International Journal of Healthcare Management

ISSN: 2047-9700 (Print) 2047-9719 (Online) Journal homepage: http://www.tandfonline.com/loi/yjhm20

Measuring patient's satisfaction of healthcare

services in the UAE hospitals: Using SERVQUAL

Hamda S. Al-Neyadi, Salam Abdallah & Mohsin Malik

To cite this article: Hamda S. Al-Neyadi, Salam Abdallah & Mohsin Malik (2016): Measuring
patient's satisfaction of healthcare services in the UAE hospitals: Using SERVQUAL,
International Journal of Healthcare Management

To link to this article: http://dx.doi.org/10.1080/20479700.2016.1266804

Published online: 16 Dec 2016.

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Measuring patient’s satisfaction
of healthcare services in the UAE
hospitals: Using SERVQUAL
Hamda S. Al-Neyadi, Salam Abdallah, Mohsin Malik
College of Business, Abu Dhabi University, Abu Dhabi, UAE
Abstract
The purpose of this paper is to evaluate the quality
of healthcare services by investigating the factors
affecting patient satisfaction in private and public
hospitals in the UAE based on five service quality
dimensions of the SERVQUAL namely; tangibles,
reliability, responsiveness, assurance, and empathy.
A modified SERVQUAL questionnaire was used to
gather the research data. The respondents of the
study consisted of 127 patients who have been
admitted within the last 6 months prior to the
onset of the investigation. The results of the study
revealed that the perceived healthcare services in
private hospitals and public hospitals do not signifi-
cantly vary. Although patients were more satisfied
with nursing care, the perceived satisfaction of
patients with the quality of services provided by
physicians and nurses as well as the quality of the
hospital environment do not significantly vary in
both public and private hospitals. The dimension
of assurance was rated the highest while responsive-
ness was perceived as the least important of the five
SERVQUAL dimensions. The five dimensions of the
SERVQUAL appeared to be a consistent and reliable
scale for measuring healthcare service quality in the
United Arab Emirates context. The modified
SERVQUAL may be used to contribute in enhancing
the quality of healthcare services in UAE and in
other similar environments.
Keywords: Patient satisfaction, Service quality,
SERVQUAL, Private and public hospital, Emerging
countries
Introduction
Over the last decade, process improvement has been
one of the most important concerns of healthcare
providers in the United Arab Emirates (UAE).
Healthcare facility administrators took measures to
ensure that their respective facilities are equipped
© 2016 Informa UK Limited, trading as Taylor & Francis Group
DOI: 10.1080/20479700.2016.1266804
Correspondence to:
Salam Abdallah College of
Business, Abu Dhabi
University.
salam.abdallah@adu.ac.
ae.ae
with technologically advanced gadgets for the diag-
nosis and treatment of various diseases to sustain
the optimum quality of health and wellbeing of
the population. Likewise, healthcare facility admin-
istrators sought to ensure that employees rendering
healthcare services meet the expectations of the cri-
teria set by the health authorities which prescribe
the qualifications and competences of healthcare
professionals. These, among others, are just some
of the few measures undertaken by healthcare provi-
ders to demonstrate effectiveness and efficiency in
delivering healthcare services. But still, the satisfac-
tion of patients continues to pose a challenge for
healthcare providers to seek better ways of upgrad-
ing the quality of services rendered to third party
payers and consumers.
Patient satisfaction with healthcare services is an
important performance measure for healthcare pro-
viders.1 In fact, it is one of the universal goals of
healthcare providers as patient satisfaction directly
reflects the status of any healthcare facility.
Meeting patient satisfaction is complicated due to
the ever changing demands and healthcare needs
of patients but it remains a generally accepted yard-
stick that equates satisfactory patient feedback to
hospital success. In addition, patient satisfaction is
one of most important indicators in determining
patient health outcomes.2 Sustaining patient satis-
faction is one of the desired outcomes of care
which in itself is a crucial element of the of health
status. All this establishes the importance of the sat-
isfaction or dissatisfaction of patients for the quality
of provided care.3
Based on the United Arab Emirates Health Care
Overview,4 there are 70 hospitals in the UAE that
are categorized as either private or public insti-
tutions. Twenty nine of these institutions are
managed by the government. The same report
depicted that patient satisfaction is low in the
Emirate of Abu Dhabi. Accordingly, only 25–30%
of the total patients admitted were satisfied with
International Journal of Healthcare Management 2016 1
Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services
the healthcare services provided in both public and
private hospitals. This satisfaction rating raises a red
flag considering that the hospitals in Abu Dhabi are
