A Study on Measurement of Service Quality in Public & Private Hospitals of Chhattisgarh

GRD Journals- Global Research and Development Journal for Engineering | Volume 6 | Issue 5 | April 2021 ISSN- 2455-5703

A Study on Measurement of Service Quality in Public & Private Hospitals of Chhattisgarh Dipti Singh Rajput Research Scholar Department of Management MATS University, Raipur, Chhattisgarh, India

Dr. Archie Dubey Assistant Professor Department of Management MATS University, Raipur, Chhattisgarh, India

Abstract The present age must be called as a “Consumer Era”. As in the present business scenario of intense competition, patient satisfaction has become the prime concern of each and every kind of industry. Elevated level of consumer fulfilment is vital in order to triumph patients and surge ahead of competitors. In order to assess the quality and effectiveness of services provided by the government and private hospitals in Chhattisgarh, a cross-sectional descriptive study was conducted among the in-patients to come across the patients' prospects and perceptions of the healthcare services of the doctors, nurses/ medical assistant, management and infrastructure. This research paper will study the service quality, expectation, perception & satisfaction towards the service quality of selected private and government hospital in Chhattisgarh. This paper also evaluate about expectation and suggestions for quality improvement. In conclusion it will identify bottlenecks, delays, and errors that may obstruct a patient’s smooth evolution through the hospital.

Keywords- Service Quality, Patient Satisfaction, Government and Private Hospitals

I. INTRODUCTION One can refer “Quality” as imminence of an actual result to the outcome expected by the witness, as defined or agreed by that observed. Healthcare sector has turn out to be one of India's largest sectors in terms of revenue as well as employment. According to the Indian Healthcare Industry Analysis by Indian Brand Equity Foundation (IBEF, January 2019), during 2008-22, the market is expected to record a CAGR of 16.28 per cent. The healthcare sector in India placed at Rs 4 trillion (US$ 61.79 billion) in 2017 and is expected to increase at a Compound Annual Growth Rate (CAGR) of 16-17 per cent to reach Rs 8.6 trillion (US$ 132.84 billion) by 2023. A momentous span for enhancing healthcare services allowing for that healthcare spending as a percentage of Gross Domestic Product (GDP) is mounting. In terms of Rural India development, whose financial statement for over 70 per cent of the population, is position to materialize as a potential demand source. This scope provides a high demand for patient satisfaction in health care industry which plays a significant role on growth of health care industry in India. Performance is considered an aspect of service industries. According to Zeithaml (2009), there are errors that occur in offering quality service that are they lead to the harming of the reputation of the firm. Ha and Jang (2009), argue that disappointment in service is experienced when the perception of the patients fail to meet the expectations. Failure in service leads to destruction of relationships among the organization and patients. Grönroos (2013), advance that when there is contact between the consumers and the patron of services there are certain considerations that influence levels of satisfaction. In production of services, many people are involved in the creation of levels of non-uniformity that is non-existence in the production of service. An example is the security investment firms where it becomes difficult to maintain the same service level as the players in the industry are many. Hence the desired expectation of high service quality is required.

A. Conceptual aspects of Service quality in Hospitals The measurement of the services offered to patients is dependent on the expectations that are formed and the results that they get.

It is then dependent on the expectations of the patients in reference to the services that they receive and the abilities of the provider of the service to deliver on the services that they expect. There are several determinants of service quality which includes; tangibility, responsiveness, assurance and empathy.

B. Tangibility Tangible defines the peripheral outlook of the amenities, personnel, apparatus and the materials used in communication (Tanomsakyut, 2011). Tangibility dimension is considered to be less important but it is seen that appearance is important in the determination of quality service. The providers of service are aware of the importance of ensuring that the appearance of the employees, equipment, uniforms and the working area are presentable. A service supplier eloquent in exceptional service is known for tangibility. Corporeal facts refer to the surroundings in which the service is delivered and where the organization and the consumer act together and also any substantial commodities that facilitate performance or communication of the service.

