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Management commitment to service quality and service recovery

performance: A study of frontline employees in public and private
hospitals

Article  in  International Journal of Pharmaceutical and Healthcare Marketing · April 2010

DOI: 10.1108/17506121011036042

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IJPHM
4,1 Management commitment
to service quality and service
recovery performance
84
A study of frontline employees in public
and private hospitals
Michel Rod
Department of Marketing, Sprott School of Business, Carleton University,
Ottawa, Canada, and
Nicholas J. Ashill
Department of Marketing, School of Business and Management,
American University of Sharjah, Sharjah, United Arab Emirates

Abstract
Purpose – The purpose of this paper is to investigate a model of management commitment to service
quality (MCSQ) and service recovery performance in the context of public and private hospitals in
New Zealand.
Design/methodology/approach – In a cross-sectional survey grounded in Bagozzi’s reformulation
of attitude theory, frontline hospital employees (FHEs) were asked about how MCSQ impacted on their
service recovery performance in both the public and private sectors.
Findings – The results of the study suggest that the relationship between MCSQ and service
recovery performance is mediated by organizational commitment. With the exception of the
relationship between MCSQ and organizational commitment, there are no differences between FHEs in
the private and public sectors.
Originality/value – Very little attention has been given to a comparative examination of those
managerial practices critical for improving frontline employee service recovery efforts in a public and
private healthcare context. Our research addresses this paucity.
Keywords Hospital management, Customer services quality, Job satisfaction, Hospitals,
Private hospitals, New Zealand
Paper type Research paper

International Journal of
Pharmaceutical and Healthcare
Marketing
Vol. 4 No. 1, 2010
pp. 84-103
q Emerald Group Publishing Limited
1750-6123
DOI 10.1108/17506121011036042
Introduction
In many western countries both the public and private sectors provide healthcare
services. The public systems are generally free to the patients and the private systems
are either paid for by the patients themselves or through some sort of medical insurance.
Over the past 30 years, consumer dissatisfaction with long public waiting lists, public
healthcare reforms, more contestable government funding of health agencies and
increased growth in private health offerings, has resulted in substantive growth in the
private sector (Fougere, 2001). Private healthcare settings are also more representative
of a commercial environment than public health settings, given the notion of a paying
customer, which historically has inferred more “right of complaint.” Public healthcare
systems on the other hand, have traditionally been less focused on the needs of the
customers although the increasing competitive environment has resulted in calls for
public healthcare facilities to become more efficient and offer higher quality (Wolfersteig MCSQ and
and Dunham, 1998) while in many countries, public healthcare is transforming from service recovery
philanthropic to more business-oriented service provision (Raja et al., 2007).
Whether in a private or public context, a better understanding of conditions in the work performance
environment that drive the delivery of service-quality and customer satisfaction is
valuable to healthcare managers (Scotti et al., 2007). Frontline hospital employees (FHEs)
in particular, play a key role in this delivery and patients will often judge their healthcare 85
experience based on these interactions (Ashill et al., 2005). Patients who are content with
their healthcare services are more likely to exhibit intentions that are favorable to the
success of the particular healthcare provider, whereas patient dissatisfaction may lead
to unfavorable behavioral intentions such as negative word-of-mouth or switching to
alternative healthcare service providers (Osborne, 2004; Ramsaran-Fowdar, 2008). Past
research indicates that managerial practices in the form of management commitment
to service quality (MCSQ) are a critical determinant of service worker behavior in the
workplace (Alexandrov et al., 2007; Babakus et al., 2003; Hartline and Ferrell, 1996).
Babakus et al. (2003, p. 3) define MCSQ as “employees’ appraisal of an organisation’s
commitment to nurture, develop, support and reward its employees to achieve service
excellence.” However, very little research has examined the impact of MCSQ on FHEs’
service recovery efforts in a healthcare setting. This is especially important given that staff
engagement is a critical component of service delivery in healthcare and FHEs are more
engaged when they perceive management to be engaged (Kerfoot, 2007).
With the preceding in mind, the purpose of this study is to examine the impact of MCSQ
on FHE service recovery performance in both private and public sectors health service
provision. This is one of the first attempts to undertake such research and in addition,
as far as we are aware, this is the first study to directly assess the service recovery
performance across a sample of public versus private sectors frontline healthcare
employees. This is an important contribution given the increase in the provision of private
healthcare globally and given the fact that there is empirical evidence that there are
marked differences in both managerial style and organizational culture between public
and private healthcare (Seren and Baykal, 2007) as well as differences in the work values
between private and public sectors healthcare employees (Midttun, 2007). An additional
contribution is the augmentation of the MCSQ construct to include a more complete set of
relevant indicators of MCSQ in a healthcare environment. Babakus et al. (2003) identified
three indicators of MCSQ in a study of retail banks. These are training, empowerment, and
rewards/recognition and are identified as well-known human resource practices by Pfeffer
(1994). However, we expand this set of MCSQ indicators to also include customer service
orientation (Lytle et al., 1998). An organizational culture which focuses on strong customer
service orientation is a must for sustaining healthy long-term relationships with
customers because a strong service orientation is imperative for the creation and/or
enhancement of good interactive marketing performance (Grönroos, 1990; Yasin and
Yavas, 1999) and is essential to maintain long-term working relationships (Boshoff and
Allen, 2000; Yavas et al., 2003). Health care organizations are becoming increasingly more
customer service orientated as patient satisfaction is increasingly recognized as an
important quality improvement initiative (Darby and Daniel, 1999; Bendall-Lyon and
Powers, 2001; Rashid and Jusoff, 2009; White, 2001).
We begin the paper by outlining the conceptual model used to guide the study. We then
outline the data collection procedure and the two-group analysis that we conducted.
IJPHM Following on from this, we discuss the results of the study and provide managerial
4,1 implications.

