CHAPTER 1

INTRODUCTION
&
DESIGN OF THE STUDY
1.1 INTRODUCTION

Service Quality is a critical element of customer perception .In the case of pure

service (e.g. health care, financial services, education), service quality will be

the dominant element in customers evaluations. In cases in which customer

services are offered in combination with physical product, service quality may

also be very critical in determining customer satisfaction.

Perception is the process of acquiring, interpreting, selecting and organizing

sensory information. Hence it is the process, which interprets and organizes

sensation to produce a meaningful experience of the world. The word

perception comes from the Latin word “percepio” meaning “receiving,

collecting and action of taking possession, apprehension with the mind or

senses.”

Service is the work done by one person or group that benefits another; but it is

the quality in the service provided that determines the effectiveness in any

particular service. There are various service sectors like transportation, health
etc. Customer expectation should be the initial factor to be considered by all

service organizations. Customer satisfaction, a business term, is a measure of

how products and services supplied by a company meet or surpass customer

expectation.

In today's highly competitive environment, hospitals are increasingly realizing

the need to focus on service quality as a measure to improve their competitive

position. Customer (i.e. patients) based determinants and perceptions of service

quality, therefore, play an important role when choosing a hospital.

In this project, we present a study on measurement of service quality of

hospitals in Kannur town.Anlaysis and interpretation is the core part of this

study. For the purpose of this study a survey of 85 patients was conducted and

data obtained have been analysed with the help of SERVQUAL method .
1.2 STATEMENT OF THE PROBLEM

There is a growing need for monitoring service quality provided by the

hospitals in Kannur town. In today’s competitive environment, hospitals have

to focus on their services as a measure to improve their competitive position but

it is however noticed that hospitals are mainly focusing only in the execution of

their services and the quality factor is neglected.

Patient’s expectations are the most vital factor to be considered in a service

sector like hospital. Patient’s ‘need fulfillment’ itself can determine the success

of the particular organization.

Therefore, it is important to ensure the safety of patients and to know how the

public perceives the quality of hospitals and hospital care. With this objective

we have measured the service quality of hospitals in Kannur town.

1.3 OBJECTIVES OF THE STUDY

1. To measure the service quality of hospitals in Kannur town.

2. To study and analyze the effectiveness of services rendered to the

patients.

3. To understand if customer expectations are met by the hospitals.

4. To present valuable suggestions on the basis of the findings of the study,

and to draw conclusions.

1.4 SAMPLE DESIGN

A sample of 85 patients from Kannur town was used for this study. These

patients were identified from 6 hospitals in Kannur town.

1.5 METHODOLGY AND DATA COLLECTION

Both primary and secondary data have been used for the study.

Primary data was collected using SERVQUAL questionnaire from patients

directly. The data for the purpose of study was collected by means of structured

questionnaire method. The patients were contacted personally to get the

necessary data related to the study.

Secondary data was collected from published sources such as journals, books

and websites.

1.6 TOOLS OF ANALYSIS

The analytical technique used for this study is simple percentage analysis. The

data were collected, tabulated and values are plotted by using pie charts.
1.7 CHAPTER SCHEME

This project report has been presented in the following format:

The first chapter deals with the introduction and design of the study which

consists of; introduction, statement of the problem, objectives of the study,

sample design, methodology and data collection, tools of analysis and chapter

scheme.

The second chapter gives a brief description of the Literature Survey.

The third chapter consists of the industry profile.

The fourth chapter consists of analysis and interpretation of data.

The fifth chapter is the concluding chapter. It includes findings of the study,

suggestions and conclusions.

 CHAPTER 2

LITERATURE SURVEY
LITERATURE SURVEY

These are published reports with regard to ‘measuring service quality in

hospitals and the prominent ones have been reviewed as under:

While there have been efforts to study service quality, there has been no general

agreement on the measurement of the concept. The majority of the work to date

has attempted to use the SERVQUAL (Parasuraman et al., 1985; 1988)

methodology in an effort to measure service quality (Chaston, 1994).

Measurement allows for comparison before and after changes, for the location

of quality related problems and for the establishment of clear standards for

service delivery. Edvardsen et al. (1994) state that, in their experience, the

starting point in developing quality in services is analysis and measurement.

While stressing on quality is one thing, the question is continuous management

of quality systems. The advantage of SERVQUAL is that it is a tried and tested

instrument which can be used comparatively for benchmarking purposes

(Brysland and Curry, 2001). SERVQUAL has five generic dimensions or

factors (van Iwaarden et al., 2003): Tangibles, Reliability, Responsiveness.

