International Journal of Health Care Quality Assurance

Customer perceived service quality, satisfaction and loyalty in Indian private

healthcare
Rama Koteswara Rao Kondasani Rajeev Kumar Panda
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Assurance, Vol. 28 Iss 5 pp. 452 - 467
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IJHCQA
28,5
452
Received 19 January 2015
Revised 4 February 2015
Accepted 11 March 2015
Downloaded by National Institute of Technology Rourkela At 21:29 01 July 2015 (PT)
International Journal of Health
Care Quality Assurance
Vol. 28 No. 5, 2015
pp. 452-467
© Emerald Group Publishing Limited
0952-6862
DOI 10.1108/IJHCQA-01-2015-0008
The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/0952-6862.htm
Customer perceived service
quality, satisfaction and loyalty
in Indian private healthcare
Rama Koteswara Rao Kondasani and Rajeev Kumar Panda
School of Management, National Institute of Technology,
Rourkela, Rourkela, India
Abstract
Purpose – The purpose of this paper is to analyse how perceived service quality and customer
satisfaction lead to loyalty towards healthcare service providers.
Design/methodology/approach – In total, 475 hospital patients participated in a questionnaire
survey in five Indian private hospitals. Descriptive statistics, factor analysis, regression and
correlation statistics were employed to analyse customer perceived service quality and how it leads to
loyalty towards service providers.
Finding – Results indicate that the service seeker-service provider relationship, quality of facilities
and the interaction with supporting staff have a positive effect on customer perception.
Practical implications – Findings help healthcare managers to formulate effective strategies to
ensure a better quality of services to the customers. This study helps healthcare managers to build
customer loyalty towards healthcare services, thereby attracting and gaining more customers.
Originality/value – This paper will help healthcare managers and service providers to analyse
customer perceptions and their loyalty towards Indian private healthcare services.
Keywords Customer satisfaction, Loyalty, Perceived service quality, Private healthcare service quality
Paper type Research paper
Introduction
Health and healthcare need to be distinguished from each other for no better reason than
that the former is often incorrectly seen as a direct function of the latter (Srinivisan, 2010).
Healthcare systems are complex; i.e., customer care, quality, insurance, healthcare
providers and legal issues, etc., often interact. Healthcare is one of India’s largest service
sectors, which can be viewed as a glass half empty or half full. The Indian healthcare
sector’s positive point is low-cost medical treatment. The challenges the sector faces are
substantial: the need to improve physical infrastructure, poor awareness about health
insurance and insufficient trained medical personnel. Under the Indian Constitution,
health is a state subject. Each state, therefore, has its own healthcare delivery system in
which both public and private (profit and non-profit) staff operate. The 12th five-year
plan (2012-2017) aims to increase public health investment in healthcare infrastructure,
services and human resources from 1.1 per cent in the 11th five-year plan (2007-2012) to
2-3 per cent of gross domestic product (GDP). The Indian healthcare sector is divided into
three categories: public; private and solely operated. The sector is large and well
established. Ironically, India has one of the largest private health sectors in the world,
with over 80 per cent of ambulatory care and 65 per cent of admissions supported
through out-of-pocket expenses. The services sector, with around 57 per cent
contribution to the GDP, has made rapid strides in the last few years and emerged as the
economy’s largest and fastest-growing sector (Ministry of Finance, 2013-2014). India is
positioning itself as the world’s medical tourism hub; fast becoming a main choice for
healthcare tourists, but is behind established medical tourism locations such as Malaysia,
 Singapore and Thailand. Many Indian private hospitals now offer several medical Customer
services that have special arrangements for foreign customers. The Indian healthcare perceived
industry, growing at a CAGR of 15 per cent is expected to reach US $250 billion by 2020
(PriceWaterhouseCoopers, 2012).
service quality
Service quality has become an important topic in relationship to profit, cost saving
and market share (Devlin and Dong, 1994). Health and economic development are so
closely related that it is impossible to achieve one without the other. While the economic 453
development in India has gained momentum over the past few decades, its health
system is at a cross-road (Ramani and Dileep, 2006). Research links service quality to
customer satisfaction (Taylor and Baker, 1994) and purchaser intentions (Zeithaml
et al., 1996). Researchers suggest that customer service quality perception is a key
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determinant in the healthcare organisation’s success owing to its primary role in

