measuring

service quality
of square
hospitals

Research Proposal
On

Measuring Service Quality of Square Hospitals

Submitted To:
Dr. A. K. Fazlul Haque Shah
Professor
Department of Marketing
University of Dhaka

Measuring service quality on Square Hospital

Page 2

Group Profile

Department of Marketing

University of Dhaka

Executive summary
Square Hospital is one of the best hospitals in Bangladesh because of its specialized and
caring services. Square Hospitals Limited is a concern of Square Group. The hospital is an
affiliate partner of Methodist Healthcare, Memphis, Tennessee, USA, SingHealth, Singapore,
Bangkok Hospital Medical Centre, Thailand and Christian Medical College, Vellore, India.
Here, huge emphasis has been made on quality nursing services to train over a hundred
nurses for over a year. To ensure optimum healthcare-hospitality, the patients are closely
monitored in their waiting times in outpatient clinics, emergency and admissions. The quality
of services is likely to be better here than that in public hospitals because of the incentive
structure. In Bangladesh, unfortunately, the health care delivery system is besieged with a
variety of problems that signal an impending crisis. With a burgeoning population and the
low level of investment in the health care sector, service quality, especially in the public
hospitals seems to have deteriorated markedly as reported with increasing frequency in the
popular media. To avert any major crisis or to halt any further deterioration in health care
delivery, two major strategic goals increasing access and improving quality must be
pursued vigorously and relentlessly to improve the nations capacity to deliver better health
care services. Appropriate health care strategies are vital to the ability of Third World
Measuring service quality on Square Hospital

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countries to achieve other development objectives. While not a sufficient condition for
development, it is important to recognize that a healthy population is better disposed to
achieve the productivity increases that are needed to sustain continued growth in other sectors
of the economy.

Contents
Introduction ................................................................................................................................................................................................ 5
Statement of the problem...................................................................................................................................................................... 6
Purpose, significance, and/or objective of the study .................................................................................................................... 6
Literature review ....................................................................................................................................................................................... 7
Research questions and hypothesis: .................................................................................................................................................. 14
Research design......................................................................................................................................................................................... 14
Data collection/field work ..................................................................................................................................................................... 15
Data analysis .............................................................................................................................................................................................. 16
Writing the report ................................................................................................................................................................................... 16
Limitations and delimitations .............................................................................................................................................................. 16
Time and cost ............................................................................................................................................................................................ 16
Conclusion .................................................................................................................................................................................................. 16
Bibliography ............................................................................................................................................................................................... 17
Appendix...................................................................................................................................................................................................... 19

Measuring service quality on Square Hospital

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Introduction
Healthcare is a rare service that people need but do not necessarily want but, remarkably
healthcare is the fastest growing service in both developed and developing countries. The
traditional services that once dominated the service sector lodging, foodservice, and
housecleaning have been increasingly supplemented by modern banking, insurance,
computing, communication, and other business services; and the interest in the measurement
of service quality is understandably high in addition to the delivery of higher levels of a
service quality strategy being suggested as critical to service providers' efforts in positioning
themselves more effectively in the marketplace. Service quality has been revealed as a key
factor in search for sustainable competitive advantage, differentiation and excellence in the
service sector. Besides, it has been recognized as highly important for satisfying and retaining
customers. A hospital is an institution of health care providing treatment with specialized
staff and equipment, but not always providing for long-term patient stay. Today hospitals are
centers of professional health care provided by physicians and nurses. Hospitals are usually
funded by the state, health organizations, health insurances or charities, including direct
charitable donations. Similarly, modern-day hospitals are largely staffed by professional
physicians, surgeons and nurses, whereas, in history this work was usually done by the
founding religious orders or by volunteers. There are several kinds of hospitals. The bestknown is the general hospital, which is set up to deal with many kinds of diseases and
injuries, and typically has an emergency ward to deal with immediate threats to health and the
Measuring service quality on Square Hospital

