A study on impact of service quality on

customer satisfaction in relation to

healthcare facilities in Selaqui

1. EXECUTIVE SUMMARY

2. INTRODUCTION

The quality of service—both technical and functional—is a key ingredient in

the success of service organisations. Technical quality in health care is defined
primarily on the basis of the technical accuracy of the diagnosis and procedures.
Several techniques for measuring technical quality have been proposed and are
currently in use in healthcare organisations. Information relating to this is not
generally available to the public, and remains within the purview of health-care
professionals and administrators. Functional quality, in contrast, relates to the
manner of delivery of health-care services. A general hospital is typically the
major health care facility in its region, with a large number of beds for intensive
care and long-term care, facilities for surgery and childbirth, bio assay
laboratories, and so forth.
Larger cities may have many different hospitals of varying sizes and facilities.
Hospital services are different and distinct from boarding and grooming
services-yet both are easily accessible to pet owners and team members.
Patients just come for diagnosis and/or therapy and then leave (outpatients), but
some others stay the nights (inpatients). Putting the patient first is a challenge
that requires not just a huge change in the mindset of all the stakeholders in
health care provision, but also the means by which to measure the levels of
satisfaction of patients, and to discover what matters to them before, during and
after their visit to any hospital.
In India, the service quality of health care is miserable and in general, the health
outcome is far from satisfactory. Therefore, government of India has adopted a
policy of health care reform having two basic objectives to achieve health
securities for all and to provide quality health facilities for all within every
district in India. In the care sector, customer satisfaction is also an important
issue as in other service sectors. A health care organization can achieve patient
satisfaction by providing quality services; keeping in view patients’ expectation
and continuous improvement in the health care service.

Healthcare System in India

India has a vast health care system, but there remain many differences in quality
between rural and urban areas as well as between public and private health care.
Despite this, India is a popular destination for medical tourists, given the
relatively low costs and high quality of its private hospitals. International
students in India should expect to rely on private hospitals for advanced medical
care.

The health care system in India is primarily administered by the states. India's
Constitution tasks each state with providing health care for its people. In order
to address lack of medical coverage in rural areas, the national government
launched the National Rural Health Mission in 2005. This mission focuses
resources on rural areas and poor states which have weak health services in the
hope of improving health care in India's poorest regions.

Market Size

 The healthcare market can increase three fold to Rs 8.6 trillion

(US$ 133.44 billion) by 2022.
 India is experiencing 22-25 per cent growth in medical tourism and
the industry is expected to reach US$ 9 billion by 2020.
 There is a significant scope for enhancing healthcare services
considering that healthcare spending as a percentage of Gross
Domestic Product (GDP) is rising. The government’s expenditure
on the health sector has grown to 1.4 per cent in FY18E from 1.2
per cent in FY14. The Government of India is planning to increase
public health spending to 2.5 per cent of the country's GDP by
2025.
Road Ahead
India is a land full of opportunities for players in the medical devices industry.
India’s healthcare industry is one of the fastest growing sectors and it is
expected to reach $280 billion by 2020. The country has also become one of the
leading destinations for high-end diagnostic services with tremendous capital
investment for advanced diagnostic facilities, thus catering to a greater
proportion of population. Besides, Indian medical service consumers have
become more conscious towards their healthcare upkeep.

State of healthcare in Uttarakhand

Falling two slots from last year’s 15th rank, Uttarakhand this year was relegated
to the 17th position among 21 states of the country in the healthcare rankings
recently released by central government think tank Niti Aayog.
Uttarakhand has a poor network of hospitals & health centres. As of the year
2018, the state had 297 primary health centers, 21 district hospitals, 27 sub
district hospitals & 4 blood bank centers. Under State Budget 2018-19, an
allocation of Rs. 2,286.57 crore had been made for health and family welfare,
AYUSH and medical education.
Hospitals and medical centres in the Uttarakhand are plagued by a shortage of
manpower, non-functioning equipment in the operating theatre and insufficient
number of labour rooms. The problem of an acute shortage of doctors in
Uttarakhand is a very real one, largely because of an unwillingness to serve in
rural areas. Uttarakhand is grappling with the accessibility problem. Skilled
personnel are unwilling to work in remote rural areas of the state due to poor
transportation and infrastructure and limited accommodation. As vacant posts
have not been filled, the workload on the existing staff has increased manifold.
The population in the state is scattered and thus the construction of more sub-
centres and primary health centres is required.
Government of Uttarakhand has set ‘Vision 2030’ & according to that efforts
have been taken on strengthening the health system in order to be able to
successfully meet the shifting health priorities associated with demographic and
epidemiological transitions and changing public expectations in the state.
GAPS IN SERVICE QUALITY
Gap 1: The difference between management perceptions of what customers
expect and what customers really do expect.
Gap 2: The difference between management perceptions and service quality
specifications - the standards gap.
Gap 3: The difference between management perceptions of what customers
expect and what customers really do expect.
Gap 4: The difference between management perceptions and service quality
specifications - the standards gap.
Gap 5: The difference between what customers expect of a service and what
they actually receive expectations are made up of experience, word-of-mouth
and needs/wants of customers measurement is based on two sets of statements
in groups according to the five key service dimensions.

