International Journal of Pharmaceutical and Healthcare Marketing

Hospital service quality as antecedent of patient satisfaction – a conceptual

framework
Swapnarag Swain, Nirmal Chandra Kar,
Article information:
To cite this document:
Swapnarag Swain, Nirmal Chandra Kar, (2018) "Hospital service quality as antecedent of patient
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

satisfaction – a conceptual framework", International Journal of Pharmaceutical and Healthcare

Marketing, Vol. 12 Issue: 3, pp.251-269, https://doi.org/10.1108/IJPHM-06-2016-0028
Permanent link to this document:
https://doi.org/10.1108/IJPHM-06-2016-0028
Downloaded on: 10 December 2018, At: 22:01 (PT)
References: this document contains references to 51 other documents.
To copy this document: permissions@emeraldinsight.com
The fulltext of this document has been downloaded 416 times since 2018*
Users who downloaded this article also downloaded:
(2018),"Hospital healthcare service quality, patient satisfaction and loyalty: An investigation in context
of private healthcare systems", International Journal of Quality & Reliability Management, Vol. 35
Iss 6 pp. 1195-1214 <a href="https://doi.org/10.1108/IJQRM-02-2017-0031">https://doi.org/10.1108/
IJQRM-02-2017-0031</a>
(2013),"Hospital service quality and its effects on patient satisfaction and behavioural intention",
Clinical Governance: An International Journal, Vol. 18 Iss 3 pp. 238-254 <a href="https://
doi.org/10.1108/CGIJ-05-2012-0016">https://doi.org/10.1108/CGIJ-05-2012-0016</a>

Access to this document was granted through an Emerald subscription provided by emerald-
srm:551360 []
For Authors
If you would like to write for this, or any other Emerald publication, then please use our Emerald
for Authors service information about how to choose which publication to write for and submission
guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information.
About Emerald www.emeraldinsight.com
Emerald is a global publisher linking research and practice to the benefit of society. The company
manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as
well as providing an extensive range of online products and additional customer resources and
services.
Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the
Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for
digital archive preservation.

*Related content and download information correct at time of download.

 The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/1750-6123.htm

Hospital
Hospital service quality as service quality
antecedent of patient satisfaction –
a conceptual framework
Swapnarag Swain 251
T.A. Pai Management Institute, Manipal, Karnataka, India, and
Received 1 June 2016
Nirmal Chandra Kar Revised 8 April 2017
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

28 September 2017
Department of Business Administration, Utkal University, Bhubaneswar, India Accepted 18 February 2018

Abstract
Purpose – The purpose of this paper is to explore dimensions of perceived service quality in hospitals and
to develop a conceptual framework showing relationship between hospital service quality, patient satisfaction
and their behavioural intention.
Design/methodology/approach – This paper is based on extensive review of existing literature on
hospital service quality, patient satisfaction and behavioural intention. Critical analysis of these literature
studies has resulted in determining and defining the dimensions of perceived service quality and establishing
relationship between hospital service quality, patient satisfaction and behavioural intention.
Findings – This study has identified six major areas through which patients perceive quality of service in
hospitals. These six areas are technical quality, procedural quality, infrastructural quality, interactional
quality, personnel quality, social support quality. Further 20 dimensions of hospital service quality are
identified under these 6 major areas. These are clinical procedure, quality of outcome, admission, discharge,
waiting time, patient safety, billing and price, follow-up, ambience, availability of resources, accessibility,
food, staff attitude, personalised attention, information availability, staff competency, trustworthiness, staff
diversity, hospital image and social responsibility. The conceptual framework proposes direct relationship
between service quality, patient satisfaction and behavioural intention.
Originality/value – Though many studies have been conducted on hospital service quality, none of them
has been able to project all the possible dimensions to measure the same. The “6-Q framework” developed by
this study explores all the possible dimensions of perceived service quality in hospitals.
Keywords Service quality, Patient satisfaction, Hospital, Behavioural intention
Paper type Research paper

Introduction
Health-care service providers can be categorised in to primary, secondary and tertiary care
institutions. Primary and secondary care institutions generally consist of primary health
centres, community health centres and district hospitals. Tertiary care institutions are
generally equipped with personnel and facilities for advanced investigation and treatment to
offer specialised consultative care usually on referral from primary or secondary medical
care institutions. These days, tertiary health-care institutions like large multispecialty and
super specialty hospitals are giving much importance to be accredited by national or
international health-care accreditation organisations like the United Kingdom Accreditation International Journal of
Forum (UKAF) in the United Kingdom, Joint Commission International (JCI) in the USA, Pharmaceutical and Healthcare
Marketing
Australian Council on Healthcare Standards International (ACHSI) in Australia and Vol. 12 No. 3, 2018
pp. 251-269
National Accreditation Board for Hospitals & Healthcare Providers (NABH) in India. As a © Emerald Publishing Limited
1750-6123
result, hospitals are required to maintain high standards of care and manage quality of DOI 10.1108/IJPHM-06-2016-0028
 IJPHM service delivery. To improve quality of care, health system needs to be effective, efficient,
12,3 accessible, patient centred, equitable and safe (World Health Organization, 2006).
Service quality management has both internal and external perspectives (Sachdev and
Verma, 2004). Internal perspective focuses on zero defect and conformance to requirements.
External perspective focuses on customers and their expectation, perception, attitude and
satisfaction. Owing to factors like growing consumer awareness, their expectations and
252 changing consumer preferences, the external perspective is gaining more importance in case
of services (Sachdev and Verma, 2004). Patients attach highest importance to the
interpersonal aspect of care in case of health services (Padma et al., 2010). Patients’ perceived
value about a hospital is a function of six dimensions such as acquisition value, transaction
value, efficiency value, aesthetic value, social interaction value and self-gratification value
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

(Chahal and Kumari, 2012). Hospital support functions have significant influence on
patients’ perception about the quality of service in hospitals which in turn influences future
patient demands and reputation of hospital (Baalbaki et al., 2008). Many researchers have
established a direct relationship between hospital service quality and patient satisfaction
(Zineldin, 2006; Dagger, Sweeney and Johnson, 2007; Duggirala et al., 2008; Vinagre and
Neves, 2008; Padma et al., 2010). Customer satisfaction can lead to competitive advantage for
a firm through repeat buying, higher prices, loyalty in crisis, word-of-mouth, one-stop
shopping and new-product innovation (Seth, 1991). So it has become imperative for hospitals
to create patient satisfaction through effective management of service quality.
Service quality is one of the vastly researched areas in business and many studies have
been conducted on hospital service quality. Review of literature shows gaps with respect to
the dimensions of hospital service quality as each of the studies has missed one or more
dimensions that are important constituents of service quality. This study focuses on
identifying all the possible dimensions through which patients evaluate or perceive quality
of service in a tertiary health-care institution, especially large hospital. It has also tried to
develop a conceptual framework (the 6-Q framework) to show the relationship between
perceived service quality, patient satisfaction and behavioural intention. The findings of this
study are based on extensive review of existing literature on hospital service quality, patient
satisfaction and their behavioural intention.

