Service Quality in Healthcare Establishments: A Literature Review

Int. J. Behavioural and Healthcare Research, Vol. 5, Nos. 1/2, 2015 1

Copyright © 2015 Inderscience Enterprises Ltd.

Service quality in healthcare establishments: a literature review

Faisal Talib* Mechanical Engineering Section, University Polytechnic, Faculty of Engineering and Technology, Aligarh Muslim University, Aligarh, India Email: [email protected] *Corresponding author

Mohammed Azam and Zillur Rahman Department of Management Studies, Indian Institute of Technology Roorkee, Roorkee, India Email: [email protected] Email: [email protected]

Abstract: Over the past two decades, Indian healthcare establishments (HCEs) have embraced service quality (SQ) and SQ dimensions in some way to their organisation in order to improve the patient’s satisfaction level. However, a recent report indicated that there is little evidence of leading Indian researchers working on healthcare quality and related areas in healthcare sector. Moreover, the perception is that whatever research has been conducted is fragmented, very specific in nature and specialised. In light of this, the purpose of the present study is to develop an extensive and systematic literature search on healthcare quality, SQ, development and application of SERVQUAL and to understand the link between SQ and patient satisfaction. The paper further identifies the healthcare quality dimensions and models for HCEs. Finally, it was concluded that further research is necessary to develop conceptual underpinning and analytical models based on quantitative studies. The outcome of this study will help Indian healthcare practitioners and quality experts to take initiative in implementing hospital SQ dimensions in their organisations as well as may propose a framework/model for enhanced performance.

Keywords: service quality; SQ; SERVQUAL; healthcare establishments; HCEs; India.

Reference to this paper should be made as follows: Talib, F., Azam, M. and Rahman, Z. (2015) ‘Service quality in healthcare establishments: a literature review’, Int. J. Behavioural and Healthcare Research, Vol. 5, Nos. 1/2, pp.1–24.

Biographical notes: Faisal Talib is an Assistant Professor at Mechanical Engineering Section, University Polytechnic, Faculty of Engineering and Technology, Aligarh Muslim University, Aligarh, (UP), India. He holds PhD degree from IIT Roorkee and Masters in Industrial and Production Engineering from AMU. He has 18 years of teaching experience and has more than

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60 publications to his credit in national/international journals and conferences. His special interest includes quality engineering, TQM, service quality, quality concepts, industrial management, operations management, qualitative and quantitative techniques and quality management in service industries.

Mohammed Azam holds PhD degree from IIT Roorkee and is MD (in Social and Preventive Medicine); MBA (with Hospital Management and Quality Management as special subject) and LLB (with administrative law as special subject). He has a long experience of practice of public health, community medicine and also as administrator of hospital being in-charge of various Cantonment General Hospitals as well as Director of Health at various levels with administrative jurisdiction over a number of hospitals while serving the Indian Army.

Zillur Rahman is an Associate Professor at Department of Management Studies, IIT Roorkee. He is a recipient of the Emerald Literati Club Highly Commended Award and one of his papers was The Science Direct Top 25 Hottest Article. His work has been published and cited in various journals including Management Decision, Managing Service Quality, International Journal of Information Management, Industrial Management and Data Systems, The TQM Magazine, International Journal of Service Industry Management, Information Systems Journal, Decision Support Systems, Journal of Business and Industrial Marketing and to name a few.

1 Introduction

In the era of competitive environment, service sector is under tremendous pressure to deliver continuing performance and quality improvement while being customer focused. In recent years, it was observed that healthcare has become one of the extremely complex industries in the world (Bertolini et al., 2011). There are an increasingly number of medical specialisations, complex therapies and equipments, disease burden, increasing healthcare quality dimensions, rapid growth in the world healthcare market and several service units revolve around different organisations (Ovretveit, 2000). The need to increase the effectiveness and efficiency of healthcare services in the present situation is the need of the hour and requires attention towards continuous improvement. Indeed, there has been an unprecedented interest on behalf of social organisations, physicians, doctors, healthcare management and government alike into the investments both financial and human in deploying continuous improvement to improve healthcare services by focusing on different management tools like continuous quality improvement (CQI); total quality management (TQM); business process reengineering (BPR); accreditation programs, simulation models etc. These management tools have brought subsequent benefits to nursing, medical, administrative staff as well as to the patients but still their understanding is limited (Savitz et al., 2000; Papadopoulos, 2011).

Papadopoulos (2011) in his qualitative study explores the link between continuous improvement (CI) and dynamic actor associations through a case of lean thinking implementation in UK national health service and suggested that the implementation of CI depends on the emergence of a favouring network from the dynamic associations between heterogeneous entities. Bertolini et al. (2011) carried out the BPR of surgical ward in a hospital in order to improve the efficiency of the ward. They identified a

Service quality in healthcare establishments: a literature review 3

number of areas for improvement. Moreover, the discrete event simulation approach led to an understanding of the most efficient management choices.

Büyüközkan and Çifçi (2012) proposed a combined fuzzy analytic hierarchy process (AHP) and fuzzy technique for order performance by similarity to ideal solution (TOPSIS)-based strategy analysis of electronic service quality (e-SQ) in Turkish healthcare industry. The work showed the applicability of the e-SQ framework via internet in this industry. Additionally, Untachai (2013) examined the SQ in a hospital of Thailand and proposed a model consisting of five components such as reliability, tangible, response, cost and empathy. He concluded that patients evaluate the healthcare SQ on these five basic dimensions.

In order to determine an organisation’s level of quality management (QM) and CI, many studies have used Malcolm Baldrige National Quality Award (MBNQA) model (Counte and Meurer, 2001). The MBNQA process requires organisations to submit an application documenting their success, which usually includes competitive benchmarking (Blazey, 2005). Meyer and Collier (2001) empirically tested the Baldrige model of QM for healthcare industry using data from US hospitals and determined the causal relationships among the Baldrige healthcare pilot criteria. It was suggested that the MBNQA healthcare criteria provides a useful framework to analyse QM practices in the healthcare settings. Adoption of other quality approaches like Six Sigma, CQI, TQM and many others have achieved considerable success in several healthcare case studies (Talib et al., 2010; Kacak et al., 2014; Agus, 2005) but still there is much scope to study quality of services and patients’ perception of quality in healthcare organisations as suggested by the current literature review.

Moreover, competitiveness among healthcare organisations depends on healthcare satisfaction which is achieved through patient satisfaction (Zineldin et al., 2011). Patient satisfaction is created by responding to patient views and needs, continuous healthcare service improvement and overall doctor-patient relationship. There are number of factors and events which affect the patients’ perception and healthcare excellence. These factors include technical, functional, infrastructural, interaction, political environment, healthcare quality, social perceptions and information technology which can dramatically change healthcare (Zineldin et al., 2011; Zineldin, 2006). All this creates a complex situation in which assessment of healthcare can be analysed through patient satisfaction.

A comprehensive review of literature has been carried in the present work that discusses the definition of health, healthcare quality, studies on Indian healthcare quality, SQ, development and application of SERVQUAL, as well as link between SQ and patient satisfaction followed by discussion on different aspects of healthcare quality perceived by patients. Finally, the paper identifies the critical dimensions of healthcare quality and models from selected studies for the healthcare establishments (HCEs).

The rest of this paper is organised as follows: next section presents a comprehensive review of literature on definition of health, healthcare quality, overview and status of Indian healthcare system and studies on healthcare quality in Indian HCEs. In the subsequent section, literatures on various components of SQ such as definition, development and applications are provided followed by literature review on some previous studies based on SQ in healthcare as well as relationship between SQ and patient satisfaction are presented. Last section provides a brief conclusion of this study including implications and scope for further research.

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2 Literature review

2.1 Health defined

Health and healthcare need to be distinguished from each other for no better reason than that the former is often incorrectly seen as a direct function of the latter. Health is clearly not the mere absence of disease. Good health confers on a person or groups’ freedom from illness and the ability to realise one’s potential. Health is therefore best understood as the indispensable basis for defining a person’s sense of well being. The health of population is a distinct key issue in public policy discourse in every mature society often determining the deployment of huge society. They include its cultural understanding of ill health and well-being, extent of socio-economic disparities, reach of health services, quality and costs of care and current bio-medical understanding about health and illness.

One widely accepted health definition is in the World Health Organization’s (WHO’s) constitution: “Health is a state of complete physical, mental and social well being and not merely an absence of disease or infirmity” [WHO, (1948), p.100]. In recent years, this statement has been amplified to include leading a socially and economically productive life [Park, (2007), p.13]. Healthcare is defined as “a multitude of services rendered to individual, families or communities by health service professionals for promoting, maintaining, monitoring or restoring health” (Last, 1993). Within these definitions, standards for maintaining health are discernible, which healthcare staff should strive to achieve.