well equipped with modern and highly advanced
technological facilities and manned by highly quali-
fied and competent healthcare professionals.
Despite the UAE being ranked as one of the emer-
gent countries in the world, there remains to be a
dearth of studies that evaluate the quality of health-
care services rendered to patient based on their sat-
isfaction. To help bridge this research gap, this study
was undertaken to evaluate the quality of healthcare
services by investigating the factors affecting patient
satisfaction in private and public hospitals in the
UAE. The result of this research can contribute sig-
nificant insights and knowledge to decision-
makers in the health authority as well as in the
various healthcare institutions in the country and
elsewhere. On the whole, the study contributes to
enhancing the quality of healthcare services ren-
dered to patients by answering following questions:
To what extent the inpatients are satisfied with
physician care, nursing care, and the hospital
environment in the public and private healthcare
facilities in Abu Dhabi?
Basheti et al.39 showed that many patients in
the Middle East seek medical remedies in phar-
macies, rather than visiting healthcare facilities
despite the state of the art healthcare facilities in
many GCC countries. The authors opined that
the patients seemed to value the advices given
at pharmacies more compared to the option of
going to hospitals for consultation. This may indi-
cate that patients are not satisfied with the ser-
vices provided by hospitals in the Middle East
region in general.
In a high-income country such as the UAE, health-
care facilities are well equipped and the healthcare
staff are qualified and competent physicians.5
Moreover, the competitive and mandatory medical
insurance entails the residents to accessible health-
care services. The UAE government also continues
to invest in the healthcare sector to ensure that
healthcare professionals are well trained and
quality healthcare services are delivered. The Abu
Dhabi Economic Vision 2030 is a stepping stone
for the Emirate’s economic progress. So one of the
identified priorities of Abu Dhabi government is
premium education, healthcare, and infrastructure
assets (General Secretariate of the Executive
Councel, Department of Planning & Economy,
Abu Dhabi Council Development, 2015). While
some studies report reasonable health services
within the UAE and credit the state health policies
for this,6 the findings in the United Arab Emirates
2 International Journal of Healthcare Management
Healthcare Overview 4 give contrary evidence by
reporting that the patients still appear to be dissatis-
fied with the healthcare services.
Satisfaction in the healthcare setting
Satisfaction is meeting the needs and wants of the
end users. For many years patient satisfaction has
been a major objective of healthcare business organ-
izations, since it has been considered to affect custo-
mer retention and the companies’ market share.
Therefore, achieving high level of patient satisfac-
tion in the healthcare service is vital.7 It is important
for every healthcare system to be aware of their hol-
istic healthcare service performance level and pro-
gress through patient satisfaction and comparative
analysis in order to sustain a competitive level in
the market.
Previous studies dedicated to satisfaction in the
healthcare setting focused on getting a better knowl-
edge of the doctor–patient relationship and how it
affects patient satisfaction on healthcare services.8
On the other hand, enhancing patients’ experiences
has become a challenge for healthcare management
as they tend to see patient as ordinary consumers
rather than healthcare services consumers. Quality
of patient care provided by primary healthcare
showed a declining level specifically in the public
healthcare system. These healthcare services pro-
grams need to be reconstructed while others indi-
cated that the government should be accountable
for improving the quality of healthcare.9
Patient satisfaction is a vital healthcare outcome
that can be used to measure the performance of
healthcare providers and facilities in general. The
feedback that healthcare facility receives are utilized
for the development of plans to continuously
improve the quality of service. Likewise, this feed-
back keeps them on-track on their level of competi-
tiveness in the market. Patient satisfaction in
healthcare is more significant than ever since the
industry is now considered competitive especially
for the private owned hospitals.9
Patient expectations
Patients’ perception on the quality of services is an
essential indicator utilized to measure the per-
formance of a healthcare facility.10 In most cases,
the patient’s perception affects the satisfaction
level as expectations on how the services should
be delivered develops within their own view.11
Commonly, interaction between the primary care-
giver and the patient during the delivery of health-
care services plays an important factor in patient
satisfaction. A study concluded that if healthcare
management would like to increase patient
2016