Literature review
Service quality is an area of research in which a large number of researchers have made
their contribution in terms of development and testing of theoretical models, development of
service quality scales, implementation of service quality scale to measure quality of service
in various sectors such as retail, banking, hospitality and health care. Service gaps model is
one of the most famous models of service quality that was developed by Parasuraman,
Zeithamal and Berry (1985). According to this model, perceived service quality is a result of
difference in consumers’ perception and expectation out of a service that can be observed
through five service gaps, which led to development of the most famous SERVQUAL scale.
Thereafter, this scale or its modified versions have been implemented to measure service
quality in health-care setting. The present study is based on review of literature comprising
two broad sections – the first section includes literature with respect to the dimensions of
service quality especially in health-care setting, and the second section includes literature
with respect to the relationship between service quality, patient satisfaction and behavioural
intention. The first section further consists of three sub sections – the first sub section deals
with studies that are based on SERVQUAL approach, the second sub section deals with
studies based on modifications of SERVQUAL and the third sub section deals with studies
that are not based on SERVQUAL approach. The set of literature for this analysis was
 obtained using the search terms “hospital/health-care service quality” and/or “patient Hospital
satisfaction” in databases like Emerald Insight, EBSCOhost and Google Scholar. Finally a service quality
total of 40 literature pieces in 15 journals were considered based on the following criteria:
 availability of full access by the researcher;
 appearance of the terms hospital/health-care service quality and/or patient
satisfaction in the title, abstract and keywords; and
 relevance to the present study. 253
Table I represents the extensive framework of literature review conducted for this study.
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

Dimensions of hospital perceived service quality

Parasuraman et al. (1985) developed SERVQUAL scale to measure service quality through
five dimensions such as reliability, assurance, tangibles, empathy and responsiveness.
Many researchers have used these five dimensions to measure service quality in health-care
organisations including public and private hospitals (Anderson and Zwelling, 1996; Wong,
2002; Sohail, 2003; Doran and Smith, 2004; Wisniewski and Wisniewski, 2005; Moghadam
and Amiresmaili, 2009; John et al., 2011; Ramanujam, 2011; Alborie and Damanhouri, 2013).
Though this scale has been used extensively to measure hospital service quality, it remains
silent about dimensions like clinical procedures and their outcome, process of admission,
discharge, billing, follow up, information dissemination, patient safety, food and social
image or responsibility.
Owing to these limitations, some researchers have modified the SERVQUAL scale by
adding some dimensions, especially for health-care organisations. Roshnee and Fowder
(2008) measured service expectations and perceptions in private clinics of general
practitioners. They developed PRIVHEALTHQUAL scale, which is an extension of
SERVQUAL scale. This instrument includes seven dimensions of health-care service quality
such as tangibility or image, reliability or fair and equitable treatment, responsiveness,
assurance or empathy, core medical services or skill or competence, equipment and records
and information dissemination. Arasli et al. (2008) developed a modified SERVQUAL scale
to evaluate service quality in both public and private hospitals. This study identified six
dimensions of hospital service quality such as empathy, relationship, giving priority to
inpatients’ needs, professionalism of staff, food and physical environment. Rashid and Jusoff
(2009) proposed a conceptual model of hospital service quality in which they added five
more dimensions to the SERVQUAL scale to make a total of ten dimensions that contribute
to service quality. These ten dimensions of hospital service quality are reliability, tangibles,
responsiveness, assurance, empathy, access, choice, information, redress and representation.
Eleuch (2011) conducted an empirical study in Japan to measure patients’ perception about
quality of service in health care. According to this study, health-care service quality consists
of both functional and technical quality. The items in SERVQUAL scale represent functional
quality. The technical quality consists of doctor’s service, performance of adequate
diagnostic tests and appropriateness of treatment. This study revealed three major
dimensions that contribute to health-care service quality such as staff behaviour, technical
quality and physical appearance. Murti et al. (2013) conducted an empirical study in India to
measure hospital service quality and its influence on patient satisfaction. This study
identified eight dimensions of hospital service quality, namely, tangibles, reliability,
responsiveness, assurance, empathy, discharge, safety measures and medicine quality
management. Mahapatra (2013) developed a logistic regression model to predict patients’
preference for private or public hospital based on gaps between their expectation and
 Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

12,3

254

Table I.
IJPHM

Framework of

the present study

literature review for
Approach to service quality dimensions
Author(s) and Nature of Modified Non Relation
year Name of the journal the study SERVQUAL SERVQUAL SERVQUAL between SQ/PS/BIa

Parasuraman Journal of Marketing Empirical 

et al. (1985)
Tomes and Peng International Journal of Health Care Quality Empirical 
(1995) Assurance
Anderson and International Journal of Health Care Quality Empirical 
Zwelling (1996) Assurance
Sower et al. Health Care Management Review Empirical 
(2001)
Wong (2002) International Journal of Health Care Quality Empirical  Yes
Assurance
Sohail (2003) Managing Service Quality Empirical 
Doran and Smith International Journal of Health Care Quality Empirical 
(2004) Assurance
Rose et al. (2004) International Journal of Health Care Quality Empirical 
Assurance
Wisniewski and International Journal of Health Care Quality Empirical 
Wisniewski Assurance
(2005)
Zineldin (2006) International Journal of Health Care Quality Empirical  Yes
Assurance
Dagger et al. Journal of Service Research Empirical  Yes
(2007)
Tam (2007) Marketing Intelligence & Planning Empirical  Yes
Arasli et al. International Journal of Health Care Quality Empirical 
(2008) Assurance
Duggirala et al. Benchmarking: An International Journal Empirical  Yes
(2008)
Mejabi and European Journal of Social Sciences Empirical 
Olujide (2008)
Roshnee and International Journal of Health Care Quality Empirical 
Fowder (2008) Assurance
(continued)
 Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

