Hospital Management Mba Project

1.
1 INTRODUCTION
Medical Tourism in Tamil Nadu
Envisioning the potential of medical tourism in the state. Tamil Nadu has come a long
way in carving a niche for itself in this field. Today, medical tourism in India is
synonymous with Tamil Nadu, and Chennai, Vellore, Madurai and Coimbatore have a
stellar role to play in the burgeoning medical tourism industry. Tamil Nadu is a pioneer in
providing the best healthcare. Ultra-modern corporate hospitals, talented medical
professionals, and battalions of paramedics and the best practices of Government
hospitals the states, have attracted people to the state to receive excellent treatment,
convalesce in enchanting locals, and recuperate swiftly. Hospitals in Tamil Nadu cater to
the treatment of various disease, like MIOT for orthopaedics (joint and bones) and
traumatology, Shankar Netralaya for ophthalmology (eye procedures); Christian medical
college for open-heart surgery; Madras Medical Mission for heart surgery; Kovai Medical
Centre and Hospital for arthroscopicm Laparoscopic and thoracoscopic surgeries. Apollo
for hip and total-knee replacement, liver, multi-organ and cord blood transplants, to name
a few. The government medical college- Stanely Medical College is well known for its
gastrointestinal procedures. Also the Government-led General Hospital is well known for
providing services for up to 7,000 in patients. The investment in public sector hospitals is
substantial, which they are able to offer state-of-the- art operation theatres and technology
at cost-effective prices. Healthcare in Tamil Nadu has earned a good reputation in the
country because both the private as well as the government hospitals are so professionally
run. With almost all government-run and private hospitals introducing newer technologies
and better services in the healthcare sector, it has fallen upon the medical sector to
benchmark medical standards in the country.
In fact, the Tamil Nadu Medical Services Corporation has an excellent tract record for
its streamlined processes for the distribution of drugs. The all- computerised system of the
corporation allows the procurement to be 25-30 per cent less than the market rate. The
quality, too, is ensured, as private laboratories test every batch of medicines
independently. The system is totally supportive and foolproof, which is how it is able to
leverage competitive rates. As a result, all government hospitals are free from the hassle
of procurement of drugs and equipment. In a bid to promote medical tourism, the
government has identified 25 city hospitals to help showcase medical tourism as well as
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inaugurated an exclusive Medical Tourism Desk at the Tamil Nadu Tourism Complex.
The medical tourism desk would be manned by trained hospital staff to help tap the vast
potential of medical tourism.
Further, Indonesia is showing interest in medical tourism initiatives of Tamil Nadu
Government and has requested Tamil Nadu Tourism to organise a Medical Tourism Fair
with participation from super speciality hospitals of the state at Jakarta. The request was
put forward during the four-day Pacific Asia Travel Association (PATA) Travel Mart held
at Bali, where Tamil Nadu Tourism had a stall at the Incredible India pavilion. The
Government of India is so taken with this high level of competence that it would like the
other states to emulate the Tamil Nadu model.
Public
hospital or Government
hospital is
a hospital which
is
owned
by
a government and receives government funding. This type of hospital provides medical
care free of charge, the cost of which is covered by the funding the hospital receives.
Most hospitals worldwide are public. Large segments of the population in developing
countries are deprived of a fundamental right: access to basic health care. Without an
appropriate and adequate health support and delivery system in place, its adverse effects
will be felt in all other sectors of the economy. In simple terms, an ailing nation equates to
an ailing economy as manifested in lower income- earning capacity of households and
significant productivity losses in those sectors that sustain the economy.
The problem of access to health care is particularly acute in India. According to a
World Bank (1987) estimate, only 45% of the population has access to primary health
services and overall health care performance remains unacceptably low by all
conventional measurements. The poor performance of the health care sector was
attributed to the following: critical staff are absent, essential supplies are generally
unavailable, facilities are inadequate, and the quality of staffing is poor. With the growth
of private health care facilities, especially in Chennai and other cities, it is important to
assess the quality of services delivered by these establishments. In particular, it is
important to determine how the quality of services provided by private clinics and
hospitals compares to that of public hospitals. If quality issues are being compromised by
these establishments, it calls for the re-evaluation of policy measures to redefine their
role, growth and coverage, and to seek appropriate interventions to ensure that these
institutions are more quality-focused and better able to meet the needs of their patients. A
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search of the literature suggests that such a comparative study has not been undertaken.
While anecdotal evidence suggests the existence of serious service-related problems in
both sectors, this study was designed to determine and compare the quality of services
provided by both private and public hospitals.
The study also attempts to determine whether the service quality ratings are
reasonable predictors of the type of hospital chosen by patients. Demographic variables of
income and education were included with service quality ratings to test the models
predictive capability. It was also important to establish the criteria for assessing service
quality. Some guidelines were available from research on this topic conducted in other
countries. The SERVQUAL framework, first proposed by Parasuraman et al. (1985,
1991), has guided numerous studies in the service sector that focus on banks, repair and
maintenance services, telephone companies, physicians, hospitals, hotels, academic
institutions and retail stores (Parasuraman et al. 1988; Carman 1990; Boulding et al.
1993).
Interestingly, while the SERVQUAL framework has been applied with great
enthusiasm, empirical support for the proposed framework and the measurements has not
always been very strong. Not surprisingly, the model and its measures have been widely
debated by marketing academics. For example, Brown et al. (1993) have suggested
measurement problems in the use of difference scores; Cronin and Taylor (1992) have
suggested that service quality can be predicted adequately by using perceptions alone
rather than using difference scores; and Carman (1990) has suggested that in specific
service situations, it may be necessary to delete or modify some of the SERVQUAL
dimensions or even introduce new ones. Moreover, in cross-sectional studies, measuring
the gap between expectations and performance can be problematic.
Consequently, instead of limiting the concepts and measures of service quality to
the theoretical structure and measures suggested by the SERVQUAL framework, a
modified framework with its attendant measures was adopted in this study. Although
several of the SERVQUAL dimensions were included in the assessment, the introduction
of additional factors was also deemed pertinent to the assessment of service quality in
hospitals India.
The modern age can be called as the Age of Consumers. In todays cut-throat
competition the consumer is considered as the king. Many policies of various
organizations are aimed at keeping the consumer happy and satisfied. It is very important
for each and every organization to keep its consumers satisfied in order to maintain its
competitiveness in the market. In the present business scenario of cutthroat competition,
customer satisfaction has become the prime concern of each and every kind of industry.
Customer Satisfaction
Whether the buyer is satisfied after purchase depends on the products
performance in relation to the buyers expectations. In general, satisfaction is a persons
feelings of pleasure or disappointment resulting from comparing a products perceived
performance in relation to his or her expectations. If the performance falls short of
expectations, the customer is dissatisfied. If the performance matches the expectations,
the customer is satisfied. If the performance exceeds expectations, the customer is highly
satisfied or delighted.
The link between customer satisfaction and customer loyalty is not proportional.
Suppose customer satisfaction is rated on a scale from one to five. At a very low level of
customer satisfaction (level one), customers are likely to abandon the company and even
bad mouth it. At levels two to four customers are fairly satisfied but still find it easy to
switch when a better offer comes along. At level five, the customer is very likely to
repurchase and even spread good word out of mouth about the company. High satisfaction
creates an emotional bond with the brand or company, not just a rational preference.
Customer Expectation
How do buyers form their expectations? From past buying experiences, friends
and associates advice, and marketers and competitors information and promises. If
marketers raise expectations too high, the buyer is likely to be disappointed. However, if
the company sets expectations too low, it wont attract enough customers. Some of
todays most successful companies are raising expectations and delivering performances
to match. These companies are aiming for TCS- total customer satisfaction.
A customers decision to be loyal or to defect is the sum of many small encounters

with the company. The key to generating high customer loyalty is to deliver high
customer value. As competition is increasing, the hospitals are making their best efforts to
provide quality health care services to its customers. They have begun practicing a patient
satisfaction strategy comprising consumer-oriented plans, policies and practices to
genuinely meet the needs of customers. Also, with increased awareness and high
expectations of the customers hospitals have to provide them better facilities. Patients
have begun to demand high quality of services i.e. a consumer oriented approach.
These days patients have become more aware about their rights so they want they
should be better facilities like responding to their queries promptly, friendly environment,
understanding their problems, availability of specialized doctors, maintaining cleanliness,
regular repots etc. i.e. providing them every type of essential facilities. So, if the hospitals
want that their customers must be satisfied, they have to provide not only better treatment
but other facilities also. The current study is focused on examining the various factors
related to patient satisfaction with the following specific objectives:
1. To study the customer expectations from hospital services.
2. To study the customer perception of hospital services.
3. To study the degree of satisfaction of customers from hospital services.
The SERVQUAL instrument consists of five dimensions of service quality:
tangibles, reliability, responsiveness, assurance and empathy.
Tangibles include physical evidence of services, such as physical
facilities, tools or
equipment, appearance of employees and other customers.

Reliability means that the promised service will be performed correctly and dependably
at the first time.
Responsiveness concerns the willingness or readiness of employees to provide service. It
involves timeliness of service.
Assurance involves knowledge, courtesy of employers and their ability to convey trust
and confidence.
Empathy is the providing of caring and individual attention to customers by staff.
Reliability
Responsiveness
H1
H2
H3
Assurance
Customer
satisfaction
H4
Empathy
H5
Tangibles
Fig: 1.1 Five Dimensions of the HOSPQUAL
Some of Tamilnadu most reputed Multi specialty Hospitals and Health Care Centre
Hospitals Website
Lifeline Multi Specialty Hospital, Chennai www.lifeline-hospital.com
Spot Hospital, Chennai www.spothospital.com
Cholayil Sanjeevanam, Chennai www.cholayilsanjeevanam.com
Rajan Eye Care Hospital, Chennai http://lasikpavilion.com
Prasanth Multispeciality Hospital, Chennai www.pfrcivf.com
Some of Tamilnadu most reputed Health care facilities:
Apollo Hospital, Chennai
Sri Ramachandra Medical Centre (SRMC), Chennai
Madras Medical Mission, Chennai
M.V. Diabetes Speciality Centre (MVDSC), Chennai

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MIOT Hospitals, Chennai
Sankara Nethralaya, Chennai
Frontier Lifeline, Chennai
Dr. Aggarwals Eye Hospital, Chennai
Vijaya Hospital, Chennai
Dr. Mehtas Hospital, Chennai
Solace Meditour Private Limited
Ayush Therapy Centre
K.G. Hospital, Coimbatore
Kovai Medical Centre and Hospital, Coimbatore
Ganga Hospital, Coimbatore
PSG Hospitals, Coimbatore
CMC, Vellore
Gandhiji Nature Cure Centre, Elagiri & Chennai
Source: Tamil Nadu Tourism News letter.