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A Study on Measurement of Service Quality in Public & Private Hospitals of Chhattisgarh (GRDJE/ Volume 6 / Issue 5 / 001)

C. Responsiveness Responsiveness indicates the enthusiasm to assist patients and endow with prompt service (Gole, 2015). Responsiveness is important since patients feel providers are responsive to their requests not just emergencies, but everyday responses to dimensions.

This aspect is concerned with dealing with the patient’s requirements, their queries and grievances quickly and attentively. An organization is recognized to be responsive when it communicates to its clients the timestamp to receive answers or have their problems dealt with.

D. Reliability Reliability is the ability to perform the promised service dependably and accurately and includes consistency of performance.

Reliability was identified as the most important dimension in the evaluation of internal service quality.

Studies show that in a hospital environment there is an expectation that there is sufficient training and professionalism to allow dependable performance of expected services. This was found that where staff had firm notions of what constituted appropriate levels of performance within their own discipline but were reluctant or unable to comment on the accuracy of work performed by those outside their own discipline.

E. Assurance This aspect of service quality refers to facts and politeness of healthcare employees and their capability to convey trust and assurance (Tanomsakyut, 2011). Service providers are likely to be the experts of service they are delivering. Study showed it is significant to converse their proficiency to patients. It implies that the people providing the service play a significant role and therefore the perceptions of the assurance dimension will influence the overall perceived service quality.

F. Empathy Empathy can be defined as concern, care and individualized concentration an organization provides to its consumers (Tanomsakyut, 2011). Services can be executed entirely to specifications yet clients may not experience medical staff care about them throughout delivery of services and it have an effect on patients’ assessments of providers’ service quality. Empathy is urbanized over a phase of time from a steady record of meeting, and sometimes even beyond patient prospects. It has significant positive relationship with patient loyalty. This fact is sustained by the conclusion of (Gronoos, 2013).

II. STATEMENT OF PROBLEM Healthcare centers play a fundamental division in Medicare system in India. They execute various programs such as In-patient, Out-patient services, Research in various fields for fast recovery and proceedings, Training etc. The major concern for hospitals is patient satisfaction. Few problems of public hospitals consist of Poor substantial conditions, primeval health information system, negligible formal quality control; Self-managed hospitals are possessing problems relating to lack of ongoing medicinal education, irrational medicine use, inferior medical care, lack of professional self-policy etc. The problems of Private hospitals are high treatment costs, unnecessary tests, non-utilization of services of specialized people etc.

The present study is being carried out to assess Government and Private hospitals service quality and to analyze service gaps between perceptions and expectations of patients. In any circumstances, if quality of services provided by healthcare division is not up-to outlook, the public will be at a very deep loss in the form of poorly health and low operational capability leading to low financial development.

III. RESEARCH METHODOLOGY The computation of service quality in a private hospital is prepared on the assumption that the patient’s satisfaction with the service supplier will have an upshot on the potential use of the service as well as the chance of recommend the service to others. This is on the other hand, made more intricate by the fact that private hospital’s patients desire a higher quality of service caused by the premium paid by these patients for services rendered. The reality that the patients are also of bad physical condition may obscure their judgment of the service, and not imitate a true perception of the quality of the service.

This is carried by the strengths of SERVQUAL which consist of: the patient’s outlook when evaluate service quality; the skill to judge against the perceptions and expectations of diverse groups of patients, determining discrepancies involving expectations and perceptions of patients; the capability to evaluate scores between participants, and assessing expectations and perceptions of other divisions and services dealt with (Butt, M. M et. al., 2010).

A. Research Framework This research is a pragmatic research based on review technique. Data requisite for this research are both primary data as well as secondary data. Primary data involving to patients of the hospital are composed through information taken via survey forms.

The study used an expressive cross-sectional research design which was worn to show the associations that subsist among the variables of the research namely tangibility, assurance, empathy, reliability and responsiveness and their upshot to the performance of the Public as well as Private Hospitals.