Approach to service quality dimensions

Author(s) and Nature of Modified Non Relation
year Name of the journal the study SERVQUAL SERVQUAL SERVQUAL between SQ/PS/BIa

Vinagre and International Journal of Health Care Quality Empirical  Yes

Neves (2008) Assurance
Chaniotakis and Managing Service Quality Empirical  Yes
Lymperopoulos
(2009)
Moghadam and International Journal of Health Care Quality Empirical 
Amiresmaili Assurance
(2009)
Naidu (2009) International Journal of Health Care Quality Conceptual  Yes
Assurance
Padma et al. Benchmarking: An International Journal Conceptual  Yes
(2009)
Rashid and International Journal of Health Care Quality Empirical 
Jusoff (2009) Assurance
Aagja and Garg International Journal of Pharmaceutical and Empirical 
(2010) Healthcare Marketing
Chahal and International Journal of Pharmaceutical and Empirical 
Kumari (2010) Healthcare Marketing
Narang (2010) International Journal of Health Care Quality Empirical 
Assurance
Padma et al. Benchmarking: An International Journal Empirical  Yes
(2010)
Atinga et al. International Journal of Health Care Quality Empirical  Yes
(2011) Assurance
Eleuch (2011) International Journal of Health Care Quality Empirical 
Assurance
John et al. (2011) Asia–Pacific Journal of Public Health Empirical 
Mehta (2011) Journal of Health Management Empirical  Yes
Ramanujam Journal of Health Management Empirical 
(2011)
(continued)

Table I.
255
service quality
Hospital
 Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

12,3

256

Table I.
IJPHM

Approach to service quality dimensions

Author(s) and Nature of Modified Non Relation
year Name of the journal the study SERVQUAL SERVQUAL SERVQUAL between SQ/PS/BIa

Zineldin et al. International Journal of Health Care Quality Empirical 

(2011) Assurance
Alborie and International Journal of Health Care Quality Empirical 
Damanhouri Assurance
(2013)
Amin and Clinical Governance: An International Empirical  Yes
Nasharuddin Journal
(2013)
Mahapatra (2013) Journal of Medical Marketing Empirical 
Mosadeghrad International Journal of Health Care Quality Conceptual 
(2013) Assurance
Murti et al. (2013) Journal of Health Management Empirical  Yes
Itumalla et al. Operations and Supply Chain Management Empirical 
(2014)
Voon and International Journal of Quality and Empirical  Yes
Abdullah (2014) Reliability Management

Notes: aSQ – Service quality; PS – Patient satisfaction; BI – Behavioural intention

 experience with respect to service quality. This study used two more dimensions of hospital Hospital
service quality, namely, accessibility and affordability in addition to the five dimensions service quality
such as tangibility, reliability, responsiveness, assurance and empathy.
Many researchers found SERVQUAL and its modifications to be insufficient to measure
quality of service as perceived by patients in a hospital setting. So they developed or tested
other instruments for measurement of hospital service quality. Tomes and Peng (1995)
developed a measurement scale to assess the quality of service provided in NHS and NHS
trust hospitals in the United Kingdom. This study identified seven dimensions of hospital 257
service quality, namely, empathy, relationship of mutual respect, dignity, understanding of
illness, religious needs, food and the physical environment. Sower et al. (2001) developed
KQCAH scale to assess hospital service quality in the USA, which identified eight
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

dimensions of hospital service quality such as respect and caring, effectiveness and
continuity, appropriateness, information, efficiency, effectiveness and meals, first
impression and staff diversity. Rose et al. (2004) conducted an empirical study in Malaysia
for predicting hospital service quality. This study identified eight quality dimensions such
as technical, interpersonal, amenities or environment, access or waiting time, cost, outcomes,
social support and patient education. Zineldin (2006) developed the 5Q multidimensional
model of health-care quality and patient satisfaction. According to this model health-care
quality is a function of five quality dimensions such as quality of object, quality of process,
quality of infrastructure, quality of interaction and quality of atmosphere.
Dagger et al. (2007) conducted an empirical study in Australia to develop a
multidimensional hierarchical scale for measuring health-care service quality. This study
identified four major dimensions of hospital service quality such as interpersonal quality,
technical quality, environment quality and administrative quality. Tam (2007) evaluated
hospital service quality in Hong Kong by using seven dimensions of medical encounter that
represent quality of service delivery. These seven dimensions are doctors’ consultation,
support staffs’ performance, nurses’ performance, physical environment, dispensers’
performance, length of wait for consultation and doctors’ proactive attitude. Mejabi and
Olujide (2008) developed a scale for measuring hospital service quality in Nigeria. This scale
included eight dimensions of hospital service quality such as resource availability, quality of
care, condition of clinic or ward, condition of facility, quality of food, attitude of doctors or
nurses, attitude of non-medical staff and waiting time for service. Duggirala et al. (2008)
identified seven dimensions of hospital service quality in Indian conditions, namely,
infrastructure, personnel quality, process of clinical care, administrative procedures, safety
indicators, social responsibility and overall experience of medical care received. Padma et al.
(2009) developed a conceptual framework to measure hospital service quality from the
perspective of patients as well as their attendants. This framework proposed eight
dimensions of service quality such as infrastructure, personnel quality, process of clinical
care, administrative procedures, safety indicators, corporate image, social responsibility and
trustworthiness of the hospital. Padma et al. (2010) conducted an empirical study to measure
hospital service quality perceptions of both patients and their attendants. For this purpose,
they used an instrument with the above mentioned eight dimensions of hospital service
quality.
Chahal and Kumari (2010) developed and empirically validated HCSQ scale to measure
health-care service quality in Indian context. This study categorised hospital service quality
in to five broad components such as physical environment quality, interaction quality,
outcome quality, service quality and image. Three sub-dimensions, namely ambient
conditions, tangibles and social factor constitute the component physical environment
quality. Four sub-dimensions like attitude and behaviour, expertise, process quality and
 IJPHM service quality constitute the component interaction quality. Similarly four sub-dimensions
12,3 such as waiting time, patient satisfaction, patient loyalty and service quality constitute the
component outcome quality. Three sub-dimensions like physical environment, staff
competence and trust constitute the component service quality. Finally three sub-
dimensions like technical image, modern equipment and technical facilities constitute the
component image. Narang (2010) considered four major dimensions of hospital service
258 quality such as health personnel practices and conduct, adequacy of resources and services,
health-care delivery and access to service to measure patients’ perception towards tertiary
health-care services in India. Aagja and Garg (2010) developed and validated PubHosQual
scale to measure perceived service quality for public hospitals in the Indian context. This
scale consists of five dimensions of hospital service quality, namely, admission, medical
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

