Mohideen BU Phd Proposal

7/21/2019 Mohideen BU Phd Proposal

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Service Quality and Customer Satisfaction in Health Care Sector:

An Comparative Study On Selected Public and Private Hospitals

of Tamil Nadu

Discipline: Marketing

Conceptual Framework:

Hospitals also known as Health care centre’s where people get their health through

products and services provided by hospital. Health is defined as state of complete

physical, mental and social well being and just not the non-existence of diseases or

ailment. Health care sector has been change with time to time. arlier before

independence health care was based on individual, medicinal properties of plants

and herbs were passed from one generation to another. !fter independence

"overnment of #ndia laid down a stress on $rimary health %are &$H%'. (ut only

government was not able to provide more facilities for health care. )o to give more

facilities to peoples government allowed private sector health care.

)ervice *uality has been defined as +the outcome of an evaluation process where

the consumer compares his expectations with the service he has received or the

difference between expected service and perceived service. uality is considered as

one of the important factors in differentiation and excellence of services and it is a

basis of competitive advantage so that its understanding, measuring, and developing

it are important challenges for all health services organiations. )ervice *uality is the

important reason patient select hospitals. /he dimensions of patient perceived

Hospital )ervice uality &H)' are0 $hysical nvironment and #nfrastructure,

$ersonnel uality, #mage, /rustworthiness, )upport, $rocess of %linical %are,

%ommunication, 1elationship, $ersonaliation, !dministrative $rocedures.

Statement of the Problem:

Hospitals play an integral part in healthcare system in #ndia. /hey perform various

functions like #n-patient, 2ut-patient services, 1esearch and 3evelopment, /raining

etc. #ndian hospitals can be categoried into $ublic hospitals &"overnment', $rivate

and not for- profit &Missionary4/rust owned' hospitals. /he $ublic hospitals are run by

the %entral and )tate "overnments and Missionary hospitals by charitable trusts

which endows with free services or at subsidied rates to the needy. 3ue to

5iberaliation, $rivatiation and "lobaliation &5$"' there is a change in economical

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empowerment of the middle class due to which there has been a boost in the

number of corporate hospitals and private hospitals that provide healthcare services

in towns and cities. Huge investment is made and high awareness programmes have

been launched by both %entral and )tate "overnments on public healthcare to

provide *uality healthcare to all.

!lso budgetary allocations have been made for hospital buildings, machinery,

e*uipments, drugs, and public awareness on health and diseases and on manpower

to ac*uire skilled employees in all medical and paramedical fields to provide *uality

treatment to the patients by all means. $atients from ($5 and lower income groups

are utiliing public healthcare services and other income groups availing treatment

from private hospitals.

/he major concern for hospitals is patient satisfaction. )ome of the problems of

"overnment hospitals include poor physical conditions, primitive health information

system and negligible formal *uality control, absence of forward planning, grouping

of unrelated activities, faulty staffing procedures, ineffective leadership, lack of

coordination, unsatisfactory supply of drugs and medical supplies, absence of sound

public relations, among others. )ome of the problems of )emi "overnment hospitals

include political interference, employee exodus, and absence of transfers, corruption

practices, and irregular medical audit, among others. )elf managed doctor hospitals

are facing problems relating to lack of continuing medical education, irrational drug

use, substandard medical care, lack of professional self regulations etc. /he

problems of corporate hospitals are high treatment costs, unnecessary tests, non-

utiliation of services of specialied people etc.

/he present study is being carried out to assess "overnment, $rivate and

Missionary hospitals service *uality and to analye service gaps between

perceptions and expectations of patients. #f *uality of services provided by

healthcare sector is not up-to expectations, the public will be at a very heavy loss in

the form of ill health and low working ability leading to low economic development.

Many studies at macro level have been conducted to measure *uality of care in

hospitals. !rea specific and organiation specific studies are also necessary to have

a clear picture about the *uality maintenance of healthcare services by hospitals.

/he present in-depth study will throw some light to the administration of both

"overnment, $rivate and Missionary hospitals on service *uality provided by them

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i.e., patient’s expectations and perceptions on healthcare services and patients’

satisfaction levels to service *uality with special reference to /amil 6adu.

