SAMZODHANA Journal of Management Research

Vol 2,
2, Issue 1 March 2014

MEASURING SERVICE QUALITY IN PRIVATE HEALTHCARE USING

SERVPERF SCALE
Byju K.P.M, Research Scholar & Dr.Y.Srinivasulu, Associate professor
Department of International Business, School of Management, Pondicherry University

Abstract
Measuring service quality is one of the most researched area in services marketing context.
Researchers over the past three decades have developed various measurement instruments to
measure service quality and its relationship with that of customer satisfaction leading to future
purchase intentions. SERVQUAL and SERVPERF are the two widely used instruments across the
globe by the service sector for measuring service quality. The expectations minus perception
approach by Parasuraman and others has got serious critics even though it is the most adopted
one till date. Many felt that expectations have multiple dimensions hence it is hard to measure.
Cronin and Taylor then came up with SERVPERF as they strongly believed that performance
model is more convenient in measuring service quality. Further research showcased its
superiority in terms of better reliability, convergent and discriminant validity and less bias than
SERVQUAL. Incorporation of SERVPERF in Indian service segment especially in healthcare is in its
nascent stage only. This article intends to measure the service quality determinants in a private
hospital using SERVPERF scale, both from patients and their attendants perspective. The results
show that there is no major difference in service quality perceptions between patients and their
attendants. Responsiveness, Empathy and Tangibility are the three main factors associated with
overall customer satisfaction.
Key words: Service quality, Customer satisfaction, SERVQUAL, SERVPERF, Private hospital

Introduction
Service quality as described by Parasuraman, Zeithmal and Berry (1988) is a global judgment
(or) attitude, relating to the superiority of the service (Urban, 2013). Managing service quality is
one of the most important tool an organization needs to posses in order to have a long term
satisfied customers (Cronin & Taylor, 1994). Cronin and Taylor (1992) argued that service

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quality has a positive influence on customer satisfaction. Service quality is in fact an antecedent
to customer satisfaction. Many researchers came to a common consensus that its service
quality and customer satisfaction which will have a long term impact in customer relationship
(Irfan, Ijaz, & Farooq, 2012). Customer satisfaction is a leading criterion for determining the
quality that is actually delivered to the customers (Vavra, 1997). According to Shierdan (1998)
companies have a competitive advantage with better service quality as they can differentiate
effectively from the competition with enhanced customer service.
Quality has been used to describe diverse phenomenon. Service quality is usually considered
mostly as a cognitive construct while satisfaction has been considered a more complex concept
that includes cognitive and affective components (Oliver,1997).The argument of taking service
quality as a mere cognitive thing (or) having an emotional influence attached to it depends
upon the service sector understudy (Kettinger & Lee, 1997) .In the past few decades service
quality has become a major area of attention to practitioners, managers and researchers awing
to its strong impact on business performance, lower costs, customer satisfaction, customer
loyalty and profitability .For an organization to remain competitive in the market it is necessary
to grab and channelize information for the purpose of enhancing service quality (Kettinger &
Lee, 1997).
Service quality needs to be monitored constantly in order to gain a competitive advantage.
Service quality becomes even more important in sectors like healthcare where the information
regarding technical aspect of the service offered is often limited or unknown to the patient. In
these circumstances the functional aspect becomes more important because the patients
evaluate the entire service based on how it was provided to them.

Objectives of the study

1. To analyze various models used for measuring quality of service across all service
sectors.
2. To find whether there is any significant difference in mean scores of patients and
attendants with respect to service quality determinants.

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3. To find out the relation between the five factors of service quality and the customer
satisfaction.
4. To analyze whether there is any significant difference is service quality perception with
respect to gender, Income level and no of visits to the hospital.

Measuring Service quality

Service quality as mentioned by Parasuraman and co as an attitude (or) judgment towards a
service rendered, is hard to measure because of its highly qualitative nature. Many authors
came out with different methods and measured service quality using their own constructs
(Carrillat, Carrillat, Jaramillo, & Muliki, 2007).
Gronroos (1984) came out with three components of service quality (i.e.) 1. Technical quality 2.
Functional quality and 3. Image of the organization. It is the former two qualities which impacts
the latter one and the latter one having a considerable impact on perceived service quality.

