Service Quality in Public and Private Hospitals in
Pakistan: An Analysis Using SERVQUAL Model
Junaid Aftab COMSATS Institute of Information
Technology, Pakistan junaidaftab05@gmail.com
Madeeha Razzaq Institute of Business & Management, UET, Lahore,
Pakistan madeehaajmal@gmail.com
Abstract: The objective of the paper is to examine patient satisfaction in the public and private hospitals using the SERVQUAL model in Pakistan. Around the world hospitals appear to gradually focus on their strategies of service quality. With a growing competition service quality plays a critical part in public and private hospitals of Pakistan. Now-a-days, patients’ satisfaction is one of the very important quality aspects in healthcare sectors. Self-administered questionnaire was used to measure the satisfaction level of the patients in which patient satisfaction was measured on the basis of five dimensions such as empathy, responsiveness, tangibility, reliability and assurance. Five point Likert scale were implied to collect data from respondents (N=550). More data was collected from private hospitals. Females made larger proportion of study’s respondents. Inter-item reliability was found to proceed with the statistics of the data. Moderate consistency was found. Using SPSS software, data was analyzed and find regression, descriptive statistics and reliability analyses. The findings of this study signifies, all the dimension of SERVQUAL model are significantly related with the Patient satisfaction, in addition our study also signified that there is a significant difference among public & private sector hospitals in terms of patient satisfaction. So, to improve service quality of hospitals, all the service quality dimensions needed to be improved. The more improved and hygienic physical accessories will improve patients’ satisfaction. Reliable service will enhance patient’s satisfaction and they will contact same hospital every time they face health issue. More attention and empathy will enhance patient’s satisfaction and trust. The study concludes with managerial implications and future directions.
Key words: Empathy, Responsiveness, Tangibility, Reliability and Assurance, Patient Satisfaction
I. INTRODUCTION
In service industries, the service quality has become one of the prime factors for the enhancement of customer relationship and value creation in the market. Every organization tried to gain competitive
Muhammad Nawaz PhD Scholar, National College of
Business Administration & Economics, Pakistan m_nawaz_progressive@yahoo.com
Bina Nazir National College of Business Administration & Economics,
Lahore, Pakistan binanazir73@gmail.com
Mehwish Jamil National College of Business Administration & Economics,
advantage in order to become driving force in the market. The trend of globalization and commercialization increasing day by day so it changed the demand of customers and they expect high quality products and services those create competitive environment among various sectors.
For offering services internationally, there is a need to understand the trends and rules of the market and perception of the people around the world to gain competitive edge in those countries. Today, manufacturing sector implements quality management practices and gained success around the globe. These products are tangible in nature, so, it is very easy to understand the tangible nature products as compare to service. Quality is recognized as the main determinant of success, to gain high return, cost-efficient tool and for continued existence in the competitive environment prevailed in services sector.
Patients are considered as Customers in Healthcare sectors so, they expect high quality services. Patient’s perception about quality of the service in healthcare sector is considered as one of the major factor to measure the quality of the service [1]. Javed & Javed have demonstrated that intangible attributes of services (or products) influence the customer’s appraisal of the service (or product) [2]. Perception about service quality not only leads to patient satisfaction but also help the management in the optimal decision making. As health care sector is more of a kind of people-oriented sector therefore it should not only develop good perception about quality but also deliver the services as perceived by patients if it is to remain viable [3].
Pakistan is a developing country. Population in Pakistan is more saturated in rural areas than urban or city areas. Although people are migrating in larger chunks from rural to urban areas still larger part live in rural areas. Both rural and urban area people face many problems relating to fundamental rights but these problems are more sever in rural areas especially healthcare facilitation is very much underdeveloped even from urban areas: most of the hospitals, private or public are located in urban areas [4]. Diversity of hospitals found in Pakistan i.e., private, public and Combined Military Hospitals (CMHs). Despite huge numbers of hospitals, the patience needs and requirements still need to be satisfied.
Although trend of service quality in healthcare sector is different in rural and urban areas, this study is conducted to examine the factors affecting on the patient’s satisfaction in the healthcare industry of Pakistan. The objectives of the study are:
To find out the difference in service quality of both public and private hospitals.
