Total Quality Management & Business Excellence

ISSN: 1478-3363 (Print) 1478-3371 (Online) Journal homepage: http://www.tandfonline.com/loi/ctqm20

Assessment of hospital service quality parameters

from patient, doctor and employees’ perspectives

Ajwinder Singh, Ajay Prasher & Navdeep Kaur

To cite this article: Ajwinder Singh, Ajay Prasher & Navdeep Kaur (2018): Assessment of hospital
service quality parameters from patient, doctor and employees’ perspectives, Total Quality
Management & Business Excellence, DOI: 10.1080/14783363.2018.1487283

To link to this article: https://doi.org/10.1080/14783363.2018.1487283

Published online: 14 Jun 2018.

Submit your article to this journal

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at

http://www.tandfonline.com/action/journalInformation?journalCode=ctqm20
Total Quality Management, 2018
https://doi.org/10.1080/14783363.2018.1487283

Assessment of hospital service quality parameters from patient,

doctor and employees’ perspectives
a*
Ajwinder Singh , Ajay Prasherb and Navdeep Kaurc
a
Department of Management, IKG Punjab Technical University, Kapurthala, Punjab, India;
b
School of Management, Bahra University, Wankaghat, Himachal Pradesh, India; cDepartment of
Business Administration, Guru Nanak Dev Engineering College, Ludhiana, Punjab, India

The Indian healthcare industry has been growing at a tremendous pace and contributing
a great deal towards the employment and revenue generation for the country. Recently,
medical tourism has also gained a huge impetus as people from all over the globe
visiting India for availing affordable and worldclass healthcare services. Hence,
delivering effective healthcare service quality and understanding the perceptions of all
stakeholders – i.e. patients, doctors and employees – has become very critical for the
success of any healthcare centre. Over a period of time, service providers have been
defining service quality parameters based on their own judgment and trying to deliver
services as per their assumptions. However, patient satisfaction requires a proper
synchronisation between what the patient expects and what the management
perceives. For addressing this issue, six new dimensions were identified using
SERVQUAL and termed it as ‘HealQual’ tool keeping in mind the needs of current
Scenario. The paper would identify those healthcare service quality parameters which
improve patient satisfaction and also generate priority weights from the perspectives
of both service reviewer, i.e. patients and the service provider, i.e. doctors and
employees.
Keywords: Fuzzy analytic hierarchy process; service quality parameters; Fuzzy set
theory; healthcare

1. Introduction
Whether it is healthcare or any other service sector, no one can deny that ‘quality’ plays a
very important role for their success. Majority of marketing managers believed that provid-
ing better service quality is mainly linked with high-cost modalities, which included
expensive infrastructure and equipment. However, no doubt these sophisticated and
costly technology adds up to the quality, but there are also many inexpensive and intangible
aspects (such as the waiting period, interaction among doctor, staff and patient). To remain
continuous in demand, the management must provide the consumer what they expect (Lee,
Delene, Bunda, & Kim, 2000). Most of the firms fail to deliver right service quality due to
the wrong attitude and behaviour of the employees, which significantly influences the cus-
tomer’s perception. Babakus and Mangold (1991) investigated the 'front-stage’ and back-
stage’ perspectives, whereby both the customer and the employees observe different per-
spectives of activities and problems that accompany the service delivery process.
Measuring healthcare service quality includes multifaceted attributes which reflect the
appropriateness of service (Rashid & Jusoff, 2009). Parasuraman, Zeithaml, & Berry (1988)
identified five basic parameters for measuring the service quality i.e. RATER, applicable to
all service industries. Later on it was observed that different service sector have different set

*Corresponding author. Email: ajwinderdhillon@gmail.com

© 2018 Informa UK Limited, trading as Taylor & Francis Group

2 A. Singh et al.

of service quality parameters and these parameters would change while studying different
sectors such as banking, healthcare, financial or real estate (Butler, Oswald, & Turner,
1996; Singh & Prasher, 2017; Weitzel, Schwarzkoff, & Peach, 1989; Yesilada & Direktör,
2010). Therefore, generalising components for improving service quality and control is
becoming difficult with every passing day. Moreover, healthcare service quality largely
depends upon the service providers, which means personal interaction and care plays a
vital role while formulating any strategies (Lupo, 2016).
Over the years, researchers have been developing models with different set of par-
ameters and sub-parameters for measuring service quality suiting the needs of the industry
such as SERVQUAL (Parasuraman, Zeithaml, & Berry, 1985), SERVPERF (Cronin &
Taylor, 1992), Retail Service Quality Scale (RSQS) (Dabholkar et al., 1996), (Knutson,
Stevens, Wullaert, Patton, & Yokoyama, 1990) developed LODGSERV, DINSERV
(Stevens, Knutson, & Patton, 1995), EduQUAL (Khan, 2008), Railqual (Prasad & Shekhar,
2010). Table 1 shows the different set of parameters being used over the years by researchers.
This paper proposed a new model for measuring healthcare service quality called as
‘HealQual’ on the basis of SERVQUAL instrument. The proposed model includes 37
items which were developed using past studies and consulting experts (mainly doctors
and consultants) from the fields of health sector, as shown in Table 2. These 37 items
were categorised into six parameters, i.e. Tangibles, Responsiveness, Reliability, Assur-
ance, Empathy and Trustworthiness.

2. Literature survey
2.1. Healthcare service quality
People judge service quality as low or high on the basis of whether or not the service deliv-
ery meets their expectations (Oliver, 1980). A. Parasuraman, V.A. Zeithaml and L.L. Berry
developed Gap model in 1985 in USA. The gap model is based on the assumption that there
are certain inconsistencies on the organisations’ service quality delivery process, which
brings dissatisfaction among customers. Based on the Gap 5 of the gap model, the SERVQ-
UAL was developed by Parasuraman et al. (1985).
Parasuraman et al. (1985) identified around 10 service quality parameters, i.e. tangibles,
reliability, communication, competence, credibility, courtesy, responsiveness, access,
security and understanding the customer. Later, Parasuraman et al. (1988) collapsed
these parameters into five generic parameters, including tangible, reliability, responsive-
ness, empathy and assurance, for the measuring service quality of any sector.
Francis, Korsch, & Morris (1969) studied 800 out-patient visiting to children’s hospitals
of Los Angeles for the outcome of patient–doctor interaction. The results showed that the
expectation of the patient were not met such as warmth in the patient–doctor relation, causes
of illness and explanation of diagnosis. Most of the organisation fails to deliver what is
expected from them due to the neglected behaviour of their employees, which influences
the perception of the customers and play important role in their decision-making while
choosing a service provider. Fuentes (1999) suggests that heath care service quality is
multi-dimensional in nature and it reflects the appropriateness of the service provided to
customers and also stresses the importance of patient–doctor relationship. Miranda, Cha-
morro, Murillo, & Vega (2010) examined the healthcare service quality using SERVQUAL
by measuring the gap score of patient and managers perceptions. Patients’ satisfaction was
considered as dependent variable and whereas hospital staff (i.e. doctors and nurses),
waiting times and the time it takes to resolve complaints, administrative staff, and cleanli-
ness, equipment and the location of the health centre were taken as independent variables.
Table 1. Summary of the various parameters used by authors.
Authors
Babakus and Bowers, Swan, Pakdil and Prasad and
Mangold and Koehler Li Dean Lee et al. Harwood Ramsaran- Shekhar Buyukozkan
Parameters (1992) (1994) (1997) (1999) (2000) (2005) Fowdar (2008) (2010) et al. (2011)
Tangibles ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Reliability ✓ ✓ – ✓ ✓ ✓ ✓ ✓ ✓
Responsiveness ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Assurance ✓ ✓ – ✓ ✓ – ✓ ✓ ✓
Empathy ✓ ✓ – ✓ ✓ – ✓ ✓ ✓
Credibility/ – – – – – ✓ – – –
trustworthiness
Interactivity – – – – – ✓ ✓ – –
Concern – – ✓ – – ✓ – – –
competence – – – – – ✓ – – –
Security – – – – – ✓ – – –
Courtesy – – – – – ✓ – – –
Emergency – – – ✓ – – – – –
Connection ✓ –– – ✓ –

