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Procedia Economics and Finance 6 (2013) 573 585

2212-5671 2013 The Authors. Published by Elsevier B.V.

Selection and peer-review under responsibility of Faculty of Economic Sciences, Lucian Blaga University of Sibiu.

doi:10.1016/S2212-5671(13)00175-5

ScienceDirect

International Economic Conference of Sibiu 2013 Post Crisis Economy: Challenges andOpportunities, IECS 2013

The Assessment of Perceived Service Quality of Public Health Care

Services in Romania Using the SERVQUAL Scale

Victor Lorin a*, Iuliana Raluca Gheorghea, Petrescub

aDepartment of Marketing and Medical Technology,

"Carol Davila" University of Medicine and Pharmacy, Bucharest, RomaniabNational School of Political Studies and Public Administration,

"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania

Abstract

The objective of this paper is to explore the application of the original SERVQUAL scale in the context of public health care

services in Romania. More specifically, we implemented the SERVQUAL scale in order to uncover whether it fits as the original

version or adjustments should be done and to define the demographic profiles of health care consumers who use public services

in Romania.

We have selected our sample respondents from a list of a gynaecological health care forum members, namely women from

Bucharest who should have posted messages on the chosen forum no more than three months before the study was conducted and

the messages should have comprised their experiences with certain physicians. The internal consistency, validity and reliability

measured as the difference between perceptions and expectations known as the gap.

Results indicated that the biggest gap score was registered by the tangibles dimension followed by responsiveness dimension and

reliability dimension.

2013 The Authors. Published by Elsevier B.V.


Keywords: health care services; service quality; SERVQUAL; Romania; public health care services.

* Corresponding author.

E-mail address:[email protected]

Available online at www.sciencedirect.com

2013 The Authors. Published by Elsevier B.V.


Open access underCC BY-NC-NDlicense.

Open access under CC BY-NC-NDlicense.
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574 Victor Lorin Purcrea et al. / Procedia Economics and Finance 6 (2013) 573 585

1.Introduction

Nowadays, increased competition has influenced both private and public service-oriented organizations

everywhere but mostly in developing countries. Therefore, in order to survive organizations have to deliver services

that satisfy consumers service quality has

increasingly been considered the key factor in differentiating services which also brings competitive advantages

such as improved customer retention, positive word-of-mouth, reduced level of staff migration, decreased costs in

attracting new consumers, increased profitability and financial performance, increased customer satisfaction and

enlarged market shares (Cronin et al, 2000; Janda et al, 2002; Gounaris et al, 2003; Yoon and Suh 2004). Hence, the

concept of service quality has caught the attention of many researchers in the Marketing sector. Knowing how to

s,

enhances efficiency as well (Mei et al, 1999).

1.1.Perceived Service Quality

perceptions regarding a certain service (Parasuraman et al, 1985). Expectations are reflected in the desires of the

consumers which they believe a service provider should offer. Once formed expectations will help the consumer

make a comparison between what he/she anticipated and what he/she actually received (Lovelock and Wright, 2002;

as a combination between what is delivered and how is delivered (Lim and Tang, 2000; Lovelock and Wright, 2002;

Zeithaml et al, 1993).

Zeithaml et al, 1990). Considering the importance of service quality, there is no surprise that many specialists have

spent a lot of time understanding and researching the underlying dimensions of the concept (Parasuraman et al,

1985; Parasuraman et al, 1988) and it als

outcomes of an organization. As consequence, during the 1980s the research in service quality increased and led to

different theoretical perspectives due to the fact that service quality is almost impossible to measure, the challenge

for experts lied in managing appearances and perceptions (Harvey, 1998).

In order to uncover the meaning of service quality, many specialists concluded that it is a two dimensional

variable (e.g. Lehtinen and Lehtinen, 1982; Gronroos, 1983; Berry, 1983). For instance, Lehtinen and Lehtinen

(1982) have defined service quality using terms such as corporate quality, interactive quality and physical quality

whereas Gronroos (1983) described service quality as a technical quality, namely what is delivered, and as well as, a

functional quality, that is, how the service is delivered.

outcome quality

(1982) as shown in figure 1.