To test the dimensions of SERVQUAL model in both public and private hospitals of Pakistan.
public and private hospitals. ‘SERVQUAL’ tool is used to assess the patient’s perception regarding service quality in public and private hospitals of Lahore; second leading city of Pakistan. For this purpose, 5 service quality dimensions; empathy, assurance, tangibility, responsiveness and reliability of service quality in provided hospitals were measured in public and private hospitals of Lahore city. To find difference, only respondents who had the perception about service quality of both hospitals; public as well as private were integrated in the study. Independent sample T-Test and Descriptive Statistics were practiced as the researchers were more inclined to actually find the difference of quality of services transported to patients of public and private hospitals in order to have more satisfied patients. Inter-item reliability was found to find out consistency of items.
II. REVIEW OF LITERATURE
Different researches indicated in their findings that service quality is the driving feature in the success or failure of any organization because it creates value and satisfaction among the customers [5]. A crucial dimension of a profession is standardization and a body of knowledge, being developed by professional associations, aids the standardization of the knowledge and practice linked with a profession [6]. Healthcare profession is one such profession where the comprehension and application of the standardization of knowledge and practices is important in creation of services that can satisfy service seekers or patients and thus help add value in the healthcare sector of the country.
The patient quality perception is chiefly measured by the outcome quality in the health-care industry. The positive word-of-mouth by service consumers about the service providers, doctors, is the outcome of the patient’s trust. Brady & Cronin [7] described in their model, there are three facets of service quality which includes physical, interactive & output quality. The customer relationship management always creates and sustains existing customers which helps them in building long term relationship.
Aragon and Gesell [8] studied emergency department of hospitals. Primary service provider theory was presented by them in order to explore patient satisfaction through three variables that re physician service, waiting time & nursing care. They find out the affiliation between patient’s satisfaction & service quality by measuring aforesaid three latent variables. Positive affiliation was found between service quality and patient satisfaction as well as patient’s trust (measured through two different ways).
like “comfort, dignity, privacy, security, degree of independence, decision making autonomy and attention to personal preferences” while secondly, quality was perceived in terms of overall satisfaction of people along with their thinking towards health at the end of few medical intervention [9].
Safavi [10] argued that patient satisfaction has relationship with three fundamental components of health-care system which were service quality, staff and organization itself. In their study, Alrubaiee and Alkaa'ida [11] had taken the patient satisfaction as mediating variable and patient’s trust dependent variable and concluded that service quality and patient’s trust are positively associated with each other.
The service quality perceptions are highly affected by the interpersonal interactions in the health-care services [12]. Physical service environment (e.g., surrounding conditions, space as well as function) play a vibrant part in the service experience of customer.
III. SERVICE QUALITY IN HEALTH SECTOR
In this vibrant era, where competition and technological progression are very important for the responsible firms, the firms are constantly adding value in their existing products or services [13]. Organizations play crucial role in development of national economy of a country as the more productive organizations a country house more likely is the country to progress in economic terms [14]. Thus in a poor country like Pakistan where healthcare sector does not receive appropriate funding as compare to other nations in the neighborhood, the effective management of healthcare organizations and their services becomes the need of an hour. Both, the service quality and patient’s satisfaction have significant consideration in healthcare organizations because this is crucial for their strategic decisions. Perception of patients about hospitals affects the profitability, as well as image extensively influenced the hospitals’ reputation, with patients’ word-of mouth and trust [15], [16]. The increased patients’ satisfaction helps hospitals’ management in terms of money and reduces time in managing patients’ complaints.
instance it is rarely used to measure physical attributes of a product. Oliveria and Ferreira [21] conducted the study using SERVQUAL in Brazilian university, argued that students show greater expectations but perceptions were not satisfactory. It was described that the functional and technical quality of cellular phones was significantly associated to consumers’ perceptions which ultimately results in quality service [22]. Therefore, following hypotheses have been proposed for the study after doing Literature Review and finding gaps in selected country:
H1: A relationship exists amongst Tangibility & Patient Satisfaction
H2: A relationship exists amongst Assurance & Patient Satisfaction
H3: A relationship exists amongst Empathy & Patient Satisfaction
H4: A relationship exists amongst Reliability & Patient Satisfaction
H5: A relationship exists amongst Responsiveness & Patient Satisfaction
H6: There exists a difference amongst public & private sector hospitals in terms of patient
satisfaction.
In Pakistan, there are very few studies conducted for the service quality of hospitals to measure patient’s satisfaction [13],[16]. All other mentioned studies were conducted for other developed and underdeveloped countries. This gap encouraged us to do research in this area and find the relationship between service quality dimensions and patient’s satisfaction.
