fully evaluate

the technical quality of healthcare services. ,he study also revealed that the hospital

service providers have to understand the needs of both patients and attendants in order to ather a holistic vie! of their services. $esults of the study are dependent on the

nature and number of respondents+ i.e. the study has captured only the perceptions of

service receivers N patients and attendants* and sample si-e of the study N 20; patients

and 20; attendants N due to limited response rate and other operational constraints.


21/37

"o!iwa$$a a! "o!iwa$$a++& ,he controls on payments by insurance companies and

overnmental aencies (Medicare+ Medicaid+ ,itle 1B) to hospitals have led to

restricted hospital services for patients. ,his situation has caused overcapacity inhospitals. "lso+ there is a surplus of both hospital capacity and doctors. 4o!ever+

there are frequent shortaes of nurses and many other trained technical personnel.

,his situation has behavioral implications !hich are discussed in this paper.A!a$ee+3& ,his study addresses ho! consumers feel about hospital advertisin and

attempts to discern the factors that e=plain consumers favorable or unfavorable

dispositions to!ard this maretin activity. Several reasons account for the need tounderstand the relevant factors. irst+ because advertisin is an important competitive

tool+ its effective use should help hospitals attract and retain clients in a rapidly

chanin environment !here the clients are increasinly involved in choosin the

8 riht hospital. Second+ a nation!ide survey sho!ed that 60 percent of the consumers

remembered seein or hearin a hospital advertisement. ,his fact represented an

increase in consumer a!areness of hospital advertisements by 11 percent from 1B56

(:hristensen and Inuan-o+ 1B5B) and indicates that consumers are payin moreattention to hospital advertisin than in prior years. ,hus+ hospitals need to taret their

clients !ith focussed messaes in selected media. In the absence of advertisin+healthcare providers may not be able to develop appropriate positionin strateies to

carve out specific maret niches. inally+ an understandin of the ey factors should

enable hospital administrators to allocate their advertisin resources more effectively.

Hei$#a+/& ,he purpose of this paper is to provide an overvie! concernin

employer brand imae in a innish hospital orani-ation. Fhat is done for

recruitment maretinX ,his study offers some proposals for improvin the

recruitment process. ,he research is a qualitative case study and the research methodused is a roup intervie!. ,he research questions are approached from an

orani-ational perspective. 9acround information about the current labour shortae

in health care is athered from the focus hospital orani-ation+ from the public mediaand from the health care trade orani-ations. %ery fe! maretin actions concernin

employer imae have been done in the focus hospital. ,here also e=isted a lac of

appropriate recruitment tools and competence. 3ata systems and the internet have not been fully e=ploited in the recruitment process. %acancies are not announced in

educational institutes. :areer development possibilities are not presented in >ob

advertisements and >ob rotation has not been used in recruitment.

Ra0u a! Loia$+5& Service quality and service maretin have both been studiede=tensively in relation to service orani-ations. In this paper !e e=amine these areas

simultaneously in terms of their impact on financial performance in the hospital

industry. 3ra!in from the literature in the quality and service maretin areas+ thearea of service quality is represented in terms of the constructs of quality conte=t and

quality outcomes. &uality conte=t (&:) describes the environment related to quality

practices !ithin a hospital !hich enerally encouraes and enhances service quality!hile quality outcomes (&) comprises of specific clinical and patient satisfaction

outcomes of the hospital. ,he area of maretin is represented in terms of the

5

constructs of maretin orientation and maret product development outcomes.


22/37

Maret orientation (M) is a !ellaccepted+ albeit comple=+ construct !ithin the

maretin literature. Eenerally+ maret orientation can be thouht of as the process of

effectively collectin+ disseminatin+ and respondin to information in order toenhance the maretin function !ithin the hospital. Such information enerally

relates to maret trends+ customers+ and competitors. Maretproduct development

outcomes (MP3) refer to specific outcomes in relation to product innovation andmaret sementation that are eneral indicators of the maretin effectiveness of the

hospital. "lthouh the evidence in the literature suests that both service quality and

maretin are independently related to orani-ational performance+ the precise natureof the relationships amon the variables described above is not clearly understood.

