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Service quality and customer loyalty in Rajashekar hospital using GAP model and SERQUAL approach
By, Swetha M 3rd Semester MBA Reg No :10VWCMA061
In the current socioeconomic context, the service sector has become increasingly more important, revealing the need to know and study the particularities of its operations and to institute specific management methodologies that fit its context and specificity. But it is necessary to understand that service processes are different from manufacturing processes, especially due to their intangible nature and the direct participation of clients. Aiming to make clients loyal, companies have made every effort to meet their needs and exceed their expectations. The SERVQUAL scale is one of the tools that can help in this sense. According to Oliver, SERVQUAL is the method that assesses client satisfaction as a result of the difference between expectation and the performance obtained. According to Zeithaml, Parasuraman and Berry, SERVQUAL is universal and can be applied to any service organization to assess the quality of services provided.
With in-creasing awareness among consumers about their rights, the patient, as a consumer of health services, expect and demand quality health care. The health care customer is changing qualitatively. The rising literacy rate, higher levels of income and increasing awareness through deeper penetration of the media, has brought the Indian consumer closer to demand quality health care. All these factors have not only contributed to the growth of health care sector in India but also for quality health care services. In the light of these developments, health care providers need to have a closer look at the perception of their patients and try to provide quality medical and health services to meet their expectations. It is the professional excellence, personaltouch-in-service, humanitarian approach and ethical values of the employees that play a significant role in the satisfaction of patients. The study of service quality perceptions from the patient viewpoint provides a basic feedback to the hospitals in the light of their patient-oriented and patient-centric efforts in attracting and satisfying the patients. In view of the above, an attempt is made in the study to examine how well the Rajashekar hospital in Bangalore is meeting the customers’ expectations on the service quality dimensions.
2. 2.1. that is. Quality Management and SERVQUAL. According to Meirelles a service is essentially intangible and only assessed when combined with other functions. which à priori cannot be touched. or roughly 6% of GDP. India’s healthcare sector is projected to grow to nearly $40 billion. with other tangible productive processes and products.2 Healthcare service Healthcare is one of India’s largest sectors. that is. Today the total value of the sector is more than $34 billion. "in service management it is important to understand how clients assess the quality of the service provided. During the 1990s. services are economic activities that create value and provide benefits to the client at specific times and in specific places as a result of a desired change in. Indian healthcare grew at a compound annual rate of 16%. This translates to $34 per capita. The private sector accounts for more than 80% of total healthcare spending in India. or on behalf of. By 2012. According to Coelho. In other words. the one that receives the service. which currently stands at roughly 9%. Production occurs starting the moment the service is ordered and it finishes as soon as the demand is met. LITERATURE REVIEW A brief theoretical review will be presented below about Service Management.2. client participation and simultaneous production and consumption. the providing of a service tends to occur simultaneously with consumption. in terms of revenue and employment. how quality is perceived by the client". and the sector is expanding rapidly. This intangible nature is associated with this process. Service Management According to Lovelock. the opportunity for significantly higher public health spending will be 3 . Unless there is a decline in the combined federal and state government deficit. Gianesi and Corrêa say the following special characteristics of service operations are the main ones: intangibility. Services have some specific characteristics that differentiate them from the manufactured goods.
it is expected that the private sector will continue to take on an increasing role in India’s healthcare system. services or manufacturing and public or private. acceptability. Despite a high annual output of medical specialist graduates. Quality in services can be defined as a customer satisfaction index for any service. i. explain the growing role of the private sector in addressing India’s healthcare needs. Responsibility and trust. eastern or western. Despite the size and reach of the public healthcare system. specialist care for the middle. and this satisfaction can be measured by any criteria.3. Quality in services provides a competitive factor for continued consumption. primary healthcare institutions. in face of the subjectivity and complexity of its meaning. large or small. especially when intangibility relations are tightened between quality and the services. and higher salaries/incentives (mostly a result of increased demand from the growing middle-class). Recently. availability. The quality and availability of specialist medical care varies greatly among the different socio economic groups and by geography. rural. and efficiency of healthcare services. better private hospital infrastructures and equipment. Quality Management Quality management is a broad theme that encompasses every sort of organization. however.e.‖ or the phenomena of highly educated Indians immigrating to western countries. According to Oliveira its concept depends on the context in which it is applied. in part. Quality is 4 . India scores poorly on most generally accepted health indicators. small hospitals providing specialist services. medical colleges. multinational or national. While different states in India have had different levels of success with implementation of such initiatives. generated by prior experience.limited. 2. paramedic training schools. Public-private partnerships have also emerged as one viable method of growing the healthcare sector while keeping public goals in mind. large hospitals providing tertiary care. This may. The public healthcare delivery system consists of a large number and a variety of institutions—dispensaries. Zeithaml and Berry (1985). laboratories. urban vs. and are important factors for determining perceived quality by clients. however. Bateson says ―quality is generally considered an attribute in consumer choices‖. The main objectives of public-private partnerships are to improve quality. etc.and upper-classes has improved due to more private hospitals. accessibility. specialist medical care has traditionally been very poor in India due to ―brain drain. two of the dimensions of service quality grouped by Parasuraman.