Assurance and Empathy.[1]

[1] Source: Journal of International Business and Economics, May, 2007 by G.V.R.K.
Acharyulu, B. Rajashekhar (page no:102-103)

Because there is growing consensus that monitoring quality care should be

based, at least in part, on patients' perceptions (Davies and Ware 1988), this

article expands earlier findings on how the public perceives the quality of

hospitals and hospital care (Boscarino 1988b). In this study, the public's overall

quality ratings of 155 short-term medical and surgical hospitals are analyzed by

the type, size, staff ratio, mortality rate, case mix, and location. The hospitals in

the study represented a national cross-section of institutions, with the results

based on 20,000 adults surveyed in 40 U.S. market areas. Initial analysis shows

that the public rates nonrural, larger, tertiary care, teaching, higher-patient

census, better-staffed, and lower-mortality facilities higher in overall quality.

Hospitals that are located in the Midwest or West, have higher average

employee salaries, and that are more costly are also perceived to be of a higher
quality. A multiple regression analysis reveals that combined these variables

account for 50 percent of the public's quality perception, with the most

important being tertiary care level, patient-census level, average employee

salary, and teaching status (all positively related to higher quality). Using these

variables in a discriminant function analysis, hospitals with high-perceived

quality can be correctly identified 80 percent of the time. It is suggested that

these findings have major significance for monitoring the quality of care, based

on patients' perceptions. A practical model for doing this, one that minimizes

patient biases and incorporates medical outcomes, is described in detail.[2]

[2]Source: The Public’s perception of quality hospitals II: Implications for patient surveys,
Boscarino JA, Journal of International Business and Economics, March, 2008. (page
no:98-99)

We have found that patients have distinct opinions about many components of

hospital care, but that little recent work has identified those components

important to today's patients in the United States. Investigators have

constructed reproducible scales to obtain evaluations. Patient evaluations of the

interpersonal features of hospital care are influenced by interventions that

physicians or nurses identify as "higher" quality of care. We do not know if

patient reports and ratings of specific aspects of care accurately reflect the

effects of hospital care on health outcomes--the quality standard that public

agencies and payers may consider the most important. However, patient

evaluations of nursing care and medical care are independently related to

patients' overall satisfaction, overall assessments of quality, and intentions to

recommend and return to the same hospital. More studies are needed to clarify

whether other components of hospital care also contribute to these ratings and

intentions and, if so, how much. No response bias affects patient surveys,

making patient ratings of care in each sample more favorable than the

population mean; we do not know how this affects conclusions of surveys that

compare hospitals or treatments. Few studies have compared how different

methods affect the reproducibility and accuracy of patient reports and ratings.

Practical issues may be the most important obstacles for users of patient ratings,

particularly regarding whether potential users will be able to interpret results

and accept them. Finally, no comprehensive instrument or survey method in the

published literature has been tested enough to be recommended as a

reproducible, accurate, and interpretable quality measure: a few do, however,

appear worthy of further testing. [3]

[3]Source: Can patients evaluate the quality of hospital care?, Rubin, Department of Medicine,
University of California, San Francisco,Journal of International Business and
Economics,July,2009.(page27-28)

Patients use more than 500 criteria to evaluate a hospital's quality. The authors

synthesized these criteria into 14 dimensions to provide the foundation of a new

instrument for measuring service quality in health care. Patients use emotional

criteria to evaluate technical quality. Therefore, hospitals must not neglect the

emotional aspects of cure. Developed around three theoretical components--

structure, process, and outcome--the quality dimensions should help hospital

marketers pinpoint what is important to patients and how they perceive the

service encounter.[4]

[4]Source: Managing perceptions of hospital quality. Negative emotional evaluations can

undermine even the best clinical quality.,Zifko-Baliga GM, Krampf RF,Institute for Quality
Center, Hudson, OH, USA.,Journal of International Business and Economics,March,2008.
(page50-55)
 CHAPTER 3

INDUSTRY PROFILE
INDUSTRY PROFILE

A hospital is an institution for health care providing treatment for patients by

specialized staff and equipment, and often, but not always providing for longer-

term as long as the patient stays.Today, hospitals usually are funded by the

public sector, by health organizations, (for profit or nonprofit), health insurance

companies or charities, including direct charitable donations. In history,

however, hospitals often were founded and funded by religious orders or

charitable individuals and leaders. Similarly, modern-day hospitals are largely

staffed by professional physicians, surgeons, and nurses, whereas in history,

this work usually was performed by the founding religious orders or by

volunteers.

