A Study on the Customer Perceptions of Quality of Services of a Large Hospital in New Delhi<br />
INTRODUCTION<br /><ul><li>Services sector accounts for  ~ 54.2% of the nation´s GDP (2007).
For service-based economies’, growth is accomplished by increasing competition and technological advances, thus reinforcin...
The provision of high-quality services is directly related to -
increase in profits
market share
cost savings
With competitive pressures and the increasing necessity to deliver patient satisfaction, the elements of quality control, ...
INTRODUCTION<br />Service Quality Measurement Scales<br />SERVQUAL (Parasuraman, Zeithaml & Berry, 1988)<br />SERVPERF (Cr...
SERVICE QUALITY<br />Disconfirmation Paradigm – Parasuraman, et. al. , 1994<br />Service quality is the gap between consum...
Positive disconfirmation  - performance evaluated above level of expectations
Confirmation  - performance equal to expectations level. </li></ul>There is growing evidence to suggest that this perceive...
SERVICE QUALITY MEASUREMENT SCALES<br />What’s not measured cannot be managed.<br />SERVQUAL<br />Disconfirmation-based<br...
THE RESEARCH PROBLEM<br /><ul><li>Objectives:
Reliability, Dimensionality and Validity Statistics for the SERVPERF scale
Report the Customer Perceptions for the five dimensions of SERVPERF/SERVQUAL study instrument
Report the Customer Perceptions for Services provided by the doctors
Study the relation of age to customer perceptions of service quality.
Assess whether the Cost of Services is justified.</li></li></ul><li>RESEARCH METHODOLOGY <br />Initial Exploratory Researc...
Likert Scale - 1 means strongly disagree 7 means strongly agree
SERVPERF Questionnaire – 22 Questions
Tangibles – 4 Questions
Reliability – 5 Questions
Responsiveness – 4 Questions
Assurance – 4 Questions
Empathy – 5 Questions
Quality of Services provided by Doctors – 9 Questions
Other Questions – 4 Questions</li></li></ul><li>RESEARCH METHODOLOGY <br />Sample Designing<br />Convenience Sampling<br /...
Paper based Questionnaire
Telephonic interviews to answer the Questionnaire</li></ul>Data Analysis<br />SPSS v16.0 used for coding and analysis of t...
RESULTS and DISCUSSION<br />
RESULTS and DISCUSSION (Contd.)<br />
RESULTS and DISCUSSION (Contd.)<br />SERVPERF SCALE ATTRIBUTES<br />Reliability - property of a measurement instrument tha...
RESULTS and DISCUSSION (Contd.)<br />Dimensionality of the SERVPERF Scale<br />A Factor analysis was performed. <br />Almo...
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A Study on the Customer Perceptions of Quality of Services of a Large Hospital in New Delhi

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This was my dissertation presentation for PGDM, at Institute of Management Technology, Ghaziabad.
I am not at liberty to disclose the name of the hospital due to ethical and legal reasons.

Thank you.
Dr. Mohit Saxena
drmnsaxena@gmail.com

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  • Expectations are not what the patient believes should be offered, but rather what the patient believes would be offered in a health care service product.Consumers’ perception of quality service in health care is distorted due to the inability of patients to judge the technical competence of the medical practitioner with any accuracy. Since patients are often unable to assess the technical quality of medical services accurately, functional qualityis usually the primary determinant of patients’ perceptions of quality.
  • Empirical studies evaluating validity, reliability, and methodological soundness of service quality scales clearly point to the superiority of the SERVPERF scale.
  • The response rates in the hospital completion group were relatively low (57%) expressing both refusal to participate or inability to respond, and reluctance to answer a questionnaire immediately after consultation because of long waiting time beforehand, or because a relative, an ambulance or a taxi is waiting to take the patient home. Further, patients completing the questionnaire immediately after consultation in the hospital, satisfaction estimates were higher than in case of home completion, in spite of procedures to preserve anonymity and confidentiality at hospital. Two studies conclude that patients express less satisfaction when the questionnaire is completed at home rather than in the medical facility. This could be interpreted as an over-estimation of patient satisfaction in case of completion in the facility, patients being more prone to express their real opinion when they have more time to consider the consultation and are safely back home. It could be concluded that completion at home may be better than immediately after consultation.For the purpose of this study, the respondents were at their homes or workplace but not in the hospital. This is to avoid bias due to the above mentioned reason.
  • None of the reliability alphas was below the cut-off point of 0.60, which is generally considered to be the criterion for demonstrating internal consistency of a scale.