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575Victor Lorin Purcrea et al. / Procedia Economics and Finance 6 (2013) 573 585

Dimension of

Quality

Lehtinen and

Lehtinen (1982)Gronroos

(1983)

Berry

(1983)

What is

provided

How is

provided

Physical

Quality

Interactive

Quality

Corporate

Quality

Technical

Quality

Functional

Quality

Outcome

Quality

Process

Quality

PERCEIVED SERVICE QUALITY

Fig. 1: Summary of the major theoretical perceptions on perceived service quality

Source: adapted from Warbridge, S.W.; Delene, L.M. (1993) Measuring Physician Attitudes of Service Quality,Journal of Health Care

Marketing, 13(1), p. 176

Some researchers assumed that service quality should be measured as a unidimensional variable by different

stakeholders (e.g. Schneider and White, 2004) but still others (e.g. Zeithaml et al, 2009) believed that service quality

should be assessed as a two-dimensional construct.

Soon, SERVQUAL scale became to be the most widely used, validated and generally accepted service quality

measurement in the services literature (Ladhari, 2009). Parasuraman et al (1988) made an exploratory research using

12 consumer focus-groups from four sectors, more specifically, banking, credit card, securities brokerage, productrepair and maintenance. The themes discussed during the focus-groups concentrated on the significance of service

quality, what are the characteristics of services and what are the criteria used to evaluate service quality. They

reached the conclusion that service quality is defined by five dimensions as follows:

Tangibles which encompass physical facilities, equipment and appearance of personnel;

Reliability reflects the ability of the provider to perform the service which was promised as accurately as

possible;

Responsiveness

service;

Assurance

trust and confidence;

Empathy

to consumers.In fact, the representation of how consumers evaluate the service quality in their minds is assessed by applying

the SERVQUAL scale. SERVQUAL (Parasuraman et al, 1988) is a multi-item instrument that consists of the above

mentioned five dimensions, characterized by 22 paired items. The SERVQUAL scale measures the expectation-

perception gap (Parasuraman et al, 1988; Parasuraman, 1998). Moreover, half of the items are elaborated in such a

perceptions (Babakus and Mangold, 1992). Consequently, the gap will be the result of the differences between

perception and expectation scores (Babakus and Mangold, 1992; Parasuraman et al, 1991). A positive gap score

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suggests that expectations have been met or are exceeded while a negative gap score indicates a failure. Gap scores

are usually analyzed as aggregated scores giving an overview for each dimension. However, gap scores can be

calculated for each individual statement. To conclude, the five dimensions and their implicit gap scores are meant to

signal the strengths and weaknesses embedded in the values of the scores so that managers can take adequate

measures in due time and prevent undesired outcomes.

Even if SERVQUAL has been widely spread and has been considered a reliable and valid instrument to measure

service quality, it has been criticized at both methodological and conceptual levels. One of the criticisms brought tolight was that the five dimensions can be, in fact, restrained to two dimensions, namely, core services and

augmented services (McDougall and Leveresque, 1994) that might be considered the equivalents of technical and

functional dimensions (Gronroos, 1983). Another criticism brought in the attention of experts is that SERVQUAL

cannot be universally applied in all service industries and it was suggested that when being implemented,

researchers should take into account the type of the service market (Carman, 1990). Other criticism focused on the

fact that the scale uses the expectations of the consumers as a base for comparison (Cronin and Taylor, 1992),

meaning the service delivery process, neglecting the technical aspects of the service encounter. Some researchers

even proposed another scale, SERVPREF, which is based on the original SERVQUAL but its reliability and

predictability proved to be more accurate for the service quality (Cronin and Taylor, 1992). Despite the fact that it is

still criticized, SERVQUAL measurement stands as the most popular scale used to assess service quality on

co -Fowdar,

2005).

Some services, such as health care services, which are high in credence qualities have a wide interpretative

margin meaning that consumers have the tendency to assess the quality based on their perceptions and reality; the

complexity of the service delivery, the discomfort, the desired results and the time elapses until the results are seen.