[Link] REVIEW

S.N TitleTit Author Publisher Objectiv Findings

o.. le e
1. Health Annadurai JKIMSU Its objective The present study
care Kalaivani , is to presents a progressive
growth in Mani identify: financing pattern in
North Geetha , Income health care in three
India Danasekara inequality is States in north India.
n Raja associated Rich spend more as a
with poor proportion of their
health. consumption
Inequities expenditure on health
exist in care. This result
service requires discussion in
utilization light of higher unmet
and need and high
financing for catastrophic
health care. expenditure among
Health care poor. Expenditure.
costs push Moreover, as a
high number proportion of income,
of poor spend more on
households basic subsistence such
into poverty as food leaving little
 in India. We for meeting other
undertook needs
this study to
ascertain
inequities in
health status,
service
utilization
and out-of-
pocket
(OOP)
health
expenditures
.
2. A Study VIDYA International •Relationshi 1: The patients are
of the PRIYA Journal of p between unlike in past where
Factors RAO Business and financial they were looking for
Influenci (Research General consideratio every cost-saving
ng Scholar, Dr Management ns and opportunity, hence
Customer Ram (IJBGM) customer financial consideration
Satisfacti Manohar satisfaction is a deciding factor
on in Lohia and has a direct
Medical Avadh •Relationshi positive correlation
sector in University, p between with their satisfaction
India Faizabad, the hospital level.
Uttar medical 2: The service quality
Pradesh, facilities and level in the hospital
India) customer has a direct positive
satisfaction correlation with the
patients satisfaction
•Relationshi level.
p between 3: The environment in
service India, as a moderating
quality and variable comprising
customer Indian government
satisfaction support, locates, and
•The the country, culture,
moderating enhance the impact on
variables the patients
(culture, satisfaction.
location, and
government)
impact on
customer
satisfaction
3. Study of Bhupesh , Mahakal This Hospitals should
Service Umath Institute of research carefully focus upon
Quality ** Amit Technology, aims to thefactors
of Indian Kumar Ujjain (M.P.) measure and (Responsiveness,
Hospitals Marwah evaluate the Assurance,
 Using ***Manish factors of Convenience,
SERVQU Soni perceived Tangible & Empathy)
AL service which significantly
Model quality in determines the
the private customer’s perception
hospitals of of service quality.
India. The The age of
study shows respondents
that how significantly
SEVQUAL determines the
model helps customer perception
to fill up the of service quality of
gaps hospitals.
between
service
provider and
service
receiver in
hospitals of
India, in
general, and
MP state, in
particular
4. Relations Dr. Journal of  To study  It shows that
hip Sunayna Research in the customer’s
between Khurana; Marketing relations perception toward
service Chandigarh hip tangibility
quality Group of between dimension of
and Colleges, service service quality has
customer Mohali quality the greatest impact
satisfacti and on customer
on. customer satisfaction
satisfacti followed by
on. competency and
 To study credibility.
the  Responsiveness,
effect reliability,
various empathy and
dimensio assurance
n of dimension of
service service quality
quality have the negligible
on impact.
customer  The results also
satisfacti show that
on. customer
expectation toward
credibility
dimension of
service quality has
 the greatest impact
on customer
satisfaction
followed by
assurance and
competency.
5. Slack Sandeep International The purpose The analysis found
based Kumar Journal of of this paper that out of total 36
measure Mogha and Health is to hospitals only ten
of Shiv Prasad Sciences and determine hospitals are relatively
efficienci Yadav Research the relative overall technical
es of Department efficiencies efficient. The average
public of of public overall technical
sector Mathematic sector efficiency 54.10 per
hospitals s, Indian hospitals in cent indicates that an
in Institute of Uttarakhand, average hospital has
Uttarakha Technology India. the scope of producing
nd (India) Roorkee, the outputs with the
Roorkee, inputs 45.90 percent
India lesser than their
existing levels. The
slack analysis results
show that on average
12.57 per cent of beds,
13.16 per cent of
doctors, 14.04 per cent
of paramedical staff
can be reduced and
17.53 per cent of out-
door patients,
66.55percentofin-
doorpatients,208.23
percentofmajorsurgeri
es,110.73 percent of
minor surgeries can be
expanded if all the
inefficient hospitals
operate at the level of
efficient hospitals.

