Service Mar Eke Ting Research

8/3/2019 Service Mar Eke Ting Research

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AssignmentService marketing

Service quality and customerloyalty in Rajashekar hospital

using GAP model and SERQUALapproach

By,

Swetha M

3rd Semester MBA

Reg No :10VWCMA061


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1. INTRODUCTION

In the current socioeconomic context, the service sector has become increasingly more

important, revealing the need to know and study the particularities of its operations and to

institute specific management methodologies that fit its context and specificity. But it is

necessary to understand that service processes are different from manufacturing processes,

especially due to their intangible nature and the direct participation of clients. Aiming to make

clients loyal, companies have made every effort to meet their needs and exceed their

expectations. The SERVQUAL scale is one of the tools that can help in this sense.

According to Oliver, SERVQUAL is the method that assesses client satisfaction as a result of the

difference between expectation and the performance obtained. According to Zeithaml,Parasuraman and Berry, SERVQUAL is universal and can be applied to any service organization

to assess the quality of services provided.

With in-creasing awareness among consumers about their rights, the patient, as a consumer of

health services, expect and demand quality health care. The health care customer is changing

qualitatively. The rising literacy rate, higher levels of income and increasing awareness through

deeper penetration of the media, has brought the Indian consumer closer to demand quality

health care. All these factors have not only contributed to the growth of health care sector in

India but also for quality health care services. In the light of these developments, health care

providers need to have a closer look at the perception of their patients and try to provide quality

medical and health services to meet their expectations. It is the professional excellence, personal-

touch-in-service, humanitarian approach and ethical values of the employees that play a

significant role in the satisfaction of patients. The study of service quality perceptions from the

patient viewpoint provides a basic feedback to the hospitals in the light of their patient-oriented

and patient-centric efforts in attracting and satisfying the patients. In view of the above, an

attempt is made in the study to examine how well the Rajashekar hospital in Bangalore is

meeting the customers expectations on the service quality dimensions.


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2. LITERATURE REVIEWA brief theoretical review will be presented below about Service Management, Quality

Management and SERVQUAL.

2.1. Service Management

According to Lovelock, services are economic activities that create value and provide benefits to

the client at specific times and in specific places as a result of a desired change in, or on behalf

of, the one that receives the service. According to Meirelles a service is essentially intangible and

only assessed when combined with other functions, that is, with other tangible productiveprocesses and products. This intangible nature is associated with this process, which priori

cannot be touched. In other words, the providing of a service tends to occur simultaneously with

consumption. Production occurs starting the moment the service is ordered and it finishes as

soon as the demand is met. Services have some specific characteristics that differentiate them

from the manufactured goods. Gianesi and Corra say the following special characteristics of

service operations are the main ones: intangibility, client participation and simultaneous

production and consumption. According to Coelho, "in service management it is important to

understand how clients assess the quality of the service provided, that is, how quality is

perceived by the client".

2.2 Healthcare service

Healthcare is one of Indias largest sectors, in terms of revenue and employment, and the sector

is expanding rapidly. During the 1990s, Indian healthcare grew at a compound annual rate of

16%. Today the total value of the sector is more than $34 billion. This translates to $34 per

capita, or roughly 6% of GDP. By 2012, Indias healthcare sector is projected to grow to nearly

$40 billion. The private sector accounts for more than 80% of total healthcare spending in India.

Unless there is a decline in the combined federal and state government deficit, which currently

stands at roughly 9%, the opportunity for significantly higher public health spending will be


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limited. The public healthcare delivery system consists of a large number and a variety of

institutionsdispensaries, primary healthcare institutions, small hospitals providing specialist

services, large hospitals providing tertiary care, medical colleges, paramedic training schools,

laboratories, etc. Despite the size and reach of the public healthcare system, however, India

scores poorly on most generally accepted health indicators. This may, in part, explain the

growing role of the private sector in addressing Indias healthcare needs. Public -private

partnerships have also emerged as one viable method of growing the healthcare sector while

keeping public goals in mind. The main objectives of public-private partnerships are to improve

quality, accessibility, availability, acceptability, and efficiency of healthcare services. While different

states in India have had different levels of success with implementation of such initiatives, it is

expected that the private sector will continue to take on an increasing role in Indias healthcare

system.The quality and availability of specialist medical care varies greatly among the different socio

economic groups and by geography, i.e. urban vs. rural. Despite a high annual output of medical

specialist graduates, specialist medical care has traditionally been very poor in India due to

brain drain, or the phenomena of highly educated Indians immigrating to western countries.