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capacity to dispatch emergency medical services. A general hospital is typically the major
health care facility in its region, with a large number of beds for intensive care and long-term
care, facilities for surgery and childbirth, bio assay laboratories, and so forth. Larger cities
may have many different hospitals of varying sizes and facilities. Hospital services are
different and distinct from boarding and grooming services-yet both are easily accessible to
pet owners and team members. Patients just come for diagnosis and/or therapy and then leave
(outpatients), but some others stay the nights (inpatients). Putting the patient first is a
challenge that requires not just a huge change in the mindset of all the stakeholders in health
care provision, but also the means by which to measure the levels of satisfaction of patients,
and to discover what matters to them before, during and after their visit to any hospital.
Patient quality initiatives, with their softer, experiential focus than clinical audit, with its
precise and scientific methods of measurement, demand different measurement techniques.
Customers perceive services in terms of quality of service and how satisfied they are with
their overall experience. These customer oriented terms quality and satisfaction have been the
focus of attention for executives and researchers alike over the last decade or more.
Companies today recognize that they can compete more effectively by distinguishing
themselves with respect to service quality and improved customer satisfaction. Service
quality is a critical element of customer perception. In the case of pure services, service
quality will be the dominant element in customers evaluations. In case, where customers
service or services are offered in combination with physical product, service quality may also
be very critical in determining customer satisfaction.

Statement of the problem

The problem statements can be defined as:
To assess the service quality provided in square hospital
To identify the service quality dimensions which play important role on customer
satisfaction.

Purpose, significance, and/or objective of the study

Broad objective
The primary objective of the study is to analyze and explore the service quality dimensions
provided by Square Hospital.
Specific Objectives

Measuring service quality on Square Hospital

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1. To know the criteria on which customers select or evaluate a hospitals services.

2. To identify which dimension(s) of SERVQUAL (Dimensions of service quality)
is/are most important for the patients.
3. To offer suggestions, if needed, based on the analytical results of the current study.

Literature review
According to many studies it has been proven that customer satisfaction (Boulding et al.,
1993;Johns

et

al.,

2004;

Kara

et

al.,2005),customer

retention

(Reichheld

and

Sasser,1990),profitability (Rust and Zahorik, 1993; Zeithaml et al.,1996) and financial

performance (Buttle, 1996) are all positively related with delivering quality service. For this
reason businesses have been trying to develop the customers perception of service quality
and the tools to measure it (Parasuraman et al., 1985, 1988). For a business which provides
service it is quiet difficult to define and measure service as the concept is vague and abstract
unlike products which possess a clear standard of given quality level ee et al., 2000). Service
quality is defined as a customer's overall service quality evaluation by applying a
disconfirmation model the gap between service expectations and performance (Cronin Jr &
Taylor, 1992; Potter et al., 1994). Parasuraman et al. (1985) defined service quality as the
difference

between

predicted

or

expected

service (customer expectations) and

perceived service (customer perceptions). According to the definition of Zeithaml et al.(1990)

service quality is customers perception of how well a service meets or exceeds their
expectations and it is judged by customers, not by organizations. The interactive nature of
service process results in the consumers evaluation of quality immediately after the
provision and performance of that service (Douglas andConnor, 2003). Thus, performance is
probably the most important competitive weapon in service business (Zeithaml et al., 1992).
After defining the concept of service quality, researchers needed a tool for measuring the
quality level of services. The tool was expected to key out the attributes that require
improvement in order to enhance quality, identify the degree or amount of improvement
required and identify how the impact of service quality improvement efforts can be assessed.
With these concerns, Parasuraman et al. (1985, 1988) developed SERVQUAL, which is the
most widely used tool to measure service quality to date. Although the model provides good
relative indication on how the service levels rate against similar competitors, it lacks a
quantitative foundation that can be used universally across industries (Baggs and Kleiner,
1996). SERVQUAL was founded on the view that customers assessment of service quality is
paramount. This assessment was conceptualized as a gap between what customer expects
Measuring service quality on Square Hospital