Total Quality Management

Comfort – – – – – – – ✓ –
Convenience – – – – – – – ✓ –
Core medical – – – – ✓ – ✓ – –
service
Professionalism/ – – – – ✓ – ✓ – ✓
skill
Caring – ✓ – – – – – –
Patient outcomes – ✓ – – – – – –
Access – – – – – ✓ – – –
Equipment – – – – – – ✓ – –
Source: Authors compilation of data.

3
4 A. Singh et al.

Table 2. Healthcare service quality requirements.

Item.
No. Items describing healthcare service quality Source
1 The medical equipment’s are up-to date, complete and Ramsaran-Fowdar (2008)
properly sterilised before use.
2 Treatment is accurate and consistent over a period of time Buyukozkan et al. (2011)
3 Confidentially of every type of patient’s record (e.g. Pakdil and Harwood (2005)
information about patients)
4 The front line staff listen to the patient’s queries calmly Proposed by experts
5 Doctors should be respectful for patients Proposed by experts
6 The patients should not wait long for their turn Buyukozkan et al. (2011)
7 Providing guarantee of successful medical treatment Proposed by experts
8 Non-Recommendation of unnecessary medical tests by the Proposed by experts
doctors to increase the bill
9 Hospital staff (nurses and FLE) is knowledgeable Maruvada and Bellamkonda
(2010)
10 Infrastructure and building layout is modern Buyukozkan et al. (2011)
11 The front line staff shows promptness in dealing with Prasad and Shekhar (2010)
patients concerns
12 Non-overcharging for the medical treatment Proposed by experts
13 Patient are thoroughly informed about their treatment Ramsaran-Fowdar (2008)
14 Individualised service and consideration to the needs of Bowers et al. (1994)
patients
15 The environment of hospital is clean and hygienic Naik, Gantasala, and
Prabhakar (2010)
16 Regular monitor of patient health Proposed by experts
17 Hospital staff is quick in delivering service Buyukozkan et al. (2011)
18 The medical fees is uniform for all and with no Buyukozkan et al. (2011)
discrimination
19 Hospital staff is always well dressed. Buyukozkan et al. (2011)
20 Minimal ignorance on the part of staff. Proposed by experts
21 Reports providing test results are not manipulated Proposed by experts
22 Adequate space for the patient to move in hospital. Proposed by experts
23 Hospital has a positive image in the market Clow, Garretson, and Kurtz
(1994)
24 Interaction between staff and patient’s is pleasant Proposed by experts
25 Inspiring confidence and trust in patient’s Pakdil and Harwood (2005)
26 Doctors having good knowledge to answer patients queries Proposed by experts
27 Hospital management staff handles patient’s grievances in Naik et al. (2010)
a healthy manner
28 There is ample parking space for the customers Barsky and Labagh (1992)
29 Complexity of medical procedures Proposed by experts
30 The doctors show positive concern towards patient’s Li (1997)
problems
31 Hospital has all kind of medical services and treatments Buyukozkan et al. (2011)
32 Doctors should be willing to help patients Buyukozkan et al. (2011)
33 Prescribing relevant medicines to the patient Proposed by experts
34 The doctors examining the patient’s has got the requisite Buyukozkan et al. (2011)
skills and qualification
35 Consideration to patient post-treatment problems Proposed by experts
36 Patient room is comfortable Prasad and Shekhar (2010)
37 Immediate response to patients call Proposed by experts
Source: Authors compilation of data.
 Total Quality Management 5

The results of their findings revealed that there is a gap between the perceptions of managers
and patients and mostly showed statistically significant negative values.
Ramseook-Munhurrun, Lukea-Bhiwajee, & Naidoo (2010) examined the quality of ser-
vices offered by the public service by measuring the gap score of Front Line Employees
(FLE) and customer perceptions. The authors measured how closely the FLE perceives
the expectations of the customers. The survey empirically examined the customer’s expec-
tations and compares these with the actual service delivered in the selected public service
department. The overall results indicated that there is a significant gap in what customers
expect from the department but on the contrary, the FLE showed sound understanding
about the expectations of customers.
Edwards (2004) investigated the difference between FLE’ perception of service versus
the customer’s perception of the service delivery within the New Zealand Real Estate Indus-
try. The author concluded that perspectives of service delivery differed between real estate
clients, employees and managers. Secondly, they found that the SERVQUAL model, with
specific adaptations to the real estate industry, could be used to examine the different per-
ceptions of service.
Alhashem, Alquraini, & Chowdhury (2011) found that around 87% of the patients in
primary healthcare clinics of Kuwait reported that there is a lack of communication
between doctor and patient. Secondly, around 79% of the patient express that they will
prefer emergency services of hospital, instead of visiting the primary clinics. They also con-
cluded that the doctors need to spend more time with their patient so as to make them more
satisfied about the treatment they are undertaking.
Pan (2011) investigated the 20 value items identified by experts from healthcare pro-
fessionals as the most important perceived values. After the empirical analyses of these
items, the results indicated that patients have given a very low score in terms of weight
and perceived value, which indicated that there are gaps between the patients and the man-
agement perceptions.
The applicability of SERVQUAL has been transformed into diverse industries such as
hospitality, airline, retailing, travel, web portals, public transport, tourism, telecommunica-
tion hospitals, banking, education, dental, catering, insurance, public sector units and many
more, as shown in Table 3.

Table 3. Applications of SERVQUAL model.

Authors Sectors
Li (1997), Lam (1997), Dean (1999), Lee et al. (2000), Bowers and Kiefe Healthcare
(2002), Pakdil and Harwood (2005)
Johns and Tyas (1996) Food service outlet
Owlia and Aspinwall (1998) Engineering
education
Mola and Jusoh (2011) Hotel
Wolfinbarger and Gilly (2003)
Web portals
Tan and Pawitra (2001) Tourism
Shahin and Janatyan (2011) Travel agency
Ramseook-Munhurrun et al. (2010) Public services
Ahmad and Sungip (2008) Insurance
Naik et al. (2010) Retail
Randheer, Al-Motawa, and Vijay (2011) Public
transportation
Source: Authors compilation of data.
6 A. Singh et al.

