SERVICE QUALITY PERCEPTION OF PATIENTS ON HEALTH CARE CENTRES IN COIMBATORE CITY Mrs. V.K. SASIKALA Assistant Professor of Commerce, JKK Nataraja College of Arts and Science Komarapalayam, Namakkal District. E-Mail: sarunetra@gmail.com Dr. N. TAMILCHELVI Associate Professor and Head, Department of Commerce, T. S. A. Arts Science and Tamil College, Perur, Coimbatore-641010. E-Mail: drtamilchelvi@gmail.com ABSTRACT India s health care service industry has turned out to be a major driver for economic growth. The multi-national healthcare segments are investing their funds on Indian soil. In India, terms such as health tourism, healthcare outsourcing and medical back office support are suddenly gaining impetus. Liberalisation, Privatisation and Globalisation also have brought unprecedented changes in the Indian healthcare industry. In this research, the researcher made an attempt to identify the service quality of the health care centres perceived by the patients in Coimbatore city. For this, 1012 respondents have been taken for examining the service quality of the health care centres in Coimbatore city by using convenient sampling method. In this research, SERVQUAL model has been used for various dimensions of service quality. The researcher found among the five various dimensions of the service quality, reliability has no gap. The other service dimensions like assurance, tangibility, responsiveness and empathy has more gap. So, the researcher recommended the health care centres should improve the four dimension services, so that the patients satisfaction level improves at the maximum level. KEYWORDS SERVQUAL, Service Quality, Patients perception, Health care centres
INTRODUCTION The healthcare sector is facing unparalleled challenges in an increasingly customer-oriented environment. A lot of health problems need intensive medical treatment and personal care. Treatment cannot be given in a patient s house or in the clinic. This is possible only in a hospital, for it consists of a large number of professionally and technically skilled people who apply their knowledge and skill with the help of world-class expertise, advanced sophisticated equipments and appliances. Hospital management performs its duties in the organizational setting of the hospital. It utilizes resources, people and technology to perform organizational goals, of which the most important is patient care. In the past, the hospitals were considered as alms houses. They were set up as charity institutions specially for the poor and weaker sections of the society. The healthcare industry in recent years has restructured its service system in order to survive in an unsuitable environment resulting from maturation of the industry, reduced funding and increased competition. The restructuring has focused on finding effective ways to satisfy the needs and desires of the patients. Consumer satisfaction is a basic requirement for healthcare providers because, the satisfaction related to quality healthcare is provided by hospitals. India s healthcare services industry grows at 13 per cent per annum over the last decade and at present, it is growing at 17 per cent annually. The healthcare industry is contributing 5.2 per cent of India s GDP. This contribution has reached up to 6.2 per cent. It is estimated to be around Rs.1000 billion at present and it is expected to reach Rs.2000 billion by 2012. This growth has been attributed to the increasing affluence and changing lifestyles and technology. Today, the Indian middle class expects healthcare services at higher level of quality. Government-run hospitals and those operated by charities were the main providers of subsidized healthcare till 1980s. During the last two decades, a number of corporate and private hospitals had mushroomed in the country. The private sector has played a critical and increasing role in providing healthcare to a growing population. India has 5,03,000 doctors, 7,37,000 nurses, 3,50,000 chemists and 162 medical colleges. There were around 15,100 hospitals accounting for 9,00,000 beds approximately during 2012. Quality changes the nature of business competition and, perhaps more than any other factor, it dictated how companies make products or deliver services. In the global economy quality is just the entry ticket. It is recognized that high quality service is essential for organizations that want to be successful in their business (Parasuraman et al 1988). The organization has to battle many competitors who have attained it. The next step is figuring out how to differentiate from others. This differentiating and improving is possible only through service quality measurement. In general research on service quality addresses two types of problems which are Instrument for Namex International Journal of Management Research 65 Vol. 4, Issue No. 1, Jan. June 2014. ISSN 2250-2076
measuring service quality and evaluation of service quality in separate framework of study indicating that it is highly desirable to incorporate both problems in a comprehensive manner. While there are a number of studies on health care industries service quality, there is very little published literature that reports the use of SERVQUAL in the assessment of healthcare industry s service quality. LITERATURE REVIEW According to James (2000) consumers evaluated the technical dimensions of nursing care, physician care, and outcome as more important than the accommodation functions of hospital care, and there are significant interactions among the technical dimensions. Both sets of dimensions were important and significant, but technical quality evaluations were not influenced by the perceived quality level of the affective attributes. The relative importance of these attribute were quite stable among various subgroups of past patients. Service quality perception and satisfaction of the patient studied from Andaleeb (2001) who explained patients perceptions about health services seem to have been largely ignored by health care providers in developing countries. Such perceptions, especially about service quality, might shape confidence and subsequent behaviours with regard to choice and use of the available health care facilities is reflected in the fact that many patients avoid the system or avail it only as a measure of last resort. Those who can afford it seek help in other countries, while preventive care or early detection simply falls by the wayside. Patients voice must begin to play a greater role in the design of health care service delivery processes in the developing countries. This study is, therefore, patients -centered and identifies the service quality factors that are important to patients it also examines their links to patients satisfaction in the context of Bangladesh. A field survey was conducted. Evaluations were obtained from patients on several dimensions of perceived service quality including responsiveness, assurance, communication, discipline, and baksheesh. Using factor analysis and multiple regression, significant associations were found between the five dimensions and patients satisfaction. Implications and future research issues are discussed. The research from Vicky and Sotiris (2012) noticed that to increased competition between health care providers and the need for patients - centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres, to test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. His analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients perceptions rather than expectations. This paper raises a number of issues that concern the applicability of SERVQUAL in health care services and Namex International Journal of Management Research 66 Vol. 4, Issue No. 1, Jan. June 2014. ISSN 2250-2076