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A Study on Measurement of Service Quality in Public & Private Hospitals of Chhattisgarh (GRDJE/ Volume 6 / Issue 5 / 001)

The vivid cross-sectional design is considered to be concrete in bond studies and assist in the analysis of the scenario, problems that relate to the cross-section populace at a given time. It gave a better considerate of service quality and the effects on the performance of Public and Private Hospitals in Chhattisgarh.

B. Sampling Scheme This section consists of sampling size, statistical tools used in this research along with parameters for evaluating service quality.

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1) Sample Size This refers to number of respondents (600) to be selected from the population to constitute a sample.

Selected private & public hospitals of Chhattisgarh.

The study area is limited to Chhattisgarh state only. A sample of 600 respondents has been selected from selected hospitals.

2) Statistical Tools Statistical tools are the mathematical techniques used to facilitate the analysis and interpretation of numerical data. Following statistical tools have been used in this study.

– Mean – Standard deviation – Service – Based Components of Quality Researchers like Valarie Zeithaml, Leonard Berry, and A. Parasuraman recognized some criteria used by patients in estimating service quality. In succeeding research, they establish a elevated grade of correlations among several of these variables and so summarizes them into five broad dimensions: (Wirtz J. et al., 2011) – Tangibles (emergence of physical essentials) – Reliability (faithful, precise performance) – Responsiveness (swiftness and kindness) – Assurance ( proficiency, courtesy, credibility and security) – Empathy (excellent interactions and patient understanding) 3) Questionnaire Design A survey questionnaire will be used during the initial stage of the research.

The following hypotheses were developed in the study: H1: There is no difference in terms of hospital selection factors between public and private hospital users in Chhattisgarh.

H2: The SERVQUAL instrument does not significantly differ between patients of private and public hospitals in Chhattisgarh.

H3: There is no significant difference between patients of public and private hospitals in Chhattisgarh in terms of patient satisfaction.

H4: There is no relationship between patient satisfaction and positive word of mouth (Recommendation of hospitals to others) of public and private hospital patients in Chhattisgarh.

H5: There is no significant difference between the SERQUAL GAP scores of public and private hospital users in Chhattisgarh.

Table 1(a): The Expectation/Perception Mean Scores of the Dimensions of the SERQUAL scale for Public Hospital Users Dimension Mean Expectation Mean Perception Tangibility 3.3617 2.4892 Responsiveness 3.4568 2.8946 Reliability 3.2978 2.9814 Empathy 3.4853 2.6584 Assurance 3.5895 2.9148 Table 1(b): The Expectation/Perception Mean Scores of Dimensions of SERVQUAL Scale for Private Hospital Users Dimension Mean Expectation Mean Perception Tangibility 3.6241 3.1248 Responsiveness 3.4892 2.9452 Reliability 3.5429 2.8465 Empathy 3.3945 2.8548 Assurance 3.6145 2.8259

Table 1(a) and 1(b) shows that the patients of the public hospitals have very high expectations for the Assurance dimension (mean = 3.5895), while the Tangibility dimension (mean = 3.6241) scored the highest mean for expectations of private hospital patients.

With regards to the perceptions, the Reliability dimension (mean = 2.9814) was the highest for the public hospital patients, while the Responsiveness dimension (mean = 2.9452) was the highest for the private hospital patients.

The group statistic composed for the overall mean scores for expectations and perceptions for both public and private hospital patients indicated that the total mean scores for private hospital patients for expectation (mean = 3.5330) was greater than the total expectation score for public hospital users (mean = 3.4382), while the overall mean perception for public hospital patients (mean = 2.7876) was lower than the overall mean perception score (mean = 2.9194) for private hospital patients. This shows that the total mean expectation for patients of both public and private hospitals exceeded their perceptions of services offered.

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A Study on Measurement of Service Quality in Public & Private Hospitals of Chhattisgarh (GRDJE/ Volume 6 / Issue 5 / 001)

The group statistics for patients’ satisfaction for both public and private hospitals (composed of the overall mean scores for satisfaction for public and private hospitals) showed that the patients in the public hospitals scored a higher overall mean satisfaction (mean = 1.5042) as opposed to the patients of the private hospitals (mean = 1.3587).