2.2. Fuzzy set theory

Zadeh (1965) defined fuzzy set as a classes with smooth boundaries. The membership
degree of a variable in a fuzzy set is number ranging between 0 and 1. In the classical
set theory, the basic notation that whether or not an element belongs to a set. But in
Fuzzy set theory (FST) an element can partly belong to a Fuzzy set. Researchers have ver-
ified that AHP and FST offers a better solution than Likert scale for evaluating customer’s
subjective judgments (Dhillon & Prasher, 2014; Dhillon & Prasher, 2016; Hu, Lee, & Yen,
2010; Lupo, 2016; Singh & Prasher, 2017; Wu, Chang, & Lin, 2006). Adopting FST on five
parameters of the SERVQUAL instrument (Wu, Hsiao, & Kuo, 2004), they explained rela-
tive standings of service quality parameters in the healthcare industry and recommended
requisite strategy. Aydin & Pakdil (2008) implemented F-AHP to measure service
quality of airline and found that tangibility is an important criterion of service quality
and empathy as least important. Maruvada & Bellamkonda (2010) developed a modified
instrument RAILQUAL on the basis of SERVQUAL and FST by studying the basic
service requirement of rail transport quality; they added three new transport parameters
(i.e. comfort, security and convenience) and founded that tangibility, convenience and
assurance get higher scores whereas reliability and responsiveness gets lowest scores.
Buyukozkan, Çifçi, & Güleryüz (2011) developed an F-AHP technique for evaluating
the perceived service quality of healthcare sector and also measures the performance of
selected hospitals in Turkey. Results showed that hospitals should focus more on
empathy, professionalism and reliability to perform satisfying and qualified service.
They concluded that each hospital should identify their individual weak points and focus
their energies towards removing them, so as to deliver what the patient is expecting.
Shekhar, Venkatasubbaiah, & Kandukuria (2012) studied the service quality in education
sector focusing mainly on engineering institution. They have used five service quality par-
ameters (i.e. Facilities, Integrated Education, Empathy, Responsiveness and Professional-
ism) in their study. Lupo (2016) identified four core service parameters (Support
Services, Responsiveness, Healthcare Staff and Relationships) and fifteen sub-parameters
for measuring service quality of nine public hospitals in Sicily, Italy. Results showed
gaps related to doctor’s ability to understand the needs of patient, staff reliability and swift-
ness in registration procedure. The summary of sector-wise application of Fuzzy SERVQ-
UAL and F-AHP is shown in Table 4.
The literature survey highlighted the gap in the perceptions of doctor and patient for
providing better service quality and the need to better understand the relationship
between the patients, doctor and staff subsequently. The authors concluded that the par-
ameters of service quality are industry specific and they play an important role in the per-
ception of service quality.

3. Research design
This study is designed as a cross-sectional and quantitative study. The research is carried
out using steps given below:
Step 1: Study the facts about Indian healthcare industry
Step 2: Define research objectives
Step 3: Conduct literature survey
Step 4: Define the research methodology
Step 5: Develop ‘HealQual’ on the lines of SERVQUAL
Step 6: Conduct a pre-test to check the validity of ‘HealQual’ instrument
Step 7: Modify the questionnaire according to the output of pre-test
 Total Quality Management 7

Table 4. Summary of the sector-wise application of Fuzzy SERVQUAL and Fuzzy Analytical
hierarchy process (F-AHP).
Authors Sectors of study
Tsaur, Chang, and Yen (2002) Airline
Wu et al. (2004) Healthcare
Mustafa, Jia, and Siaw (2005) Airline
Kong and Liu (2005) E-commerce
Wu et al. (2006) Healthcare
Aydin and Pakdil (2008) Airline
Hu et al. (2010) Healthcare
Maruvada and Bellamkonda (2010) Railways
Lee, Tzeng, and Chiang (2011) Travel Website
Ban (2011) Tourism
Afsharkazemi, Manouchehri, Salarifar, and Nasiripour (2013) Healthcare
Srichetta and Thurachon (2012) Notebook computer selection
Golam Kabir (2012) Logistic
Toni Lupo (2013) Education
Stefano, Casarotto Filho, Barichello, and Sohn (2015) Hotel
Toni Lupo (2016) Healthcare
Source: Authors compilation of data.

Step 8: Perform data collection through questionnaires filled by interviewing patients

Step 9: Analyze the collected data
Step10: Draw conclusions
An empirical study is conducted using both primary and secondary sources for identifying
parameters and sub-parameters specific to the healthcare systems which served as a bench-
mark for designing the questionnaire. The primary data were collected from the patient’s,
doctors and hospital staff. Healthcare service quality parameters and sub-parameters are
shown in Table 5.

3.1. Survey questionnaire

The survey questionnaire is divided into three parts A, B and C. Section (A) consists of
questions related to respondents’ demographics, Section (B) contains questions related to
service delivered by hospitals based on based on Likert-type scale ranging from 1 to 7
(1 = strongly disagree and 7 = strongly agree) and lastly, Section (C) consists of pair-wise
evaluation of the parameters and sub-parameters of ‘HealQual’ with respect to each
other. (The judgments were based on the original fuzzy scale (Saaty, 1989) a 1–9 impor-
tance scale, shown in Table 6)

3.3. Sample
The data were collected from 26 multi-specialty private hospitals in Northern India. A pilot
survey was conducted on 50 respondents, which consisted of 25 patients, 10 doctors and 15
staff personnel’s to test the validity of the questionnaire. The sample size of the study is
1850 respondents, amongst whom 1000 questionnaires were distributed between both
the in-patients and out-patients who had undergone some form of treatment in selected hos-
pitals. Three hundred and fifty questionnaires were distributed among the hospital doctors
and 500 questionnaires were distributed among hospital staff (nurse, receptionist, adminis-
tration, lab technician, etc.), out of which 862 responses were found valid.
8 A. Singh et al.

Table 5. Healthcare service quality parameters and sub-parameters.