Page 7

from a class of service providers and their evaluations of the performance of a particular
service provider (Buttle, 1996). SERVQUAL measures service quality in five dimensions i.e.
reliability, tangibles, responsiveness, assurance and empathy by 22 items. Each item is
written twice; first to determine customers expectations from service providers in the service
category being investigated, second to measure perceptions of performance of a particular
firm (Llosa et al., 1998). SERVQUAL was used in various industries; however, the findings
of these studies indicate that the number of dimensions of service is not unique (Llosa et al.,
1998). Parasuraman et al. (1988) have claimed that SERVQUAL provided a basic skeleton
through its expectations/perceptions format and when necessary, the skeleton can be adopted
or supplemented to fit the characteristics or specific research needs of a particular
organization.
The health care service can be broken down into two quality dimensions: technical quality
and functional quality (Gronroos, 1984). While technical quality in the health care sector is
defined primarily on the basis of the technical accuracy of the medical diagnoses and
procedures or the conformance to professional specifications, functional quality refers to the
manner in which the health care service is delivered to the patients (Lam, 1997). In other
words, technical quality is about what the customers get, functional quality is about how they
get it. Research has shown that technical quality falls short of being a truly useful measure for
describing how patients evaluate the quality of a medical service encounter (Bowers et al.,
1994). Ware and Snyder (1975) state that although technical quality has high priority with
patients, most patients do not have the knowledge to evaluate effectively the quality of the
diagnostic and therapeutic intervention process or information necessary for such evaluation
is not shared with the patients. Thus, patients base their evaluation of quality on interpersonal
and environmental factors, which medical professionals have always regarded as less
important. Moreover, most patients

cannot

distinguish

between

the

caring

performance and the curing performance of medical care providers (Lam, 1997). In their
studies, Cronin and Taylor (1994) found that there is a link between the patients perception
of quality of service and patient satisfaction. Research has shown that consumers tend to
evaluate the quality of the health care services by focusing on more functional issues like
physical facilities, interactions with receptionists or brochures rather than hard-to evaluate
technical aspects of the service delivery (Brown and Swartz, 1989). Research finds that
patient satisfaction is positively related to purchase intentions (Cronin and Taylor, 1994),
loyalty toward health care providers (John, 1992) and adherence to medical treatment
recommendations (Hall and Dornan, 1990). According to Oswald et al. (1998), consumers
Measuring service quality on Square Hospital

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must rely on attitudes toward caregivers and the facility itself in order to evaluate their
experiences. They point out that there is a strong connection between health service quality
perceptions and customer satisfaction. Healthcare providers focus is providing the
appropriate treatment to their patients. They believe that this actually is the focus of the
patients as well (Bopp, 1990). However, as Swartz and Brown (1989) observed, patients
perceptions often differ from those of the physician and physicians may misperceive their
patients evaluations. This causes dissatisfaction on the patients side and leads the patient to
look for an alternative provider and spread negative word of mouth which would affect
potential clients (Brown and Swartz, 1989; Swartz and Brown, 1989).
Several tools have been developed to measure patients perceptions and expectations, but
SERVQUAL instrument developed by Parasuraman et al. (1988) is the most widely used tool
(Sohail, 2003).