IV. THEORETICAL FRAMEWORK
Building upon the studies mentioned in the literature review concerning SERVQUAL Model, following theoretical framework was selected for the study.
The definition of each of the variables involved in the framework is shown below
Tangibility It refers to physical accessories which can be touched e.g. equipment, machinery, physical facilities and aspect of human resource as well.
Reliability It refers how much staff is reliable about giving services perfectly and steadily.
Responsive
ness It refers how abundant staff is keen to give attention and help patients out. Assurance It refers to awareness regarding their fields of specialization and gentility
competency to initiate trust and confidence.
Empathy It denotes to feel care about patients and provide individual attention to their patients.
V. RESEARCH METHODOLOGY
Empirical study has been conducted as it might better meet the objectives of the study. In this article we used quantitative survey techniques to evaluate the service quality level in both private and public hospitals. To explain the difference and make a close appraisal between public and private hospital, only those patients having the experience of both types of hospitals were included. Patients from whom data was collected were availing facilities of health care from both public and private hospitals. This study was conducted in Lahore which is the second largest city of Pakistan.
For the sample selection four hospitals were selected on the basis of random sampling, Services Hospital, Ganga Ram Hospital, Hamid Latif Hospital, Society Welfare Hospital Mughalpura and Hijaz Hospital. The questionnaire has been developed on the basis of SERVQUAL model [23]. The questionnaire consists of five dimensions: empathy, responsiveness, tangibility, reliability and assurance. The questionnaire was filled from 550 patients.
The details are given in the results section. Shabbir [16] used 18 items questionnaire in his study. Same trend was adopted for our study and used 18 items in the questionnaire along with demographic details of respondents. The same author used strategy of selecting private and public hospitals and then tried to find difference among both. The same strategy is used in our research.
point Likert scale ranging from 1 to 5 (strongly disagree to strongly agree) including 18 questions to measure patient’s satisfaction in terms of service quality [16].
VI. RESULTS AND DISCUSSIONS
Following results have been produced using SPPS (version 18) using the collected data from the respondents.
TABLE 1
DEMOGRAPHIC VARIABLES
Table 1 reveals that most of the interviewees were females (51.7%) and males were (48.3%). This table also shows that most of the data gathered from the public sector hospital in order to determine the satisfaction level of the patients (50.5%).
TABLE 1(a) RELIABILITY STATISTICS
Table 1(a) reveals that total number of items is 18 with cronbach’s alpha value 0.756. The value also reveals that inter-item reliability is moderately consistence. This reliability value encouraged us to move further in our research and derive more results to prove hypothesis.
Category Classification Frequency Percentage%
Gender Male 244 48.3
Female 261 51.7
Sector Public 255 50.5
Private 250 49.5
N %
Cases Valid
Excludeda
Total
550 100.0
0 .0
550 100.0
a. List wise deletion based on all variables in the procedure
Reliability Statistics
Cronbach's Alpha N of Items
TABLE 2 CORRELATION
Patient Satisfaction
Tangibility Pearson Correlation .477**
Sig. (2-tailed) .000
Reliability Pearson Correlation .365**
Sig. (2-tailed) .000
Responsiveness Pearson Correlation .439**
Sig. (2-tailed) .000
Assurance Pearson Correlation .293**
Sig. (2-tailed) .000
Empathy Pearson Correlation .314**
Sig. (2-tailed) .005
**Correlation is significant at the 0.01 level (2-tailed)
Table 2 shows that the correlation between the patient satisfaction and tangibility is .477(**) that indicates that they are moderately correlated and highly significant with each other. The patient satisfaction also moderately and significantly correlated with the responsiveness is .439(**). The patient satisfaction weakly but significantly correlated with the reliability, assurance and empathy. So, patients are more concerned about tangibility of services i.e. hospital equipment and hygiene is more important. They are least concerned about assurance of services (.293). So, tangibility and responsiveness dimensions are more important in this model and by focusing more on these, patient’s satisfaction can be increased.
TABLE 3 MODEL SUMMARY
Model R R Square Adjusted R Square Std. Error of the Estimate
1 .528a .279 .271 .55987
Predictors: Patient Satisfaction
total difference with its linear relationship of patient satisfaction and tangibility, responsiveness, reliability, assurance, empathy.
TABLE 4 ANOVA
Model Sum of Squares Df Mean Square F Sig.