The research model and hypotheses

We follow the lead of Babakus et al. (2003) in using Bagozzi’s (1992) reformulation of
attitude theory grounded in Lazarus’s (1991, 2001) cognitive appraisal theory of
86 emotions, to create the theoretical underpinnings to our model. Drawing upon a critique
of existing attitude theories (the theory of reasoned action, the theory of planned
behavior and the theory of trying), Bagozzi’s framework reformulates attitude theory to
posit a process of self-regulation where the individual will appraise past, present and
future outcomes. The outcomes lead to emotions that then lead to coping responses
(behaviors), hence the sequence of appraisal, emotional reactions, and coping responses
(Schmit and Allscheid, 1995). For example, if an individual experiences a pleasant event
he or she will experience a positive emotional response which then directs the individual
to take the appropriate steps to attain that outcome. Thus, an individual’s cognitive
evaluation of an event, outcome, and situation precedes his or her affective reaction, and
it is these affective responses that play a determining role in directing individual
behavior (Bagozzi, 1992).
We classify management practices that embody MCSQ as appraisal variables.
Consistent with Bagozzi (1992), these MCSQ appraisal variables are hypothesized to lead
to an underlying emotional response or affect toward the organization. Specifically, the
conceptual framework (Figure 1) examines the process through which MCSQ influences
FHE job satisfaction (feelings toward the job) and organizational commitment (feelings
toward the organization), and the relationship between these job attitudes and FHE
service recovery performance (the abilities and actions of FHEs to resolve a service
failure to the satisfaction of the patient).
Ahmed and Parasuraman (1994, p. 85) defined MCSQ as “the conscious choice of
quality initiatives as operational and strategic options for the firm, and engaging in
activities such as providing visible quality leadership and resources.” A synthesis of

Management commitment Performance

Affective outcomes
to service quality (MCSQ) outcomes

Employee rewards

Organizational
commitment
Customer service training
Service
recovery
performance
Empowerment

Job
Figure 1. satisfaction
Conceptual model of
Customer service orientation
service recovery
performance
Appraisal Emotional response Behavior
the services management literature (Bowen and Lawler, 1995; Tax and Brown, 1998) and MCSQ and
the healthcare literature suggests that training (Young et al., 2009), empowerment service recovery
(Steinke, 2008), rewards (Lee et al., 2006; Rad and de Moraes, 2009) and customer service
orientation (Bendall-Lyon and Powers, 2001; Rashid and Jusoff, 2009) are relevant performance
indicators of the construct and MCSQ is manifested through a simultaneous emphasis
on all four variables.
87
Management commitment to service quality
Employee rewards. The relationship between employee rewards and service performance
has been shown to be a significant one (Parasuraman, 1987). Notwithstanding the
established literature on the potential dysfunctional effects of extrinsic rewards (see
Grover and Hui, 2005, for example), we favour the position that the rewards employees
receive induce them to provide higher quality services and motivates them to deal better
with customer complaints (Yavas et al., 2003). For FHEs that are generally low-paid,
financial reward acknowledging quality is likely to matter. In addition, the healthcare
sector is likely to attract staff with more intrinsic motivation to the extent that money may
not be the only reward that is valued (Mee, 1999). Thus, other non-monetary rewards are
likely to be appreciated also. If FHEs perceive the rewards to be tangible then this is likely
to have a significant impact on job satisfaction and commitment to the organization.
Through the reward system, the management can demonstrate its commitment to service
quality (Rondeau, 1994).

Customer service training

Poorly trained employees fail to provide a high level of service quality and deal poorly
with customer complaints (Bettercourt and Gwinner, 1996; Yavas et al., 2003). It is
not only important to have the right employees for the right jobs but also necessary to
train these employees to deal with problems and situations that arise (Boshoff and Allen,
2000). In the context of healthcare, FHEs need to be ready to deal with customers more
and more prepared to vent their frustration and anger at what they perceive to be poor
service. Research shows that customer service training positively impacts upon job
satisfaction as it helps employees to develop the skills to handle the service failures
effectively (Babakus et al., 2003; Benoy, 1996; Schneider and Bowen, 1995). Research also
shows that employees able to benefit from customer service training programs are
more committed to the organization (Sweetman, 2001; Tsui et al., 1997) The presence of
employee training programs sends a clear signal to FHEs that the management is
committed to service quality (Babakus et al., 2003).