that is. regardless of the type of service. courtesy and precision. that is. These dimensions are briefly commented below (BATESON and HOFFMAN. and there is no way to change client perception regarding the service received. 2. in the mid and long term. quality is only measured at the end of the process. security and empathy. According to Grönroos perceived quality is determined "by the gap between expected quality and experienced quality". . SERVQUAL According to Parasuraman.Responsibility: are company employees helpful and capable of providing fast service? It is responsible for measuring company and employee receptiveness towards clients. responsibility. Zeithaml and Berry. even those that are not explicit or are unconscious. Managing gaps in service will help the company improve its quality. clients often trust the tangible evidence that surrounds it when making their assessment. it is the difference between client perceptions and expectations. However. But gaps are not the only means clients use to judge a service. consumers basically use the same criteria to assess quality. tangibility. They can also use five broad-based dimensions as judgment criteria: reliability. Reliability is the most important dimension for the consumer of services.4. equipment.Tangibility: how are the service provider’s physical installations.judged according to perceived satisfaction. educated. . and 5 . . competent and trustworthy? This dimension encompasses the company’s competence.Reliability: is the company reliable in providing the service? Does it provide as promised? Reliability reflects a company’s consistency and certainty in terms of performance. which is constituted by a series of successful or unsuccessful experiences. when the service has been concluded. LOVELOCK): . According to the same author. people and communication material? Since there is no physical element to be assessed in services. Service quality is a general opinion the client forms regarding its delivery.Security: are employees well-informed. it is important to develop competences to achieve their real needs. Satisfying the clients’ immediate and explicit expectations should be sought in the short term.
It is difficult to measure the quality of service operations because they have the characteristic intangibility. These differences between perceptions and expectations are addressed in the quality in service model shown in Figure 1. In reality.. Parasuraman. according to Kilbourne . Does the service company provide careful and personalized attention? These elements clearly have a highly subjective factor linked to the person who perceives the service. which will depend on environment characteristics or type of activity.Empathy: this is the capacity a person has to experience another’s feelings. This model seeks to help managers understand the sources of problems in quality and how they can improve them. Zeithaml and Berry developed a methodology in which there is a comparison between several orders of expectations and perceptions of service quality by the consumer. Aimed at solving this problem. 6 . every type of service can have determining factors that are considered more important than others.
GAP 1: Not knowing what customers expect: Lack of marketing research orientation Inadequate upward communication Too many levels of management 7 . The model’s five gaps and factors affecting it are Key factors contributing to the gaps.Figure 1: Quality in services model SERVQUAL is an instrument to measure quality that stems from this model and works with the difference in scores (gaps) in the form of a questionnaire.
GAP 2: The wrong service quality standards: Inadequate management commitment to service quality Perception of infeasibility Inadequate task standardization Absence of goal setting GAP 3: Service performance gap: Employee role ambiguity Employee role conflict Poor Employee job fit Poor Technology job fit Inappropriate evaluation and reward systems Lack of empowered service employees Lack of teamwork GAP 4: When promises do not match delivery: Inadequate horizontal communication Tendency to overpromise GAP 5: customer satisfaction: Depends on gap 1-4 The greater the gap the lower the customer satisfaction. because expectation and perception do not match. 8 .
Although this research is highly accurate.4 Source of Data Data is collected through both. (iii) Sampling size . it does not gather the causes behind a situation. Descriptive research is mainly done when a researcher wants to gain a better understanding of a topic.3 TYPE OF STUDY It is a descriptive research to understand Service quality and customer loyalty in Rajashekar hospital. articles and journals. Primary Sources: The data for the study was collected with the help of a questionnaire with a sample size of 15. 3.6 Sampling Plan (i) (ii) Sampling unit – patients in Rajashekar hospital. Sampling method – The sampling method used for the study is Non probability convenience sampling.2 Objective of the Study To understand the service quality provided at Rajashekar hospital. 3. Secondary sources: official websites. To know the customer loyalty.RESEARCH METHODOLOGY 3. The main goal of this type of research is to describe the data and characteristics about what is being studied.5 Tools for Data Collection 3. In order to collect information questionnaire will be used. 3.1 Research Title Service quality and customer loyalty in Rajashekar hospital using GAP model and SERQUAL approach 3.15 9 .