Recently, however, specialist care for the middle- and upper-classes has improved due to more

private hospitals, better private hospital infrastructures and equipment, and higher

salaries/incentives (mostly a result of increased demand from the growing middle-class).

2.3. Quality Management

Quality management is a broad theme that encompasses every sort of organization, multinational

or national, eastern or western, large or small, services or manufacturing and public or private.

According to Oliveira its concept depends on the context in which it is applied, in face of the

subjectivity and complexity of its meaning. Bateson says quality is generally considered an

attribute in consumer choices. Quality in services can be defined as a customer satisfaction

index for any service, and this satisfaction can be measured by any criteria. Quality in services

provides a competitive factor for continued consumption, especially when intangibility relations

are tightened between quality and the services. Responsibility and trust, two of the dimensions of

service quality grouped by Parasuraman, Zeithaml and Berry (1985), generated by prior

experience, and are important factors for determining perceived quality by clients. Quality is


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judged according to perceived satisfaction. According to Grnroos perceived quality is

determined "by the gap between expected quality and experienced quality", that is, it is the

difference between client perceptions and expectations. Satisfying the clients immediate and

explicit expectations should be sought in the short term. However, in the mid and long term, it is

important to develop competences to achieve their real needs, even those that are not explicit or

are unconscious. According to the same author, quality is only measured at the end of the

process, that is, when the service has been concluded, and there is no way to change client

perception regarding the service received.

2.4. SERVQUAL

According to Parasuraman, Zeithaml and Berry, regardless of the type of service, consumers

basically use the same criteria to assess quality. Service quality is a general opinion the client

forms regarding its delivery, which is constituted by a series of successful or unsuccessful

experiences. Managing gaps in service will help the company improve its quality. But gaps are

not the only means clients use to judge a service. They can also use five broad-based dimensions

as judgment criteria: reliability, tangibility, responsibility, security and empathy.

These dimensions are briefly commented below (BATESON and HOFFMAN, LOVELOCK):

- Reliability: is the company reliable in providing the service? Does it provide as promised?

Reliability reflects a companys consistency and certainty in terms of performance. Reliability is

the most important dimension for the consumer of services;

- Tangibility: how are the service providers physical installations, equipment, people and

communication material? Since there is no physical element to be assessed in services, clients

often trust the tangible evidence that surrounds it when making their assessment;

- Responsibility: are company employees helpful and capable of providing fast service? It is

responsible for measuring company and employee receptiveness towards clients;

- Security: are employees well-informed, educated, competent and trustworthy? This dimension

encompasses the companys competence, courtesy and precision; and


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- Empathy: this is the capacity a person has to experience anothers feelings. Does the service

company provide careful and personalized attention? These elements clearly have a highly

subjective factor linked to the person who perceives the service. In reality, according to

Kilbourne , every type of service can have determining factors that are considered more

important than others, which will depend on environment characteristics or type of activity.

It is difficult to measure the quality of service operations because they have the characteristic

intangibility. Aimed at solving this problem, Parasuraman, Zeithaml and Berry developed a

methodology in which there is a comparison between several orders of expectations and

perceptions of service quality by the consumer. These differences between perceptions and

expectations are addressed in the quality in service model shown in Figure 1. This model seeks

to help managers understand the sources of problems in quality and how they can improve them.


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Figure 1: Quality in services model

SERVQUAL is an instrument to measure quality that stems from this model and works with the

difference in scores (gaps) in the form of a questionnaire. The models five gaps and factors

affecting it are

Key factors contributing to the gaps.

GAP 1: Not knowing what customers expect:

Lack of marketing research orientation Inadequate upward communication Too many levels of management


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GAP 2: The wrong service quality standards:

Inadequate management commitment to service quality Perception of infeasibility Inadequate task standardization Absence of goal settingGAP 3: Service performance gap:

Employee role ambiguity Employee role conflict Poor Employee job fit Poor Technology job fit Inappropriate evaluation and reward systems Lack of empowered service employees Lack of teamworkGAP 4: When promises do not match delivery:

Inadequate horizontal communication

Tendency to overpromise

GAP 5: customer satisfaction:

Depends on gap 1-4 The greater the gap the lower the customer satisfaction, because expectation and perception

do not match.


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RESEARCH METHODOLOGY

3.1 Research Title

Service quality and customer loyalty in Rajashekar hospital using GAP model and SERQUALapproach

3.2 Objective of the Study

To understand the service quality provided at Rajashekar hospital. To know the customer loyalty.