Empowerment
Empowerment is when the employees are given the opportunity and motivation to
develop and make the best use of their talents (Chebat and Kollias, 2000). If management
empowers employees, then the employees gain control over the delivery of the service
(Hartline and Ferrell, 1996) and can provide quick, appropriate remedies to dissatisfied
customers (Boshoff and Allen, 2000). Research conducted in the healthcare context
shows that empowerment plays a significant role in increasing employee job satisfaction
(Laschinger et al., 2001; Ugboro, 2006; Upenieks, 2003) and organizational commitment
(Kuokkanen et al., 2003; Laschinger et al., 2001).
IJPHM Customer service orientation
4,1 Customer service orientation is a culture in the organization stemming from policies and
procedures that support behaviors of employees geared toward delivering service
excellence (Lytle et al., 1998). An organizational culture with a strong customer service
orientation lets the employees know that the priorities of the organization are aligned to
the priorities of the FHE. Theoretically, Jaworski and Kohli (1993) have argued that
88 employees who work in a market-oriented organization will develop a sense of pride as
the organization works towards the goal of satisfying customers and will feel that they
are contributing to something worthwhile, will have a sense of belongingness and,
therefore, commitment to the organization. Empirically, frontline employees perceptions
of service organization customer orientation have been shown to positively influence
their affective organizational commitment (Karatepe et al., 2007). Thus, employees
supported by such a culture will be more committed to the organization and are likely to
be more satisfied in their employment.
To summarize, the conceptual model in Figure 1 posits that employee rewards,
customer service training, empowerment and customer service orientation together reflect
the construct MCSQ. On their own these factors are insufficient to create committed and
satisfied employees (Babakus et al., 2003; Boshoff and Allen, 2000), however, when
implemented simultaneously they impact upon the employees’ affective states (emotional
responses) and ultimately performance. Therefore, our first set of hypotheses is as follows:
H1a. For both public and private sectors FHEs, there is a positive relationship
between MCSQ and FHE job satisfaction.
H1b. For both public and private sectors FHEs there is a positive relationship
between MCSQ and FHE organizational commitment.

Organizational commitment
Organizational commitment has been defined as the degree to which employees feel
a sense of connection, obligation, and reward in working for the organization (Allen and
Meyer, 1990). Research tells us that workers that are committed (i.e. identify and involve
themselves) to their organizations perform to a higher standard (Meyer et al., 1989;
Mowday et al., 1979) and with higher perceived service quality (Malhotra and
Mukherjee, 2004). In the context of service recovery performance, when there is some
sort of service failure then the more committed the employee is the more successful the
employee should be in addressing the failure. In this way the customer will be satisfied.
Thus, our next hypothesis is:
H2. For both public and private sectors FHEs, there is a positive relationship
between organizational commitment and service recovery performance.

Job satisfaction
Job satisfaction is a product of the evaluation of the job, taking into account all aspects of
the job such as pay, benefits, supervisor style, communication, and discretion (Burke,
1989) and can be defined as “the favorableness or unfavorableness with which
employees view their work” (Grieshaber et al., 1995, p. 18). Research suggests that there
is a positive relationship between work performance and job satisfaction as well as
between service quality and job satisfaction (Malhotra and Mukherjee, 2004). Further
research in services suggests that job satisfaction is an antecedent of customer-oriented
behavior (Hartline and Ferrell, 1996; Yoon et al., 2001). This customer-oriented behavior MCSQ and
is likely to include being helpful to the customer, empathising and being considerate. service recovery
Service recovery involves many of these traits, therefore our final hypothesis is:
performance
H3. For both public and private sectors FHEs, there is a positive relationship
between job satisfaction and service recovery performance.