  • Tangibles – score 5.209 - the highest among all the latent variables. ‘Materials associated with the services’ - can be improved with relative ease for the hospitalNeatness - Nowadays, the customers are highly discerning and they expect hospitals to provide clean and hygienic environment with adequate civic amenities. The hospital needs to take regular measures to upgrade facilities.
  • Reliability - 4.702 - worrisome sign for the hospital since the customers perceive the hospital to be low on reliability. This aspect of their services has to be improved a great deal if they want to retain their customers. The hospital should, ideally, provide its services at the time it promises to do so. However, it should definitely provide the services it promises. But the scores for the variables are 4.84 and 4.91 respectively. This shows that the customers do not have faith in the services promised by the hospital. The lowest rated service attribute is ‘The hospital gets things right the first time’ with a mean score of 4.53.
  • Responsiveness - 4.703 - again a warning sign for the hospital since this points towards a lack of service functionality in an, essentially, a service organization. ‘Personnel in the hospital are never too busy - may be difficult to overcome due to many reasons, like staff shortage. However, this attribute has to be taken seriously by the hospital to improve the perceptions of service quality on the whole and to maintain competitive advantage.
  • Assurance - 4.866Patients expect hospital personnel to be polite and with improved socio-economic status, this expectation becomes more explicit. If the personnel are not perceived to be polite this can be a significant dissatisfier. They need to be counseled and sensitized on this account. With proper feedback, there is tremendous scope of improvement.
  • Empathy - 4.553 - The medical profession is a grim profession and empathy towards patients is a cornerstone of the profession. This shows lack of training of staff in empathic behaviour. The hospital needs to train its staff in empathy towards its customers if they are to survive the competition from other hospitals.
  • Cost - This shows that the customers do not agree with the current prices of the services provided by the hospital. The hospital should look into ways for cutting costs and reducing prices for their services to maintain competitive advantage among the hospitals in the Delhi region.The hospital either has to improve its service quality to justify for the prices they charge or it has to reduce the prices for its services.
  • As this study concludes, Customers’ perception of service quality remains a challenge.
  • Transcript of "A Study on the Customer Perceptions of Quality of Services of a Large Hospital in New Delhi"

    1. 1. A Study on the Customer Perceptions of Quality of Services of a Large Hospital in New Delhi<br />
    2. 2. INTRODUCTION<br /><ul><li>Services sector accounts for ~ 54.2% of the nation´s GDP (2007).
    3. 3. For service-based economies’, growth is accomplished by increasing competition and technological advances, thus reinforcing service quality as an important and sustaining competitive advantage .
    4. 4. The provision of high-quality services is directly related to -
    5. 5. increase in profits
    6. 6. market share
    7. 7. cost savings
    8. 8. With competitive pressures and the increasing necessity to deliver patient satisfaction, the elements of quality control, quality of service, and effectiveness of medical treatment have become vitally important.</li></li></ul><li>INTRODUCTION<br />Definition of Service Quality: <br />Cronin and Taylor, 1994: ‘a form of attitude representing a long-run overall evaluation’<br />Parasuraman, Zeithaml and Berry (1985): ‘a function of the differences between expectation and performance along the quality dimensions’.<br />Service Quality — both technical and functional— a key ingredient in the success of service organizations . <br />Technical quality in health care is defined primarily on the basis of the technical accuracy of the diagnosis and procedures. <br />Functional quality relates to the manner of delivery of health-care services. <br />
    9. 9. INTRODUCTION<br />Service Quality Measurement Scales<br />SERVQUAL (Parasuraman, Zeithaml & Berry, 1988)<br />SERVPERF (Cronin &Taylor, 1992)<br />SERVPERF-M<br />Purpose of this study: <br />Measure consumer perceptions of quality of services delivered by a large hospital in Delhi.<br />Evaluate the practical usefulness and the psychometric proprieties of SERVPERF in accessing patients’ perceptions of the hospital service environment.<br />
    10. 10. SERVICE QUALITY<br />Disconfirmation Paradigm – Parasuraman, et. al. , 1994<br />Service quality is the gap between consumer’s perceptions of service performance and level of expectations. <br />The outcome of this process is: <br /><ul><li>Negative disconfirmation - performance rated below level of expectations
    11. 11. Positive disconfirmation - performance evaluated above level of expectations
    12. 12. Confirmation - performance equal to expectations level. </li></ul>There is growing evidence to suggest that this perceived quality is the single most important variable influencing consumers’ perceptions of value, and that this, in turn, affects their intention to purchase products or services.<br />
    13. 13. SERVICE QUALITY MEASUREMENT SCALES<br />What’s not measured cannot be managed.<br />SERVQUAL<br />Disconfirmation-based<br />by Parasuraman, Zeithaml & Berry, 1988<br />22 pairs of statements that measure consumer’s expectations and perceptions of service performance<br />SERVPERF<br />Performance-based<br />By Cronin & Taylor, 1992<br />22 statements that measure consumer’s perceptions of service performance<br />SERVPERF-M<br />
    14. 14. THE RESEARCH PROBLEM<br /><ul><li>Objectives:
    15. 15. Reliability, Dimensionality and Validity Statistics for the SERVPERF scale
    16. 16. Report the Customer Perceptions for the five dimensions of SERVPERF/SERVQUAL study instrument
    17. 17. Report the Customer Perceptions for Services provided by the doctors
    18. 18. Study the relation of age to customer perceptions of service quality.