SCOPE OF THE STUDY:

/he medical profession has broadened its horion globally and #ndia is no exception.

%orporate hospitals are emerging as new breed in healthcare industry in #ndia.

/hese hospitals are attracting a number of patients because of their super-

specialties. /here is keen competition among these hospitals for market share. /he

emphasis is not only to provide specialied services more efficiently and effectively,

but also to maintain the *uality of overall services.

#n view of changing needs of customers, changing world, changing life style and

technological innovations, the market has become customer service oriented.

/herefore, in service delivery and services management the service *uality has

become an essential need in this competitive environment. !s the physiological

contentment of the people got satisfied7 there is a demand for more satisfaction.

Human’s desire to live long has resulted in special healthcare services like health

and fitness clubs, multi specialty hospitals, nursing homes etc.

/he patients evaluate service *uality experience as the outcome of the gap between

expected and perceived *uality. /he )189!5 model measures )ervice uality

and identifies potential gaps within the service organiation that may lead to most

serious final gap named as )ervice gap i.e. the difference between what customers

expected and perceived against to what was delivered.

Oeriew of !iterature:

1. Rameshan (2004), aimed to studied the *uality of service of primary health

centers. He reveals that the services rendered by $H%s are deficient in many

respects in the perception of customers and community members of the villages and

that the doctors and the staff are unable to redress ade*uately the grievances raised

by villagers. 8illagers do not like the panchayat coming into the picture for improving

the services of $H%s, district officials totally discount privatiation as a means for

providing effective primary health care in rural areas.

2. Mququ (2005), attempted to explore the customer satisfaction, expectations and

perceptions as a measure of service *uality. He shows that the )!6() customers

are not satisfied with the service they receive, both on a one &geographical'

perspective and also on a customer group perspective. xpectations of private

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hospitals and rural state hospitals have higher ratings than those of urban state

hospitals.

3. Jain et al. (2006), studied the health seeking behavior and perception among

rural community. He founds out that for health related problems, community

members first discuss with family members and other influential persons of their

caste community and accordingly take decision regarding where to seek care and4or

treatment. Majority of people first try some home treatment and only when they are

not relieved they opt for approaching any provider. %hoice of health provider is in fact

dependant on decision makers which could be elder male family members or some

other person from the community 5iteracy status, socioeconomic status, past

experience and perceived *uality of health care services also play pivotal role in

selection of provider. uality of available health care services was poor in the

opinion of respondents as a result of which rural community prefers to approach

private providers ranging from indigenous medical practitioners, 1M$s’ and *ualified

doctors.

4. Rao et al. (2006), studied the use of :;-item scale having good reliability and

validity. $atient perceptions of *uality at public health facilities are slightly better than

neutral. Multivariate regression analysis results indicate that for outpatients, doctor

behavior has the largest effect on general patient satisfaction followed by medicine

availability, hospital infrastructure, staff behavior, and medical information. <or in-

patients, staff behavior has the largest effect followed by doctor behavior, medicine

availability, medical information, and hospital infrastructure.

5. Çaha (2007), indicates that patient’s perception towards the private hospitals was

more due to believe that they provide *ualitative health service. (ut large number of

patients complains about services given by private hospitals. /he complaints are

mainly about the length of the time that they wait for treatment and the consultation

time given to them. /he lack of physical and human capacities of these hospitals

seems to be the main reasons behind the *uality of their service.

6. Costa (2008), focuses on developing a health management information system.

More physicians were worked on private sector located in urban areas. !ccess of

women physicians was low &=.>?'. !ll providers were negatively correlated to )%

proportion and positively to )/ proportions in the districts. $erception of policy maker

on public and private health sector was value conflict and morality.

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7. nan! an! "inha(2008), investigated the need of cognitive intermediation, which

is likely to define core competence of health care organiations in #ndia. #t seems to

have received relatively higher level of health workers’ visit. 5evel of public facilities’

utiliation is higher in this segment. !djusted segment characteried by higher

literacy level, higher standard of living, high level of health workers’ visit and

medium4high media exposure. 6eglected and marginalied segment is characteried

by the highest level of illiteracy, higher proportion of non-Hindu, not visited by health

workers’ visits, low women autonomy, low media exposure.