While the findings of some studies confirm the five generic quality

dimensions of SERVQUAL (Babakus and Mangold, 1992; Youssef 1996), others either
identified less number of dimensions (Lam, 1997) or used a modified version of the
instrument and identified additional dimensions (Reidenback and Sondifer-Smallwood,
1990).
Reidenback and Sondifer-Smallwood (1990) employed a modified SERVQUAL approach to
understand the relationship among patients perceptions of inpatient, outpatient and
emergency room services and their overall perceptions of service quality satisfaction with
their care and willingness to recommend the hospitals services to others. Seven dimensions
were identified and differential impacts of these dimensions were found in the three hospital
settings. Patient confidence was found to affect patient satisfaction in all three settings in
addition to influencing perceptions of service quality in both the inpatient and the outpatient
settings. Babakus and Mangold (1992) found that SERVQUAL is reliable and valid in the
hospital environment. Silvestro and Johnston (1992) identified care as a quality factor.
Johnston (1995) further developed the research of Silvestro and Johnston (1992) and found
eighteen quality dimensions, namely, cleanliness, aesthetics, comfort, functionality,
reliability, responsiveness, flexibility, communication, integrity, commitment, security,
competence, courtesy, friendliness, attentiveness, care access and availability.
Youssef (1996) investigated patients satisfaction with National Health Service (NSH)
hospitals in the UK using SERVQUAL. The findings showed that reliability was the most
important of the five dimensions in influencing patients overall quality perceptions. Empathy
was the second important dimension, closely followed by responsiveness and assurance.
Tangibility was found to be the least important of the five SERVQUAL dimensions. Lam
Measuring service quality on Square Hospital

Page 9

(1997) examined the validity, reliability and predictive validity of SERVQUAL and analyzed
its applicability to the health care sector in Hong Kong.
Study results show that SERVQUAL is a consistent and reliable scale to measure health care
service quality. However, factor analysis did not confirm the five generic quality dimensions.
The results of the factor analysis indicated that the scales could be treated as onedimensional, for the results identified one dominating factor representing expectations and
perceptions. Sewell (1997) in their study on NHS patients found that the most important
quality dimension was reliability followed by assurance. Empathy and responsiveness
dimensions were rated as almost equal. Tangibles were identified as the fifth dimension.
Angelopoulou et al. (1998) investigated service quality provided in public and private
hospitals in Greece. They found that patients in public hospitals were satisfied about the
competence of physicians and nurses. Their findings on private hospitals show that patients
are more satisfied with physical facilities, waiting times and admission procedures compared
to the public hospitals patients. Camilleri and examined public and private hospitals in Malta
in terms of their care service quality and concluded that both type of hospitals services
exceeded the corresponding customers expectations. Dean (1999) conducted research in two
different health service settings in Australia to test the transferability of SERVQUAL. It was
concluded that quality factors differ not by industry, but also by the type of health service.
Lim and Tang (2000) conducted a modified SERVQUAL with six dimensions, namely,
tangibles, reliability, assurance, responsiveness, empathy, accessibility and affordability on
252 patients in Singapore hospitals. They concluded that hospitals needed improvements
across all six dimensions. Andaleeb (2001) in Urban Bangladesh found out that patient
perceptions were sought on five aspects of service quality including responsiveness,
assurance, communication, discipline and baksheesh.
Boshaff and Gray (2004) conducted their study on patients in private health care
organizations in South Africa. They found that the service quality dimensions of nursing staff
empathy, assurance and tangibles have positive impact on patients loyalty measured by
purchasing intensions. Kilbourne et al. (2004) used perception only scores of service quality
as they proposed that these scores appear to have higher convergent and predictive validity.
The results showed that SERVQUAL is capable of capturing even slight quality indicators in
a multidimensional way, namely, tangibles, responsiveness, reliability and empathy, as well
as the overall service quality. Varinli and Cakir (2004), in their study onpatients in a private
hospital in Turkey, identified four service quality dimensions; physicians, nurses, process and
the personnel. They found that patient satisfaction was influenced by physicians and nurses
Measuring service quality on Square Hospital

Page 10

and slightly by price. The exploratory study conducted to understand health care quality in
exploratory

the

Mauritian

context. Ramsuran-Fowder (2005) found two additional

dimensions, namely, core medical outcomes and professionalism/skill/competence and a

