A Study of Patients Expectation and Satisfaction in Dindigul Hospitals

ASIAN JOURNAL OF MANAGEMENT RESEARCH Online Open Access publishing platform for Management Research Copyright 2010 All rights reserved Integrated Publishing association Review Article ISSN 2229 3795 A Study of Patients Expectation and Satisfaction in Dindigul Hospitals Manimaran.S 1, Sindhya.R 2, Venkateshwaran.P.S 3 1 Professor and Head of the Department, Department of Management studies, PSNA College of Engineering and Technology, Dindigul, Tamilnadu 2 Lecturer, Department of Management studies, PSNA College of Engineering and Technology, Dindigul, Tamilnadu 3 Lecturer, Department of Management studies, PSNA College of Engineering and Technology, Dindigul, Tamilnadu venkatespsna07@gmail.com ABSTRACT In today s competitive environment, hospitals are achieving a phenomenal growth especially in India. The effect of service quality on hospitals has been examined in SERVQUAL Scale framework. Intangible aspects of service performance have a stronger direct effect on service quality of hospitals than tangible aspects. The hospital administration members should improve the intangible aspects according to the up to date technological requirements of the users in order to create a good image and service rendered by the hospitals among the patients. An analysis covering 221 patients revealed that there was an overall service quality gap between patients' expectations and perceptions. Thus, improvements are required across all the five dimensions, namely, tangibility, reliability, responsiveness, assurance and empathy. In view of this widespread belief, an attempt has been made in the present paper to study the service quality of hospitals with a view to offer suggestions to make overall service quality in hospitals more effective and efficient. 1. Introduction The service sector plays an important role in modern economics, the contribution of service sector to the gross domestic product (GDP) in India and is increasing at a faster rate than the other sectors. Especially, the growth of hospital based services has been seen very obvious during the past decades in India. The up to date technological growth and advancement in equipment, subject knowledge of doctors and other experts lead to improve and perceive the service quality of hospitals and satisfaction of patients who are visiting the hospitals. 2. Literature Review As it is well known, quality is accepted as being an important factor that determines the demand of goods and services as well as a main indicator that affects the competitive advantage of firms ASIAN JOURNAL OF MANAGEMENT RESEARCH 31

(Fitzsimmons & Fitzsimmons, 1994). There is a rich collection of research literature on service performance and service quality. The term of quality in the service sector seems to be different from the term in the goods market. Since the production in the service sector is generally an abstract term, evaluating service quality becomes more difficult than evaluating the quality of goods. Therefore, service quality measurements are, in general, made by means of using consumers (patients) perception about the quality of the services. Consumer s perception is the main indicator of quality in health care service (O Connor, Shewchuk & Carney, 1994; Cronin & Taylor, 1992). According to some researchers, although true level of service quality can be quite low (or high) the main key is how consumers perceive the quality of service and the efficiency of the health care (Petersen 1988). Most of the researchers on that issue believe that there is a relationship between the perception of the consumers on the quality of the services and their satisfaction (Cronin &Taylor, 1994; McAlexander, Kaldenberg & Koenig, 1994). Consumer satisfaction appears to be a major device in order to take critical decisions in the health care services (Gilbert, Lumpkin & Dant, 1992). Therefore, service providers, as a matter of fact, take the satisfaction of customers into account as a main goal of the strategies of their firms (Zeithaml & Bitner, 2000). There are many studies on measuring service quality in the health care sector that use satisfaction of consumers. Service quality studies are mainly based on the satisfaction of patients or their judgment about service quality (Babakus & Mangold, 1992; Carman, 1990; Parasuraman, Zeithaml, & Berry, 1985; Parasuraman, Zeithaml, & Berry, 1988; Zeithaml, Berry, & Parasuraman, 1993; Reidenbach & Sandifer Smallwood, 1990),Lehman (2001). These expectations are based on one s own and others experiences. Most service sector literature focus upon the static models (Parasuraman, Zeitham & Berry, 1985, 1988, 1993; Babakus & Mangold, 1992; Cronin & Taylor, 1992, 1994; Boulding, Kalra & Stealing 1993; Johnson & Ferstl, 1999). However, one needs to remember that there are also some researchers who work with a dynamic framework as well ( Kopalle & Lehman 2001; Kara, Tarım & Zaim, 2003). We have some studies on the quality of the public health care sector in India. It has been observed, through these studies, that the quality of the public health care sector is quite low and inadequate. Patients are dissatisfied with the level of service provided in the public hospitals (Kara, Tarım & Zaim, 2003; Dursun & Cerci, 2004). Most of the service sectors consider that works quality is explained by perception and expectation. These studies usually use Parasuraman s SERVQUAL scale to measure service quality or consumers overall satisfaction.3 According to this scale, quality defines a gap between perceived expectations (E) and performance (P) and if the performance exceeds expectations the consumer will attain more satisfaction.(lehman, 2001). These expectations are based on one s own and others experiences. Most service sector literature focus upon the static models (Parasuraman, Zeitham & Berry, 1985, 1988, 1993; Babakus & Mangold,1992; Cronin & Taylor, 1992, 1994; Boulding, Kalra & Stealing 1993; Johnson & Ferstl, 1999). However, one ASIAN JOURNAL OF MANAGEMENT RESEARCH 32