8. #a!ma et al. (200$), studied two instruments for measuring the dimensions of

hospital service *uality, one each from the perspective of patients and attendants,

are proposed.

$. "in%h (2010), concluded that the important reasons to visit government hospitals

are fewer charges, geographical proximity, recommended by their friends or

relatives. $atients are found to be dissatisfied with the doctors’ checkups. Mostly

patients were found dissatisfied with the hygiene and overall condition of the basic

amenities. Half of the patients were satisfied with the recovery since admission in the

hospital. Majority of patients were satisfied with various diagnostic services

provided by hospitals. Mostly patients did not lodge complaint against the behavior

of staff and *uality of services.

10. &a'ihiti (2010), clearly reveal that the perception of doctors and nursing staff in

case of "overnment "eneral Hospital. /here is a perceptible gap in the minds of

doctors and nursing staff and also on the dimensions of service expected and

received by the patients on the environment created for achieving patient centre

hospitals. However, the gap is thin in case of the doctors and nursing staff of )t.

@oseph’s and 61# "eneral Hospitals.

11. Raen!'an et al. (2010), identifies that patients and attendants treat the

interpersonal aspect of care as the most important one, as they cannot fully evaluate

the technical *uality of healthcare services. /he study also revealed that the hospital

service providers have to understand the needs of both patients and attendants in

order to gather a holistic view of their services.

12. "hah et al. (2010), indicates that the deficiencies in the public health delivery

system of #ndia, was the key to growth of private infrastructure in healthcare. /he

shift of hospital industry for Awelfare orientation’ to Abusiness orientation’ was

marked by the advent of corporate hospitals, supported by various policy level

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initiatives made by the government. /his paper tracks the various government

initiatives to promote private investment in healthcare and attempts to explore

the reasons for preference of the private sector. )urprisingly, in contrast to

contemporary belief, *uality of medical care doesn’t seem to be the leading cause for

preference of the private sector. xcept for a few select corporate and trust hospitals,

*uality of medical care in private sector seems to be poor and at times compromised.

13. Chun!u'i (2011), clearly reveal that service *uality was the one of the important

drivers in selection of a hospital. /he researcher would like to state that each

demographic was associated with the choice of hospitals. /he results of analysis

show that the attitudes of the patients within each dimension having a uniform or

e*ual attitude for any item between hospitals.

14. "ha'ma (2011), shows that AHealthcare delivery’ and Afinancial and physical

access to care’ significantly impacted the perception among men while among

women it was Ahealthcare delivery’ and Ahealth personnel conduct and drug

availability’. Bith improved income and education, the expectations of the

respondents also increased. /he overall *uality of healthcare services is perceived

to be higher in $rimary Healthcare %enters than in %ommunity Healthcare %enters

&%H%s'. #nade*uate availability of doctors and medical e*uipments, poor clinical

examination and poor *uality of drugs were the important drawbacks reported at

%H%s.

!nother interesting finding that emerged was with respect to #$3 and 2$3 patients

and their intention to visit the health centre in future. <or those visiting the hospital

for minor health problems, physical and financial access to health centers, and

availability of doctors providing sufficient time, and satisfactory prescription to help

them recover fast were more important than other factors.

15. &ata'aan (2011), reveals that "ujarat has a socio-economic environment which

is conducive to achieve these goals. )ignificant gains have been made in improving

the health care indicators in the )tate by increasing financial support, a planned

approach to improve the health care system and involvement of all stakeholders to

attain the desired goals.

16. *'+an (2011), studied that private hospitals in $akistan are making better efforts

as compared to the public hospitals. $rivate hospitals like the other service

organiations are focusing on their patients demands and developing themselves in

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order to provide maximum healthcare facilities to their patients. Bhereas the poor

*uality of healthcare services delivered to patients by public hospitals as compare to

the private hospitals are due to the many factors. /hese factors include0 government

funding, lack of government interest in development of new healthcare projects rural

areas and over burdened public hospitals due to rapid growth in population and

people trends to move from rural areas to major cities. /hese factors are affecting

the service *uality of public hospitals.

