Satsfaction Hospital

ETHIOPIAN MANAGEMENT INSTITUTE
The effect of service quality & interpersonal bond dimensions on

patient satisfaction: the Case of public hospitals in Ethiopia
Team members
Research
አዲስ አባባ August, 2018
Consultancy Training
ABSTRACT
Understanding customer satisfaction is essential at every level within an organization.
Achieving satisfaction is worthy in itself even though difficult to accomplish. Measuring
patient satisfaction easily relates to a change in practice to improve the quality of care
provided. It also generates more compliance to care. Measuring client or patient satisfaction
has become an integral part of hospital/clinic management strategies across the globe.
Moreover, the quality assurance and accreditation process in most countries requires that the
satisfaction of clients be measured on a regular basis.This study has examined the effect of
service quality and interpersonal bonds dimensions on patient satisfaction. It has also
examined the service quality perception of the patients as well as the
levelofpatientsatisfactionin the public hospitals in Ethiopia. The ten hypotheses were
generated with the help of existing knowledge and literature related to service quality,
interpersonal bonds and patient/customer
satisfaction.Theformulatedhypothesesweretestedthrough primary data collected from eight
referral hospital user. A total of 450 public hospital users from different backgrounds, with
differing cultural values and beliefs responded to 58 questions in both English and Amharic
Languages respectively. The researcher used descriptive and explanatory research design to
carry out the research and to achieve intended objective of study. Quantitative techniques
were applied for data analysis using The IBM SPSS statistics 25 software. Multicolinearity
was also checked for structural model using the variance inflation factors (VIF). For the
current model the VIF values are all below 10 and the tolerance statistics are all 0.2950 (>0)
confirms no multicollinearity threat within independent variables. The study has revealed
that the overall patient satisfaction in this study is very low (64.7%) compared to studies
done in Asella, hospital, Nigeria, Black Lion Referral Hospital and Mekelle Hyder referral
Hospital where the rate of patient satisfaction was 80.7% ,96.1%), 90.1%, 79.7%
respectively. Similarly, the evaluation of inter-correlation between the
factorsofservicequalityand interpersonal bonds along with patientsatisfactionshowsthat each
dimension of service quality and interpersonal bonds are positively correlated with patient
satisfaction and which is also significant at the 0.01 level. Next, regression analysis
demonstrates that the R2 value of this study model was 0.70 and therefore 70% of the
variance of patient’s overall satisfaction is explained by the service quality and interpersonal
bonds dimensions. Finally, the research offers a number of recommendations to federal public
organizations on how M&E system promote good governance successfully.
Key word: Service quality, satisfaction, interpersonal bonds, healthy care
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Contents
CHAPTER1: INTRODUCTION...................................................................................................................4
1.1. Background of the study.............................................................................................................4
1.2. Statement of the problem.............................................................................................................6
1.3. Research Hypothesis....................................................................................................................7
1.4. Objectives of the Study................................................................................................................8
1.3.1. Specific objectives..........................................................................................................8
1.5. Significance of the Study.............................................................................................................8
1.6. Scope and limitation of the Study................................................................................................8
1.7. Definition of Terms.....................................................................................................................9
CHAPTER 2........................................................................................................................................10
LTTERATURE REVIEW...................................................................................................................10
2.1. The ServiceWorld......................................................................................................................10
2.2. Quality and Customer Satisfaction.............................................................................................10
2.3. Service Quality Instrument........................................................................................................11
2.4. Criticisms within Service Quality Dimensions..........................................................................12
2.5. Patient Satisfaction....................................................................................................................13
2.6. Importance of Measuring Patient Satisfaction...........................................................................14
2.7. Conceptual Framework..............................................................................................................15
CHAPTER 3: METHODOLOGY.................................................................................................................17
3.1. Introduction...............................................................................................................................17
3.2. Research Paradigm....................................................................................................................17
3.3. Research approach.....................................................................................................................17
3.4. Research Design........................................................................................................................17
3.5. Sampling Methods.....................................................................................................................17
3.6. Method of Data Collection, and Sources...................................................................................18
3.7. Instruments and Measure...........................................................................................................19
3.8. Method of Data Analysis...........................................................................................................19
3.9. Validity and reliability...............................................................................................................20
3.10. Ethical consideration.................................................................................................................20
CHAPTER 4...........................................................................................................................................21
DATA ANALYSIS AND DISCUSSION.......................................................................................................21
4.4.1. T-Test........................................................................................................................................27
4.4.2. Regression Analysis...................................................................................................................28
4.4.3. Bivariate correlation analysis.....................................................................................................30
Table 4.10 the bivariate correlation matrix for the whole factor.................................................30
4.4.4. Hypothesis testing......................................................................................................................30
4.5. Discussion of the Main Findings.............................................................................................31
CHAHPTER 5........................................................................................................................................33
CONCLUSION AND RECOMMENDATION.............................................................................................33
5.1. Conclusion.................................................................................................................................33
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5.2. Recommendations.....................................................................................................................34
5.3. Limitations and Further Research.................................................................................................35
Appendices..........................................................................................................................................36
Questionnaire........................................................................................................................................36
4
CHAPTER1: INTRODUCTION
1.1. Background of the study1
Healthcare is one of the most essential components in human life and is defined as the
management or treatment of any health problem through the services that might be offered by
medical, nursing, dental or any other health- related service providers.
Service is generally perceived as any activity undertaken to meet the social needs. Public
health service particularly refers to those activities of government and private institutions
aimed at satisfying the needs and ensuring the well-being of the people in the society. Service
delivery refers to the systematic arrangement of activities in service giving institutions with
the aim of fulfilling the needs and expectations of service users and other stakeholders with
optimum use of resources. In short, improvement of service delivery means increasing the
cost- effectiveness, coverage, and impact of services. Therefore, service quality is the key to
measure user satisfaction. Similarly WHO also defines that health as a complete state of
physical, mental and social well-being and not merely the absence of disease or illnessin the
past years when hospitals were symbols of humanitarian efforts for community welfare,
accountability for performance was of little concern.
Patient satisfaction is the level of satisfaction that clients experience having used a service. It,
therefore, reflects the gap between the expected service and the experience of the service,
from the client's point of view. Measuring client or patient satisfaction has become an integral
part of hospital/clinic management strategies across the globe. Moreover, the quality
assurance and accreditation process in most countries require-s that the satisfaction of clients
be measured on a regular basis (Mathew S, Beth E 2001).
Patient satisfaction survey also plays a vital role in the holistic aspects of healing and
emotional well-being. First, hospitals that have better engagement with patients may
encourage greater observance to clinical standards of care and follow-up; patients who are
more satisfied with a service may be more likely to come in for visits and follow the
recommendations of the clinicians who they trust. Second, better patient experience scores
could indicate that a hospital has stronger teamwork, organizational leadership, and
commitment for improvement (Mehta, 2015).
1
.
Despite a pretty good level of patient satisfaction, a small, but by no means insignificant, the
proportion of patients expressed dissatisfaction. The fact that patients expressed
dissatisfaction with the services indicates that hospital administration needs to do more in the
drive towards improving services (Qadri S. S, 2012).Patient satisfaction with hospital care is
significantly influenced by patient-provider interactions during the episodes of care, the
surrounding physical environment, interpersonal skills in terms of courtesy, respect by health
care providers, communication skills, explanation and clear information, and technical skills
such as clinical competency and hospital equipment (Al-Abri R., Al-Balushi A.,2014).
To improve the quality of services, satisfying patients and clients is the primary goal of the
Ethiopian government's reform program. Community participation is guaranteed that patients'
and clients' opinions are heard and their satisfaction with services is optimized through
regular surveys on client satisfaction. Hospitals play a crucial role in maternal mortality
reduction and should provide quality service to the community and ensure client satisfaction
(MOH, 2014).
Asking patients what they think about the care and treatment they have received is an
important step towards improving the quality of care, and ensure local health services are
meeting patients' needs. It is an established fact that satisfaction influences whether a person
seeks medical advice complies with treatment and maintains a continuing relationship with
practitioners. Donabadian, as cited by James (1990), arguably the leading theorist in the area
of quality assurance, has emphasized that Client satisfaction is of fundamental importance as
a measure of the quality of care because it gives information on the provider's success at
meeting those client values and expectations, which are matters on which the client is the
ultimate authority
Most public hospitals in Ethiopia are 20 or more years oldest, through time, the significant
increase in population growth has resulted in an extremely increased demand for health
services, while the hospital capacity and facilities are not correspondingly changing. Most of
the Ethiopian government run health institutions showed low client satisfaction because of
long waiting time and unavailability of basic drugs, understaffed and less equipped, problems
relating to accommodating patients (Srinivasan, 2015).
The Federal and regional government are striving hard to fulfill the hospitals with the right
service quality to meet the needs of the customer/patient. However, still, the needs of the
people have not yet been adequately met.This study,therefore, is aiming at discussing the
level of patient satisfaction and identifies& examines determinant factors that influence
customer/patient satisfaction in Ethiopia public hospitals context.
1.2. Statement of the problem
Health Service sector is one of the major healthcare service providers in the country.
Complaints about poor customer care in hospitals are rife and the most cited health
institutions are government hospitals. In recent times, this sector encountering an army of
problems with poor customer care and poor quality service in government healthcare
institutions thus greatly affect its corporate image. Due to poor customer care and satisfaction
in government hospitals, it failed to attract healthcare customers. In addition, the government
hospitals health workers poor attention, negative attitudes and behaviors towards their
clients/patients, intense competition between public and private health institutions, lack of
modern equipments and significant shift of customers from government hospitals to private
hospitals adversely affect the government hospitals revenue and it leads to declining revenue,
no quality service delivery for clients/patients, acute financial crunch and failed to modernize
government hospitals to satisfying the customers(Srinivasa,2015).
Despite major strides to improve the health of the population in the last one and half decades,
Ethiopia’s population still face a high rate of morbidity and mortality and the health status
remains relatively poor (HSDP, 2010/11 – 2014/15).In Ethiopia, 35.5% of maternal deaths
that occurs in hospitals are related to medical errors and inadequate hospital services such as
lack of blood for transfusion, delay in transfusion, and inappropriate treatment (Hailue and
Mesfin, 2014). Although infrastructure expansion was phenomenal in Ethiopia in the last
decade, some health facilities were made operational without the necessary materials and the
necessary human resources, which cast doubts about the service quality rendered in the
rapidly expanding facilities. This demonstrates that there has been low customer care inthe
public health sector.
One of the main factors that hinder access to quality healthcare is inadequate financing. In
Ethiopia, public health facilities are increasingly unable to finance standard health care. Many
facilities often fall short of operational costs and are usually unable to pay for standard
medical supplies and equipment. This has led to the deterioration in the quality of services
provided in public hospitals, decreased staff motivation and increased movement of health
workers from the public to private hospitals and to greener pastures abroad (Zelelew, 2014).
Delivery arising from overcrowding, and shortages of equipment, supplies, and trained staff,
management weaknesses, professionally unethical both in structure and staffing and to the
absence of good controls and systems, This has drastically affected the service quality and
satisfaction in the hospital (all Africa.com, 2017).
A study from Bangladesh reported that the most powerful predictor ofclient satisfaction with
health services was provider behavior, especially respect and politeness. It is indicated that
health care systems in most developing countries suffer from serious deficiencies in
financing, efficiency, equity, and quality and are poorly prepared to meet these challenges
(Peter, 2010).
Several studies conducted in the Out Patient Departments of different hospitals in Ethiopia
revealed client satisfaction level ranging from 22.0% in Gondar to 57.1% in Jimma. Long
waiting hours during registration, visiting of Doctors after registration, laboratory procedures
and re-visiting of the Doctor for evaluation with laboratory results, failure to obtain
prescribed medications from the hospitals' pharmacies and difficulty to locate different
sections were the frequently faced problems affecting utilization leading to dissatisfaction
(Dagnew M, Zakus D, 2006).
Patient satisfaction is a very important aspect of medical care. We may have the most
renowned medical professionals and infrastructure available, but there are many factors that
affect patient satisfaction. We may not be aware of all of them. In modern times when
expectation from healthcare institutions are increasing and level of satisfaction is decreasing,
leading to increased number of legal suits and physical manhandling of medical
professionals,it is very important to know the variables affecting patient satisfaction. Hence it
was decided to take up the present study.
This study would have an important input in assessing the level of patient satisfaction and
examine the factors affecting the patient' satisfaction and provide a recommendation on an
improved health service delivery that will be helpful to fill research knowledge gaps which
ultimately contributes to enhance the quality of patient services in the hospital.
1.3. Research Hypothesis
In order to address the research problem appropriately and propose applicable solutions, ten
research hypothesesare designedto level of patient ' satisfactionin public hospitals.
Research Question
 H1: Responsiveness has a significantly positive influence on patient satisfaction.