i# et a$.+2 & 4ealth care mareters face unique challenes around the !orld+ due in

part to the role the health care field plays in contributin to public !elfare. 4ospital

maretin in Corea is particularly challenin since Corean la! prohibits hospitalsfrom runnin any advertisin. "s a result+ Corean hospitals depend heavily on

customer relationship manaement (:$M). ,his study identifies five factors that

influence the creation of brand equity throuh successful customer relationshipsG trust+

customer satisfaction+ relationship commitment+ brand loyalty+ and brand a!areness."n empirical test of the relationships amon these factors suests that hospitals can

be successful in creatin imae and positive brand equity if they can manae their customer relationships !ell.

Loueau et a$.+% & Maretin is a central activity of modern orani-ations. ,

survive and succeed+ orani-ations must no! their marets attract sufficientresources+ convert these resources into appropriate services+ and communicate them to

various consumin+ publics. in the hospital industry+ a maretin orientation is

currently reconi-ed as a necessary manaement function in a hihly competitive and

resourceconstrained environment urther+ the literature supports a maretinorientation as superior to other orientation types+ namely production+ product+ and

salesG In this article+ the results of the first national crosssectional study of the

maretin orientation of '.S. hospitals in a manaed care environment are reported. B

$o4i( et a$.+' & Eermanys statutory healthcare system is bo!in more and more

to the principles of the maret. ,his means hospital manaers must cope !ith ne!challenes. "s competition for patients and cases becomes fiercer+ hospitals must

come up !ith competitive and distinctive service portfolios L and actively maret

them. or!ard looin hospital maretin puts the focus squarely on physicians.

4ospitals+ doctors and patients alie stand to benefit.

$eferences

18 $am 4erstein and #yal Eamliel (200A)+ ,he role of private brandin in improvinservice quality+ Manain Service &uality %ol. 1A @o. /+pp. /0A/1B.

15 ,amilla :urtis+ $ussell "bratt Y Filliam Minor (200B) :orporate brand

manaement in hiher educationG the case of #$"'+ Dournal of Product Y 9randManaement 15A+ ;0;N;1/.

1B @atalia ,roen and 'ur ?avas (2002) @onprofit multihospital

orani-ationsG challenes and prospects+ Dournal of Manaement in Medicine+%ol. 1A @o. A+ pp. ;61;A2.


23/37

20 4eather 4art!ell and Dohn #d!ards (200B) 3escriptive menus and brandin in

hospital foodserviceG a pilot study+ International Dournal of :ontemporary 4ospitality

Manaement %ol. 21 @o. 8+ pp. B0AB1A.21 Panchapaesan Padma+ :handraseharan $a>endran and Praash Sai oachari

(2010)Service quality and its impact on customer satisfaction in Indian hospitals+

9enchmarinG "n International Dournal %ol. 18 @o. A+ pp. 5085;1.22 ?e-di 4. Eodi!alla and Shirley ?. Eodi!alla (2002) Maretin issues for the

hospitality industry+ International Dournal of 4ealth :are &uality "ssurance

161+ 2625.2/ Syed Saad Andalee" 012234 4ospital "dvertisinG ,he Influence of Perceptual and

3emoraphic actors on :onsumer 3ispositions+ Dournal of Services Maretin+ %ol.

5 @o. 1+ pp. ;56B

2; Pia ".C. 4eilmann (2010) #mployer brand imae in a health care orani-ation+Manaement $esearch $evie! %ol. // @o. 2+ pp. 1/;1;;.

B/

26 P.S. $a>u and S.:. onial (2002) ,he impact of service quality and maretin on

financial performance in the hospital industryG an empirical e=amination+ Dournal of $etailin and :onsumer Services B+ //6N/;5.

2A Cyun 4oon Cim+ Can Si Cim+ 3on ?ul Cim+ Don 4o Cim+ Su 4ou Can(2005) 9rand equity in hospital maretin+ Dournal of 9usiness $esearch A1+ 86N52.

28 Patricia $ oubeau* $obert Dant-en and inda :upit (1BB5) ,he effect of

manaed care on hospital maretin orientation+ Journal of Healthcare

Management5 MayDun 1BB5* ;/+ /+ pp.22B.