17. *tumalla (2011), concluded that $atients have pointed out several shortcomings

including lack of responsiveness to patients’ needs, delays, unreliable supply of

medicines in hospital, maintaining cleanliness and inade*uate availability of

diagnosis services. Health personnel conduct and practices was rated lowest with

C>.>?out of four aspects of service *uality such as Health personnel conduct and

practices, !de*uacy of resources and services, healthcare delivery and

financial and physical accessibility. 2verall respondents in hospital based study

perceived *uality of care at the hospital 2$3 as favourable.

18. 'ahm-hatt et al. (2011), shows that 2ut of D dimensions $rivate hospitals

perform better than public hospital in > dimensions namely $hysical !spects,

ncounter, $rocess and $olicy, while public sector hospitals perform better than

private sector only in one dimension namely 1eliability. 2verall private sector is

performing better in ncounter dimension, but specific ncounter-1esponsiveness

public sector has lowest score.

1$. &a'an% (2011), aims to investigate differences across various socio-

demographic characteristics of the respondents. /he opinions of the respondents

towards health care *uality were not very favourable. 6egative scores were obtained

on items, +availability of ade*uate medical e*uipments and +availability of doctors

for women. ducation, gender and income were found to be significantly associated

with user perception.

20. a/itha (2012), measures the gap between the management’s perceptions of

patient expectations and the patients expectations of service *uality. /he‟

perceptions of the 3octors representing the management about the patient’s

expectations of service are very high when compared to the patient’s expectations in

both hospitals. !ggregate mean values of the two hospitals are calculated and it is

found that for all the dimensions, there is significant difference between the mean

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scores of management’s perceptions of patient expectations and patients’

expectations.

However, as between the hospitals, there is no significant difference between the

hospitals in the doctor’s perceptions about patient’s expectations.

21. Mu'th(2012), shows that macro and micro factors affect the health care

situation and identifies mpathy as a key factor on which private hospitals score over

public hospitals. /he nurse acts as an interface between customer and hospital and

thus is very important from the point of view of customer satisfaction. /he registration

desk was to improve to ease of registration. /he private sector scores over the public

sector in having access to the most modern e*uipment and technology.

22. 'n!ahl (2012), concludes that patients’ perceptions of *uality of care and

patient satisfaction ranged from lower to higher depending on whether all

patients or groups of patients were studied. = clusters of patients were

identified regarding their scores on patient satisfaction and patients’ perceptions

of *uality of care. 2ne group consisted of patients who were most satisfied and had

the best perceptions of *uality of care, a second group of patients who were less

satisfied and had better perceptions, and a third group of patients who were less

satisfied and had the worst perceptions. /he *ualitative study revealed > categories

of importance for patients’ satisfaction0 desire to regain health, need to be met

in a professional way as a uni*ue person, perspective on life, and need to

have balance between privacy and companionship.

23. "ha'mila (2013), study indicates that service *uality in private hospitals is

meeting patientsA satisfactions and private hospitals are delivering better healthcare

services. /he result can be used by the hospitals to reengineer and redesign

creatively their *uality management processes and the future direction of their

more effective healthcare *uality strategies.

24. ashist an! Jain (2013), concludes $rivate sector delivers awareness about

*uality of medical care, greater penetration of insurance, increased purchasing

power, changing demographic structure, etc. $rivate sector also changes day to day.

!s healthcare was viewed as a profitable venture, corporate culture takes part in

healthcare delivery. #nherent factors like improved efficiency, better *uality, greater

reliability and transparency has also aided in the growth of private sector in

healthcare.

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25. ani et al.(2013), study shows that #ndia lags behind in regard of health

improvement as compared to 9.).!, %anada, %hina, and (rail, but contrary to other

developing countries like $akistan, (angladesh the scenario is better with life

expectancy, Mortality ratios, health care spending speak volumes about the

healthcare status. Bhen analyed through the prism eye, within #ndia there are

large disparities amongst states in achieving health outcomes as well. (efore

liberaliation the improvement was at a snail’s pace, but after liberaliation the whole

picture changed because the key initiatives to improve the current healthcare

standard a two prong strategy focusing on the infrastructure needs and the

technology solution were implemented, which resulted in the healthy scenario of

the healthcare industry.