 H2: Empathy has a significantly positive influence on patient satisfaction.
 H3: Assurance has a significantly positive influence on patient satisfaction.
 H4: Reliability has a significantly positive influence on patient satisfaction.
 H5: Tangible has a significantly positive influence on patient satisfaction
 H6: Familiarities has a significantly positive influence on patient satisfaction.
 H7: Trust has a significantly positive influence on patient satisfaction.
 H8: Communication has a significantly positive influence on patient satisfaction
 H9: Friendship between hospitals and the patient has a positive impact on satisfaction.
 H10 Caring capabilities of a healthcare provider positively influence patient satisfaction
1.4. Objectives of the Study

The general objective of this study was to empirically examine and investigate the role of the
service quality and interpersonal bonds dimension on the overall satisfaction of patients in
public hospitals in Ethiopia.
1.3.1. Specific objectives
The specific objectives of the study are:
 To assess the level of customers satisfaction in public health hospitals in Ethiopia
 To examine the service quality dimensions which play an important role in
customer satisfaction
 To examine the interpersonal bonds dimensions which play an important role in
customer satisfaction
1.5. The Significance of the Study
Understanding satisfaction and service quality, for some considerable time, been recognized
as critical to developing service improvement strategies, this study is significant in that it will
also help to identify factors determining patient satisfaction with the public hospital service
given. The result of the study will be used as an input for health care planners, policymakers,
and managers to improve the health care; to modify their service delivery in order to make
their patients’ more satisfied with the provision of the care. In addition, the study will be used
as baseline information that would enable governmental and non-governmental bodies and
health planners to make professional decisions or to further study in the area of patient
satisfaction.
1.6. Scope and limitation of the Study
This study is limited to the investigation of the determinants’ of patient satisfaction in the
public health sector in Ethiopia with specific reference to 8 selected referral hospitals in
Addis Ababa, Oromia, and SNNP. This study will not be able to examine all the factors that
influence patient satisfaction in the public health sector in Ethiopia but will only examine
specific factors such as Reliability, Responsiveness, and Tangible, Assurance, Empathy,
Trust, Familiarity, rapport, friendship and care.
1.7. Definition of key Terms
 Functional qualityrefers to the manner in which the healthcare service is delivered to
the patients
 Health servicesa wide array of services that affect health, including those for physical
and mental illnesses.
 Service quality: Service quality is defined as “a global judgment or attitude relating
to the overall excellence or superiority of the service” (Parasuraman et al., 1988
 Technical quality refers on the basis of the technical accuracy of the medical
Diagnoses and procedures or the conformance to professional specifications, (Choi, et
al 2008)
 Independent //predictor/Variable: A variable that predicts/explains other variables
 Dependent /criterion/ Variable: A variable that is predicted by another variable
 Reliability: Extent to which a measurement procedure “would” yield the same result
upon several independent trials under identical conditions. In other words, low
random measurement error (any systematic error would replicate).
 Extraneous variablesare all variables other than the independent variables that affect
CHAPTER 2
LTTERATURE REVIEW
2.1. The ServiceWorld
The service industry differs greatly, especially among nations. For instance, the government
delivers services through hospitals, courts, police and fire departments, postal services,
employment services and schools (Kotler, 2005). The service world expectations are well
defined by service marketers as “meeting or exceeding customer expectations (Kong, 1996,
p. 6). Service managers have to manage these expectations in order to satisfy clients (Peters,
1988).Customers that share the same values and expectations might be of help by offering
possible market segmentation strategies as suggested by (Jean trout, 1994). In order to
improve the Service industry, marketers can match these two core concept namely; service
quality and customer satisfaction inmarket theory and practice (Mackoy, 2011). Today, there
is an intense competition in the service industry and it is generally believed that the strategy
to maintain a competitive advantage lies in delivering continuous high quality services
tocustomers. The service industry category includes tourism, health, banking, tertiary
institutions, legal services and a lot of others.It can be intangibility, inseparability, perish
ability and heterogeneity in nature (Bitner M.J., 1998). This implies that the gateway to
customer satisfaction is provided through the delivery of quality services
(Parasuraman.1985). Behind the complexity of the service world lies the concept
ofproductivity.
2.2. Quality and Customer Satisfaction

The only way a private healthcare provider can better align to the ever demanding customers
and retain them is to exceed customers’ expectations by constantly measuring their
expectations and perceptions. A customer service quality expectation has an unquestionable
effect on the preference of a health care provider. Quality also comes with the ability to heal
alongside the customers best interests which include the lowest cost (Ramsaran-Fowdar,
2005). The relationship between service quality and customer satisfaction is reciprocal
(Mnagold & Parasuraman et al., 2010).Customers find it difficult to measure technical quality
in health Care, since SRVIQUAL may be measured using a more technical approach,thus
making it difficult for patients to relate to and understand. At thispoint, patients can only
share, understand and even measure a laboratory technician’s personal hygiene and the
surrounding cleanliness of a place. This is because customers are better placed to understand
functional quality rather than technical quality (Aksarayli, 2010). Service quality may lead to
customer satisfaction (Antreas, 2010).The history of servqual measurements go back a long
way and has been criticized by Drew (2004) on the use of the gap scores. However, in spite
of this criticism, several studies have continued to use ServQual to measure the quality of
care delivered to customers (Headley,1993).
2.3. Service Quality Instrument

The service quality instrument is widely used in many service industries today, such as
hotels, hospitals, universities, transport agencies and many more (Foster, 1995). Most
research work on health care servqual is based on the servqual instruments, even though
several other models assessing health care have been proposed.Coulter (1991) claimed that
there are four areas which need to be considered when assessing the health care environment:
assess the pattern of care for specific patientgroups,assess the treatment procedure, for
example, surgicalprocedures,assess the institutions or the organizations as awhole, andassess
the health caresystem.
Above mentioned areas are considered to be important in many studies related to Customer
satisfaction (Cochrane, 1997). Cochrane also summarized three principles which could be
used to assess medical procedures, such as the effectiveness of the procedure, equality, and
efficiency. Social acceptability was later proposed in addition to the above three by Sitzia
and Wood(1997). Parasuraman, Zeithaml and Berry (1985), recommended ten dimensions to
perceived ServQual namely; tangibility, responsiveness, competence, courtesy, credibility,
access, security, communication reliability and the preparedness to listen to customer
complaints (Boshoff. & Gray, 2004). However, it was later classified by Parasuraman et al
(1998), into five dimensions used by several service industries particularly healthcare
providers, to evaluate their standards (Carmam, Lam, & sheikh, 2006). These five dimensions
considered were asfollows:
Tangibility: this refers to the physical appearance of the personnel, equipment and facilities.
Hospitals or clinics with good infrastructures, neat personnel and equipment visually appeals,
and attracts lots of customers. This simply creates a positive impact and signals quality to
patients, thus encourages them to visit such hospital environments for treatment.
Reliability: this is the ability to perform promised services and duties proficiently to
customers. This dimension is very significant to hospitals that need to evaluate their overall
service quality level. For instance, when hospital schedules are reliable, especially in problem
solving, time, date, recording data, and the fulfillment of an agreement, customers tend to
trust the health provider.
Responsiveness: this is the willingness to provide prompt and helpful services to customers.
Many patients are dissatisfied when they have to wait hours for treatment or consultation.
Hospitals should place more emphasis on promptness and communicate important treatment
plans ahead of time in order to satisfy customers. Dealing with client complaints and requests
is another issue, and hospital personnel should be trained to tackle them easily andreadily
Assurance: the knowledge and courtesy of the health care provider to be able to convey trust
and confidence. “Health is wealth” no one can afford to risk it. Patients/customers with
uncertainty about the service quality have little or no confidence in the healthcare provider.
This seeps into the feelings of doubt about the diagnosis or even the treatment. Health care
providers should endeavor to courteously convey constant trust to the customers
Empathy:This is the ability to provide individualized care and attention to customers.
Generally, a good customer/employee relationship can be established when the employee
understands the personal needs and values of the customer. The attentionpaid to the customer
and the uniqueness in the manner in which this is addressed can build trust, empathy, and
satisfaction between the customer and the service provider.
2.4. Criticisms within Service Quality Dimensions