achieving patient satisfaction and hospital profitability (Donabedian, 1966). Thus, our
main objective is to analyse perceived service quality, customer satisfaction and loyalty
in Indian private hospitals.
In today’s highly competitive healthcare, public and private organisation managers
need to measure their financial and non-financial performance to improve function
and increase their competitiveness. Service quality therefore interests service
marketing researchers. Superior service quality helps differentiate itself from its
competition, gain a sustainable competitive advantage and enhance efficiency. Many
empirical studies have investigated the relationships among service quality,
customer satisfaction and loyalty in many service sectors. Grönroos (1984) defined
service quality as a perceived judgement resulting from an evaluation process where
customers compare their service expectations with what they perceive to have
received. Dabholkar (1995) suggested that service quality and satisfaction
antecedents are situation specific and if a consumer is cognitive oriented then s/he
will perceive the relationship as service quality causing satisfaction, whereas
if a consumer is affective oriented then s/he will perceive the relationship as
satisfaction causing service quality. There is ample evidence that service quality
affects perceived value, customer satisfaction and behaviour intentions including
word-of-mouth, loyalty, personal recommendation and willingness to pay more
(Baker and Crompton, 2000).

Literature review
Premium service quality enables hospital managers to differentiate the hospital and
gain a sustainable competitive advantage and enhance efficiency (Olorunniwo et al.,
2006). Grönroos (1984) defined perceived quality as evaluation process, where the
consumer compares his/her expectations with his/her service perceptions. Eleuch
(2011) showed that health service quality perception is a judgement about whether the
service performed for a patient and was the most appropriate to produce the best result
that could be reasonably expected by the patient. According to O’Connor et al. (1994),
the customer perspective is increasingly being viewed as a meaningful health services
quality indicator that represents the most important perspective. According to Aagja
and Garg (2010) hospital service quality is the discrepancy between customer
perceptions and their expectations about hospitals offering such services. Some studies
on patient perception conducted in developing countries show that customers are able
to assess and evaluate service structure, process and outcome (Haddad et al., 1998;
Andaleeb, 2001; Baltussen et al., 2002). Anbori et al. (2010) and that service quality
improvements were required to achieve high-quality services in the private hospitals to
 IJHCQA increase loyalty among patients. Peer and Mpinganjira (2011) found that service
28,5 quality is an important factor in ensuring patient overall satisfaction and loyalty
towards a private medical practice. Jakobsson and Holmberg (2012), indicate that
physician- and nurse-provided information supplement each other and both should be
targeted to improve service quality. Manimay (2014) suggest that providing effective
training to nurses, doctors and support staff on interpersonal skills and effective
454 communication leads to inpatient satisfaction. There is growing evidence that
perceived service quality is the most important variable that influences customer
perceptions and intention to adopt more services (Zeithaml et al., 1996). According to
(Parasuraman et al., 1991) service quality attributes are not expected to be equally
important across service industries. Including importance weights in the service
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quality measurement scales, therefore, is important.

Healthcare service quality perception

Service quality is generally viewed as an outcome, especially in healthcare. According
to Bitner and Hubbert (1994, p. 77) service quality is “the consumer’s overall impression
of the relative inferiority/superiority of the organization and its services”. Service
quality assessments are not one-dimensional (Choi et al., 2004) and are defined as how
well the service meets or exceeds customer expectations on a consistent basis
(Parasuraman et al., 1985). Service consistency varies between regions and sectors.
Unlike product quality, service quality is hard to define and measure as inter-
relationships between user expectation and the impact on specific features in service
such as intangibility, inseparability, heterogeneity and perishability (Parasuraman
et al., 1985; Zeithaml et al., 2006). The Service Quality Gaps Model and SERVQUAL
scales proposed by Parasuraman et al. (1985, 1988) are widely accepted tools for
measuring service quality (Sohail, 2003; Ladhari, 2008). Hardeep and Madhu (2012)
find that perceived quality and loyalty have positive influence on brand equity in
healthcare sector. In healthcare, the two tools are also popular for assessing service
quality in various categories such as an acute care hospital, independent dental offices,
AIDS service agencies, with physicians and nurses and hospitals (Taner and Antony,
2006). Perceived quality is the consumer’s evaluative judgement regarding superior
service performance (Zeithaml, 2000). Thus, perceptions provide the basic measurement
tool in which individuals evaluate product or service attractiveness and/or desirability.