Public versus private sectors 89

Although there has been little or no theoretical support advanced regarding differences
between public and private sectors FHE appraisals of their organization’s commitment
to service quality, there is limited empirical evidence to suggest differences may exist.
In a retail banking context, Babakus et al. (2003) found that when public versus private
ownership was used a control variable, it was found to be significant and their results
showed that private sector FHEs had more positive perceptions of MCSQ than public
sector employees. In a healthcare context, in a comparison of public versus private
hospital service quality, Angelopolou et al. (1998) found patient care to be comparable
but that private hospitals were better in terms of physical facilities, waiting times and
admissions procedures. Many public sector hospitals are blamed and criticized for their
lack of speed owing to the inflexibility of their traditional hierarchical structures in
respect of their quality improvement and numerous studies have concluded that
inpatients perceive public hospitals to be inferior in the quality of their service provision
(Arasli et al., 2008; Kara et al., 2005; Pakdil and Harwood, 2005). As alluded to in the
introduction, there is empirical evidence for the existence of differences in both
managerial style and organizational culture between public and private healthcare
service provision (Seren and Baykal, 2007) as well as differences in work values between
private and public sectors healthcare FHEs (Midttun, 2007). These work values
encompass such dimensions as professionalism, remuneration and benefits
expectations as well as autonomy. Midttun (2007) found that physicians working in
the private sector and physicians combining private and public work spend relatively
more time on patient-assignments than their public counterparts, while public
physicians allocate more time to administrative and research/educational tasks.
In addition, in the context of service quality, research has shown that patients also
perceive differences between public versus private sectors hospital service quality across
various quality dimensions such as empathy, tangibles (equipment, facilities, hours of
operation), reliability (promises versus performance), administrative responsiveness, and
assurance (employee knowledge, courteousness, support) (Jabnoun and Chaker, 1993;
Chowdhury, 2008) in addition to giving priority to inpatient needs, relationships between
staff and patients, professionalism of staff, food and the physical environment (Arasli et al.,
2008; Kara et al., 2005; Pakdil and Harwood, 2005).
Against this background, we therefore tested for possible differences in the
hypothesized relationships across public versus private healthcare with the expectation
that the relationships between the model constructs will be stronger for FHEs in private
healthcare.

Research methodology
Measures
We adapted scales from the relevant literature for our measures. We analyzed the
service recovery performance literature (Babakus et al., 2003; Boshoff and Allen, 2000;
IJPHM Lucas et al., 1990; Mowday et al., 1979; Parasuraman et al., 1990; Yavas et al., 2003) and
4,1 the healthcare literature (Budge et al., 2001; Lee et al., 2003; McGillis, 2003; Rafferty et al.,
2001; Weiseman et al., 1981) to find the appropriate scales to adapt. Organizational
commitment was measured using three items from Mowday et al. (1979). A three-item
empowerment scale was adapted from Hayes (1994). Customer service orientation was
measured with five items using the customer orientation section of Narver and Slater’s
90 (1990) market orientation measure. Finally, the items for employee rewards (three items),
job satisfaction (three items), customer service training (three items), and service
recovery performance (three items) were drawn from Boshoff and Allen (2000). Previous
work (Bitner et al., 1994; Schneider and Bowen, 1995) has shown that the perceptions of
frontline staff generally converge with that of customers, therefore we measure service
recovery performance via a self-report measure. All of the items were on a five-point
scale anchored by “5 – strongly agree” and “1 – strongly disagree” The measures can be
seen in Appendix Table AI.

Data collection
Data were collected from healthcare FHEs (receptionists, ward assistants and nurses) in
a convenience sample of public and private hospitals in a large New Zealand city. A total
of 281 questionnaires were distributed: 152 to full-time FHEs representing a range
of outpatient departments/clinics in an inner-city public hospital and 129 to full-time
FHEs in four inner-city private hospitals providing both secondary services and a range
of specialist tertiary services to the 135,000 people who live within their catchment area.
The absence of medical staff (doctors) in the sample reflects the nature of outpatient
clinical areas where the first point of contact for patients coming into the hospital typically
concerns administrative matters such as managing appointment arrivals and handling
non-medical issues. All of the FHEs of both the public and private hospitals spent most of
their time directly dealing with patients and there was comparability across the two
hospitals in terms of the types of frontline staff surveyed. The research team personally
distributed questionnaires. Managers of each department informed their FHEs about the
confidential and anonymous self-administered survey questionnaire and encouraged them
to participate. When completing the questionnaire each FHE was asked to focus on his or her
frontline duties and not issues pertaining to medical treatment (such dual roles are often
performed by nurses). In terms of age and tenure, the profiles of the respondents were
comparable to the population of FHEs in each of the hospitals participating in the research.
By the cut-off date for collection, 186 questionnaires had been received for an overall
response rate of 66 percent. Of those 186, 82 were from the private sector and 104 were
from the public sector. This is a 64 percent response rate for private sector FHEs and a
68 percent response rate for public sector FHEs. In the public sector sample (n ¼ 104), the
majority of respondents (80 percent) were female and in a full-time position (67 percent);
26 percent were nurses, 47 percent were administrators/receptionists and 27 percent
represented other frontline positions. In the private sector sample (n ¼ 82), the majority
of respondents (95 percent) were also female; 31 percent were nurses, 62 percent were
administrators/receptionists, and 7 percent represented other frontline positions (mainly
technical support staff). These profiles are typical of most hospital non-inpatient clinical
areas (both public and private), from which data for this study was drawn.
Early and late respondents were compared on all variables of interest, using traditional
t-tests following Armstrong and Overton’s (1977) recommendations. Unpaired t-tests were
used to compare the group and differences were not statistically significant at the 0.05 MCSQ and
level, indicating that there were no differences between early and late respondents. Hence, service recovery
it was assumed that non-response bias was not a problem. Following the recommendation
of Mentzer and Flint (1997), 30 non-respondents were also contacted and asked five performance
questions (survey items) relating to the hypotheses. There was no statistically significant
difference between the answers of respondents and non-respondents to these questions.
91
Non-response and common method bias
We checked for non-response bias by following the recommendations of Armstrong and
Overton (1977). We compared early and late respondents on all the variables of interest
using t-tests. Our analysis indicated that there was no significant difference between the
early and late respondents on these dimensions at the 0.05 level. Thus, we were able to
conclude that non-response bias was not a problem.
Owing to the self-report nature of the survey, method variance is identified as a
potential issue. Spector (1987) reported that the most frequently found sources of
method variance in self reports are acquiescence and social desirability bias. The
survey instrument was also organized into various sections by separating the
independent and dependent variables in an effort to reduce single-source method bias
(Podsakoff et al., 2003).
A further post hoc test for common method bias, a Harman’s (1967) one-factor test
was also performed. All of the self-report items were entered into a principal components
factor analysis with varimax rotation. According to this test, if a single factor emerges or
one factor accounts for more than 50 percent of the variance in the variables, common
method variance is present (Podsakoff et al., 2003). Our analysis showed that no general
factor was present.