A significant number of studies recently have used the servqual model as a measuring
framework. Despite the criticisms ofboth theoretical and operational aspects of the ServQual
model. Marketing research literature by Babakus,(1992); Newman, (2001); Smith, (1995),
have exchanged different ideas as well as criticisms in the interpretation and implementation
process of the ServQual framework, thus making the five dimensions of ServQual
questionable (Carman, 1990; Cronin 1992).However, there is no standard measurement or
scale to account for ServQual, even though it is difficult to measure. It is still widely used
simply because it is more adaptable and appropriate in terms of different organizational
settings and also provides a backbone for many research models (Parasuraman, 1988). Buttle
(1996) concurred and stated that ServQual measurement is still very valuable and the most
widely used and appears to be the best existing model as compared with others. While Angur,
(1999) also added that ServQual measurement significantly supports leaders in addressing
complex problem areas especially during service managementcrisis.
2.5. Patient Satisfaction
Patient/customer satisfaction refers the psychological state of patient involves their positive
or negative feelings or attitudes toward their experience and some specific aspects in the
service encounter (Chang et al., 2013). It is a key to long-term success of business, which is
major factor in shaping customer’s intentions for future repurchase. It provides an essential
link between post- purchase phenomena and cumulative purchase in relation to brand
loyalty,repeat purchase,attitudechange(ChurchillandSurprenant,1982). It is argued that
satisfied customers would prefer to share their good experience to their friends and relatives
so they will work as referral thorough words-of-mouth, which motivates even others to make
their purchase desires with the company (Mittal and Kamakura, 2001). Satisfaction is the
difference between performance and expectation but still,somearguethatthereisa
differencebetweensatisfaction and quality. As Parasuraman et al. (1991) stated that
satisfaction is a result of experience or decision made after service experiences whereas
quality is something-
Satisfaction is a feeling of pleasure as a result of achieving something, and an action of
fulfilling desire, expectation and need (Magesh, 2010).
Customers are always selective sotheycomparetheirexpectationsaboutspecificservices or

products, and benefits they achieve from the service. According to Kotler and Armstrong
(2012), satisfaction is an individual’s feeling of disappointment or pleasure
resultingfromthecomparisonofexpectationinreferenceto the perceived performance of product
or services. Similarly, Zeithmaletal.(2009)statedthatsatisfactionisthemeasure of the capability
of service/product to meet customer’s expectation. In which, Razak et al. (2007) also argued
that satisfaction is the result of customer’s measurement of a specific experience linked with
the service provider. So, if customers are satisfied with the organization’s services, then
customersbecomeloyaltothemandasresultcustomerwill be retained with the company that
provides positive results for the organization because the customer retention also means
increasing customer base, higher market share, higher sales and profit (Karatepe et al.,
2005)already ready for delivery tocustomers.
Satisfaction is the terms related to a particular transaction means the difference between
perceived service and predicted service in contrast with attitudes that are less situation
oriented and more enduring (Zeithaml et al., 2009). There two general conceptualization of
customer satisfactions “cumulative satisfaction” and “transaction specific satisfaction”
(Boulding et al., 1993). Cumulativesatisfactionisdefinedastheoverallcustomer’s evaluation of
consumption experience and transactions specific satisfaction refers to evaluation of
customers on their reactions and experience to particular service encounter (Yi and La,2004).
According to Hill et al. (2007), “Customer satisfaction is a measure of how
yourorganization’s total product performs in relation to a set of customer requirements”.
Obviously, the client’s vision towards any company’s performance is an opinion. The
customer’s view about their satisfaction is in their minds and they may or may not follow the
situational reality. So, measurement of customer satisfaction is all about quantifying how
customer remarks the performance of the service/product providing organization. Thus,
patient/customer satisfaction is a psychological state involves their positive or negative
feelings or attitudes toward their experience with the service encounter. Satisfaction captures
the provision of services/goods that fulfill the patients/customers’ expectations in terms of
service and quality in association to the price paid.
Outcome expectations depend on the end result of care services, and whether or not it equals
the patient’s needs and wants. An example would be that of a patient after a complex surgery;
in this case, patient satisfaction is subjected to a gradual symptomatic relief outcome. (Lee,
2009). Moreover, patients‟ expectations and satisfaction related causal factors certainly
determine the characteristics of patients themselves. One of the most socio-demographic
factors of patient satisfaction is Age. Blanchard CG. & JC.,(2009) stated the fact that younger
generations tend to be less satisfied than the older generation, which explains why the old
easily comply to treatment and demand less from their physicians as compared to the young.
Another demographic factor is the educational level which correlated to satisfaction as
mention by Hall, (1990). Similarly, gender, occupation, cultural origin and Income level
also play an essential part in determining satisfaction levels (Hall JA., 1990).
2.6. Importance of Measuring Patient Satisfaction

Understanding customer satisfaction is essential at every level within an organization.
Achieving satisfaction is worthy in itself even though difficult to accomplish. Measuring
patient satisfaction easily relates to a change in practice to improve the quality of care
provided. It also generates more compliance to care. Measuring satisfaction in hospitals is
beneficial for the economy of many countries.
2.7. Conceptual Framework
A Conceptual framework is a schematic presentation which identifies the variables that when
put together explain the issue of concern (Mugenda and Mugenda, 2003). The conceptual
model of this study put forward some five important factors (interpersonal bonds) and five
dimensions of service quality which contribute to improving customer satisfaction. As
shown in the schematic figure 2.1 of this study, the constructs in model propose that the five
interpersonal bonds as referred by Gremler & Brown (2001) namely; Care, Friendship,
rapport, familiarities and trust are contributing factors to satisfaction. The constructs in the
model also proposes the five dimensions of service quality using the work of Peng and Wang,
(2006) and Parasuraman (1993) namely; Reliability, responsiveness, Tangibility, Assurance
and Empathy. Details of the constructs model with each hypothesized relationship are
confirmed below.
Figure 2: 1 Conceptual framework of the research
The Interpersonal Bond

Trust
Rapport
Familiarities
Friendship
Care
Patient satisfaction
Service quality Dimensions

Reliability
Responsiveness
Tangibility
Assurance
Empathy
Source: Adopted based onParasuraman (1993) and Peng and Wang, (2006)
Independent variables
Familiarity
Familiarity is defined as the customers‟ perspective in terms of how well a service provider
recognizes each customer’s needs and wants‟.
Friendship
Research has confirmed that a reciprocal action plays an important role in the development of
Friendship (Crosby & Cowles, 1990).Most customers think of service providers as their
friends (Price, 1999). Such feelings of friendship can be noticed between health care
providers and patients who meet almost frequently within ashort time interval.
Care
The intangible nature of service indicates some caution when dealing with customers. The
manner in which service providers deliver care is important for the development of customer
trust (Gremler, 2008)
Rapport
Rapport is a positive sentiment from care and friendliness (Tickle-Degnen & Robert, 1990),
while Gremler (2000) believed rapport is a personal connection (with the chemistry of care
and friendliness enjoyed). Rapport is seen as a key element accountable for patient care
(Trojan & Yonge,1993).
Trust
Most often, individuals tend to trust without doing so, consciously. People think they are
independent, but we all rely on other people(s) object(s) or an organization to assist us to
achieve and keep those things in life that are valued the most (Pask 1995).
Tangibility: this refers to the physical appearance of the personnel, equipment and facilities.
Hospitals or clinics with good infrastructures, neat personnel and equipment visually appeals
and attracts lots of customers.
Reliability: this is the ability to perform promised services and duties proficiently to
customers.
Responsiveness: this is the willingness to provide prompt and helpful services to customers.
Many patients are dissatisfied when they have to wait hours for treatment or consultation.
Assurance: the knowledge and courtesy of the health care provider to be able to convey trust
and confidence. “Health is wealth” no one can afford to risk it.
Empathy:This is the ability to provide individualized care and attention to customers.
Generally, a good customer/employee relationship can be established when the employee
understands the personal needs and values of the customer
CHAPTER 3: METHODOLOGY
3.1. Introduction
This chapter presents the various stages and phases that were followed in completing the
study. It involved a blueprint for the collection, measurement and analysis of data. Therefore,
in this section, the research identified the procedures and techniques that were used in the
collection, processing and analysis of data.
3.2. Research Paradigm

Every research project is guided and governed by some underlying beliefs and assumptions.
This set of beliefs relates to the existence and nature of reality (ontology); the perceived
relationship with the object being studied, which is considered real (epistemology); and the
process and means of knowing something considered real (methodology). Orlikowski and
Baroudi (1991) classified research as positivist when there is evidence of quantifiable
measures of variables, hypothesis testing and the drawing of inferences about a phenomenon
from the sample to a stated population. This is relevant to this study, which intends to make
inferences about the effect quality and interpersonal bonds dimensions onpatient satisfaction
based on sample organizations studied.
3.3. Research approach