2.2 Healthcare quality

Healthcare quality has several interpretations. According to Institute of Medicine (2001), healthcare quality can be assessed from two viewpoints: patients and technical or professional. The former includes assessment of service provider’s ability to meet customer demand, customers’ perception and satisfaction. Customer perception with respect to evaluation of healthcare quality has been supported by a number of researchers (Mashhadiabdol et al., 2014; Kitapci et al., 2014). Many studies observe that quality perceptions impact satisfaction, meaning that the service quality (SQ) is the preceding thing of satisfaction (Parasuraman et al., 1994; Kitapci et al., 2014; Dasanayaka et al., 2012). Liyanage and Egbu (2005) emphasise that to improve quality, healthcare staff have to be medically qualified and clinically effective. The Quality Digest (2001) introduces quality as fulfilling customer requirements at a lower cost with built-in preventive actions in the processes, ensuring the best product to the end user with timely delivery. According to Walters and Jones (2001), serious deficiencies are likely to occur if there is any attempt to achieve quality without fully understanding customer requirements and expectations. To remain customer-focused, one must review how a business is managed, i.e., begin with customer problems, needs and priorities. Rose et al. (2004) emphasise customer factors, organisational performance and healthcare and hospital SQ components. For patients, switching providers could be detrimental to their health, as treatment and non-compliance costs could influence healthcare outcomes and create psychological trauma owing to the uncertainty of adjusting to a new service provider (Ovretveit, 2000). Typical patient complaints include long waiting times, high costs and unfriendly, apathetic and uncaring staff. It is, therefore, important to identify


healthcare quality parameters that are practically useful for the organisation, patient and society.

Improving quality of healthcare services and patient satisfaction apart from increasing accessibility and affordability to its population in the face of limited resources have become a major challenge for developing countries and have gained increasing attention in recent years (Badri et al., 2009, 2008; Narang, 2011; Talib et al., 2011; Dasanayaka et al., 2012; Zineldin, 2006; Kacak et al., 2014; Uzochukwu et al., 2004). Literature on healthcare quality stresses the importance of patient’s views as an essential tool for assessing and improving SQ. It suggests that majority of healthcare institutions are going for a patient-centred attitude. Consequently, many studies have used patient satisfaction as an outcome in their studies to measure the performance of healthcare institutions (Azam et al., 2012b; Badri et al., 2009; York and McCarthy, 2011).

2.3 The Indian healthcare system

Health is an essential component of nation’s development and is vital to the growth of economy and internal stability of the country. Assuring a minimal level of healthcare to its population is a critical constituent of the development process. Since independence, India has built up a vast health infrastructure and health personnel at primary, secondary and tertiary care in public, voluntary and private sectors. The Indian healthcare system include medical care providers, physicians, specialist clinics, nursing homes, hospitals, medical diagnostic centers, pathology laboratories and paramedical institutions including Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) institutions, which have been set-up for producing skilled human resources (Planning Commission Report, 2010).

Considerable achievements have been made over the last five decades in an effort to improve health standards, such as life expectancy, child mortality, infant mortality, maternal mortality and patient satisfaction. But still the country is dealing with rising cost of healthcare and growing expectations of the people. High healthcare costs can lead to entry into poverty. The importance of public provisioning of quality healthcare to enable access to affordable and reliable health services cannot be underestimated. The challenge of quality health services to the people of India has to be urgently met. Given the magnitude of the problem, there is need to transform public healthcare into an accountable, accusable and affordable system of quality services during the next five year plan (Planning Commission Report, 2010).

Currently, healthcare is one of India’s largest service industries, in terms of revenue and employment. During the 1990s, Indian healthcare grew at a compound annual rate of 16%. In year 2009, the total value of the sector was more than $35 billion. By 2012, India’s healthcare sector is projected to grow to nearly $70 billion (Planning Commission Report, 2010). Figure 1 depicts the predicted growth pattern of Indian healthcare sector. According to ASSOCHAM and YES BANK Report (2010), during the period 2000–2009, the sector has registered a growth of 9.3%, comparable to the sectoral growth rate of other developing nations such as Mexico and Brazil. According to the report, the growth of the sector will be driven by healthcare facilities in private and public sectors, medical tourism and medical insurance sectors. The per capita expenditure on health is around $80 in India as compared to $230 for China and $6,714 for the USA. Also, there are 60 doctors per 100,000 persons which is way below the other countries like Brazil, Russia and China having 115, 425 and 106 respectively (The Times of India, 2009).

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Further, the current share of public expenditure on health as proportion of gross domestic product (GDP) is 1% and will rise to a target of 2–3% of GDP by 2012. Private spending accounts for almost 80% of the total healthcare expenditure and is quite dominant in the healthcare sector. Inadequate public investment in health infrastructure has given an opportunity to private hospitals to capture a large share of the market. Some of the prominent corporate hospital networks in the country are Apollo Hospital, Fortis Healthcare, Max Healthcare, Wockhardt Hospital and Manipal Group. Simultaneously, a number of new players like Artemis Health Institute, Paras Group and MediCity among others are also in the process to set-up their establishments in the country.

Figure 1 Growth of Indian healthcare industry

0 100 200 300

1

2

3

4

Year

US Dollar (in billion)

Source: Planning Commission Report (2010)

Apart from the above statistics that reflect the state of affairs of Indian healthcare sector, the ‘voice of the customer’ in healthcare is weak. The above facts and statistics are a pointer to the fact that all is not well for healthcare sector in India. Accessibility, infrastructure (facilities and equipment) and personnel are some of the major factors for the deteriorating quality of healthcare facilities. This coupled with the patients’ economic conditions, weak ‘voice of the customer’ and the high credence attributes that are endemic in healthcare services (Zeithaml and Bitner, 2003).

The Indian healthcare industry is witnessing a sudden paradigm shift in last five year (Figure 1). Though this change was inevitable and the industry has been working towards it for a decade now, this has been visible only in last two years. All sectors in India are undergoing a change from unorganised to an organised structure and so is also seen in healthcare. The growth and sudden interest in the healthcare business can be attributed to many factors. Some of them are: strong Indian economy, increasing options for healthcare financing, growth in medical tourism, increasing opportunities in healthcare delivery, saturation of other sectors like IT, retail and gradual corporatisation of the healthcare sector.


Notwithstanding the sector’s rapid growth and potential, in many respects, but still India’s healthcare falls well below international benchmarks for physical infrastructure and manpower and even falls below the standards existing in comparable developing countries. Thus, India’s healthcare sector needs to scale up considerably in terms of the availability and quality of its physical infrastructure as well as human resources so as to meet the growing demand and to compare favourably with international standards. Also, despite the giant steps taken by the Indian healthcare industry, there is a need for improvement in customer service.

2.4 Literature on Indian studies in healthcare quality

Numerous studies are available on Indian healthcare focusing on various healthcare aspects and related issues such as SQ, SQ dimensions, SQ model, customer satisfaction (CS) and many others. Some of the studies have been undertaken to measure the perception of patient/beneficiaries of hospital services regarding SQ (Rahman and Qureshi, 2009; Dasanayaka et al., 2012; Sohail, 2003). Despite these attempts, there is still lack of literature available on development of an integrated quality model for Indian HCEs. Some of the selected studies on healthcare and related issues in Indian context as reported in the healthcare literature are presented in Table 1.

Table 1 Literature on Indian healthcare studies

Study Objective Methodology/approach Major findings

Deshwal et al. (2014)

To identify the SQ dimensions that play an important role in patient satisfaction in campus clinics in Delhi and assess student satisfaction with service and suggest ways to improve areas of dissatisfaction

Questionnaire survey using convenience sampling method was used to approach respondents

The dimensions that affects patient satisfaction were: staff professionalism; clinic staff reliability; clinic accessibility and basic facilities; tangibles; cleanliness; awareness of the clinic/diseases and how clinic staff deals with emergencies

Padma et al. (2014)

To provide strategic recommendations to Indian hospital administrators for improving SQ by analysing performance dimensions and the importance attached to them by patients and attendants

Patient and attendant perceptions were collected using a questionnaire

Patients and attendants have different perceptions. Different customers have different needs of which providers need to be aware to better serve their consumers

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Table 1 Literature on Indian healthcare studies (continued)


Chaudhuri and Lillrank (2013)

To identify capabilities required for healthcare service providers to provide mass services and provide directions to conduct empirical studies to understand the phenomenon of mass personalisation

A literature review followed by field visits and interviews conducted at a leading healthcare service providers

Literature review coupled with field visits and interviews helped in identifying the key research questions related to mass personalisation of Indian healthcare system

Talib and Rahman (2013)

To examine the current status and demographic characteristics of Indian healthcare and hospitality industries

Questionnaire survey of 120 Indian healthcare and, hotels and tourism companies were conducted and employed chi-square statistical test