Challenges to the Industry
Tamil Nadu is emerging as an attractive, affordable destination for healthcare But
there are some challenges that the country has to overcome to become a tourist
destination with competent health care industry:
A. Infrastructural facilities
Roads
Sanitation
Power Backups
Rest/ Guest Houses
Public Utility Services
B. The Foreign Customer Concerns and Expectations:
The biggest challenge that the Indian hospitals face is assuring the foreign patients
that they will receive quality care with no hidden costs. The industry experts need to
develop the decision making models through a thorough study on the factors that
motivate the patients to choose India as a health care solution spot.
The basic expectations that the industry feels are important to be concerned about
are:
Hygiene
Staff ( trained technically as well as in soft skills)
Customization
Insurance Cover
Stability
Connectivity
International standard certification
Para Medical Ambulance facilities (to and fro from Airport).
C. The Image of India needs to be enhanced (Standardization)

The only one quality that Indian health industry lacks in is Health standards and
hygiene. Indian hospitals lack accreditation from the Joint Commission on Accreditation
of Healthcare Organisations (JCAHO), suffer from a lack of standards in terms of quality
and rates for healthcare procedures, have no gradation system and a far from perfect
insurance sector. In addition, top Indian hospitals have high infection and mortality rates,
and are unwilling to disclose data regarding these. Even if we were having the best of
quality standards as has Indraprastha Apollo Hospital we will still be perceived as inferior
in standards. This can be avoided by getting Quality standards .Apollo group of hospitals
which has become the first hospital in India to get a JCI certification, the gold standard
for US and European Hospitals. The same has to come to more hospitals of India.
D. Market accessibility
The next challenge for the Indian industry is to make the Indian market accessible
by tourist travel agents and websites of Indian health tourism. The government can play a
vital part as the same can bring in lots of foreign revenue.
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The major ways of promoting our health tourism could be:
Tour operators and Travel agencies of India
Doctors of India visiting foreign countries- Pre/Post treatment.
International websites on Indian tourism with True Perceptions.
Globalization of marketing activities by Indian Tour & Travel Agents
Tying up with foreign Travel Agents for promotion
Insurance companies abroad who target customers
E. Excess Glamourisation of Health Care

It has been seen that the doctors and key player hospitals in India emphasis more
on glamorization of health care than its actual advantages or research uniqueness. We
need to work more on our research in medical field to be competent enough to beat our
international competitor. In other words SERVICES should be given more attention and
importance than PACKAGING.
F. State Intervention
As this is a product which needs international tie-ups and international marketing,
the state should help in the same. It should help the companies, hospitals and states in
promoting health tourism abroad so that we can tap a wider range of customers.
G. Infrastructure
Indian hospitals must create exclusive infrastructure for corporate medical tourism
Chartered flight services, attractive tourism packages could be part of infrastructure.
There's growing pressure on U.S. corporate to reduce expenditure on healthcare.
H. Competition (Neighboring countries)
Countries that actively promote medical tourism include Cuba, Costa Rica,
Hungary, India, Israel, Jordan, Lithuania, Malaysia and Thailand. Belgium, Poland and
Singapore are now entering the field. South Africa specializes in medical safaris-visit the
country for a safari, with a stopover for plastic surgery, a nose job and a chance to see
lions and elephants. Thus India has enough competition from the international
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market.This will be one of our major threats in bringing up and developing the health
tourism industry.
I. Insurance Backup
One good way of tapping the foreign customers is tying up with Insurance
companies abroad who could provide a genuine database of target customers. They can
benefit from us by our services. Thus this would become a way of mutual marketing tacit
cs between the Indian health tourism industry and the foreign Insurance agencies.
J. Local Demand vs. Global Demand
It can be seen in case of hospitals like Apollo and Escorts that the Local demand
itself to be catered to is vast. We should remember that we should have the facilities
enough to manage the foreign customers not neglecting the local markets. Thus it is a
challenge for both the Alternate therapy industry and Corporate Health Care Service
Providers to cater to this vast market efficiently without compromises in quality on either
side.
Conclusion
Tamil Nadu has long been a centre of ancient healing traditions based on herbal
medicine and holistic treatments that have evolved from folk knowledge as well as Asian
well-being therapies such as Indian Ayurvedic and Allopathic practices. With the growing
popularity of holistic healing techniques that restore balance and rejuvenate mind, body
and spirit, in addition to conventional medical treatment, Tamil Nadu offers a one-stop
shop that leaves you looking good and feeling great from hospital to hospitality.
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2.1 Need of the Study

This study helps to identify its service quality of the Hospitals both public and
private by which the industry can further improve its performance to enjoy high
reputation among patients.
This study also helps to making necessary changes in the attributes of the services
offered by the Hospital industry, so that the patients can enjoy the benefits of the service
provider.
The need for the study also arises to identify and offer additional services
according to the expectations of the patients.
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2.2 Objectives
1.
To determine the patient profile in Tamilnadu districts.
2. To identify the perception and expectation level of the hospital service.

3.
To identify the relative importance of service quality weights preferred by

patients.
4. To determine the overall satisfaction of the patients towards hospitals in

Tamilnadu
5. To suggest the ways to improve the quality of service in hospital.
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2.3 SCOPE OF THE STUDY

The Project entitled Service Quality Assessment in Hospitals with special
reference to Selected Districts in Tamilnadu will enable from the patients point of
view to refer the performance of the Hospitals, their relative growth and thereby decide
on to continue to the same.
The outcome of the study, which is based on the above aspects, can be utilized by
the Health Department.
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2.4 Review of Literature

Many studies have been conducted on the customer satisfaction. An attempt has
been made to present in brief, a review of literature on customer satisfaction in general as
well as on the customer satisfaction from hospital services.
According to Bolton and Drew (1991) proposed a model of how customers with
prior experiences and expectations assessed service levels, overall service quality and
service value. They applied the model to residential customers of local telephone services.
Their study explored how customers integrate their perceptions of a service to form an
overall evaluation of that service. They developed a multistage model of determinants of
perceived service quality and service value. The model described how customers
expectations, perceptions of current performance and disconfirmation experiences
affected their satisfaction or dissatisfaction with a service, which in turn affected their
assessment of service quality and value.
Boulding et al (1993) stated that the service quality relates to the retention of
customers at aggregate level. The author has offered a conceptual model of the impact of
service quality on particular behavior that signal whether customers remain with of defect
from a company. The results of the study show strong evidence of their being influenced
by service quality. The findings also reveal difference in the nature of the service quality.
Sharma and Chahal (1999) had done a study of patient satisfaction in outdoor
services of private health care facilities. They had done a survey to understand the extent
of patient satisfaction with diagnostic services. They have constructed a special
instrument for measuring patient satisfaction. The instrument captures the behaviour of
doctors and medical assistants, quality of administration, and atmospherics. The role of
graphic characters like gender, occupation, education, and income is also considered.
Based on their findings, they also suggested strategic actions for meeting the needs of the
patients of private health care sector more effectively. In their study provided suggestions
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like becoming more friendly and understanding to the problems of patients, maintaining
cleanliness in the units, both internally and externally, providing regular report regarding
the patients progress without waiting for them to demand, conducting surveys to know
about the attitude of the patients with regard to the employees and adopting patientoriented policies and procedures.
Dholakia and Morwitz (2002) have examined the scope and persistence of the
effect of measuring satisfaction on consumer behavior over time. In an experiment
conducted in a financial services setting, they found that measuring satisfaction changes
one-time purchase behavior, changes relational customer behaviors and results in effects
that increase for months afterward and persist even a year later. Their results raised
questions concerning the design, interpretation and ethics in the conduct of applied
marketing research studies.
Sharma and Chahal (2003) stated that due to increased awareness among the
people patient satisfaction had become very important for the hospitals. The authors
examined the factors related to patient satisfaction in government outpatient services in
India. They said that there are four basic components which had impact on the patient
satisfaction namely, behaviour of doctors, behaviour of medical assistants, quality of
atmosphere, and quality of administration. They also provided strategic actions necessary
for meeting the needs of the patients of the government health care sector in developing
countries.
According to Margot Fleuren We searched 11 databases, mainly medical ones, for
articles that were published between 1990 and 2000 and were written in English or in
Dutch. We chose this time period because the tradition of innovation studies in the Weld
of health care is quite young and we assumed that the results of earlier relevant studies
would have been incorporated into the studies published between 1990 and 2000. The
databases were Medline, PsycLIT, Eric, Combined Health Information Database (CHID),
Healthpromis, Healthstar, Sociological Abstracts, Heclinet, Pica (a Dutch database of all
university libraries), GLIN (a Dutch database on literature in the Netherlands), and SWTL
(a Dutch social scientific journal on literature). We used keywords related to the specific
database. Furthermore, we searched for free text, and, finally, checked the references in
the studies we found. Examples of keywords are: innovation, guidelines, clinical
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protocols, implementation, institutionalization, change, diffusion of innovation, and

health plan implementation.
Inclusion criteria were:
(i) Studies in which innovation processes within health care organizations were
described and in which determinants were reported;
(ii) Studies in which the innovations were aimed at changing the behaviour of
health professionals (e.g. guidelines)
(iii) Studies in which the health care organizations should have provided direct
patient care and at least 10 professionals should have been involved in the innovation
(iv) Empirical studies only.
Public health services in the United States or Europe have introduced full TQM
programmes, although there are many smaller-scale initiatives which are often called
TQM programmes. One of the few reported long-term evaluations is of selected hospitals
and community health services taking part in the United Kingdom National Health
Service / Department of Health and Social Security
TQM pilot programme (62). This study found that:
Three of the 20 services had relaunched their quality programmes two

years after starting, and are now using a Deming TQM approach
Many services had not introduced a full TQM strategy, but were
encouraging small-scale initiatives in different departments and professions;
There were some changes in personnels understanding of quality methods

and attitudes in nearly all sites;
Investment in the TQM quality programme was between 5% and 10% of

that in two comparable non-health organizations
Little training was done in basic quality awareness, quality methods or

process improvement
Only one site perceived any improvement, but had little measurable
evidence of changes in processes or outcomes
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Only four services in the sample had been able to involve physicians
Most programme had dwindled due to personnel turnover, restructuring,

too few resources and poor programme management.
Reinartz et al (2004) in their study of Customer Relationship Management Process