satisfaction, they should focus primarily on the
enhancement of nursing and staff care to achieve
optimum improvement.12
Waiting time plays an important role in the
satisfaction level among clientele. The length of
time by which patients that are to be attended
gives them the impression of being cared for or
neglected, thus directly affecting patient satisfac-
tion. Length of waiting time is determined by
several factors: emergency department capacity
and current load which result in slower phase of
service. The high number of patients compared to
the limited ward capacity ends up in delivering
low quality of service.13
Patients value the presence of nurses and any
other form of attention healthcare providers give
as measures of how caring and concerned they are.
This is based on the expectation of patients that
they should always have nurses by their side. On
the other hand, a patient who expects some delay
will have no problem waiting for laboratory
results, admission, or discharge.
Reason for dissatisfaction
Language barrier and differences in cultural prac-
tices result to a wide range of dissatisfaction
ratings by patients who come from different
countries. In a study conducted on patient satisfac-
tion in the United States of America (USA),
Hispanic patients expressed lower satisfaction in
the medical services rendered to them as opposed
to white English speakers.14 Language barrier
leads to communication breakdown between the
patient and healthcare providers resulting in
patient dissatisfaction.10 Another study stated that
some patients were not able to express themselves
while healthcare providers could not freely commu-
nicate with the patient essential information.
Information needed to be communicated carefully
and accurately to patients include facts about pro-
cedures and the duration of their treatment and its
associations with health status. Likewise, infor-
mation about health insurance or the absence
thereof, and care limitations for low income patients
are to be discussed with the patient.15
A study conducted in Boston showed that
English-speaking patients were less satisfied with
the courtesy shown by the staff as compared to
Spanish speaking patients who were happy with
the gestures in the emergency department.16
Cultural norms and values affect patient dissatisfac-
tion. American culture promotes independence,
hence, if healthcare provider tends to be overly assis-
tive leads to dissatisfaction. On the contrary,
American with Hispanic ancestry tends to be
International Journal of Healthcare Management 2016
Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services
dissatisfied if healthcare providers insist on them
high level of independence and projects lesser
level of assistance.
Patients show a high level of dissatisfaction due to
accessibility problems with healthcare services.
Availability of appointments and geographical
access to the healthcare facilities leads to a low
patient satisfaction rating. Thus, the concepts of sat-
isfaction and dissatisfaction do not capture the
complex feelings, beliefs and values that patients
expressed about their illness and its treatment.17
The UAE healthcare sector
Since its unification in 1971, the UAE enjoys a
remarkable advancement in all aspect of progress
including healthcare services.18 The approximately
8.2 million residents of the country enjoy the utiliz-
ation of high standard healthcare facilities. The said
facilities were established favorably due to the coun-
try’s oil deposits and sustained security environ-
ment. But the growing population of UAE
increases the demand for further growth in the
healthcare sector. This in turn increases the
demand for healthcare personnel and facilities
which is expected to drive the country’s healthcare
market to Dh 3.5 billion to Dh 4 billion by 2018.19
As of 2009, UAE had a total of 26 public hospitals,
with 4100 total bed capacity, excluding 28 private
healthcare facilities. The ministry of health is
encouraging the establishment of more private hos-
pitals with the provision of operating within the set
rules and policies of the ministry to maintain health-
care standard. This initiative is to satisfy the objec-
tive of creating a competitive environment that
will boost the quality of healthcare services within
the country.18 In addition, the UAE government
has established 106 primary healthcare centers in
its aim to bring healthcare service closer to the
population.20 All of this led to UAE being ranked
27th out of 191 countries in terms of quality health-
care service, according to the World Health
Organization (WHO).
Private hospitals are able to offer healthcare ser-
vices at a lower cost with the aim of acquisition of
new clients through feedback collection. This
make an impression that patient receives higher
quality of healthcare, development of trust, and a
feeling of better satisfaction. This makes the
private hospitals the preferred care providers for
the patients as compared to their public or govern-
ment counterparts.21
Differences between private and public hospitals
Patients in private and public hospitals both experi-
ence dissatisfaction. The reason behind the said
3
Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services
dissatisfaction may differ. A comparison between
public owned hospitals in Quebec, Canada, and
California showed that there was no clear distinction
between private and public healthcare institutions
in terms of patient satisfaction.22 Likewise a study
in the Middle East Region showed that patients of
both public and private hospitals similarly were
served adequately.23 Regardless of public or
private hospital, an adequate service leads to a
higher level of patient satisfaction.
Another study indicated that patients who took
treatment from private hospitals recorded higher
satisfaction compared to public hospitals. Data
showed that only one percent (1%) could not be
served by medical specialists and consultants in
private hospitals. In another study, results indicated
that only 40% of patients from a public hospital
would prefer to see a consultant rather than a clini-
cian.24 A recent study by Bishop et al.25 revealed that
the service provision in private and public health-
care facilities differ in terms that private hospitals
offered greater opportunities and treatment
options. Private hospitals likewise offered services
by appointment system with high level of flexibility
even within a short notice to respond to clients
demand leading to a better level of patient satisfac-
tion compared to public hospitals.26
For profit-making hospitals to receive enough
clients, they have to offer competitive services to
ensure that patients revisit the facilities or rec-
ommend them to family and friends.27 However,
another study found contradicting result which
showed that public hospitals were significantly
more efficient with relatively fewer resources. The
study reflected that public hospitals ensure
optimum utilization of their limited resources that
result to productivity. Certain percentage of
private hospitals tends to compromise the quality
of services in the efforts of maintaining profitability
and high net income.28 Evidently, the efficiency of
hospitals translates to better services, which lead
to patient satisfaction.
A comparison between the services offered by
public and private hospitals in the UAE showed sig-
nificant difference in terms of service quality. The
study has shown that the public hospitals outscored
private hospitals on tangibles and reliability. The
study recommended a careful design of patient-
oriented programs and procedures to improve
patient satisfaction within private hospitals to
attain competitive level with their public
counterparts.29
A study on the UAE healthcare facilities30 ident-
ified that patients were generally satisfied with the
quality of service rendered by their chosen hospitals.
4 International Journal of Healthcare Management
It also showed that leadership is the most important
factor that affects patient satisfaction. Another
study indicated that the demand for quality ser-
vices started taking shape a few decades ago,
when hospitals started paying more attention
to their patients and their respective needs.31
Hospitals that offer excellent quality of services
were found to record higher patient satisfaction32
with good experience for the patient due to the
availability of competent nurses that directly
increases patient satisfaction compared to other
hospitals that performed average that resulted to
patients recommendation of the healthcare provi-
der to other people.32
Service quality in healthcare
Every healthcare provider has its own way of pro-
viding services, contributing to the variability in
the services quality of provided healthcare ser-
vices.33 Patients either in or outpatient receive
several services in medical care and their judgment
of the quality of services delivered to them
varies.34 Patient satisfaction is a valid indicator for
measuring service quality. Service quality has two
dimensions: (a) technical i.e. the core service pro-
vided and (b) functional dimension, i.e. how the
service is provided. Satisfaction with these dimen-
sions indicate the success of service organizations.35
However, most of the patients focus on functional
quality to evaluate the health services as they lack
of medical expertise for evaluating the technical
attributes.36
A SERVQUAL instrument has been used in
different type of services industries as healthcare
industry, hotels, and dentistry, education, travel,
and construction services. The SERVQUAL has
five dimensions: responsiveness, reliability, assur-
ance, tangibles, and empathy which are assessed
on the basis of customers’ expectations and percep-
tions.37 Arasli and Salih38 define these dimensions
as follows:
(1) Tangibles – facilities, equipment, and the
presence of personnel;
(2) Reliability – ability to perform the promised
service responsibly and accurately;
(3) Responsiveness – willingness to provide help
and a prompt service to customers;
(4) Assurance – the knowledge and courtesy of
employees and their ability to inspire trust
and confidence; and
(5) Empathy – caring and understanding, which
a company provides and/or offers its custo-
mers in terms of its individualized and per-
sonalized attention
2016
 Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services