Assessment of measures
For our data analysis, we followed the steps laid out by Calantone et al. (1996) for
conducting a multiple group analysis. We used EQS 6.1 for Windows. The steps laid out
by Calantone et al. (1996) are a general extension of the two-step approach (Anderson
and Gerbing, 1982, 1988; Bollen, 1989) with slight modifications to take account the
multiple groups. We begin with a confirmatory factor analysis (CFA) for both groups
individually. The purpose of these individual CFAs was to test for construct validity and
to eliminate any measures with either cross-loadings or insignificant loadings.
For the public hospital sample, all of the loadings of the items to the respective
constructs were statistically significant ( p , 0.01) (Appendix Table AI). The results
of the CFA for the public hospitals sample show a very good fit for the model
(x 2 ¼ 258.165 on 209 df, comparative fit index (CFI) ¼ 0.932, non-normed fit index
(NNFI) ¼ 0.918, incremental fit index (IFI) ¼ 0.936 and root mean square error of
approximation (RMSEA) ¼ 0.049). As with the public hospital sample, for the private
hospital sample, all of the loadings of the items to their respective constructs were
statistically significant ( p , 0.01) (Appendix Table AI). The results of the CFA for the
private hospital sample show another very good fit for the model (x 2 ¼ 265.707 on 209
df, CFI ¼ 0.923, NNFI ¼ 0.907, IFI ¼ 0.927 and RMSEA ¼ 0.058). These fit statistics
indicate a great deal of consistency across the two models and in addition to this the two
samples incorporated identical items in the models for all of the constructs. The average
variance extracted scores were also above the minimum threshold of 0.5 (Hair et al., 2006)
IJPHM in both samples. Composite reliabilities ranged across both samples from 0.80 for service
4,1 recovery performance to 0.90 for customer service training (Appendix Table AI).
In this study, measurement invariance is limited to metric invariance (i.e. invariance
of factor loadings), which indicates that members in different groups interpret and
respond to measures in an identical manner (Steenkamp and Baumgartner, 1998). We
conducted a two-group CFA using the private and public hospitals samples
92 simultaneously as this would allow us to establish whether or not we had measurement
equivalence across the two samples (Bollen, 1989). We ran the two-group CFA with
complete constraints on the factor patterns and factor loadings. We used the Lagrange
multiplier (LM) test to indicate whether any of the constraints should be released. This
initial two-group CFA gave a very good overall fit (x 2 ¼ 590.201 on 456 df,
CFI ¼ 0.908, NNFI ¼ 0.898, IFI ¼ 0.911, RMSEA ¼ 0.040). However, results of the LM
test indicated that we should release certain constraints. We released these constraints
one by one each time checking the results of the LM test to see if any more constraints
should be released. The final two-group CFA had a good fit (x 2 ¼ 557.453 on 451 df,
CFI ¼ 0.927, NNFI ¼ 0.918, IFI ¼ 0.930, RMSEA ¼ 0.036). The factor patterns were
the same across the two groups and there was no difference in 20 out of the 22 factor
loadings. This is comparable to the study by Calantone et al. (1996) that found no
difference in 14 of the 16 factor loadings. From this we are able to conclude that the
measurement models are invariant across the public hospital and private hospital
samples (Steenkamp and Baumgartner, 1998).