1.2.Perceived Quality in Health Care Services

Health care services are important to all societies that revolve around patients. Health care services are interesting

by nature because they are services that most individuals do not want but need at a certain point in time (Berry and

Beudapudi, 2007). Moreover, health care services are required to meet the physical, psychological and social needs

of people who seek care.

Nowadays, many health care organizations begin to recognize that quality should be assessed for survival.

Factors such as new incentive structures, declining reimbursement and increasing competition have placed a

pressure on health care organizations to deliver health care efficiently and effectively. On the other hand, health care

managers hope to decrease operating costs, expand access and improve service quality. In other words, if the health

care organization cannot offer a threshold level of quality then patients will utilize it for minor ailments or see it as a

last resort besides other forms of treatments (Andaleeb, 2001).

Therefore, quality in health care services is at the forefront of professional and managerial attention because it is

considered as the means to achieve competitive advantage and long-term profitability (Brown and Swartz, 1989) as

well as achieve the suitable health outcomes for consumers (Dagger and Sweeney, 2006).

Service quality measurements have been applied in different areas of health care in order to

perceptions regarding patient satisfaction (e.g. Bowers et al, 1994), AIDS service agencies (e.g. Fusilier and

Simpson, 1995), physicians (e.g. Brown and Swartz, 1989; Walbridge and Delene, 1993), nurses (e.g. Uzun, 2001)

and hospitals (e.g. Babakus and Mangold, 1992; Lim and Tang, 2000).

The service quality in health care was assumed to be made up of two basic dimensions such as the technical

technical or clinical quality in

health care services

specifications (Lam, 1997). Technical quality also reflects the competence of the professionals, the skills of the

doctors, and the labo

quality has the highest priority, most patients have an inability to evaluate what was provided to them because they

lack the expertise. Therefore, researchers resorted to measure technical quality by proxy, helping patients make a

The functional qualityrefers to the

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manner in which health care services were delivered to consumers. Due to the intangibility nature of the services,

consumers will look for tangible physical evidence such as equipment, appearance of employees, environmental

design, dcor signage, to form their expectations (Sureshchander et al, 2002). The functional aspect of the health

care process not only encompasses the environmental surroundings but also the empathic quality of the practitioner

skills reflected in sharing information, explanations, finding solutions, impairing information (Lam, 1997; Heskett et

al, 1997).Service quality measurement in health care developed in time based on the framework of SERVQUAL. Despite

all controversies regarding the validity and reliability of SERVQUAL, with or without modifications, proved to be a

successful background in health care as well. As consequence, the extended or shortened versions of SERVQUAL

dimensions vary from researcher to researcher. For instance, Lim and

initial SERVQUAL scale to 18 dimensions and Reindenbach and Sandifer-Smallwood (1990) extended the five

dimensions already existed in SERVQUAL to seven dimensions. Other researchers thought of regrouping the initial

SERVQUAL dimensions into other dimensions. For example, Tomes and Ng (1995) grouped under the empathy

nclude dimensions such as

These mixed results indicate that health care service quality is far from being solved and will still be a subject of

great debate. Therefore, the objective of this paperis to measure the service quality in Romanian public health care

units using the initial SERVQUAL. In other words, we want to uncover if the SERVQUAL scale can successfully

be applied in health care services in Romania, determine the dimensions which register the highest gap scores as

well as define the demographic profiles of the Romanian health care consumers of public services.

2.Material and Methods

After the development of the SERVQUAL scale, many specialists conducted various studies to prove its

employment and usefulness in the health care sector, either in its 22 item format or in modified versions in hospitals,

clinics or medical center environments in different countries (e.g. Lam, 1997; Mangold and Babakus, 1991; Lim andTang, 2000).

Most studies used the self-administered questionnaire choosing their sample respondents from lists with patients

regardless their health issues or their geographic distributions but still some of the studies were conducted either in

private or public health units or both.

In order to determine our sample of participants we wanted to select the list of patients from a health care forum.