This paper tested the following hypotheses: ranging from 1 = strongly disagree to 5 = strongly
agree.
(1) There are no differences between public and
private concerning hospital service quality. Results
(2) There are no differences between public and
A total of 160 questionnaires were distributed to the
private concerning physicians’ care, nursing
respondents who were convenience selected from
care and hospital’s environment.
private and public hospitals Out of this total
number, 127 valid responses were obtained repre-
senting a response rate of 79.37% – a percentage
Methods deemed acceptable by the researcher. Of the total
respondents, most (72%) belonged to the 18– 35
The quantitative approach was used to assess
age range, majority of whom are males (58%) as
patient satisfaction levels from the feedback of
shown in Tables 1 and 2.
adult inpatient. To this effect, adult inpatients
Employing the SERVQUAL scale was useful for
between the ages of 18–66 both male and female,
measuring inpatient satisfaction. The mean values
expatriates and UAE nationals, comprised the
depicted in Table 3 generally shows that inpatients
respondents of the study.
in public hospitals were satisfied with the services
This exploratory research used quantitative analy-
provided in terms of tangibles, reliability,
sis in determining the influence of the different
empathy, and assurance but were uncertain of
factors that affect patient satisfaction in the UAE
their satisfaction regarding the responsiveness of
healthcare sector. The items of the SERVQUAL
such services. On the other hand, the inpatients in
were rephrased in both wording and contextual
private hospitals were very satisfied with the assur-
applications to suit the purpose of the study.
ance of the services provided; satisfied with the tan-
Therefore, we primarily developed a modified
gibles, reliability, and empathy dimensions of the
SERVQUAL scale for public and private hospitals
services; and uncertain regarding the responsive-
in the Emirates of UAE aiming to compare service
ness of the services.
quality in both types of hospitals in terms of their
The data were further analyzed using ANOVA to
effectiveness in meeting the expectation of their
determine whether the observed numerical differ-
inpatients. The Likert scale was used with close
ences in the means statistically varied or not.
ended questions to facilitate discovery of the poten-
Considering the sensitive nature of construct
tial relationship between inpatient satisfaction as
( patient satisfaction) investigated, size of the
dependent variable and other independent vari-
sample and the units of analysis ( perceptions),
ables. The survey questionnaire designed in both
English and Arabic versions to cater to the language
Table 1 Gender of respondents
preferences of the respondents.
The instrument used in this study was tested for Valid Cumulative
validity and reliability to ensure a high-quality F % percent percent
measure. Cronbach Alpha was used for the
Valid Male 61 48.0 58.1 58.1
purpose of reliability measurement. The modified Female 44 34.6 41.9 100.0
questionnaire has 40 components with 37 statements Total 105 82.7 100.0
making up the five dimensions to be investigated: Missing System 22 17.3
Tangibles (9); Reliability (9); Responsiveness (7); Total 127 100.0
Safety (5); and Empathy (6). Cronbach’s Alpha
yielded r = 0.944 which reflected reasonable val-
idity of the scale and the high internal reliability of Table 2 Age of respondents
the individual constructs. This indicated that the
Valid Cumulative
questionnaire was suitable for the purpose of F % percent percent
study as r = 0.944 is considered as excellent.
The SERVQUAL assessed the five dimensions of Valid 18–25 21 16.5 21.0 21.0
26–35 51 40.2 51.0 72.0
service quality attributes. It measured the study par-
36–45 20 15.7 20.0 92.0
ticipants’ perceptions of the actual healthcare service 46–55 4 3.1 4.0 96.0
performances along the various attributes. Multiple 56–65 4 3.1 4.0 100.0
comparison tests and regression analysis were used Total 100 78.7 100.0
to analyze the data using SPSS. Responses to all Missing System 27 21.3
items were elicited on a five-point Lickert scale Total 127 100.0