The finding present a holistic picture of current status of these two Indian service industries which may help the Indian service managers and practitioners to further exploit opportunities in these two industries

Azam et al. (2012a)

To identify and conceptualise quality parameters in healthcare establishment (HCE) at professional technical level as well as at supportive managerial level

Questionnaire survey of 440 bed multi-specialty government hospital of North India

Validated the parameters with acceptance of these quality dimensions by the hospital staff appreciating its practical utility for patient care both from professional technical and management point of view

Khan et al. (2012)

To measure SQ performance in corporate hospitals using AHP

SERVQUAL model and AHP tool was adopted

The ranking of the dimensions like reliability, assurance, tangible, empathy and responsiveness were done to get best quality of services

Narang (2011)

To measure the perception of patients towards quality of services in public healthcare centres in rural India

A reliable and validated instrument was employed for the study. Mixed sampling technique was employed to select the sample

The opinions of the respondents towards healthcare quality were not very favourable. Negative scores were obtained on items, ‘availability of adequate medical equipments’ and ‘availability of doctors for women’. Education, gender and income were found to be significantly associated with user perception




Chahal and Kumari (2011)

To examine the three dynamics of customer relationship management (CRM), namely, SQ, CS and customer loyalty (CL) in the healthcare sector through indoor patients’ judgment

About 400 indoor patients from different departments were selected using proportionate stratified random sampling method. Data validity and reliability were duly assessed using exploratory factor analysis (EFA). The data were then analysed using structural equation modelling

Based on data analysis, the direct effect of CRM dynamics, i.e., physical environment quality (PEQ) and interaction quality (IQ) on SQ and their ultimate effect on CS and CL is found to be significant. However, the model fit values came out poor

Yeoh (2011) To contribute to the literature on emerging multinationals by studying the internationalisation strategies of two established companies in the Indian pharmaceutical industry: Ranbaxy and Wockhardt

A longitudinal case-study approach was utilised to capture Ranbaxy’s and Wockhardt’s dynamic internationalisation patterns

The internationalisation patterns of Ranbaxy and Wockhardt suggest that the mainstream internationalisation models are more effective in explaining exploitative learning while the emerging internationalisation models are more effective in explaining exploratory learning

Gaur et al. (2011)

To examine how patients’ loyalty and confidence in their doctors, are influenced by doctors’ interaction behaviour, namely, listening and explaining behaviour

Primary data collection followed by reliability and validity tests. Finally regression analysis was performed

The study demonstrates that doctors’ interaction behaviour is instrumental in developing an effective relationship with their patients and boosts patients’ confidence in their doctors. Also, effective interaction enhances patients’ loyalty to their service providers

Dongre et al. (2010)

To evaluate the possibility of marketing specific low-cost drugs across segmented markets in India.

Empirical study based on the primary data gathered through actual field survey. The study analyses the attitudes, perceptions and experiences from 20 healthcare organisations from different parts of the State of Karnataka in India

The survey findings revealed that patients would be happy and would have better access to medicine if the same is offered at a lower price. Doctors are willing to prescribe generic drugs. Generic drug market has good economic feasibility

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Aagja and Garg (2010)

To measure perceived service quality of public hospitals.

Literature review using Delphi method. Experts’ opinion on development of scale. Survey and scale validation

A reliable and valid scale called public hospital SQ (PubHosQual) was developed to measure the five dimensions of hospital SQ: admission, medical service, overall service, discharge process and social responsibility

Padma et al. (2009)

To determine the dimensions of SQ in Indian hospitals, from the perspectives of patients and their family members/friends (referred to as ‘attendants’)

Based on the existing models and the literature on healthcare services, a framework is proposed to conceptualise and measure hospital SQ

Two instruments for measuring the dimensions of hospital SQ, one each from the perspective of patients and attendants, are proposed

3 Service quality

Voluminous literature is available on SQ with studies ranging from exploration of its inherent dimensions to its impact on service outcomes. This section presents an overview of the existing literature on the definitions of SQ, its development, measurement and application in healthcare sector as well as its influence on patient satisfaction.

3.1 SQ defined

According to Padma et al. (2009), SQ means perceived SQ, the literature on healthcare SQ has considered evaluating services from patients’ perception. Patients are interested not only in the quality of care but also in the quality of service. Generally, healthcare organisations do not pay significant attention to quality of services. Lim and Tang (2000) argued that SQ can be used as a strategic differentiation weapon for building distinctive advantages. The literature on SQ suggest that it can be broken down into two distinct dimensions (Grönroos, 2000; Zineldin et al., 2011). They are: technical dimension and process/functional dimension. Technical dimension in the healthcare sector is defined primarily on the basis of the technical accuracy of the medical diagnoses and procedures, or the conformance to professional specification and standards. Functional dimension refers to the manner in which the healthcare service is delivered to the patients and quality of patient relationship with the organisation.

Parasuraman et al. (1988), who developed the widely used SERVQUAL scale, defined SQ as a judgment or evaluation relating to service superiority. They explained SQ on five dimensions i.e., tangibility, empathy, assurance, reliability and responsiveness. They further elaborated SQ as the gap between customers’ expectations of service and their perception of the service experience. They proposed SERVQUAL framework to assess perceived SQ for variety of sectors. SERVQUAL quality is a multidimensional concept and in order to operationalise it, many variables have to be considered (Zineldin, 2006). According to Rust and Oliver (1994), SQ stems from service


specific attributes or cues, while satisfaction involves a wider range of determinants, including quality judgments, needs and equity perceptions. They developed a three dimensional concept of SQ: service product, service environment and service delivery. While Otani et al. (2009) observed that the excellent service attributes that influence on patient satisfaction and loyalty are admission, nursing care, physician care, staff care, food and room. Similarly, Camgöz-Akdağ and Zineldin (2010) asserted that SQ in healthcare not only depends on the quality of physicians but also includes the staff, nurses, building, waiting room, equipments and machines used during care of patient. It can further be said that healthcare quality and patient satisfaction is more detailed than just dividing the quality of service into technical and functional dimensions.

The technical, functional and SERVQUAL quality models can be expanded into a structure of five quality dimensions namely quality of object-the technical quality, quality of processes-the functional quality, quality of infrastructure-the basic resources, quality of interaction-measures the quality of information exchange and quality of atmosphere-the relationship and interaction process between the parties are influenced by the quality of the atmosphere in a specific environment where they cooperate and operate (Zineldin, 2000).

3.2 Development of SERVQUAL

Parasuraman et al. (1985) asserted that perceived SQ is an overall evaluation similar to attitude. They proposed that SQ is a function of the differences or gaps between customers’ expectation and performance along the quality dimensions and therefore, this model is called ‘gaps model’. Gaps model indicates five gaps during service delivery process, which may lead to dissatisfaction of the customers. Later, Parasuraman et al. (1988) refined their existing model and came up with a new scale to measure SQ known as ‘SERVQUAL’. This scale consisted of five dimensions namely tangibles, reliability, responsiveness, assurance and empathy. The description of these dimensions is as follows:

• tangibles-physical evidence in a service facility (e.g., personnel, equipment, etc)

• reliability-ability to provide services accurately and dependably

• responsiveness-readiness or quickness in responding to customers’ needs

• assurance-courtesy and knowledge of the employees and their ability to convey trust and confidence

• empathy-caring and individualised attention provided to customers.

Since than several SQ models have been evolved from different authors’ works (Table 2). But Parasuraman et al. (1985, 1988) SERVQUAL model is the prominent one. Despite controversies regarding SERVQUAL validity and reliability (Purcărea et al., 2013; Newman et al., 2001; Cronin and Taylor, 1992); its application, with or without modification, is common especially in healthcare sector. Parasuraman et al. (1991) further addressed the issues raised by Babakus and Boller (1992) by vindicating the use of gap scores for measuring SQ. They modified the negatively worded items in their instrument to improve the overall reliability values of the scale. Cronin and Taylor (1992) disagreed with the gaps-score measurement and proposed that measuring SQ in terms of performance alone would be sufficient and developed performance-only measurement

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scale, which is known as ‘SERVPERF’ instrument. Parasuraman et al. (1994) responded to these concerns and again revised their original instrument accordingly. However, Carman (1990) arrived at a different dimensional structure while using SERVQUAL scale in a study pertaining to hospitals. Nine dimensions were found: admission service, tangible accommodations, tangible food, tangible privacy, nursing care, explanation of treatment, access and courtesy afforded visitors, discharge planning and patient accounting. These dimensions explained sufficient variance in SQ. Table 2 Hospital SQ dimensions and models from selected studies

Author(s) SQ dimensions/model

Parasuraman et al. (1985) Tangibles, reliability, responsiveness, communication, credibility, security, competence, courtesy, understanding and access