2n the basis of above studies, it has been found that numbers of studies have been

conducted on service *uality of hospital sector. /his is one of the rapid growing

sectors of #ndia. (ut still number of geographical regions have been uncovered in the

above studies i.e. %hennai sub urban like /rivallur, Eanchipuram, /ambaram. /he

title of the proposed research is also focusing on the different dimensions of service

*uality which have been studied at different geographical regions in #ndia. /he

proposed research will also be covering the service *uality part of hospitals in /amil

6adu including sub urban. /he present research topic is an effort to understand the

service *uality of hospital sector with special reference to /amil 6adu. Hence the

present study i.e. +! study on )ervice uality Measurement in Healthcare sector is

undertaken. /he study is an attempt to diagnose failure gaps in )ervice uality. /he

present study analyses the gap between patients’ expectations and perceptions of

the services offered and standards maintained by select hospitals i.e., "overnment,

$rivate and Missionary owned with the help of )189!5 scale and suggest

measures for better service *uality offered by them.

Ob"ectie of the stu#$

:. /o analye factors affecting selection of hospitals by consumer F. /o 3evelop an instrument to measure perceived service *uality in the health

care sector =. /o identify the determinants of patient satisfaction and behavioral intentions

9



>. /o )tudy the relationships among perceived service *uality, patient

satisfaction and behavioral intensionsD. /o %ompare the perceived service *uality among public and private hospitals%& /o suggest appropriate measures to Hospitals.

'esearch Desi(n

/he study is based on exploratory and descriptive research design with the objective

of measuring the perceptions of service *uality at hospitals in /amil 6adu through

)18$1< scale. /he study uses both primary and secondary information.

'esearch )etho#olo($

!n #nitial exploratory research will be done by the researcher using secondary data

to identify the important factors for customer perceptions of service *uality that maybe included in the *uestionnaire.

$rimary data on the customer’s perceptions of *uality of services provided by the

hospitals will be collected through the structured *uestionnaire, which will be

prepared on the basis of exploratory research done.

<urther analysis of the data is done for achievement of the research goals through

the use of statistical software.

Sample Desi(n an# Selection0

/he study presents the customer perception on healthcare services *uality, on a

sample population. /he respondents will be either the patients themselves or their

relatives. /he information will be collected through a structured *uestionnaire.

%onvenience sampling will be used for the study.

Data *nal$sis

8arious statistical techni*ues will be used on the primary data collected from the

respondents. /o investigate the reliability of the scales, %ronbach’s alpha will be

computed. )$)) 8.:; will be used for data analysis.

'eferences:

• !lamgir, Mohammed and )hamsuddoha, Mohammad &FGG>', +)ervice uality

3imensions0 ! %onceptual !nalysis, The Chittagong University Journal of

Business Administration, 8ol. :.

10



• !nand, )andip and )inha E.1. &FG:F', +)egmentation of %lients in #ndia on

the (asis of 1eproductive Health Belfare #ndex, %onnecting (usiness I

)ociety, J#M, (hubaneswar, #ndia.

• (rahmbhatt, Mamta, (aser, 6arayan, @oshi, 6isarg &FG::', +!dapting the

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$erceptions of )ervice uality, ZENITH International Journal of

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• Laha, Havva &FGGK', +)ervice uality in $rivate Hospitals in /urkey Journal

of Economic and #ocial !esearch" 8ol. &:', pp DD-;.

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$rivate and $ublic Hospitals0 mpirical vidences from $akistan,

Journals of $uality and Technology Management" 8olume 8## &#', pp :-

FF.

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3issertation, Earlstad 9niversity )tudies, )weden.

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Business and Management &I%#!JBM'" 8ol. F&:', pp =K->=.

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#ndia.

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and $erceptions as a Measure of )ervice uality in )anbs, 1hodes

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#ndustry in (angalore, I%#! Journal of Business and Management

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%are, 8olume :C &;', pp >:>N>F:.

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• )amina Mufti, adri ".@., /abish ).!., Mufti )amiya, 1iya 1. &FGGC',

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)ector, #nformation Management and (usiness 1eview, 8ol.: &F', pp. K-CK.

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#ndia0 /he 9ser $erspective, 8#E!5$!, 8olume:, &@anuary-March', pp D:-;G.

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FG;.

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Mohideen BU Phd Proposal