International Journal of Healthcare Management 2016 5

Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services

Table 3 Differences in perceived level of satisfaction

Dimensions Hospital n Mean Std. deviation F Sig.

Reliability Public 58 3.6130 0.85593 3.490 0.065
Private 46 3.9372 0.90711
Total 104 3.7564 0.88944
Empathy Public 57 3.4812 0.62715 1.615 0.207
Private 45 3.6635 0.82187
Total 102 3.5616 0.72154
Tangible Public 56 3.7421 0.71824 1.234 0.269
Private 48 3.9028 0.75555
Total 104 3.8162 0.73650
Assurance Public 59 3.8508 0.89873 4.582 0.035
Private 47 4.2085 0.79559
Total 106 4.0094 0.86910
Responsiveness Public 24 2.6667 0.70826 0.070 0.792
Private 33 2.7186 0.74444
Total 57 2.6967 0.72345

the researcher set a more rigorous significance level
(α = 0.01) in verifying the research hypothesis.
Accordingly, the results obtained in comparing
public and private hospitals showed P = P ≥ 0.01
in all the dimensions of service quality indicating
that there is no significant difference in the per-
ceived level of satisfaction among patients regarding
the services provided in public and private hospitals
along the five dimensions.
Hence, the type of hospital where the patients
were admitted was not a discrimination factor for
differentiating their satisfaction. On the whole, it
can be claimed that regardless of hospital, inpatients
were typically satisfied with the tangibles, empathy,
reliability, and assurance dimensions of the services
provided but were similarly uncertain regarding the
responsiveness of such services. On the basis of the
foregoing findings, Hypothesis 1 stating that there is
no difference between public and private hospitals
in terms of service quality is hereby accepted.
The degree of relationship of the five service
quality dimensions was also examined using
Pearson Correlation. Accordingly, Table 4 shows
that all the SERVQUAL dimensions are significantly
inter-correlated except for responsiveness which
only correlates significantly with empathy. This
indicates that the patients perceived the responsive-
ness of the service more on the basis of the care pro-
vided to them. It has to be noted in Table 3 that
patients were satisfied with the empathy they
experienced but were uncertain about their satisfac-
tion with the responsiveness of services provided.
On the basis of the correlation, the perceived respon-
siveness of the services provided could be consider-
ably improved by showing more care and giving
more attention to patients.
The study also looked into how physicians,
nurses, and the hospital environment influenced
patient satisfaction in public and private hospitals.
Accordingly, the mean values depicted in Table 5
shows that patients were generally satisfied with
the quality of care provided by physicians and
nurses as well as the quality of the hospital environ-
ment in both public and private hospitals. To this
effect, the ANOVA was used to determine statistical
variance in the mean values observed. Accordingly,
the P values obtained in comparing public and
private hospitals showed P ≥ 0.005 for the care

Table 4 Correlation of the service quality dimensions

Reliability Empathy Tangible Assurance

Empathy Sig. (2-tailed) 0.791** – – –
N 100 – – –
Tangible Sig. (2-tailed) 0.794** 0.673** – –
N 101 99 – –
Assurance Sig. (2-tailed) 0.873** 0.742** 0.762** –
N 104 103 103 –
Responsiveness Sig. (2-tailed) −0.083 0.358** 0.141 0.006
N 57 54 54 57
**r = 0.50.

6 International Journal of Healthcare Management 2016

 Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services

Table 5 Differences in the perceived satisfaction of factors

Factors Hospital N Mean Std. deviation F value Sig.

Physicians Public 58 3.6103 0.60804 1.181 0.280
Private 46 3.7522 0.72257
Nurses Public 26 3.4615 0.54677 5.324 0.025
Private 32 3.7882 0.52751
Hospital Environment Public 56 3.6265 0.75143 2.678 0.105
Private 45 3.8796 0.79843