had stated that it is very important for maintaining healthy relations with the customers in
order to provide them satisfaction. In their study, they (1) conceptualize a construct of the
CRM process and its dimensions, (2) operationalize and validate the construct, and (3)
empirically investigate the organizational performance consequences of implementing the
CRM processes. Their research questions are addressed in two cross-sectional studies
across four different industries and three countries. The key outcome is a theoretically
sound CRM process measure that outlines three key stages: initiation, maintenance, and
termination.
Gustafsson et al (2005) in their study of telecommunications services examine the
effect of customer satisfaction, affective commitment, and calculative commitment on
retention and the potential for situational conditions to moderate the satisfaction-retention
relationship. Their results support consistent effects of customer satisfaction, calculative
commitment and prior-churn on retention.
Thompson (2005) in his study had shown that consumers often misjudge their
health risks owing to a number of well-documented cognitive biases. These studies
assume that consumers have trust in the expert systems that culturally define safe and
risky behaviours. Consequently, this research stream does not address choice situations
where consumers have reflexive doubts toward prevailing expert risk assessments and
gravitate toward alternative model of risk reductions. This study explores how dissident
health risk perceptions are culturally constructed in the natural childbirth community,
internalized by consumers as a compelling structure of feeling, and enacted through
choices that intentionally run counter to orthodox medical risk management norms.
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Research Methodology
3.1 Introduction
The present chapter describes the research methodology of the study. It includes
the Research Framework, Sample design and selection, Collection of Data, Methods for
analysis of data.
To study consumers expectations, perception and their satisfaction level it was
required to examine the following aspects
Patients expectations from the behaviour of the doctors,
Patients expectations from the behaviour of the medical assistants,
Patients expectations from the quality of administration of hospitals,
Patients expectations from the services provided by the hospitals,
Patients perceptions for the behaviour of the doctors,
Patients perceptions for the behaviour of the medical assistants,
Patients perceptions for the quality of administration of hospitals,
Patients perceptions for the services provided by the hospitals,
Patients satisfaction level for the behaviour of the doctors,
Patients satisfaction level for the behaviour of the medical assistants,
Patients satisfaction level for the quality of administration of hospitals and
Patients satisfaction level for the services provided by the hospitals,
3.2 Research Design
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Research design is the plan, structure to answer whom, when, where and how the
subject is under investigation. Here plan is an outline of the research scheme & which the
researcher has to work. The structure of the research is a more specific outline and the
strategy out, specifying the methods to be used in the connection & analysis of the data.
3.2.1 Descriptive Research Design
The type of research design is Descriptive Research. The main characteristics of
this method is that the researcher has no control over the variables and he can only report
what has happened or what is happening. This study which evaluates the performance of
the Hospitals has been undertaken based on the opinions of the patients. Hence, this
research study is categorized as Descriptive Research Method.
3.3 Data Collection
The main source of information for this study is based on the data collection. Data
collected are both primary and secondary in nature.
Primary Data
Primary data have been directly collected from the patients by survey method
through undisguised structured questionnaire.
Questions like open ended, close ended, multiple choice, dichotomous and
ranking type have been used for the purpose of data collection.
Secondary Data
Secondary data was also collected from various books, journals, magazines etc.
3.4 Types of Questions

Open Ended Question
Open ended question are the type of question used to get suggestion from the
respondent in order to give feed back to the organization.
Close Ended Question
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Close ended question are the type of questions with a clear declined set of
alternatives that confine the respondents to choose one of them.
Multiple Choice Questions
It consists of multiple choices in which the respondents can choose more than one
Likert Scale
It uses 5 point or 7 point scale to elicit respondents favour or unfavour towards an
object.
Dichotomous question
It consists of two choices of answers in which the respondent has to choose one of
them.
Ranking
In ranking, questions will have the ranking skill, which the respondents are free to
rank them according to their preference.
3.5 Sampling
Judgment Sampling is used in this survey. Judgment sampling is a form of
Convenience Sampling in which the population elements are selected based on the
judgment of the researcher. The Researcher exercise judgment chooses the elements to be
included in the sampling.
3.5.1 Sample Size
Sample size is the total number of samples selected for the study from the
sampling population. Sample size for the study was arrived at 375.
3.5.2 Research area
In the present study, researcher has planned to collect the primary data through
structured Questionnaire in selected Tamil Nadu districts Chennai, Virudhunagar,
Kanyakumari, Madurai and Kancheepuram.
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3.6 Methods / Tools of Analysis

Tools used for analysis are:
Reliability analysis
Factor analysis
Descriptive statistics
Chi-square test
Multiple Regression
Weighted average method
Paired sample t test
One-way Anova
Service gap Analysis
3.6.1. Reliability and Validity of the Instrument

3.6.1.1. Reliability
The researcher states that each question in the SERVQUAL could be accordingly
rephrased for consistency with the particular service area that is to be measured. The
SERVQUAL has been used to appraise a firms quality along with each of the four
behavioral dimensions, by averaging the distinction scores on items making up the
dimension. The SERVQUAL could also provide an overall measure of service quality in
the form of an average score across all four dimensions. SERVQUAL has been limited to
present customers of an organization because significant responses to the statements
require respondents to have some knowledge and experience with the company being
investigated.
3.6.1.2. Validity
The validity of the scale is empirically evaluated by examining its convergent
validity of the relationship between SERVQUAL scores and answers to a question where
customers are asked to provide an overall quality rating for the firm they have been
evaluating. The SERVQUAL validity is further assessed by examining whether the
construct measured by it is empirically associated with measures of other conceptually
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related variables. According to Gay (1996), if the coefficient is high, the instrument has
good concurrent validity.
3.6.2. Factor Analysis
Factor analysis is a statistical method used to describe variability among observed
variables in terms of a potentially lower number of unobserved variables called factors. In
other words, it is possible, for example, that variations in three or four observed variables
mainly reflect the variations in a single unobserved variable, or in a reduced number of
unobserved variables. Factor analysis searches for such joint variations in response to
unobserved latent variables. The observed variables are modeled as linear combinations
of the potential factors, plus "error" terms. The information gained about the
interdependencies between observed variables can be used later to reduce the set of
variables in a dataset. Factor analysis originated in psychometrics, and is used in
behavioral sciences, social sciences, marketing, product management, operations
research, and other applied sciences that deal with large quantities of data
3.6.3. Descriptive Statistics
Descriptive statistics shows the entire population in terms of percentages.
Percentage = No. of respondents *100
Total respondents
3.6.4. Chi-Square Test
There may be situation in which it is not possible to make any rigid assumption about
distribution of the population from which samples being drawn. This limitation has led to
the development of a group of alternative techniques known as non-parametric tests. Chisquare describes the magnitude of the discrepancy between theory and observation
n
[(Oi Ei) 2] with n-1 degrees of freedom
i =1
Ei
3.6.5. Multiple Regressions

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Regression analysis includes any techniques for modeling and analyzing several
variables, when the focus is on the relationship between a dependent variable and one or
more independent variables. More specifically, regression analysis helps us understand
how the typical value of the dependent variable changes when any one of the independent
variables is varied, while the other independent variables are held fixed. Most commonly,
regression analysis estimates the conditional expectation of the dependent variable given
the independent variables that is, the average value of the dependent variable when the
independent variables are held fixed. Less commonly, the focus is on a quantile, or other
location parameter of the conditional distribution of the dependent variable given the
independent variables. In all cases, the estimation target is a function of the independent
variables called the regression function. In regression analysis, it is also of interest to
characterize the variation of the dependent variable around the regression function, which
can be described by a probability distribution.
3.6.6. Weighted Average Method
This method is widely used in finding the weightage given to different attributed
by respondents. The respondents assign different weightage to the different ranking and
weighted average percentage is found and graphs are plotted.
Net score = (weight for column * no. of respondents)
Total weight
Net score in %age = net score in row
Total net score*100
3.6.7. Paired T Test
The paired t-test is actually a test that the differences between the two
observations are 0. So, if D represents the difference between observations, the
hypotheses are:
Ho: D = 0 (the difference between the two observations is 0)
Ha: D 0 (the difference is not 0)
23
The test statistic is t with n-1 degrees of freedom. If the p-value associated with t
is low (< 0.05), there is evidence to reject the null hypothesis. Thus, you would have
evidence that there is a difference in means across the paired observations.
3.6.8. One-Way ANOVA
A One-Way Analysis of Variance is a way to test the equality of three or more
means at one time by using variances.
The ANOVA is based on the fact that two independent estimates of the population
variance can be obtained from the sample data. A ratio is formed for the two estimates,
where:
one is sensitive to
and the other to
treatment effect & error between groups estimate

Error
within groups estimate
3.6.9. Service Gap Analysis

The most popular assessment tool used in service quality is called SERVQUAL
(Stands for SERVICEQUALITY) gap Analysis, which involves a set of the 5 most
important dimensions of quality according to rankings of customers and involves a set of
5 gaps which represent the difference between customers expectations and perceptions or
in other words the difference between expected level of service vs. Actual level of service
provided
24
PHASE I OF THE STUDY

3.7.1. Reliability and Validity of the HOSPQUAL instrument:
The final stage of scale development process is the assessment of the reliability
and validity of proposed scale. The Cronbachs alpha coefficients of theoretical
dimensions, after the purification process, are briefly explained in the following tables
3.1, 3.2, 3.3.
The scales are developed by the previous researchers for the measurement of
service quality. It has laid a strong foundation for evolving items in BIB measurement
taken for this present study. Additionally, the items required for each of the dimensions
are developed out of discussions with the doctoral fellows in the area of services
marketing. It also held with the experts in bank executives, insurance agents, doctors and
hotel executives. In this way a total of 26 statements are developed in each service
industry and they are purified through substantiation of the literature.
The executives and customers are asked to check for the appropriateness of
assigning the 13 statements into a preset of four behavioral dimensions. Hence a pool of
13 statements is finalized for inclusion in the final scale. The scale items are measured on
a seven-point scale ranging from strongly agree (=7) to strongly disagree (=1).
HOSPQUAL proposes a gap- based conceptualization of service quality in which
the gap indicates the extent to which service obtained confirms to expectations. Since
service quality is a theoretical construct, researcher has defined its dimensions based on
the setting which is used to explore the construct.
25
PERCEPTION SCALE
HOSPQUAL ITEMS
The hospital/clinic will have modern
looking equipment
The physical facilities of hospital will be
visually appealing
Personnel at hospital/clinic will be neat in
appearance
Materials associated with the service(such
as pamphlets or statements)will be
visually appealing in an excellent
hospital /clinic
Variety of surrounding activities meet
customers' needs
convenient location
Services are operated at convenient time
TANGIBILITY DIMENSION
Staff of the hospital are dependable in
handling customers' service problems
Performance of services provide at the
time they promised
Performance of services at right every
time
Settling patients' claims with no
unnecessary delays
Accuracy of medical/expense reports
RELIABILITY DIMENSION
Ease of admission in hospital
Readiness of doctors/nurses/personnel to
provide service
Response to needs of the customers
Ease of discharge in hospital
RESPONSIVENESS DIMENSION
Knowledge able doctors/nurses in hospital
Experienced doctors/nurses in hospital
Respect for patients' privacy
Cronbachs
Alpha
EXPECTATION SCALE
HOSPQUAL Cronbachs
ITEMS
Alpha
0.971
E1
0.955
0.971
E2
0.955
0.971
E3
0.955
0.971
E4
0.955
0.971
E5
0.955
0.971
0.971
0.971
E6
E7
0.956
0.956
0.954
0.971
E8
0.955
0.971
E9
0.955
0.971
E10
0.957
0.971
E11
0.955
0.971
0.970
0.971
E12
E13
0.956
0.954
0.955
0.971
E14
0.956
0.971
0.971
0.971
0.971
0.971
0.971
E15
E16
0.955
0.955
0.954
0.956
0.956
0.956
E17
E18
E19
26
Favourable attitude towards visitors

Sense of security and trust hospital
provided
ASSURANCE DIMENSION
Convenient timing of service delivery for
patients
Ease of communication with the doctor
Getting approval from patient before
test/treatment
Considering patients' problem best interest
in their heart
0.971
E20
0.955
0.971
E21
0.956
0.971
0.955
0.971
E22
0.956
0.971
E23
0.956
0.971
E24
0.955
0.971
E25
0.955
politeness of hospital personnel
0.971
E26
0.956
EMPATHY DIMENSION
0.970
0.954
Table 3.1 Estimation of the Cronbachs Alpha Value

Table3.1 illustrates the Cronbachs Alpha-value if an item is to be deleted. It
presents the mean value for the twenty six items of perception and expectation scale of
HOSPQUAL instrument, consisting of the seven point scale. As can be seen in reliability
item statistics table 3.2, all the 26 items seems to be reasonably well to the scales
reliability. A deletion of any item doesnt reflect much on the Cronbachs
alpha value
(reliability).
Mean for HOSPQUAL
Perception Scale Expectation Scale
Item Means
Item Variances
Inter-Item Co variances
Inter-Item Correlations
4.663
1.761
0.928
0.538
6.132
0.627
0.261
0.437
No of Items
26
26
26
26
Table 3.2 Reliability item statistics for HOSPQUAL of hospital

Another method to decide the reliability of the HOSPQUAL scales of hospital is
to analyze the inter-item correlations. Hair et al (1998) suggests that the Inter-item
correlation should exceed 0.60 for the data to be reliable. The item statistics presents the
current study statistics where Inter-item correlation is 0.606 for
perception scale and
0.735 for expectation scale.