The method followed in the current study was a quantitative survey method. This strategy is
compatible with the selected paradigm and suitable for the stated purpose of the study. It was
a causal study, which done in a natural environment, i.e. in a non-contrived setting.
3.4. Research Design

Descriptive and Explanatory research designs were used in the study. According to Kothari
(2004) description studies allow facts finding as well as information with important
principles of knowledge and solution as its major purpose is the description of the state of
affairs as it exists at present. The design was appropriate since it allowed the use of research
instruments like questionnaires, further; explanatory research design is suitable for those
studies that seek to determine cause and effect relationship between variables. Variables used
in this study were such as the dependent variable was patient satisfaction in the health sector
and the independent variables are reliability, responsiveness, assurance, empathy, tangibles,
Familiarities, friendship, trust, Rapport and Care.
3.5. Sampling Methods
The study was conducted in Addis Ababa, Bishoftu, Adama and Awassa city. Minilik,
Yekaktit 12, Tirunesh Bejing, Gandi, Zewditu, Bishoftu, Adema and Hawassawere the eight
(8) public hospitals selected purposively.All patients except seriously ill or unable to
communicate admitted to hospitals during the study period were included.
Sample size was calculated using a single population proportion formula considering the
assumptions of 50% satisfaction rate (Medford, 2016) 95% level of confidence, Zα/2 = 1.96,
and a 5% margin of error (e = 0.05):
n= z2Pq
e2
The sample size was 384, and adding for 25% possible nonresponsive rate, the total sample
size was 480 participants. Accordingly, copies of the 480 questionnaire were distributed
among study participants. Therefore, based on the above formula, the sample was calculated
as follows:
n = 1.96 2/0.052 x 0.5 (1- 0.5)
n = 3.84/0.0025 x 0.5 (0.5)
n = 1536 x 0.25 = 384+96
n=480
For the data collection, a three stage sample design was applied. At the first stage, the
8Referral hospitals purposely chosen as primary sampling units these hospitalswere selected
due to the fact that they have been accommodating a significant number of patient per day
from all of the corners. At the second stage of sampling, an equal number of respondents
(480/8=60) were considered at each hospital. Finally, 60 study participants were randomly
picked at each hospital for data collection.
3.6. Method of Data Collection, and Sources

This study relied on primary data which was collected by the use of a questionnaire. The
questions contained in the questionnaire addressed the objective of this study which seeks to
investigate the factors affecting patient satisfaction in public hospitals. Primary data were
collected from the patients of 8 public hospitals using a structured questionnaire. The aim
was to obtain relevant, reliable and sufficient information. For this purpose, only closed types
of questions have been prepared. The questionnaire was adapted from previous studies and
literatures. To enhance its quality, the questionnaire was distributed to areas expertise and
consequently, their comments were incorporated. Besides, in order to ensure its reliability
pilot testing were carried out using Cronbach’s alpha (see Table3.4)
3.7. Instruments and Measure

A part of demographics also used in the questionnaire in which questions related to gender,
marital status, age, education level were included. All measures were obtained by using“Self-
report”questionnaireexceptthedemographicpartall
theitemsweremeasuredonafivepointLikertscalethrough1to5
inwhich1indicatestronglydisagreeand5indicatestronglyagree. The already established scales are
used for measurement.
Table 3.1: Factors of the study
No Factors /Dimensions No of Reference

Items
1 Reliability 4 (Peng & Wang,(2006); Parasuraman A. L., (1993).
2 Responsiveness 4 (Peng & Wang,(2006); Parasuraman A. L., (1993).
3 Tangibility 6 (Peng & Wang,(2006); Parasuraman A. L., (1993).

4 Assurance 3 (Peng & Wang,(2006); Parasuraman A. L., (1993).
5 Empathy 4 (Peng & Wang,(2006); Parasuraman A. L., (1993).
6 Trust 3 (Peng & Wang,(2006); Parasuraman A. L., (1993).
7 Satisfaction 4 (Oliver(1997)
8 Familiarity 5 (Gremler et al.(2001)
9 Rapport 5 (Gremler and Gwinner (2000)
10 Friendship 6 (Gremler and Gwinner(2000)
11 Care 4 Gremler (2001)
Total 48
The five points Likert scale is used 1 for strongly disagree agree to 5 for strongly agree.
3.8. Method of Data Analysis

To prepare the data for the intended analysis, the data were examined for missing values,
outliers and normality. The IBM SPSS statistics 25 was used to prepare the data, for
descriptive and inferential statistics. The regression model was used to test the relationship
between the dependentandindependentvariable.Patientsatisfactionisused as the dependent
variable and the dimension of service quality and interpersonal bonds namely reliability,
responsiveness, assurance, empathy ,tangibles, Familiarities, friendship, Trust, care and
Rapport as the independentvariable The OLS model is as follows:
CSHS=α+β1 x 1+β2 x 2+β3 x 3+β4 x 4+β5 x 5+ β6 x 6+ β7 x 7+ β8 x 8+ β9 x 9+ β10 x 10+e

X1=Reliability, X2=Responsiveness, X3=assurance, X4=empathy,X5=Tangibles. X6=
Familiarities. X7= friendship. X8= Trust. X9=Care. X10=Rapport
In this regression line, α is constant and βs are coefficients, and e is the error term. In order to
check out inter-correlation among variable bi-variate correlation analysis was used. In order
to check the internal consistency among items factor analysis alsoperformed.
3.9. Validity and reliability

Validity and reliability tests were performed on the survey instrument. To determine the
reliability of the questionnaire, the coefficients of Cranbach’s alpha (1951) were taken into
account. The value of Cronbach’s Alpha ranges from 0 (completely unreliable) to 1 (perfectly
reliable). An alpha value of 0.5 to 0.6 is considered acceptable but 0.7 or higher is highly
preferred (Hair et al. 2010). The reliability is supported based on Cronbach’s α greater than
0.70 (Hair et al. 2010). Hence, results from Table 3.2 proven instrument reliability.
. Table 3.2: Describes the Reliability Scores

No Construct No of Items Cronbach Alpha Remark
1 Reliability 4 0.751 highly preferred

2 Responsiveness 3 0.77 highly preferred
3 Tangibility 6 0.781 highly preferred
4 Assurance 3 0.761 highly preferred
5 Empathy 4 0.767 highly preferred
6 Trust 3 0.759 highly preferred
7 Satisfaction 4 0.826 highly preferred
8 Familiarities 5 0.866 highly preferred
9 Rapport 5 0.895 highly preferred
10 Friendship 6 0.756 highly preferred
11 Care 4 0.554 Acceptable
Source: survey data, 2017
3.10. Ethical consideration

Sometimes the researchers undertake research without telling the truth about the purpose and
nature of the research. In addition, sometimes respondents mislead about the reality of the
study because of fearing of lack of confidentiality. The participants in this study were briefed
about the purpose and nature of the study by the enumerators. In relation to this, the
participants were asked for their informed consent to participate in the study. To make the
participant free from stress or anxiety the issue of confidentiality was promised for the
information that they provide.
CHAPTER 4
DATA ANALYSIS AND DISCUSSION
4.1. SampleCharacteristics
GENDER
Out of the total sample size of 450 properly completed questionnaires, the overall
number of male respondents were of 218 (49.3%) and female were 224 (50.73%) Hence,
a slightly higher percentage of females responded to the questionnaire as compared with
the male respondents.
Figure 4.1: Distribution of Respondents by Gender

Male Female
Female ; 0.507; 51%

Male ; 0.493; 49%
Age and experience of the respondents with the hospital
Table 2.1.displays the age and experience of the of respondents with the hospital in
percentages, whereby respondents under 30 years of age represented in total 119(27%) of the
sample size; whereas between the ages of 30-45,227 (51.5%) were part of the sample size,
and between the ages of 46-60, 82 (18.6%) and finally abovethe ages of 60, just13 (2.9%)
were recorded as the smallest group of respondents. Most of the respondents were between
the ages of 30and 45 followed by the second largest group of respondents below 30
years.The composition of the respondents by an experience of receiving service at the
hospital is also represented in Table2.1. The findings revealed that the majority 353(80%) of
the respondents had 4 years and above experience with the hospital that enable them to aware
of the issues sought by the study.
Table 4.1: Age of Respondents * Experience of respondents with Hospital Cross tabulation
Experience of respondents with Hospital Total
1-3 years 4-6 years 7 years and

above
Count 56 37 26 119
Below 30
% of Total 12.7% 8.4% 5.9% 27.0%
Count 27 107 93 227

30-45
% of Total 6.1% 24.3% 21.1% 51.5%
Age of Respondents
Count 5 30 47 82
46-60
% of Total 1.1% 6.8% 10.7% 18.6%
Count 0 3 10 13
Above 60
% of Total 0.0% 0.7% 2.3% 2.9%
Count 88 177 176 441
Total
% of Total 20.0% 40.1% 39.9% 100.0%
MARITAL STATUS
Figure 4.2 illustrates the marital status distribution by percentage which clearly indicates
that more than half of the respondents were married with a total number of 312 (69.3% ),
single second by 101(22.4%) respondents , and 29 (6.4%)were divorced respondents,
followed by any other status represented by a total of 5 (1.1%).
Figure 4.2 Distributions of Respondents by Marital Status
350
312
300
250
200
150
101
100
50 29
5
0
Single Married Divorced Others
EDUCATIONAL LEVEL
Out of the total sample size of 450, the majority came from respondents who held Bachelor
degrees representing a total of 205 (46%), followed by 142 (32%) respondents with diploma.
Thirdly, a total of 51 respondents (111.3%) had certificate. A total of 19(4.2%) respondents
had achieved master levelsas seen on figure 4.3below.
Figure 4.3 Distribution of the Education Level of the Respondents

Below 10 grade Certificate Diploma
Degree Masters
4% 6%
11%
46%
32%
4.2. Descriptive statistics