We assumed that health care forums offer more confidentiality and anonymity rather than hospital health care

In Romania, there is a vast paletteof health care forums that cover a wide range of health care topicswhich focus on treatments, physicians, debates on adjacent health issues and illnesses. To narrow downthe health care field, we decided to select a gynecological forum which covers exclusively topics for

(Looker and

Stichler, 2001)and only these forums follow the characteristics suggested by Kozinets (2010).Due to the fact that our selected forum covered too many threads, we decided to focus only on the members who

posted messages about health care experiences with a physician. So, the sample was made out of women who were

members of the selected online forum, but since the database was big, further, we applied the following criteria to

filter them:

Members should have posted online messages no more than three months before the study;

Members should have posted messages about their experiences with physicians in public health care

units;

Members should have been from Bucharest.

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.42%3

21.81%

15.6

18.27%5.81% under 1000 RON

1100-1500 R N

1600-1800 RON

1900-2200 RON

2300-2500 R N

over 2500 R N

The sample size was determined following the guidelines of Catoiu et al (2002). So, we concluded that a sample

size of 1000 persons will be enough to give us a clear insight of the researched problem. We have sent invitations to

take part in the study to 1000 women on their e-mail addresses. From 1000 women, 407 agreed to participate.

After applying the criteria mentioned above, from 407 women, 263 were suitable as respondents to be included in

our sample. Consequently, we have sent the 263 selected women, e-mails on their addresses with instructions about

the confidentiality agreements, their remuneration with 35 RON and the methodology employed in filling the

research questionnaire. Finally, from 263 respondents, we received 208 completed questionnaires (a response rate ofapprox. 70%) but we validated 183 responses.

The instrument employed to collect data was the self-administered questionnaire as it was applied onseveral occasions by other researchers following the initial SERVQUAL guidelines (Parasuraman et al,1985). The questionnaire comprised of two parts: on one hand, the first part collected demographicinformation about the respondents and on the other hand, the second part, contained 22 pairs of Likert-type statements found in the original SERVQUAL scale. Each item appeared twice because one partmeasured the expectations and one measured the perceptions of respondents regarding a health careservice offered by a physician in a public health care unit, on a 5-point Likert scale ranging from

while the SERVQUAL scale was checked using the factor analysis.

e used P version 13 and Microsoft Excel for the data collection and for statistical analysis.

. indings

3.1. Demographic profiles of the respondents

From 183 participants, more than half (52.57%) had ages between 25-34 and had university degrees (82.63%).

Some of the women were married (

income levels varied from 1100-1500 RON (38.42%) to 1600-1800 RON (21.81%), having technical jobs (30.09%)

and managerial jobs (28.38%) as illustrated in figure 2 and figure 3. Most of the respondents had a good health

status (89.63%) at the moment of filling in the questionnaire and they went for a health consultation for routine

check-ups (73.25%) and for analysis (18.25%). Some women have known their physicians from family and friends

(23.63%) and from health care forums (15.47%) as shown in table 1

Fig. 2: The percentages of jobs of the respondents F g. 3: The percentages of monthly incomes of the respondents

Source: Gheorghe, I.R. (2012) Marketing Communications in Health Care Services. An Electronic Word-o Mouth Approach (Doctoral thesis).

cademy of Economic Studies, Bucharest, p. 151

15.69%

28.38%30.09%

17.33

8.51% Professional position

Managerial position

Technical position

Support position

Sales position

Retired

Freelancer

Student

Other

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Table 1: The percentages of the methods used by respondents to find a physician

Source: Gheorghe, I.R. (2012) Marketing Communications in Health Care Services. An Electronic Word-of-Mouth Approach (Doctoral thesis).

Academy of Economic Studies, Bucharest, p. 151

3.2. SERVQUAL Scale Applied in Health Care Services

3.2.1. Internal Consistency of the SERVQUAL Scale

alpha is a value that ranges from 0 to 1. The value 0.7 was indicated to be the accepted limit (Nunnally, 1978) but

other values lower than this, for instance 0.6, were encountered in the literature (e.g. Wright, 2007). However, the

ha should not be lower than 0.5 (Hair et al, 1998). As such, for the overall

dimension are illustrated in table 2.