6. Service Ramaiah International The aim of The present study

Quality Itumalla Journal of this study is provided a customer
in Health Innovation, to satisfaction in a
Care: An Management understand private hospital of
Empirical and how India. Using a CSI
Study of Technology, hospitals index, the study has
Private Vol. 3, No. 4, could better produced an index of
Hospital August 2012 manage their 75.87 out of a possible
in India services and 100. This shows that
harness there is still a lot of
 information space for
technologies improvement in the
to enhance hospital. Specifically,
their the hospital as a whole
services. seems to be weak in
The factors such as;
objectives of Communication,
this study Promptness and
are to study Availability.
the
relationship
between
information
technology
and service
quality, to
measure the
patient
satisfaction
levels using
a Consumer
Satisfaction
Index [CSI]
model and to
develop a
model for
better IT-
Enhanced
Service
Quality in
hospital.
7. The C. Department of The The results reveal that
relationsh Boshoff* Business objective of the service quality
ips and B. Management, this study dimensions Empathy
between Gray University of was to of nursing staff and
service Port Elizabeth investigate Assurance impact
quality, whether positively on both
customer superior Loyalty and
satisfacti service Cumulative
on and quality and satisfaction. The
buying superior customer satisfaction
intentions transactions dimensions
in the pecific Satisfaction with
private customer meals, Satisfaction
hospital satisfaction with the nursing staff
industry will enhance and Satisfaction with
loyalty (as fees all impact
measured by positively on both
purchasing Loyalty and
intentions) Cumulative
 among satisfaction
patients in
the private
health care
industry.
The research
design
allowed an
assessment
of the
relative
impact of
individual
dimensions
of service
quality and
transaction-
specific
customer
satisfaction
on two
dependent
variables,
namely
loyalty (as
measured by
intentions to
repurchase)
and
customer
satisfaction,
the latter
measured as
‘overall’ or
cumulative
satisfaction.
8. The role Jeen-Su Management To find out This study has
of Lima , Kee- Science Letters the impact of contributed in
hospital Sook Limb, service developing a
service John H. quality in its conceptual model that
quality in Heinrichsc , dimensions shows the
developi Khulud Al- (COMPETE relationships among
ng the Aalid, NCE, hospital service
satisfacti Alamzeb CREDIBILIT quality, patient
on of the Aamire and Y, satisfaction, hospital
patients Muhammad RELIABILIT utilization, and
and Imran Y, hospital financial
hospital Qureshif RESPONSIV performance. The
performa ENESS, analysis results
nce ASSURANC endorse the previous
 E, findings that hospital
TANGLIBL service quality is
ES, positively related to
COMMUNI patient satisfaction
CATION) on
customer
satisfaction.
9. Hospital
service
Muslim
Amin King
Clinical
Governance:
This paper
aimed to
The results confirm
that the five
quality Saud An examine a dimensions –
and its University International conceptual admission, medical
effects on Journal model for service, overall
patient the service, discharge and
satisfacti relationships social responsibility –
on and between are a distinct construct
behaviour hospital for hospital service
al service quality. Each
intention quality, dimension has a
patient significant
satisfaction, relationship with
hospital hospital service
utilization, quality. The findings
and hospital of this study indicate
financial that the establishment
performance of higher levels of
hospital service
quality will lead
customers to have a
high level of
satisfaction and
behavioural intention.
10. Service
Quality
Saad
Ahmed
InternationalJo
urnal of Health
The purpose This paper attempts to
of this paper explain degree of
and Javed Care Quality is to assess influences of five
Satisfacti Institute for Assurance the influence service quality
on in Grey of patients’ constructs (empathy,
Healthcar Systems expectations responsiveness,
e Sector and from tangibility, reliability
of Decision healthcare and assurance) on
Pakistan Sciences,Gr service Pakistani patients’
– The eySys quality on expectations from the
Patients' Foundation, their private and public
Expectati Lahore, satisfaction sector hospitals and
ons Pakistan with nursing thus patient
in public and satisfaction
private
hospitals of
Pakistan.
RESEARCH METHODOLOGY
The study is based mainly on the primary data collected from patients of the
hospitals of Selaqui with the help of a structured questionnaire based on 22
statements given by SERVQUAL instrument. On the basis of these statements
the questionnaire form (a sample has been added at the end of the paper) was
prepared and it was filled by the patients. Factors which determine the service
satisfaction level were studied with the help of five point Likert scale ranging
from strongly agree to strongly disagree. Perceptions of patients about service
satisfaction was measured using a battery of statements derived from the results
of the Likert scale. Responses were measured on five point scale with 5
indicating strongly agreed and 1 indicating strongly disagrees. In order to
achieve the objectives of the study, analysis was carried out using tools
provided by Google Forms.