Regression 56.228 5 11.246 35.876 .000b
Residual 145.131 463 .313
Total 201.359 468
Dependent variable: Patient Satisfaction
Predictor: tangibility, reliability, responsiveness, assurance, empathy.
Table 4 shows appropriate level of significance since the value of “P” is less than .05 so it is accepted that impact of patient satisfaction on tangibility, reliability, responsiveness, assurance, empathy is highly significant. The value of f =35.876 shows overall goodness of fitness of the framework.
TABLE 5 COEFFICIENT
Model Un-standardized Coefficient Standardized
Coefficient t Sig.
B Std Error Beta
(Constant) 2.758 .127 21.760 .000
Tangibility .163 .026 .346 6.177 .000
Reliability .020 .033 .036 .614 .540
Responsiveness .138 .039 .209 3.499 .001
Assurance .071 .052 .096 1.366 .173
Empathy .074 .048 .100 1.541 .124
Dependent variable: Patient Satisfaction
In Table 5, A=.917 is the average of Patient satisfaction when tangibility, reliability, responsiveness, assurance, empathy is zero.
The other values and their relation with patient’s satisfaction are explained as below: Patient Satisfaction = 2.758 + .163 (Tangibility)
This equation shows that 1% tangibility will bring 16.3% change in Patient Satisfaction. Patient Satisfaction = 2.758+ .020 (Reliability)
This equation shows that 1% responsiveness will bring 13.8% change in Patient Satisfaction. Patient Satisfaction = 2.758 + .071 (Assurance)
This equation shows that 1% assurance will bring 7.1% change in Patient Satisfaction. Patient Satisfaction = 2.758+ .074 (Empathy)
This equation shows that 1% empathy will bring 7.4% change in Patient Satisfaction.
Here, tangibility and responsiveness also results out as most important factors to be focused for improving patient’s satisfaction in terms of service quality of hospitals.
TABLE 6 GROUP STATISTICS
Sector N Mean Std. Deviation Std. Error Mean
Patient satisfaction Private 255 4.0641 .63286 .03963
Public 250 3.6747 .60189 .03807
Table 6 shows that mean of patient satisfaction in private sector is 4.06 and in public sector is 3.67. The difference between the two means is positive, that also indicates that there is a difference in service quality of public and private hospitals. The standard deviation of Private sector is 0.63 and for public sector is 0.60. Table 6 also shows standard deviation that gives the dispersion of data from its mean.
TABLE 7
INDEPENDENT SAMPLES TEST Levene's
Test for Equality of
Variances
t-test for Equality of Means
F Sig. T df Sig.
(2-tail ed)
Mean
Difference Std. ErrorDifference Confidence95% Interval of the
Difference Lower Upper
Patient Satisfaction
Equal variances
assumed 3.192 .075 7.082 503 .000 .38939 .05498 .28137 .49740 Equal
variances not assumed
7.086 502.538 .000 .38939 .05495 .28142 .49735
significant and the sig. (2-tailed value) is .000 which is less than the p=0.05 showing that there is significant difference between patient satisfaction for public and private sector.
In the light of the derived results and statistics for undertaken research, it is therefore summarized that the entire null hypothesis extracted from literature review has been accepted. So, theoretical framework has been proved as fit for the study undertaken and it has shown that SERVQUAL model also seems fit for measuring patient’s satisfaction in public and private hospitals of Pakistan.
VII. CONCLUSION
Service quality is one of the key attributes of quality in healthcare sector. Hypothesis testing and data analyses concluded that service quality of private hospitals and public hospitals have significant difference (p=0.75). In Lahore, People are satisfied with service quality of private hospitals than the public hospitals. Private hospitals fulfill the requirements of the patients according to their service quality demand, in contrast, public hospitals are failed to fulfill patients demand because of lack of resources availability. Private hospitals charge high amount of charges regarding service quality facilities, these facilities are satisfied but every person cannot afford that treatment while in public hospital every person can easily avail medical facilities. The patients are anxious with the condition of public hospitals because environment is not healthy and hygienic. The patients are frustrated with behavior of doctors in public hospitals. In summary, the situation of public hospitals is very pathetic than the private hospitals. The public and private hospitals management must take actions to modify their medical system and provide high quality services to patients. In public hospitals maximum improvements are required than the private hospitals due to less satisfaction of patients.
VIII. SCOPES FOR FUTURE STUDY
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