r every dimension

included

Dimension Expectation Perception

Tangibles 0.50 0.65

Reliability 0.51 0.96

Responsiveness 0.57 0.94

Assurance 0.52 0.94

Empathy 0.54 0.93

0.61 0.73

Combined scales: 0.67



Was recommended by the General Practitioner 6.25%

Was recommended by friends 12.83%

Was recommended by family members 26.63%

Heard about the physician from newspapers, journals, TV, radio 2.80%

Heard about him from the internet 15.47%

Other methods 37.02%

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3.2.2.Factor analysis

Factor analysis is a method used to diminish the number of items contained in a scale into a more composite scale

based on the relationships established between the initial items (Hair et al, 2009). Actually, factor analysis offers the

possibility to uncover latent structures by grouping the items already observed in a scale. Variables that load on one

factor should have the highest values, eventually higher than 0.4, that would explain the variance according to a high

percentage.Before performing the factor analysis, a preliminary statistical test, the Kaiser-Meyer-Olkin (KMO) index

in order to examine if data are inter-correlated.

lower than 0.05. In our case, the KMO index for the expectation scale was 0.75 while the perception scale was 0.84

inter-correlated and the factor analysis is suitable to be performed.

The method employed to uncover variables by the factor analysis us the correlation matrix. SPSS has five

methods of determining the rotation of a matrix, but in our case we used the Varimax rotation. Table 3 and Table 4

show that for each scale, factors load accordingly on their dimensions.

3.2.3.The Gap Analysis

Service quality is calculated as the difference between the perception and the expectation for each dimension,

Table 5, Table 6, Table 7, Table 8 and Table 9 indicate the gaps assessed for every dimension included in the

SERVQUAL scale.

Table 3: The Rotation Matrix of the Expectation Scale, Source: Gheorghe, I.R. (2012) Marketing Communications in Health Care Services. An

Electronic Word-of-Mouth Approach (Doctoral thesis). Academy of Economic Studies, Bucharest, p. 157

Component

1 2 3 4 5

e_ta1 .643 -.097 .125 .219 -.119

e_ta2 .618 -.232 .183 .154 -.142

e_ta3 .537 -.144 .227 .174 -.104

e_ta4 .490 .271 .017 .162 -.003

e_rel1 .038 -.050 -.087 .634 .186

e_rel2 .052 -.045 -.015 .820 -.659

e_rel3 -.050 -.049 -.149 .491 -.100

e_rel4 .067 .034 -.147 .651 .456

e_rel5 .026 -.153 .068 .666 -.187

e_resp1 -.260 .495 -.252 .123 .132

e_resp2 -.040 .806 -.011 -.131 -.099

e_resp3 .096 .427 .121 .055 .109

e_resp4 .087 .724 .019 -.092 -.201

e_ass1 -.067 .118 .174 -.254 .458

e_ass2 .236 .226 -.172 -.462 .478

e_ass3 .350 .178 -.193 .037 .635

e_ass4 -.011 .078 -.107 -.058 .683

e_emp1 -.203 -.004 .659 -.006 -.025

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e_emp2 -.145 .188 .476 .293 -.061

e_emp3 .004 .121 .726 .045 .255

e_emp4 .048 .030 .504 -.004 -.087

e_emp5 .074 .081 .609 -.077 -.039

Table 4: The Rotation Matrix of the Perception Scale

Component

1 2 3 4 5

p_t1 -.002 -.065 -.086 -.024 .672

p_t2 .077 .038 -.054 -.024 .794

p_t3 -.056 -.009 -.133 -.196 .804

p_t4 .030 -.056 .078 -.048 .470

p_rel1 .944 -.035 -.047 -.021 .048

p_rel2 .961 -.015 -.049 -.018 .041

p_rel3 .897 -.032 -.058 -.077 -.013

p_rel4 .909 .048 .048 .015 .006

p_rel5 .941 -.040 -.026 .005 .014

p_resp1 -.044 .028 -.009 .959 -.066

p_resp2 -.078 .070 -.049 .898 -.019

p_resp3 -.014 -.010 -.015 .919 -.106

p_resp4 .048 .007 -.015 .898 -.146

p_ass1 -.030 -.018 .935 -.070 -.071

p_ass2 -.037 .031 .906 -.028 -.073

p_ass3 -.033 .033 .931 -.018 .003

p_ass4 -.021 .064 .960 .029 -.028

p_emp1 -.020 .990 .020 .030 -.023

p_emp2 -.026 .929 -.006 .009 -.028

p_emp3 -.017 .846 .010 .005 -.080

p_emp4 .010 .795 .066 .032 -.011

p_emp5 -.019 .907 .016 .022 -.018

Table 5: Average Tangibles SERVQUAL Score

Factors under Tangibles

Dimension Expectation

Perception

(Average)