few additional items within each of the five SERVQUAL quality dimensions. The findings of
the study indicate that SERVQUAL dimensions could not be replicated fully to the health
care services.
In the same year, Mostafa (2005) investigated how patients perceived service quality in
Egypts public and private hospitals. Factor analysis extracted a three factor solution, thus the
five generic dimensions were not confirmed. The discriminant function developed was found
to be significant in explaining patients choice of the type of the hospital. Again in 2005,
Gonzalez-Valentin et al. (2005) conducted their research on patients in a regional university
hospital in Southern Spain with the purpose of assessing the satisfaction of patients with
nursing care by using SERVQUAL. Factor analysis did not reproduce the five dimensions,
but extracted three factors only. Yagci and Duman (2006) analyzed the relationship between
service quality and customer satisfaction in public, private and university hospitals in Turkey.
Quality perceptions were measured with four factors, namely; services before the treatment,
physician services, care for private needs, laboratory services and physical environment. It
was found that public hospitals had the lowest values in service quality dimensions and
overall satisfaction followed by university and private hospitals. Demirel et al. (2009)
identified nursing services and trust, treatment, and physical environment as the three factors
related to service quality. They also found that perceived service quality has positive
correlation with patient satisfaction, willingness to recommend and intention to visit the
hospital again.

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Model Development: Research Framework

Research on measuring
service quality dimensions
and identifying
homogenous customer
groups

Identifying
dependant and
independent
variables

Literature review

Questionnaires preparation
comprising 19 Items

Fieldwork to conduct Survey

Analysis

Data Analysis
Measuring service quality on Square Hospital

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Regression

Factor
Analysis

Analytical Model:
Our principal tool is leaner regression model which is commonly known as the
multiple regression model. The formula is
Y=0+ 1X1+ 2X2+ 3X3+ 4X4+ 5X5+ 6X6+ 7X7+ 8X8+ 9X9+ 10X10+e

Here,
Y= Service Quality.
0=Constant (Intercept of Independent Variable)
1= Coefficient of Modernized Equipments.
X1= Impact of Modernized Equipments.
2= Coefficient of Environment.
X2= Impact of Environment.
3= Coefficient of Physical aspects.
X3= Impact of Physical aspects.
4= Coefficient of Promised services.
X4= Impact of Promised services.
5= Coefficient of Error free records.
X5Square
= Impact
of Error free records.
Measuring service quality on
Hospital
6= Coefficient of Service fees and charges.
X6= Impact of Service fees and charges.

Page 13

Research questions and hypothesis:

Does service quality of Square Hospital depend on modernized equipments?

Does service quality of Square Hospital depend on the environment inside Square?

Does service quality of Square Hospital depend on error free record of the patients?

Does service quality of Square Hospital depend on modernized equipments?

Does service quality of Square Hospital depend on service fees and charges?

Does service quality of Square Hospital depend on the time the patient needs to wait
for doctors?

Does service quality of Square Hospital depend on special attention given to an

individual customer?

Research design
Nature of the study:
A descriptive study has been carried out to get a clear picture of the research topic by
interacting with patients, with regard to expectation and perception towards hospital services.
In collecting the data, structured questionnaires are used. We have developed a questionnaire
regarding our topic to give them a clear indication about our needed information. The study
will be followed by casual research in which relationships among variables will be defined
for further findings.

Measuring service quality on Square Hospital

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Measurement and Scaling

The SERVQUAL scale is based on a marketing perspective with the support of the Marketing
Science Institute. As an instrument for measuring service quality it can apply across a broad
range of services with minor modifications in the SERVQUAL scale. SERVQUAL is
foundation for research that pertains to the make and evaluates the quality among service
industries. There are five dimensions of service quality that are applicable to serviceproviding organizations in general like, tangibles-physical facilities, equipment, and
appearance of personnel; reliability-ability to perform the promised service dependably and
accurately; responsiveness willingness to help customers and provide prompt service;
assurance-knowledge and courtesy of employees and their ability to inspire trust and
confidence; and empathy-caring, the individualized attention the firm provides its customers
(Parasuraman, Zeithaml, and Berry 1988).