service, discharge process, overall service and social responsibility. Mehta (2011) empirically
evaluated service quality and patient satisfaction in Indian health-care context in which he
identified three dimensions of hospital service quality such as promptness, medical aids and
patient interest. Results of this study also found promptness to be the most important
determinant of service quality followed by medical aids and patient interest.
Zineldin et al. (2011) used 5Q model to empirically evaluate health-care service quality in
Kazakhstan. This study measured service quality through eight dimensions such as
infrastructure, atmosphere, interaction, process, staff skills, waiting time, object and
adequacy. Atinga et al. (2011) empirically measured hospital service quality in Ghana
through four dimensions such as communication, patient–provider relationship,
environment and waiting time. Amin and Nasharuddin (2013) empirically investigated
service quality in Malaysian health-care setting in which they considered five dimensions,
namely admission, medical service, discharge, overall service and social responsibility to
measure service quality of both private and public hospitals. Mosadeghrad (2013) conducted
a qualitative study to propose a broad definition of hospital service quality in Iranian health-
care setting based on expectations of nine different stakeholders such as patients, patients’
relatives, providers, managers, policymakers, suppliers, payers, accreditation staffs and
quality managers. This study defined hospital service quality through eight quality rights:
“right care in the right way for the right individual in the right place at the right time by the
right person and for the right price to achieve the right results”. Voon and Abdullah (2014)
conducted an empirical study and developed HospiSE scale to measure service quality of
both public and private hospitals in Malaysia. This measurement scale included three broad
dimensions, namely, employee orientation, patient orientation and competitor orientation
that represent service excellence environment in hospitals. Employee orientation includes
parameters like internal coordination and communication, employee motivation and
competency along with innovative approach in delivering service. Patient orientation
includes parameters like hospital’s commitment to provide service, understanding patients’
needs and resolving their problems along with provision for measurement of patient
satisfaction at regular intervals. Itumalla et al. (2014) developed HospitalQual scale to
measure service quality for in-patient services in hospitals. This scale consists of seven
dimensions such as medical service, nursing services, supportive services, administrative
services, patient safety, patient communication and hospital infrastructure. This study also
established these seven dimensions as significant determinants of inpatient service quality.

Relationship between hospital-perceived service quality, patient satisfaction and behavioural

intention
Cronin et al. (2000) conducted an empirical study to establish linkage between constructs
like quality, value, satisfaction and behavioural intention in service settings. They observed
 direct influence of quality, value and satisfaction on behavioural intention. This study also Hospital
confirmed a model showing indirect effects of service quality and service value on service quality
behavioural intention. According to this study, service value and customer satisfaction play
mediating role while linking the effect of service quality on behavioural intention of
customers. Thus, it can be inferred that service quality influences perceived value or utility
of service, which, in turn, influences customers’ satisfaction level that decides their
behavioural intention towards usage of a particular service provider. Caruana (2002)
empirically tested and validated a model establishing indirect relationship between 259
perceived service quality and service loyalty of consumers (that represents consumers’
behavioural intention to say positive about a service provider, consider repurchase and
recommend a service provider to friends and relatives) through their level of satisfaction.
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

Olorunniwo et al. (2006) conducted an empirical research to establish linkage between

service quality, customer satisfaction and behavioural intention in service factory. Findings
suggest both direct and indirect impact of service quality on behavioural intention. This
study confirms that the indirect impact of service quality on behavioural intention mediated
through customer satisfaction is greater than that of the direct impact. Li et al. (2011)
empirically investigated moderating effect of customer satisfaction on the relationship
between service quality and behavioural intention in hospital setting. Findings suggest
positive moderating effect for service quality dimensions like reliability and empathy
whereas negative moderating effect for dimensions like responsiveness and assurance.
Mohamed and Azizan (2015) proposed and empirically tested a model that confirms
significant association between perceived service quality, patient satisfaction and
behavioural compliance in health-care organisation. This study establishes patient
satisfaction as the dominant and significant determinant of behavioural compliance. It also
establishes direct as well as indirect influence of perceived service quality on behavioural
compliance mediated through patient satisfaction. Sadeh (2017) validated direct linkage
between service quality and patient satisfaction, service quality and patient loyalty as well
as patient satisfaction and patient loyalty.
Wong (2002) found the five dimensions of service quality considered in SERVQUAL
scale as significant predictors of overall satisfaction of ambulatory patients in a bone
densitometry unit. Dagger et al. (2007) empirically validated a model, which shows patients’
perception of service quality has significant impact on their level of satisfaction towards
health-care service delivery, which in turn influences their behavioural intention. Zineldin
(2006) developed a multidimensional model of health-care quality and patient satisfaction,
according to which five quality dimensions constitute total quality in health care which
influences patient satisfaction that results in positive behavioural intention of patients to
recommend a health service provider. Tam (2007) conducted a longitudinal study which
shows improvement in quality of health service delivery improves patient satisfaction
which in turn, encourages patients’ behavioural intention to revisit a specific health-care
service provider. Duggirala et al. (2008) found seven dimensions of patient perceived total
quality service in health-care as significant predictors of overall patient satisfaction. Vinagre
and Neves (2008) developed a model to establish direct impact of service quality, patient’s
emotion, involvement and expectations on patient satisfaction. Padma et al. (2009) proposed
a conceptual framework which shows the eight dimensions of hospital service quality
influence customer satisfaction which in turn, influences their behavioural intention.
Naidu (2009) proposed a conceptual model, which shows health service quality perception as
antecedent of patient satisfaction and their behavioural intention in terms of the level of
loyalty towards a health-care service provider. Chaniotakis and Lymperopoulos (2009)
developed a model based on empirical study, which shows direct influence of service quality
 IJPHM dimensions like tangibles, assurance and responsiveness on patient satisfaction and their
12,3 behavioural intention to spread the word-of-mouth. Padma et al. (2010) explored the impact
of hospital service quality dimensions on patients’ and their attendants’ satisfaction. This
study found service quality dimensions like personnel quality, clinical care, image and
trustworthiness having statistically significant impact on patients’ satisfaction. Service
quality dimensions like infrastructure, personnel quality, process of clinical care and
260 administrative procedure were found to have statistically significant impact on attendants’
satisfaction. Mehta (2011) established the cause and effect relationship between hospital
service quality and patient satisfaction. Atinga et al. (2011) found service quality dimensions
like communication, provider–patient relationship, environment and waiting time as
significant predictors of patients’ satisfaction with quality of health service delivery.
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

