Based on the analysis of 20 articles on this topic the services quality in hospital or

healthcare industry. The article by Maria Helena Vinagree and Jose Neves ( 2008) investigated
the service quality and patients emotions on satisfaction. Using a sample of 317 patients, the
results revealed stated that service quality measures have shown that with the exception of
physical elements, all the remaining measures refer to the human element linked to service
performance. Using a revised SERVQUAL scale for service quality evaluation and an adapted
DESII scale for assessing patient emotions. The results support process complexity that leads
to health service satisfaction, which involves diverse phenomena within the cognitive and
emotional domain, revealing that all the predictors have a significant effect on satisfaction.
Panchapakesan Padma et al. (2010) empirically explored the conceptualize hospital service
quality into its component decisions from perpectives of patients and attendants for a sample of
204 patients and attendants. The research revealed that patients and attendants treat the
interpersonal aspect of care as the most important one, as they cannot fully evaluate the
technical quality of healthcare services. The 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.

Based on a sample of 1000 mothers who have given to a child in Greece,

Lymperopoulos et al.(2009) proposed and tested five dimension of SERVQUAL variables, to
identify the effects of each variable to satisfaction and word of Mouth (WOM). The results
revealed that, in addition to “satisfaction”, the only service quality dimension that directly affects
WOM, is “empathy”. In addition, “empathy” affects “responsiveness”, “assurance” and
“tangibles” which in turn have only an indirect effect to WOM through “satisfaction”. The
limitations relate to the use of a non-probability sample and the restricted geographical area of
the field research that only investigated in Greece only while this study identified the dimension
of empathy is directly affect the WOM through satisfaction. Ramsaran-Fowdar (2008) stated the
new service quality instrument called PRIVHEALTHQUAL based on the “reliability and fair and
equitable treatment” factor. The “reliability and fair and equitable treatment” factor was found to
be the most important healthcare service quality dimension as addition to the SERVQUAL is not
a generic service quality measure for all industries. Assaf et al. (2008) demonstrated that the
SERVQUAL survey results were extremely useful in measuring the functional quality of the
hospitals assessed. It is the intention to add the SERVQUAL scale to the patient satisfaction
and suggest that all hospital administrators use that scale to evaluate their healthcare services.
However, it must be noted that functional quality should be evaluated with clinical quality when

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the quality of a hospital service is determined. Hospital administrations should develop policies
that include both quality dimensions. Panchapakesan Padma et al, (2009) reported on the
findings the two instruments for measuring the dimensions of hospital service quality, one each
from the perspective of patients and attendants. A path analysis or framework of service quality,
customer satisfaction and behavioral enables hospital managers to understand how patients
and their attendants evaluate the quality of healthcare provided in respect of every dimension
on SERVQUAL. A comparison of perceptions between patients and attendants would aid them
to allocate resources to various aspects of healthcare.Hospital administrators can use the
instruments proposed to obtain feedback on their performance on service quality parameters so
that they can benchmark themselves with their competitors.Based on the survey on 200 patients
on the service quality of a student health clinic , Koubek et al (2006) using a modified form of
SERVQUAL, termed SERVUSE. SERVUSE was modified by adding an additional factor of
usability. This factor allows for the analysis of a system’s ease of use in the eyes of the
customers. SERVUSE was found to be a valid tool for measuring service quality. The health
clinic received a gap score of 20.357, showing that customer expectations were not met.
SERVUSE is a tool that can be used to aid in improving a health clinic’s service quality.
Usability is an important feature for healthcare providers to improve. But the limitation of this
study is only focus on populations of student health clinic and need to more broadly investigated
in able to know the validity of SERVUSE tool.