need to remember that there are also some researchers who work with a dynamic framework as well (Kopalle & Lehman 2001; Kara, Tarım & Zaim, 2003). Hence the study on the quality of the hospital sector in Dindigul district. It has been observed, through these studies, serval factors affect the quality of hospitals. 3. Research Methodology Research Design: The research design is descriptive research design. Data collection: Primary data was collected through a structured questionnaire. Sample design: Convenient Sampling Sample size: 221 Patients from 5 hospitals at Dindigul town. 1. City Hospital 48, 2. Kamala Hospital 39, 3. Bavani Hospital 35 4. Rajarjeswari Hospital 38 5. Best Hospital 61 (Note: For this paper the data are collected from the inpatients who stayed in the Hospital more than 5 days which can help the patients to understand about overall nature of the service provided by the Hospital.) 3.1 Questionnaire Design When designing the questionnaire, the 22 items in the SERVQUAL questionnaire developed by Parasuraman et al. (1985) were referred to. Some modifications and adaptations were made to selected questions to make them more relevant to the hospital services at Dindigul. The questionnaires which consisted of 22 questions in five dimensions: tangibility, reliability, responsiveness, assurance and empathy, were given to 221 in house patients, for their invaluable feedback. The questionnaire contained an "expectations" section with 22 statements and a "perceptions" section consisting of a set of matching statements. The statements in both the expectations and perceptions sections were grouped into the following five dimensions, each with a range of applicable statements: A 5 point Likert scale was used for the scoring system with 1 representing Strongly Disagree and 5 representing Strongly Agree. Dimensions used for this study is shown below. Statements 1 4 Tangibles Statements 5 9 Reliability Statements 10 13 Responsiveness Statements 14 17 Assurance Statements 18 22 Empathy ASIAN JOURNAL OF MANAGEMENT RESEARCH 33

Table 1: Shows the Expectation Perception of Patients in Dindigul Hospitals STATEMENTS Mean Score Serv Gap Average Mean for Dimension Expectation Perception Exp Per Tangibility (statements 1 4) Tangibility (statements 1 4) Exp Per 1.Excellent Hospitals will have modern looking equipment 1. The Hospital has modern looking equipment. 3.45 3.56 0.11 2.The physical facilities at excellent hospitals will be visually appealing 3.Staff at excellent Hospitals will be neat in appearance 4.Materials associated with the service (such as pamphlets or statements) will be visually appealing in an excellent Hospital Reliability (statements 5 9) 5.When excellent Hospitals promise to do something by a certain time they will do so. 6.When a patient has a problem, excellent Hospitals will show a sincere interest in solving it. 7.Excellent Hospitals will get things right the first time. 8.Excellent Hospitals will provide their services at the time they promise to do so. 9.Excellent Hospitals will insist on error free records. 2. The physical facilities in the hospital/ clinic are visually appealing. 3.32 3.55 0.23 3. Staff in the Hospital is neat in appearance. 3.19 3.81 0.62 4. Materials associated with the service (such as pamphlets or statements) are visually appealing. Reliability (statements 5 9) 5. When the Hospital promises to do something by a certain time it does so 6. When you have a problem, the Hospitals shows a sincere Interest in solving it. 7. The Hospital gets things right the first time. 8. The Hospital provides its Services at the time it promises to do so. 9. The Hospital insists on Error free records. 2.75 3.32 0.57 Ave. Gap= 1.53 3.54 3.07 3.23 3.74 3.19 3.58 3.82 3.30 2.53 3.26 0.47 0.51 0.39 0.52 0.73 Ave. Gap= 0.64 2.542 2.84 3.262 3.39 ASIAN JOURNAL OF MANAGEMENT RESEARCH 34