Loyalty
Our study’s dependent variable was loyalty, which indicates whether a customer will
return or not. Customers frequently develop an attitude towards purchasing based on a
prior service experience. They also undergo a cognitive decision-making process about
whether to stay with or leave a service (Zeithaml, 2000). Oliver (1997) referred to loyalty
as the stated likelihood to engage in a particular behaviour. Loyalty is considered to
include a willingness to recommend, revisit and positive word-of-mouth (WOM)
intentions. Zeithaml et al. (1996) grouped behavioural intentions into favourable:
positive feedback, recommending, remaining loyal and paying more, and unfavourable
loyalty as negative feedback, switching to another organisation, complaining to
external agencies and doing less business with a company. Positive WOM is proven to
be the strongest predictor for shaping future behaviour and attitudes, which includes
oral, person-to-person communication between a receiver and a communicator whom
the receiver perceives as non-commercial, regarding a brand product or service (Buttle,
1998). Willingness to pay more is the customer’s intention to pay a higher price than
 competitors charge for the benefits that the customer currently receives from the Customer
service provider. Zeithaml et al. (1996) use willingness to pay as a behavioural proxy perceived
for value. A customer who has a stronger bond with a specific provider (e.g. loyal
customer) will be willing to pay (WPM) higher prices based on value provided by that
service quality
provider’s products and services (Bigné et al., 2008). Several studies investigated
service quality and satisfaction’s direct effect on loyalty. Findings indicate that service
quality and satisfaction has a direct relationship with WOM and WPM (Ladhari, 2009; 455
Hanzaee and Shojaei, 2011) (Figure 1).

Methodology
Our major concern is to identify the important parameters affecting private healthcare
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patients’ service quality perceptions. To determine the healthcare dimensions and their
relationships with loyalty, a questionnaire survey was conducted. The questionnaire
was finalised using focus group discussion with healthcare users and a detailed
discussion with hospital managers. The questionnaire had two parts: first, six
questions concerning the respondent’s demography; and second, 55 questions
exploring respondents’ perceived service quality, customer satisfaction and loyalty
towards service quality in private healthcare. In total, 550 respondents were randomly
selected from Bhubaneswar and Hyderabad (Odisha, eastern India and Andhra
Pradesh, southern India to collect perceived service quality, customer satisfaction and
loyalty data. Out of 550 questionnaires distributed in the private hospitals (110 each);
86.4 per cent responded. The sampling unit was a patient or patient attendant in a
private hospital. A five-point Likert scale was used: 5 ¼ strongly agree, 3 ¼ neutral and
1 ¼ strongly disagree (Appendix).

Scale development
Developing a scale for analysing perceived service quality, customer satisfaction and
loyalty involved these steps: perceived service quality, customer satisfaction and
loyalty variables or items taken from previous studies (Parasuraman et al., 1988;
Boulding et al., 1993; Taylor and Baker, 1994; Youssef et al., 1996; Lam, 1997; Andaleeb,
2001; Sower et al., 2001; Sureshchandar et al., 2002; White and Yu, 2005; Olorunniwo
et al., 2006; Bigné et al., 2008; Ramsaran-Fowdar, 2008; Aagja and Garg, 2010). The
questionnaire was pre-tested several times to ensure that the format, total questions
and sequence were appropriate. During each successive pre-test, feedback was
obtained from staff in five private hospitals (Table I).