Coefficient Alpha
SQ Dimensions
Number of Items
Perception Scale
Expectation Scale
27
Reliability
Assurance
Empathy
Tangibility
Responsiveness
5
5
5
7
4
26
0.972
0.972
0.972
0.972
0.972
0.972
0.957
0.957
0.957
0.957
0.957
0.957
Table 3.3 Cronbachs coefficient of five HOSPQUAL dimensions

As shown in Table 3.3, the five HOSPQUAL dimensions for the total scale have
resulted in good internal consistency, which is evidenced by alpha method. The 7-item
scale measuring reliability has a coefficient alpha of 0.972 for perception and 0.957 for
expectation. In this study, the item tangibility perception and expectation scale has a
coefficient alpha of 0.972 and 0.957 for the empathy, assurance and responsiveness
perception and expectation scale, the coefficient alpha is also 0.972 and 0.957
3.7.2 Content and construct validity analysis of HOSPQUAL expectation scale of
Hospitals
The next stage of data analysis is to explore the dimensions of Service Quality in
the Hospital. The factor analysis should be analyzed in order to reach underlying factors
that have the most effect in customer expectation. Thus doing an explorative factor
analysis, the results are subjected to varimax rotation with Kaiser Normalization. Table
3.5 suggests that five factors emerge as dimensions of Service Quality in this study with
reference to hospital. For this reason, the researcher has conducted KMO and Bartletts
test and results are shown in table 3.4. The result of 0.885 shows the appropriateness of
factor analysis for the above mentioned purpose. The appropriateness of using factor
analysis depends on the number of KMO.
This number should be bigger than 0.70. Also, the result of Bartletts test of
Sphericity taken for this study is equal to significant 0.000 which confirms our method.
The acceptable number is less than 0.05
Kaiser-Meyer-Olkin Measure of Sampling Adequacy. 0.885
Bartlett's Test of Sphericity
Approx. Chi-Square 1.470E4
Sig.
0.000
Table 3.4 KMO and Bartlett's Test for hospitals
28
The result of rotated component matrix and total Variance are shown in the
following table. Using the Varimax rotation, the researcher has divided 26 items into three
component factors of the HOSPQUAL. The rotated component matrix in expectation
survey shows the importance of specific factors for the consumers expectation towards
hospitals.
HOSPQUAL expectation items of hospital

Sector
The hospital/clinic will have modern looking
equipment
The physical facilities of hospital will be
visually appealing
Personnel at hospital/clinic will be neat in
appearance
Materials associated with the service(such as
pamphlets or statements)will be visually
appealing in an excellent hospital /clinic
Variety of surrounding activities meet
customers' needs
Convenient location
Services are operated at convenient time
Staff of the hospital are dependable in
handling customers' service problems
Performance of services provide at the time
they promised
Performance of services at right every time
Settling patients' claims with no unnecessary
delays
Accuracy of medical/expense reports
Ease of admission in hospital
Readiness of doctors/nurses/personnel to
provide service
Response to needs of the customers
Ease of discharge in hospital
Knowledge able doctors/nurses in hospital
Experienced doctors/nurses in hospital
Respect for patients' privacy
Favorable attitude towards visitors
Sense of security and trust hospital provided
Component
3
0.664
0.385
0.198
0.128
0.098
0.376
0.452
0.198
0.271
0.083
0.340
0.539
0.226
0.263
0.149
0.267
0.616
0.238
0.230
0.093
0.439
0.638
0.179
0.136
0.135
0.233
0.228
0.713
0.630
0.064
0.125
0.101
0.226
0.193
0.166
0.075
0.636
0.411
0.159
0.120
0.709
0.352
0.040
0.125
0.154
0.788
0.184
-0.052
0.104
0.090
0.649
0.307
0.252
0.107
0.027
0.477
0.513
0.369
0.099
0.290
0.115
0.164
0.401
-0.016
0.447
0.594
0.111
0.337
0.208
0.064
0.393
0.174
0.159
0.141
0.094
0.129
0.120
0.012
0.355
0.179
0.215
0.196
0.322
0.148
0.405
0.288
0.796
0.774
0.790
0.393
0.776
0.503
0.749
0.128
0.121
0.111
0.049
0.152
0.251
-0.031
0.076
0.118
0.186
0.754
0.127
29
HOSPQUAL expectation items of hospital

Convenient timing ofSector
service delivery for
patients
Ease of communication with the doctor
Getting approval from patient before
test/treatment
Considering patients' problem best interest in
their heart
politeness of hospital personnel
Component
0.094
0.304
0.067
0.800
0.107
0.051
0.285
0.221
0.164
0.837
0.317
-0.007
0.250
0.600
0.339
0.117
0.300
0.122
0.855
0.072
0.439
0.071
-0.044
0.499
0.521
Table 3.5 Component Matrix for expectation scale of hospital

Component
1
1
0.513
2
-0.496
3
0.385
4
0.277
5
0.515
2
0.507
-0.072
0.389
-0.426
-0.636
3
0.437
0.833
0.080
-0.037
0.327
4
0.443
-0.219
-0.791
-0.339
0.121
5
0.303
0.080
-0.261
0.791
-0.456
As in the table 3.5, the Factor 1 holds with largest contribution of 49.672% of total
variance, Factor 2 holds 8.685% of total variance, Factor 3 holds with 5.522%, Factor 4
holds with 4.168 % of total variance and fifth factor with 3.648% of total variance.
Therefore to conclude, the five factors hold 71.694% of variations.
30
4. DATA ANALYSIS AND RESULTS

PHASE II OF THE STUDY
4.1. Descriptive Statistics
4.1.1 Gender wise classification
Frequency
Male
194
Female 181
Total
375
Percent
51.7
48.3
100.0
Table 4.1.1 Gender wise classification
From the above table 4.1.1 reveals that out of 375 samples taken for the survey,
194 persons are male respondents and remaining 181 persons are female respondents.
31
4.1.2 Age Group classification
Frequency Percent
Less than 18 years
21
5.6
19 to 20 years
88
23.5
30 to 39 years
102
27.2
40 to 49 years
71
18.9
50 to 59 years
50
13.3
Above 60 &
Older
43
11.5
Total
375
100.0
Table 4.1.2 Age Group classification
From the above table 4.1.2 inference that total samples, majority of respondents
27.2% belongs to the age group of 30 to 39, and 23.5% respondents belongs to the age
group of 19 to 29, the remaining percentage of the respondents belongs to the age group
of others.
4.1.3 Occupation wise classification
32
Frequency Percent
Professionals(Doctors, Engineers)
21
5.6
Manager/Business Executive
11
2.9
Banking & Finance
17
4.5
Clerk/Police/Army
24
6.4
Student
51
13.6
Academic/Education
25
6.7
Marketing & Sales
1.3
Technician
16
4.3
Own Business
39
10.4
House Wife
84
22.4
Pension/Retired
36
9.6
Unemployed
12
3.2
Other(s)
34
9.1
Total
375
100.0
Table 4.1.3 Occupation wise classification
33
From the above table 4.1.3 it indicate that, majority of the respondents 22.4% are
house wife,13.6% respondents are belongs to the Student category, 10.4% respondents are
own Business and pension/retired persons are 9.6% and the remaining respondents are
other category.
4.1.4 Income Wise Classification
Frequency Percent
< Rs.5000
37
9.9
Rs. 5001 to Rs. 10000
100
26.7
Rs.10001 to Rs.15000
134
35.7
Rs.15001 to Rs.25000
75
20.0
> Rs.25001
29
7.7
Total
375
100.0
Table 4.1.4 Income Wise Classification
34
From the above table 4.1.4 it inference that from the total samples, majority of
respondents are lies between Rs10001 -15000 having the percentage of 35.7% and 26.7%
of respondents are having the income of Rs5001-10000.
4.1.5 Ownership of hospital
Table 4.1.5 Ownership of
Frequency Percent
Private
204
54.4
Public
171
45.6
Total
375
100.0
hospital
From the above table 4.1.5 inference that from the total samples 375, the
majority of respondents 54.4% are currently taking treatments in private hospital and the
remaining 45.6% of them in public hospital. So it indicates that private hospital owning
the highest preference among the respondents.
4.1.6 Average time spent by doctor in examine patient
Up to 5 minutes
6 to 10 minutes
10 to 15 minutes
Frequency
88
132
82
Percent
23.5
35.2
21.9
35
15 to 20 minutes
Above 20 minutes
Total
49
24
375
13.1
6.4
100.0
Table 4.1.6 Average time spent by doctor in examine patient
From the above table 4.1.6 indicate that out of total samples, 35.2 percentage of
patients gave the opinion of the average time spent by doctor in examine patients from 6
to 10 minutes,23.5 % of patients gave the opinion of the average time spent by doctor in
examine patients from up to 5 minutes.
4.1.7 Average arrival time from the source (location) to the service provider
(hospital)
Frequency Percent
up to 5 minutes
20
5.3
6 to 10 minutes
64
17.1
10 to 15 minutes
91
24.3
15 to 20 minutes
90
24.0
Above 20 minutes
110
29.3
Total
375
100.0
Table 4.1.7 Average arrival time from the source (location) to the service provider
36
From the above table 4.1.7 indicate that out of total samples 29.3 percentage of
patients gave the opinion above20 minutes time from the source to the hospital,24.3 % of
patients have the opinion of arrival time from the source to the hospital is 10-15 minutes.
4.1.8 Patient Undergone Treatment in Hospital
Frequency Percent
General checkup
47
12.5
Fever
47
12.5
E&T
25
6.7
Cardiologist
40
10.7
Eye
42
11.2
Orthology
25
6.7
Neurology
19
5.1
Gynagologist
21
5.6
Dentist
11
2.9
37
Dermatologist
12
3.2
Others
86
22.9
Total
375
100.0
Table 4.1.8 Patient Undergone Treatment in Hospital
From the above table 4.1.8 indicate that, 22.9 % of patients are taking
treatment for other diseases in hospital, 12.5%of patients are taking treatment for fever
and general checkup, 11.3% of patients are taking treatment for Eye in hospital, and
remaining patients are taking treatment like Orthology, Cardiologist and neurology.
38
4.2 Cross tabulation & Chi - Square