25 9>Zrn 9lochin+ 4arald . Stoc and Dochen Scheel (2005) 4ospital maretin

should focus on physiciansG essons from Eermany+ Journal of Medical Marketing

(2005) 5+ /0/ N /10.


24/37

6ERVICE 7UALIT) & AN INTRO8UCTION

,he oal of the follo!in discussion is to provide a revie! of the principal

literature relatin to this study+ !hich is service quality. In addition+ it !ill evaluatethe e=istin literature and establish the identity of the aps in the literature+ !hich

!ill provide the frame!or on !hich this research is based. "s part of introducin

the study the literature on services maretin !ill be e=amined from a purelyhistorical perspective to determine its impact on the field of service quality. ,hen+

a brief revie! of the relationship bet!een customer satisfaction and service

quality precedes the literature revie! definin service quality+ and measurin

service quality.,he literature revie! points to S#$%&'" developed by Parasuraman+ et

al (1B55) as the optimum measurin device that can be modified to accomplish

predictin customer perceptions aainst e=pectations and the castin of those perceptions and e=pectations aainst the service provider perceptions of !hat it

!ill require to satisfy the customers service needs. 9ased upon S#$%&'" as

a measurement device+ the chapter loos at the dimensions in measurin servicequality+ the S#$%&'" model+ the use of the S#$%&'" model to evaluate

service quality+ and the validity of S#$%&'" in the measurement of service

quality.,he study of the literature !ill then focus on the importance of service

quality measurement in hospitals+ service as an element of hospital selection+service quality impact on hospital profitability+ and the validity of S#$%&'" inhospital applications.

,here is limited literature in predictin hospital patient perceptions aainst

e=pectations and the castin of those perceptions and e=pectations aainst the

hospital service provider perceptions of !hat it !ill require to satisfy the patient sservice needs. ,he available literature addresses service quality but limited to

;5

deal !ith the aforementioned perceptions and e=pectations. ,his study !ill utili-ea survey instrument in primary research based upon a modified S#$%&'"

instrument to obtain results that !ill be utili-ed in fillin aps in no!lede about

service quality. ,he discussion concludes by focusin on the conceptualframe!or of the study and a summary of the research issues.

6ervi4e 9areti(

Service maretin !as the precursor leadin to the study of service

quality. It !as beinnin to be reconi-ed as an industry function in the early tomid 1B80s. #mpirical research !as limited in the early days as maretin

struled !ith the differences bet!een this ne! service sector and the

conventional maretin methods for the maretin of produced oods. Pioneer


25/37

research in this area// (Eeore and 9arsdale+ 1B8;) identified several distinct

differences bet!een the maretin of JserviceK firms and JmanufacturinK firms.

,heir research found an unusual concept in the service firms in that themaretin effort !as not confined to a formal maretin department+ but !as

shared across orani-ational lines. ,he manufacturin firm by contrast operated

!ith a more clearly delineated maretin department.It !as Shostacs (1B88) research that brouht to the fore the distinct

nature of services maretin/;. She noted that services !ere intanible+

rendered+ e=perienced+ and unable to be stored. :onsequently+ her conclusion!as that services should be mareted differently from tanible products. It !as

her early !or that ave equal !eiht to the components of JserviceK as it did to

Jproduct.K 4er research concluded that service maretin strateies should deal

!ith specific issues related to distinct elements !ithin each product. She alsoconcluded that chanes in any sinle element could impact other elements !ithin

the function+ and as such+ services maretin should consider products more

holistically+ meanin to loo at each item on its merits alone.