Responsiveness (statements 10 13) 10. Staff in excellent hospitals will tell patients exactly when services will be performed. 11. Staff in excellent Hospitals will give prompt service to patients. 12. Staff in excellent Hospitals will always be willing to help patients. 13. Staff in excellent Hospitals will never be too busy to respond to patients' requests. Responsiveness (statements 10 13) 10. The staff in the Hospital tell you exactly when services will be performed. 11. Staff in the Hospital give you prompt service. 12. Staff in the Hospital is always willing to help you. 13. Staff in the Hospital is never be too busy to respond to your requests. 2.88 3.59 0.71 3.30 3.60 0.3 3.30 3.73 0.43 3.49 3.08 0.41 Ave. Gap= 1.03 2.594 2.79 Assurance (statements 14 17) 14. The behaviour of staff in excellent Hospitals will instill confidence in patients. 15. Patients of excellent Hospitals will feel safe in their dealings with the Hospital. 16. Staff in excellent Hospitals will be consistently courteous with patients. 17. Staff in excellent Hospitals will have the knowledge to answer patients' questions. Assurance (statements 14 17) 14. The behaviour of 3.49 3.02 staff in the Hospital 0.47 instills confidence in you 15. You feel safe in your dealings with the Hospital. 3.87 3.49 0.38 16. Staff in the Hospital is consistently courteous with you. 3.28 3.40 17. Staffs in the Hospital have the knowledge to answer your questions. 0.12 2.90 2.57 0.33 Ave. Gap= 1.03 2.708 2.49 Empathy (statements 18 22) 18. Excellent Hospitals will give patients individual attention. Empathy (statements 18 22) 18. The Hospital gives you individual attention. 3.92 3.38 0.54 ASIAN JOURNAL OF MANAGEMENT RESEARCH 35

19. Excellent Hospitals will have operating hours convenient to all their patients. 19. The Hospital has operating hours convenient to all its patients. 3.58 3.39 0.19 20. Excellent Hospitals will have staffs who give patients personal attention. 21. Excellent Hospitals will have the patients' best interests at heart. 22. The staff of excellent hospitals/ Clinics will understand the specific need of the patients 20. The Hospital has staffs who give you personal attention. 21. The Hospital has your best interests at heart. 22. The staff of the Hospital understand your specific needs 3.58 3.46 0.12 3.36 3.34 0.02 3.28 3.09 0.19 Ave. Gap= 1.06 3.544 3.33 The expectations of patients along with the hospitals performance as perceived by patients are shown in Table 1.The authors also computed the service quality gap for each statement and dimension, which is a good indicator of any service shortage in the hospitals. Table 1 show that there were mean differences between patients expectations and perceptions in all the dimensions. Table 2: Shows the Highest Expectation Statements Highest Expectation Statements Statements number Mean Score Excellent Hospitals will give patients individual attention. E 18 3.92 Patients of excellent Hospitals will feel safe in their dealings with the Hospital. E 15 3.87 Excellent Hospitals will provide their services at the time they promise to do so. E 8 3.82 Excellent Hospitals will have operating hours convenient to all their patients. E 19 3.58 Excellent Hospitals will have staffs who give patients personal attention. E 20 3.58 From the above three of the highest expectations (E18, E19 and E 20) are in the Empathy dimension. The second highest expectation is statement E15 in the Assurance dimension and the other highest expectations is statement E8 in the reliability dimension. ASIAN JOURNAL OF MANAGEMENT RESEARCH 36

Table 3: Shows the Lowest Expectation Statements Lowest Expectation Statements Statements number Mean Score Excellent Hospitals will insist on error free records. E 9 2.53 Materials associated with the service (such as pamphlets or statements) E 4 2.75 will be visually appealing in an excellent Hospital Staff in excellent hospitals/ clinics will tell patients exactly when E 10 2.88 services will be performed. Staff in excellent Hospitals will have the knowledge to answer patients' E 17 2.90 questions. Excellent Hospitals will get things right the first time. E 3 3.19 One of the lowest expectation statements, E9 are in the reliability dimension, two of the lowest expectation statements, E4 and E10, are in the tangibility and responsiveness dimension. E 17 and E 3 of the lowest expectation statements are in the assurance and tangibility dimension. Table 4: Shows the Highest Perception Statements Highest Perception Statements Statements number Mean Score Staff in the Hospital is always willing to help you. P 3 3.81 When you have a problem, the Hospitals show a sincere Interest P 6 3.74 in solving it. Staff in the Hospital is neat in appearance. P 12 3.73 Staff in the Hospital give you prompt service. P 11 3.60 The staff in the Hospital tells you exactly when services will be performed. P 10 3.59 The highest perception statement P 3 is in the tangibility dimension and P 6 is in the reliability dimension. Three of the perception statements, P 10, P 112 and P 12, are in the responsiveness dimension. Table 5: Shows the Lowest Perception Statements Lowest Perception Statements Statements number Mean Score Staff in the Hospital has the knowledge to answer your P 17 2.57 questions. The behaviour of staff in the Hospital instills confidence in you P 14 3.02 The staff of the Hospital understand your specific needs P 5 3.07 Staff in the Hospital is never be too busy to respond to your requests. P 13 3.08 ASIAN JOURNAL OF MANAGEMENT RESEARCH 37