    19. 19. Assess whether the Cost of Services is justified.</li></li></ul><li>RESEARCH METHODOLOGY <br />Initial Exploratory Research - secondary data and case studies to identify the important factors for customer perceptions of Service Quality.<br />Questionnaire Designing<br /><ul><li>Demographics – 7 Questions
    20. 20. Likert Scale - 1 means strongly disagree 7 means strongly agree
    21. 21. SERVPERF Questionnaire – 22 Questions
    22. 22. Tangibles – 4 Questions
    23. 23. Reliability – 5 Questions
    24. 24. Responsiveness – 4 Questions
    25. 25. Assurance – 4 Questions
    26. 26. Empathy – 5 Questions
    27. 27. Quality of Services provided by Doctors – 9 Questions
    28. 28. Other Questions – 4 Questions</li></li></ul><li>RESEARCH METHODOLOGY <br />Sample Designing<br />Convenience Sampling<br />The respondents were at their homes or workplace but NOT in the hospital.<br />Primary Data Collection<br /><ul><li>Web based Questionnaire
    29. 29. Paper based Questionnaire
    30. 30. Telephonic interviews to answer the Questionnaire</li></ul>Data Analysis<br />SPSS v16.0 used for coding and analysis of the data <br />
    31. 31. RESULTS and DISCUSSION<br />
    32. 32. RESULTS and DISCUSSION (Contd.)<br />
    33. 33. RESULTS and DISCUSSION (Contd.)<br />SERVPERF SCALE ATTRIBUTES<br />Reliability - property of a measurement instrument that causes it to give similar results for similar inputs.<br />
    34. 34. RESULTS and DISCUSSION (Contd.)<br />Dimensionality of the SERVPERF Scale<br />A Factor analysis was performed. <br />Almost all the items loaded on a single factor in the unrotated component matrix.<br />Validity of the SERVPERF Scale<br />Face Validity – ensured by determining from literature<br />Content Validity - adapted from the SERVQUAL measure and consensus achieved in the literature<br />
    35. 35. RESULTS and DISCUSSION (Contd.)<br /><ul><li>Construct validity
    36. 36. Factor Analysis with Varimax Rotation conducted
    37. 37. Could not identify any meaningful dimensions that conform to the dimensions recommended by the SERVQUAL instrument.
    38. 38. This could be due to the highly correlated nature of the five dimensions of service quality.
    39. 39. Predictive Validity
    40. 40. Examined by regressing Overall Service Quality (dependent variable) on the 22 SERVPERF statements scores (independent variables).
    41. 41. Strong evidence of the performance ability in explaining the variance in the Overall Service Quality ratings.</li></li></ul><li>SERVPERF SCORES<br />
    42. 42. SERVPERF SCORES<br />
    43. 43. SERVPERF SCORES<br />
    44. 44. SERVPERF SCORES<br />
    45. 45. SERVPERF SCORES<br />
    46. 46. SERVPERF SCORES<br />The calculated mean Global Service Quality on the SERVPERF scale for the hospital is 4.791. However, the mean Overall Service Quality on the survey is 4.26. <br />This means that the customers may regard individual service quality attributes higher than when asked for Overall Service Quality.<br />
    47. 47. CUSTOMER PERCEPTIONS OF QUALITY OF SERVICES PROVIDED BY DOCTORS<br />Scale Attributes – Reliabilityand Dimensionality<br />Factor analysis - All the items loaded on a single factor in the unrotated component matrix .<br />The reliability, as assessed by Cronbach’s alpha, was 0.934.<br />Hence, the scale can be treated as uni-dimensional.<br />
    48. 48. CUSTOMER PERCEPTIONS OF QUALITY OF SERVICES PROVIDED BY DOCTORS<br />Scale Attributes – Reliabilityand Dimensionality<br />Factor analysis - All the items loaded on a single factor in the unrotated component matrix .<br />The reliability, as assessed by Cronbach’s alpha, was 0.934.<br />Hence, the scale can be treated as uni-dimensional.<br />Factor Analysis - The factors were reduced to two dimensions :<br /><ul><li>Time Consciousness
    49. 49. Service Consciousness</li></li></ul><li>CUSTOMER PERCEPTIONS OF QUALITY OF SERVICES PROVIDED BY DOCTORS<br />Scale Score<br />
    50. 50. AGE AND SERVICE QUALITY<br /><ul><li>It was observed that older patients have a higher opinion of care provided than others.