Parameter Sub-parameter
Tangibles (T) Equipment (TE)
Infrastructure (TI)
Hygiene (TH)
Appearance (TA)
Parking (TP)
Responsiveness (RS) Quickness (RSQ)
Completeness (RSC)
Promptness (RSP)
Procedure (RSProc.)
Wait (RSW)
Reliability (RT) Consistency (RTC)
Skills (RTS)
Knowledge (RTK)
Image (RTI)
Confidentiality (RTCon.)
Assurance (A) Cost (AC)
Confidence (ACon.)
Ignorance (AI)
Consideration (ACD)
Empathy (E) Politeness (EP)
Understanding (EU)
Concern (EC)
Grievances (EG)
Interaction (EI)
Trustworthiness (TS) Honesty (TSH)
Relevance (TSR)
Non-Overcharging (TSOC)
Non-Manipulation (TSNM)

4. Fuzzy analytical hierarchical process

Zadeh (1965) defined fuzzy sets as classes with smooth boundaries. The membership
degree of a variable in a fuzzy set is a number ranging between 0 and 1. In the classical
set theory, the basic notation that whether or not an element belongs to a set. But, in
case of FST, an element can partly belong to a Fuzzy set.
Buckley’s (1985) method Fuzzy Analytical Hierarchical Process (F-AHP), but to
measure the relative priority weights for both the parameters and different alternatives
have been proposed, as the results are widely accepted in different areas.
A seven-step method of F-AHP is as follows:
Step 1: Comparing the respondent scores
The linguistic terms shown in Table 6 displays the comparative strength of one par-
ameter against other parameters and assign corresponding Fuzzy Triangular Number

Table 6. Definition and FTN of fuzzy scale (Saaty, 1989).

Intensity of importance Definition FTN
1 Equal importance (EI) 1,1,1
3 Weak importance of one over another (WI) 2,3,4
5 Essential or strong importance (SI) 4,5,6
7 Demonstrated importance (VSI) 6,7,8
9 Absolute importance (EMI) 9,9,9
 Total Quality Management 9

(FTN). If a respondent states one parameter as strongly important than the other parameter,
then it will take (4,5,6) as the FTN and the other parameter will take (1/6,1/5,1/4) value.
Equation (1) shows the pair-wise comparison matrix, where a
kij displays the kth individual
choice of the ith parameter over the jth parameter.
⎡ ⎤
ãk11 ãk12 ··· ãk1n
⎢ ãk21 ··· ··· k ⎥
ã2n ⎥
k ⎢
à = ⎢ . . ⎥, (1)
⎣ .. ··· · · · .. ⎦
ãkn1 ãkn2 · · · ãknn

Step 2: Aggregating the preference scores of each respondent (akij ) using Equation (2),
ãij is obtained.

K k
K=1 d̃ij
ãij = , (2)
K

Step 3: Assigning the updated aggregate responses to form pair-wise comparison matrix
using Equation (2).
⎡ ⎤
ã11 ··· ã1n
⎢

= ⎣ .. .. .. ⎥,
A . . . ⎦ (3)
ãn1 ··· ãnn

Step 4: Computing geometric mean for fuzzy evaluation matrix as shown in Equation
(4).

n 1/n

r̃ i = ãij , i = 1, 2 . . . ..n, (4)

j=1

Step 5: It includes following steps:

4.1. Compute the sum for each r̃ i .

4.2. Inversing the sum obtained and re-writing the FTN in an increasing order.
4.3. Multiply each r̃ i with its inverse value obtained in step 5.2 to compute the fuzzy
weight:
w̃i = r̃i ⊗ (r̃ 1 ⊕ r̃ 2 ⊕ . . . . . . r̃ n )−1 = (lwi , mwi , uwi ), (5)

Step 6: De-fuzzying the FTN value using the centre of area method (Chou & Chang, 2008),
by using Equation (6).

lwi + mwi + uwi

Mi = , (6)
3
10 A. Singh et al.

Step 7: Normalisation of non-fuzzy number by using Equation (7).

Mi
Ni = n , (7)
i=1 Mi

5. Applying F-AHP in Punjab healthcare sector

The proposed methodology has been applied on Indian healthcare sector. The Punjab state
of India has been selected for this study as the state is renowned for providing best health-
care services in the country.

5.1. Determining relative weights of parameters and sub-parameters from patient,

doctor and staff perspective
For generating relative weights of each parameter, the respondents were asked to compare
the service quality parameters and sub-parameters with respect to each other using FTN.
The aggregated pair-wise comparison data from patient perspective for ‘HealQual’ par-
ameter are represented by linguistic evaluation matrix shown in Table 7 and fuzzy evalu-
ation matrix in Table 8.
After following the first three steps, we get an aggregated fuzzy evaluation matrix of the
patient’s responses. Geometric mean r̃ 1 of each parameter is calculated using Equation (4),
in fourth step.
Geometric mean of ‘Tangibles’ parameter is calculated in Equation (8);

n 1/n

r̃i = ãij = [(1∗1/4∗1/6∗1/4∗1/4∗1/4)1/5 ; (1∗1/3∗1/5∗1/3∗1/3∗1/3)1/5 ;

j=1

(1∗1/2∗1/4∗1/2∗1/2∗1/2)1/5 )]
= [.2305; .3009; .4352],
(8)

The geometric means of all parameters are computed and the summed and reversed
values are shown in Table 9.
Using step five, the fuzzy weight is calculated for Tangibility parameter using Equation
(5) as

W̃ i = [(0.2305∗0.1110); (0.3009∗0.1360); (0.4352∗0.1722)]

(9)
= [0.0256; 0.0409; 0.0750].

Table 7. Fuzzy pair-wise comparison matrix using linguistic variables for ‘HealQual’ parameters
given by patient.
Parameters T RS RT A E TS
T EI
RS WI EI
RT SI EI EI
A WI EI EI EI
E WI WI WI WI EI
TS WI WI EI WI EI EI
 Total Quality Management 11

Table 8. Pair-wise comparison matrix based on FTN for ‘HealQual’ parameters given by patient.
Parameters T RS RT A E TS
T (1,1,1) (1/4,1/3,1/2) (1/6,1/5,1/4) (1/4,1/3,1/2) (1/4,1/3,1/2) (1/4,1/3,1/2)
RS (2,3,4) (1,1,1) (1,1,1) (1,1,1) (1/4,1/3,1/2) (1/4,1/3,1/2)
RT (4,5,6) (1,1,1) (1,1,1) (1,1,1) (1/4,1/3,1/2) (1,1,1)
A (2,3,4) (1,1,1) (1,1,1) (1,1,1) (1/4,1/3,1/2) (1/4,1/3,1/2)
E (2,3,4) (2,3,4) (2,3,4) (2,3,4) (1,1,1) (1,1,1)
TS (2,3,4) (2,3,4) (1,1,1) (2,3,4) (1,1,1) (1,1,1)

Using the fuzzy weights, average weight is computed as average of the three fuzzy
weights for each parameter. Average is computed by dividing the Average Weight
column with the Total and the normalised weight vector is computed as shown in
Table 10. Hence, the obtained weights for each parameter are shown in Table 11.
After determining non-fuzzy normalised relative weights for each parameter, similar
steps are followed for finding relative weights of sub-parameters. For example, in
case of tangibles, there are five sub-parameters; so a pair-wise comparison between the
sub-parameter is carried out and relative weights are calculated.
Pair-wise comparison matrix based on TFN of Tangibles from patient perspective is
shown in Table 12.
After getting the weights, the geometric means and fuzzy weights for Tangibles by
patient are shown in Table 13.
The Summary for the measured weights of ‘HealQual’ parameter and sub-parameters
given by patient is shown in Table 14.
The similar procedure has been followed for getting priority weights from doctor’s and
employees’ perspective as shown in Table 15 and Table 16.
Importance ranking of the ‘HealQual’ parameters and sub-parameters by all respon-
dents i.e. patient, doctor and employees is shown in Table 17.