Research Tools and Forms

A 19-item questionnaire to measure hospital service quality was developed using the focus
group data. Data collected from 30 patients will be used to verify the dimensionality of the
service quality construct and to assess the validity and reliability of the instrument.
The findings from these questionnaires can be used to:
provide feedback to senior management and hospital staff;
recognize areas that are working well;
indicate areas of improvement;
provide a component of the hospital accreditation process;
serve as baseline data for future client satisfaction measurements.
Sampling Scheme

Our total populations are the current and previous customers or patients of Square Hospital
and using simple random sampling from the sampling frame of the total population we have
chosen 30 respondents to participate in the survey.

Data collection/field work

The data for the study has been collected from both primary and secondary sources. Research
method used in the study is simple random sampling to collect the required information. The
data was analyzed by using one sample t test and regression analysis. Data was collected
Measuring service quality on Square Hospital

Page 15

through structured questionnaire by using seven point scale. A sample of 30 respondents was
selected for personal interview.

Data analysis
We have used regression model to analyze data for the service quality measurement of
Square Hospital and for data analyzing and tabulating we have used SPSS version 16.0 which
will be used for survey authoring and deployment.

Writing the report

A formal report will be submitted based on our research and a formal presentation will be
presented for demonstrating our works and findings.

Limitations and delimitations

A self-administered questionnaire was the only option available given these constraints.
Recognizing that self-administered questionnaires have lower response rates than telephone
and/or in-person interviews by trained interviewers, the working group concentrated efforts
of getting buy-in and cooperation from front-line hospital staff for questionnaire distribution.

Time and cost

Time constraint is a big limitation for this study. It was recognized early in the process that
budget and human resource constraints limited the choices available for the questionnaire
methodology.

Conclusion
This study aims to diagnose the service quality of Square Hospital based on the difference
between the patients expectation of quality services and their perception of the services
received. It is found that there is a huge gap on reliability, responsiveness and tangibility
services. The majority of comments provided by respondents also reflected the quality of
service provided. Hospital staff in particular received numerous comments praising their
professionalism and caring attitudes. While some respondents offered suggestions for change
and the need for improvement, the majority of comments reflected the high levels of
satisfaction found in every question.

Measuring service quality on Square Hospital

Page 16

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Service Quality, in Swartz, T.A., Bowen, D.E. and Brown, S.W. (Eds.). Advances In Services
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Please feel free to answer the following questions from your point of view. Information
provided will only be used for academic purposes.
Direction: Please Bold your preferred answer cell.
Thank you in advance for your assistance.

Appendix
Questionnaire for measuring the service quality dimension of Square Hospital Limited

Demographics:
Name:....Sex:
Age:
41

Below 10 years

11 to 20 years

21 to 30 years

Male

31 to 40 years

Female
above

Occupation: Location:

Statements

Stron
gly
agree
1

Disag
ree
2

Somewhat Neither
disagree
agree nor
3
disagree
4

Somew
hat
agree
5

Agree
6

Q1. Square hospital

cleanliness and hygiene are
excellent.
Q2. Personnel of the Square
appear neat.
Q3. Square always have upto-date equipment.
Q4. Staffs are pleasant when
Measuring service quality on Square Hospital

Page 19

Strongl
y agree
7

dealing with patients.

Q5. Square hospital always
has visitor parking available.
Q6. Square provides prompt
services every time.
Q7. Square always provides
accurate reports.
Q8. Patients receive adequate
information about their
medical condition
Q9. Hospital administration
staffs are efficient at dealing
with patient's queries.
Q10.Hospital employees
inform patients exactly by
when services will be
performed.
Q11. Hospital reception
should answer outside phone
calls promptly.
Q12. The expenses of the
square hospital are not
affordable by the lower class
people.
Q13. Patients in square
hospital are treated with a
warm and caring attitude.
Q14. Medical staff always
show understanding towards
patients' feeling of
discomfort
Q15. Employees always
respect patients' privacy.
Q16. Square uses sound
feedback mechanisms.
Q17. Employees of
Square provide
individualized medical
attention.
Q18.I am satisfied with the
overall service quality
delivered by Square
Hospital.
Q19. Square provides
available services on 24 x 7
basis

Measuring service quality on Square Hospital

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Measuring service quality on Square Hospital

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