Perceived Service Customer

Quality Loyalty

Physical Environment,
Customer
Reliability,
Customer Friendly Staff, Satisfaction Figure 1.
Communication, Perceived service
Responsiveness, quality, customer
Privacy & Safety,
Customer Satisfaction,
satisfaction and
Loyalty loyalty
 IJHCQA Variable Frequency %
28,5
Gender
Male 266 56
Female 209 44
Treatment
456 Inpatient 224 47.16
Outpatient 251 52.84
Residence
Rural 214 45.05
Urban 261 54.95
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Education
Primary level 52 10.95
Secondary level 92 19.37
Graduates 155 32.63
Above post graduation 176 37.05
Hospital visit
First visit 172 36.21
Repeat visit 303 63.79
Employment status
Unemployed 22 4.62
House wife 48 10.11
Government employee 87 18.31
Private employee 229 48.21
Table I. Self-employed 31 6.54
Demographic Retired 58 12.21
characteristics Note: n ¼ 475

Data analysis
Data were subjected to various statistics such as factor, regression and correlation
analyses using SPSS version 20. Cronbach’s α statistic and factor analysis reduce total
items. Before the factor analysis, two tests were performed: Bartlett’s sphericity and
Kaiser-Meyer-Olkin (KMO) sampling adequacy (Table II). Item reliability was assessed
by computing the coefficient α (Cronbach, 1951), which measures the internal
consistency. Coefficient α should be above 0.7 (Nunnally, 1978). In our study, Cronbach’s
α was 0.91, which indicates good consistency among items (Tables III-V).
Factor analysis used the principal component extraction method with varimax
rotation. In the initial application, variables were reduced from 58 to 44. In the second
application, 44 variables were classified under eight dimensions based on their factor
loadings. Factor loadings ⩽0.45 were not considered and were dropped as redundant
variables (Table III). Based on the factor analysis, the variables were classified into

Kaiser-Meyer-Olkin measure of sampling adequacy 0.815

Table II. Bartlett’s test of sphericity Approx. χ2 16,164.613
KMO and df 990
Bartlett’s test Sig. 0.000
 Component
Customer
Variable no. F1 F2 F3 F4 F5 F6 F7 F8 perceived
V1 0.637
service quality
V2 0.628
V3 0.518
V4 0.512
V5 0.502 457
V6 0.501
V7 0.498
V8 0.481
V9 0.462
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V10 0.459
V11 0.451
V12 0.757
V13 0.746
V14 0.628
V15 0.611
V16 0.516
V17 0.502
V18 0.500
V19 0.723
V20 0.714
V21 0.689
V22 0.664
V23 0.504
V24 0.727
V25 0.618
V26 0.605
V27 0.510
V28 0.501
V29 0.493
V30 0.478
V31 0.714
V32 0.623
V33 0.522
V34 0.441
V35 0.778
V36 0.703
V37 0.515
V38 0.502
V39 0.694
V40 0.599
V41 0.573
V42 0.612
V43 0.512
V44 0.500 Table III.
Notes: Extraction method: principal component analysis; rotation method: varimax with Kaiser Rotated component
normalisation. aRotation converged in 16 iterations matrixa

eight dimensions, which are suitably named as physical environment, reliability,

customer friendly staff, communication, responsiveness, privacy and safety, customer
satisfaction and customer loyalty. Generally, factor loading represents how much a
factor explains a variable. High loading indicates that the factor strongly influences
 IJHCQA the variable. A factor loading W 0.7 has a high impact on the variables. Table III
28,5 indicates that some variables o 0.7 need attention re-grading perceived service quality
improvement in Indian private hospital contexts.

Results
Physical environment
458 Factor 1 refers to physical facilities, infrastructure, hospital functions, medical
apparatus, devices and instruments, medical staff appearance, etc. It includes
neatness, cleanliness and environmental tranquillity, important for the patient’s
health condition. Since a patient has to stay until discharge, to address his/her food
and auxiliary service requirements, tangibles – menus and related service is also
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added to the physical environment. High factor loading, −0.637 (hospital is well
equipped with medical equipment), indicates that this factor strongly influences
perceived service quality.

Reliability
Reliability refers to medical personnel’s capability to deliver desired/promised
services systematically, accurately and dependably. The reliability criterion resides
on issues like speed, registration time and doctor availability in real-time, treatment,
effectiveness, medicines, etc. An appropriate diagnosis and adequate nursing time
are essential. In this dimension’s high factor loading, −0.757 (hospital staff maintain
error-free medical records, fee receipt, etc.), indicates that the factor strongly
influences the variable. This variable needs to be properly addressed in the private
healthcare sector.