6. Results and discussion

6.1. ‘Healqual’ parameters
From Table 17, the ranking of ‘HealQual’ parameters were obtained, where all the respon-
dents have given different prioritised weights.
For Patients, ‘Empathy’ has scored the maximum points where as ‘Tangibles’ scored
the least. Rest of the parameters follows the ranking as ‘Trustworthiness’, ‘Reliability’,

Table 9. Calculating geometric mean of ‘HealQual’ parameters given by patient.

Parameters GM(ri )
T 0.2305 0.3009 0.4352
RS 0.6597 0.8011 1.0000
RT 1.0000 1.1075 1.2457
A 0.6597 0.8011 1.0000
E 1.7411 2.4082 3.0314
TS 1.5157 1.9331 2.2973
Col_Sum 5.8069 7.3522 9.0098
Inverse 0.1722 0.1360 0.1110
Increasing Order 0.1110 0.1360 0.1722
12 A. Singh et al.

Table 10. Calculation of normalised weight of ‘HealQual’ parameters given by patient.

Parameters Fuzzy weights Avg_weight Average Norm_wt
T 0.0256 0.0409 0.0750 0.1415 0.0472 0.0443
RS 0.0732 0.1090 0.1722 0.3544 0.1181 0.1109
RT 0.1110 0.1506 0.2145 0.4761 0.1587 0.1490
A 0.0732 0.1090 0.1722 0.3544 0.1181 0.1109
E 0.1932 0.3276 0.5220 1.0482 0.3476 0.3263
TS 0.1682 0.2629 0.3956 0.8267 0.2756 0.2587
Total 3.2013

‘Assurance’ and ‘Responsiveness’. This shows that patients are mainly concerned with the
care with which they are being attended in the hospital, their complaints are being addressed
and how staff interacts with patients.
In case of Doctors, ‘Reliability’ has the maximum score and ‘Responsiveness’ has
got the minimum score. The other parameters followed the order as ‘Tangibles’, ‘Assur-
ance’, ‘Trustworthiness’ and ‘Empathy’. As treating someone require skills and expertise
of the doctors, therefore ‘Reliability’ has the higher ranking in comparison to other
parameters.
For Staff, the highest and the lowest rank were given to ‘Assurance’ and ‘Empathy’. The
remaining parameters followed the order ‘Responsiveness’, ‘Tangible’, ‘Trustworthiness’
and ‘Reliability’. The hospital staff gave ‘Assurance’ top priority as they feel providing
favourable cost and providing post-treatment consideration are very significant to satisfy
the patients.

6.2. ‘Healqual’ sub-parameters

. From Patient Perspective, in ‘Tangibles’, ‘equipment’ has been rated high, then the
‘appearance’, ‘infrastructure’, ‘hygiene’ and lastly, least concerned is ‘parking’.

Table 11. Normalised fuzzy weight vector for

‘HealQual’ parameters given by patient.
Parameters Fuzzy weight
T 0.0443
RS 0.1109
RT 0.1490
A 0.1109
E 0.3263
TS 0.2587

Table 12. Pair-wise comparison matrix based on TFN of Tangibles from patient perspective.
Sub-parameters TE TI TH TA TP
TE (1,1,1) (1,1,1) (2,3,4) (2,3,4) (2,3,4)
TI (1,1,1) (1,1,1) (1,1,1) (1,1,1) (2,3,4)
TH (1/4,1/3,1/2) (1,1,1) (1,1,1) (1/4,1/3,1/2) (2,3,4)
TA (1/4,1/3,1/2) (1,1,1) (2,3,4) (1,1,1) (4,5,6)
TP (1/4,1/3,1/2) (1/4,1/3,1/2) (1/4,1/3,1/2) (1/6,1/5,1/4) (1,1,1)
 Total Quality Management 13

Table 13. Calculation of Geometric means and fuzzy weights for Tangibility by patient.
Sub-parameters GM (ri ) Fuzzy Weight (wi) Average (Mi) Norm_Wt (Ni)
TE 1.515 1.933 2.297 0.209 0.322 0.471 0.3345 0.3179
TI 1.148 1.245 1.319 0.159 0.207 0.270 0.2125 0.2019
TH 0.659 0.802 1.000 0.091 0.133 0.205 0.1434 0.1363
TA 1.319 1.718 2.168 0.182 0.286 0.445 0.3047 0.2896
TP 0.230 0.301 0.435 0.031 0.050 0.089 0.0571 0.0543
Col_Sum 4.874 6.001 7.221 Total 1.0521 1
Inverse 0.205 0.166 0.138
Inc. Order 0.138 0.166 0.205

In case of ‘Responsiveness’ parameter, patients rated procedure as their top priority as they
feel the documentation should be minimum and easier, the next is the amount of hours the
patient spend in queues, then how quickly the staff responds to patient problems and hos-
pitals having all kinds of treatment.
For ‘Reliability’ parameter, the confidentiality of patient treatment/reports is priority,
then about the public image of hospital, consistency of treatment, knowledge of the hospital
staff and finally the expertise and skills of the doctor.

Table 14. Summary for the measured weights of ‘HealQual’ parameter and sub-parameters given by
patient.
Parameters Priority weights Sub-parameters Priority weights
Tangibles 0.0443 Equipment 0.3179
Infrastructure 0.2019
Hygiene 0.1363
Appearance 0.2896
Parking 0.0543
Responsiveness 0.1109 Quickness 0.1827
Completeness 0.1461
Promptness 0.0982
Procedure 0.3498
Wait 0.2232
Reliability 0.1490 Consistency 0.2119
Skills 0.1387
Knowledge 0.1731
Image 0.2644
Confidentiality 0.2119
Assurance 0.1109 Cost 0.1426
Confidence 0.4169
Ignorance 0.2662
Consideration 0.1742
Empathy 0.3263 Politeness 0.1168
Grievances 0.2236
Concern 0.3017
Interaction 0.2724
Understanding 0.0856
Trustworthiness 0.2587 Honesty 0.1904
Relevance 0.1556
Non-Manipulation 0.2910
Non-Overcharging 0.3631
14 A. Singh et al.