Gap model (Parasuraman, Zeithamal and Berry, 1985)

The gap model proposed by Parasuraman et.al is a function of differences between expectation
and performance along the quality dimensions. It is developed on the basis of gap analysis
which includes five, stated as
1. Customer expectations minus management perceptions of those expectations.
2. Difference between management perceptions of consumers expectations and service
quality specifications.
3. Difference between service quality specifications and the actual service delivered.
4. Difference between the actual service quality and the communications to consumers
about service quality.
5. Difference between consumers expectation and perceived service quality.

Performance only model (Cronin and Taylor, 1991)

The authors conceptualized the measurement of service quality and its relationship with
customer satisfaction and future purchase intentions. The argument put forward for
performance only measurement (SERVPERF) is that service quality is a form of customer
attitude and performance only measure of service quality is an enhanced means of measuring

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service quality. They maintained that performance instead of performance minus expectations
determines service quality.
And there are many other models such as
1. Attribute and overall affect model by Dabholkar (1996) which is mainly framed for self
service options.
2. PCP attribute model by Philip and Hazlett (1997) where three main classes of attributes
where taken into consideration namely pivotal, core and peripheral attributes.
3. Synthesized model of service quality by Brogowicz et.al (1990), the purpose of the
model is to identify the dimensions associated with service quality in planning,
implementation and control process. The synthesized model of device quality
considered three factors viz., company image, external influences and traditional
marketing activities as the factors influencing technical and functional quality
expectations to name a few (Carrillat, Carrillat, Jaramillo, & Muliki, 2007).

Study area & construct used

Study was conducted in a service oriented 1200 bedded hospital in Pondicherry region.
SERVPERF scale was used to gather information regarding service quality from the respondents.
Total respondents were 183 out of which 103 -patients and 80 - attendants.
The questionnaire had two parts.
1. A total of 10 questions dealing with the Geographical and Demographical data of the
respondents.
2. A total of 27 questions (Psychometric) focusing on the five latent factors of service
quality and the overall customer satisfaction.
The five factors taken for the study are:
1. Tangibility (Measured by 5 constructs)
Tangibility represents the service physically. It is defined as the appearance of physical
facilities, staff appearance and communication materials that are used to provide services for
them. Often firms use tangibility to highlight their image and quality.
2. Reliability (Measured by 4 constructs)

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It is the ability to perform promised service accurately on time. It generally means the company
delivers on its promises regarding delivery, service provision and problem resolution.
3. Responsiveness (Measured by 4 constructs)
Being willingness to help, it is the willingness or readiness to help customers and to provide
prompt service. This dimension emphasizes attentiveness and promptness in dealing with
customer requests, questions, complaints and problems.
4. Empathy (Measured by 4 constructs)
Treating customers as individuals is defined as empathy. Caring, individual attention a firm
provides to its customers.
5. Assurance (Measured by 4 constructs)
Inspiring trust and confidence is defined as Assurance. The employees knowledge and courtesy
and the ability of the firm and its employees to inspire trust and confidence.

Hypothesis
1. H01: There is no significant difference in service quality perception between male and
female.
2. H02: There is no significant difference in service quality perceptions with respect to
income levels of the respondents.
3. H03: There is no significant difference in service quality perceptions with respect to
number of visits to the hospital.
4. H04: There is no significant relation between all the five service quality factors and
overall customer satisfaction.
All the statistical measures mentioned below were computed using SPSS 20.0 version. All
the following analyses are done at 5% level of significance. Hence the cutoff p value to accept
null hypothesis is .05 for all the subsequent analysis.
The reliability value of the scale items are computed using Cronbachs alpha. The Cronbachs
alpha value is .893 which is consistent with the values obtained from research using the same
scale (Narang, 2010).

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Analysis and Discussion

Demographics
Of the total 183 respondents 179 were male and 161 female. 56% of the patients were from
Puducherry union territory and 19% from Cuddalore district, while the remaining from nearby
districts of puducherry. 38% of the respondents had a minimum of three visits to the hospital
before as inpatients while 33% of the respondents were using the facility for more than four
times. So the major junk of the patients (79%) had repeated visits to the hospital facility
before. Hence they were in much better position to evaluate the quality of service provided.

Mean value of all the Factors

The following table shows the mean value of all the factors taken for the study both the
patients, attendants and overall perspective. The mean score consistently above 4.10 for all
the factors shows that both attendants as well as patients as highly satisfied with the service
outcomes.