Amin and Nasharuddin (2013) developed a model establishing positive relationship between
dimensions of hospital service quality, patients’ satisfaction and their behavioural intention.
Murti et al. (2013) developed a model, which suggests the seven dimensions of hospital
service quality as significant predictors of patient satisfaction as well as their behavioural
intention. Voon and Abdullah (2014) suggested dimensions of hospital service quality
having positive and significant influence on employee perceived overall quality, patient
satisfaction and their repurchase intention.

Development of the conceptual framework

After extensive review of existing literature on hospital service quality, patient satisfaction
and their behavioural intention, this study has identified six major areas through which
patients and their attendants perceive or evaluate quality of service in a hospital. These six
areas are technical quality, procedural quality, infrastructural quality, interactional quality,
personnel quality and social support quality. “Technical quality” refers to patients’
impression about the core medical service of hospital. “Procedural quality” refers to patients’
impression about the administrative procedures involved in delivery of health-care service.
“Infrastructural quality” refers to patients’ impression about the physical facilities in
hospital to facilitate service delivery. “Interactional quality” refers to patients’ impression
about the interaction or communication with hospital staff during stay in hospital.
“Personnel quality” refers to patients’ impression about skills and ability of hospital staff.
“Social support quality” refers to patients’ impression about ethical and social role of
hospital leading to its reputation in the society.
Further, this study identified 20 dimensions of hospital perceived service quality under
these 6 broad areas. Technical quality consists of two dimensions like clinical procedure and
quality of outcome. Procedural quality consists of six dimensions like admission, discharge,
waiting time, patient safety and privacy, billing and price and follow-up. Infrastructural
quality consists of four dimensions like ambience, availability of resources, accessibility and
food. Interactional quality consists of three dimensions like staff attitude, personalised
attention and information availability. Personnel quality consists of three dimensions like
staff competency, trustworthiness and staff diversity. Social support quality consists of two
dimensions like hospital image and social responsibility. Table II represents these twenty
dimensions of perceived service quality along with description for each of them.
On the basis of the authors’ understanding of the above concept related to perceived
service quality in a hospital setting, this study has tried to develop an exhaustive conceptual
framework (shown in Figure 1) showing relationship between the dimensions of perceived
service quality and patient satisfaction with delivery of service. According to this model,
patients’ overall perceived service quality about hospital is a function of patients’ service
experience in 6 major areas consisting of 20 dimensions, as described in Table I. This model
 Major areas of
Hospital
hospital service Dimensions of perceived Description for dimensions of perceived hospital service service quality
quality hospital service quality quality

Technical Clinical procedure Performing thorough and adequate number of clinical or

quality diagnostic tests, efficient medical treatment along with
appropriate pre-operative and post-operative advice
Quality of outcome Effectiveness of medical treatment in curing illness along 261
with management of complications and infections
Procedural Admission Easy access to ambulance and emergency service and
quality smooth transition from emergency or outpatient
department to wards
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

Discharge Explanation about the discharge process and precautions

to be taken post discharge and proper documentation
Waiting time Time required to get appointment, meet with doctors and
get reports of diagnostic tests
Patient safety/privacy Hygienic care, safety measures to prevent fall and security
to prevent theft of personal belongings
Billing and price Accuracy and transparency in billing, and charging
reasonable price for medical services
Follow-up Tracking health status of patients even after discharge
from hospital
Infrastructural Ambience Level of cleanliness, comfort, noise, decoration in hospital
quality wards and presence of directional signage
Availability of resources Availability of doctors, nurses, ambulance, medical
equipment, clinical and diagnostic test facilities, drugs,
housekeeping facilities
Accessibility Convenient location and operating hours of the hospital,
easy access to ambulance as well as emergency service
Food Taste, quantity, temperature, presentation of meals served,
timeliness of serving meals and promptness in removing
dirty dishes
Interactional Staff attitude Friendly, caring and helping behaviour of hospital staff
quality towards patients
Personalised attention Extent to which patients are being paid individual
attention with respect and dignity
Information availability Extent to which patients are informed about their medical
condition, clinical or diagnostic procedures to be performed
and rules to be followed in the hospital wards
Personnel Staff competency Skill and qualification of medical and paramedical staff to
quality deal with patients’ illness
Trustworthiness Patients’ confidence in doctors and credibility of hospital in
delivering services as promised
Staff diversity Availability of medical and paramedical staff from
different specialisations
Social support Hospital image Sincere and honest practices followed in hospital, its
quality reputation and hospital’s focus on technology and
innovation
Social responsibility Providing fair medical treatment to different segments of Table II.
people in society, provision of medical service at nominal Dimensions of
cost to the needy patients and ethical practices followed by perceived hospital
the hospital service quality
 IJPHM Clinical procedure
Technical Quality
12,3 Quality of outcome

Admission

Discharge

Waiting time
262 Procedural Quality
Patient safety/privacy

Billing and price

Follow up
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

Ambience
Overall
Availability of resources Patient
Perceived
Infrastructural Quality Satisfaction
Service
Accessibility
Quality
Food

Behavioural
Staff attitude
Intention
Personalized attention Interactional Quality
Information availability

Staff competency

Trustworthiness Personnel Quality

Staff diversity
Figure 1.
The 6-Q framework Hospital image
for hospital service Social support Quality
Social responsibility
quality and patient
satisfaction
Dimensions of Hospital Service Quality

further proposes a direct relationship between patients’ overall perceived service quality and
their level of satisfaction with the service delivery. This direct relationship represents the 20
dimensions of hospital service quality as antecedents of patients’ satisfaction, which, in turn,
influences their behavioural intention. Patients’ behavioural intention reflects their tendency
to spread word of mouth about the hospital, recommend a hospital to their friends and
relatives to avail services and consider repeat visit in case of illness in future.