3.3 TYPE OF STUDY

It is a descriptive research to understand Service quality and customer loyalty in Rajashekar

hospital. The main goal of this type of research is to describe the data and characteristics about what is

being studied. Although this research is highly accurate, it does not gather the causes behind a situation.

Descriptive research is mainly done when a researcher wants to gain a better understanding of a topic.

3.4 Source of Data

Data is collected through both,

Primary Sources: The data for the study was collected with the help of a questionnairewith a sample size of 15.

Secondary sources: official websites, articles and journals.3.5 Tools for Data Collection In order to collect information questionnaire will be used.

3.6 Sampling Plan

(i) Sampling unitpatients in Rajashekar hospital.(ii) Sampling method The sampling method used for the study is Non probability

convenience sampling.

(iii) Sampling size - 15


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3.8 Limitations of the Study

The data required to be collected would be based on the opinions of the patients whichare liable to change with time, hence the findings may require, being reviewed before

using them for further studies.

Time being a limitation, there could be a possibility that some data can get over looked,though maximum effort would be made to see that all relevant data are included.


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4. Service quality and GAP Model of Healthcare

4.1 Service Quality in Rajashekar Hospital

The following aspects were examined under the SERQUAL dimensions.

Fig 2: SERQUAL dimensions

Tangibility: They should have up to date equipment& technology. Their physical facilities should be visually appealing. Bathroom should be very clean. Room should be clean. Meals should be attractive. Food should have right temperature.

Nurses should respect privacy. Room should be quiet. Parking should be convenient.

SERQUALDimensions

Tangibility

Assurance

Responsiveness

Reliability

Courtesy

Empathy


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Assurance:

Food should be delivered by a certain time. When staff of the institutions promises to do something by a certain time, they should do

it.

They should keep patients' records accurately. Hospital charges should be accurate

Responsiveness:

They should be expected to tell their customer exactly when services will be performed. Patients who will be discharged should expect prompt service from employees of the

hospital for the discharging operations.

Patients should expect prompt services from nurses when the patient needs to them. Patients who come to hospital should expect prompt service from employees of the

hospital for the admission operation.

Employees of the hospital should always be willing to help their patients. Employee of the hospital should address customers' questions appropriately about the

discharging process.

Employee of the hospital should address customers' questions appropriately about anyprocedure.

Treatment should be explained to the patient very clearly. Discharge should be explained to the patients' family.


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Reliability:

Customer should be able to trust nurses of the hospital. Patient should be positive that they have recovered well before they are discharged.

Patient should be able to trust billing. Patients should be able to feel safe in their transactions with these institutions' employees. Patients should be able to feel safe that nurses are knowledgeable.

Courtesy:

Employees should be polite during admissions procedure. Employees should be polite during housekeeping process.

Nurses' behavior should be very polite to customers. Nurses should be cheerful. Visitors should be treated well.

Empathy:

Patients should expect employees to know what they need from them. Patients should expect nurses to give them their personal attention.


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4.2 GAP model of service quality in health care

Patients

Hospital

Gap 4

Gap 3

Gap 1

Gap 2

Fig 3: GAP model of service quality in health care

Above Fig 3 Conveys a clear message that the key to closing the Patient gap is to close gaps 1

through 4.To the extent that one or more of gaps 1 through 4 exist, perceive service quality

shortfalls.

Provider (Hospital) gap 1: Not Knowing what the patients expects

Provider gap 2: Not selecting the right service designs and standards

Provider gap 3: Not delivering to service standards

Provider gap 4: Not matching performance to promises

Customer (Patient) gap 5: Not Knowing what the Hospital delivers

The basic Objective of the hospital is to develop the strategies in such a way that it can influence

the patients expectations and perceptions so that all the four gaps that take place due to

differences in expectations and perceptions can be filled up.

Hospital perceptions on

patients expectations

Expected service

Perceived service

Service Delivery

Patient driven service

design and standards

External communication

to customers


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Let us diagnose the specific causes for each of the gaps as shown in the fig 1

Gap-1: Services expected by Patients minus hospital perception of patients expectations.

Causes for Gap 1:

Lack of interaction between the patient and doctor

Unwillingness to ask patients about expectations

Unpreparedness to address the expectations

Gap-2: Inability to set the right type of standards

Causes for Gap 2:

Lack of patient driven service standards

Absence of Process (delivery of services) management to focus on patients requirements

Absence of formal system for setting service quality

Inadequate administration commitment towards the services

No systematic process for the development of new services to be offered.

Failure to connect services offered to patients

Gap-3: Patients-driven service designs minus service delivery

Causes for Gap 3:

Ineffective staff to provide good service

Failure to match supply and demand

Failure to smooth peaks and valley of demand

Over reliance on government funds

Gap-4: Service delivery minus external communications to Patients

Causes for Gap 4:

Ineffective management ofpatients expectations.