could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. From the above research study, the researcher made an attempt to study the service quality of the patients about the health care centre services in Coimbatore city. MAIN AIM OF THE STUDY To examine the service quality perception of the patients about the health care centre in Coimbatore city. METHODOLOGY Descriptive research study has been used in this research. Service quality of the health care centres has been measured by using five dimensions like tangibility, reliability, responsiveness, assurance and empathy with using five point likert scaling technique. SERVQUAL model applied and found gap between each and every dimensions. For 1012 patients have been collected in Coimbatore city. RESULTS AND DISCUSSION The standard scale of SERVQUAL was administered to 1012 respondents. Primary data was analyzed using mean average. Gap analysis was done by calculating the average mean for individual statements and dimensions namely: reliability, assurance, tangibility, empathy and responsiveness. Table No. 1: Service Quality Gap Analysis Attributes Expectations (E) Perceptions (P) Gaps (E)-(P) % of Satisfaction Tangibility Best & Latest modern looking medical Equipments 3.81 3.44-0.37-9.7 Visually appealing Physical facilities 3.52 2.97-0.55-15.6 Reliability Doctors keep their promises 3.50 4.23 0.73 20.9 The hospital staff show sincere interest in solving the problems of the 3.71 4.21 0.49 13.5 patients Responsiveness The employees in hospital inform exactly when services will be 4.20 3.68-0.52-12.4 performed The employees in hospital give prompt service to patients 3.63 3.36-0.27-7.4 Assurance Employees behaviour instill patient confidence 3.60 3.12-0.49-13.3 Patients feel safe in their treatment 3.72 3.16-0.55-15.1 Empathy The hospital employees give patients individual attention 3.60 3.44-0.17-4.4 Hospital has operating hours convenience to all patients From the above analysis, it is found that among the ten statements in different 3.66 3.43-0.23-6.3 dimensions only two statements have a positive service gap viz., The doctors Namex International Journal of Management Research 67 Vol. 4, Issue No. 1, Jan. June 2014. ISSN 2250-2076
keep their promises (0.73) and the hospital staff show sincere interest in solving patients problems (0.49). On the other hand, the other variables are having negative service gap. Table No. 2 : Mean Scores of Five Dimensions Dimensions Expectations (E) Perceptions (P) Gaps (P)-(E) % of Satisfaction Tangibility 3.64 3.49-0.15-4.19 Reliability 3.54 4.04 0.50 14.18 Responsiveness 3.60 3.44-0.15-4.26 Assurance 3.61 3.35-0.27-7.34 Empathy 3.56 3.49-0.07-1.86 Overall Results 3.59 3.56-0.03-0.8 Quality is critical success factor in Service industries. The research measuring service quality has focused primarily on how to meet or exceed the external patients expectations and views service quality as a measure of how the delivered service level matches patients expectations. These perspectives can also be applied to the employees of the health care industry and in this case, other major gaps can be closed in service quality gaps model. FINDINGS On the basis of mean score calculated for individual dimensions, It is found that assurance dimension of Health Care Service has more gap. Then tangibility and responsiveness dimensions are having as second and third more service gap respectively and Empathy as fourth in the list. On the other hand, only the dimension of reliability has no gap. Overall the gap in assurance, tangibility and responsiveness are more in service quality in Health Care Industry which need to be taken care. The Health care industry has to improve in these four dimensions tangibility, responsiveness, assurance and empathy, so that their overall satisfaction level reaches at the maximum level. SUGGESTIONS AND CONCLUSION The researcher suggests that the hospital management should appoint a manager of each department and set a training programme for their staff in order to strengthen their (kind) communication and improve their service in action with outpatients during service procedures. So, it makes the staff to become more individually concerned towards the outpatients. The researcher recommends that the hospital management can add more outpatients services during night time in order to lower the consulting time. Waiting time is the main reason and it affects the patients level of satisfaction towards the service quality in multi-speciality hospitals. Besides, the hospital can provide magazines, books and television to help outpatients and their families occupy themselves during the waiting time. The researcher recommends that nursing care is always associated with underlying support services of hospitals such as maintenance of cleanliness, ventilation and lighting in the wards, quantity and quality of beds, instructions displayed in and outside the Namex International Journal of Management Research 68 Vol. 4, Issue No. 1, Jan. June 2014. ISSN 2250-2076
wards, quality of meals and sanitary facilities. This makes the patients feel the homely way of care and increases their trust towards the health care centres services. REFERENCES http://indiabudget.nic.in/es2011-12/echap- 10.pdf http://healthcare.financialexpress.com/sectio ns/it-healthcare/2343-effective-itpolicies-to-save-lives http://articles.economictimes.indiatimes.com /2013-09- 17/news/42148654_1_bpm-councilbpo-sector-industry http://www.ibef.org/industry/healthcareindia.aspx Parasuraman, A., Zeithaml, V.A. and Berry, L.L., SERVQUAL: a Multiple-item Scale for Measuring Consumer Perceptions of Service Quality, Journal of Retailing, Vol. 64, Springer, pp. 12-40, 1988. James M. Carman, Patients Perceptions of Service Quality Combining the Dimensions, Journal of Services Marketing, 14 (4): 2000, 337-52. Andaleeb SS, Service quality perceptions and patients satisfaction: a study of hospitals in a developing country, Soc Sci Med. 52(9): 2001, 1359-70. Vicky Papanikolaou and Sotiris Zygiaris, Service quality perceptions in primary health care centres in Greece Article first published online: 2 FEB 2012. Namex International Journal of Management Research 69 Vol. 4, Issue No. 1, Jan. June 2014. ISSN 2250-2076