The most important factors that influenced respondents in search of quality and satisfactory
services were Trust” (mean score = 3.37), “Familiarity” (mean score = 3.2977),
“Rapport”(mean score =3.2769), “Reliability ”(mean score = 3.2744), “Tangibility ”(mean
score = 3.2445), “Care ”(mean score = 3.2394) , “Empathy ”(mean score = 3.2257), “Care
”(mean score = 3.2394), “Assurance ”(mean score = 3.2187) “Responsiveness ”(mean score
=3.2145) followed by the least important factor that influenced patient/respondents
satisfaction and choice of healthcare,” Friendship”(mean score = 3.1828) as indicated in
Table 4.2. The Cranbach’s α value of each dimension is also
calculatedinwhichhighestvalueis.895and.866 thatisthevalue of patient rapport and
familiarities respectively.
Table 4.2: Shows Mean, Cronbach Alpha and STD of all Variables (excluding satisfaction)
N Mean Std. Deviation
Cronbach Alpha
Reliability 450 3.2744 .93251

0.751
Responsiveness 450 3.2145 1.03548

0.77
Tenability 450 3.2445 .85348

0.781
Assurance 450 3.2187 1.01301

0.761
Empathy 450 3.2257 .95798

0.767
Trust 450 3.3732 .99227

0.759
Familiarity 450 3.2977 1.00459

0.866
Rapport 450 3.2769 1.00982

0.895
Friendship 450 3.1828 .80029

0.756
Care 450 3.2394 .97167

0.554
Valid N (list wise) 450

Table 4.3: Level of satisfaction of respondents with the different components of satisfaction (n = 450)
Satisfaction items measured (Oliver1997) N Mean Satisfaction (%)
I am satisfied with the overall service quality delivered by the of 450 3.148 62.96%
hospital.
I am satisfied with the professional competence of this health care 450 3.3267 66.534%
provider.
I am satisfied with the performance of the frontline employees of 450 3.2589 65.178%
this health care service provider.
I am satisfied with the cost provided for the services offered 450 3.5367 70.734%
Overall sample mean 3.317575 66.3515%

In all satisfaction item measured, “Cost of the service” was scored the highest 3.5369 (70%)
proportion of satisfaction while the overall service quality delivered by the hospital had the
lowest 3.148 (62.96) proportion of satisfaction. The result in the table above shows that the
overall level of sampled Patients satisfaction was 3.3175(66.35%)
4.3. Factor analysis

We thoroughly analyzed the results of this section that were collected from 450 respondents.
Application of principal component analysis using SPSS was employed to investigate the
latent factors linked to those 48items. The Kaiser-Mayer- Olkin and Bartlett's Test of
Sphericity was carried out to check the strength and sufficiency of sample and relationship
among variables. Generally, data are factorable if the KMOMSA is between 0.5 and 1 and the
BTOS is significant (that is, below 0.05) (Hair. 2010). Further, the sample size should satisfy
the case-to-variable ratio of 5:1 as a minimum, but would preferably be 10:1. In this study,
KMOMSA (0.961), BTOS (0.000) and case to the variable ratio (9:1) revealed data are
factorable (Table 4.4)
Table 4.4 KMO and Bartlett's Test
Kaiser-Meyer-Olkin Measure of Sampling Adequacy. .961

Approx. Chi-Square 13848.518
Bartlett's Test of Sphericity Df 1326
Sig. .000
Table 4.5: Shows Factor Loadings of all Variables
Variables Factor Loadings SMEAN(Emp6.4) .629

Reliability Trust
MEDIAN(Rel2.1,2) .540 SMEAN(Tr7.1) .690
MEAN(Rel2.2,2) .599 SMEAN(Tr7.2) .602
SMEAN(Rel2.3) .606 SMEAN(Tr7.3) .643
SMEAN(Rel2.4) .549 Satisfaction
Responsiveness SMEAN(Sat8.1) .664
SMEAN(Res3.1) .519 SMEAN(Sat8.2) .624
SMEAN(Res3.2) .564 SMEAN(Sat8.3) .513
SMEAN(Res3.3) .593 SMEAN(sat8.4) .564
Tangibility Familiarities
SMEAN(Tan4.1) .716 SMEAN(Fam10.1) .615
SMEAN(Tan4.5) .492 G SMEAN(fam10.5) .614
SMEAN(Tan4.6) .650 Rapport
Assurance SMEAN(Rap11.1) .667
SMEAN(Ass5.1) .589 SMEAN(Rap11.2) .689
Empathy SMEAN(Rap11.5) .682
SMEAN(Emp6.1) .598 Friendship
SMEAN(Emp6.2) .585 SMEAN(Fr12.1) .608
SMEAN(Emp6.3) .537 SMEAN(Fr12.2) .658
SMEAN(Fr12.3) .625 SMEAN(Car13.2) .531
SMEAN(Fr12.6) .584
Care
SMEAN(Car13.1) .612
Table 4.5 above presents the composite reliability of factor loadings for each variable. This
means variables were selected to relate the importance of individual respondents on certain
factors when choosing a particular healthcare provider during times of need. The minimum
factor loading was .492 from tangibility and maximum 0.716 from tangibility, out of
48factors. In the current study factor with the loadings greater than 0.5 are accepted. We have
dropped one variable (Tan4.5) on the basis of our results which have a loading of less than
0.5.
4.4. Inferential statistics
4.4.1. T-Test
Table 4.6: Patient Satisfaction Level with hospital service
Test Value = 0
t df Sig. (2-tailed) Mean Difference 95% Confidence Interval of the

Difference
Lower Upper
Satisfaction 71.648 449 .000 3.32173 3.2306 3.4128

One sample t-test was employed to examine the patient satisfaction level with hospital
service. The study revealed that the rate of overall patient satisfaction lies between mean
score of 3.2306 (64.6%) and3.4128 (68.25%). The one sample t-test found to be statistically
significant (p < 0.01).
Table 4.7: Service quality level of hospital service
Test Value = 0
t df Sig. (2-tailed) Mean Difference 95% Confidence Interval of the

Difference
Lower Upper
Service quality 86.362 449 .000 3.23552 3.1619 3.3092

One sample t-test was also employed to examine the service quality level of hospital service
with respect to SERVIQUAL quality dimensions. The results from the above table revealed
that the overall service qualitylevel of public hospitals lies between mean score of 3.16
(63.2%) and 3.3092 (66.18%). The one sample t-test found to be statistically significant (p <
0.01).
4.4.2. Regression Analysis

Analysisofregressioncoefficientsexplainstherelationship between dependent and each
independent variable. To evaluate the relative significance of each dimension in the
prediction of the patient’s satisfaction, the linear regression analysis was performed. Based on
the regression results, the R2 value of this study model was 0.70 and therefore 70% of the
variance of patient’s overall satisfaction is explained by the service quality and interpersonal
bonds dimensions. This means that other factors not studied in this research contribute 30%.
Therefore, further research should be conducted to establish other factors affecting
satisfaction.
The regression coefficients show that the regression model was statistically significant and
six independent variables were positively effective in the patient satisfaction, but the
reliability, empathy, care and friendship did not significantly affect the patient’s overall
satisfaction (Table 4.8).Therelativeimportanceoftheservicequality and interpersonal bonds
dimensionswasindicatedbytheirStandardized Beta Coefficients. As is evidentfrom Table
4.8, the strongest impact on satisfaction was by trust (β = 0.294). The next most
important was familiarity (β = .279), followed by assurance (β = .140),rapport (β =.135),
tangibility (β =.109 and responsiveness (β =.0.084).
 Here X1(Responsiveness) =0.084 i.e. 100% change in Responsiveness leads

to 8.4% change in customer/patient satisfaction level.
 X2(Tangibility) = 0.109 i.e.,100%changeintangibility leadsto10.9% change in

customer satisfactionlevel.
 X3 (Assurance) =0.140 i.e. 100% change in assurance leads to 14% change in

 X4 (Trust) =0.294 i.e.100% change in trust leads to 29.4% change in

customer satisfaction level.
 X5(Familiarity) =0.279i.e. 100%changeinFamiliarityleadsto27.9% change in

 X6 (Rapport) =0.135 i.e. 100% change in rapport leads to 13.5% change in

Table 4.8: Regression coefficient analysis of the model

Squared Multiple Correlations(R2)= 0.70, Sig. : 0.000b and constant =-0.061
Dependent variable Path Independent variable Standard Beta t P
Satisfaction <--- .044 1.149 .251

Reliability
Satisfaction <--- .084 -2.040 .042
Responsiveness
Satisfaction <--- .109 3.066 .002
Tangibility
Satisfaction <--- .140 3.079 .002
Assurance
Satisfaction <--- .010 -.247 .805
Empathy
Satisfaction <--- .294 7.817 .000
Trust
Satisfaction <--- .279 5.857 .000
Familiarity
Satisfaction <--- .135 2.941 .003
Rapport
Satisfaction <--- .077 1.802 .072
Friendship
Satisfaction <--- .019 .554 .580
Care
Multicollinearity was also checked for the structural model using the variance inflation factor
(VIF) and the tolerance statistics. A tolerance close to 1 means there is little multicollinearity,
whereas a value close to 0 suggests that multicollinearity may be a threat. The reciprocal of
the tolerance is known as the Variance Inflation Factor (VIF). VIF value below 10 reveals
there is little multi-collinerity. For the current model, the VIF values are all well below 10
and the tolerance statistics are all well above 0.295, confirms multicollinearity is not a
problem (see Table 4.9)
Table 4.9: Colinearity Statistics coefficient