Conclusion
Extensive review of literature on hospital service quality strongly indicates that the
dimensions discussed under SERVQUAL and modified SERVQUAL instruments are not
adequate to cover the holistic perspective of perceived service quality in a health-care
setting. Thus, understanding and measurement of hospital service quality needs a non-
SERVQUAL or different approach to address all the concerned areas, as it is adapted by
many researchers that are discussed earlier in the literature review section. With reference to
all the literature considered for the present study, this article has tried to develop an
exhaustive framework (The 6-Q framework for hospital service quality and patient
 satisfaction) to provide a holistic impression about hospitals service quality through 6 broad Hospital
quality areas consisting of 20 dimensions. service quality
This “6-Q framework for hospital service quality and patient satisfaction” also supports
earlier researchers’ view about the direct relationship between hospital service quality and
patient satisfaction, as well as the mediating role of patient satisfaction while linking
hospital service quality with behavioural intention. This “6-Q framework” clearly suggests
that patients evaluate quality of service delivery in a hospital through the 20 dimensions
which results in patients’ overall perception about the service quality of a hospital. This 263
overall perception about service quality directly influences the level of patients’ satisfaction
with health-care service provider. Depending on the level of satisfaction, patients show
either positive or negative behavioural intention with respect to spreading word of mouth,
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

future usage and recommending a particular health service provider to others.

Managerial implications
The conceptual framework projects all the possible dimensions through which patients
evaluate or perceive quality of service delivery in hospitals. Health-care managers/
administrators should take all possible measures to take feedback from patients and/or their
attendants at regular interval to evaluate quality of service, identify gaps across these
dimensions and fix issues accordingly. All health-care organisations should attach highest
importance to technical quality, as it addresses management of the core medical service that
comprises treatment and its outcome for which patients basically visit to hospitals. Without
proper management of technical quality, a hospital can never be rated higher for its service
delivery. The second most important area that should be managed by hospitals is the
procedural quality, which addresses essential administrative functions like admission,
discharge, waiting time, billing and follow-up that are associated with medical treatment.
Thus, health-care managers need to understand that technical quality and procedural
quality are the basic expected level of service associated with hospitals. All the other four
areas such as infrastructural quality, interactional quality, personnel quality and social
support quality can be considered as elements of augmentation to the basic health service.
Thus, depending on the availability of physical/financial/manpower resources, health-care
managers can prioritise their focus on these four areas to improve patients’ experience
during hospital stay. This will help improve patient satisfaction and spread positive word-
of-mouth, thereby improving hospital’s image as well as profitability.

Direction for future research

The conceptual framework developed in this study is applicable only for tertiary health-care
institutions, especially large hospitals. This model can be validated and tested empirically
for both public and private hospitals. The instrument given in Appendix can be used to
measure perceived service quality, patients’ satisfaction level with the service delivery and
their behavioural intention.

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.
Alborie, 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.
 IJPHM Amin, M. and Nasharuddin, S.Z. (2013), “Hospital service quality and its effects on patient satisfaction and
behavioral intention”, Clinical Governance: An International Journal, Vol. 18 No. 3, pp. 238-254.
12,3
Anderson, E.A. and Zwelling, L.A. (1996), “Measuring service quality at the university of Texas M.D. Anderson
cancer center”, International Journal of Health Care Quality Assurance, Vol. 9 No. 7, pp. 9-22.
Arasli, H., Ekiz, E.H. and Katircioglu, S.T. (2008), “Gearing service quality into public and private
hospitals in small islands, empirical evidence from Cyprus”, International Journal of Health Care
Quality Assurance, Vol. 21 No. 1, pp. 8-23.
264
Atinga, R.A., Nkrumah, G.A. and Domfeh, K.A. (2011), “Managing healthcare quality in Ghana: a
necessity of patient satisfaction”, International Journal of Health Care Quality Assurance, Vol. 24
No. 7, pp. 548-563.
Baalbaki, I., Ahmed, Z.U., Pashtenko, V.H. and Makarem, S. (2008), “Patient satisfaction with
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

healthcare delivery systems”, International Journal of Pharmaceutical and Healthcare