Over or under promising about the quality of service

Inadequate horizontal communications.

Tourists Gap -5:patients expectations of service minus Patients perceptions of service

Causes for Gap 5:

The central focus of the gaps model is the Patient gap, the difference between patient

expectations and perceptions.

Expectations are the reference points patients have coming in to a service experience.

Perceptions reflect the service as actually received.


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5. Data Analysis and Interpretation

Source: Primary data (filled questionnaire)

Fig 5.1: Training as part of organization strategy

Interpretation: from the above chart it is clear that majority of the patients in rajshekar

hospital i.e, 84% of them agree that physicians attend the patients during their first visit within

15 minutes without any delay and only few of them i.e., 12% of them say that the physicians

provide service lately and only 4% of them say that there is huge delay in providing service

84%

12%4%

0%

response time of attending physician in

emergency visit

15 minutes

30 minutes

1 hourmore than 1 houe


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Fig 5.2: how you rate Quality of services?

Interpretation: from the above chart it is clear that majority of the patients in rajshekar

hospital i.e,36% of them agree to average extent that service offered are not that good and 35%

of them had rate the service quality as poor as they sure dissatisfied with service provided to

them . Only of about 5% rate it as excellent where these patients are financially stable and

serviceproviders value for money. Therefore we can interpret that the service quality is not god

in the hospital.

5%

24%

36%

35%

SalesQuality of services

excellent

good

Average

Poor


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Fig 5.3: how you rate hygiene control measure in hospital?

Interpretation:from the above chart it is clear that majority of the patients in rajshekar

hospital agree to a great extent that overall hygiene control measures in hospital in good and are

satisfied with it .

32%

56%

12%

hygiene control measures

Excellent

good

average

poor


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Fig 5.4: condition of Medical instruments used for diagnosis

Interpretation:from the above chart it is clear that half of the patients believe that

instruments used might be old and rest of others dont know about it and only 5% of them say

instruments used are latest .

5%

48%

0%

47%

Medical instruments used for diagnosis

Latest

old

outdated

dont no


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Fig 5.5: Dealing with hospital

Interpretation:from the above chart it is clear that half of the 10 patients believe that they

feel safe in dealing with hospital and rest disagrees to that.

10

5

safe in dealing with hospital

yes

No


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Fig 5.6: whether hospital gives individual attention

Interpretation:from the above chart it is clear that half of the 10 patients believe that they get

individual attention and rest disagree to that.

0

1

2

3

4

5

6

7

8

9

10

yes no


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Fig 5.7: whether hospital give prompt service

Interpretation:from the above chart it is clear that half of the 15 patients believe that they

wont get prompt service and rest disagree to that.

5

15

hospitl gives prompt service

yes

no


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Fig 5.8: whether personnel in hospital understand specific need

Interpretation:from the above chart it is clear that half of the 15 patients believe that

personnel on hospital dont understand their specific needs and rest disagree to that.

Findings

In the hospital there is gap between thepatients expectations and the hospital perception about

patients expectations

5

15

personnel understan ds specific need

yes

no


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Annexure

Questionnaire (employee)

I, Swetha.M, am a student of alliance business academy. As part of the curriculum, I am doing a survey

on the effectiveness of training in Perry Johnson Outsourcing with regard to this, I request you to

kindly fill in the questionnaire. I ensure that the data will be kept confidential and used only for

academic purpose

(Please indicate your choice by putting a tick mark in the appropriate boxes)

1. What was the response time of attending physician on your first visit in the OPD/emergency of the

hospital?

15 minutes [ ]

30 minutes [ ]

1 hour [ ]

More than 1 hour [

2. How do rate the quality of service in terms of paramedical staff

Excellent [ ]

Good [ ]

Average [ ]

Poor [ ]

3. How was the overall hygiene or infection control measure in hospital?

Excellent [ ]

Good [ ]

Average [ ]

Poor [ ]


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4. How was the condition of equipment/medical instrument used for diagnosis?

Latest [ ]

Old [ ]

Outdated [ ]

Dont know [ ]

Disagree [ ]

5. You feel safe in your dealing with hospital

Yes [ ]

No [ ]

6. The hospital gives you individual attention

Yes [ ]

No [ ]

7. Do the personnel in the hospital give you prompt service

Yes [ ]

NO [ ]

8. The personnel of the hospital understands your specific needs

Yes [ ]

No [ ]

Service Mar Eke Ting Research

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