3. though maximum effort would be made to see that all relevant data are included. 10 . there could be a possibility that some data can get over looked. Time being a limitation. being reviewed before using them for further studies. hence the findings may require.8 Limitations of the Study The data required to be collected would be based on the opinions of the patients which are liable to change with time.
11 . Service quality and GAP Model of Healthcare 4. Food should have right temperature.4. Bathroom should be very clean. Parking should be convenient. Tangibility Empathy Assurance SERQUAL Dimensions Courtesy Responsiveness Reliability Fig 2: SERQUAL dimensions Tangibility: They should have up to date equipment& technology. Room should be quiet. Meals should be attractive. Nurses should respect privacy. Their physical facilities should be visually appealing. Room should be clean.1 Service Quality in Rajashekar Hospital The following aspects were examined under the SERQUAL dimensions.
Employees of the hospital should always be willing to help their patients. Employee of the hospital should address customers' questions appropriately about any procedure. they should do it. Patients should expect prompt services from nurses when the patient needs to them. Employee of the hospital should address customers' questions appropriately about the discharging process. Patients who come to hospital should expect prompt service from employees of the hospital for the admission operation. They should keep patients' records accurately. Patients who will be discharged should expect prompt service from employees of the hospital for the discharging operations. Treatment should be explained to the patient very clearly. When staff of the institutions promises to do something by a certain time.Assurance: Food should be delivered by a certain time. Discharge should be explained to the patients' family. 12 . Hospital charges should be accurate Responsiveness: They should be expected to tell their customer exactly when services will be performed.
Patient should be positive that they have recovered well before they are discharged.Reliability: Customer should be able to trust nurses of the hospital. Visitors should be treated well. Nurses' behavior should be very polite to customers. Patients should expect nurses to give them their personal attention. Courtesy: Employees should be polite during admissions procedure. Nurses should be cheerful. Patient should be able to trust billing. Patients should be able to feel safe in their transactions with these institutions' employees. 13 . Employees should be polite during housekeeping process. Empathy: Patients should expect employees to know what they need from them. Patients should be able to feel safe that nurses are knowledgeable.
2 GAP model of service quality in health care Expected service Patients Perceived service Hospital Service Delivery Gap 4 Gap 3 Patient driven service design and standards Gap 2 Hospital perceptions on patient’s expectations External communication to customers Gap 1 Fig 3: GAP model of service quality in health care Above Fig 3 Conveys a clear message that the key to closing the Patient gap is to close gaps 1 through 4. perceive service quality shortfalls. 14 .4. Provider (Hospital) gap 1: Not Knowing what the patients expects Provider gap 2: Not selecting the right service designs and standards Provider gap 3: Not delivering to service standards Provider gap 4: Not matching performance to promises Customer (Patient) gap 5: Not Knowing what the Hospital delivers The basic Objective of the hospital is to develop the strategies in such a way that it can influence the patient’s expectations and perceptions so that all the four gaps that take place due to differences in expectations and perceptions can be filled up.To the extent that one or more of gaps 1 through 4 exist.
Failure to connect services offered to patients Gap-3: Patients-driven service designs minus service delivery Causes for Gap 3: Ineffective staff to provide good service Failure to match supply and demand Failure to smooth peaks and valley of demand Over reliance on government funds Gap-4: Service delivery minus external communications to Patients Causes for Gap 4: Ineffective management of patient’s expectations. Tourists Gap -5: patient’s expectations of service minus Patient’s perceptions of service Causes for Gap 5: The central focus of the gaps model is the Patient gap. Causes for Gap 1: Lack of interaction between the patient and doctor Unwillingness to ask patients about expectations Unpreparedness to address the expectations Gap-2: Inability to set the right type of standards Causes for Gap 2: Lack of patient driven service standards Absence of Process (delivery of services) management to focus on patients requirements Absence of formal system for setting service quality Inadequate administration commitment towards the services No systematic process for the development of new services to be offered. Expectations are the reference points patients have coming in to a service experience. Over or under promising about the quality of service Inadequate horizontal communications. the difference between patient expectations and perceptions. Perceptions reflect the service as actually received.Let us diagnose the specific causes for each of the gaps as shown in the fig 1 Gap-1: Services expected by Patients minus hospital perception of patients expectations. 15 .