There are a lot of study on service quality in hospital investigated the comparison of
determinant service quality between public and private hospitals based on the five dimension of
SEVQUAL . Mostafa, (2005) highlighted a three-factor solution for the SERVQUAL instrument
with 67 per cent of variance explained. The result does not support the five-components original
SERVQUAL. The model was found to be significant in explaining patients’ choice of the type of
hospital which is the private hospitals’ patients are generally more satisfied than public
hospitals’ patients. While Antony et al. (2006) indicate that inpatients in the private hospitals
were more satisfied with service quality than those in the public hospitals. The results revealed
that inpatients in the private hospitals were more satisfied with doctors, nurses and supportive
services than their counterparts in the public hospitals while reasonable costs is the biggest
determinants of service quality in the public hospitals. But according to Huseyin Arasli et al.
( 2008) identifies six factors regarding the service quality as perceived in both public and
private Northern Cyprus hospitals. These are consist of empathy, giving priority to the
inpatients needs, relationships between staff and patients, professionalism of staff, food and the

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physical environment. Research results revealed that the various expectations of inpatients
have not been met in either the public or the private hospitals.

According to Eleonora Karassavidou et al. (2009) investigated how the patients perceive
quality in Greek NHS Hospitals. The research results revealed a three-dimension SERVQUAL
construct which is human aspect, physical environment or infrastructure and access that proved
to be a valid, reliable and flexible tool for measuring quality in Greek hospitals. The human
factor was revealed as being the most critical dimension of quality, reflecting the significance of
the traditional view of the doctor-patient relationship. Hsiu-Yuan Hu et al. (2009) examined to
assess the perceived service quality properly using Fuzzy logic and verify whether it is a better
solution than the Likert scale. The SERVQUAL questionnaire was developed according to the
characteristics of each hospital’s out-patient service. The study successfully introduced Fuzzy
linguistic analysis into the Gap theory and SERVQUAL measurements, and proved that the
Fuzzy linguistic scale surpasses the Likert scale in terms of all five dimensional and total
reliability values. This indicated that the Fuzzy linguistic scale creates more internal consistency
and stability than the Likert scale. The research done by Rasasi et al. (2005) investigated the
relationship between transformational leadership and service quality in UAE hospitals. The
result revealed that UAE patients were generally satisfied with the service quality rendered by
hospitals. It however found that hospital employees had a low rating of their leaders in terms of
the transformational leadership and contingent reward. Finally, service quality was found to be
positively related to all dimension of transformational leadership and the transactional
leadership dimension of contingent reward. The two dimensions of active exception and passive
avoidant leadership were negatively related to service quality. This research provided important
guidelines for managers on the dimensions of leadership that needed to be enhanced in order
to improve service quality.
Nilubon Sivabrovornvatana et al.( 2005) has examined the relationship between
technology, QMS and service quality in Thai hospitals. The study’s outcomes clearly suggest
factors that make significant contribution to service quality. These factors can be categorized
according to five SERVQUAL dimensions (reliability, responsiveness, assurance, empathy, and
tangibility), although some factors required slightly different interpretation. The findings suggest
that what service providers think is important for their service is not necessarily viewed by
customers as being equally important. The technology will need to become an active part of
services in the future. As service providers become more proficient at using technology, this will
provide customers with a more convenient and time saving service. Based on the sample of