Parasuraman et al. (1988) Tangibles, reliability, responsiveness, assurance and empathy

Carman (1990) Admission, tangibles accommodation, tangible food, tangible privacy, nursing, explanation visitor access, courtesy, discharge planning and patient accounting

Edvardsson et al. (1994) Experience, knowledge and competence of hospital personnel, combined with their commitment and willingness to serve the customer, reliability, trust, empathy and handling of critical factors

Zairi (1998) Deming prize, Malcolm Baldridge National Quality Award (MBNQA), European Quality Award and the George M Low NASA quality award

Ovretveit (2000) Client, professional and management quality

Zeithaml et al. (2002) Information availability, ease of use, privacy/security, graphic style reliability

Raduan et al. (2004) Security; performance aesthetics, convenience, economy and reliability

Duggirala et al. (2008a) Infrastructure, personnel quality, process of clinical care, administrative procedures, safety indicators, overall, experience of medical care received and social responsibility

Padma et al. (2009) Infrastructure, personnel quality, process of clinical care, administrative procedures, safety indicators, corporate image, social responsibility, trustworthiness of the hospital

Aagja and Garg (2010) Admission, medical service, overall service, social responsibility, discharge (PubHosQual Model)

Zineldin et al. (2009) Object, processes, infrastructure, interaction and atmosphere

Hsieh (2012) MOT Model: managerial, operational and technical quality dimensions

Untachai (2013) Reliability, tangible, response, cost and empathy

Deshwal et al. (2014) Staff professionalism, clinic staff reliability, clinic accessibility and basic facilities, tangibles, cleanliness, awareness of the clinic/diseases and how clinic staff deals with emergencies

Lim and Tang (2000) added ‘accessibility/affordability’, Tucker and Adams (2001) ‘caring and outcomes’ while Johnston (1995) increased SERVQUAL to 18 dimensions,


which generally fall under those identified by Potter et al. (1994): technical, interpersonal, amenities and environment. Hence, it can be believed that SERVQUAL modifications vary from researcher to researcher and is still the most widely used model in the field of SQ. Table 2 provides a summary of dimensions and models on SERVQUAL as used by different researchers in their studies.

Further, several researchers have identified the advantages of adopting SERVQUAL, some of them are (Isik et al., 2011; Rohini and Mahadevappa, 2006; Padma et al., 2009):

• it is accepted as a standard for assessing different dimensions of SQ

• it has been shown to be valid for a number of service situations

• it has been known to be reliable

• the instrument is parsimonious in that it has a limited number of items. This means that customers and employers can fill it out quickly

• it has a standardised analysis procedure to aid interpretation and results.

3.3 Applications of SERVQUAL

During the past few decades, SQ has become a major area of attention to practitioners, managers and researchers owing to its strong impact on business performance, lower costs, customer satisfaction (CS), customer loyalty (CL) and profitability (Newman et al., 2001; Dagger and Sweeney, 2006; Kuo et al., 2009; Khan et al., 2012; Kitapci et al., 2014). There have been several important researches on SQ especially the application of SERVQUAL framework. Several attempts have also been made to apply this framework in different industries and sectors like healthcare, banking, hospitality, tourism and many others to assess customers’ perceptions of SQ (Rohini and Mahadevappa, 2006; Duggirala et al., 2008a, 2008b; Kitapci et al., 2014). An examination of the literature on SERVQUAL in different sectors is depicted in Table 3. Table 3 Applications of SERVQUAL

Sector Literature

Healthcare Curry and Sinclair (2002), O’Connor and Shewchuk (2003), Boshoff and Gray (2004), Taner and Antony (2006), Duggirala et al. (2008a, 2008b), Ramsaran-Fowdar (2008), Padma et al. (2009), Butt and de Run (2010), Isik et al. (2011), Khan et al. (2012), Dasanayaka et al. (2012), Abuosi and Atinga (2013), Purcărea et al. (2013), Duan et al. (2014) and Mashhadiabdol et al. (2014)

Banking Gan et al. (2006), Herington and Weaven (2007), Poolthong and Mandhachitara (2009), Tsoukatos and Mastrojianni (2010), Awan et al. (2011), Al-Zubaidi and Al-Asousi (2012) and Choudhury (2013)

Hospitality and tourism

Lau et al. (2005), Nadiri and Hussain (2005), Narayan et al. (2009), Qin et al. (2010), Crick and Spencer (2011), Bastič and Gojčič (2012), Lee (2014) and Albayrak and Caber (2015)

Education Mai (2005), Sahu (2007), Shekarchizadeh et al. (2011), Abili et al. (2012), Al-Borie and Damanhouri (2013), Alnsour et al. (2014) and Shahin et al. (2014)

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3.4 SQ in healthcare (application of SERVQUAL)

Measuring SQ in healthcare industry is difficult to evaluate as understanding the patient perception and satisfaction is quite complex and significant (Padma et al., 2009). The plausible reason may be that in healthcare industry, different hospitals provide the same type of services, but they do not provide the same quality of services (Youseff et al., 1996). Thus, studying the SQ in healthcare is essential. Furthermore, consumers today are more aware of alternatives being offered and rising standards of services. These changes have increased their expectations (Lim and Tang, 2000). With increased competition due to globalise and tough market conditions as well as the need to satisfy patients, the elements of quality control, quality service and effectiveness of medical treatment have become vital (Suki et al., 2011). To overcome these issues, SERVQUAL scales have been widely used in healthcare studies to assess customers’ perception of SQ in a number of service categories like patient satisfaction, acute care hospital, etc. (Lim and Tang, 2000; Taner and Antony, 2006; Zineldin et al., 2009; Dasanayaka et al., 2012; Mashhadiabdol et al., 2014). Its use in healthcare has produced varied results suggesting that it need further improvement (Duggirala et al., 2008a; Purcărea et al., 2013; Kitapci et al., 2014).

In a study conducted by Rohini and Mahadevappa (2006), applied SERVQUAL framework and factors in their study on Bangalore (India) hospitals. They obtained the perceptions of both the patients and the hospital management. The study concluded that there exist an overall gap between patient’s perceptions and expectations and also between management’s perception of patients’ expectations and patient’s expectations. The authors provided recommendations to fill those gaps.

Sohail (2003) measured the SQ in Malaysia using the SERVQUAL model and found that all scores for perception exceeded the expectations for all measures examined. This indicated that the perceived value of SQ has exceeded the initial expectation for all variables within all dimensions. This would suggest that hospitals in Malaysia provide services that exceed the expectations of their patients. The t-test confirmed the finding of the study.

Aagja and Garg (2010) developed a scale for measuring perceived SQ for one multi-specialty public hospital in Ahmedabad (India) from the user’s (patient’s) perspective. The objective was to measure perceived SQ of public hospitals. PubHosQual was developed to measure the five dimensions of hospital SQ: admission, medical service, overall service, discharge process and social responsibility. Duggirala et al. (2008a) proposed that healthcare SQ consisted of seven dimensions, namely, infrastructure, personnel quality, process of clinical care, administrative processes, safety indicators, overall experience of medical care and social responsibility.

Strawderman (2005) performed researched on human factors. To model SQ, six dimensions were proposed whereby the five dimensions of SERVQUAL were used (i.e., responsiveness, reliability, assurance, empathy and tangibles). A sixth dimension, usability, was added in a modified survey instrument termed SERVUSE. Both measurement tools, SERVQUAL and SERVUSE, were found to be significant predictors of SQ, satisfaction and behavioural intention in the healthcare setting.

In another study by Eleuch (2011) assessed Japanese patients’ healthcare SQ perceptions through a nonlinear approach. The study relies on a nonlinear approach to assess patient overall quality perceptions in order to enrich knowledge. Furthermore, the research was conducted in Japan where healthcare marketing studies were scarce owing


to cultural and language barriers. Japanese culture and healthcare system characteristics are used to explain and interpret the results.

In a study conducted by Butt and de Run (2010) developed and test validated the SERVQUAL model to measure the Malaysian private health SQ. Means, correlations, principal component and confirmatory factor analysis (CFA) were performed to establish the modified SERVQUAL scale’s reliability, underlying dimensionality and convergent, discriminant validity. A moderate negative quality gap for overall Malaysian private healthcare SQ was found. A moderate negative quality gap on each SQ scale dimension was also indicated. The major contribution of the study was that it offered a way to assess private healthcare SQ and successfully developed a scale that can be used to measure health SQ in Malaysia.

Further, Abuosi and Atinga (2013) examined two key issues in healthcare institutions, one to assess patients’ hospital SQ perceptions and expectation using SERVQUAL and other to outline the distinct concepts used to assess patient perceptions. In doing so, they observed that patient expectations were not being met during medical treatment. Perceived SQ was rated lower than expectations for all variables. Implying that the hospital managers should consider stepping up staffing levels by client-centred training programs to help clinicians deliver care to patients’ expectations.