provided by physicians and nurses and the quality
of the hospital environment. This indicates that
there is no significant difference in the level of satis-
faction of inpatients regarding the quality of phys-
ician and nursing care as well as the quality of the
hospital environment in both public and private
hospitals. This means that regardless of the type of
hospital, the quality of physician, nursing care,
and the hospital environment quality were similarly
perceived to have satisfied the inpatients.
On the whole, the satisfaction of inpatients on the
quality care provided by physicians and nurses as
well as the quality of the environment could not
be discriminated on the basis of the type of hospital
where they were admitted. As a corollary, the results
invariably show that the services provided by phys-
icians and nurses as well as the quality of the
environment do not significantly vary according to
the type of hospital. On the basis of the foregoing
findings, Hypothesis 2 stating that there is no differ-
ence between public and private hospitals in terms of
physician care, nursing care, and hospital environment,
is accepted.
As a follow-up to the aforementioned findings,
the overall perceived satisfaction of the patients
was determined together with their perception on
whether their expectations were met and whether
they would recommend the hospital to a friend or
family member. Accordingly, the results depicted
in Table 6 shows that the inpatients in both public
and private hospitals all agreed that they were satis-
fied with the services provided; their expectations
were equally met; and that they would recommend
the hospital to a friend or family member.
The t-test was used to further determine the stat-
istical variance in the observed means.
Accordingly, the P values in both public and
private hospitals showed P = P ≥ 0.005 for the
three inpatient attitudes. This indicates that there is
no significant difference in the attitudes of patients
toward both public and private hospitals in terms
of physician and nursing care and hospital environ-
ment. This means that the type of hospital was not a
discriminating factor in differentiating the attitudes
of the patients. This invariably implies that the per-
ceived quality of physician and nursing care as well
as the quality of hospital environment do not vary in
both public and private hospitals. On the whole,
inpatients have equally similar attitudes toward
the services provided by physicians and nurses
regardless of the hospital where they are admitted.
Discussion
On the whole, the results of the study do not affirm
the findings of previous studies particularly indicat-
ing low levels of satisfaction with healthcare facili-
ties and services in the UAE19 nor the greater
reliance on pharmacies rather than hospitals
typical to patients in the Middle East.39 The study
neither supports the findings that language and
cultural barriers can be causes of patient dissatisfac-
tion10,14 since the respondent of the study consisted of
both nationals and expatriates suggesting that they
are multi-lingual and multi-cultural. Furthermore,
results of the study showing a significant difference
in service quality among hospitals in the UAE29 is
not supported by the findings of this study.

Table 6 Attitudes toward services provided

Std. Sig.
Hospital n Mean deviation (2-tailed)
I would recommend the hospital to a friend or family Public 59 3.6441 1.06290 0.026
member Private 50 4.1000 1.03510
Overall I am satisfied with quality of service provided by Public 59 3.7966 0.94284 0.260
the hospital Private 50 4.0200 1.11557
The services I received at the hospital have met my Public 59 3.5763 1.03729 0.092
expectations Private 50 3.9200 1.06599

International Journal of Healthcare Management 2016 7

Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services
Compared to the foregoing studies, the results
obtained in this study can be on account of several
factors. First, the tremendous improvement of
healthcare in Abu Dhabi for the past 2 years. It has
to be noted that the low level of patient satisfaction
in Abu Dhabi was reported in 2013. With the current
findings, this can only imply that the countless
improvements that have been implemented since
then have contributed to increasing the satisfaction
of patients in public and private hospitals. Second,
the greater trust placed by patients on the healthcare
system. In the past, nationals had the tendency to
seek medical treatment abroad however, the influx
of both technology and foreign expertise into the
healthcare system is slowly changing the picture.
Today, more and more patients trust the expertise,
services, and technology in local hospitals. One
interesting finding of the study indicating this is
the greater trust placed by inpatients on the nurse.
Nurses play an important role in enhancing
patients’ experience within the hospital and evi-
dently, the services they provide to patients in
both public and private hospitals are becoming
more patient-centric. This concurs with the con-
clusion of a study that healthcare management
would likely increase patient satisfaction if it
focuses primarily on the enhancement of nursing
care to achieve optimum improvement.12 Third,
there is evidently improved communication with
patients hence language barriers are no longer con-
straints. This is supported by the various initiatives
for improving patient experience through effective
and responsive customer service strategies. Fourth,
the findings show that public hospitals are keeping
up with the competition in the local healthcare
market. The general notion is that private hospitals
provide better services. This, however, is being
proven to be a questionable in the light of current
realities obtaining in the UAE particularly in Abu
Dhabi.
The results of the study corroborate the findings
of Pierre-Yves Crémieux et al.22 that there is no
clear distinction between private and public health-
care institutions in terms of patient satisfaction. The
study also supports the findings that patients of both
public and private hospitals in the Middle East
region were similarly served adequately.23
Likewise, the findings of this study concur with
the results of the study of Jabnoun and Rassasi16
who found that patients are generally satisfied
with the quality of service of their chosen hospitals
in the UAE. The fact that the respondents of this
study were inpatients makes the results more cred-
ible since their hospital stay allowed them to experi-
ence the services provided on an extended basis.
8 International Journal of Healthcare Management
Going back to what was earlier stated that any
form of dissatisfaction among patients can either
point to failure or the opportunity for improvement,
it appears that the aspect of failure does not apply
within the context of the study on the basis of the
findings obtained. However, there is still room for
improvement. The results particularly show that
inpatients are generally satisfied with the five
service quality dimension with the exception of
assurance in private hospitals which patients were
very satisfied with. This can serve as a benchmark
for the other dimensions which means that improv-
ing tangibles, reliance, empathy, and responsiveness
on the part of hospitals can still raise the bar of sat-
isfaction among patients.
Limitations of the study
The findings of the study also open the potential for
future research which may focus on identifying
differences in expectations and perceptions of
service quality in private and public ownership as
well as between patient and service provider percep-
tions. The research instrument could be expanded
with new items and might include questions about
the importance of certain variables for the patients.
Additionally, public hospital ought to work on
enhancing nursing skills as these play an essential
role within the hospital and considered as the
main link between physician and patients.
Implications for future research
Employing the SERVQUAL scale was useful for
measuring inpatient satisfaction. The findings of
the study should not be taken as a cause for public
and private hospitals in Abu Dhabi to rest on their
laurels. Rather, the findings pose the greater chal-
lenge of enhancing and sustaining patient satisfac-
tion in both private and public hospital in the
emirate. The positive and significant correlation
among the five quality dimensions mean that the
effects of these quality dimensions are intercon-
nected hence a change in one dimension is likely
to bring about a change in other dimensions. This
suggests that any improvement that needs to be
introduced into the system has to be holistic and
should consider system-wide consequences. This
means not only improving technical and functional
quality but designing the improvement in such a
way that it enhances the capacity of both the hard
and soft technologies of hospitals to deliver
patient-centric services.
To this effect, the study recommends that continu-
ous attention be given to hospital improvement that
is grounded on the five quality dimensions, focused
2016