;B'hl and 'pahs (1B5/)/6 research built on Shostacs (1B88) !or+ but set

forth the concept that services maretin !as sinificantly different from productmaretin. ,hey found that services are intanible+ incapable of bein stored+

incapable of bein transported+ and are for use and not o!nership. or e=ample+

they noted that a hospital doctors services could not be stored+ and if thoseservices !ent unused+ they !ould be lost.

oveloc (1B5/)/A too the intanible service maretin function and broe

it do!n to the specific service function+ and then established service

classifications that emphasi-ed the fact that service oriented orani-ations could be quite different from each other. 4e created five four!ay classification

schemes that considered three service aspectsG (1) the nature of the service act

involvin people or thins !hether tanible or intanible actions* (2) the nature of service delivery !hich comprised formal relationships or nonformal relationships

!ith customers* and (/) the nature of customi-ation involvin hih or lo! service

provider >udments reardin customer needs or customi-ation requirements.,he limited research that follo!ed/8 ($euert+ et al+ 1B56* Faler and

$euert+ 1B58) vie!ed maretin manaement as a function or a tas+ and did

not embrace the services maretin approach across the orani-ation. 4o!ever+

subsequent research/5 (Parasuraman and 3eshpande+ 1B5;* 3eshpande andFebster+ 1B5B) provided evidence that suested orani-ational culture has a

sinificant influence on orani-ational behavior.

#nis and $oerin (1B5;)/B !ere unconvinced that there is a distinction bet!een service maretin and manufacturin maretin. It !as their conclusion

that the strateies used for all product is strictly a Jbundle of benefitsK reardless

of !hether they are tanible or intanible.,he principal study by Reithaml+ et al (1B56);0 fostered a direct

relationship bet!een customer satisfaction and service quality and broadened

60

the unique characteristics of service products. ,hey e=plained that service in its


26/37

production sense and consumption occurs simultaneously. Production and

consumption of service products cannot e=ist in isolation+ requirin them to be

simultaneously produced and consumed. "dditionally+ they suest that service production and consumption is by its o!n nature heteroeneous. ,heir research

!as sinificant in that it hihlihted the differences bet!een manufactured

products and service products+ and it introduced the interrelationships bet!eencustomer service and customer satisfaction throuh the measurement of aps.

Re$atiosi; etwee Custo#er 6atisfa4tio a! 6ervi4e 7ua$it<

In this study+ it is important to establish the relationship bet!een customer satisfaction and service quality. ,his section !ill establish the e=istin

relationship. nly !ithin the last fe! years has there been much research

conducted in the area of determinin !hether customer satisfaction influences

behavioral tendencies more than service quality does or the opposite prevails.Perhaps+ the issue revolves around the onoin debate as to !hether

satisfaction precedes service quality or in the alternative+ does service quality

precede satisfactionX

:ustomers have a difficult time in attemptin to determine service quality based upon ob>ectivity and as a result need some structured effort on the part of

the service provider to plan the service function;1 (Shostac+ 1B56). 9ouldin+ etal (1BB/);2 noted that service quality and customer satisfaction !ere treated as

one and the same by the business press. ,hey indicated that this should be a

dynamic process model to e=amine the sub>ect from e=pectations to behavioralintentions.

,he sub>ect too another turn !hen there !as a substantial amount of

posturin in the literature as to !hether both constructs (satisfaction

dissatisfaction and service quality) are truly attitudes. 9itner (1BB0);/ vie!ed61

satisfaction dissatisfaction as an episodic+ transactionspecific measure+ and

this !as subsequently the conclusion of :lo! and 9eisel (1BB6);;. Still notconvinced+ 9itner and 4ubbert (1BB;);6 subsequently raised the question

!hether or not service quality and customer satisfaction is distinuishable from

the customers perspective.4o!ever studies by :ronin and ,aylor (1BB2);A and research conducted

by liva+ et al (1BB2);8 treated satisfaction dissatisfaction as a cumulative effort

than discrete measure. It became obvious that satisfactiondissatisfaction had to

be separated into t!o distinct types based on a iven service encounter or a totalservice e=perience.

,hey described service quality as Jsimilar in many !ays to an attitudeK

developed over all encounters !ith the service providin firm;5 (Parasuraman+ etal+ 1B55). :ronin and ,aylor (1BB2);B found that there is a ma>or problem !hen

service quality is not termed an attitude. ,hey sa! a sinificant problem !hen the

disconfirmation paradim is used to measure perceptions in service quality+ andit has also been used to distinuish customer satisfaction from service quality.

,his !as identified as an inconsistent approach !ith the differentiation noted

bet!een these constructs in the satisfaction and attitude literature.