4.2.1 Cross tabulation between the Occupation wise and Age wise classifications
H0: There is no significance difference between the occupations for the patient.
HA: There is a significance difference between the occupations for the patient.
Less
than
18
year
s
Occupatio
n
Professionals(Doctors
, Engineers)
Manager/Business
Executive
Banking & Finance
Clerk/Police/Army
Student
Academic/Education
Marketing & Sales
Technician
Own Business
House Wife
Pension/Retired
Unemployed
Other(s)
Total
19 to 30 to 40 to 50 to
20
39
49
59
year year year year
s
s
s
s
Abov
e 60
&
Older
Total
13
21
11
0
0
20
0
0
1
0
0
0
0
0
21
6
0
30
5
2
3
3
13
0
5
3
88
3
12
1
10
3
4
10
24
2
3
18
102
5
4
0
8
0
8
14
18
5
0
8
71
0
5
0
2
0
0
10
17
11
2
2
50
3
3
0
0
0
0
2
12
18
2
3
43
17
24
51
25
5
16
39
84
36
12
34
375
Table 4.2.1 Cross tabulation between the Occupation wise and Age wise
classifications
Chi-square test
Value
df Asymp. Sig. (2-sided)
a
Pearson Chi-Square 3.603E2 60
0.000
N of Valid Cases
375
The p-value is printed as 0.000. The chi-square test statistic is 3.603E2a with an
associated p<0.05.The null hypothesis is rejected, since p<0.05 and a conclusion is made
that occupation is not associated with the age wise classification. The frequency table
shows that 22.4% of the respondents are coming under the occupation are mostly for
house wife. The chi-square value which is 3.603E2a and it is significant value of p is
39
0.000 levels. So there is a significance difference between the occupations for the
patients.
4.2.2 Cross tabulation between the Income wise and Age wise classifications
H0: There is no significance difference between the income wise classifications for
the patient.
HA: There is a significance difference between the income wise classifications for
the patient.
Income wise
classification
Total
< Rs.5000
Rs. 5001
to Rs.
10000
Rs.10001
to
Rs.15000
Rs.15001
to
Rs.25000
>
Rs.25001
Less
than
18
years
3
19 to
20
years
30 to
39
years
40 to
49
years
50 to
59
years
Above
60 &
Older
Total
13
37
29
29
14
14
100
10
19
38
22
27
18
134
23
19
23
75
29
21
88
102
71
50
43
375
Table 4.2.2 Cross tabulation between the Income wise and Age wise classifications
Chi-square test
Value Df Asymp.Sig. (2-sided)
Pearson Chi-Square 6.437a 20
0.000
N of Valid Cases
375
The p-value is printed as 0.000. The chi-square test statistic is 6.437a with an
associated p<0.05. The null hypothesis is rejected, since p<0.05 and a conclusion is made
shows that 35.7% of the respondents are coming under the income wise are mostly for
Rs.10001 to Rs.15000. The chi-square value which is 6.437a and it is significant value of
p is 0.000 levels. So there is significance difference between income wise classifications
for the patient.
40
4.2.3 Cross tabulation between Ownership of hospital and Age wise classification
H0: There is no significance difference between the ownership of the hospital.
HA: There is a significance difference between the ownership of the hospital.
Ownership
of hospital
Total
Less
than 18
years
Private 12
Public 9
21
19 to
20
years
52
36
88
30 to
39
years
54
48
102
40 to
49
years
36
35
71
50 to
59
years
29
21
50
Above
60 &
Older
21
22
43
Total
204
171
375
Table 4.2.3 Cross tabulation between

Ownership of hospital and Age wise classification
Chi-Square Test
Value Df Asymp. Sig. (2-sided)
0.832
N of Valid Cases
375
The p-value is printed as 0.832 The chi-square test statistic is 2.1201a with an
associated p<0.05. The null hypothesis is accepted, since p<0.05 and a conclusion is
made that occupation is not associated with the age wise classification. The frequency
table shows that 54.4% of the respondents are coming under the ownership of the hospital
are mostly for Private. The chi-square value which is 2.120a and it is significant value of p
is 0.385levels. So there is no significance difference between the ownership of the
hospital.
4.2.4 Cross tabulation between the Average time spent by doctor in examine patient
and Age wise classification
H0: There is no significance difference between the average time spent by doctor
in examine patient.
HA: There is a significance difference between the average time spent by doctor in
examine patient.
Less
than
19 to
20
30 to
39
40 to
49
50 to
59
Above
60 &
Total
41
Up to 5
minutes
6 to 10
minutes
10 to 15
minutes
15 to 20
minutes
Above
20
minutes
Average time
spent by
doctor in
examine
patient
Total
18
years
years
years
years
years
Older
20
16
19
13
64
17
28
18
14
91
16
22
26
14
90
32
30
19
14
110
21
88
102
71
50
43
375
Table 4.2.4 Cross tabulation between the

Average time spent by doctor in examine patient and Age wise classification
Chi-Square Test
Value
Df Asymp. Sig. (2-sided)
0.002
N of Valid Cases
375
shows that 35.2% of the respondents are coming under the time spent by doctor in
examine patient for 6 to 10 minutes. The chi-square value which is 43.198a and it is
significant value of p is 0.000 levels. So there is a significance difference between the
average times spent by doctor in examine patient.
4.2.5 Cross tabulation between the Average arrival time from the source (location) to
the service provider (hospital) and age wise classification
H0: There is a no significance difference between the average arrival times from
the source (location) to the service provider (hospital).
HA: There is a significance difference between the average arrival time from the
source (location) to the service provider (hospital).
42
Average arrival time

from the
source(location) to
the service
provider(hospital)
up to 5
minutes
6 to 10
minutes
10 to 15
minutes
15 to 20
minutes
Above
20
minutes
Total
Less
than
18
years
19 to
20
years
30 to
39
years
40 to
49
years
50 to
59
years
Above
60 &
Older
Total
20
16
19
13
64
17
28
18
14
91
16
22
26
14
90
32
30
19
14
110
21
88
102
71
50
43
375
Table 4.2.5 Cross tabulation between the Average arrival time from the source
(location) to the service provider (hospital) and age wise classification
Chi-Square Test
Value
a
Pearson Chi-Square 29.406 20
0 .080
N of Valid Cases
375
shows that 29.3% of the respondents are coming under the Average arrival time from the
source (location) to the service provider (hospital) above 20 minutes. The chi-square
value which is 29.406a and it is significant value of p is 0.080 levels. So there is a
significance difference between the average arrival time from the source (location) to the
service provider (hospital).
4.2.6 Cross tabulation between the Patient treatments undergone in hospital and age
wise Classification
H0: There is no significance difference between the patient treatments undergone
in hospital.
HA: There is a significance difference between the patient treatments undergone
in hospital.
Less
19 to
30 to
40 to
50 to
Above
Total
43
than
20
39
49
59
60 &
years
years
years
years
Older
13
18
47
14
0
0
3
0
0
1
0
0
1
21
20
5
2
10
1
3
3
5
5
21
88
4
10
6
7
10
11
7
6
3
20
102
1
6
17
10
6
1
4
0
3
19
71
2
3
10
9
6
2
3
0
1
9
50
6
1
5
3
2
2
3
0
0
16
43
47
25
40
42
25
19
21
11
12
86
375
18
years
General
checkup
Fever
E&T
Patient
Cardiologist
treatment
Eye
undergone in Orthology
Neurology
hospital
Gynagologist
Dentist
Dermatologist
Others
Total
Table 4.2.6 Cross tabulation between the Patient treatments undergone in hospital
and age wise Classification
Chi-Square Test
Value
a
0.000
N of Valid Cases
375
shows that 22.9% of the respondents are coming under the Patient treatment undergone in
hospital for others. The chi-square value which is 1.582E2a and it is significant value of p
is 0.000 levels. So there is a significance difference between the patient treatments
undergone in hospital.
4.2.7 Cross tabulation between the Age wise and Gender wise classification
H0: There is a no significance difference between the age wise classifications for
the patient.
HA: There is a significance difference between the age wise classifications for the
patient.
Less
19 to
30 to
40 to
50 to
Above
Total
44
Gender wise
Male
Female
classification
Total
than 18
20
39
49
59
60 &
years
4
17
21
years
48
40
88
years
55
47
102
years
35
36
71
years
26
24
50
Older
26
17
43
194
181
375
Table 4.2.7 Cross tabulation between the Age wise and Gender wise classification
Chi-Square Test
Value
a
.053
N of Valid Cases
375
that occupation is not associated with the gender wise classification. The frequency table
shows that 27.2% of the respondents are coming under the respondents of age wise
classification for 30-39 years. The chi-square value which is 10.493a and it is significant
value of p is 0.007 levels. So there is a significance difference between the age wise
classifications for the patient.
4.2.8 Cross tabulation between the occupation wise and Gender wise classification
H0: There is no significance difference between the occupations for the patient.
HA: There is a significance difference between the occupations for the patient.
Male Female Total

Occupation Professionals(Doctors, Engineers) 19
2
21
Manager/Business Executive
7
4
11
Banking & Finance
6
11
17
Clerk/Police/Army
20
4
24
Student
22
29
51
Academic/Education
8
17
25
Marketing & Sales
5
0
5
Technician
15
1
16
Own Business
33
6
39
House Wife
4
80
84
45
Pension/Retired
Unemployed
Other(s)
Total
30
7
18
194
6
5
16
181
36
12
34
375
Table 4.2.8 Cross tabulation between the occupation wise and Gender wise
classification
Chi-Square Test
Value
a
0.000
N of Valid Cases
375
associated p<0.05.The null hypothesis is rejected, since p<0.05 and a conclusion is made
shows that 22.4% of the respondents are coming under the occupation are mostly for
house wife. The chi-square value which 1.518E2a and it is significant value of p is 0.000
levels. So there is a significance difference between the occupations for the patient.
4.2.9 Cross tabulation between the Income wise and Gender wise classification
H0: There is no significance difference between the income wise classifications for
the patient.
HA: There is a significance difference between the income wise classifications for
the patient.
< Rs.5000
Rs.5001 to Rs.10000
Income wise classification Rs.10001 to Rs.15000
Rs.15001 to Rs.25000
> Rs.25001
Total
Male Female Total

18
19
37
62
38
100
63
71
134
35
40
75
16
13
29
194
181
375
Table 4.2.9 Cross tabulation between the Income wise and Gender wise classification
Chi-Square Test
46

0.167
N of Valid Cases
375
made that occupation is not associated with the gender wise classification. The frequency
table shows that 35.7% of the respondents are coming under the income wise are mostly
for Rs.10001 to Rs.15000. The chi-square value which is 6.465a and it is significant value
of p is 0.167 levels. So there is no significance difference between the income wise
classifications for the patient.
4.2.10 Cross tabulation
wise classification
between
the
Ownership of hospital
and
Gender
H0: There is no significance difference between the ownership of the hospital.