Table 2: Overall Mean Patient Satisfaction Scores of Dimensions of the SERVQUAL scale for Private/Public Hospital Hospital Type Mean Satisfaction Standard Deviation Public Hospitals 1.5042 .43218 Private Hospitals 1.3587 .50198

However, satisfaction scores of both public and private hospital users were below the average score on the scale. This shows that both types of patients are in fact not satisfied with the services offered in both private and public hospitals in Cameroon (see table 2).

IV. CONCLUSION, RECOMMENDATIONS AND FUTURE SCOPE Yet in our study, the mean scores for patient satisfaction of both groups were lower than the 2.5 midpoint and this shows that patients in both the public and private sectors are not satisfied. Patients of the public hospitals tend to be slightly better off than those of the private sector.

The study found that there was no significant difference in the expectations of patients in public and private hospitals. We must note that overall, the expectation of the patients for both public and private hospitals were very low. The low expectations in general for hospitals can be related to the fact that patients don’t trust the services of the hospitals.

Perceptions differ for the public and private hospitals users in the dimensions of tangibles, reliability and responsiveness.

The overall perceptions scores were lower for both groups of hospitals. Though the income level of the population is low, the public hospitals with limited resources and equipment strive to satisfy their patients with the quality of care they offer.

A. Policy Implication There are several implications of the current study. The study indicates the existence of a service gap in the healthcare sector in Chhattisgarh. Strategies could be broadly devised to counter the current dissatisfaction that exists in the healthcare sector, particularly in the private sector where patients are paying premium amounts for the service. In terms of Long-term strategies, it should concentrate on the government’s arrangement to advance more resources into the healthcare sector, systematize educational crusade for health with the intention of sensitize the population on the benefits of hospital care and visiting fully qualified doctors.

On the private healthcare sector, they should try to remember patients have the resources to buy medical services elsewhere and hence for long term sustainability, they should improve the level of service they offer. Firstly, they should avoid focusing solely on tangibles and focus more on the reliability, assurance and empathy dimensions of the service they offer to patients.

B. Recommendations – Improvements in the economic situation of the country can lead to improved services of public hospitals in the country.

– On the other hand, the private hospitals with good tangible facilities should try to concentrate some of their resources in training quality staff and doctors. In order to have a greater market share, since the patients are ready to pay for the services, they should improve their level of care offered to these patients.

– Managers and administrators of hospitals should work hard to improve the tangibles of the hospitals to the satisfaction of the patients since the first encounter is important.

– Management of hospitals should be committed in their duties which are going to improve on the roles of nurses and doctors.

The hospitals should also encourage training programs for their staff and doctors to improve their skills and human relation techniques.

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A Study on Measurement of Service Quality in Public & Private Hospitals of Chhattisgarh (GRDJE/ Volume 6 / Issue 5 / 001)

Fig. 1: Survey Form

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A Study on Measurement of Service Quality in Public & Private Hospitals of Chhattisgarh (GRDJE/ Volume 6 / Issue 5 / 001)

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Gole, T. (2015). Strategy implementation and project management, International Journal of Project Management.

Grönroos C., (2013). ``A service quality model and its market implications’’, European Journal of Marketing, Vol.18 No.4, pp.36-44 Ha, C., & Jang, N. (2009). “Barclays Life patient satisfaction and loyalty tracking survey: a demonstration of patient loyalty research in practice “International Journal of Bank Marketing 16/7 287–292 Jochen Wirtz, Lovelock Christopher, “Services Marketing: People, Technology, and Strategy”, 7th Edition, Journal of Services Marketing • January 2011, Pearson Publications, pp.: 400-403 Tanomsakyut, T., Thawesaengskulthai, N., Anuntavoranich, P. (2010).A Case Study of Concept Development of Service Quality Measurement System for Mobile Telecom Service Encounter in Thailand, International Journal of Computer Applications (0975 –8887) Volume 9– No.11 www.ibef.org Zeithaml, V.A., (2009). “Service quality delivery through websites: a critical review of extant knowledge” Journal of the academy of marketing science, Vol. 30, No 4.

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