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We would like your impressions of Debre Berhan Hospital’s service performance

relative to your service expectations. Please consider the following areas as you
think about the qualities listed in the survey below: Based on your experiences as
a consumer of health care services, please think about the kind of hospital
that would deliver excellent quality service. In the second column below,
please show the extent to which you think such a hospital would possess the
factor described in the first column. If you feel the factor is not at all
important for hospital in general, circle 1. If you feel a factor is very important for
hospital in general, circle 5. Circle a number in between if you feel less strongly
about that factor.
Quality Questions Expectation1-Strongly Perception 1-Strongly Agree
Dimension Agree 5-Strongly Disagree
5-Strongly Disagree
Tangibles 1. The hospital has modern 1 2 3 4 5 1 2 3 4 5
looking
Equipments.
2. The physical facilities in 1 2 3 4 5 1 2 3 4 5
the Hospital are
visually appealing
3. Personnel in the hospital 1 2 3 4 5 1 2 3 4 5
are neat in
appearance
4. Materials associated with 1 2 3 4 5 1 2 3 4 5
the service (such
as pamphlets or statement)
are visually
appealing
Reliability 5. The hospital Keeps it 1 2 3 4 5 1 2 3 4 5
promises in time
6. When you have a 1 2 3 4 5 1 2 3 4 5
problem, the hospital
shows sincere interest in
solving it
7. The hospital get things 1 2 3 4 5 1 2 3 4 5
right the first time
8. The hospital provides it’s 1 2 3 4 5 1 2 3 4 5
services at the
time it promises to do so’
9. It insists on error-free 1 2 3 4 5 1 2 3 4 5
record
Responsiveness 10. The personnel in the 1 2 3 4 5 1 2 3 4 5
hospital inform
you exactly when the
services will be
performed
11. Personnel give you promt 1 2 3 4 5 1 2 3 4 5
services
12. Personnel in the 1 2 3 4 5 1 2 3 4 5
hosptal are willing
to help you
13. Personnel are never too 1 2 3 4 5 1 2 3 4 5
busy to
response to your need
Assurance 14. The behavior of the 1 2 3 4 5 1 2 3 4 5
personnel instils
confidence in you
15. You feel safe in your 1 2 3 4 5 1 2 3 4 5
dealings with
the hospital
16. Personnel in the 1 2 3 4 5 1 2 3 4 5
hospital are
consistently courteous to you
17. Personnel in the 1 2 3 4 5 1 2 3 4 5
hospital are
knowledgeable enough to
answer your
questions

Empathy 18. The hospital gives you 1 2 3 4 5 1 2 3 4 5


individual
attention
19. The hospital has 1 2 3 4 5 1 2 3 4 5
operating hours
convenient to all it’s patients
20. The personnel in the 1 2 3 4 5 1 2 3 4 5
hospital give
you individual attention
21. The hospital has your
best interest
at heart 1 2 3 4 5 1 2 3 4 5
22. The personnel in the
hospital
understand your specific 1 2 3 4 5 1 2 3 4 5
needs

Listed below are five features pertaining to hospitals/clinics and the service they offer.
We would like to know how important each of these features is to you when you evaluate
the service offered by a hospital or clinic. Please allocate a total of 100 points among the
five features according to how important each feature is to you - the more important a
feature is to you, the more points you should allocate to it. Please ensure that the points
you allocate to the five features add up to 100.
1. The appearance of the hospital/clinic’s physical facilities,
equipment, personnel and communication materials. _____ points
2. The hospitals/clinic's ability to perform the promised service
dependably and accurately. _____ points
3. The hospital/clinic's willingness to help patients and provide
a prompt service. _____points
4. The knowledge and courtesy of the hospital/clinic personnel
and their ability to convey trust and confidence. _____ points
5. The caring, individualised attention the hospital/clinic
provides its patients. _____ points
TOTAL points allocated 100 points
________________________________________________________________________
____
Which one feature of the above five is most important to you ? __________
(Please enter the feature's number)
Which feature is second most important to you ? __________
Which feature is least important to you ? ___________