During the Middle Ages the hospital could serve other functions, such as

almshouse for the poor, hostel for pilgrims, or hospital school. The name comes

from Latin hospes (host), which also is the root for the English words hotel,

hostel, and hospitality. The modern word hotel derives from the French word
hostel, which featured a silent s, eventually removed from the word to leave a

circumflex on modern French hôtel. The word also is related to the Sanskrit

word 'Ispital' and the German 'Spital'.

Some patients go to a hospital just for diagnosis, treatment, or therapy and then

leave ('outpatients') without staying overnight; while others are 'admitted' and

stay overnight or for several weeks or months ('inpatients'). Hospitals usually

are distinguished from other types of medical facilities by their ability to admit

and care for inpatients.

The best-known type of hospital is the general hospital, which is set up to deal

with many kinds of disease and injury, and typically has an emergency

department to deal with immediate and urgent threats to health. A general

hospital typically is the major health care facility in its region, with large

numbers of beds for intensive care and long-term care; and specialized facilities

for surgery, plastic surgery, childbirth, bioassay laboratories, and so forth.

Larger cities may have many several hospitals of varying sizes and facilities.

Some hospitals, especially in the United States, have their own ambulance

service.

Types of specialized hospitals include trauma centers, rehabilitation hospitals,

children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with

specific medical needs such as psychiatric problems, certain disease categories,

and so forth.

A hospital may be a single building or a number of buildings on a campus.

Many hospitals with pre-twentieth-century origins began as one building and

evolved into campuses. Some hospitals are affiliated with universities for

medical research and the training of medical personnel such as physicians and

nurses, often called teaching hospitals. Worldwide, most hospitals are run on a

nonprofit basis by governments or charities. Within the United States, most

hospitals are nonprofit.

 CHAPTER 4

ANALYSIS

&

INTERPRETATION OF DATA
ANALYSIS AND INTERPRETATION OF DATA

The data after collected has to be processed and analysed in accordance with

outline laid down for the purpose at the time of developing the research

plan.This is essential for a scientific study and for ensuring that we have all

relevant data for making computation of certain measures along with searching

for patterns of relationship that exists among data groups.

Analysis of data in a general way involves a number of closely related

operations ,which are preferred with the purpose of summerising the collected

data and organizing these in such a manner that they answer the research

question.

Interpretation refers to the task of drawing inference from the collected facts

after an analytical study.Infact, it is a search for broader meaning of research

findings.Interpretation has two major aspects mainly:

• The effort to establish continuity in research through linking the result of a

given study with those of another.

• The establishment of some explanatory concepts.

Thus interpretation is the device through which the factor that seem to explain

what has been observed by researcher in the course of the study can be

understood and it provides a theoretical conception which can serve as a guide

for researchers.

Defining and measuring the quality of service has been a major challenge in

healthcare industry. The service quality measurement scale (SERVQUAL) has

been widely used in research to measure quality of service in a hospital service

environment. Service firms like hospital organizations are realizing the

significance of patient-centered philosophies and are turning to quality

management approaches to help managing their businesses. SERVQUAL as an

effective approach has been studied and its role in the analysis of the difference

between patient expectations and perceptions has been highlighted through a

study conducted at hospitals in Kannur town.

The dimensions of service quality have been identified through the pioneering

research of Parsu Parashuraman, Valarie A Zeithaml and Leonard Berry.Their

research identified 5 specific dimensions of service quality that apply across

variety of service contexts.The 5 dimensions defined here as drivers of service

quality are:

• Reliability:Ability to perform the promised service dependably and

accurately.

• Assurance:Employees knowledge,courtesy and their ability to inspire

trust and confidence.

• Empathy:Caring and individual attention given to customers.

• Tangibility:Appearance of physical facilities,equipments,personnel and

written materials.

The above dimensions represent how consumers organize information about

service quality in their minds.With the help of the above dimensions service

quality in hospitals of Kannur town have been measured.