Dimensions Variables

Physical environment (X1) 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11

Reliability (X2) 12, 13, 14, 15, 16, 17, 18
Customer friendly staff (X3) 19, 20, 21, 22, 23
Communication (X4) 24, 25, 26, 27, 28, 29, 30
Responsiveness (X5) 31, 32, 33, 34
Table IV. Privacy and safety (X6) 35, 36, 37, 38
Dimensions and Satisfaction (X7) 39, 40, 41
variables Loyalty (X8) 42, 43, 44

Dimensions Eigenvalue % Variation Cumulative %

Physical environment 15.609 31.816 31.816

Reliability 3.411 7.153 38.969
Customer friendly staff 2.468 6.416 45.385
Communication 1.811 5.024 50.409
Responsiveness 1.648 4.611 55.020
Privacy and safety 1.400 3.601 58.621
Table V. Customer satisfaction 1.213 3.211 61.832
Dimension variances Loyalty 1.359 3.020 64.852
 Customer friendly staff Customer
Customer friendly staff refers to employee dedication, customer caring and perceived
hard work. It also shows hospital staff’s commitment to providing a friendly
environment, superior-quality and compassionate care. This dimension’s high
service quality
factor loading, −0.723 (provides services at convenient times), indicates that the
private hospital staff provide services at customer preferred times. This
variable indicates that Indian private hospital staff are more concerned about 459
treatment times.

Communication
Communication is about keeping customers well informed, acknowledging and
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listening to their problems in an observant and effective manner. It includes counselling

by staff and the reciprocal response (customer friendly language/layman language)
involved in the treatment mechanism. Doctors should attempt to understand the
patient’s problem or his/her disease and the patient should be able to clearly spell out
his/her problem/disease. This is possible through effective two-sided communication.
In this dimension, a high factor loading, −0.727 (doctors give adequate information on
treatment), indicates that private hospital doctors are communicating to customers
using layman language. It helps to increase customer perception and positive
behaviour towards private hospitals.

Responsiveness
Responsiveness aims to develop the technical tools to assess, monitor and raise
awareness of how people are treated and the environment in which they are treated
when seeking healthcare. It upholds a particular focus on inequitable treatment
associated with social status. Responsiveness can be defined as the outcome that can be
achieved when institutions and institutional relationships are designed in such a way
that they are cognisant and respond appropriately to the universally legitimate
expectations. Responsiveness can be viewed from two angles: first, the user is often
portrayed as a consumer, with greater responsiveness being perceived as a means to
attract consumers; or second, responsiveness is related to safeguarding customer rights
to adequate and timely care. In this dimension, a high factor loading, −0.714 (staff are
courteous), is the highest factor loading. This variable indicates that service providers
are highly responsive, attentive and loyal.

Privacy and safety

Privacy and safety has been defined as avoiding or reducing to acceptable limits, actual
or potential harm from healthcare. Patient safety practices have been defined (Institute
of Medicine, 2004), as those that reduce adverse events risk, related to exposure to
medical care across diagnoses or conditions. In this dimension, a high factor loading,
−0.778 (hospital provides confidential medical treatment), indicated that services are
private and safe.

Customer satisfaction
Customer satisfaction is overall satisfaction that immediately follows a service
encounter. Satisfaction is an outcome, which is an evaluation and an emotion-based
response to any service. Customer satisfaction’s high factor loading, −0.694
(satisfied with my decision to visit the hospital), indicates that customers feel their
 IJHCQA decision was correct by choosing the particular private hospital, which leads
28,5 to customer loyalty towards.

Correlation analysis
To find associations between dimensions, a correlation analysis was applied (Table VI).
The highest significant positive correlation was between loyalty (X8) and customer
460 satisfaction (X7). A high significant positive correlation is also observed between
communication (X4) and loyalty (X8), physical environment (X1) and loyalty (X8),
responsiveness (X5) and loyalty (X8). There was no negative correlation between
variables.
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Regression analysis
We used a regression analysis to gain a deeper understanding about the relationship
between service quality perception, loyalty and Indian private hospital care.