Marketing, Vol. 2 No. 1, pp. 47-62.
Caruana, A. (2002), “Service loyalty – the effects of service quality and the mediating role of customer
satisfaction”, European Journal of Marketing, Vol. 36 Nos 7/8, pp. 811-828.
Chahal, H. and Kumari, N. (2010), “Development of multidimensional scale for healthcare service
quality in Indian context”, Journal of Indian Business Research, Vol. 2 No. 4, pp. 230-255.
Chahal, H. and Kumari, N. (2012), “Consumer perceived value, the development of a multiple item scale
in hospitals in the Indian context”, International Journal of Pharmaceutical and Healthcare
Marketing, Vol. 6 No. 2, pp. 167-190.
Chaniotakis, I.E. and Lymperopoulos, C. (2009), “Service quality effect on satisfaction and word of
mouth in the health care industry”, Managing Service Quality: An International Journal, Vol. 19
No. 2, pp. 229-242.
Cronin, J.J., Brady, M.K. and Hult, G.T.M. (2000), “Assessing the effects of quality, value, and customer
satisfaction on consumer behavioural intentions in service environments”, Assessing the Effects
of Quality, Vol. 76 No. 2, pp. 193-218.
Dagger, T.S., Sweeney, J.C. and Johnson, L.W. (2007), “A hierarchical model of health service quality:
scale development and investigation of an integrated model”, Journal of Service Research, Vol. 10
No. 2, pp. 123-142.
Doran, D. and Smith, P. (2004), “Measuring service quality provision within an eating disorders
context”, International Journal of Health Care Quality Assurance, Vol. 17 No. 7, pp. 377-388.
Duggirala, M., Rajendran, C. and Anantharaman, R.N. (2008), “Patient-perceived dimensions of
total quality service in healthcare”, Benchmarking: An International Journal, Vol. 15 No. 5,
pp. 560-583.
Eleuch, A.K. (2011), “Heathcare service quality perception in Japan”, International Journal of Health
Care Quality Assurance, Vol. 24 No. 6, pp. 417-429.
Itumalla, R., Acharyulu, G.V.R.K. and Shekhar, B.R. (2014), “Development of HospitalQual – a service
quality scale for measuring in-patient services in hospitals”, Operations and Supply Chain
Management, Vol. 7 No. 2, pp. 54-63.
John, J., Yatim, F.M. and Mani, S.A. (2011), “Measuring service quality of public dental healthcare
facilities in Kelantan, Malaysia”, Asia Pacific Journal of Public Health, Vol. 23 No. 5, pp. 742-753.
Li, S.J., Huang, Y.Y. and Yang, M.M. (2011), “How satisfaction modifies the strength of the influence of
perceived service quality on behavioural intentions”, Leadership in Health Services, Vol. 24 No. 2,
pp. 91-105.
Mahapatra, S. (2013), “A comparative study of service quality between private and public hospitals:
Empirical evidences from India”, Journal of Medical Marketing: Device, Diagnostic and
Pharmaceutical Marketing, Vol. 13 No. 2, pp. 115-127.
Mehta, S. (2011), “Service quality as predictor of patient satisfaction: a study of the healthcare sector”,
Journal of Health Management, Vol. 13 No. 2, pp. 211-229.
 Mejabi, O.V. and Olujide, J.O. (2008), “Dimensions of hospital service quality in Nigeria”, European Hospital
Journal of Social Sciences, Vol. 5 No. 4, pp. 141-157.
service quality
Moghadam, M.N. and Amiresmaili, M. (2009), “Hospital services quality assessment – Hospitals of
Kerman University of Medical Sciences as a tangible example of a developing country”,
International Journal of Health Care Quality Assurance, Vol. 24 No. 1, pp. 57-66.
Mohamed, B. and Azizan, N.A. (2015), “Perceived service quality’s effect on patient satisfaction and
behavioural compliance”, International Journal of Health Care Quality Assurance, Vol. 28 No. 3,
pp. 300-314. 265
Mosadeghrad, A.M. (2013), “Healthcare service quality: towards a broad definition”, International
Journal of Health Care Quality Assurance, Vol. 26 No. 3, pp. 203-219.
Murti, A., Deshpande, A. and Srivastava, N. (2013), “Patient satisfaction and consumer behavioral
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

intentions: an outcome of service quality in healthcare services”, Journal of Health Management,

Vol. 15 No. 4, pp. 549-577.
Naidu, A. (2009), “Factors affecting patient satisfaction and healthcare quality”, International Journal of
Health Care Quality Assurance, Vol. 22 No. 4, pp. 366-381.
Narang, R. (2010), “Measuring perceived quality of healthcare services in India”, International Journal
of Health Care Quality Assurance, Vol. 23 No. 2, pp. 171-186.
Olorunniwo, F., Hsu, M.K. and Udo, G.F. (2006), “Service quality, customer satisfaction, and behavioral
intention in the service factory”, Journal of Services Marketing, Vol. 20 No. 1, pp. 59-72.
Padma, P., Rajendran, C. and Lokachari, S.L. (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.
Padma, P., Rajendran, C. and Prakash Sai, L. (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.
Parasuraman, A., Zeithamal, V.A. and Berry, L.L. (1985), “A conceptual model of service quality and its
implication for future research”, Journal of Marketing, Vol. 49 No. 4, pp. 41-50.
Ramanujam, P.G. (2011), “Service quality in healthcare organizations: a study of corporate hospitals in
Hyderabad”, Journal of Health Management, Vol. 13 No. 2, pp. 177-202.
Rashid, W.E.M. and Jusoff, H.K. (2009), “Service quality in healthcare setting”, International Journal of
Health Care Quality Assurance, Vol. 22 No. 5, pp. 471-482.
Rose, R.C., Uli, J., Abdul, M. and Looi, K.N. (2004), “Hospital service quality: a managerial challenge”,
International Journal of Health Care Quality Assurance, Vol. 17 No. 3, pp. 146-159.
Roshnee, R. and Fowder, 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.
Sachdev, S.B. and Verma, H.V. (2004), “Relative importance of service quality dimensions: a
multisectoral study”, Journal of Services Research, Vol. 4 No. 1.
Sadeh, E. (2017), “Interrelationships among quality enablers, service quality, patients’ satisfaction and
loyalty in hospitals”, The TQM Journal, Vol. 29 No. 1, pp. 101-117.
Seth, J.N. (1991), “Competitive advantage through customer satisfaction”, BMA Review, Vol. 9 No. 2,
pp. 13-25.
Sohail, M.S. (2003), “Service quality in hospitals: more favourable than you might think”, Managing
Service Quality: An International Journal, Vol. 13 No. 3, pp. 197-206.
Sower, V., Duffy, J., Kilbourne, W., Kohers, G. and Jones, P. (2001), “The dimensions of service quality
for hospitals: development and use of the KQCAH scale”, Health Care Management Review,
Vol. 26 No. 2, pp. 47-59.
Tam, J.L.M. (2007), “Linking quality improvement with patient satisfaction: a case study of a health
service Centre”, Marketing Intelligence & Planning, Vol. 25 No. 7, pp. 732-745.
 IJPHM Tomes, A.E. and Peng, S.C. (1995), “Service quality in hospital care: the development of an in-patient
questionnaire”, International Journal of Health Care Quality Assurance, Vol. 8 No. 3, pp. 25-33.
12,3
Vinagre, M.H. and Neves, J. (2008), “The influence of service quality and patients’ emotions on
satisfaction”, International Journal of Health Care Quality Assurance, Vol. 21 No. 1, pp. 87-103.
Voon, B.H. and Abdullah, F. (2014), “Developing a HospiSE scale for hospital service excellence”,
International Journal of Quality & Reliability Management, Vol. 31 No. 3, pp. 261-280.
266 Wisniewski, M. and Wisniewski, H. (2005), “Measuring service quality in a hospital colonoscopy clinic”,
International Journal of Health Care Quality Assurance, Vol. 18 No. 3, pp. 217-228.
Wong, J.C.H. (2002), “Service quality measurement in a medical imaging department”, International
Journal of Health Care Quality Assurance, Vol. 15 No. 5, pp. 206-212.
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

World Health Organization (2006), Quality of Care, a Process for Making Strategic Choices in Health
Systems, WHO Press, Geneva.
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 Health
Care Quality Assurance, Vol. 19 No. 1, pp. 60-92.
Zineldin, M., Akdag, H.C. and Vasicheva, V. (2011), “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.