Table 15. Summary for the measured weights of ‘HealQual’ parameter and sub-parameters given by
doctor.
Parameter Priority weight Sub-parameter Priority weight
Tangibles 0.2569 Equipment 0.1745
Infrastructure 0.2454
Hygiene 0.4574
Appearance 0.0914
Parking 0.0313
Responsiveness 0.0485 Quickness 0.0956
Completeness 0.1609
Promptness 0.0833
Procedure 0.2459
Wait 0.4141
Reliability 0.2569 Consistency 0.1298
Skills 0.4216
Knowledge 0.1431
Image 0.0551
Confidentiality 0.2501
Assurance 0.2105 Cost 0.4917
Confidence 0.0978
Ignorance 0.1510
Consideration 0.2593
Empathy 0.0986 Politeness 0.0686
Grievances 0.3182
Concern 0.1360
Interaction 0.2806
Understanding 0.1963
Trustworthiness 0.1287 Honesty 0.1570
Relevance 0.1922
Non-manipulation 0.2836
Non-overcharging 0.3670

In ‘Assurance’ parameter, the patient feel that the doctor should provide requisite con-
fidence among the patient about treating their ailment, then having uniform costing for all
with no discrimination, patient also prefers post-treatment care and lastly, zero ignorance
from hospital.
In case of ‘Empathy’, ranking includes interaction at the top, after this the individua-
lised concern the authority show towards the patient, then how the grievances are being
taken care by the management, and lastly, the understanding of patient needs.
Lastly, for ‘Trustworthiness’, non-overcharging was put at the top concern for the
patient, as they fear big branded hospitals would be charging extra, secondly providing
correct reports are also necessary as many established hospitals were caught manipulating
the reports of the patient so that they undergo costly treatments, then, prescribing unnecess-
ary test so as to increase the patient bill and lastly, relevance of prescribing correct medicine
to the patient.

. For Doctors, under the ‘Tangibles’ parameter, the foremost concern for them is the
hygienic environment, next they give preference to infrastructure and equipment
the hospital have, next the way the hospital staff is dressed and lastly the parking
facility.
 Total Quality Management 15

Table 16. Summary for the measured weights of ‘HealQual’ parameter and sub-parameters given by
Staff.
Parameters Priority weight Sub-parameter Priority weight
Tangibles 0.1268 Equipment 0.2353
Infrastructure 0.1864
Hygiene 0.1220
Appearance 0.3593
Parking 0.0969
Responsiveness 0.2077 Quickness 0.2649
Completeness 0.0803
Promptness 0.3545
Procedure 0.0901
Wait 0.2101
Reliability 0.1077 Consistency 0.1714
Skills 0.4568
Knowledge 0.1369
Image 0.1123
Confidentiality 0.1226
Assurance 0.4017 Cost 0.1866
Confidence 0.0801
Ignorance 0.4817
Consideration 0.2517
Empathy 0.0485 Politeness 0.1329
Grievances 0.0641
Concern 0.1679
Interaction 0.4318
Understanding 0.2030
Trustworthiness 0.1077 Honesty 0.3851
Relevance 0.1090
Non-manipulation 0.2274
Non-overcharging 0.2783

In case of ‘Responsiveness’ parameter, doctors have given the foremost preference to

lesser waiting hours, the procedural delays, having multi-speciality, and then finally
responding quickly and promptly to the queries of the patient.
For ‘Reliability’ parameter which is rated as the top most priority by the doctor includes
the skills sub-parameter at the top. The doctor feels more the expertise better would be the
result, next is privacy of the patient records, then having consistent service record. After that
the knowledge of the front line staff matters and then finally, image the hospital is carrying
outside in the minds of the people.
The fourth parameter, i.e. the ‘Assurance’, the doctors rated costing for patients as
major concern, then giving post-treatment consideration, then minimum ignorance on
the part of the hospital staff towards the patient is utmost required and lastly, building
trust and confidence among the patient.
For ‘Empathy’ parameter, the doctors ranked highest the grievance handling system as
the foremost job of any organisation, then how you interact with the patient dispels your
intention towards them, understanding their needs and requirement, showing positive
concern about their ailment and finally dealing in a polite manner with the patient is
required as they are already suffering from pains and frustrations.
Finally, for the last parameter ‘Trustworthiness’, doctors rated similar to patients, i.e.
non-overcharging and non-manipulation of reports which builds the trust among the
16 A. Singh et al.

Table 17. Importance ranking of the ‘HealQual’ parameters and sub-parameters by all respondents.
Importance ranking of the Parameters 1. Empathy
based on Fuzzy AHP Patient Doctor Staff
1. Reliability 1. Assurance
2. Trustworthiness 2. Tangibles 2. Responsiveness
3. Reliability 3. Assurance 3. Tangibles
4. Assurance 4. Trustworthiness 4. Trustworthiness
5. Responsiveness 5. Empathy 5. Reliability
6. Tangibles 6. Responsiveness 6. Empathy
Importance ranking of the Sub-parameters
Tangible 1. Equipment 1. Hygiene 1. Appearance
2. Appearance 2. Infrastructure 2. Equipment
3. Infrastructure 3. Equipment 3. Infrastructure
4. Hygiene 4. Appearance 4. Hygiene
5. Parking 5. Parking 5. Parking
Responsiveness 1. Procedure 1. Wait 1. Promptness
2. Wait 2. Procedure 2. Quickness
3. Quickness 3. Completeness 3. Wait
4. Completeness 4. Quickness 4. Procedure
5. Promptness 5. Promptness 5. Completeness
Reliability 1. Image 1. Skills 1. Skills
2. Confidentiality 2. Confidentiality 2. Consistency
3. Consistency 3. Knowledge 3. Knowledge
4. Knowledge 4. Consistency 4. Confidentiality
5. Skills 5. Image 5. Image
Assurance 1. Confidence 1. Cost 1. Ignorance
2. Ignorance 2. Consideration 2. Consideration
3. Consideration 3. Ignorance 3. Cost
4. Cost 4. Confidence 4. Confidence
Empathy 1. Concern 1. Grievances 1. Interaction
2. Interaction 2. Interaction 2. Understanding
3. Grievances 3. Understanding 3. Concern
4. Politeness 4. Concern 4. Politeness
5. Understanding 5. Politeness 5. Grievances
Trustworthiness 1. Non- 1. Non- 1. Honesty
overcharging overcharging
2. Non- 2. Non- 2. Non-
manipulation manipulation overcharging
3. Honesty 3. Relevance 3. Non-
manipulation
4. Relevance 4. Honesty 4. Relevance

patient towards the hospital, then prescribing correct medicine is necessary and finally, non-
recommendation of tests which is not required for the treatment.

. For Staff, in ‘Tangibles’ parameter, the appearance of staff in hospital is rated first,
then they rated up-to-dated equipment, then infrastructure, hygiene and finally, the
least concerned is the parking.

For ‘Responsiveness’, the staff had chosen how quickly the hospital management
responds and how promptly they answer those queries. Next comes the length of time
the patient spend in hospital and process through which he has to go through to avail the
treatment and lastly they ranked having complete healthcare service which they don’t
find as important than other parameters.
 Total Quality Management 17

In third parameter, ‘Reliability’, the staff has ranked expertise and consistency of the
doctors at the top. Then, they ranked knowledge the staff possess with the confidentiality
of the patient data, which is very important in today’s circumstances. Lastly, they supported
the image the hospital carries in the eyes of the public.
In case of ‘Assurance’ parameter, the sub-parameters were ranked as having zero ignor-
ance on the part of the hospital management on the top, next they rated post-treatment con-
sideration. Then, having favourable and uniform costing for the patient visiting and lastly
the last parameter is the confidence that is required to build in patient.
Then, in case of ‘Empathy’ sub-parameter the staff rated interaction between the patient
and the staff at the top, followed by how much is the understanding between the two parties.
Then, how much individualised concern is shown by the doctor is ranked and then, finally
the grievance system the hospital.
In the last parameter (i.e. the ‘Trustworthiness’), the sub-parameter was ranked in the
following manner, at the top is non-recommendation of unnecessary test the doctor
asked the patient to have so as to increase the bill, next is non-overcharging and non-
manipulation of the patient reports and lastly, referring to the correct medicine.