on the medical, nursing, and environmental com-
ponents of the hospital setting, and oriented
strongly toward greater satisfaction as a universal
patient experience and outcome.
Disclaimer statements
Contributors None.
Funding None.
Conflicts of interest None.
Ethics approval None.
References
1. Crosier M, Scott J, Steinfeld B. Improving satisfaction
in patients receiving mental health care: a case study. J
Behav Health Serv Res 2012;39(1):42–54.
2. Fincham JE, Wertheimer AI. Predictors of patient sat-
isfaction in a health maintenance organization. J
Health Care Mark 1986;6(3):5–11.
3. Hardy TS. A retrospective study relating six com-
ponents of patient care to patient satisfaction in com-
munity healthcare centers (Psy.D.). Denver: The
University of the Rockies; 2014.
4. United Arab Emirates, Heath Care Overview. (P. 12).
2013. Available from: http://Content.Argaam.Com
.S3-Eu-West-1.Amazonaws.Com/F87f8b53-5202-
4270-9c06-Adf27080b044.Pdf
5. Kandela P. Health and wealth in the United Arab
Emirates. Lancet 1999;353(9169):2047.
6. Hassan R, Rehman A. Doctor patient relationship in
gynecology department of public and private hospi-
tals of Rawalpindi and Islamabad. Pakistan J Med
Res 2011;50(2):75–9.
7. Ismail MBM, Velnampy T. Determinants of patient
satisfaction (Ps) in public health service organizations
(Phso) in eastern province of Sri Lanka. USV Ann
Econ Public Adm 2013;13(2):135–45.
8. Howard J. Hospital customer service in a changing
healthcare world: does it matter? J Health Care
Manage 1999;44(4):312–25.
9. York AS, McCarthy KA. Patient, staff and physician
satisfaction: a new model, instrument and their impli-
cations. Inter J Health Care Qual Assur 2011;24(2):
178–91. doi: 10.1108/09526861111105121
10. Zamil AM, Areiqat AY, Tailakh W. The impact of
health service quality on patients’ satisfaction over
private and public hospitals in Jordan: a comparative
study. Inter J Mark Stud 2012;4(1):123–37.
11. Werner RM, Chang VW. The relationship between
measured performance and satisfaction with care
among clinically complex patients. J General Intern
2008;23(11):1729–35.
12. Otani K, Waterman B, Dunagan WC. Patient satisfac-
tion: how patient health conditions influence their sat-
isfaction. J Health Care Manage 2012;57(4):276–92.
13. Maleki MR, Nabi KH, Ayoubian A, Dehaghi ZH. The
relation between physical access in emergency ward
and the time patients have to wait before being
served in Tehran hospitals 2011. Kuwait Chap
Arabian J Bus Manage Rev 2014;3(11A):83–92.
14. O’Brien M, Shea J. Disparities in patient satisfaction
among Hispanics: the role of language preference. J
Immigrant Minority Health/Center Minority Public
International Journal of Healthcare Management 2016
Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services
Health 2011;13(2):408–12. doi: 10.1007/S10903-009-
9275-2
15. Becker G, Newsom E. Socioeconomic status and dis-
satisfaction with health care among chronically Ill
African Americans. Am J Public Health 2003;93(5):
742–8.
16. Carrasquillo O, Orav EJ, Brennan TA, Burstin HR.
Impact of language barriers on patient satisfaction in
an emergency department. J General Inter Med
1999;14(2):82–7. doi:10.1046/J.1525-1497.1999.00293.X
17. Coyle J, Williams B. Seeing the wood for the trees:
defining the forgotten concept of patient dissatisfac-
tion in the light of patient satisfaction research.
Leadersh Health Serv 1999;12(4):95–124.
18. Badri MA, Attia S, Ustadi AM. Healthcare quality and
moderators of patient satisfaction: testing for causal-
ity. Inter J Health Care Qual Assur 2009;22(4):
382–410. doi: 10.1108/09526860910964843