" set of definitions to clarify the different types of evaluation methods !as


27/37

proposed by 9itner and 4ubbert (1BB;)60. ,hey noted and established

conceptual lins bet!een satisfaction in sinle service encounter+ satisfaction

!ith the entire service e=perience+ and service quality. It !as determined usintheir concept that consistently ood service !ould mitiate one sinle episode of

poor service+ and as a result !ould not sinificantly impact overall satisfaction.

:onversely+ neative information from some credible source may cause thecustomer to evaluate service quality less favorably+ even thouh the past

e=periences have been very satisfyin.

629olton and 3re! (1BB;)61 in their research found there is a difference

bet!een a sinle encounter and the total service e=perience and in that reard

statedG

(In a dynamic frameork, customer satisfaction ith a secific ser!iceencounter deends on re'e6isting or contemoraneous attitudes a"out ser!ice

.uality and customer ost'usage attitudes deend on satisfaction7*89 0Bolton and

:re7 1223) age 1;


28/37


29/37


30/37

:hurchill and Suprenant (1B52)6; !ere amon the earliest to hold the vie!

later shared by others that service quality !as an attitude. ,hey !ere the first

researchers to see the sinificance of attitude as a principal factor leadin to6A


31/37

superior service quality. ne year after this sinificant research+ e!is and

9ooms (1B5/)66 concluded that satisfaction !as similar to attitude+ and

consequently they noted the sinificance of processes and outcomes in defininservice quality. In addition+ they did not directly state+ rather they alluded to

satisfaction as bein similar to attitude. ,he difference bet!een service quality

and attitude is that service quality is seen as a eneral+ comprehensive appraisalof some product or service. 9y contrast it !as noted by Eronroos (1B52b)6A that

service maretin had follo!ed t!o distinctly different paths. In his vie! based on

empirically reliable research+ service !hen taen alone is indeed physicallyintanible. It does not matter if it is a hospital service or a restaurant service*

service occurs !hen someone does somethin for the customer in either case.

4e notedG

($his holds e!en for situations here there are no human reresentati!esof the firm in!ol!ed5 then the firm uses hysical or technical resources and the

co'oeration of the customer instead, in order to "e a"le to do something for its

customers7 $his acti!ity for e6amle, a hosital ser!ice, a restaurant ser!ice, or

an airline tri is roduced, at least artly, often to a great e6tent, in the resenceof the consumer, ith his co'oeration, and moreo!er, hile he simultaneously

consumes the ser!ice7*8; 0=ronroos 712>9") age ?14Eronroos (1B52b)65 concluded that the act of somethin bein done for

the customer !as the sinificant element in satisfyin the customer+ and this act

did not have to involve a person performin the act rather it !as simply a matter of the JfirmK relyin upon physical or technical resources doin somethin for the

customer !ith the customer cooperatin by consumin the JserviceK. "s noted

from his research+ customer a!areness of somethin bein done in their behalf

played a sinificant role in the deree of satisfaction. 4olbroo and :orfman(1B56)6B e=panded on the concept of an act bein performed and defined

68

perceived quality as a lobal value >udment. ,hey indicated that quality does byits nature seem to e=press eneral approval.

,herefore+ it is indicated that JqualityK or Jhih in qualityK means that

somethin is Jood.K ,hey stated that the use of the terms promotionally ise=tremely imprecise. ,o define quality+ they sa! quality as fittin into three

dimensions as stated belo!G

($he first dimension distinguishes "eteen definitions that regard .uality

as something resent imlicitly in an o"-ect as oosed to some e6licit asect or function thereof7 A second dimension contrasts more mechanicalistic

definitions of .uality ith those more humanistic in nature7 A third dimension

distinguishes concetual definitions of .uality from those relati!ely moreoerational in nature7*


32/37

equation. 4e brouht service quality bac to the earliest held vie!s that service

quality !as the e=tent to !hich a product offers the characteristics that the

individual desires. 4e differed from the earlier vie!s in that he sa! quality as anormative concept that could equip the consumer function effectively in the

maretplace. "dditionally+ he felt that quality could best be measured and defined

usin quality as a !eihted averae of characteristics. 4e defended hismeasurement and definition throuh the follo!in statementG

65

(inally, it is orth noting that the .uality scoring systems utilied "yConsumers /nion and all its counterarts conform in essence, though not to

form, to the model roosed here7*


33/37

,he common element that can be derived from the numerous researchers

is that various methodoloies e=ist !hich allo!s service quality to be measured.