Structural model
Our next step was to test our proposed structural model for the private and public
hospitals samples individually. Through this we would be able to validate our
hypothesized model from Figure 1. Although our study draws upon a small convenience
sample, SEM models containing five or fewer constructs (as is the case with this
research) and high item communalities (0.6 or higher) (in our research all items exhibited
communalities above 0.6) can be adequately estimated with samples as small as 100-150
(Hair et al., 2006). We took the lead of Babakus et al. (2003) in using the composite scores
of the items (scores summed and divided by the number of items) from customer service
training, employee rewards, empowerment, and customer service orientation as
indicators for the construct, MCSQ. In this way, we acknowledge the multidimensional
nature of the construct (Bagozzi and Heatherton, 1994). Strong correlations among
customer service training, employee rewards, empowerment and customer service
orientation provided empirical justification for treating these four measures as
indicators of MCSQ.
We tested the individual models using EQS 6.1 for Windows. For the private hospital
sample, the overall fit of the model was very good (x 2 ¼ 86.571 on 61 df, CFI ¼ 0.937,
NNFI ¼ 0.919, IFI ¼ 0.939, RMSEA ¼ 0.072, standardized root mean square residual
(SRMR) ¼ 0.037, goodness of fit index (GFI) ¼ 0.972). Three of the four hypothesized
paths were significant and in the hypothesized direction with only the path between job
satisfaction and service recovery performance not significant. For the public hospital
sample, the overall fit of the model was very good (x 2 ¼ 86.915 on 61 df, CFI ¼ 0.923,
NNFI ¼ 0.902, IFI ¼ 0.927, RMSEA ¼ 0.065, SRMR ¼ 0.045, GFI ¼ 0.912). The same
three out of the four hypothesized paths were significant with the path between job
satisfaction and service recovery performance not significant.
 Our next step was to test our structural model for the private hospital and public hospital MCSQ and
sample simultaneously. The purpose of this test was to see if the path coefficients are
invariant across the two samples. To do this we constrained all the path coefficients to be
service recovery
equal across the two samples and used the LM test to see if any of the constraints should be performance
released. The results of the fully constrained model were very good (x 2 ¼ 198.400 on 136 df,
CFI ¼ 0.916, NNFI ¼ 0.904, IFI ¼ 0.918, RMSEA ¼ 0.050, SRMR ¼ 0.038, GFI ¼ 0.945).
The LM test was used to see which of the path coefficients differed. The results of the LM test 93
showed us that the path between MCSQ and organizational commitment should be released.
We then reran the model with this constraint released and the results of this model showed a
very good fit (x 2 ¼ 193.498 on 135 df, CFI ¼ 0.921, NNFI ¼ 0.909, IFI ¼ 0.923,
RMSEA ¼ 0.049, SRMR ¼ 0.044, GFI ¼ 0.954). Therefore, we are able to conclude that
three out of the four structural parameter estimates are invariant across the private and
public hospitals samples.

Results
The first set of hypotheses was supported in the analysis. As such, MCSQ was found
to affect organizational commitment positively (standardized loading ¼ 0.419, p , 0.01
for the public sample and standardized loading ¼ 0.778, p , 0.01 for the private sample)
and also to affect job satisfaction positively (standardized loading ¼ 0.437, p , 0.01 for
both the private and public sector sample).
The results of our analysis also showed that H2 was supported. Organizational
commitment was found to affect service recovery performance positively in the public
sector sample (standardized loading ¼ 0.678, p , 0.01) and in the private sector sample
(standardized loading ¼ 0.598, p , 0.01). However, H3 was not supported as we were
unable to find a significant relationship between job satisfaction and service recovery
performance (standardized loading ¼ 2 0.063, p . 0.05 for the public sector sample and
standardized loading ¼ 0.003, p . 0.05 for the private sector sample).