Model Colinearity Statistics
Tolerance VIF
Reliability .462 2.163
Responsiveness .392 2.549
Tangibility .528 1.894
Assurance .326 3.071
Empathy .430 2.324
1
Trust .473 2.116
Familiarity .295 3.389
Rapport .319 3.139
Friendship .366 2.735
Care .577 1.734
Dependent Variable: Satisfaction Source: survey data, 2018
a.
4.4.3. Bivariate correlation analysis
The correlation matrix for factors is displayed in Table 4.10 all the correlation
coefficients are positive, with a maximum value of 0.758 and a minimum value of 0.517.
Furthermore, they are all significant at the 0.01 level, thereby implying that the
coefficients are significantly different from zero. It should, however, be noted that this is
not a cause-and-effect relationship. The study revealed that there were strong positive
correlations between all independent variables and satisfaction i.e. as levels of all
independent variables increased, so did levels of satisfaction.
Table 4.10the bivariate correlation matrix for the whole factor
Responsevnes
Satisfaction
Tangibility
Familiarity
Friendship
Assurance
Reliability
Empathy
Rapport
Trust
Care
s
1 .623 .583 .551 .67 .575 .722 .758 .705 .656 .517
Pearson Correlation
6
.000 .000 .000 .000 .000 .00 .000 .000 .000 .00
Satisfaction Sig. (2-tailed)
0 0
45 450 450 450 450 450 450 450 450 450 450
N
0
4.4.4. Hypothesis testing

Table 4.11: summary of hypothesis testing
Hypothesis Hypothesized path Standard Beta P-value Correlation t-value Results
H1 REl SAT .044 .251 0.623 1.149 Not supported
H2 RES SAT .084 .042 0.583 2.040 Supported
H3 TAN SAT .109 .002 0.551 3.066 Supported
H4 ASS SAT .140 .002 0.676 3.079 supported
H5 EMP SAT .010 .805 0.575 0.247 Not Supported
H6 TRU SAT .294 .000 0.722 7.817 Supported
H7 FAM SAT .279 .000 0.758 5.857 Supported
H8 RAP SAT .135 .003 0.705 2.941 Supported
H9 FRI SAT .077 .072 0.656 1.802 not supported
H10 CAR SAT .019 .580 0.517 0.554 Not supported
Satisfaction = SAT, Reliability =REL, Responsiveness=RES,Tangibility=TAN,Assurance-ASS,Empathy=EMP,Trust=TRU,
Familiarity=FAM,Rapport=RAP, Care =CAR, Friendship=FRI
The P- values of H2,H3,H4,H6,H7 and H8 are less than 0.05, which indicate that loading
factors have statistically meaningful difference with zero. Therefore, the six hypotheses are
accepted in this study.
4.5. Discussion of the Main Findings
This study has examined the effect of service quality and interpersonal bonds dimensions on
patient satisfaction in the public hospitals in Ethiopia. It has also examined the service quality
perception of the patients/customers of the public hospitals as well as the
levelofpatientsatisfactioninthepublic hospitalsinthe study area.
The evaluation of mean scores for the factor of service quality implies that all the
components of service quality has mean score of (3.16 <<3.31) out of 5; and the overall
service quality has mean scores 3.23 which represent 64.7% indicates that public hospitals
are providing average (Majid and McCafer, 1997) level of quality in the view of
patients/customers.Similarly, the overall rate of patient’ satisfaction was 3.32 (66.43%) at
95% CI indicating that there is also average level (Majid and McCafer, 1997)of patient
satisfaction at the public hospitals. The overall patient satisfaction in this study is very low
compared to studies done in Asella hospital (Ethiopia), where the rate of patient satisfaction
was 80.7% (R. Amdemichael, M. Tafa, and H, 2013). It is low as compared to studies done
in Nigeria and India. The satisfaction rate was 96.1%, and 89.1% of the patients were
satisfied (A. O. Adekanye, 2013). In Ethiopia Black Lion Referral Hospital (BLRH) also, the
overall patient satisfaction rate was high (90.1%) (M. Molla, A. Berhe, 2014). In Ethiopia
Mekelle Hyder referral Hospital, the overall patient satisfaction rate was 79.7% (Taklu and
Hinsermu, 2018).The difference might be due to characteristics of the study population.This
precisely means that the public hospitals have significant limitations in terms of satisfying its
customers/ patients need and wants.
Similarly, the evaluation of inter-correlation between the

factorsofservicequalityandinterpersonal bonds along with patientsatisfactionshowsthat each
dimension of service quality and interpersonal bonds are positively correlated with patient
satisfaction and which is also significant at the 0.01 level. The findings are consistent with
many previous studies. Oliver (1993) asserted that quality of
serviceisantecedenttocustomersatisfactionirrespectiveof whether the constructs are
transaction specific or cumulative. Whereas service quality emphasizes on the specific
dimension of service, unlike this, satisfaction is a broader term however the factors such as
product directly or indirectly affect customer’s satisfaction and perceived service quality is an
indispensable component of determining customer satisfaction (Zeithaml et al., 2009).
Similarly, a research by Agarwal and Singh (2016) found significant relationships between
service quality dimension and patient satisfaction. Another study by Chang et al. (2013) also
found significant links between service quality and patient satisfaction in interpersonal –
based medical servicesencounters.
Next, regression analysis demonstrates that the R2 value of this study model was 0.70 and
therefore 70% of the variance of patient’s overall satisfaction is explained by the service
quality and interpersonal bonds dimensions. This means that other factors not studied in this
research contribute 30%. Therefore, further research should be conducted to establish other
factors affecting satisfaction. The regression coefficients show that the regression model was
statistically significant and six independent variables (Trust, familiarity, tangible,
responsiveness, rapport and assurance) in the model have significant impacts on patient
satisfaction, but the reliability, empathy, care and friendship did not significantly affect the
patient’s overall satisfaction.
Therelativeimportanceoftheservicequality and interpersonal bonds
dimensionswasindicatedbytheirStandardized Beta Coefficients. The strongest impact on
satisfaction was by trust (β = 0.294). The next most important was familiarity (β = .279),
followed by assurance (β = .140), rapport (β =.135), tangibility (β =.109 and
responsiveness (β =.0.084). The P- values of H2, H3, H4, H6, H7 and H8 are less than 0.05,
which indicate that loading factors have statistically meaningful difference with zero.
Therefore, the findingssupportthe six hypotheses are accepted in this study.This result is
consistent with many earlier studies in other settings and other industries. A study by
Andaleeb (2001) found that service quality has significant impacts on patient satisfaction in
the hospitals in a developing country. Similarly, according to Pouragha and Zarei (2016),
service quality dimensions have significant impacts on outpatient satisfaction. Similarly,
another study by Alghamdi (2014) found statistically significant impacts of service quality
factors on patient satisfaction. Likewise, as Wilson et al. (2008) asserted that service quality
is very important to provide a higher level of customer satisfaction. Thus, the result of this
research is consistent with many earlier studies.
CHAPTER5
CONCLUSION AND RECOMMENDATION
5.1. Conclusion
Successofanycountrydependsonitspeopleiftheywerehealthy then they will be active and can do

better for their country by actively participating in their work, but if they were not healthy,
they cannot actively participate in their work, so it is very important to upgrade hospitals and
improve their service quality in order to satisfied patients. It is also important to identify
whether people are satisfied with their hospital or how much they are satisfied with the
services of their hospital.
This empirical research investigated the effect of service quality&interpersonal bond

dimensions on patient satisfaction in the public hospitals in Ethiopia. This research has also
evaluated the perceptions of the customers about service quality in public hospitals andthe
extent of their satisfaction.Theresearchwasconductedthroughthe influenceofpositivism
philosophy and deductive approach. The ten hypotheses were generated with the help of
existing knowledge and literature related to service quality, interpersonal bonds and
patient/customer satisfaction.Theformulatedhypothesesweretestedthrough primary data
collection from the patient/customers of different8 public hospitalsinEthiopia.
The researcher targeted a sample of 482patients but managed to obtain the correct responses
from 450 representing 93.36 % response rate. Female formed the majority of the respondent
than their male counterparts. The result of the study was obtained from the evaluation of
primary data with the help of statistical tools using SPSS 21.The evaluation of mean scores
for the factor of service quality implies that all the components of service quality have mean
score more of 3.23 out of 5; which represents 64.7% indicatethat public hospitals are
providing average (Majid and McCafer, 1997) level of quality in the view of
patients/customers. Similarly, the assessment of mean
scoresforthecomponentsofpatientsatisfactionlies between mean score of 3.2306 (64.6%) and
3.4128 (68.25%) at 95% confidence interval indicating the average level of patient
satisfaction at the public hospitals. The evaluation of inter-correlation between the
independent and dependent variables shows that each dimension of independent variables is
positively correlated with dependent variable (patient satisfaction), and which is significant
at the 0.01 level.
Similarly, the six constructs such as Trust, familiarity, tangible, responsiveness, rapport and
assurance used in this study explain 70 % variance in the overall satisfaction of
patients. In this study, however, the reliability, empathy, care and friendship constructs in
the model did not significantly affect the patient’s overall satisfaction. Our empirical
findings provide several important managerial implications for public hospitals by
offering them practical guidelines to improve quality attributes that would increase
patient satisfaction. From a strategic standpoint, hospital officials can determine
therelativeimportanceofthe ten servicequality and interpersonal bond dimensionsinpredicting
patient satisfaction. By doing so, hospital officials can determine which dimension(s) they
should pay most attentionto.
5.2. Recommendations
Public hospitals should pay attention toanycomplaint from the patients, and resolve
immediately. In order to improve patient satisfaction, the researchers recommend the
introduction of a separate wing which engages to redress consumer grievances. In this
context,Hospital is one of important place where all types of people are using services. In the
modern period, the private sectors are offering competitive health care services to the people
at par with government health care services. Therefore, itbecomes important to maintain the
quality of health services thereby can retain the customers. The public hospitals can further
focus on employee training and development for the enhancement of quality of service by
particularly focusing on how to enhance patientservice.
Hospital official should encourage employees to create relationships marketing, and have
discussions to help them find solutions to customer problems. Such determination of action
may lead to developing a customer’s level of trust, rapport and familiarity, keeping and
winning a patient in the service industry, especially healthcare institutions greatly depends
on Care alongside satisfactory adjustments. Training and awards should be given to
employees to help improve their social interaction skills at a professional level.
Recognizing the dominant role played by the employees in delivering quality service,
hospital officials should also make sure that there are always sufficient staffing levels.
In so doing, they will optimize service delivery and provide a prompt service at
alltimes.
Giventheimportanceoftangibility, responsiveness and

assuranceasamajordeterminantofsatisfaction,asdemonstratedin this study, it is
imperative for hospital officials to identify the relevant extrinsic and intrinsic cues
used by customers in order to effectively communicate to them the relevant quality
signals. Hospital officials need to ensure that all tangible attributes related to employee
performance create a desirable impact on customer perception of quality. This is
important as customer continue to look for a tangible cue as a means to reduce
perceived risk and describe their service experience (Chen & Chang,2005).
Finally, it is recommended that service quality be assessed on an annual basis. The

initial assessment provides a baseline for comparison with future assessments. This
comparison is essential for monitoring the effectiveness of service quality improvement
efforts and identification of service quality trends as they emerge. The assessment
would also providea broader picture of interest to governments who would then be
aware of the potential areas of interest to their citizens (Scott & Scieff, 1993).
5.3. Limitations and Further Research