Gap Score (Expectation-

Perception)

Average Tangibles

SERVQUAL Score

IT1 4 2.02 -1.98

1.97IT2 4 1.96 -2.04

IT3 4 1.84 -2.16

IT4 4 2.08 -1.92

Average Tangibles Gap Score -2.02

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Table 6: Average Reliability SERVQUAL Score

Factors under Reliability Gap Score (Expectation- Average Reliability

IT1 5 3.47 -1.53

3.47IT2 5 3.46 -1.54

IT3 4 3.38 -0.62

IT4 4 3.36 -0.64IT5 4 3.72 -0.28

Average Reliability Gap Score -0.92

Table 7: Average Responsiveness SERVQUAL Score

Factors under

Responsiveness

Dimension

Expectation

(Average)


Perception)

Average Responsiveness

SERVQUAL Score

IT1 4 3.21 -0.79

2.98IT2 5 3.00 -2.00

IT3 4 3.03 -0.97

IT4 4 2.70 -1.30Average Tangibles Gap Score -1.26

Table 8: Average Assurance SERVQUAL Score

Factors under Assurance

Dimension Expectation

(Average)


Perception)

Average Assurance

SERVQUAL Score

IT1 4 3.62 -0.38

3.33IT2 5 3.52 -1.48

IT3 4 3.32 -0.68

IT4 4 2.88 -1.12

Average Tangibles Gap Score -0.91

Table 9: Average Empathy SERVQUAL Score

Factors under Empathy

Dimension

Expectation

(Average)


Perception)

Average Empathy

SERVQUAL Score

IT1 4 3.10 -0.9

3.26IT2 4 3.16 -0.84

IT3 4 3.43 -0.57

IT4 4 3.24 -0.76

IT5 4 3.38 -0.62

Average Reliability Gap Score -0.73



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4.Discussion

The implementation of the SERVQUAL scale in order to assess service quality, proved to be a controversial

ality in the

context of health care services, even if they differ significantly from the ones of the providers.

In a dynamic environment in which there is a continuous change in demographics, preferences and lifestyles, it is

required a persistent investigation of the consumer expectations and perceptions if an organization desires to survive

on a long term period. Understanding the health care consumer in a competitive market is highly important and

relevant. Apart from organizations, researching the consu

into the quality of health care industry overall. An improvement in the health care system can reduce the in-patient

stays and lower mortality. Failing to accomplish the needs of patients in a health care environment can lead to

identify opportunities and draw their weaknesses. From a managerial perspective, SERVQUAL helps when

organizati

of the service gaps and the intention to close these gaps by managers is likely to increase the service quality

perception and the consumer satisfaction.

Most specialists measured the service quality in health care using the SERVQUAL instrument as the difference

between perceptions and expectations, known as the gap. Thus, the values of the gap varied across contexts. For

instance, Mangold and Babakus (1991) and Babakus and Mangold (1992) measured the service quality in a US

hospital, concluding that the assurance had the lowest gap score, followed by reliability, responsiveness, empathy

and tangibles. Moreover, Lam (1997) applied the SERVQUAL scale in a hospital in Hong Kong. It was concluded

that the highest gap score was registered by the empathy dimension, followed by responsiveness, assurance and

reliability. Furthermore, Lim and Tang (2000) applied the SERVQUAL scale in a hospital located in Singapore and

concluded that responsiveness was the dimension that had the highest gap score, followed by assurance and

reliability. In Romania, Popa et al (2011) assessed the service quality in Oradea that resulted in the highest gap score

for empathy followed by reliability and assurance. In our case study, tangibles dimension turned out to have the

highest gap score, followed by responsiveness and reliability.