A recent study by Akdag et al. (2014) applied the fuzzy multiple criteria decision-making (MCDM) to evaluate the SQ of Istanbul (Turkey) hospitals. The authors make use of many MCDM techniques to evaluate the hospitals SQ like AHP, TOPSIS, Yager’s min-max approach together with some numerical application techniques. The results were obtained and compared.

In spite of SERVQUAL’s popularity, some authors developed their own instrument to measure SQ, which may accomplish their research objectives.

3.5 SQ and patient satisfaction

In recent years, SQ and patient satisfaction has gained increasing attention especially in healthcare context (Azam et al., 2012b; Badri et al., 2006, 2009; York and McCarthy, 2011; Owusu-Frimpong et al., 2010). Also, past studies showed that there is a strong link between SQ and patient satisfaction (Andaleeb, 2001; Badri et al., 2009; Kitapci et al., 2014). In the healthcare literature, SQ and patient satisfaction have been considered as two major issues. Importance of patient satisfaction especially service encounters is well documented in the marketing and management literature (Meirovich and Bahnan, 2008). SQ in service encounters is frequently depicted as being the outcome of an interactive process between the service provider and the service receiver. The interactive features of SQ in service encounters are thus, crucial to the ultimate outcome (Owusu-Frimpong et al., 2010). Further, patient satisfaction in healthcare organisations is considered crucial when planning, implementing, evaluating service delivery, as well as in quality improvement, overall customer relationship management (CRM) and strategic planning initiatives (Evenhaim, 2000). In fact, meeting patient’s needs and developing healthcare standards are obligatory for high quality care (Badri et al., 2009).

There are several studies which focus on SQ and patient satisfaction. Many of them provided empirical evidences for the positive link between SQ and patient satisfaction (Lim and Tang, 2000; Strawderman, 2005; Padma et al., 2010; Lee et al., 2012).

Gonzàlez et al. (2005) confirmed the positive relationship between patient satisfaction and healthcare SQ during hospital stay. Dagger and Sweeney (2006) also supported with

16 F. Talib et al.

the finding that SQ is closely related to the CS. They further asserted that performance of SERVPERF is better than SERVQUAL in explaining CS. A study by Boshoff and Gray (2004) on CS and loyalty among patients in the private healthcare industry in South Africa observed that SERVQUAL dimensions like nursing staff empathy, assurance and tangibles, impact positively on patients’ loyalty.

Similarly, a study by Hong and Goo (2004) observed the path SQ → CS → loyalty to be significant in Taiwanese service firms. Otani and Kurz (2004) concluded that nursing was more important in improving CS and behavioural intentions than other factors. Another study by Tam (2004) found that as customers’ perceptions of the quality of the service increased, they felt more satisfied with the service and in turn perceived higher value.

A study by Curry and Sinclair (2002) utilised the SERVQUAL model to establish that patient satisfaction is enhanced when communication between patients and providers is such that patients have access to information relating to their conditions and treatment. Lin and Ding (2005) looked into the moderating effect of prior information technology experience on the link between network quality and satisfaction. The effect was not found to be significant, while it significantly affected the link between and service recovery and satisfaction. Suhonen et al. (2004) proposed an individualised care model linking patient satisfaction with nursing care, patient autonomy and perceived health related quality of life. Their approach included dimensions related to healthcare quality and patient satisfaction.

A comprehensive structural equation-based SQ and patient satisfaction model was developed and presented by Badri et al. (2009) to measure the patient’s condition before and after discharge in United Arab Emirates public hospitals. The structural equation modelling (SEM) supported the healthcare quality-patient status-satisfaction model. Further, a study by Owusu-Frimpong et al. (2010) explored patients’ satisfaction with access to treatment in both the public and private healthcare sectors in London. The results revealed varying access experiences among public and private care users.

Padma et al. (2010) conceptualise hospital SQ into its component dimensions from the perspectives of patients and their attendants and analysed the relationship between SQ and CS in government and private hospitals of India. The study revealed that the hospital service providers have to understand the needs of both patients and attendants in order to gather a holistic view of their services. The study allowed the hospital administrators to benchmark their hospitals with those of their competitors by comparing the mean values of the dimensions of SQ. The study also allows a comparison of the performance of government and private hospitals in terms of the services offered.

In another study by York and McCarthy (2011) on patient, staff and physician satisfaction, developed a new model and instrument for measuring customer-satisfaction level and compared it with traditional techniques using data gathered from healthcare clinics. Findings suggested that the ultimate question provides similar ratings to existing models at lower costs.

Finally, Kitapci et al. (2014) investigated the effect of SQ dimensions on patient satisfaction, identified the effect of satisfaction on word-of-mouth communication and repurchase intention and searched a significant relationship between word-of-mouth and repurchase intention in Turkish healthcare industry. The study adopted SERVQUAL variables and utilised SEM. They found that empathy and assurance dimensions are positively related to CS. Additionally, CS has a significant effect on word-of-mouth and repurchase intention which were found to be highly related.


The related literature acknowledges the importance of SQ and patient satisfaction and thus, the researchers may use this feedback for further study in improving the performance of HCEs.

4 Conclusions

This study present the extensive literature review on various aspects pertaining to healthcare quality and its related issues. The literature is classified into various categories like definitions of health, healthcare quality, studies on Indian healthcare system, SQ, development and application of SERVQUAL, as well as link between SQ and patient satisfaction. Literature review on different studies applied to link SQ and patient satisfaction for healthcare organisations has also been reported. From review of this literature, certain gaps were identified and these gaps provide a direction to conduct the present research efforts. An attempt has been made in this research which contribute to the body of knowledge on the above identified issues and areas to create scope for future research in HCEs. This paper also discerns the hospital SQ dimensions and models from selected studies for the HCEs as suggested by a number of authors. In continuation to this, some key healthcare SQ dimensions were identified which may be utilised for development of an integrated model of quality for HCEs as suggested by some researchers. The implications of this study elucidate an understanding that the management of SQ requires both a focus on healthcare quality dimensions as well as day-to-day operational management. It is recommended that healthcare researchers and practitioners focus on the critical dimensions identified herein and employ this literature survey to manage and better understand the nature of hospital QM practices not only India but across wider geographical regions and over longer time periods. Moreover, the outcome of this literature review is important for Indian healthcare managers and practitioners with respect to the outpatient aspects of SQ. They should make effort to modernise hospitals and should successfully improve the level of SQ. Finally, the study attempts to provide a comprehensive review of literature for Indian healthcare managers and practitioners to enable them a better understanding of healthcare services and implement them in their HCEs to achieve greater levels of patient satisfaction.

This paper although successfully achieves the set objectives, there are opportunities for further research. Further in-depth investigation needs to develop and validate the HCE model using SEM by gathering primary data through the survey of Indian HCEs like multi-specialty, super-specialty, private nursing homes, government aided hospitals and civil hospitals so that the quality of services could be improved and sustained by achieving higher patients’ satisfaction level. An attempt should also be made to further explore a more appropriate method of improving SQ level in Indian HCEs through a comparative study of international standard criteria and/or awards to generalisability.

References Aagja, J.P. and Garg, R. (2010) ‘Measuring perceived service quality for public hospitals

(PubHosQual) in the Indian context’, International Journal of Pharmaceutical and Healthcare Marketing, Vol. 4, No. 1, pp.60–83.

Abili, K., Thani, F.N. and Afarinandehbin, M. (2012) ‘Measuring university service quality by means of SERVQUAL method’, Asian Journal on Quality, Vol. 13, No. 3, pp.204–211.

18 F. Talib et al.

Abuosi, A.A. and Atinga, R.A. (2013) ‘Service quality in healthcare institutions: establishing the gaps for policy action’, International Journal of Health Care Quality Assurance, Vol. 26, No. 5, pp.481–492.

Agus, A. (2005) ‘The structural linkages between TQM, product quality performance, and business performance: preliminary empirical study in electronics companies’, Singapore Management Review, Vol. 27, No. 1, pp.87–105.

Akdag, H., Kalaycı, T., Karagöz, S., Zülfikar, H. and Giz, D. (2014) ‘The evaluation of hospital service quality by fuzzy MCDM’, Applied Soft Computing, Vol. 23, pp.239–248.

Albayrak, T. and Caber, M. (2015) ‘Prioritisation of the hotel attributes according to their influence on satisfaction: a comparison of two techniques’, Tourism Management, Vol. 46, No. 1, pp.43–50.

Al-Borie, H.M. and Damanhouri, A.M.S. (2013) ‘Patients’ satisfaction of service quality in Saudi hospitals: a SERVQUAL analysis’, International Journal of Health Care Quality Assurance, Vol. 26, No. 1, pp.20–30.