The main limitations of this research are: small sample of482 patients from just 8 public
hospitals based in Addis and Its outskirt only; use of quantitative data analysis techniques
only rather than using mixed methods; and use of questionnaires survey with fixed
alternatives for data collection from the patients, in which patients have to choose an answer
from the alternatives provided in the questionnaires, and so they may not provide answer
freely in the survey. So, it is suggested to conduct an extensive research with large sample
survey bytaking many hospitals from differentpartsofEthiopia inordertotestthevalidityofcurrent
research findings.Similarly, the further researcher can identify more factors of
patient/customer satisfaction especially associated to hospitalsector.Future work can also
focus on developing a richer model that incorporates other potential variables beyond the
current used.
Appendices
Questionnaire
Dear Respected Respondents:

The following survey is part of a research project that aims at exploring the ‘Service Quality
and Patients’ Satisfaction in Health Care Service: the Case of Selected Public
Hospitals.’ The information you provide will be used for research purposes only and will be
kept confidential at all level. We would appreciate you for taking your time to complete the
survey. We kindly request you to remember that the quality of this work is completely
dependent upon your frank opinions. Please consider each statement carefully before you
give it an evaluation. If you have any questions or concerns about your rights as a research
participant, please contact the researcher at 0911-317129. Your cooperation is highly
appreciated and valued.
SECTION 1: ORGNIZATIONAL/ RESPONDENT PROFILE
Please Age of Level of Marital Experience Occupation
indicate status
your gender respondents1=Be educatio 1= Single (Years)
0= male, low 30 n 2= 1= 1-3 years
1= female 2=30-45 1= Married 2=4-6 years
3=46-60 Illiterate 3=Divorce 3=7 and
4=above 60 2= d above
Certificat 4=others
e
3=Diplom
a
4=Degree
5=Master
s
6= PhD
Please indicate the extent to which you agree that each of the statements by ticking „√‟ in
the appropriate box (from 1 to 5)
(እባክዎበሚከተሉትዓረፍተነገሮችላይያለዎትንየስምምነትደረጃያመልክቱ፡፡) 1= Strongly Disagree (
በጣምአልስማም) 2 = Disagree ( አልስማም) 3 = Neutral (ለመወሰንያስቸግረኛል) 4 = Agree (
እስማማለሁ) 5 = Strongly Agree( በጣምእስማማለሁ)
SECTION 2: Service quality (የአገልግሎትጥራት)

No Description of items (መግለጫ) 1 2 3 4 5
1 This hospital fulfills its promises to meet patient’s need. (ሆስፒታሉ በቃሉ መሰረት
የህሙማንን ፍላጎት ያሟላል፡፡)
2 The hospital’s personnel can handle a problem in a very good and timely way.
(የሆስፒታሉ ሰራተኞች ችግሮችን በጊዜና በጣም ጥሩ በሆነ መንገድ ይፈታሉ፡፡)
3 The hospital provides services at the promised date and time. ( ሆስፒታሉ በቃሉ
መሰረት አገልግሎቶችን በቀኑና በሰዓቱ ይሰጣል፡፡)
4 The hospital maintains a secure data entry records. (ሆስፒታሉ ደህንነቱ የተጠበቀ የዳታ
አያያዝ ስርዓት አለው፡፡)
5 The hospital’s personnel provide timely and regular information concerning
delivery of services. (የሆስፒታሉ ሰራተኞች አገልግሎቶችን መች እንደሚሰጡ በየጊዜው
ለተገልጋይ መረጃ ይሰጣሉ፡፡)
6 The frontline personnel are prompt in providing services like welcoming
customers, handling emergencies, carrying out diagnosis.( የሆስፒታሉ የመጀመሪያው
ረድፍ ሰራተኞች (frontline employees) እንግዳ አቀባበል፣ ድንገተኛ፣ ምርመራና ሌሎች
ችግሮችን ለመፍታት ዝግጁ ናቸው፡፡)
7 The hospital personnels constantly and readily provide quality services to me.
(የሆስፒታሉ ሰራተኞች በቋሚነትና በተጠንቀቅ ጥራት ያለቸው አገልግሎቶችን
ሰጥተውኛል፡፡)
8 This hospital is using modern, up to date technology and operating facilities.
(ሆስፒታሉ ዘመናዊና ወቅታዊ የቴክኖሎጂ አቅርቦቶችና አገልግሎቶች አሉት፡፡)
9 Equipment associated with services are visually appealing. ( አገልግሎት ላይ ያሉ
የመገልገያ መሳሪያዎች ለዕይታ ማራኪ ናቸው፡፡)
10 The hospital’s employees have neat and professional appearance. (የሆስፒታሉ
ሰራተኞች ንፁህና ሙያዊ አለባበስ አላቸው፡፡)
11 The hospital ensures strict hygienic condition and cleanliness in every level.
(ሆስፒታሉ ጥብቅ የንፅህና አጠባበቅን በሁሉም ደረጃ ያረጋግጣል፡፡
12 I am satisfied with the convenience of the location. (በቦታው ምቹነት ረክቻለሁ፡፡)
13 My doctor has equipment needed to provide complete care. ( ሀኪሜ ሙሉ ህክምና
ለመስጠት የሚያስፈልጉ መሳሪያዎች አሉት/አሏት፡፡)
14 The hospital’s employees instill confidence in me. ( የሆስፒታሉ ሰራተኞች እምነት
እንዳሳድርባቸው/እንድተማመንባቸው አድርገውኛል፡፡)
15 The reputation of this hospital is trustworthy and I always feel secure.( የሆስፒታሉ
ገፅታ እምነት የሚጣልበት ስለሆነ ሁል ጊዜ ደህንነት ይሰማኛል፡፡)
16 Employees of this hospital are always courteous and respect me as a customer.(
የሆስፒታሉ ሰራተኞች ትሁቶች ስለሆኑ እንደደንበኛ ያከብሩኛል፡፡)
17 The personnels listen to me and use language that I can understand.(የሆስፒታሉ
ሰራተኞች ያዳምጡኛል፤ በሚገባኝ ቋንቋም/አነጋገርም ያናግሩኛል፡፡)
18 The personnel in this hospital provide services relying mainly on the customers’s
best interests at heart. ( እዚህ ሆስፒታል ውስጥ ያሉ ሰራተኞች በደንበኛው ፍላጎት ላይ
የተመሰረተና ደንበኛውን ሊያረካ የሚችል አገልግሎት ይሰጣሉ፡፡)
19 The hospital’s employees understand patient’s specific needs and personal
requirement. (የሆስፒታሉ ሰራተኞች የታማሚዎችን እያንዳንዱን የግል ፍላጎት ይገነዘባሉ፡፡)
20 The hospital’s working hours are appropriate to me. ( የሆስፒታሉ የስራ ሰዓት አመቺ
ነው፡፡)
SECTION 3: Trust (እምነት)

1 The billing system of this health care service is trustworthy. 1 2 3 4 5
(የሆስፒታሉ የክፍያ ስርዓት ተአማኒ ነው፡፡)
2 The policies, practices, as well as reputation of this health
care service are trustworthy. ( የሆስፒታሉ ፖሊሲዎችና ልማዶች
እንዲሁም ደግሞ የሆስፒታሉ ገፅታ እምነት የሚጣልበት ነው፡፡)
3 The service process provided by this hospital is secure.
(የሆስፒታሉ የአገልግሎት አሰጣጥ ሂደት አስተማማኝ ነው፡፡)
SECTION 4: Satisfaction (እርካታ)

1 I am satisfied with the overall service quality delivered by 1 2 3 4 5
the of hospital. ( በሆስፒታሉ አጠቃላይ የአገልግሎት አሰጣጥ ጥራት
ረክቻለሁ፡፡)
2 I am satisfied with the professional competence of this health
care provider. ( በሆስፒታሉ ሰራተኞች ሙያዊ ብቃት ረክቻለሁ፡፡)
3 I am satisfied with the performance of the frontline
employees of this health care service provider. ( በሆስፒታሉ
የመጀመርያ ረድፍ ሰራተኞች (frontline employees) የስራ አፈፃፀም
ረክቻለሁ፡፡)
4 I am satisfied with the cost provided for the services offered.
(ለተሰጠኝ አገልግሎት በከፈልኩት ክፍያ ረክቻለሁ፡፡)
SECTION 6: Familiarity (ቤተሰባዊነት)

1 I feel confident when I come to this hospital for treatment. 1 2 3 4 5
(ለህክምና ወደሆስፒታሉ ስመጣ በራስ የመተማመን ስሜት ይሰማኛል፡፡
2 Employees recognize and call me by name. ( ስራተኞቹ አክብረው
በስሜ ይጠሩኛል፡፡)
3 Employees know how to best serve me. ( ስራተኞቹ የተሻለ
አገልግሎት እንዴት እንደሚሰጡኝ ያውቃሉ፡፡)
4 Employees perform services correctly from the first time.
(ስራተኞቹ ከመጀመሪያው ጀምሮ በትክክል ያስተናግዳሉ፡፡)
5 I am comfortable concerning the relationship I have with the
health care personnel. (ከስራተኞቹ ጋር ባለኝ ግንኙነት ደስተኛ ነኝ፡፡)
SECTION 7: Rapport (ተግባቦት)