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201 respondents, Garg et al. (2010) develop a scale for measuring perceived service quality for
public hospitals from the patient’s perspective. A reliable and valid scale called public hospital
service quality (PubHosQual) is developed to measure the five dimensions of hospital service
quality which are admission, medical service, overall service, discharge process, and social
responsibility. The proposed scale PubHosQual could be used as a diagnostic tool to identity
areas where specific improvements are needed, and to pinpoint aspects of the hospital’s
services that require modification. Since, this study was conducted in India only, the
generalizability of the PubHosQual scale has to be tested in other countries in able to know the
effectiveness of this scale as compared to SERVQUAL.
Chin et al. (2008) develop an alternative method of measuring out-patient satisfaction
where satisfaction is the central construct. The Gap Model operationalized by SERVQUAL is
widely used to measure service quality. However, the SERVQUAL instrument only measures
expectations and perceptions. A partial least squares (PLS) approach, a form of structural
equation modeling, is used to develop a framework to evaluate patient satisfaction in three
service process segments: pre-process, process, and post-process service experiences.
Results indicate that each process stage mediates subsequent stages, that the process
segment is the most important to the patient and that the antecedents have differing impacts on
patient satisfaction depending where in the process the antecedent is evaluated. The limitation
of this study is only one out-patient surgery center was evaluated and patient satisfaction criteria
specific to hospital selection are not included in this study. Ugolini, (2009) examined to solving
the problem of communicating quality to service users. In particular, it seeks to focus on how to
render quality tangible for the users within the health service, characterized by a high
information asymmetry. The method adopted is a case study, preceded by a rapid theoretical
focus on the role of communication in a model for service quality (SERVQUAL). The main
finding is a managerial tool of the Patient’s Charter in which the health organization explicitly
expresses its commitments, its standards and makes quality tangible for users. The research
limitations are linked to the single case taken into consideration moreover, findings are
confirmed by other studies about health organizations. Based on the 224 respondent Zineldin,
(2006) described a new instrument and a new method which assure a reasonable level of
relevance, validity and reliability, while being explicitly change-oriented. This study argues that a
patient’s satisfaction is a cumulative construct, summing satisfaction with five different qualities
(5Qs) of the hospital which are quality of object, processes, infrastructure, interaction, and
atmosphere. The use of the 5Q dimensions provides both a structure for designing a service
quality measurement instrument and a framework for prioritizing results and findings. The 5Qs
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results can be used in a variety of ways which is understanding current service quality,
comparing performance across different hospitals and countries, comparing performance across
different parts of the service and assessing the impact of improvement initiatives”.
Kui-Son Choi et al. (2005) investigated the structural relationships between out-patient
satisfaction and service quality dimensions under a South Korea health care system where
patients have substantial freedom in choosing their medical service providers and to further
study the causal relationship between service quality and satisfaction between out-patient
subgroups obtained on the basis of gender, age and types of services received. After assessing
the construct validity of the service quality dimensions based on confirmatory factor analysis, a
path model specifying the relationships between service quality dimensions and patient
satisfaction was estimated. Results indicated that the general causal relationship between
service quality and patient satisfaction was well supported in the South Korean health-care
delivery system. An examination of the estimated path coefficients showed that the pattern of
relationships between service quality and patient satisfaction was similar across the gender,
age, and service type subgroups. Results also revealed that the level of satisfaction, on the
other hand, was not the same for subgroups when divided by age and the types of services
received. Pui-Mun Lee et al. ( 2006) investigated healthcare service quality from the viewpoint
of its negative impact on the industry when there is a deficiency in the delivery of service quality.
A new way of looking at service quality performance, through the impact of deficient service.
The economic impacts of poor service quality could easily be quantified, and such economic-
based results are usually a better motivator for managers and workers to deploy quality
improvement initiatives. The results provides an alternative approach to quantify service quality
performance and proposes a system-based approach to enhance service process performance.
From this brief review of analysis on 20 articles about the service quality in hospital and
healthcare industry, i find that, almost the studies have using SERVQUAL scale as a standard
instrument for measuring functional service quality, is reliable and valid in a hospital
environment. Based on the 20 articles, almost the result revealed no all five component original
SERVQUAL support the result. Besides that, there are also other tools as addition to the
SEVQUAL tools such SERVUSE, 5Qs, and PRIVHEALTHQUAL that modifying the SERVQUAL
tool which the additional tools will measure the service quality especially in hospital will reliable
and valid.

REFERENCES

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Antony, J. and Taner ,T. (2006). Comparing public and private hospital care service quality in
Turkey. Leadership in Health Services , Vol. 19 No.2.