7. Conclusion and future work

The main objective of this research is to validate the ‘HealQual’ scale following the meth-
odology given by Parasuraman et al. (1988), a model which can evaluate the perceived
healthcare service quality in India. The survey research examined the difference between
the patient’s perception of the service quality (Service receiver) in private hospitals and
the management’s (Doctor, nurse, administration, etc.) perception of what services they
are delivering in their hospitals (service provider).
This study has supported the importance of patient’s, doctor’s and staff’s perspectives
and it must be considered before designing the service delivery process of the hospital. The
impact of patient’s perception related to service delivered in hospitals has reported a wide
mismatch between the perceptions of service provider and service receiver. The survival
and profitability of the hospital largely depends upon its ability to retain and attract new
patients. The management needs to understand the priorities of patient’s accurately and
standardised their processes to match with the expectation of patients. The proposed
model was evaluated by F-AHP, which provided a comparative study of the performance
of different hospitals. The future directions would be to use other MCDM approaches.

Disclosure statement
No potential conflict of interest was reported by the authors.

ORCID
Ajwinder Singh http://orcid.org/0000-0002-5994-0086

References
Afsharkazemi, M. A., Manouchehri, J., Salarifar, M., & Nasiripour, A. A. (2013). Key factors affect-
ing the hospital performance: A qualitative study using fuzzy logic. Quality & Quantity, 47(6),
3559–3573.
Ahmad, A., & Sungip, Z. (2008). An assessment on service quality in Malaysia insurance industry.
Communications of the IBIMA, 1, 13–26.
18 A. Singh et al.

Alhashem, A. M., Alquraini, H., & Chowdhury, R. I. (2011). Factors influencing patient satisfaction
in primary healthcare clinics in Kuwait. International Journal of Health Care Quality
Assurance, 24(3), 249–262.
Aydin, O., & Pakdil, F. (2008). Fuzzy SERVQUAL analysis in airline services. Organizacija,, 41(3),
108–115.
Babakus, E, & Mangold, W. G. (1992). Adapting the SERVQUAL scale to hospital services: an
empirical investigation. Health services research, 26(6), 767.
Babakus, E., & Mangold, W. (1991). Service quality: The front-stage vs. the back-stage perspective.
Journal of Services Marketing, 5(4), 59–70.
Ban, O. I. (2011). Fuzzy multicriteria decision making method applied to selection of the best touristic
destinations. International Journal of Mathematical Models and Methods in Applied Science, 5
(2014), 264–271.
Barsky, J. D., & Labagh, R. (1992). A strategy for customer satisfaction. The Cornell Hotel and
Restaurant Administration Quarterly, 33(5), 32–40.
Bowers, M. R., & Kiefe, C. I. (2002). Measuring health care quality: Comparing and contrasting the
medical and the marketing approaches. American Journal of Medical Quality, 17(4), 136–144.
Bowers, M. R., Swan, J. E., & Koehler, W. F. (1994). What attributes determine quality and satisfac-
tion with health care delivery? Health Care Management Review, 19(4), 49–55.
Buckley, J. J. (1985). Fuzzy hierarchical analysis. Fuzzy Sets and Systems, 17(3), 233–247.
Butler, D., Oswald, S. L., & Turner, D. E. (1996). The effects of demographics on determinants of
perceived health-care service quality: The case of users and observers. Journal of
Management in Medicine, 10(5), 8–20.
Buyukozkan, G., Çifçi, G., & Güleryüz, S. (2011). Strategic analysis of health care service quality
using fuzzy AHP methodology. Expert Systems with Applications, 38(8), 9407–9424.
Chou, S. W., & Chang, Y. C. (2008). The implementation factors that influence the ERP (enterprise
resource planning) benefits. Decision Support Systems,, 46(1), 149–157.
Clow, K. E., Garretson, J. A., & Kurtz, D. L. (1994). An Exploratory study into Hotel Property
Characteristics and Occupancy Rate: 45.
Cronin, J. J., & Taylor, S. A. (1992). Measuring service quality: A reexamination and extension.
Journal of Marketing, 56, 55–68.
Dabholkar, P. A., Thorpe, D.I., & Rentz, J.O. (1996). A measure of service quality for retail stores:
scale development and validation. Journal of the Academy of marketing Science, 24(1), 3.
Dean, A. M. (1999). The applicability of SERVQUAL in different health care environments. Health
Marketing Quarterly, 16(3), 1–21.
Dhillon, A. S., & Prasher, A. (2014). Service quality measurement with SERVQUAL using analytic
hierarchy process model: An empirical study of private Eye hospitals in punjab. Journal of
Research in Marketing, 2(3), 187–197.
Dhillon, A. S., & Prasher, A. (2016). Performance based ranking of healthcare service providers using
fuzzy ahp methodology. Indian Journal of Economics & Business, 15(2), 197–213.
Edwards, V. (2004). An investigation of service delivery: the difference between front-line employees’
and customer’s perception of the service delivery within the New Zealand real estate industry
(Doctoral dissertation, Auckland University of Technology).
Francis, V., Korsch, B. M., & Morris, M. J. (1969). Gaps in doctor-patient communication: Patients’
response to medical advice. New England Journal of Medicine, 280(10), 535–540.
Fuentes, M. C. (1999). Measuring hospital service quality: A methodological study. Managing
Service Quality, 9(4), 230–240.
Hu, H. Y., Lee, Y. C., & Yen, T. M. (2010). Service quality gaps analysis based on Fuzzy linguistic
SERVQUAL with a case study in hospital out-patient services. The TQM Journal, 22(5), 499–
515.
Johns, N., & Tyas, P. (1996). Use of service quality gap theory to differentiate between foodservice
outlets. Service Industries Journal, 16(3), 321–346.
Kabir, G. (2012). Third party logistic service provider selection using fuzzy ahp and topsis method.
International Journal for Quality Research, 6(1), 71–79.
Khan, M. S. (2008). Studies on some aspects of service quality evaluation with specific relevance to
Indian service industries (Doctoral dissertation).
Knutson, B., Stevens, P., Wullaert, C., Patton, M., & Yokoyama, F. (1990). LODGSERV: A service
quality index for the lodging industry. Journal of Hospitality & Tourism Research, 14(2), 277–
284.
 Total Quality Management 19