When the Hospital promises to do something by a certain time it does so. P 22 3.09 The least of the two lowest five perceptions statement, P17and P 14, is in the assurance dimension, and the next lowest perception statement, P5 is in the reliability dimension. However, two other lowest expectation statements, P13 and P22, are in the responsiveness and Empathy dimension. Table 6: Shows the Highest Service Gaps Statements Highest service Gaps Statements number Mean Score Excellent Hospitals will insist on error free records. S 9 0.73 Staff in excellent hospitals will tell patients exactly when services will S 10 0.71 be performed. Materials associated with the service (such as pamphlets or statements) S 3 0.62 will be visually appealing in an excellent Hospital Excellent Hospitals will insist on error free records. S 4 0.57 When a patient has a problem, excellent Hospitals will show a sincere interest in solving it. S 18 0.54 The largest difference between expectations/perceptions is S 9 which is in reliability dimension. The next largest difference between expectations/perceptions is S 10 is in responsiveness dimension. Two of the largest differences between expectations/perceptions, S 3 and S 4, are in the tangibility dimension. Table 7: Shows the Lowest Service Gaps Statements Lowest service Gaps Statements number Mean Score Excellent Hospitals will have the patients' best interests at S 21 0.02 heart. Excellent Hospitals will have modern looking equipment S 1 0.11 Staff in excellent Hospitals will be consistently courteous with patients. Excellent Hospitals will have staffs who give patients personal attention. Staff in excellent Hospitals will give prompt service to patients. S 12 0.12 S 20 0.12 S 11 0.30 ASIAN JOURNAL OF MANAGEMENT RESEARCH 38

The lowest difference between expectations/perceptions is S 21 which is in Empathy dimension. The next the lowest difference between expectations/perceptions is S 1 in tangibility dimension. Two of the smallest differences between expectations/perceptions are S 11 and S 12 in the responsiveness dimension. The other one of the smallest differences between expectations/perceptions is S 20 in the empathy dimension. Table 8: Shows Relative Importance Of Service Quality Dimensions S.no STATEMENTS 1 Hospitals will have modern equipment, clean environment and good directional sign 2 Hospital doctors are providing services in time and accurately 3 Willingness of the doctors to provide proper service and to be responsive to the patients needs 4 Knowledge and courtesy of the Doctors and their ability to convey trust and confidence 5 Hospitals will have staffs who give patients care and personal attention. DIMENTIONS Percentage Tangibility 22.29 Reliability 19.23 Responsiveness 20.41 Assurance 18.05 Empathy 20 3.2 Relative Importance of Service Quality Dimensions as Evaluated By Patients The above Table shows the most valuable elements of the SERVQUAL analysis to determine the relative importance of the five dimensions. The highest (22.29 percent) in the Tangibility dimension is the most relative importance of the SERVQUAL scores. The next highest (20.41 percent) in the Responsiveness dimension of the SERVQUAL scores. The lowest (18.05 per cent) is in the Assurance dimension is the least important, relatively, of the SERVQUAL scores. Table 9: Opinion about Overall Service Quality S.no Statements Excellent Good Neutral Poor Very Poor 1 Service Quality 21.6 27.4 24.4 16.7 9.9 From the above it is clear that 21.6% of the Patients said the service quality is Excellent. 27.4% of the Patients said the service quality is good. ASIAN JOURNAL OF MANAGEMENT RESEARCH 39