Independent variables (X)

The proposed seven dimensions are treated as independent variables in the regression
equation: physical environment (X1), reliability (X2), customer friendly staff (X3),
communication (X4), responsiveness (X5), privacy and safety (X6) and customer
satisfaction (X7).

Dependent variable (Y)

Customer loyalty is treated as a dependent variable. The mathematical representation
can be written as follows:

Y ¼ b0 þ b1 X 1 þ b2 X 2 þ b3 X 3 þ b4 X 4 þ b5 X 5 þ b6 X 6 þ b7 X 7 (1)

where b0 is constant, it gives the dependent variable a value when all independent
variables are zero; b0 is also called an intercept because it determines where the
regression line meets the Y-axis; b1, …, b7 are coefficients that represent the estimated
change in dependent variable’s mean value for each unit change in independent
variable values. Using Table VII and VIII, the regression equation will be:

Y ¼ 0:442 þ 0:348X 1 –0:008X 2 þ 0:318X 3 þ 0:149X 4 þ 0:217X 5 – 0:028X 6 þ 0:413X 7

(2)

Table IX shows that the relationship between loyalty (Y) and various dimensions
(X1, …, X7) are statistically significant (p o 0.05). Also, the adjusted R2 value, 0.711,
indicates that the relationship is statistically significant. Five dimensions: physical
environment (X1), customer friendly staff (X3), communication (X4), responsiveness (X5)
and customer satisfaction (X7) are statistically significant (p o 0.05). Additionally, the
physical environment (X1) dimension has the greatest influence on loyalty followed by
customer friendly staff (X3), responsiveness (X5) and customer satisfaction (X7).
However, two dimensions, reliability (X2), privacy and safety (X6) are not statistically
significant, which calls for concrete action from healthcare managers to improve these
important areas.
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X1 X2 X3 X4 X5 X6 X7 X8

X1 Pearson correlation 1
Sig. (2-tailed)
X2 Pearson correlation 0.591** 1
Sig. (2-tailed) 0.000
X3 Pearson correlation 0.425** 0.532** 1
Sig. (2-tailed) 0.000 0.000
X4 Pearson correlation 0.524** 0.484** 0.416** 1
Sig. (2-tailed) 0.000 0.000 0.000
X5 Pearson correlation 0.567** 0.368** 0.393** 0.467** 1
Sig. (2-tailed) 0.000 0.000 0.000 0.000
X6 Pearson correlation 0.405** 0.286** 0.398** 0.363** 0.472** 1
Sig. (2-tailed) 0.000 0.000 0.000 0.000 0.000
X7 Pearson correlation 0.750** 0.553** 0.596** 0.623** 0.665** 0.439** 1
Sig. (2-tailed) 0.000 0.000 0.000 0.000 0.000 0.000
X8 Pearson correlation 0.810** 0.713** 0.622** 0.598** 0.614** 0.472** 0.419** 1
Sig. (2-tailed) 0.000 0.000 0.000 0.000 0.000 0.000 0.000
Note: **Correlation is significant at the 0.01 level (two-tailed)
Customer

service quality

Correlation analysis
Table VI.
461
perceived
 IJHCQA Conclusions
28,5 We briefly describe Indian private hospital patients’ service quality perceptions from a
loyalty perspective. A seven-dimension model, using regression analysis, was
developed to analyse customer perceived service quality and loyalty in Indian private
hospitals. The result indicates that two dimensions: reliability, and privacy and safety
are not contributing significantly towards loyalty. This implies that service providers
462 fail to provide these in healthcare services. Therefore, the insight gained in this study
may offer a foundation for future service quality perception and loyalty research.
Our research also provides useful recommendations to healthcare service providers for
improving their services. However, our research is limited to private hospitals, so our
results may not be generalised to all healthcare services. Our small sample may not
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represent the population, so, in future, research can be conducted with a larger sample
to facilitate a robust examination of service quality perception and loyalty. Future
studies can also be conducted to identify each dimension’s relative importance.
Extending this study can include the service providers’ perspective to understand these
issues in private hospitals. Extending this study and model to other sectors are other
directions.