Tangibles dimension, having a negative value means that marketing managers should invest as soon as possible

consumers in service industries, lacking the technical knowledge, try to evaluate a service after tangible elements

such as the environment and the price. Managers should be careful at their health care environments maybe by

applying strategies used in ergonomics, as for example music. In order to raise the scores of responsiveness and

reliability dimensions, managers should pay great attention to the recruitment stage of their personnel based on

backgrounds and communication with patients.

5.References

Andaleeb, S.S. (2001) Service Quality Perceptions and Patient Satisfaction. A study of hospitals in a developing country, Social Science and

Medicine, 52, p. 1359-1370

Babakus, E. and Mangold, W.G. (1992) Adapting the SERVQUAL scale to hospital services: An empirical investigation,Health Services

Research, 26, pp. 768-786Berry, L. (1983) Services Marketing is different,Business, 30, p. 23-26

Berry, L. and Beudapudi, N. (2007) Health care. A fertile field for services research,Journal of Service Research, 10(2), p. 111-122

Bowers, M.R., Swan, J.E., Koehler, W.F. (1994) What attributes determine quality and satisfaction with healthcare delivery?Healthcare

Management Review, 19(4), p. 49-55

Brown, S.W. and Swartz, T.A. (1989) A gap analysis of professional service quality,Journal of Marketing, 53, p. 92-98

International Journal of Health Care Quality

Assurance, 11(4), p. 127-133

Carman, J.M. (1990) Consumer perceptions of service quality: an assessment of the SERVQUAL dimensions,Journal of Retailing, 66(1), p. 33-

55

8/9/2019 1-s2.0-S2212567113001755-main

12/13


Catoiu, I. (Ed.), Balan, C., Orzan, G., Popescu, I.C., Veghes, C., Danetiu, T., Vranceanu, D. (2002). Cercetari de Marketing. Bucharest: Uranus

Publishing House

Cronin, J.J. and Taylor, S.A. (1992) Measuring service quality: a reexamination and extension,Journal of Marketing, 56(3), p. 55-68

Cronin, J.J., Brady, M.K., Hult, G.T.M. (2000) Assessing the effects of quality, value, and customer satisfaction on consumer behavioral

intentions in service environments,Journal of Retailing, 76(2), p. 193-218

Dagger, T.S. and Sweeney, J.C. (2006) The effect of service evaluation on behavioral intentions and quality of life,Journal of Service Research,

9(1), p. 2-19

Journal of Health Care Marketing, 15(1), p. 49-53Gabbott, M. and Hogg, G. (1998). Consumers and Services. Chichester: Wiley

Gheorghe, I.R. (2012) Marketing Communications in Health Care Services. An Electronic Word-of-Mouth Approach (Doctoral thesis). Academy

of Economic Studies, Bucharest

Gounaris, S.P., Stathakopoulos, V., Athanassopoulos, A.D. (2003) Antecedents to perceived service quality: an exploratory study in the banking

industry, The InternationalJournal of Bank Marketing, 21(4/5), p. 168-190

Gronroos, C. (1983) Strategic Management and Marketing in the Service Sector. Boston: Marketing Science Institute

Hair, J.F., Anderson, R.E., Tatham, R.L., Black, W.C. (1998)Multivariate Data Analysis, New Jersey: Prentice Hall

Hair, J.F., Black, W.C., Babin, B.J., Anderson, R.E. (2009).Multivariate Data Analysis. Prentice Hall: Upper Saddle River

Harvey, J. (1998) Service quality: a tutorial,Journal of Operations Management, 16, p. 583-597

Heskett, J.L., Sasser, W.E., Schlesinger, L.A. (1997) The Service-Profit Chain, Free Press, New York

Janda, S., Trocchia, P.J., Gwinner, K.P. (2002) Consumer perceptions of internet retail.International Journal of Service Industry Management,

13(5), p. 412-431

Johnston, R. (1995) The determinants of service quality: satisfiers and dissatisfiers,International Journal of Service Industry Management, 6(5),

p. 53-71Kozinets, R.V. (2010). Netnography. Doing ethnographic research online, London: Sage

Ladhari, R. (2009) A review of twenty years of SERVQUAL research.International Journal of Quality and Service Sciences, 1, p. 172-198

in Hong Kong. Total Quality Management, 8(4),

p. 145-152

Lehtinen, U. and Lehtinen, J. (1982) Service Quality: a study of quality dimensions. Service Management Institute, Helsinki

isfaction in Singapore hospitals,International Journal of Health

Care Quality Assurance, 13, p. 290-299

Marketing Health Services, 21(3), p. 33-34

Lovelock, C. and Wright, L. (2002)Principles of service marketing and management. New Jersey: Prentice Hall

Mangold, W.G. and Babakus, E. (1991) Service quality: The front-stage vs. the back-stage perspective,Journal of Services Marketing, 5(4), p.