Factor
1. Tangibility

Overall
4.13

Patients
4.18

Attendants
4.08

2. Reliability

4.08

4.06

4.11

3. Responsiveness

4.14

4.18

4.24

4. Assurance
5. Empathy

4.22
4.24

4.22
4.21

4.23
4.27

6. Customer Satisfaction

4.32

4.31

4.33

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2, Issue 1 March 2014
H01: There is no significant difference in service quality perception between male and female.
Table: 2
Independent Samples Test
t-test for Equality of Means

Levene's
Test
for
Equality of
Variances
F
Sig. t

df

Sig.
Mean
Std. Error 95%
(2Difference Difference Confidence
tailed)
Interval of the
Difference
Lower Upper

Equal
variances
2.283 .133
181
.038 -.10353
.04954
2.090
assumed
Customer
Equal
sat sum
variances
178.041 .029 -.10353
.04696
not
2.204
assumed
To identify whether there is any significant difference in perceptions of overall

.20128 .00578
.19621 .01085
customer

satisfaction between male and female respondents, Independent sample T Test was performed.
The Levens test for equality of variances is .133 which is higher than .05 (at 5% level of
significance) which states that there is inequality in variances among two groups. The p value
under equal variance not assumed is .029 which is less than .05 (at 5% level of significance). H01
is rejected. There is significant difference between male and female with respect to perceptions
of overall customer satisfaction.
H02: There is no significant difference in service quality perceptions with respect to income
levels of the respondents.
Anova Table Table: 3
Sum of Squares

df

Mean Square

Sig.

Between Groups

2.600

.650

6.491

.000

Within Groups

17.824

178

.100

Total

20.424

182

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SAMZODHANA Journal of Management Research

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2, Issue 1 March 2014
To determine whether there is any significant difference in respondents perceptions towards
overall customer satisfaction with respect to the income levels of the respondents, one way
analysis of variance measure was employed. The p value which denotes the significance level of
the test used is .000 which is lesser than .05 (at 5% level of significance).hence the null
hypothesis stands rejected which states that there is significant difference in respondents
perceptions towards overall customer satisfaction with respect to the income levels of the
respondents. Post-Hoc analysis was done to examine the groups in detail to have multiple
comparisons between them. Turkey HSD the preferred method for Post Hoc analysis was
employed. The following table reveals that the 5 types of income groups can be clubbed into
three subsets but will have overlapping between them.
Table: 4
Customer sat sum
Monthly income

Subset for alpha = 0.05

1
4.1000
4.2673

25,001-30,000
16
<10,000
110
4.2673
10,001-15,000
15
4.3867
4.3867
15,001-20,000
22
4.4545
4.4545
20,001-25,000
20
4.5500
Sig.
.419
.302
.444
H03: There is no significant difference in service quality perceptions with respect to number of
visits to the hospital
Table: 5
Anova Table
Customer sat sum
Sum of Squares

df

Mean Square

Sig.

Between Groups

.868

.217

1.975

.100

Within Groups

19.556

178

.110

Total

20.424

182

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SAMZODHANA Journal of Management Research

Vol 2,
2, Issue 1 March 2014
To measure whether there is any significant difference in based on number of visits they had to
the hospital before, one way analysis of variance measure was employed.
The p value which denotes the significance of the measure used is .100 higher than .05 (at 5%
significance level). Hence the null hypothesis H03 is accepted that there is no significant
difference in respondents perception towards the overall customer satisfaction based on the
number of visits they had to the hospital before.
H04: There is no significant relation between all the five service quality factors and overall
customer satisfaction
Table: 6
Correlations
Pearson Correlation
Tangibility sum
Sig. (2-tailed)
N
Pearson Correlation
Reliability sum
Sig. (2-tailed)
N
Pearson Correlation
Responsiveness sum Sig. (2-tailed)
N
Pearson Correlation
Empathy sum
Sig. (2-tailed)
N
Pearson Correlation
Assurance sum
Sig. (2-tailed)
N
Pearson Correlation
Customer sat sum
Sig. (2-tailed)
N
**. Correlation is significant at the 0.01 level (2-tailed).
Correlation matrix

Customer sat sum

.663**
.000
183
.442**
.000
183
.690**
.000
183
.660**
.000
183
.557**
.000
183
1
183

Correlation analysis was performed to identify the relationship between all the five factors
contributing towards service quality with that of overall customer satisfaction. All the five
correlation coefficients are positive and statistically significant at 1% level of significance.