Alnsour, M.S., Tayeh, B.A. and Alzyadat, M.A. (2014) ‘Using SERVQUAL to assess the quality of service provided by Jordanian telecommunications Sector’, International Journal of Commerce and Management, Vol. 24, No. 3, pp.209–218.

Al-Zubaidi, H. and Al-Asousi, D. (2012) ‘Service quality assessment in central blood bank: blood donors’ perspective’, Journal of Economic and Administrative Sciences, Vol. 28, No. 1, pp.28–38.

Andaleeb, S. (2001) ‘Service quality perceptions and patient satisfaction: a study of hospitals in a developing country’, Social Science and Medicine, Vol. 52, No. 12, pp.1359–1370.

ASSOCHAM and YES BANK Report (2010) Healthcare Services in India (2012): The Path Ahead, India [online] http://www.yesbank.in/knowledge-banking/life-sciences/knowledge-reports.html (accessed 10 December 2013).

Awan, H.M., Bukhari, K.S. and Iqbal, A. (2011) ‘Service quality and customer satisfaction in the banking sector: a comparative study of conventional and Islamic banks in Pakistan’, Journal of Islamic Marketing, Vol. 2, No. 3, pp.203–224.

Azam, M., Rahman, Z. and Talib, F. (2012a) ‘Core quality and associated supportive quality parameters: a conceptual quality frame work in health care establishment’, International Journal of Business Excellence, Vol. 5, No. 3, pp.238–277.

Azam, M., Rahman, Z. and Talib, F. and Singh, K.J. (2012b) ‘A critical study of quality parameters in health care establishment: developing an integrated quality model’, International Journal of Health Care Quality Assurance, Vol. 25, No. 5, pp.387–402.

Babakus, E. and Boller, G.W. (1992) ‘An empirical assessment of the SERVQUAL scale’, Journal of Business Research, Vol. 24, No. 3, pp.253–268.

Badri, M., Attia, S. and Ustadi, A. (2008) ‘Testing the not so obvious models in healthcare quality’, International Journal for Quality in Healthcare, Vol. 21, No. 2, pp.159–174.

Badri, M., Cleary, S., Maartens, G., Pitt, J., Bekker, L-G., Orrell, C. and Wood, R. (2006) ‘When to initiate highly active antiretroviral therapy in sub-Saharan Africa? A South African cost-effectiveness study’, International Medical Press, Vol. 11, No. 1, pp.63–72.

Badri, M.A., Attia, S. and Ustadi, A.M. (2009) ‘Healthcare quality and moderators of patient satisfaction: testing for causality’, International Journal of Health Care Quality Assurance, Vol. 22, No. 4, pp.382–410.

Bastič, M. and Gojčič, S. (2012) ‘Measurement scale for eco-component of hotel service quality’, International Journal of Hospitality Management, Vol. 31, No. 3, pp.1012–1020.

Bertolini, M., Bevilacqua, M., Ciarapica, F.E. and Giacchetta, G. (2011) ‘Business process re-engineering in healthcare management: a case study’, Business Process Management Journal, Vol. 17, No. 1, pp.42–66.

Blazey, M.L. (2005) Insights to Performance Excellence 2005: An Inside Look at the 2005 Baldrige Award Criteria, ASQ Press, Milwaukee.


Boshoff, C. and Gray, B. (2004) ‘The relationships between service quality, customer satisfaction and buying intentions in the private hospital industry’, South African Journal Business Management, Vol. 35, No. 4, pp.27–38.

Butt, M.M. and de Run, E.C. (2010) ‘Private healthcare quality: applying a SERVQUAL model’, International Journal of Health Care Quality Assurance, Vol. 23, No. 7, pp.658–673.

Büyüközkan, G. and Çifçi, G. (2012) ‘A combined fuzzy AHP and fuzzy TOPSIS based strategy analysis of electronic service quality in healthcare industry’, Expert Systems with Applications, Vol. 39, No. 3, pp.2341–2354.

Camgöz-Akdağ, H. and Zineldin, M. (2010) ‘Quality of health care and patient satisfaction: an exploratory investigation of the 5Qs model at Turkey’, Clinical Governance: An International Journal, Vol. 15, No. 2, pp.92–101.

Carman, J.M. (1990) ‘Consumer perceptions of service quality: an assessment of the SERVQUAL dimensions’, Journal of Retailing, Vol. 66, No. 1, pp.33–55.

Chahal, H. and Kumari, N. (2011) ‘Evaluating customer relationship dynamics in healthcare sector through indoor patients’ judgment’, Management Research Review, Vol. 34, No. 6, pp.626–648.

Chaudhuri, A. and Lillrank, P. (2013) ‘Mass personalization in healthcare: insights and future research directions’, Journal of Advances in Management Research, Vol. 10, No. 2, pp.176–191.

Choudhury, K. (2013) ‘Service quality and customers’ purchase intentions: an empirical study of the Indian banking sector’, International Journal of Bank Marketing, Vol. 31, No. 7, pp.529–543.

Counte, M.A. and Meurer, S. (2001) ‘Issues in the assessment of continuous quality improvement implementation in health care organizations’, International Society for Quality in Health Care, Vol. 13, No. 3, pp.197–207.

Crick, A.P. and Spencer, A. (2011) ‘Hospitality quality: new directions and new challenges’, International Journal of Contemporary Hospitality Management, Vol. 23, No. 4, pp.463–478.

Cronin, J.J. and Taylor, S.A. (1992) ‘Measuring service quality: a re-examination and extension’, Journal of Marketing, Vol. 56, No. 3, pp.55–68.

Curry, E. and Sinclair, A. (2002) ‘Assessing the quality of physiotherapy services using SERVQUAL’, International Journal of Health Care Quality Assurance, Vol. 15, No. 5, pp.197–205.

Dagger, T.S. and Sweeney, P.M. (2006) ‘The effect of service evaluation on behavioral intentions and quality of life’, Journal of Service Research, Vol. 9, No. 1, pp.2–19.

Dasanayaka, S.W.S.B., Gunasekera, G.S.P. and Sardana, G.D. (2012) ‘Quality of healthcare service delivery in public sector hospitals: a case study based on Western Province in Sri Lanka’, World Review of Entrepreneurship, Management and Sustainable Development, Vol. 8, No. 2, pp.148–164.

Deshwal, P., Ranjan, V. and Mittal, G. (2014) ‘College clinic service quality and patient satisfaction’, International Journal of Health Care Quality Assurance, Vol. 27, No. 6, pp.519–530.

Dongre, Y., Mahadevappa, B. and Rohini, R. (2010) ‘Building access to healthcare in rural India: possibility and feasibility of low-cost medicine’, International Journal of Pharmaceutical and Healthcare Marketing, Vol. 4, No. 4, pp.396–407.

Duan, G., Qiu, L., Yu, W. and Hu, H. (2014) ‘Outpatient service quality and doctor-patient relationship: a study in Chinese public hospital’, International Journal of Services, Economics and Management, Vol. 6, No. 1, pp.97–111.

Duggirala, M., Rajendran, C. and Anantharaman, R.N. (2008a) ‘Patient-perceived dimensions of total quality service in healthcare’, Benchmarking: An International Journal, Vol. 15, No. 5, pp.560–583.

20 F. Talib et al.

Duggirala, M., Rajendran, C. and Anantharaman, R.N. (2008b) ‘Provider-perceived dimensions of total quality management in healthcare’, Benchmarking: An International Journal, Vol. 15, No. 6, pp.693–722.

Edvardsson, B., Thomasson, B. and Ovretveit, J. (1994) Quality of Service: Making it Really Work, McGraw-Hill International Limited, Maidenhead.

Eleuch, A.K. (2011) ‘Healthcare service quality perception in Japan’, International Journal of Health Care Quality Assurance, Vol. 24, No. 6, pp.417–429.

Evenhaim, A. (2000) ‘Building relationships: healthcare CRM strategies on the net’, Pharmaceutical Executive Supplement, Vol. 12, No. 2, pp.36–44.

Gan, C., Clemes, M., Limsobunchai, V. and Weng, A. (2006) ‘A logit analysis of electronic banking in New Zealand’, International Journal of Marketing, Vol. 24, No. 6, pp.360–383.

Gaur, S.S., Xu, Y., Quazi, A. and Nandi, S. (2011) ‘Relational impact of service providers’ interaction behavior in healthcare’, Managing Service Quality, Vol. 21, No. 1, pp.67–87.

Gonzàlez, M.E., Quesada, G., Mack, R. and Urrutia, I. (2005) ‘Building an activity-based costing hospital model using quality function deployment and benchmarking’, Benchmarking: An International Journal, Vol. 12, No. 4, pp.310–329.

Grönroos, C. (2000) Service Management and Marketing – A Customer Relationship Management Approach, John Wiley and Sons, Chichester.