Model R R2 Adjusted R2 SE of the estimate

Table VII.
a
Model summary 1 0.835 0.721 0.711 0.34811

Model Sum of squares df Mean square F Sig.

1 Regression 158.925 7 25.311 213.125 0.000b

Residual 57.066 468 0.113
Table VIII. Total 215.992 474
ANOVAa Note: aDependent variable: loyalty; bsignificant at 0.05 level

Unstandardised coefficients Standardised coefficients

Model B SE β t Sig.

1 Constant 0.442 0.119 3.841 0.000

X1 0.348 0.031 0.412 10.915 0.000
X2* −0.008 0.029 −0.012 −0.127 0.809
X3 0.318 0.027 0.213 7.918 0.000
X4 0.149 0.019 0.184 6.171 0.000
X5 0.217 0.022 0.335 7.512 0.000
X6* −0.028 0.052 −0.018 −0.501 0.690
Table IX. X7 0.413 0.021 0.451 9.176 0.000
Coefficientsa Note: aDependent variable: loyalty. *Predictors (Constant), X1, X2, …X7
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(PubHosQual) in the Indian context”, International Journal of Pharmaceutical and service quality
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(See Appendix follows overleaf.)

 IJHCQA Appendix
28,5

No. Variable

V1 Hospital is well equipped with all necessary medical equipment

466 V2 Physical facilities are visually appealing
V3 Staff are neat in appearance
V4 Materials related to outpatient services are visually appealing
V5 The different departments, divisions and labs are easily recognised
V6 Hospital canteen is good
V7 Hospital staff and public can be easily differentiated
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V8 Hospital wards, cabins, corridors and toilets/washrooms are regularly cleaned

V9 Hospital provides holistic environment
V10 Sufficient visitor waiting rooms
V11 The hospital environment, as a whole, generates a favourable impression
V12 Hospital staff maintain error-free records (e.g. medical records, fee receipt)
V13 Appointment system in the hospital was easy (phone/internet/other type)
V14 Gives prompt services to customers
V15 Hospital staff are always willing to help
V16 Staff are never too busy to respond to customer requests
V17 Customers made to feel safe in their interaction with staff
V18 The time it took to meet doctor is not too long
V19 Provides services at convenient times
V20 Staff depends on managers to handle customers
V21 Prompt service without appointment
V22 Competent in providing accurate service
V23 Medical staff that instil confidence in customers
V24 Doctors give adequate information on treatment
V25 Tests are adequately explained
V26 Physicians are willing to listen and answering questions
V27 Health condition information/reports are timely
V29 Medical staff effectively listening to patient requests/problems
V29 Hospital personnel explain the discharge process to the patient and family
V30 It was difficult to connect with the doctor
V31 Staff are courteous
V32 Staff have a warm and caring attitude
V33 Doctors and staff handle peak hospital traffic
V34 Operating hours are convenient to customers
V35 Hospital provides confidentiality
V36 Hospital not misusing customers information
V37 Hospital located in safe and secured place
V38 Customers feel safe in the hospital premises
V39 Satisfied with my decision to visit this hospital
V40 Choosing this hospital was a wise
V41 My experience in the hospital was good
V42 I will recommend this private hospital to others
V43 If I feels sick, I will go to the same private hospital again
V44 Encourage my friends and relatives for treatment in private hospitals
V45 Hospital staff give accurate medical bills to customers
V46 Hospital staff are able to answer customer questions
V47 Sufficient parking is available in the hospital premises
Table AI.
Questionnaire (continued )
 No. Variable
Customer
perceived
V48 Hospital provide services without delay
V49 Doctors are available whenever customers need medical services
service quality
V50 Hospital staff ask for feedback from the customers after treatment
V51 Hospital staff handle their customers gently
V52 Hospital maintain error-free services every time
V53 Staff perform services right first time 467
V54 Customers feel some risk when doctors treat them
V55 Hospital offers all medical services
V56 Hospital provides exact and precise service delivery
V57 There are sufficient staff available in the hospital
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V58 Hospital staff properly handle any problem that arise Table AI.

Corresponding author
Rama Koteswara Rao Kondasani can be contacted at: ramatnitrkl@gmail.com

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