59-70

McDougall, G. and Levesque, T. (1994) A revised review of service quality dimension: an empirical investigation,Journal of Professional

Service Marketing, 11(1), p. 189-210

Mei, A.W.O., Dean, A.M., White, C.J. (1999) Analyzing service quality in the hospitality industry,Managing Service Quality, 9(2), p. 136-143

Nunnally, J.C. (1978).Psychometric Theory, New York: McGraw-Hill

Parasuraman, A. (1998) Customer service in business-to-business markets: An agenda for research.Journal of Business and Industrial

Marketing, 13, p. 309-321

Parasuraman, A., Berry, L., Zeithaml, V. (1991) Refinement and reassessment of the SERVQUAL scale,Journal of Retailing, 66(2), p. 34-45

Parasuraman, A., Zeithaml, V., Berry, L. (1988) SERVQUAL: a multiple-item scale for measuring consumer perceptions of service quality,

Journal of Retailing, 64(1), p. 12-40

Parasuraman, A., Zeithaml, V.A., Berry, L.L. (1985) A conceptual model of service quality and its implications for future res earch,Journal of

Marketing, 49, p. 41-50

Popa, A.L., Rosca, R.D., Mihoc, F. (2011)Investigating the Patient satisfaction within Romanian Public and Private Hospitals. Available online

at: http://core.kmi.open.ac.uk/display/1057879, accessed 11.07.2012

Ramsaran-Fowdar, R.R. (2005) Identifying healthcare quality attributes,Journal of Health and Human Service Administration, 27(4), p. 428-443

Reidenbach, R.E. and Sandifer-Smallwood, B. (1990) Exploring perceptions of hospital operations by a modified SERVQUAL approach,

Journal of Health Care Marketing, 10(4), p. 47-55

Schneider, B. and White, S. (2004). Service Quality: Research Perspectives. Thousand Oaks: Sage Publications

Sureshchander, G.S., Rajendran, C., Anantharaman, R.N. (2002) The relationship between service quality and customer satisfaction- a factor-specific approach,Journal of Services Marketing, 16(4), p. 363-379

Tomes, A. and Ng, S.C.P. (1995) Service quality in hospital care: the development of in-patient questionnaire,International of Health Care

Quality Assurance, 8(3), p. 25-33

Tucker, J.L. and Adams, S.R

of their care,Managing Service Quality, 11(4), p. 272-287

Uzun, O. (2001) Patient satisfaction with nursing care at a university hospital in Turkey,Journal of Nursing Care Quality, 16(1), p. 24-33

Warbridge, SW and Delene, LM (1993) Measuring Physician Attitudes of Service Quality,Journal of Health Care Marketing, 13(1), p. 175-180

Wright, B.E. (2007) Public service and motivation: does mission matter?Public Administration Review, 67(1), p. 54-64

Yoon, S. and Suh, H. (2004) Ensuring IT consulting SERVQUAL and user satisfaction: a modified measurement tool.Information Systems

Frontiers, 6(4), p. 341-351

8/9/2019 1-s2.0-S2212567113001755-main

13/13


Zeithaml, V., Berry, L., Parasuraman, A. (1993) The nature and determinants of customer expectations of service.Journal of the Academy of

Marketing Science, 21(1), p. 1-12

Zeithaml, V., Bitner, M.J., Gremler, D.D. (2009) Services marketing: integrating customer focus across the firm(5thedition). New York: Mc-

Graw Hill

Zeithaml, V.A., Parasuraman, A., Berry, L.L. (1990)Delivering Quality Service: Balancing Customer Perceptions and Expectations, New York:

The Free Press

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