Herington, C. and Weaven, S. (2007) ‘Can banks improve customer relationships with high quality online services?’, Managing Service Quality, Vol. 17, No. 4, pp.404–427.

Hong, S.C. and Goo, Y.J.J. (2004) ‘A causal model of customer loyalty in professional service firms: an empirical study’, International Journal of Management, Vol. 21, No. 4, pp.531–541.

Hsieh, S.Y. (2012) ‘Using complaints to enhance quality improvement: developing an analytical tool’, International Journal of Health Care Quality Assurance, Vol. 25, No. 5, pp.453–461.

Institute of Medicine (2001) Crossing the Quality Chasm, p.21, National Academic Press, Washington, DC.

Isik, O., Tengilimoglu, D. and Akbolat, M. (2011) ‘Measuring health care quality with the SERVQUAL method: a comparison in public and private hospitals’, HealthMED, Vol. 5, No. 6, pp.1921–1930.

Johnston, R. (1995) ‘The determinants of service quality; satisfiers and dissatisfiers’, International Journal of Service Industry Management, Vol. 6, No. 5, pp.53–71.

Kacak, H., Ozcan, Y.A. and Kavuncubasi, S. (2014) ‘A new examination of hospital performance after healthcare reform in Turkey: sensitivity and quality comparisons’, International Journal of Public Policy, Vol. 10, Nos. 4/5, pp.178–194.

Khan, A.M.R., Prasad, P.N. and Rajamanoharane, S. (2012) ‘Service quality performance measurement management in corporate hospitals using analytical hierarchy process’, International Journal of Manufacturing Technology and Management, Vol. 26, Nos. 1/2/3/4, pp.196–212.

Kitapci, O., Akdogan, C. and Dortyol, I.T. (2014) ‘The impact of SQ dimensions on patient satisfaction, repurchase intentions and word-of-mouth communication in the public healthcare industry’, Procedia-Social and Behavioral Sciences, Vol. 148, No. 1, pp.161–169.

Kuo, Y., Wu, C. and Deng, W. (2009) ‘The relationship among service quality, perceived value, customer satisfaction, and post-purchase intention in mobile value-added services’, Computer in Human Behavior, Vol.25, No. 4, pp.887–896.

Last, J.M. (Ed.) (1993) A Dictionary of Epidemiology, Oxford University press, New York. Lau, P.M., Akbar, A.K. and Fie, D.Y.G. (2005) ‘Service quality: a study of luxury hotels in

Malaysia’, The Journal of American Academy of Business, Vol. 7, No. 2, pp.46–56. Lee, K-J. (2014) ‘Attitudinal dimensions of professionalism and service quality efficacy

of frontline employees in hotels’, International Journal of Hospitality Management, Vol. 41, No. 1, pp.140–148.


Lee, S.M., Lee, D.H. and Kang, C-Y. (2012) ‘The impact of high-performance work systems in the health-care industry: employee reactions, service quality, customer satisfaction, and customer loyalty’, The Service Industries Journal, Vol. 32, No. 1, pp.17–36.

Lim, P.C. and Tang, N.K.H. (2000) ‘The development of a model for total quality healthcare’, Managing Service Quality, Vol. 10, No. 2, pp.103–111.

Lin, C.P. and Ding, C.G. (2005) ‘Opening the black box: assessing the mediating mechanism of relationship quality and the moderating effects of prior experience in ISP service’, International Journal of Service Industry Management, Vol. 16, No. 1, pp.55–80.

Liyanage, C. and Egbu, C. (2005) ‘Controlling healthcare associated infections (HAI) and the role of facilities management in achieving quality in health care: a three-dimensional view’, Facilities, Vol. 23, Nos. 5/6, pp.194– 215.

Mai, L.W. (2005) ‘A comparative study between UK and US: the student satisfaction in higher education and its influential factors’, Journal of Marketing Management, Vol. 21, Nos. 7/8, pp.859–878.

Mashhadiabdol, M., Sajadi, S.M. and Talebi, K. (2014) ‘Analysis of the gap between customers’ perceptions and employees’ expectations of service quality based on fuzzy SERVQUAL logic (case study: Mofid children’s hospital in Tehran, Iran)’, International Journal of Services and Operations Management, Vol. 17, No. 2, pp.119–141.

Meirovich, G. and Bahnan, N. (2008) ‘Product/service quality and the emotional aspect of customer satisfaction’, Academy of Management Proceedings, Academy of Management, New York, pp.1–6.

Meyer, S.M. and Collier, D.A. (2001) ‘An empirical test of the causal relationships in the Baldrige health care pilot criteria’, Journal of Operations Management, Vol. 19, No. 4, pp.403–425.

Nadiri, H. and Hussain, K. (2005) ‘Perceptions of service quality in North Cyprus hotels’, International Journal of Contemporary Hospitality Management, Vol. 17, No. 4, pp.469–480.

Narang, R. (2011) ‘Determining quality of public health care services in rural India’, Clinical Governance: An International Journal, Vol. 16, No. 1, pp.35–49.

Narayan, B., Rajendran, C. and Prakash Sai, L. (2009) ‘Scales to measure and benchmark service quality in tourism industry: a second-order factor approach’, Benchmarking: An International Journal, Vol. 15, No. 4, pp.469–493.

Newman, K., Maylor, U. and Chansarkar, B. (2001) ‘The nurse retention, quality of care and patient satisfaction chain’, International Journal of Health Care Quality Assurance, Vols. 14, No. 2, pp.57–68.

O’Connor, S.J. and Shewchuk, R. (2003) ‘Commentary-patient satisfaction: what is the point?’, Health Care Management Review, Vol. 28, No. 1, pp.21–24.

Otani, K. and Kurz, S. (2004) ‘The impact of nursing care and other healthcare attributes on hospitalized patient satisfaction and behavioural intentions’, Journal of Healthcare Management, Vol. 49, No. 3, pp.181–197.

Otani, K., Waterman, B., Faulkner, K.M., Boslaugh, S. and Boslaugh, T. (2009) ‘Patient satisfaction: focusing on excellent’, Journal of Health Management, Vol. 54, No. 2, pp.93–103.

Ovretveit, J. (2000) ‘Total quality management in European healthcare’, International Journal of Health Care Quality Assurance, Vol. 13, No. 2, pp.74–79.

Owusu-Frimpong, N., Nwankwo, S. and Dason, B. (2010) ‘Measuring service quality and patient satisfaction with access to public and private healthcare delivery’, International Journal of Public Sector Management, Vol. 23, No. 3, pp.203–220.

Padma, P., Lokachari, P.S. and Chandrasekharan, R. (2014) ‘Strategic action grids: a study in Indian hospitals’, International Journal of Health Care Quality Assurance, Vol. 27, No. 5, pp.360–372.

Padma, P., Rajendran, C. and Lokachari, P.S. (2010) ‘Service quality and its impact on customer satisfaction in Indian hospitals: perspectives of patients and their attendants’, Benchmarking: An International Journal, Vol. 17, No. 6, pp.807–841.

22 F. Talib et al.

Padma, P., Rajendran, C. and Sai, L.P. (2009) ‘A conceptual framework of service quality in healthcare perspectives of Indian patients and their attendants’, Benchmarking: An International Journal, Vol. 16, No. 2, pp.157–191.

Papadopoulos, T. (2011) ‘Continuous improvement and dynamic actor associations: a study of lean thinking implementation in the UK National Health Service’, Leadership in Health Services, Vol. 24, No. 3, pp.207–227.

Parasuraman, A., Berry, L.L. and Zeithaml, V.A. (1991) ‘Refinement and reassessment of the SERVQUAL scale’, Journal of Retailing, Vol. 67, No. 4, pp.420–450.

Parasuraman, A., Zeithaml, V. and Berry;, L. (1988) ‘SERVQUAL: a multiple-item scale for measuring consumer perceptions of service quality’, Journal of Retailing, Vol. 64, No. 1, pp.12–40.

Parasuraman, A., Zeithaml, V.A. and Berry, L.L. (1994) ‘Reassessment of expectations as a comparison standard in ensuring service quality: implications for further research’, Journal of Marketing, Vol. 58, No. 2, pp.111–124.

Parasuraman, A., Zeithaml, V.A. and Berry, L.L., (1985) ‘A conceptual model of service quality and its implications for future research’, Journal of Marketing, Vol. 49, No. 4, pp.41–50.

Park, K. (2007) Park’s Textbook of Preventive and Social Medicine, 19th ed., p.13, February, Banarsidas Bhanot Publishers, Jabalpur, India.

Planning Commission Report (2010) Government of India [online] http://www.planningcommission.nic.in/sector/health.html. (assessed 17 August 2011).