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2, Issue 1 March 2014
The correlation between Responsiveness, Tangibility and Empathy are highly correlated with
that of overall satisfaction (r values - .690, .663 and .660 respectively). Whereas Reliability and
Assurance have a moderate correlation with overall customer satisfaction (r values- .557 and
.442 respectively).
Regression Table: 7
Model Summaryd
Model R
R
Adjusted
Square R Square

Std. Error of the Change Statistics

Estimate
R Square F
df1
df2 Sig.
F
Change
Change
Change
1
.690a .476
.473
.24312
.476
164.548 1
181 .000
b
2
.739 .546
.541
.22698
.070
27.657 1
180 .000
c
3
.755 .570
.563
.22152
.024
9.975
1
179 .002
a. Predictors: (Constant), Responsiveness sum
b. Predictors: (Constant), Responsiveness sum, Empathy sum
c. Predictors: (Constant), Responsiveness sum, Empathy sum, Tangibility sum
Table 8 Coefficientsa
Model
Unstandardized Standardized t
Sig.
Collinearity
Coefficients
Coefficients
Statistics
B
Std. Beta
Tolerance VIF
Error
(Constant)
1.655
.208
7.947 .000
1
Responsiveness
.631
.049 .690
12.828 .000
1.000
1.000
sum
(Constant)
1.250
.209
5.978 .000
Responsiveness
2
.411
.062 .449
6.603 .000
.546
1.833
sum
Empathy sum .316
.060 .358
5.259 .000
.546
1.833
(Constant)
1.204
.205
5.887 .000
Responsiveness
.284
.073 .311
3.905 .000
.380
2.633
sum
3
Empathy sum .261
.061 .295
4.265 .000
.501
1.995
Tangibility sum .194
.061 .242
3.158 .002
.409
2.447
a. Dependent Variable: Customer sat sum
The correlation shows strong and moderate relation between the independent variables (5
factors of service quality) and the dependent variable (overall customer satisfaction). In order
to know which of these variables predicts the customer satisfaction significantly a multiple
regression analysis was performed.
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The Multiple regression analysis was done through stepwise method in order to determine the
best possible factors determining the overall customer satisfaction level. Three different
models are analyzed here
1. Taking Responsiveness only as the Independent variable.
2. Taking both Responsiveness and Empathy as Independent variables.
3. Taking Responsiveness, Empathy and Tangibles as Independent variables.
The other 2 factors Assurance and Reliability were ignored because of Non significant F values.
The table provides the model summary. The adjusted r square values of 3 models were
compared and the 3rd model has the highest adjusted r square value - .563. The 3rd model
explains 56.30 percent of the total variance in the dependent variable. Table

provides the

coefficients of the Independent variables taken for the study here all the coefficients are
statistically significant at 1% level of significance. From this table the below regression equation
is framed. Overall customer satisfaction = 1.204 +.311*Responsiveness + .295* Empathy + .242
* Tangibility.

Conclusion
The incorporation of SERVPERF scale in Indian healthcare is at its nascent stage. The reliability
values shows that the scale is consistent as proven in other service sectors in India and other
healthcare sectors worldwide. This study took a 2 dimensional view of capturing the
perceptions of both the Attendants and Patients towards service quality and customer
satisfaction. The mean values of all the five factors and customer satisfaction reveals that there
is common consensus between the two groups towards the service offered. The difference in
perceptions towards customer satisfaction with respect to different income levels is mainly due
to lesser satisfaction levels with higher income groups as their expectations creeps up more.
Relation between five factors and the overall customer satisfaction is positive and further
analysis revealed that its only Responsiveness, Empathy and Tangibles that can predict the
customer satisfaction levels significantly. The overall model explains sufficient variance in the
dependent variable. Responsiveness and Empathy both handled by the nursing staff in a
healthcare organizations emerged as the two top factors in determining customer satisfaction

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levels. It states the need of employee empowerment and increased internal marketing efforts
to have enhanced customer experience. Tangibility factor often lacks behind in developing
countries like India when compared with other developed ones. With the recent rapid increase
in Healthcare segment which is poised to reach USD 158 billion by 2017 hope this void gets
filled up.

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