    51. 51. This contributes to construct validity of satisfaction questionnaires.
    52. 52. Null Hypothesis H0: There is no relation between Age and Overall Service Quality perception.
    53. 53. Alternate Hypothesis H1: There is a relation between Age and Overall Service Quality perception.
    54. 54. Pearson Chi-Square test has a significance of 0.011 (p<0.05).
    55. 55. Hence the null hypothesis is rejected.</li></li></ul><li>
    56. 56. OTHER QUESTIONS<br />
    57. 57. SALIENT FINDINGS AND RECOMMENDATIONS<br />Nowadays, the customers are highly discerning and they expect hospitals to provide clean and hygienic environment with adequate civic amenities. The hospital needs to take regular measures to upgrade facilities.<br />Reliability of their services has to be improved a great deal if they want to retain their customers. The study shows that the customers do not have faith in the services promised by the hospital.<br />Responsiveness has a mean score of 4.703, again a warning sign for the hospital since this points towards a lack of service functionality in an, essentially, a service organization. <br />
    58. 58. SALIENT FINDINGS AND RECOMMENDATIONS<br />The hospital personnel should always respond to the requests of the customers. This service attribute may be difficult to overcome due to many reasons, like staff shortage. However, this attribute has to be taken seriously by the hospital to improve the perceptions of service quality on the whole and to maintain competitive advantage.<br />The personnel at the hospital are perceived as courteous. Patients expect hospital personnel to be polite and with improved socio-economic status, this expectation becomes more explicit. If the personnel are not perceived to be polite this can be a significant dissatisfier. The personnel need to be counseled and sensitized on this account. With proper feedback, there is tremendous scope of improvement.<br />
    59. 59. SALIENT FINDINGS AND RECOMMENDATIONS<br />An encouraging sign for the hospital since the customers believe that the hospital personnel are professionally capable of solving their queries. <br />Empathy rates the lowest among the service quality dimensions.<br /> The medical profession is a grim profession and empathy towards patients is a cornerstone of the profession. This shows lack of training of staff in empathic behaviour. The hospital needs to train its staff in empathy towards its customers if they are to survive the competition from other hospitals. <br />The customers may regard individual service quality attributes higher than when asked for Overall Service Quality.<br />
    60. 60. SALIENT FINDINGS AND RECOMMENDATIONS<br />The study shows that the customers have more faith in the doctors at this hospitalthan they have in the hospital itself.<br />The waiting times are perceived as high, which points towards inefficiency in handling the rosters. The hospital needs to augment services and streamline the number of patients seen per physician, so as to decrease waiting time and improve service quality.<br />The patients are also happy with the doctors in terms of their communication and taking their opinions into account. There is need to sensitize doctors about patient expectations, which if heeded to, can improve the service quality without any additional input in terms of resources.<br />
    61. 61. SALIENT FINDINGS AND RECOMMENDATIONS<br />The customers’ perception towards administrative procedures, like completing papers, is not favourable and should be streamlined to improve efficiency and speed of processing.<br />The customers do not agree with the current prices of the services provided by the hospital. The hospital either has to improve its service quality to justify for the prices they charge or it has to reduce the prices for its services.<br />
    62. 62. CONCLUSION<br />This is an initial study that is limited in scope. <br />It can for the basis of further studies on the hospital to gauge improvements in service performance and, thus, help in maintaining competitive advantage.<br />This survey can be considered as a pro-active marketing activity designed to improve functional service quality and as a result, increasing customer / patient satisfaction, which is the desired outcome. <br />It is a cost-effective method for assessing service quality and provides insights on deficiencies and potential improvements. <br />This survey should be used as a marketing strategy since it shows that the hospital is a responsive organization.<br />
    63. 63. CONCLUSION (Contd.)<br />Top management must place emphasis on change management. Managers in the hospital must use whatever benchmark information that is available to identify potential improvement areas and then use best practices in the industry to improve in these areas. <br />As a long-term solution, it is recommended that the managers should implement an information system that can support efficient management decisions. <br />Help in comparing data with other hospitals to gauge their own performances against those of others. <br />It can reasonably be said that in the current competitive healthcare scenario, customer perception surveys can be an important market information and research tool in the hands of contemporary hospital administrators.<br />
    64. 64. Thank You<br />

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