Parasuraman, Zeithaml, and Berry (PZB’s1988) introduced five dimensions

which led to the development of SETVQUAL, these dimensions are as follows:
(a) Tangibles-physical facilities, equipment and appearance
of personnel;
(b) Empathy- caring, individualized attention;
(c) Assurance- knowledge and courtesy of employees and
their ability to convey trust and confidence;
(d) Reliability- ability to perform the promised service dependably and
accurately; and
(e) Responsiveness- willingness to help customers and provide prompt service.

LIMITATIONS
This research examined the concept of hospital service quality, patient
satisfaction and behavioural intention from the perspective of patients.
However, this study did not explore the perspective of service providers. This is
a limitation in as much as it only considers the patients view, which might be
different from the providers view

CONCLUSIONS
This study aims to diagnose the service quality based on the difference between
the patients’ expectation of quality services and their perception of the services
received. It is found that there is a huge gap on reliability, responsiveness and
tangibility services. With the increasing number of new and unknown diseases
attacking mankind, the hospital industry faces a colossal and tough task of
ensuring rapid treatment and sound health. The timely and correct information
provided by the hospitals determines the very course of treatment of the
diseases. Hence the hospital industry needs to revamp its prevailing image.
Management needs to inculcate professionalism and implement modern
techniques of customer relationship management.
Literature survey suggests that patient satisfaction and perceived service quality
both should be considered together for the stability of a health care organization
in a competitive environment. Researchers have suggested different models and
methods of measuring patient satisfaction considering service quality as one of
the antecedents.
Different literatures established that SERVQUAL is a popular model for
measuring service quality. SERVQUAL is a standardized and reliable
instrument that identifies five different dimensions of service quality and
validates those dimensions in different service situations (Rohini and
Mahadevappa, 2006). Parasuraman [Link].(1988), in their SERVQUAL model,
identified five dimensions viz. responsiveness, reliability, assurance, tangibles
and empathy on the basis of which customers’ expectations and perceptions are
measured. They explained all the above-mentioned dimensions with the help of
twenty two statements that have been identified as attributes creating those five
dimensions (Parasuraman et. al., 1988, Bhattacherjee,2010). Babakus and
Mangold (1992) identified SERVQUAL as a reliable and valid model in the
hospital environment.

QUESTIONNAIRE
Quality Questions Expectati Perception
Dimension on
1-Strongly
1-Strongly Agree
Agree
5-Strongly
5-Strongly Disagree
Disagree
Tangibles 1. The hospital has modern looking 1 2 3 4 5 1 2 3 4 5
equipments.

1 2 3 4 5 1 2 3 4 5
2. The physical facilities in the
Hospital are visually appealing

1 2 3 4 5 1 2 3 4 5
3. Personnel in the hospital are neat
in appearance

1 2 3 4 5 1 2 3 4 5
4. Materials associated with the
service (such as pamphlets or
statement) are visually appealing
Reliability 5. The hospital Keeps it promises in 1 2 3 4 5 1 2 3 4 5
time
6. When you have a problem, the 1 2 3 4 5 1 2 3 4 5
hospital shows sincere interest in
solving it
1 2 3 4 5 1 2 3 4 5
7. The hospital get things right the
first time
8. The hospital provides it’s services 1 2 3 4 5 1 2 3 4 5
at the time it promises to do so’
9. It insists on error-free record 1 2 3 4 5 1 2 3 4 5
Responsiven 10. The personnel in the hospital 1 2 3 4 5 1 2 3 4 5
ess
 inform you exactly when the
services will be performed 1 2 3 4 5 1 2 3 4 5
11. Personnel give you promt
services

1 2 3 4 5 1 2 3 4 5
12. Personnel in the hosptal are
willing to help you
1 2 3 4 5 1 2 3 4 5

13. Personnel are never too busy to

response to your need
Assurance 14. The behavior of the personnel 1 2 3 4 5 1 2 3 4 5
instils confidence in you
15. You feel safe in your dealings 1 2 3 4 5 1 2 3 4 5
with the hospital
16. Personnel in the hospital are
1 2 3 4 5 1 2 3 4 5
consistently courteous to you
17. Personnel in the hospital are
knowledgeable enough to answer 1 2 3 4 5 1 2 3 4 5
your questions
Empathy 18. The hospital gives you individual 1 2 3 4 5 1 2 3 4 5
attention
19. The hospital has operating hours 1 2 3 4 5 1 2 3 4 5
convenient to all it’s patients
20. The personnel in the hospital
1 2 3 4 5 1 2 3 4 5
give you individual attention
21. The hospital has your best
interest at heart 1 2 3 4 5 1 2 3 4 5

22. The personnel in the hospital 2 3 4 5 1 2 3 4 5

understand your specific needs 1
2 3 4 5 1 2 3 4 5