84% of them agree that physicians attend the patients during their first visit within 15 minutes without any delay and only few of them i.5.e.. Data Analysis and Interpretation Source: Primary data (filled questionnaire) response time of attending physician in emergency visit 0% 12% 4% 15 minutes 30 minutes 1 hour 84% more than 1 houe Fig 5.e. 12% of them say that the physicians provide service lately and only 4% of them say that there is huge delay in providing service 16 .1: Training as part of organization strategy Interpretation: from the above chart it is clear that majority of the patients in rajshekar hospital i.
Only of about 5% rate it as excellent where these patients are financially stable and service provider’s value for money.e.Source: Primary data (filled questionnaire) SalesQuality of services 5% 35% 24% excellent good Average Poor 36% Fig 5.36% of them agree to average extent that service offered are not that good and 35% of them had rate the service quality as poor as they sure dissatisfied with service provided to them . Therefore we can interpret that the service quality is not god in the hospital.2: how you rate Quality of services? Interpretation: from the above chart it is clear that majority of the patients in rajshekar hospital i. 17 .
Source: Primary data (filled questionnaire) hygiene control measures 12% 32% Excellent good average 56% poor Fig 5.3: how you rate hygiene control measure in hospital? Interpretation: from the above chart it is clear that majority of the patients in rajshekar hospital agree to a great extent that overall hygiene control measures in hospital in good and are satisfied with it . 18 .
4: condition of Medical instruments used for diagnosis Interpretation: from the above chart it is clear that half of the patients believe that instruments used might be old and rest of others don’t know about it and only 5% of them say instruments used are latest .Source: Primary data (filled questionnaire) Medical instruments used for diagnosis 5% 47% Latest 48% old outdated don’t no 0% Fig 5. 19 .
20 .5: Dealing with hospital Interpretation: from the above chart it is clear that half of the 10 patients believe that they feel safe in dealing with hospital and rest disagrees to that.Source: Primary data (filled questionnaire) safe in dealing with hospital 5 yes No 10 Fig 5.
Source: Primary data (filled questionnaire) 10 9 8 7 6 5 4 3 2 1 0 yes no Fig 5.6: whether hospital gives individual attention Interpretation: from the above chart it is clear that half of the 10 patients believe that they get individual attention and rest disagree to that. 21 .
7: whether hospital give prompt service Interpretation: from the above chart it is clear that half of the 15 patients believe that they won’t get prompt service and rest disagree to that. 22 .Source: Primary data (filled questionnaire) hospitl gives prompt service 5 yes no 15 Fig 5.
8: whether personnel in hospital understand specific need Interpretation: from the above chart it is clear that half of the 15 patients believe that personnel on hospital don’t understand their specific needs and rest disagree to that.Source: Primary data (filled questionnaire) personnel understan ds specific need 5 yes no 15 Fig 5. Findings In the hospital there is gap between the patient’s expectations and the hospital perception about patient’s expectations 23 .
M. As part of the curriculum.Annexure Questionnaire (employee) I. What was the response time of attending physician on your first visit in the OPD/emergency of the hospital? 15 minutes 30 minutes 1 hour More than 1 hour [ ] [ ] [ ] [ 2. I ensure that the data will be kept confidential and used only for academic purpose (Please indicate your choice by putting a tick mark in the appropriate boxes) 1. am a student of alliance business academy. How was the overall hygiene or infection control measure in hospital? Excellent Good Average Poor [ ] [ ] [ ] [ ] 24 . I am doing a survey on the “effectiveness of training in Perry Johnson Outsourcing” with regard to this. Swetha. I request you to kindly fill in the questionnaire. How do rate the quality of service in terms of paramedical staff Excellent Good Average Poor [ ] [ ] [ ] [ ] 3.
The hospital gives you individual attention Yes No [ ] [ ] [ ] [ ] 7. Do the personnel in the hospital give you prompt service Yes NO [ ] [ ] 8. The personnel of the hospital understands your specific needs Yes No [ ] [ ] 25 . How was the condition of equipment/medical instrument used for diagnosis? Latest Old Outdated Don’t know Disagree [ ] [ ] [ ] [ ] [ ] 5. You feel safe in your dealing with hospital Yes No 6.4.
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