Kong, F., & Liu, H. (2005). Applying fuzzy analytic hierarchy process to evaluate success factors of
e-commerce. International Journal of Information and Systems Sciences, 1(3–4), 406–412.
Lam, S. S. (1997). SERVQUAL: A tool for measuring patients’ opinions of hospital service quality in
Hong Kong. Total Quality Management, 8(4), 145–152.
Lee, H., Delene, L. M., Bunda, M. A., & Kim, C. (2000). Methods of measuring health-care service
quality. Journal of Business Research, 48(3), 233–246.
Lee, C. C., Tzeng, G. H., & Chiang, C. (2011). Determining service quality measurement key indi-
cators in a travel website using a fuzzy analytic hierarchy process. International Journal of
Electronic BusinessManagement, 9(4), 322–333.
Li, L. X. (1997). Relationships between determinants of hospital quality management and service
quality performance – a path analytic model. Omega, 25(5), 535–545.
Lupo, T. (2013). A fuzzy ServQual based method for reliable measurements of education quality in
Italian higher education area. Expert Systems with Applications, 40(17), 7096–7110.
Lupo, T. (2016). A fuzzy framework to evaluate service quality in the health care industry: An empiri-
cal case of public hospital service evaluation in Sicily. Applied Soft Computing, 40, 468–478.
Maruvada, D. P., & Bellamkonda, R. S. (2010). Analyzing the passenger service quality of the Indian
railways using railqual: Examining the applicability of fuzzy logic. International Journal of
Innovation, Management and Technology, 1(5), 478–482.
Miranda, F. J., Chamorro, A., Murillo, L. R., & Vega, J. (2010). An importance-performance analysis
of primary health care services: Managers vs. patients perceptions. Journal of Service Science
and Management, 3(02), 227–234.
Mola, F., & Jusoh, J. (2011). Service quality in Penang hotels: A gap score analysis. World Applied
Sciences Journal, 12(T&H), 19–24.
Mustafa, A., Jia, F. P., & Siaw, L. P. (2005, January). The evaluation of airline service quality using
the Analytic Hierarchy Process (AHP). In Proc. 2005 the International Conference on Turism
Development, 382–390.
Naik, C. K., Gantasala, S. B., & Prabhakar, G. V. (2010). Service quality (SERVQUAL) and its effect
on customer satisfaction in retailing. European Journal of Social Sciences, 16(2), 231–243.
Oliver, R. (1980). A cognitive model of the antecedents and consequences of satisfaction decisions.
Journal of Marketing, 17(10), 460–469.
Owlia, M. S., & Aspinwall, E. M. (1998). A framework for measuring quality in engineering edu-
cation. Total Quality Management, 9(6), 501–518.
Pakdil, F., & Harwood, T. N. (2005). Patient satisfaction in a preoperative assessment clinic: An
analysis using SERVQUAL parameters. Total Quality Management & Business Excellence,
16(1), 15–30.
Pan, F. F. (2011). Perceived values on hospital services: A fuzzy logic application. African Journal of
Business Management, 5(11), 4465–4475.
Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1985). A conceptual model of service quality and
its implications for future research. Journal of Marketing, 49, 41–50.
Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1988). SERVQUAL: A multiple-item scale for
measuring customer perceptions of service quality. Journal of Retailing, 64(1), 12–40.
Prasad, M. D., & Shekhar, B. R. (2010, June). Measuring service quality of Indian Rail passenger
services using RAILQUAL model (A study of South Central Railways). In Management of
Innovation and Technology (ICMIT), 2010 IEEE International Conference on (292–296).
IEEE.
Ramsaran-Fowdar, R. R. (2008). The relative importance of service dimensions in a healthcare
setting. International Journal of Health Care Quality Assurance, 21(1), 104–124.
Ramseook-Munhurrun, P., Lukea-Bhiwajee, S. D., & Naidoo, P. (2010). Service quality in the public
service. International Journal of Management and Marketing Research, 3(1), 37–50.
Randheer, K., Al-Motawa, A. A., & Vijay, P. J. (2011). Measuring commuters’ perception on service
quality using SERVQUAL in public transportation. International Journal of Marketing
Studies, 3(1), 21–34.
Rashid, W. E. W., & Jusoff, K. (2009). Service quality in health care setting. International Journal of
Health Care Quality Assurance, 22(5), 471–482.
Saaty, T. L. (1989). Decision making, scaling, and number crunching. Decision Sciences, 20(2), 404–
409.
20 A. Singh et al.

Shahin, A., & Janatyan, N. (2011). Estimation of customer dissatisfaction based on service quality
gaps by correlation and regression analysis in a travel agency. International Journal of
Business and Management, 6(3), 99–108.
Shekhar, N. C., Venkatasubbaiah, K., & Kandukuria, N. R. (2012). Establishing the overall service
quality of engineering education: Fuzzy logic approach. European Journal of Engineering
Education, 37(6), 575–591.
Singh, A., & Prasher, A. (2017). Measuring healthcare service quality from patients’ perspective:
Using Fuzzy AHP application. Total Quality Management & Business Excellence, Online
(22 march 2017), 1–17. http://dx.doi.org/10.1080/14783363.2017.1302794
Srichetta, P., & Thurachon, W. (2012). Applying fuzzy analytic hierarchy process to evaluate and
select product of notebook computers. International Journal of Modeling and Optimization,
2(2), 168–173.
Stefano, N. M., Casarotto Filho, N., Barichello, R., & Sohn, A. P. (2015). A fuzzy SERVQUAL based
method for evaluated of service quality in the hotel industry. Procedia CIRP, 30, 433–438.
Stevens, P., Knutson, B., & Patton, M. (1995). DINESERV: A tool for measuring service quality in
restaurants. The Cornell Hotel and Restaurant Administration Quarterly, 36(2), 5–60.
Tan, K. C., & Pawitra, T. A. (2001). Integrating SERVQUAL and Kano’s model into QFD for service
excellence development. Managing Service Quality: An International Journal, 11(6), 418–
430.
Tsaur, S. H., Chang, T. Y., & Yen, C. H. (2002). The evaluation of airline service quality by fuzzy
MCDM. Tourism Management, 23(2), 107–115.
Weitzel, W., Schwarzkoff, A. B., & Peach, E. B. (1989). The influence of customer service on retail
stores. Journal of Retailing, Spring, 65(1), 27–39.
Wolfinbarger, M., & Gilly, M. C. (2003). Etailq: Dimensionalizing, measuring and predicting etail
quality. Journal of Retailing, 79(3), 183–198.
Wu, C. R., Chang, C. W., & Lin, H. L. (2006). Evaluating the organizational performance of
Taiwanese hospitals using the analytic hierarchy process. Journal of Statistics and
Management Systems, 9(3), 633–649.
Wu, W. Y., Hsiao, S. W., & Kuo, H. P. (2004). Fuzzy set theory based decision model for determining
market position and developing strategy for hospital service quality. Total Quality
Management & Business Excellence, 15(4), 439–456.
Yesilada, F., & Direktör, E. (2010). Healthcare service quality: A comparison of public and private
hospitals. African Journal of Business Management, 4(6), 962–971.
Zadeh, L. A. (1965). Fuzzy sets. Information and Control, 8(3), 338–353.