Further reading
Frimpong, N.O., 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.

Appendix
It represents the items that can be used to measure each of the 20 dimensions of perceived
service quality in a hospital, patients’ satisfaction level with the service delivery and their
behavioural intention.
(1) Clinical procedure:
 thorough investigation or examination of illness by doctors;
 performance of adequate number of clinical or diagnostic tests;
 efficient handling of critical incidents during the course of medical treatment;
 pre-operative advice given by doctors; and
 efficient management of post-operative treatment.
(2) Quality of outcome:
 complications owing to inadequate or negligent care;
 deterioration in health after treatment;
 incidence and severity of nosocomial infections; and
 effectiveness of treatment in curing illness.
(3) Admission:
 convenience in getting appointment with doctors;
 prompt and simple admission process;
 ease of availing emergency service of the hospital;
 short and simple process of allocation of beds or wards; and
 smooth transition from OPD to wards.
 (4) Discharge: Hospital
 prompt and simple discharge process; service quality
 proper explanation about the discharge process; and
 explanation about precautions and medicines to be taken post discharge.
(5) Waiting time:
 time required to meet doctors in the OPD;
 time required to receive first care by doctors in wards; 267
 time required to get diagnostic test reports; and
 time required to receive emergency care when needed.
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

(6) Patient safety and privacy:

 adequate hygienic care and procedures to prevent infections;
 presence of safety measures like ramps, hand rails, elevators to prevent fall;
 adequate security to prevent theft of personal belongings; and
 maintenance of patient’s privacy and confidentiality.
(7) Billing and price:
 reasonable pricing of services offered by the hospital;
 accuracy in the billing process; and
 fairness and transparency in billing process.
(8) Follow-up:
 explanation about the follow up dates or schedule; and
 provision of follow up about patient’s condition post discharge.
(9) Ambience:
 cleanliness of wards, waiting area, toilets etc;
 visual appeal of the physical facilities;
 effective layout of different facilities in the hospital;
 level of comfort such as temperature, noise, ventilation, odour, etc.;
 presence of directional signage; and
 presence of display boards about patient education.
(10) Availability of resources:
 availability of doctors and nurses;
 availability of ambulance service;
 availability of clinical and diagnostic test facilities;
 availability of medical equipment in proper working condition;
 availability of required medicines;
 availability of blood in time;
 availability of housekeeping facility; and
 availability of life-support facilities.
(11) Accessibility:
 convenient location of the hospital;
 access to ambulance and emergency services;
 transportation and communication facility to the hospital; and
 convenient operating hours of the hospital.
 IJPHM (12) Food:
12,3  quantity of food served in the hospital;
 taste of the food served;
 temperature of the food served;
 hygiene of the food served;
 option to choose from menu; and
268
 promptness in removal of dirty dishes after taking food.
(13) Staff attitude:
 friendly and caring attitude shown by doctors;
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

 friendly and caring attitude shown by nurses and other paramedical staff;
 courtesy shown by the administrative staff;
 willingness of hospital staff to help patients and their attendants;
 responsiveness of medical staff to queries or problems of patients and their
attendants; and
 level of coordinated effort shown by hospital staff as a team.
(14) Personalised attention:
 individual attention paid to patients by hospital staff;
 hospital staff’s orientation towards patients’ concerns and requirements; and
 treating patient as an individual but not just a bed number.
(15) Information availability:
 information about the treatment procedures and their possible outcomes;
 information about diagnostic tests to be performed;
 information about rules and regulations to be followed during the hospital stay;
 clarity of information about various processes in the hospital; and
 information about finances involved in the treatment process.
(16) Staff competency:
 qualification of doctors to treat critical illness and deal with complex conditions;
 skills and expertise of doctors to plan effective treatment;
 skills and expertise of nursing and paramedical staff to take proper care; and
 skills and expertise of administrative staff to run hospital operations smoothly.
(17) Trustworthiness:
 patients’ level of confidence in doctors involved in treatment process;
 credibility of services and administration of the hospital;
 extent to which hospital delivers services as promised; and
 extent to which hospital has patients’ best interest at heart.
(18) Staff diversity:
 presence of a team of staff members from various fields; and
 presence of doctors from different specialisations.
(19) Hospital image:
 reputation of the hospital;
 extent to which the hospital follows ethical practices; and
 hospital’s orientation towards innovation and technology adoption.
 (20) Social responsibility: Hospital
 provision of medical services at nominal cost to needy patients; service quality
 fair medical treatment provided to patients; and
 delivery of equitable medical care to patients from different segments of society.
(21) Patient satisfaction:
 level of satisfaction with hospital procedures such as admission, stay and
discharge; 269
 level of satisfaction with the medical care by doctors and nurses;
 level of satisfaction with the care provided by support and administrative staff;
Downloaded by Universitas Pelita Harapan, User Trisakti At 22:01 10 December 2018 (PT)

 level of satisfaction with the amount of expenses incurred compared to the medical
care received; and
 level of satisfaction with environment in the hospital required for a comfortable
stay.
(22) Behavioural intention:
 extent to which patients spread positive word of mouth about the hospital;
 patient’s willingness to come back for treatment at the same hospital in case of any
illness in future; and
 patient’s willingness to refer this hospital to friends or relatives for treatment in
case of any illness.

About the authors

Swapnarag Swain is working as an Assistant Professor, Management and Head (i/c), the Department
of Business in the School of Business & Commerce, Glocal University. He has six years of experience
in the areas of training, teaching, education administration, market research and business
development. His teaching and research interests lie in the areas of service marketing, consumer
behaviour, brand management, quality management and market research. Swapnarag Swain is the
corresponding author and can be contacted at: swapnarag.swain@gmail.com
Dr Nirmal Chandra Kar is a Professor, Management in the Department of Business
Administration, Utkal University. He has an extensive experience of more than 30 years in teaching
and research with more than 50 publications in national and international journals of repute. His
teaching and research interests lie in the areas of services management, financial services and
business research.

For instructions on how to order reprints of this article, please visit our website:
www.emeraldgrouppublishing.com/licensing/reprints.htm
Or contact us for further details: permissions@emeraldinsight.com