 TANGIBILITY

TABLE NO.1
TANGABILITY
PARTICULARS NO OF RESPONDANTS PERCENTAGE
EXCELLENT 241 23.63
GOOD 318 31.18
AVERAGE 313 30.69
BAD 104 10.20
VERY BAD 44 4.31

4.31
10.20
23.63

VERY BAD

BAD

AVERAGE
30.69
GOOD

31.18 EXCELLENT

INFERENCE

Tangible: From the tangible table and chart, it can be observed that 4.31% of
the patients in Kannur town feel that tangibility of hospitals is very bad,
10.20% of the patients feel that its bad, 30.69% of the patients feel its average
and 31.18% feels its good, only 23.63% feels that hospitals in Kannur town are
excel
 RELIABILITY

TABLE NO.2
RELIABILITY
PARTICULARS NO OF RESPONDANTS PERCENTAGE
EXCELLENT 148 19.35
GOOD 242 31.63
AVERAGE 242 31.63
BAD 86 11.24
VERY BAD 47 6.14

6.14
19.35
11.24

VERY BAD

BAD

AVERAGE

GOOD
31.63
31.63
EXCELLENT

INFERENCE

Reliability: From the reliability table and chart it can be observed that 6.14%
of the patients in Kannur town feel that reliability of hospitals is very bad,
11.24% of the patients feel that its bad, 31.63% of the patients feel its average
and 31.63% feels its good, only 19.35% feels that hospitals in Kannur town are
excellent.

RESPONSIVE
 TABLE NO.3
RESPONSIVE
PARTICULARS NO OF RESPONDANTS PERCENTAGE
EXCELLENT 161 21.05
GOOD 271 35.42
AVERAGE 256 33.46
BAD 53 6.93
VERY BAD 24 3.14

3.14
6.93
21.05

VERY BAD
BAD
AVERAGE
33.46 GOOD
EXCELLENT

35.42

INFERENCE

Responsive: From the responsive table and chart, it can be observed that
3.14% of the patients in Kannur town feel that responsive of hospitals is very
bad,6.93% of the patients feel that its bad,33.46% of the patients feel its
average and 35.42% feels its good, only 21.05% feels that hospitals in Kannur
town are excellent.

EMPATHY
 TABLE NO.4
EMPATHY
NO OF
PARTICULARS RESPONDANTS PERCENTAGE
EXCELLENT 7 1.37
GOOD 49 9.61
AVERAGE 172 33.73
BAD 199 39.02
VERY BAD 83 16.27

1.37
9.61
16.27

VERY BAD

BAD

AVERAGE
33.73
GOOD

EXCELLENT

39.02

INFERENCE

Empathy: From the empathy table and chart, it can be observed that 1.37% of
the patients in Kannur town feel that empathy of hospitals is very bad, 9.61% of
the patients feel that its bad, 33.73% of the patients feel its average and 39.02%
feels its good, only16.27 % feels that hospitals in Kannur town are excellent.
ASSURANCE
 TABLE NO.5
ASSURANCE
NO OF
PARTICULARS RESPONDANTS PERCENTAGE
EXCELLENT 11 2.59
GOOD 27 6.35
AVERAGE 151 35.53
BAD 165 38.82
VERY BAD 71 16.71

2.59
6.35
16.71

VERY BAD

BAD

35.53 AVERAGE

GOOD

EXCELLENT

38.82

INFERENCE

Assurance: The assurance table and chart, it can be observed that 2.59% of the
patients in Kannur town feel that assurance of hospitals is very bad,6.35% of
the patients feel that its bad,35.53% of the patients feel its average and 38.82%
feels its good, only 16.71% feels that hospitals in Kannur town are excellent.
 CHAPTER 5

FINDINGS, SUGGESTIONS

&

CONCLUSION

FINDINGS
1. It was found that the hospital authorities in Kannur town are not
communicating with the insurance providers which is causing
inconvenience to the patients.

2. The hospitals in Kannur town are seen to be more aware about

Cleanliness & Hygiene.

3. The patients in Kannur town feel that they are being overcharged for the
services provided by the hospitals.

4. It was seen that the patients were satisfied with the doctor’s diagnosis.

5. Most of the patients are not satisfied with the availability of medicines
inside the hospital pharmacy.

6. From the study it is clear that majority of the hospitals are computerized
but there is a lack of intercom facilities.

7. It is found that majority of the patients would prefer the same hospitals
the next time.

8. Most of the people were of the opinion that they were well informed
about the operations in advance.

SUGGESTIONS
 1. Hospitals should provide more facilities in contacting insurance providers.

2. Helpline numbers of hospitals should be displayed at crowded places like

railway stations.

3. The charges by the hospitals should be made reasonable as they are

considered to be overcharging patients.

4. Previous records of patients should be maintained properly for further

reference.

5. The hospitals should conduct periodical survey for measuring their

service quality and customer satisfaction.

6. The facilities provided should be changed in order to meet the changing

technology.