"dditionally+ it can be measured from several perspectives+ !hich !ill be fullydetailed by discussion of a number of important studies in the follo!in section.

,he reatest area for dispute is !hat constitutes the best and most accurate

method for measurement of service quality.A asi4 u!ersta!i( of servi4e =ua$it ro$e of !i#esios i

6ERV7UAL (ives s4o;e to 0oi ot of te to;i4s of Hos;ita$s a! 6ervi4e

7ua$itective of this paper is to develop and purify the scale for measurin service quality suitin the Indian hospitals sector.

Hos;ita$ ? A 6ervi4e Or(ai@atio

,he overall process !hich involves hospital business is service. ,here isnothin !hich is tanible+ !hich can be physically touched or verified and !hich

is not perishable also. "ll the characteristics of the concept of service are very

!ell fit in !ith hospital business too. rani-ations enaed in hospital business provide a !ide variety of services lie providin beds+ complete nursin to the

patients or providin equipment for dianosin all sorts of ailments+ arranin

transportation in the form of ambulances+ caterin services+ etc. to the

individuals. #=ample of providin services to overnment can be traced bac tothe services iven to the overnment officials and the persons !ho hold hih

positions in the overnment. 4ospitals provide services to the businessmen also

!hich is self e=planatory. ,hey provide health services by creatin oodatmosphere and so on.

,he business of hospitals also qualifies the definitions of services iven by

Sir 9everde82. "ccordin to him+ services refer to social efforts includinA1

overnment to fiht five iant evils. Fant+ 3isease+ Inorance+ Squalor and

Illness in the society. 4ere too+ one finds that hospital services also fiht aainst

these evils if one calls them evils.


34/37

,he main ob>ective of hospital is providin services aainst specific

ailments. Inorance is also removed from the services provide by hospital. ne

comes to no! more and more !hen he or she oes out of his or her o!n !orld.,he overnment hospitals and hospitals established by the act provide services

to the people !ho are nelected in the society or !ho are belo! the poverty line.

,he fifth evil is illness !hich is the primary purpose of a hospital to cure. In this!ay one can observe that hospitals are !ell qualified under this definition. ,he

definition provided by Prof. ".%.S. $ao in 3r. ,. Sreenivas8/ + JServices can also

be defined as a human effort !hich provides succor to the needy. It may be foodto a hunry person+ !ater to a thirsty person+ medical services to an ailin one

and education to a student+ loan to a farmer+ transport to a consumer+

communication aid to t!o persons !ho !ant to share a thouht+ pleasure or

painK is also relevant to the hospital orani-ation.,he ist of this definition is that the services are provided free of chare or

commercially. ,his aspect is self e=planatory. ,here are ample evidences that

overnment hospitals are providin services free of chare and corporate

hospitals providin services usually aainst price. Fhatever be the mode+ patients are ettin immediate care throuh one of the !ays.

In vie! of the definition iven by ?aeshel 4asenfield et al8;+ as action(s)of orani-ation(s) that maintain and improve the !ell bein and functionin of

people+ !e notice that efforts of hospitals are directed to!ards maintainin and

improvin the !ell bein of the persons !ho come to the hospital for any reason!hatsoever. ,hese orani-ations improve the !ell bein or the patients in many

!ays. or e=ample+ prosperity of the country is directly proportionate to the

health of the persons livin in the society. 4ospitals are playin a vital role in

A2maintainin the !ell bein of the people. ,here are many advantaes of the

similar nature !hich !ill be discussed appropriately in the comin chapters.

'nlie the traditional manufacturin system !ors on input bein processed to et the output demandin the facilities+ materials everythin to be

treated mechanistically+ hospitals have to treat patients not lie machines but as

human required to attend their problems most of them are can not be treated serviced in the same !ay. In all one can say that the hospital services are lined

!ith other supplementary services.