HA: There is a significance difference between the ownership of the hospital.
Male
Ownership of hospital Private 113
Public 81
Total
194
Female
91
90
181
Total
204
171
375
Table 4.2.10 Cross tabulation between the Ownership of hospital and Gender
wise classification
Chi-Square Test
0.121
b
N of Valid Cases
375
made that occupation is not associated with the age wise classification. The frequency
table shows that 53.5% of the respondents are coming under the ownership of the hospital
are mostly for Private. The chi-square value which is 2.398a and it is significant value of p
is 0.121levels. So there is no significance difference between the ownership of the
hospital.
47
4.2.11 Cross tabulation between the Average time spent by doctor in examine patient
and the Gender wise classification
H0: There is no significance difference between the average time spent by doctor
in examine patient.
HA: There is a significance difference between the average time spent by doctor in
examine patient.
Male
Average time spent
by doctor in
examine patient
Female Total
Up to 5 minutes
47
41
88
6 to 10 minutes
10 to 15 minutes
15 to 20 minutes
Above 20 minutes
64
42
29
12
68
40
20
12
132
82
49
24
194
181
375
Total
Table 4.2.11 Cross tabulation between the Average time spent by doctor in examine
patient and the Gender wise classification
Chi-Square Test
0.775
N of Valid Cases
375
table shows that 35.2% of the respondents are coming under the time spent by doctor in
examine patient for 6 to 10 minutes. The chi-square value which is 1.784a and it is
significant value of p is 0.775levels. So there is no significance difference between the
average time spent by doctor in examine patient.
4.2.12 Cross tabulation between the Average arrival time from the source (location)
to the service provider (hospital) and the Gender wise classification
H0: There is a no significance difference between the average arrival times from
the source (location) to the service provider (hospital).
HA: There is a significance difference between the average arrival time from the
source (location) to the service provider (hospital).
48
Average arrival time

from the source
(location) to the
service provider
(hospital)
up to 5 minutes
6 to 10 minutes
10 to 15
minutes
15 to 20
minutes
Above 20
minutes
Total
Male
11
34
Female
9
30
Total
20
64
49
42
91
47
43
90
53
57
110
194
181
375
Table 4.2.12 Cross tabulation between the Average arrival time from the source
(location) to the service provider (hospital) and the Gender wise classification
Chi-Square Test
0.930
N of Valid Cases
375
table shows that 29.3% of the respondents are coming under the Average arrival time
from the source (location) to the service provider (hospital) above 20 minutes. The chisquare value which is 0.862a and it is significant value of p is 0.930 levels. So there is no
significance difference between the average arrival times from the source (location) to the
service provider (hospital).
4.2.13 Cross tabulation between the patient treatment undergone in hospital and the
Gender Wise classification
H0: There is no significance difference between the patient treatments undergone
in hospital.
HA: There is a significance difference between the patient treatments undergone
in hospital.
Patient treatment
undergone in hospital
General
checkup
Fever
E&T
Male
Female
Total
24
23
47
21
19
26
6
47
25
49
Cardiologist
Eye
Orthology
Neurology
Gynagologist
Dentist
Dermatologist
Others
Total
31
20
16
13
0
5
11
34
194
9
22
9
6
21
6
1
52
181
40
42
25
19
21
11
12
86
375
Table 4.2.13 Cross tabulation between the patient treatment undergone in hospital
and the Gender Wise classification
Chi-Square Test
Value
a
0.000
N of Valid Cases
375
shows that 22.9% of the respondents are coming under the Patient treatment undergone in
hospital for others. The chi-square value which is 56.857a and it is significant value of p is
0.000 levels. So there is a significance difference between the patient treatments
undergone in hospital.
4.3. Multiple Regressions

Predictive Validity 1
The metrics validity is assessed empirically by examining its predictive or
criterion- related validity - i.e., the extent to which the patient scores can predict
customers perception ratings on their overall satisfaction.
Testing of Hypothesis
H0: There is an absence of significant evidence that overall satisfaction will have a
significant impact on individual service quality dimensions of hospitals.
50
HA: There is significant evidence that overall satisfaction will have a significant
impact on individual service quality dimensions of hospitals.
4.3.1 Predictor of SAT Dimensions on overall satisfaction of Hospital
The multiple regressions are applied to analyze the individual service quality
dimensions (RATER) as independent variables against a separate measure of Overall
satisfaction of hospital as dependent variable. The items are summed up to reproduce the
five original dimensions which are analyzed separately against the overall Service Quality
as follows,
Variables Entered
Model
1
Variables Entered
Average perception ratings of Tangibility,
Responsiveness, Assurance and Empathy (a)
Method
Reliability, Enter
a) All requested independent variables entered

b) Dependent Variable: Overall satisfaction of the hospital
Sum of squares
Regression
Residual
Total
166.827
118.735
285.562
D.f
5
259
264
Mean Square
33.365
.458
F
Sig.
72.781 0.000a
Table 4.3.1 ANOVA table for the Hospital

Dependent Variable: Overall satisfaction of hospital
Predictors :( constant): Average perception ratings of Tangibility, Reliability,
The above table 4.3.1 tests the acceptability of model from a statistical
perspective. The ANOVA table shows F-Ratio for the regression model which indicates
statistical significance of the Overall regression model. The F-ratio is the result of
comparing the amount of explained variance to unexplained variance.
The F-value is the mean square regression divided by the Mean Square Residual,
yielding F=72.781 .The p-value associated with this F value is very small (0.000). The
51
significance value of the F-Statistic is less than 0.05. In this table the significance variable
is less than 0.05 so that the group of variables tangibility, reliability, responsiveness,
assurance and empathy (a) can be used to reliably predict Overall Service Quality of
hospital (the dependent variable).
Multiple R R Square Adjusted
R Square
0.764
0.584
0.576
Table 4.3.2 Summary of regression model
The above table 4.3.2 reports strength of relationship between the dependent
variable (Overall Service Quality) and individual service quality dimensions as
independent variables of hospital. Multiple R is the correlation coefficient (at this step)
for the simple regression of Reliability (X1), Empathy (X2), Assurance (X3),
Responsiveness (X4) and Tangibility (X5), and the dependent variable of overall Service
Quality (Y). R - R is the square root of R-Squared and is the correlation between the
observed and predicted values of dependent variable. The strength of correlation
coefficient is 0.764. There is a strong positive strength of correlation between the
observed variable X1, X2, X3, X4 and X5 and predicted values of dependent variable
(Y).The R-square shows the percentage of variation in one variable that is accounted by
another variable. In this case the RATER dimensions accounts values of 58% for
Hospital. R square (R2) is the correlation coefficient squared; also it is referred as the
coefficient of determination. The adjusted R-square attempts to yield a honest value to
estimate the R-squared for the population. The value of adjusted R-square is 0.576.
4.3.3 Regression coefficient for impact of overall SAT of Hospital on Individual
RATER dimensions
The table 4.2.2 shows the regression coefficient for independent variables
of hospital. These are the values for the regression equation for predicting dependent
variable, Overall Satisfaction of Hospital (Y) from the independent variable(s) of RATER
dimensions. The t-test examines the question of whether the regression coefficient is
different from zero to be statically significant or not. In this step, five independent
variables are used to calculate the regression equation for the dependent variable. The
coefficient table shows result for constant component in the regression equation. The
52
column labeled significance shows statistical significance of the regression co-efficient

for independent variable as measured by t-test.
(Constant)
Un standardized
Standardized
Coefficients
Coefficient
t
Sig.
B
Std. Error Beta
1.485
0.659
2.256 0.025
Tangibility
0.073
0.056
0.080
1.300 0.195
Reliability
0.086
0.072
0.088
1.203 0.230
Responsiveness 0.389
0.066
0.412
5.861 0.000
Assurance
0.253
0.063
0.262
3.991 0.000
Empathy
-0.045
0.102
-0.018
-0.438 0.662
Table 4.3.3 Regression coefficients for hospital

The coefficient table 4.3.3 shows two predictors in the model of Hospital. The two
significant coefficients for Hospital are Reliability and Responsiveness and three nonsignificant coefficients are tangibility, assurance and empathy dimension. Since these
non-significances exceed 0.05 indicating that these variables do not contribute much to
the model.
It also shows that the relative importance of significant predictors is determined
by looking at the standardized coefficient. Reliability dimension has the highest
standardized coefficient with the lowest significance (p=0.05) which means that
reliability is the main predictor for overall Service Quality. By analyzing whole table
results, the orders of significance for predictor dimensions of Overall Satisfaction of
Hospital are reliability and responsiveness.
The predicted value (regression equation) is Y1 predicted (Hospital) = 1.485+
0.073*Tangibility+ 0.086*Reliability+ 0.389*Responsiveness + 0.253*Assurance +
-0.045*Empathy.
Predictive Validity-2
53
The metrics validity is assessed empirically by examining its predictive or

criterion- related validity - i.e., the extent to which the patient scores can predict
customers perception ratings on their overall service Quality.
H4: There is an absence of significant evidence that overall service Quality will
have a significant impact on individual service quality dimensions of hospitals.
HA: There is significant evidence that overall Service Quality will have a
significant impact on individual service quality dimensions of hospitals.
4.4.1 Predictor of SQ Dimensions on overall Service Quality of Hospital
The multiple regressions are applied to analyze the individual service quality
dimensions (RATER) as independent variables against a separate measure of Overall
Service Quality of hospital as dependent variable. The items are summed up to reproduce
the five original dimensions which are analyzed separately against the overall Service
Quality as follows,
Variables Entered
Model
1
Variables Entered
Average perception ratings of Tangibility,
Method
Reliability,
Enter
a) All requested independent variables entered

b) Dependent Variable: Overall Service Quality of the hospital
Sum of squares
Regression
Residual
Total
188.421
129.601
318.023
D.f
5
259
264
Mean
Square
37.684
.500
F
75.309
Sig.
.000a
Table 4.4.1 ANOVA table for the Hospital

Dependent Variable: Overall Service Quality of hospital
54
Predictors :( constant): Average perception ratings of Tangibility, Reliability,