Poolthong, Y. and Mandhachitara, R. (2009) ‘Customer expectations of CSR, perceived service quality and brand effect in Thai retail banking’, International Journal of Bank Marketing, Vol. 27, No. 6, pp.408–427.

Potter, C., Morgan, P. and Thompson, A. (1994) ‘Continuous quality improvement in an acute hospital :a report of an action research project in three hospital departments’, International Journal of Health Care Quality Assurance, Vol. 7, No. 1, pp.4–29.

Purcărea, V.L., Gheorghe, I.R. and Petrescu, C.M. (2013) ‘The assessment of perceived service quality of public health care services in Romania using the SERVQUAL scale’, Procedia-Economics and Finance, Vol. 6, No. 1, pp.573–585.

Qin, H., Prybutok, V.R. and Zhao, Q. (2010) ‘Perceived service quality in fast-food restaurant: empirical evidence from China’, International Journal of Quality and Reliability Management, Vol. 27, No. 4, pp.424–437.

Raduan, C.R., Uli, J., Mohani, A. and Kim, L.N. (2004) ‘Hospital service quality: a managerial challenge’, International Journal of Health Care Quality Assurance, Vol. 17, No. 3, pp.146–159.

Rahman, Z. and Qureshi, M.N. (2009) ‘Fuzzy approach to measuring healthcare service quality’, International Journal of Behavioural and Healthcare Research, Vol. 1, No. 2, pp.105–124.

Ramsaran-Fowdar, R.R. (2008) ‘The relative importance of service dimensions in a healthcare setting’, International Journal of Health Care Quality Assurance, Vol. 21, No. 1, pp.104–124.

Rohini, R. and Mahadevappa, B. (2006) ‘Service quality in Bangalore hospitals – an empirical study’, Journal of Services Research, Vol. 6, No. 1, pp.59–85.

Rose, R.C., Uli, J., Abdul, M. and Ng, K.L. (2004) ‘Hospital service quality: a managerial challenge’, International Journal of Health Care Quality Assurance, Vol. 17, No. 3, pp.146–159.

Rust, T. and Oliver, L. (1994) ‘Service quality: insights and managerial implications from the frontier’, in Rust, R.T. and Oliver, R.L. (Eds.): Service Quality: New Directions in Theory and Practice, pp.1–19, Sage, Thousand Oaks, CA.

Sahu, A.K. (2007) ‘Measuring service quality in an academic library: an Indian case study’, Library Review, Vol. 56, No. 3, pp.234–243.

Savitz, L., Kaluzny, A. and Kelly, D. (2000) ‘A life-cycle model of continuous clinical process innovation’, Journal of Healthcare Management, Vol. 45, No. 5, pp.307–316.


Shahin, A., Jamkhaneh, H.B. and Cheryani, S.Z.H. (2014) ‘EFQMQual: evaluating the implementation of the European quality award based on the concepts of model of service quality gaps and ServQual approach’, Measuring Business Excellence, Vol. 18, No. 3, pp.38–56.

Shekarchizadeh, A., Rasli, A. and Hon-Tat, H. (2011) ‘SERVQUAL in Malaysian universities: perspectives of international students’, Business Process Management Journal, Vol. 17, No. 1, pp.67–81.

Sohail, S.M. (2003) ‘Service quality in hospitals: more favourable than you might think’, Managing Service Quality, Vol. 13, No. 3, pp.197–206.

Strawderman, L. (2005) Human Factors for Consideration in Quality Service Metrics Forhealthcare Delivery, Unpublished Doctoral Dissertation, The Pennsylvania State University, University Park, PA.

Suhonen, R., KI-Lima, M., Msocsci, J. and Leino-Kilpi, H. (2004) ‘Patient characteristics in relation to perceptions of how individualized care is delivered: research into the sensitivity of the individualized care scale’, Journal of Professional Nursing, Vol. 22, No. 4, pp.253–261.

Suki, N.M., Lian, J.C.C. and Suki, N.M. (2011) ‘Do patients’ perceptions exceed their expectations in private healthcare settings?’, International Journal of Health Care Quality Assurance, Vol. 24, No. 1, pp.42–56.

Talib, F. and Rahman, Z. (2013) ‘Current health of Indian healthcare and hospitality industries: a demographic study’, International Journal of Business Research and Development, Vol. 2, No. 1, pp.1–17.

Talib, F., Rahman, Z. and Azam, M (2010) ‘Total quality management implementation in the healthcare industry: a proposed framework’, Proceedings of Second International Conference on Production and Industrial Engineering (CPIE-2010), Organized by Department of Industrial and Production Engineering, Dr. B.R. Ambedkar National Institute of Technology, Jalandhar (NITJ), Punjab, India, 3–5 December, pp.1361–1368.

Talib, F., Rahman, Z. and Azam, M. (2011) ‘Best practices of total quality management implementation in healthcare setting’, Health Marketing Quarterly, Vol. 28, No. 3, pp.232–252.

Tam, J.L.M. (2004) ‘Customer satisfaction, service quality and perceived value: an integrative model’, Journal of Marketing Management, Vol. 20, Nos. 7/8, pp.897–917.

Taner, T. and Antony, J. (2006) ‘Comparing public and private hospital care service quality in Turkey’, Leadership in Health Service, Vol. 19, No. 2, pp.1–10.

The Quality Digest (2001) Quality: How to Define It? [online] http://www.qualitydigest.com/html/qualitydef.html (accessed 2 October2009).

The Times of India (2009) ‘Accreditation results in high quality care and patient safety’, The Times of India, 19 July, p.5.

Tsoukatos, E. and Mastrojianni, E. (2010) ‘Key determinants of service quality in retail banking’, EuroMed Journal of Business, Vol. 5, No. 1, pp.85–100.

Tucker, J.L. and Adams, S.R. (2001) ‘Incorporating patients’ assessments of satisfaction and quality: an integrative model of patients’ evaluations of their care’, Managing Service Quality, Vol. 11, No. 4, pp.272–287.

Untachai, S. (2013) ‘Modeling service quality in hospital as a second order factor, Thailand’, Procedia-Social and Behavioral Sciences, Vol. 88, No. 1, pp.118–133.

Uzochukwu, B.S.C., Onwujekwe, O.E. and Akpala, C.O. (2004) ‘Community satisfaction with the quality of maternal and child health services in Southeast Nigeria’, East African Medical Journal, Vol. 81, No. 6, pp.293–299.

Walters, D. and Jones, P. (2001) ‘Value and value chains in healthcare: a quality management perspective’, The TQM Magazine, Vol. 13, No. 5, pp.319–335.

WHO (1948) World Health Organization, No. 2, p.100 [online] http://www.who.int/about/definition/en/print.html (assessed 15 December 2013).

24 F. Talib et al.

Yeoh, P-L. (2011) ‘Location choice and the internationalization sequence: insights from Indian pharmaceutical companies’, International Marketing Review, Vol. 28, No. 3, pp.291–312.

York, A.S. and McCarthy, K.A. (2011) ‘Patient, staff and physician satisfaction: a new model, instrument and their implications’, International Journal of Health Care Quality Assurance, Vol. 24, No. 2, pp.178–191.

Youseff, F., Nel, D. and Bovaird, T. (1996) ‘Service quality in NHS hospitals’, Journal of Management in Medicine, Vol. 9, No. 1, pp.66–74.

Zairi. M. (1998) ‘Managing human resources in healthcare: learning from world class practices – part I’, Health Manpower Management, Vol. 24, No. 2, pp.48–57.

Zeithaml, V., Parasuraman, A. and Malhotra, A. (2002) ‘Service quality delivery through web sites: a critical review of extant knowledge’, Journal of the Academy of Marketing Science, Vol. 30, No. 4, pp.362–375.

Zeithaml, V.A. and Bitner, M.J. (2003) Services Marketing: Integrating Customer Focus Across the Firm, 3rd ed., McGraw-Hill, New York, NY.

Zineldin, M. (2000) Total Relationship Management, Student Litterateur, Sweden. Zineldin, M. (2006) ‘The quality of healthcare and patient satisfaction: an exploratory investigation

of the 5Qs model at some Egyptian and Jordanian medical clinics’, International Journal of Healthcare Quality Assurance, Vol. 19, No. 1, pp.60–92.

Zineldin, M., Camgöz-Akdağ, H. and Vasicheva, V. (2009) ‘Measuring, evaluating and improving hospital quality parameters/dimensions – an integrated healthcare quality approach’, International Journal of Health Care Quality Assurance, Vol. 24, No. 8, pp.654–662.

Zineldin, M., Camgoz-Akdag, H. and Vasicheva, V. (2011) ‘Assessing quality in higher education: new criteria for evaluating students’ satisfaction’, Quality in Higher Education, Vol. 17, No. 2, pp.231–243.

Service Quality in Healthcare Establishments: A Literature Review

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