6i(ifi4a4e of 6ervi4e 7ua$it< i Hos;ita$s

or a hospital customers are patients. or any customer for that saeeven for patients service quality is the function of perceptions+ e=pectations and

performance. #arly !ritin on the topic of service quality+ defines service quality

as a comparison of !hat patients feel a hospital as a service provider shouldoffer (i.e. their e=pectations) !ith ho! the hospital as provider actually performs

and Jservice quality is a measure of ho! !ell the service level delivered matches

patients e=pectations. 3eliverin quality service means conformin to patientse=pectations on a consistent basisK.

Service &uality as perceived by patients is defined as the deree and

directions of discrepancy bet!een patients service perceptions and

e=pectations. It is also defined as difference bet!een Jtechnical qualityK (!hat is


35/37

delivered in the form of treatment) and Jfunctional qualityK (ho! it is delivered)+

and as Jprocess qualityK (>uded durin the treatment of process) and Joutput

qualityK (>uded after the treatment).Importance of service &uality+ direct relationship bet!een service quality

and profitability+ helps in defensive and offensive maretin i.e. patient repeat

dependability and increase of assurance on the specific hospital is done+ striinA/

a balance bet!een patients perception and e=pectations+ increasin visits on to

the specific hospital+ free advertisin throuh !ord of mouth. ,oo much ne!nesscan do more harm than ood. Some of the problems are communication ap+

service proliferation and comple=ity+ improper selection and trainin of service

staff lie doctors+ paramedical staff+ nurses etc+ short run vie! of the business. If

a hospital ives a quality treatment service+ they can survive and run over anyind of crunch situation.

,he concept of liberali-ation and lobali-ation opened the maret to

intense competition throuhout the !orld. So+ today the patients are not ready to

opt for the service based on only its physical characteristics+ brand name+ or chares alone. ,he use of services offered by hospital is made mostly on

patients perception of quality attached to a service. ,his is truer in a competitivesector lie hospitals in current scenario. So more and more hospitals in the !orld

need to start the service quality initiations to retain the e=istin patients

e=pectations and also to ensure that more and more ne! patients start believinin their services.

-ro$e#s Ca$$e(es 4urret$< fa4e! < I!ia Hos;ita$s

1. Crisis fa4e! i I!ia Hea$t Care 6e4tor ? Ne4essit< of 6ervi4e

7ua$it<

Ma>ority of the hospitals particularly the overnment hospitals are

severely under pressure due to the crisis bein faced in delivery of

qualitative services. ,his is found to be very sinificant factor amon theall challenes faced by these hospitals. #ven corporate hospitals+ at times+

are not e=empted from these short falls. ,he more increase in a!areness

of patients+ the more the crisis bein faced in the hospitals. ,he demandsare increasin day by day+ as !ell the hopes. ,he inability of providin the

anticipated services to patients leadin hospitals to be on toes to search

for a !ay !herein they can come out of this* proceed to!ards shore.

A;India+ in the past one decade is fast becomin a lobal hub of

medical tourism !ith !ide rane of health care centers caterin to a

spectrum of medical fields+ namely+ allopathy+ homeopathy+ ayurvedic+yoa centric and so on for providin medical solutions to physical and

mental related problems. ,he recent boom in the orani-ed sector of

medical hospitals+ comprisin small+ medium+ lare hospitals and hospitalchains + not to be left behind+ the medical transcription fields as !ell+

sinifies the da!n of ne! era of successful phase in Indian health care

services sector.

,he phenomenal ro!th in fitness centers across the country


36/37

coupled !ith the sure in traditional pharma industries at lobal level

suest that India has been vie!ed as a reliable hub for medical solutions

at competitive costs and more admirably !ith appreciable customer care.,ouchin upon this critical aspect of [customer care !hich determines the

satisfaction level of customers of any service orani-ation+ more

specifically+ the hospital services+ the Indian hospitals sector has !oe upto this reality and !orin more on service quality aspects+ vi-. reliability

and responsiveness !hich score over everythin else in clinchin clientele

for hospital services. ,he current bu-- !ord in this industry is [customer centric operations.