19. UAE Health Care Market to Reach Dh3.5b in 2018.
Gulf news. Dubai, 2013, November 22. Available from
http://Adezproxy.Adu.Ac.Ae/Docview/1460316729?
Accountid = 26149
20. Alshammari F. Patient satisfaction in primary health
care centers in hail city, Saudi Arabia. Am J Appl Sci
2014;11(8):1234–40.
21. Alrubaiee L, Alkaa’ida F. The mediating effect of
patient satisfaction in the patients’ perceptions of
healthcare quality – patient trust relationship. Inter J
Mark Stud 2011;3(1):103–27.
22. Pierre-Yves Crémieux, Ouellette P, Rimbaud F,
Vigeant S. Hospital cost flexibility in the presence of
many outputs: a public-private comparison. Health
Care Manage Sci 2005;8(2):111–20. doi: 10.1007/
S10729-005-0394-6
23. Andaleeb SS, Siddiqui N, Khandakar S. Patient satis-
faction and quality of hospital services in Bangladesh.
Health Policy Plan 2007;22(4):263–74.
24. Hurst K. NHS outpatient and private outpatient satis-
faction. Inter J Health Care Qual Assur 1992;5(6):11.
25. Bishop FL, Amos N, Yu H, Lewith GT. Heath-care
sector and complementary medicine: practitioners’
experiences of delivering acupuncture in the public
and private sectors. Prim Healthcare Res Dev 2012;
13(3):269–78.
26. Owusu-Frimpong N, Nwankwo S, Baba Dason.
Measuring service quality and patient satisfaction
with access to public and private healthcare delivery.
Inter J Public Sector Manage 2010;23(3):203–20. doi:
10.1108/09513551011032455
27. Zarei A, Arab M, Froushani AR, Rashidian A, Ghazi
Tabatabaei SM. Service quality of private hospitals:
the Iranian patients’ perspective. BMC Health Serv
Res 2012;12:31. doi: 10.1186/1472-6963-12-31
28. Roh C-Y, Moon MJ, Jung K. Efficiency disparities
among community hospitals in Tennessee: do size,
location, ownership, and network matter? J Health
Care Poor Underserved 2013;24(4):1816–33.
29. Jabnoun N, Chaker M. Comparing the quality of
private and public hospitals. Managing Serv Qual
2003;13(4):290–99.
30. Jabnoun N, Aisha Juma AL Rasasi. Transformational
leadership and service quality in UAE hospitals.
Managing Serv Qual 2005;15(1):70–81.
31. Holloway B, Mobbs D. Customer focus groups:
developments in health care. TQM Mag 1994;6(1):
13–7.
32. Jha AK, Orav EJ, Zheng J, Epstein AM. Patients’ per-
ception of hospital care in the United States. New
9
Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services
England J Med 2008;359(18):1921–31. doi: 10.1056/
Nejmsa0804116
33. Youssef F, Nel D, Bovaird T. Service quality in NHS
hospitals. J Man Med 1995;9(1):66–73.
34. Kui-Son C, Woo-Hyun C, Lee S, Lee H, Kim C. The
relationships among quality, value, satisfaction and
behavioral intention in health care provider choice: a
South Korean study. J Bus Res 2004;57(8):913–21.
35. Chakraborty R, Majumdar A. Measuring consumer
satisfaction in healthcare sector: the applicability of
SERVQUAL. Res World 2011;4(3):149–60.
36. Ramez W. Patients’ perception of health care
quality, satisfaction and behavioral intention: an
10 International Journal of Healthcare Management 2016
empirical study in Bahrain. Int J Bus Soc Sci 2012;
3(18):131–41.
37. Parasuraman A, Zeithaml VA, Berry L. SERVQUAL: a
multiple-item scale for measuring consumer percep-
tion. J Retailing 1988;64(1):21–40.
38. Arasli H, Ekiz EH, Katircioglu ST. Gearing service
quality into public and private hospitals in small
islands. Int Journal of HCare Qual Ass 2008;21(1):8–23.
39. Basheti IA, Qunaibi EA, Hamadi SA, Abu-Gharbieh
E, Saleh S, Aburuz S, et al. Patient perspectives of
the role of the community pharmacist in the Middle
East: Jordan, United Arab Emirates and Iraq.
Pharmacol Pharm 2014;5(6):588–99.