The above table 4.4.2 tests the acceptability of model from a statistical
perspective. The ANOVA table shows F-Ratio for the regression model which indicates
statistical significance of the Overall regression model. The F-ratio is the result of
comparing the amount of explained variance to unexplained variance.
The F-value is the mean square regression divided by the Mean Square Residual,
yielding F=75.309. The p-value associated with this F value is very small (0.000). The
significance value of the F-Statistic is less than 0.05. In this table the significance variable
is less than 0.05 so that the group of variables tangibility, reliability, responsiveness,
assurance and empathy (a) can be used to reliably predict Overall Service Quality of
hospital (the dependent variable).
Multiple R R Square Adjusted R Square
0.770
0.592
0.585
Table 4.4.2 Summary of regression model
The above table 4.4.2 reports strength of relationship between the dependent
variable (Overall Service Quality) and individual service quality dimensions as
independent variables of hospital. Multiple R is the correlation coefficient (at this step)
for the simple regression of Reliability (X1), Empathy (X2), Assurance (X3),
Responsiveness (X4) and Tangiblity (X5), and the dependent variable of overall Service
Quality (Y). R - R is the square root of R-Squared and is the correlation between the
observed and predicted values of dependent variable. The strength of correlation
coefficient is 0.770. There is a strong positive strength of correlation between the
observed variable X1, X2, X3, X4 and X5 and predicted values of dependent variable
(Y).The R-square shows the percentage of variation in one variable that is accounted by
another variable. In this case the RATER dimensions accounts values of 58% for
Hospital. R square (R2) is the correlation coefficient squared; also it is referred as the
coefficient of determination. The adjusted R-square attempts to yield a honest value to
estimate the R-squared for the population. The value of adjusted R-square is 0.585.
4.4.3 Regression coefficient for impact of overall SQ of Hospital on Individual
55
RATER Dimensions
The table 4.4.2 shows the regression coefficient for independent variables of
hospital. These are the values for the regression equation for predicting dependent
variable, Overall Service Quality of Hospital (Y) from the independent variable(s) of
RATER dimensions. The t-test examines the question of whether the regression
coefficient is different from zero to be statically significant or not. In this step, five
independent variables are used to calculate the regression equation for the dependent
variable. The coefficient table shows result for constant component in the regression
equation. The column labeled significance shows statistical significance of the regression
co-efficient for independent variable as measured by t-test.
(Constant)
Un standardized
Coefficients
B
Std. Error
1.291
0.688
Standardized
Coefficient
Beta
Tangibility
0.157
0.059
0.163
2.661
0.008
Reliability
0.035
0.075
0.034
0.466
0.642
Responsiveness
0.402
0.069
0.404
5.802
0.000
Assurance
0.258
0.066
0.253
3.898
0.000
Empathy
-0.052
0.107
-0.020
-0.484 0.629
Sig.
1.876
0.062
Table 4.4.3 Regression coefficients for hospital

The coefficient table 4.4.3 shows two predictors in the model of Hospital. The two
significant coefficients for Hospital are Reliability and Responsiveness and three nonsignificant coefficients are tangibility, assurance and empathy dimension. Since these
non-significances exceed 0.05 indicating that these variables do not contribute much to
the model.
It also shows that the relative importance of significant predictors is determined
by looking at the standardized coefficient. Reliability dimension has the highest
standardized coefficient with the lowest significance (p=0.05) which means that
reliability is the main predictor for overall Service Quality. By analyzing whole table
56
results, the orders of significance for predictor dimensions of Overall Service Quality of
Hospital are reliability and responsiveness.
0.157*Tangibility+ 0.035*Reliability+ 0.402*Responsiveness + 0.258*Assurance +
-0.052*Empathy.
4.4. Customer preference in choosing service provider

Service provider/
Preference of Rank
109 83 47 55
38
43
73.38
Tariff Charges
78
97 52 46
56
46
69.38
Service Quality
45
81 97 61
43
48
65.71
Quick Recovery
65
61 80 67
58
44
65.52
Location
38
38 37 85
69
108
50.81
Brand Name
37
20 63 59 112
84
50.43
Referred Doctor
Weighted Mean Rank
Table 4.4 Order of priority for choosing your hospital
57
The above table 4.4, it reveals that respondents are asked to rank from one to six
with one being the most influential reasons for choosing the hospital and six being the
least influential for choosing the hospital. The respondents giving preference as Referred
doctor as selected as the rank one with a weighted mean of 73.38, Following closely in
second rank is Tariff charge with having a weighted mean of 69.38 and remaining values
of the service providers as shown in the above table. Location and Brand name holds least
rank by the respondents in Tamilnadu.
4.5 Paired Sample T -Test

Paired sample t test for perception and expectation ratings of hospital
H0: There is no significant evidence that the perception ratings of customers are
almost equal to their expectation ratings in Hospital
HA: There is significant evidence that the perception ratings of customers are
greater than expectation ratings in Hospital
Paired statements
Pair 1 Perception & Expectation ratings of Tangibility
S.D
1.22204 -16.697
Sig.(2-tailed)
0.00
58
Pair 2 Perception & Expectation ratings of Reliability
1.10605 -15.694
0.00
Pair 3 Perception & Expectation ratings of Responsiveness 1.30374 -18.591
0.00
Pair 4 Perception & Expectation ratings of Assurance
1.12555 -41.623
0.00
Pair 5 Perception and Expectation ratings of Empathy
1.27877 -32.308
0.00
Table 4.5 Paired sample t test for perception and expectation ratings of Hospital
The above table 4.5, measures the gap between the perception and expectation
ratings of RATER dimensions of service quality in hospital. It can be observed that from
the first paired sample test in which Pair 1, Expectation ratings are significantly lesser
than perception ratings of service quality (t = -16.697). It falls in negative rejection area (16.697 < 1.96) and H0 is not valid. The number of t for all 5 pairs is bigger than 1.96
means t falls under the alternative hypothesis of H 1. The paired sample t test is
conducted on the total amount of perceptions and expectations of respondents ratings
which should confirm the service gap between expectation and perception in hospital.
4.6. One Way ANOVA
4.6.1 One Way ANOVA for Significant difference in impact of overall SAT on
demographic profile of Hospital
H0: There is an absence of significant evidence that differences in gender, age
Income level and occupation will have a significant impact on overall SAT of
hospital
HA: There is significant evidence that differences in gender, age, Income level and
occupation will have a significant impact on overall SAT of hospital
59
Demographic
characteristics
Between Groups
Within Groups
Total
Between Groups
Gender
Sum of
Squares
1.418
64.756
66.174
34.800
Mean
Square
5
.284
259
.250
264
5
6.960
Df
Age
Within Groups
523.706
259
Group
Total
558.506
264
Between Groups
Within Groups
Total
Between Groups
Within Groups
Total
10.665
287.131
297.796
208.470
2740.526
2948.996
5
259
264
5
259
264
Income Level
Occupation
Sig.
1.134
.343
3.442
.005
2.133
1.109
1.924
.091
41.694
10.581
3.940
.002
2.022
Table 4.6.1 one way ANOVA test for profile of hospital on overall SAT
The table 4.6.1 shows that the overall Fs for demographic profile of hospital on
Overall SAT which are significance or not by using the ANOVA. From the demographics
profile of customers, Age group and Occupation of customers differ significantly where F
ratio is used to determine size of the mean differences for each individual independent
variables comparison, The test between groups shows that F ratio for occupation and age
group are statistically significant (p<0.05) level. Hence it is concluded that there is a
significant difference among age group and occupation profile of customers based on
overall SAT in hospital.
4.6.2. One Way ANOVA for Significant difference in impact of overall service quality
on demographic profile of hospital
H0: There is an absence of significant evidence that differences in gender, age,
Income level and occupation will have a significant impact on overall service
quality of hospital
HA: There is a significant evidence that differences in gender, age, Income level
and Occupation will have a significant impact on overall service quality of
hospital
60
Demographic
characteristics
Gender
Age
Group
Income Level
Occupation
Between Groups
Within Groups
Total
Between Groups
Within Groups
1.117
65.057
66.174
13.726
544.780
Mean
F
Sig.
Square
6
0.186 0.738 0.619
258 0.252
264
6
2.288 1.083 0.373
258 2.112
Total
558.506
264
Between Groups
Within Groups
Total
Between Groups
Within Groups
Total
8.293
289.504
297.796
121.678
2827.318
2948.996
6
1.382
258 1.122
264
6 20.280
258 10.959
264
Sum of Squares
df
1.232 0.290
1.851 0.090
Table 4.6.2 One way ANOVA test for profile of hospital on overall SQ
The table 4.6.2 shows that the overall Fs for demographic profile of hospital on
Overall SQ which are significance or not by using the ANOVA. From the demographics
profile of customers, Age group, Income Level and Occupation of customers differ
significantly where F ratio is used to determine size of the mean differences for each
individual independent variables comparison, The test between groups shows that F ratio
for occupation and level of income are statistically significant (p<0.05) level. Hence it is
concluded that there is a significant difference among age group, level of income and
occupation profile of customers based on overall service quality in hospital.
4.7. Service Gap Analysis
4.7.1 Service Gap Analysis for Hospitals in Tamilnadu
Tamilnadu
Reliability
Dimensions/Districts
Service gap
score
Important
Weights
Weighted score
VIR
MDU
KNY
KAN
CHN
-0.68
-1.06
-1.01
-0.96
-1.83
0.19
0.21
0.21
0.21
0.21
-0.13
-0.22
-0.21
-0.20
-0.38
61
Assurance
Tangibility
Empathy
Responsiveness
Total
Service gap
score
Important
Weights
Weighted score
-2.31
-2.87
-2.94
-2.5
-2.7
0.19
0.18
0.16
0.19
0.19
-0.44
-0.52
-0.47
-0.48
-0.51
Service gap
score
Important
Weights
-0.86
-1.38
-0.98
-1.15
-1.65
0.24
0.23
0.24
0.24
0.24
Weighted score
-0.21
-0.32
-0.24
-0.27
-0.4
Service gap
score
Important
Weights
Weighted score
-1.78
-2.9
-2.18
-2.26
-2.89
0.19
0.17
0.19
0.18
0.18
-0.33
-0.49
-0.41
-0.40
-0.52
Service gap
score
Important
Weights
-0.81
-1.7
-1.37
-1.43
-1.85
0.18
0.21
0.20
0.18
0.18
Weighted score
-0.14
-0.35
-0.27
-0.25
-0.33
Service gap
score
Important
Weights
-1.25
-1.98
-1.69
-1.66
-2.18
1.00
1.00
1.00
1.00
1.00
Weighted score
-0.24
-0.38
-0.31
-0.32
-0.43
Rank
Table 4.7.1 Service Gap Analysis summary table for Tamilnadu