Discussion
This study examined the concept of MCSQ and how it is linked to service recovery
performance mediated through certain affective outcomes. We extended the model
proposed by Babakus et al. (2003) that used Bagozzi’s (1992) reformulation of attitude
theory as its theoretical base. We tested our model using FHEs in both the public and
private sectors of the New Zealand healthcare system.
From our analysis it appears that MCSQ has a positive impact upon both the job
satisfaction of the frontline FHEs and also their organizational commitment. This finding
lends further empirical support to the underlying theoretical framework of Bagozzi’s
(1992) reformulation of attitude theory, in that we see that FHE appraisal of MCSQ
influences affect (i.e. their satisfaction and organizational commitment) in both public and
private contexts. We can also see from our study that the simultaneous implementation of
employee empowerment, employee training, employee rewards, and customer service
orientation jointly affects service recovery performance through the mediating role played
by organizational commitment but not through job satisfaction. Service recovery
performance being partially mediated by affective responses to appraisals of MCSQ again
lends support for the attitude theoretical framework utilized in this study. Whereas we did
not necessarily expect differences between private and public in terms of this appraisal
! affect/emotion ! behavior sequence, we did anticipate differences in the strengths of
these relationships.
IJPHM On the whole, we found no difference between private and public sectors, although the
4,1 path between MCSQ and organizational commitment was different with the standardized
coefficient almost double for the private sector sample. This might be explained by private
healthcare “culture” being perceived as more collaborative and less power-focused (Seren
and Baykal, 2007). Alternatively, this substantially larger coefficient could be as a result of
the intrinsic differences that exist between those FHEs working in private hospitals and
94 those employed in public hospitals. One may expect FHEs of public institutions to be more
driven by a belief in helping those in need as compared to those FHEs in private healthcare
institutions who may see it as more of a job than vocation. This difference between
public versus private sectors employee motivation has been demonstrated empirically
(Jurkiewicz et al., 2007) and motivation is often operationalized as an aggregate construct
including such concepts as organizational commitment, job satisfaction, and job
involvement (Locke and Latham, 2004; Moynihan and Pandey, 2007). Slovensky et al.
(1998) have argued that increasing dissatisfaction with the complexity, fragmentation,
inefficiency, and cost of current public healthcare systems may also cause FHEs to be less
committed to their organizations than their private sector counterparts.
We are not surprised to see that there is a strong relationship between organizational
commitment and service recovery performance in both public and private sectors
samples. When the frontline FHEs of the organization are heavily committed to the goals
of the organization is seems completely plausible that they would want the organization
to do well. The one way in which these FHEs are able to contribute to the success of the
organization is through their own individual performance. Thus, one of the ways that
the commitment manifests itself is through improved service recovery performance.
An interesting finding is the non-significant relationship between job satisfaction
and service recovery performance. It may be the case in this study that our definition
and measurement of the job satisfaction construct was too narrow. Despite the fact that
the positive link between job satisfaction and behavior is well established in the
literature, where there are contrary findings, the consensus seems to be that it is based
on how job satisfaction is measured (Williams et al., 2007). When we conceptualized
this construct we focused on extrinsic measures of job satisfaction but we acknowledge
that service workers in the healthcare industry may be more motivated by intrinsic
factors possibly due to their nature in being drawn to healthcare work. Extrinsic job
satisfaction may not be important to people in a “carer” role. What might be more
important to these individuals is the satisfaction derived from knowing they are
alleviating patient/customer problems and distress. Research shows that FHEs
working in healthcare organizations are motivated by the desire to care for other
people (Hayes, 1993). This intrinsic motivation that exists in frontline healthcare
employees could be what drives them in their work. If so this would go a long way
toward explaining the lack of support for H3.
Our findings suggest several guidelines for managerial action. MCSQ is a
significant predictor of FHE job satisfaction and organizational commitment in both
public and private healthcare settings with the impact of MCSQ on organizational
commitment being almost twice as strong for the private healthcare setting. Only
organizational commitment is a significant predictor of FHE service recovery
performance in both settings. Given this finding, organizational commitment should be
identified as a critical work lever and receive priority from management in both
healthcare settings and especially in the public sector where the impact of FHE
organizational commitment is not as strong. Public and private healthcare managers MCSQ and
should also explicitly design and establish organizational policies pertaining to service recovery
employee empowerment, education/training, and reward systems and so on in order to
develop a system that will facilitate a higher level of commitment to the hospital and performance
therefore service-orientated service recovery performance. Internal marketing within
the hospital environment in both settings should emphasize hospital management
commitment to training, empowerment, rewards, and customer service orientation and 95
communicate clear organizational policies about each. By not taking into consideration
all of these variables, managerial action to improve individual and organizational
performance may fail (Babakus et al., 2003; Lytle and Timmermann, 2006). For
example, Bowen and Lawler (1995) and Argyris (1998) state that empowerment cannot
be effective if it is not aligned with appropriate rewards and training. In other words,
training and rewards systems are necessary for empowered frontline hospital staff to
be effective in their jobs. Similarly, Hart et al. (1990) and Forrester (2000) argue that
training is unlikely to produce the intended results unless reward mechanisms are
also in place.

Conclusions and future research

In this study, we have used Bagozzi’s (1992) reformulation of attitude theory (Bagozzi,
1992) to frame our study of how service recovery performance is influenced by MCSQ.
We contribute to the extant services literature by examining a model linking MCSQ
variables, affective job outcomes and service recovery performance in the novel context
of public versus private healthcare. Recently, no attention has been given to a
comparative examination of those managerial practices critical for improving FHE
service recovery efforts in a public and private healthcare context. Our research
addresses this paucity. We were able to validate our model showing that Bagozzi’s
(1992) reformulation can be used in the service recovery performance context. With the
exception of the relationship between MCSQ and organizational commitment, our
findings demonstrate that there are no differences between the public and private
sectors suggesting that any future privatization efforts are unlikely to run into
problems of the service recovery kind.
There are some limitations to our study. We did not measure possible differences in
compensation and benefits received, locus of control, or service delivery procedures across
public versus private FHEs which should be addressed in future research. The data we
collected was cross-sectional therefore we are unable to infer causality. To remedy this
future research should try and make use of longitudinal data. In addition we used a
self-report measure for service recovery performance. Future research should incorporate
actual service recovery performance with the way to do that through collecting data from the
patients who suffered the service failure. In addition, the respondents were drawn from a
small convenience sample with the sample of private hospital FHEs falling short of the
minimum recommended by Hair et al. (2006). Our sample of FHEs also comes from
the outpatient departments of five metropolitan hospitals which limits the generalizability of
the study results to other hospital settings.