1 Employees of the hospital easily communicate and collaborate 1 2 3 4 5
with me.
(የሆስፒታሉ ስራተኞች በቀላሉ ተግባቢና ተባባሪዎች ናቸው፡፡)
2 Employees work hard to build a strong relationship with me.
(ስራተኞቹ ከኔ ጋር ጠንካራ ግንኙነት ለመፍጠር ጠንክረው ይሰራሉ፡፡)
3 Employees of the hospital put effort to solve
customers’complaints.
(የሆስፒታሉ ስራተኞች የደንበኞችን ቅሬታ ለመፍታት የተቻላቸውን ሁሉ
ያደርጋሉ፡፡)
4 Services offerd by this hospital makes me feel respected and
welcomed.
(ከሆስፒታሉ ያገኘሁት አገልግሎት በአክብሮትና በጥሩ አቀባበል ነው ፡፡)
5 Employees of the hospital created a trusting and harmonious
relationship with me. (የሆስፒታሉ ስራተኞች ከኔ ጋር አስተማማኝና
ሰላማዊ ግንኙነት ፈጥረዋል፡፡)
SECTION 8: Friendship (ጓደኝነት)

1 I prefer to be served by the same employees.(ከሆስፒታሉ ተመሳሳይ 1 2 3 4 5
ስራተኞች አገልግሎት ማግኘት እፈልጋለሁ፡፡)
2 I am satisfied with the friendliness and politeness of the
employees.
(በስራተኞቹ ትህትናና ቤተሰባዊ ቀረቤታ ረክቻለሁ፡፡)
3 The hospital’s personnel/employees are always helpful to me in
case of any problem. (የሆስፒታሉ ስራተኞች ማንኛውም ችግር
ሲገጥመኝ ለመተባበር ዝግጁ ናቸው፡፡)
4 I care strongly about the employees. (የስራተኞቹ ጉዳይ ያሳስበኛል፡፡)
5 I look forward to meeting with the employees when I visit the
hospital next time (ሌላ ጊዜ ወደሆስፒታሉ ስመጣ ስራተኞቹን በድጋሚ
ማግኘት እፈልጋሉ፡፡)
6 Employees have personal interest in me. (ሰራተኞቹ ከኔ የሚፈልጉት
የግል ፍላጎት አላቸው፡፡)
SECTION 9 Care (እንክብካቤ)

1 Doctors explain the side effect of drugs, check on allergies and 1 2 3 4 5
gives advice. (ሀኪሞቹ ስለመድሃኒቶች የጎንዮሽ ጉዳትናአወሳሰዱን
ያብራራሉ፤አለርጂዎች መፈጠራቸውን ያያሉ፤ ምክርም ይሰጣሉ፡፡)
2 Hospital employees focus on continuity of care .( የሆስፒታሉ
ስራተኞች ቀጣይነት ላለው እንክብካቤ ትኩረት ይሰጣሉ፡፡)
3 Doctors explain prescription, procedures and hold on patient‟s
consent(ሀኪሞች ስላዘዙት መድሃኒት ገለፃ ያደርጋሉ፤ መወሰድ ያለባቸውን
ጥንቃቄዎች ይዘረዝራሉ፤ የታካሚውንም ፍላጎት ግምት ውስጥ ያስገባሉ፡፡)
4 Doctors support patients’ values. (ሀኪሞች የታካሚውን እሴት
ይደግፋሉ፡፡)
5 Employees have personal interest in me( ሰራተኞቹ ከኔ የሚፈልጉት
የግል ፍላጎት አላቸው፡፡)
Thank you for your cooperation

(ለትብብርዎ እናመሰግናለን)!
Factor loading
Extractio
n
This hospital fulfills its promises to meet patient’s need .541
The hospital’s personnel can handle a problem in a very good and timely way .607
The hospital provides services at the promised date and time .588
The hospital maintains a secure data entry records .530
The hospital’s personnel provide timely and regular information concerning delivery of services .504
The frontline personnel are prompt in providing services like welcoming customers, handling emergencies, .577
carrying out diagnosis, and in solving other problems
The hospital personnel constantly and readily provide quality services to me .593
This hospital is using modern, up to date technology and operating facilities .718
Equipment associated with services are visually appealing .547
The hospital’s employees have neat and professional appearance. .514
The hospital ensures strict hygienic condition and cleanliness in every level .529
I am satisfied with the convenience of the location .488
My doctor has equipment needed to provide complete care .643
The hospital’s employees instill confidence in me .596
The reputation of this hospital is trustworthy and I always feel secure. .562
Employees of this hospital are always courteous and respect me as a customer .615
The personnel’s listen to me and use language that I can understand .603
The personnel in this hospital provide services relying mainly on the customers’ best interests at heart .573
The hospital’s employees understand patient’s specific needs and personal requirement .539
The hospital’s working hours are appropriate to me .628
The billing system of this health care service is trustworthy .596
The policies, practices, as well as reputation of this health care service are trustworthy .537
The service process provided by this hospital is secure .629
I am satisfied with the overall service quality delivered by the of hospital .660
I am satisfied with the professional competence of this health care provider .629
I am satisfied with the performance of the frontline employees of this health care service provider .506
I am satisfied with the cost provided for the services offered .551
I intend to continue using this health care service the future .688
Even if other health care providers’ price is lower, I am not willing to change my health care provider .642
I am willing to say positive things about their services to other people .679
I will encourage friends and relatives to use same hospital .677
I feel confident when I come to this hospital for treatment .659
Employees recognize and call me by name .494
Employees know how to best serve me .582
Employees perform services correctly from the first time .612
I am comfortable concerning the relationship I have with the health care personnel .611
Employees of the hospital easily communicate and collaborate with me .671
Employees work hard to build a strong relationship with me. .714
Employees of the hospital put effort to solve customers’ complaints. .601
Services offered by this hospital makes me feel respected and welcomed .671
Employees of the hospital created a trusting and harmonious relationship with me. .688
I prefer to be served by the same employees .609
I am satisfied with the friendliness and politeness of the employees .657
The hospital's personnel/employees are always helpful to me in case of any problem .621
I care strongly about the employees .559
I look forward to meeting with the employees when i visit the hospitals next time .572
Employees have personal interest in me. .580
Doctors explain the side effect of drugs, check on allergies and gives advise .601
Hospital employees focus on continuity of care. .508
Doctors explain prescription, procedures and hold on patient’s consent .650
Doctors support patients' values .499
Extraction Method: Principal Component Analysis.

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ETHIOPIAN MANAGEMENT INSTITUTE

The effect of service quality & interpersonal bond dimensions on

Key word: Service quality, satisfaction, interpersonal bonds, healthy care

 H1: Responsiveness has a significantly positive influence on patient satisfaction.

1.4. Objectives of the Study

2.2. Quality and Customer Satisfaction

2.3. Service Quality Instrument

2.4. Criticisms within Service Quality Dimensions

Customers are always selective sotheycomparetheirexpectationsaboutspecificservices or

2.6. Importance of Measuring Patient Satisfaction

The Interpersonal Bond

Service quality Dimensions

3.2. Research Paradigm

3.3. Research approach

3.4. Research Design

3.6. Method of Data Collection, and Sources

3.7. Instruments and Measure

No Factors /Dimensions No of Reference

3 Tangibility 6 (Peng & Wang,(2006); Parasuraman A. L., (1993).

3.8. Method of Data Analysis

CSHS=α+β1 x 1+β2 x 2+β3 x 3+β4 x 4+β5 x 5+ β6 x 6+ β7 x 7+ β8 x 8+ β9 x 9+ β10 x 10+e

3.9. Validity and reliability

. Table 3.2: Describes the Reliability Scores

1 Reliability 4 0.751 highly preferred

3.10. Ethical consideration

Figure 4.1: Distribution of Respondents by Gender

Female ; 0.507; 51%

Source: survey data, 2018

Age and experience of the respondents with the hospital

Experience of respondents with Hospital Total

1-3 years 4-6 years 7 years and

Count 27 107 93 227

Figure 4.2 Distributions of Respondents by Marital Status

Figure 4.3 Distribution of the Education Level of the Respondents

Source: survey data, 2018

4.2. Descriptive statistics

Reliability 450 3.2744 .93251

Responsiveness 450 3.2145 1.03548

Tenability 450 3.2445 .85348

Assurance 450 3.2187 1.01301

Empathy 450 3.2257 .95798

Trust 450 3.3732 .99227

Familiarity 450 3.2977 1.00459

Rapport 450 3.2769 1.00982

Friendship 450 3.1828 .80029

Care 450 3.2394 .97167

Valid N (list wise) 450

Satisfaction items measured (Oliver1997) N Mean Satisfaction (%)

Overall sample mean 3.317575 66.3515%

4.3. Factor analysis

Kaiser-Meyer-Olkin Measure of Sampling Adequacy. .961

Table 4.5: Shows Factor Loadings of all Variables

Variables Factor Loadings SMEAN(Emp6.4) .629

t df Sig. (2-tailed) Mean Difference 95% Confidence Interval of the

Satisfaction 71.648 449 .000 3.32173 3.2306 3.4128

t df Sig. (2-tailed) Mean Difference 95% Confidence Interval of the

Service quality 86.362 449 .000 3.23552 3.1619 3.3092

4.4.2. Regression Analysis

 Here X1(Responsiveness) =0.084 i.e. 100% change in Responsiveness leads

 X2(Tangibility) = 0.109 i.e.,100%changeintangibility leadsto10.9% change in

 X3 (Assurance) =0.140 i.e. 100% change in assurance leads to 14% change in

 X4 (Trust) =0.294 i.e.100% change in trust leads to 29.4% change in

 X5(Familiarity) =0.279i.e. 100%changeinFamiliarityleadsto27.9% change in

 X6 (Rapport) =0.135 i.e. 100% change in rapport leads to 13.5% change in