A Study on the Customer Perceptions of Quality of Services of a Large Hospital in New Delhi

INTRODUCTION

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 reinforcing service quality as an important and sustaining competitive advantage .
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, quality of service, and effectiveness of medical treatment have become vitally important.

INTRODUCTION
Definition of Service Quality:
Cronin and Taylor, 1994: ‘a form of attitude representing a long-run overall evaluation’
Parasuraman, Zeithaml and Berry (1985): ‘a function of the differences between expectation and performance along the quality dimensions’.
Service Quality — both technical and functional— a key ingredient in the success of service organizations .
Technical quality in health care is defined primarily on the basis of the technical accuracy of the diagnosis and procedures.
Functional quality relates to the manner of delivery of health-care services.

INTRODUCTION
Service Quality Measurement Scales
SERVQUAL (Parasuraman, Zeithaml & Berry, 1988)
SERVPERF (Cronin &Taylor, 1992)
SERVPERF-M
Purpose of this study:
Measure consumer perceptions of quality of services delivered by a large hospital in Delhi.
Evaluate the practical usefulness and the psychometric proprieties of SERVPERF in accessing patients’ perceptions of the hospital service environment.

SERVICE QUALITY
Disconfirmation Paradigm – Parasuraman, et. al. , 1994
Service quality is the gap between consumer’s perceptions of service performance and level of expectations.
The outcome of this process is:

Negative disconfirmation - performance rated below level of expectations
Positive disconfirmation - performance evaluated above level of expectations
Confirmation - performance equal to expectations level.

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.

SERVICE QUALITY MEASUREMENT SCALES
What’s not measured cannot be managed.
SERVQUAL
Disconfirmation-based
by Parasuraman, Zeithaml & Berry, 1988
22 pairs of statements that measure consumer’s expectations and perceptions of service performance
SERVPERF
Performance-based
By Cronin & Taylor, 1992
22 statements that measure consumer’s perceptions of service performance
SERVPERF-M

THE RESEARCH PROBLEM

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.

RESEARCH METHODOLOGY
Initial Exploratory Research - secondary data and case studies to identify the important factors for customer perceptions of Service Quality.
Questionnaire Designing

Demographics – 7 Questions
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

RESEARCH METHODOLOGY
Sample Designing
Convenience Sampling
The respondents were at their homes or workplace but NOT in the hospital.
Primary Data Collection

Web based Questionnaire
Paper based Questionnaire
Telephonic interviews to answer the Questionnaire

Data Analysis
SPSS v16.0 used for coding and analysis of the data

RESULTS and DISCUSSION

RESULTS and DISCUSSION (Contd.)

SERVPERF SCALE ATTRIBUTES
Reliability - property of a measurement instrument that causes it to give similar results for similar inputs.

Dimensionality of the SERVPERF Scale
A Factor analysis was performed.
Almost all the items loaded on a single factor in the unrotated component matrix.
Validity of the SERVPERF Scale
Face Validity – ensured by determining from literature
Content Validity - adapted from the SERVQUAL measure and consensus achieved in the literature

Construct validity
Factor Analysis with Varimax Rotation conducted
Could not identify any meaningful dimensions that conform to the dimensions recommended by the SERVQUAL instrument.
This could be due to the highly correlated nature of the five dimensions of service quality.
Predictive Validity
Examined by regressing Overall Service Quality (dependent variable) on the 22 SERVPERF statements scores (independent variables).
Strong evidence of the performance ability in explaining the variance in the Overall Service Quality ratings.

SERVPERF SCORES

SERVPERF SCORES
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.
This means that the customers may regard individual service quality attributes higher than when asked for Overall Service Quality.

CUSTOMER PERCEPTIONS OF QUALITY OF SERVICES PROVIDED BY DOCTORS
Scale Attributes – Reliabilityand Dimensionality
Factor analysis - All the items loaded on a single factor in the unrotated component matrix .
The reliability, as assessed by Cronbach’s alpha, was 0.934.
Hence, the scale can be treated as uni-dimensional.

Scale Attributes – Reliabilityand Dimensionality
Factor analysis - All the items loaded on a single factor in the unrotated component matrix .
The reliability, as assessed by Cronbach’s alpha, was 0.934.
Hence, the scale can be treated as uni-dimensional.
Factor Analysis - The factors were reduced to two dimensions :

Time Consciousness
Service Consciousness

Scale Score

AGE AND SERVICE QUALITY

It was observed that older patients have a higher opinion of care provided than others.
This contributes to construct validity of satisfaction questionnaires.
Null Hypothesis H0: There is no relation between Age and Overall Service Quality perception.
Alternate Hypothesis H1: There is a relation between Age and Overall Service Quality perception.
Pearson Chi-Square test has a significance of 0.011 (p<0.05).
Hence the null hypothesis is rejected.

OTHER QUESTIONS

SALIENT FINDINGS AND RECOMMENDATIONS
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 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.
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.

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.
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.

An encouraging sign for the hospital since the customers believe that the hospital personnel are professionally capable of solving their queries.
Empathy rates the lowest among the service quality dimensions.
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.
The customers may regard individual service quality attributes higher than when asked for Overall Service Quality.

The study shows that the customers have more faith in the doctors at this hospitalthan they have in the hospital itself.
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.
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.

The customers’ perception towards administrative procedures, like completing papers, is not favourable and should be streamlined to improve efficiency and speed of processing.
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.

CONCLUSION
This is an initial study that is limited in scope.
It can for the basis of further studies on the hospital to gauge improvements in service performance and, thus, help in maintaining competitive advantage.
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.
It is a cost-effective method for assessing service quality and provides insights on deficiencies and potential improvements.
This survey should be used as a marketing strategy since it shows that the hospital is a responsive organization.

CONCLUSION (Contd.)
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.
As a long-term solution, it is recommended that the managers should implement an information system that can support efficient management decisions.
Help in comparing data with other hospitals to gauge their own performances against those of others.
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.

Thank You