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 Appendix

Scale items, reliabilities, and CFA Scale items, reliabilities, and CFA
results for public sample results for private sample
Construct and items Standardized loadings t-values Standardized loadings t-values

Employee rewards (a ¼ 0.86 public a ¼ 0.83 private)

Staff of this hospital are rewarded for dealing
effectively with patient problems 0.71 10.8 0.68 9.6
I am rewarded for satisfying complaining patients 0.65 9.6 0.68 9.6
I receive visible recognition when I excel in serving
patients 0.80 12.1 0.82 12.9
Customer service training (a ¼ 0.90 public, a ¼ 0.82 private)
Staff in this hospital receive continued training to
provide good service 0.88 14.7 0.94 16.8
Staff in this hospital receive extensive patient service
training before they come into contact with patients 0.73 11.1 0.74 10.4
Staff of this hospital receive training on how to serve
patients better 0.89 14.9 0.83 13.2
Empowerment (a ¼ 0.83 public, a ¼ 0.81 private)
I am encouraged to handle patient problems by
myself 0.73 11.1 0.77 10.8
I do not have to get management’s approval before I
handle patient problems 0.75 11.6 0.67 9.6
(continued)
performance
service recovery
MCSQ and

Table AI.
101
 4,1

102
IJPHM

Table AI.
Scale items, reliabilities, and CFA Scale items, reliabilities, and CFA
results for public sample results for private sample
Construct and items Standardized loadings t-values Standardized loadings t-values

I have control over how I solve patient problems 0.92 15.7 0.91 16.2
Customer service orientation (a ¼ 0.82 public, a ¼ 0.81 private)
This hospital measures patient satisfaction on a
regular basis 0.64 9.2 0.93 16.6
This hospital sets objectives in terms of patient
satisfaction 0.83 13.4 0.71 10.1
This hospital is totally committed to serving its
patients well 0.78 11.9 0.70 9.9
A reputation for good service is stressed in my
hospital 0.60 8.2 0.57 7.2
Organizational commitment (a ¼ 0.82 public, a ¼ 0.84 private)
I really care about the future of the hospital 0.70 10.4 0.73 10.3
I am proud to tell others that I work for this hospital 0.60 8.2 0.72 10.2
I am willing to put in a great deal of effort beyond
that normally expected in order for this hospital to be
successful 0.59 7.9 0.64 8.4
Job satisfaction (a ¼ 0.89 public, a ¼ 0.86 private)
I am satisfied with the amount of pay I receive for the
job I do 0.97 16.9 0.93 16.6
I am satisfied with my working conditions 0.87 14.5 0.86 13.8
Given the work I do, I feel I am fairly paid. 0.77 11.8 0.90 16.2
Service recovery performance (a ¼ 0.82 public, a ¼ 0.80 private)
Considering all the things I do, I handle dissatisfied
patients quite well 0.69 10.2 0.62 8.0
I do not mind dealing with complaining patients 0.71 10.8 0.80 12.6
No patient I deal with leaves with problems
unresolved 0.72 11.0 0.82 12.9
About the authors MCSQ and
Michel Rod, PhD, is an Associate Professor in Marketing in the Sprott School of Business at Carleton
University, Canada. His research interests include service recovery performance, burnout, the service recovery
development and management of collaborative relationships amongst university, industry, and performance
government organizations within the health sciences sector as well as the commercialisation of
university-developed intellectual property. He has published articles in Journal of Services Marketing,
Journal of Strategic Marketing, Journal of Retailing and Consumer Services, Marketing Intelligence and
Planning, Managing Service Quality, International Journal of Pharmaceutical and Healthcare 103
Marketing, Qualitative Market Research: An International Journal, Journal of Information and
Knowledge Management, Journal of Entrepreneurship and Innovation, Management Research News,
Journal of Transnational Management Development, and Science and Public Policy. Michel Rod is the
corresponding author and can be contacted at: michel_rod@carleton.ca
Nicholas J. Ashill, PhD, is an Associate Professor in Marketing at the American University of
Sharjah, United Arab Emirates. He has contributed to such journals as the Journal of Management,
European Journal of Marketing, Decision Sciences, Journal of Services Marketing, Journal of
Strategic Marketing, Journal of Marketing Management, Marketing Intelligence and Planning,
Managing Service Quality, International Journal of Pharmaceutical and Healthcare Marketing,
Qualitative Market Research: An International Journal, Journal of Asia-Pacific Business, Journal of
Business and Management, International Journal of Bank Marketing, and the International Review
of Public and Non Profit Marketing.

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