Many incidents are reported daily in media e=hibitin the inability of

hospitals in passin on the required level of service to patients. ailure to

attend the specific needs of patients main these hospitals to haveretrospection as !hat e=actly they are doin and e=plore the !ays to

modify them in order to ain the confidence of patients aain.

Service &uality is oin to be one of the best solutions for these

problems. ,he researcher here attempted to study this in elaboration.Some hospitals thouh practicin fe! service quality aspects+ a ap is

A6 potentially e=istent. Measurin that ap in service quality is the point of the

need.

+. Co#;etet a! a;;ro;riate$< =ua$ifie! staff avai$ai$it<

"s the hospitals are ro!in+ as the needs of patients ro!in+ the

requirement for competent and qualified staff is also ro!in. Most of the

hospitals are findin this problem. ,he reasons may be multiple. ,he

country may not be producin enouh number of required staff or thenumber of patients needed the services may be ro!in or even it may be

possible that the number of hospitals offerin the services may be

ro!in. ?et another typical comple=ity may be the e=istin staff may not be equipped !ith the dynamic requirements of patient community.

$ecently+ a patient met !ith accident brouht to the Eandhi 4ospital and

badly in need of medical help. 3ue to either unavailability of necessaryequipment+ he !as directed to some other hospital.

3. Coer4io fro# te staff to atte! te Ba;;ro;riate fa4i$it<

It could be the e=perience of some of the patients that durin their

visit to a hospital it could have been happened that some of the staff members varyin from the capacity of hihest raned doctor to the lo!er

cateory member of a hospital+ a compounder miht have not !illin to

attend the required support to them. It may be very less in deree in thestaff holdin hihest capacities but it can not be told that the coercion is

absent.

/. Leve$ of fees to e or < te ;atiets i various for#s i4$u!i(

!ia(osti4s> 4osu$tatio> atte!ats> e!> ursi( a! oter

servi4es

,hese problems are not only evident in corporate hospitals but also

are quite visible and e=perienced in the overnment hospitals. Some


37/37

AA

patients did e=pressed that thouh the overnment hospitals do not

chare for consultation+ bed and nursin chares+ they are needed tospend money to e=ternal facility centers for services lie dianostics etc+

due to the unavailability of the important services in the hospitals. :omin

to the corporate and some private hospitals most of the patients aree=periencin the pinch of fees and chares.

5. Cost of tras;ort i4$u!i( a#u$a4e servi4es

#=cept fe! trust based hospitals+ it is the e=perience of relatives of patients !hile shiftin the patients to hospitals. ,he ambulance service

providers do chare them >ust adhoc and barain based on the need and

urency of people. ,houh this is part of hospital services and must have

been fi= priced+ ma>ority of times+ it oes unorani-ed. In other situation+there are fe! corporate and medical collee combined hospitals in India

!hich need special transportation services. Some times this costs the

patients more than the normal and some other times+ it is touh for them

to find the travel mode.2. Avai$ai$it< of !ia(osti4 a! tera;euti4 fa4i$itiesIn some of the hospitals+ the patients have to either o out todistant places or opt out of the hospital due to the absence of some of the

critical facilities lie dianostics and therapeutics. ,his could some times

become very problematic to the patients because of scarcity of time andurency of the services for further treatment.

%. +/ ours avai$ai$it< of s;e4ia$t< servi4es

,his may not be a chance for bi branded corporate hospitals. 9ut

there can be fe! secondary care hospitals and nursin homes !ithout theavailability of 2; hours specialty services causin very inconvenience for

the patients !ho could have come to these hospitals !ith lots of

e=pectations and urency. ,houh this may not be a mistae of theseA8

hospitals it is the patients !ho are not able to et the needy in time+ in

particular time of causality.

'. Lar(e s4a$e of te os;ita$ ei( a treso$! for so#e ;atiets

,here are instances for fe! patients !ho visited the multi specialty

corporate hospitals for a seeminly uncomplicated health problem. Most of

these hospitals follo! a method of facilities called Jroup technoloyK!hich allo!s concentratin their resources of one ind at one place. "

patient !ill be made to move bet!een these clusters in the process of

consultation+ treatment+ dianostics+ etc+ as many times as the patient becomes inpatient of movin so. In some of the overnment hospitals this

pro

review andhra good

Documents