From the table 4.7.1, show that the gap analysis of both public and private
hospitals in Tamil Nadu, the lowest service gap is occurred in Reliability and
Responsiveness dimension and little bigger service gap in occurred in the Assurance
dimension.
4.7.2 Service Gap Analysis for Tamilnadu Districts both public and Private
Hospitals.
62
Total
Responsiveness
Empathy
Tangibility
Assurance
Reliability
Dimensions/
Districts
Virudhunagar
Madurai
Kanyakumari Kancheepuram
Chennai
Pvt
Pub
Pvt
Pub
Pvt
Pub
Pvt
Pub
Pvt
Pub
Service gap
score
Important
Weights
Weighted
score
-0.94
-0.45
-1.37
-0.63
-1.92
-2.03
-0.36
-2.11
-1.37
-2.54
0.21
0.19
0.21
0.20
0.21
0.21
0.21
0.21
0.21
0.22
-0.20
-0.09
-0.29
-0.13
-0.40
-0.43
-0.08
-0.44
-0.29
-0.56
Service gap
score
Important
Weights
Weighted
score
-2.6
-1.7
-3.13
-2.52
-5.08
-5.91
-2.00
-5.52
-2.17
-3.51
0.19
0.20
0.19
0.20
0.17
0.15
0.20
0.19
0.20
0.19
-0.49
-0.34
-0.59
-0.50
-0.86
-0.89
-0.4
-1.05
-0.43
-0.67
Service gap
score
Important
Weights
Weighted
score
-1.21
-0.57
-1.79
-0.71
-1.85
-1.93
-0.38
-2.55
-1.01
-2.61
0.23
0.24
0.23
0.22
0.25
0.22
0.24
0.25
0.24
0.25
-0.27
-0.13
-0.41
-0.15
-0.46
-0.42
-0.09
-0.68
-0.24
-0.65
Service gap
score
Important
Weights
Weighted
score
-2.38
-1.26
-3.28
-2.36
-4.13
-4.42
-1.68
-5.00
-2.33
-3.74
0.19
0.19
0.19
0.19
0.18
0.20
0.18
0.17
0.18
0.17
-0.45
-0.23
-0.62
-0.44
-0.74
-0.88
-0.30
-0.85
-0.41
-0.63
Service gap
score
Important
Weights
Weighted
score
-1.43
-0.27
-2.03
-1.25
-2.61
-2.79
-0.81
-3.14
-1.36
-2.58
0.18
0.18
0.18
0.19
0.19
0.22
0.17
0.18
0.18
0.17
-0.25
-0.04
-0.36
-0.23
-0.49
-0.61
-0.13
-0.56
-0.24
-0.43
Service gap
score
Important
Weights
Weighted
score
-1.71
-0.85
-2.32
-1.49
-3.11
-3.41
-1.04
-3.66
-1.6
-2.99
1.00
1.00
1.00
1.00
1.00
1.00
1.00
1.00
1.00
1.00
-0.33
-0.16
-0.45
-0.29
-0.59
-0.64
-0.2
-0.71
-0.32
-0.58
Table 4.7.2 Service Gap Analysis for Tamilnadu Districts
63
From the above table 4.40 it is vivid that Madurai District in Tamil Nadu and
Virudhunagar District has less Service Gap when compared to all other Districts in Tamil
Nadu.
5.1. Findings
By applying descriptive statistics, determined the demographic profile of 375

samples, the majority of respondents 54.4% are currently taking treatments in
private hospital and the remaining 45.6% of them in public hospital. So it
indicates that private hospital owning the highest preference among the
respondents.
The majority of respondents 27.2% belongs to the age group of 30 to 39, and
23.5% respondents belong to the age group of 19 to 29; the remaining percentage
of the respondents belongs to the age group of others.
From the total number of samples, 22.9 % of patients are taking treatment for
other diseases in hospital, 12.5% of patients are taking treatment for fever and
general checkup, 11.3% of patients are taking treatment for Eye in hospital, and
64
remaining patients are taking treatment like Orthology, Cardiologist and

neurology.
By applying the chi-square statistics, there is a significance difference between the

occupations and the age wise classifications of the patients; there is a significance
difference between the income and the age wise of the patients in Tamilnadu.
By applying the chi-square statistics, there is no significance difference between

the ownership of the hospital and the age wise of the patients in Tamilnadu.
By applying the chi-square statistics, there is a significance difference between the

average times spent by doctor in examine patient and age wise patients
classifications, there is a significance difference between the patient treatments
and the Gender wise classifications of the patients in Tamilnadu.
By applying the regression analysis, the orders of significance for predictor

dimensions of Overall Satisfaction of Hospital are reliability and responsiveness
0.073*Tangibility+ 0.086*Reliability+ 0.389*Responsiveness + 0.253*Assurance
+ -0.045*Empathy.
By analyzing the regression analysis, the orders of significance for predictor

dimensions of Overall Service Quality of Hospital are reliability and
responsiveness. The predicted value (regression equation) is Y1 predicted
(Hospital) = 1.291+ 0.157*Tangibility+ 0.035*Reliability+ 0.402*Responsiveness
+ 0.258*Assurance + -0.052*Empathy.
By applying the weighted average method, the respondents giving preference to

Referred doctor as the rank one with a weighted mean of 73.38, following closely
in second rank is Tariff charge having a weighted mean of 69.38. Rest of them
Location and Brand name holds least rank by the respondents in Tamilnadu.
By applying the paired sample t test, the service gap between expectation and
perception dimension ratings of service quality in hospitals in Tamilnadu.
By applying the one way ANOVA test, there is an association difference between
gender, and income level of the patients based on overall satisfaction in Hospitals
and there is a no association difference between age and income level of patients
based on overall Satisfaction in Tamilnadu Hospitals.
65
By applying the one way ANOVA test, there is an association difference between
gender, age, occupation and income level of the patients based on overall Service
Quality of the Hospitals in Tamilnadu.
By applying the gap analysis for the hospitals in Tamil Nadu, it shows that lowest
service gap is occurred in Reliability and Responsiveness dimension and little
bigger service gap in occurred in the Assurance dimension.
By applying the gap analysis for the hospitals in Tamil Nadu, it vivid that Madurai
District in Tamil Nadu and Virudhunagar District has less Service Gap when
compared to all other Districts in Tamil Nadu.
5.2. Suggestions
It is suggested to improve the patients satisfaction level thro providing more

amenities to the patients then only the more number of patients are preferred to
select Tamilnadu hospitals.
The public Hospitals may be allowed (funded) by the State Govt. to set-up
additional infrastructure to cope with the rush generated by their populist measure
and implement other facilities. So that the patients who are beneficiary of systems
like GHS are not inconvenienced.
66
The Government hospitals want to improve the various factors that can affect the
patients satisfaction like behavior of doctors and the availability of specialized
doctors.
5.3. Conclusion
This Research project would explain differences in the perceived quality of
services provided by public and private hospitals. This contention was reasonably
supported: private hospitals were evaluated better on responsiveness, communication, and
discipline. By responding to these needs, hospitals in Tamilnadu districts can improve
their image and be perceived more favorably. Private hospitals are playing a meaningful
role in Tamilnadu districts, by justifying their existence, continuous and growth.
These results also suggest that service quality can be improved in the health care
sector by gradually exposing the hospitals to market incentives.
67
Bibliography
1. Parasuraman A, Zeithaml VA, Berry LL. 1985. A conceptual model of service
quality and its implications for future research.
2. Parasuraman A, Zeithaml VA, Berry LL. 1988. SERVQUAL: A multiple-item
scale for measuring customer perceptions of service quality.
3. Parasuraman A, Berry LL, Zeithaml VA. 1991. Refinement and reassessment of
the SERVQUAL scale.
4. Aurora S and Malhotra M (1997) Customer satisfaction: A comparative analysis
of the satisfaction level of customer of public and private sector banks.
68
5. Anderson E W, Fornell C and Mazvancheryl S K (2004) Customer satisfaction

and shareholder value.
6. Boulding W, Kalra A, and Staelin R and Zeithmal VA (1993) A dynamic process
model of service quality: from expectations to behavioral intentions.
7. David K and Wilton P C (1988) Models of consumer satisfaction formation: An
extension.
8. Dholakia A M and Morwitz G (2002) The scope and persistence of meremeasurement effects: Evidence from a field study of consumer satisfaction Folkes
V S and Patrick V M (2003) The postivity effect in perceptions of services.
69

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1.

A customers decision to be loyal or to defect is the sum of many small encounters

equipment, appearance of employees and other customers.

Lifeline Multi Specialty Hospital, Chennai www.lifeline-hospital.com

Spot Hospital, Chennai www.spothospital.com

Cholayil Sanjeevanam, Chennai www.cholayilsanjeevanam.com

Rajan Eye Care Hospital, Chennai http://lasikpavilion.com

Prasanth Multispeciality Hospital, Chennai www.pfrcivf.com

Some of Tamilnadu most reputed Health care facilities:

Apollo Hospital, Chennai

Sri Ramachandra Medical Centre (SRMC), Chennai

Madras Medical Mission, Chennai

M.V. Diabetes Speciality Centre (MVDSC), Chennai

MIOT Hospitals, Chennai

Sankara Nethralaya, Chennai

Frontier Lifeline, Chennai

Dr. Aggarwals Eye Hospital, Chennai

Vijaya Hospital, Chennai

Dr. Mehtas Hospital, Chennai

Solace Meditour Private Limited

Ayush Therapy Centre

K.G. Hospital, Coimbatore

Kovai Medical Centre and Hospital, Coimbatore

Ganga Hospital, Coimbatore

PSG Hospitals, Coimbatore

Gandhiji Nature Cure Centre, Elagiri & Chennai

Source: Tamil Nadu Tourism News letter.

Rest/ Guest Houses

Public Utility Services

B. The Foreign Customer Concerns and Expectations:

Staff ( trained technically as well as in soft skills)

International standard certification

Para Medical Ambulance facilities (to and fro from Airport).

C. The Image of India needs to be enhanced (Standardization)

The major ways of promoting our health tourism could be:

Tour operators and Travel agencies of India

Doctors of India visiting foreign countries- Pre/Post treatment.

International websites on Indian tourism with True Perceptions.

Globalization of marketing activities by Indian Tour & Travel Agents

Tying up with foreign Travel Agents for promotion

Insurance companies abroad who target customers

E. Excess Glamourisation of Health Care

2.1 Need of the Study

To determine the patient profile in Tamilnadu districts.

2. To identify the perception and expectation level of the hospital service.

To identify the relative importance of service quality weights preferred by

4. To determine the overall satisfaction of the patients towards hospitals in

2.3 SCOPE OF THE STUDY

2.4 Review of Literature

protocols, implementation, institutionalization, change, diffusion of innovation, and

Three of the 20 services had relaunched their quality programmes two

There were some changes in personnels understanding of quality methods

Investment in the TQM quality programme was between 5% and 10% of

Little training was done in basic quality awareness, quality methods or

Most programme had dwindled due to personnel turnover, restructuring,

Reinartz et al (2004) in their study of Customer Relationship Management Process

Patients expectations from the behaviour of the doctors,

Patients expectations from the behaviour of the medical assistants,

Patients expectations from the quality of administration of hospitals,

Patients expectations from the services provided by the hospitals,

Patients perceptions for the behaviour of the doctors,

Patients perceptions for the behaviour of the medical assistants,

Patients perceptions for the quality of administration of hospitals,

Patients perceptions for the services provided by the hospitals,