24.4% of the Patients said don t want to comment about the quality of service provided by the Hospitals and said Neutral. 16.7 % of the Patients said the service quality is poor. 9.9% of the patients said the service quality is very poor. Table 10: Priority for Each Service Dimensions SERVQUAL Dimension Tangibility Reliability Responsiveness Assurance Empathy Average Mean for Dimension Exp. Score Per.Score 2.542 2.848 3.262 3.390 2.594 2.798 2.708 2.496 3.544 3.332 Gap Score Priority 0.306 1 0.128 3 0.204 2 0.212 4 0.212 5 From the above, the patients at Dindigul hospitals were given 1 st Priority to Tangibility followed by responsiveness and reliability. Fourth and fifth Priority given to assurance and Empathy. Table 11: Result of Comparison of Tangibility Statements For Expectation And Perception STATEMENTS Sum of Squares df Mean Square F Sig. Between Groups 260.425 4 65.106 Within Groups 79.385 216 0.368 177.147 0.000 Total 339.810 220 The result of ANOVA between expectations and perceptions for tangibility is shown above. The calculated F value is 177.147 which is greater than the Table F (4,216) = 2.3719 value. P value is less than the significant value of P=.05. So null hypothesis is rejected. Hence, there is a tiny difference in the mean value of Patients expectations and perceptions for tangibility factor in service quality. Table 12: Result of Comparison of Reliability Statements for Expectation And Perception STATEMENTS Sum of Squares df Mean Square F Sig. Between Groups 239.286 4 59.822 342.661 0.000 Within Groups 37.709 216 0.175 Total 276.995 220 ASIAN JOURNAL OF MANAGEMENT RESEARCH 40

The result of ANOVA between expectations and perceptions for reliability is shown above. The calculated F value is 342.661 which is greater than the Table F(4,216) = 2.3719 value. P value is less than the significant value of P=.05. So null hypothesis is rejected. There is a service gap between the patients expectancy and perception for reliability of the hospitals and services provided by them. Table 13: Result of Comparison of Responsiveness Statements for Expectation and Perception STATEMENTS Sum of Squares df Mean Square F Sig. Between Groups 328.562 4 82.141 Within Groups 16.678 216 0.077 Total 345.240 220 1063.838 0.000 The result of ANOVA between expectations and perceptions for responsiveness is shown above. The calculated F value is 1063.838 which is greater than the Table F (4,216) = 2.3719 value. P value is less than the significant value of P=.05. So null hypothesis is rejected. Hence there is a service gap in the Patients expectations and perceptions for Dindigul hospital s staff and doctors responsiveness about their job. Table 14 : Result of Comparison of Assurance Statements for Expectation and Perception STATEMENTS Sum of Squares df Mean Square F Sig. Between Groups 278.100 4 69.525 655.645 0.000 Within Groups Total 22.905 216.106 301.005 220 The result of ANOVA between expectations and perceptions for responsiveness is shown above. The calculated F value is 1063.838 which is greater than the Table F(4,216) = 2.3719 value. P value is less than the significant value of P=.05. So null hypothesis is rejected. Hence there is a tiny difference in the mean value of Patients expectations and perceptions for Assurance in service quality. ASIAN JOURNAL OF MANAGEMENT RESEARCH 41

Table 15: Result of Comparison of Empathy Statements for Expectation and Perception STATEMENTS Sum of Squares df Mean Square F Sig. Between Groups 282.072 4 70.518 441.070 0.000 Within Groups 34.534 216 0.160 Total 316.606 220 The result of ANOVA between expectations and perceptions for responsiveness is shown above. The calculated F value is 1063.838 which is greater than the Table F(4,216) = 2.3719 value. P value is less than the significant value of P=.05. So null hypothesis is rejected. Hence there is a service gap in the Patients expectations and perceptions for Dindigul hospital s staff and doctors empathy on patients. 4. Findings and Recommendations 1. The lowest service gap in Empathy and tangibility shows that patients are satisfied with hospital care about them and the equipment equipped in the hospitals. If a Hospital is lacking of modern equipments then the patients are facing trouble. But maximum patients are satisfied with the modern equipments at present in the Hospital at Dindigul. 2. The highest service gap is there at reliability. This indicates that the patients are expecting reliable records for their expenses and error free records. The next highest service gap is on responsiveness. This shows that patients wants to know about their treatment details brief and effective. By the way of providing responsible data and details about the patients treatment history may reduce the service gap certainly. 3. There is a service gap between the patients expectancy and perception for reliability of the hospitals and services provided by them. Hospitals at dindigul can be reliable by the way of staff and Doctors are attending the cases at the time they promises to do so. The reliability service gap can be reduced by the way of attending the patients on said time and providing error free records. 4. There is a service gap in the Patients expectations and perceptions for Dindigul hospital s staff and doctors responsiveness for their job. Patients are expecting that doctors and staff must be courteous and ready to answer for their treatment related queries. 5. Patients expectations and perceptions shoes a service gap which reveals there is no empathy on patients. The patients are expecting individual attention about them and their need should be considered and resolved immediately. 5. Conclusion The overall results of this study have several implications for individual hospitals at dindigul.this research helps to identify the service gap areas in the hospitals. This study identifies what these hospitals have to do to reduce the service gap and enhance their services effectively and efficiently. ASIAN JOURNAL OF MANAGEMENT RESEARCH 42

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