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Health Care Service Quality: A Comparison of Public and Private Hospitals
Introduction
According to research, there is a significant relationship between quality service delivery, customer satisfaction, loyalty, customer retention, profitability, costs, service guarantee as well as the financial performance of the service business. Service quality is an elusive and abstract concept which is difficult to measure and define, unlike products whose quality can be measured. Service quality according to Berry et al. (1988) can be defined as the conformance to the customer specifications. The interactive nature of the services process results of the client’s evaluation of quality immediately after the provision and performance of the particular services and this makes performance to be one of the most important and competitive weapon in the service business.
SERVQUAL is the most widely used tool in the measurement of service quality and was based on the disconfirmation model that proposes that satisfaction is a function of disconfirmation of perception from expectation. The assessment tool was founded on the perspective that the client’s assessment of service quality was paramount, conceptualizing the assessment as a gap that existed between what the customers expect from a class of service providers and the evaluations of the performance of a certain service provider. The SERVQUAL tool measures the service quality in five dimensions that include; responsiveness, tangibles, assurance, reliability, and empathy by 22 items and each of the items are written twice. The initial writing is to determine the expectations of the customer from the service provider while the other writing is to measure the perceptions of the performance of a particular firm.
Service quality in the health care industry
The health care service is broken down into two quality dimensions that include; functional and technical quality. Technical quality is defined based on the technical accuracy of the medical diagnosis and procedures or the conformance to the professional specifications, and it refers to what the customers get. Functional quality, on the other hand, can be defined as how the health care services are delivered to the patients, basically referring to how the customers obtain the services. Most of the patients lack the knowledge of effectively evaluating the quality of the diagnostic and therapeutic intervention process and this explains why the technical quality falls short of being a beneficial measure for describing how the patients evaluate the quality of medical services. Due to this, patients tend to base their evaluation on quality on the interpersonal and environmental factors, to which are taken less seriously by the medical professionals. Most of the patients, however, cannot differentiate between the caring and the curing performance of medical care providers.
Research objectives
Three objectives were used in the study
1. To test the dimensionality of the SERVQUAL instrument in the Northern Cyprus health care industry.
2. To assess the service quality provided in public and private hospitals in Northern Cyprus.
3. To identify the service quality dimensions which play important role in customer satisfaction.
Materials and methods
Data was collected in two phases; through questionnaires that consisted of four parts and the evaluation of the three parts in the questionnaire. The sample was drawn from the people living in northern Cyprus aged 18 years and above. Sample size determined as 990 with a 95% confidence level. The data collection process was conducted by KADEM, a professional research company in Northern Cyprus, with the assistance of 12 trained interviewers assigned to collect data through face to face interview technique.
Analysis
The initial objective of the study was to test the dimensionality of the SERVQUAL instrument in Northern Cyprus health care industry and to fulfill the objective, and the scale was factor analyzed by principal components method with varimax rotation. Cronbach Alpha coefficients of the factors extracted in the analysis were identified to test the reliability of the dimensions. The gap model was later used to assess the service quality provided by both private and public hospitals. To determine the service quality gaps for the hospitals under review, the generally accepted formula (weighted perception-weighted expectation) was put in use; the gaps were then calculated by multiplying the weight assigned to each of the dimensions by expectation scores and the perception scores of each hospital.
Results
Three factors that include; reliability-confidence (α= 0.933), empathy (α= 0.837) and tangibles (α= 0.732) were extracted in the factor analysis using a standard eigenvalue of 1.0.
Discussion
The results of the analysis revealed that reliability-confidence, empathy, and tangibles are the three dimensions of service quality in accordance with the first objective of testing the dimensionality of the SERVQUAL assessment tool. This result does not support the five-factor model of the original SERVQUAL. Objective number two was to assess the service quality provided in public and private hospitals. The gap scores indicate that in all the three dimensions, perceived service falls behind the expectations implying that both public and private hospitals fail to offer the expected service quality to the patients. The finding, therefore, has significant implications, especially for the public hospitals, as the gap scores are much bigger in all the dimensions compared to the private hospitals.
The biggest gap in the public hospitals exists in the reliability-confidence dimension that constitutes from the reliability, assurance and responsiveness issues. The public hospitals depict poor performance in the empathy dimension which is based on the understanding of the specific needs of the patients as well as providing personal attention. The huge gap in the tangibles dimension indicates that the equipment does not look modern and the physical facilities are not visually appealing to the clients. The huge gaps, therefore, signify mismanagement of the public hospitals, and this can be attributed to the non-profit nature of the public hospitals. , and therefore there is no aim of making a profit.
Private hospitals, on the other hand, are perceived as much better service providers than public hospitals. Despite being better service providers, there are still some small gaps in all the dimensions of service quality. The small gaps can be explained by the incentive nature of the private hospitals, as unlike the public hospitals, which are characterized by no profit concerns, inadequate resources as well as the lack of performance management, the private hospitals are profit oriented; and this means that they have to raise funds and use resources efficiently as they are not provided by the government. The private hospitals compete among each other and the other hospitals in the region, and this means that there is still room for improvement in spite of the levels of satisfaction.
The third objective of the study was identifying the dimensions that exert influence patient satisfaction. The logistic regression analysis indicated that the reliability-confidence dimension is significantly effective on satisfaction both in private and public hospitals, and thus an improvement in this dimension would significantly increase in the service quality, thus affecting customer satisfaction. Being empathetic is as well acknowledged to exert influence on customer satisfaction on both public and private hospitals although with a lower intensity. The tangibles dimension have no significant effect on customer satisfaction in the public hospitals’ context but are more or equally influential with empathy in private hospitals.
Recommendations for future studies
Three significant recommendations are provided that include: The SERQUAL scale should be tested on other industries as well as in different parts of the globe. Further investigations should be made for both private and public hospitals to find out the underlying causes of the gaps identified within the organizations and provide high-quality services to their customers. More comprehensive suggestions can be made if price and behavioral intentions are included in future studies.
Reference
Yesilada, F., & Direktör, E. (2010). Health care service quality: A comparison of public and private hospitals. African Journal of business management, 4(6), 962. Retrieved from: https://academicjournals.org/journal/AJBM/article-full-text-pdf/3F06DCA23828