Assaf, A.F. , Coskun,B. and Akgun, H.S. (2008). The role of expectations in patient
assessments of hospital care. International Journal of Healthcare , Vol.21 No.4, 343-355.

Chin,W.W and Angela , M. W. (2008). Measuring the three process segments of a customer’s
service experience for an out-patient surgery center. International Journal of Healthcare Quality
Assurance , Vol.21 No.1, 24-38.

Eleonora Karassavidou, Niki, G. and Ghrissoleon, T.P. (2009). Quality in NHS hospitals: no one
knows better than patients. Measuring Business Excellence , Vol 13 No 1, 34-36.

Garg, R. and Jayesh, P. A (2010). Measuring perceived service quality for public hospitals
(PubHosQual) in the Indian context. International Journal of Pharmaceutical and Healthcare
Marketing , Vol.4 No.1, 60-83.

Hsiu-Yuan Hu, Yu-Cheng Lee and Min Yen. (2009). Service quality gaps analysis based on
Fuzzy linguistic SERVQUAL with a case study in hospital out-patient services. Managing
Service Quality , 229-242.

Huseyin Arasli, Erdogan Haktan Ekiz and Salih Turan Katircioglu. (2008). Gearing service
quality into public and private hospitals in small islands. International Journal of Healthcare
Quality Assurance , Vol21. No 1, 8-23.

Koubek,R. and Lesley, S. (2006). Quality and usability in a student health clinic. International
Journal of Healthcare Quality Assurance , Vol.19 No.3, 225-236.

Kui-Son Choi, Hanjoon Lee, Chankon Kim, and Sunhee Lee. (2005). The service quality
dimensions and patient satisfaction relationships in South Korea:comparisons across gender,
age and types of service. Journal of Service Marketing , 140-149.

Lymperopoulos, C. and Ioannis, E. (2009). Service quality effect on satisfaction and word of
mouth in the health care industry. Managing Service Quality , 229-242.

Mostafa, M. M. (2005). An empirical study of patients’expectations and satisfactions in Egyptian

hospitals. International Journal of Healthcare Quality Assurance , Vol.18 No.7, 516-532.

Neves. J and Vinagre M. H. (2008). The Influence of Service Quality and Patients's Emotions on
Satisfaction. International Journal Healthcare Quality Assurance , 87-103.

Nilubon Sivabrovornvatana, Sununta siengthai, Donyaprueth Krairit and Himangshu Paul.

(2005). Technology usage, quality management system, and service quality in Thailand.
International Journal of Healthcare Quality Assurance , Vol 18 No.6, 413-423.

Panchapakesan Padma, Chandrasekharan Rajendra and L. Prakash Sai. (2009). A conceptual

framework of service quality in healthcare Perspectives of Indian patients and their attendants.
Bechmarking An International Journal , Vol.16 No.2, 157-191.

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Panchapakesan Padma, Chandrasekharan Rajendra and L. Prakash Sai. (2010). Service
Quality and Its Impact on Customer Satisfaction in Indian Hospitals: Perpectives of Patients and
Attendants. Chennai-India: Department of Management Studiea.

Pui-Mun Lee, PohWah Khong and Dhanjoo N. Ghista. (2006). Impact of deficient healthcare
service quality. The TQM Magazine , Vol.18 No. 6, 563-571.

Ramsaran-Fowdar, R. R. (2008). The relative importance of service dimensions in a healthcare

setting. International Journal of Healthcare Quality Assurance , 104-124.

Rasasi, A.J. and Naceur, J. (2005). Transformational leadership and service quality in UAE
hospitals. Managing Service Quality , Vol.15 No. 1, 70-81.

Ugolini, M. (2009). Can quality become tangible for health service users? The TQM Journal ,
Vol.21 No.4, 400-412.

Zineldin, M. (2006). The quality of health care and patient satisfaction. International Journal of
Healthcare Quality Assurance , Vol.19 No 1, 60-92.

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