7. Unnecessary treatments should be avoided.

8. The hospital pharmacy should be well stocked with medicines.

CONCLUSION
The project study entitled “Measurement of Service Quality of Hospitals in

Kannur town” gave an insight to the quality of hospitals and also on the

patient’s perception of hospitals. Anlaysis and interpretation is the core part of

this study with the help of which measurement of service quality was made

easier.The 5 dimensions in the Servqual method helped in giving a clear view

on the survey made.

Ensuring the safety of patients and improving quality have seen to become the

important objectives of hospitals and, meeting the needs of the patients has

become a major challenge for hospitals. Patient experiences and

outcomes are affected by how hospitals provide access to the services provided

by them.

The study gave us the view that patients are not fully satisfied with the services

provided by the hospitals but their expectations are increasing day by day.

BIBLIOGRAPHY
Journal of International Business and Economics, May, 2007 by G.V.R.K.
Acharyulu, B. Rajashekhar (page no:102-103)

The public’s perception of quality hospitals II: Implications for patient surveys,
Boscarino JA, Journal of International Business and Economics, March,
2008. (page no:98-99)

Can patients evaluate the quality of hospital care?, Rubin, Department of

Medicine, University of California, San Francisco,Journal of International
Business and Economics,July,2009.(page27-28)

• Managing perceptions of hospital quality. Negative emotional evaluations

can undermine even the best clinical quality.,Zifko-Baliga GM, Krampf
RF,Institute for Quality Center, Hudson, OH, USA. Journal of
International Business and Economics,March,2008.(page50-55)

• ‘Service Marketing-Integrating Customer Focus Across The Firm’,Valarie

A Zeithaml,Dwayne D Gremler,Mary Jo Bitner,Ajay Pandit , (page118-
120)
APPENDIX

QUESTIONNAIRE
 Did the hospital have modern looking equipments?

1 2 3 4 5

 Were the hospital employees neat in appearance?

1 2 3 4 5

 Did they render the promised service on time?

1 2 3 4 5

 Did the hospital show a sincere interest in solving your problem?

1 2 3 4 5

 Did they inform about your operation well in advance?

1 2 3 4 5
 Were they willing to help you whenever needed?

1 2 3 4 5

 Was the service of the duty doctor satisfactory?

1 2 3 4 5

 Were they trying to make any tests which were not necessary?

1 2 3 4 5

 How would you rate the cleanliness of the hospital?

1 2 3 4 5

 How often did the duty doctor come for check up?
 1 2 3 4 5

 Were the hospital authorities courteous with you?

1 2 3 4 5

 Did they have enough knowledge to answer all your queries?

1 2 3 4 5

 Were they concentrating in giving individual attention?

1 2 3 4 5

 Were the operation hours convenient to you?

1 2 3 4 5

 Were you given extra attention by the authorities?

 1 2 3 4 5

 Were they willing to satisfy your needs?

1 2 3 4 5

 Do you think that they maintain error free records?

1 2 3 4 5

 Did the nurses provide you proper follow up?

1 2 3 4 5

 Was the dressing done at regular intervals?

1 2 3 4 5
 Did the hospital authorities communicate with the Insurance provider?

1 2 3 4 5

 Will you prefer the same hospital next time?

1 2 3 4 5

 Do you feel they are over charging you?

1 2 3 4 5

 Are you provided with proper water supply?

1 2 3 4 5

 Do you feel the services are worth the charges paid by you?

1 2 3 4 5
 Do they provide up to date documentation material?

1 2 3 4 5

 Were you provided with proper electricity suuply?

1 2 3 4 5

 Did the frequent visitors disturb you?

1 2 3 4 5

 Did the hospital strictly follow the visiting hours?

1 2 3 4 5

 Were the medicines prescribed by the doctor available in the hospital pharmacy?

1 2 3 4 5

 Did the doctor properly diagnosis you?

1 2 3 4 5
 Were you treated with sophisticated and modern equipments?

1 2 3 4 5

 Were the procedures in the hospital computerized?

1 2 3 4 5

 Were intercom facilities provided 24*7?

1 2 3 4 5

 Was there any delay in the allotment of rooms?

1 2 3 4 5

 Was the hospital staff sincerely willing to provide the services?

1 2 3 4 5
 Did the hospital staff provide prompt services?

1 2 3 4 5

 Do you feel that the services provided by the hospital are as mentioned as in the
advertisements?

1 2 3 4 5

 Did they soothe you with kind words?

1 2 3 4 5

 Do the employees understand the specific needs of the customers?

1 2 3 4 5

 Do you feel safe and confident in the hands of the employees?

1 2 3 4 5
 Did the paramedical team inform you regarding the treatment which will be given to
you in due course?

1 2 3 4 5