PATIENT’S PERCEPTION TOWARDS HEALTHCARE SERVICES

Submitted To:

Muhammad Labib

Submitted By:

UMER SALEEM

BS(Hons)Commerce

Roll No. 86

Session 2010-2014

A Thesis Submitted In Partial Fulfillment of the Requirements of

The Islamia University of Bahawalpur for the Degree of BS

Department of Commerce

The Islamia University of Bahawalpur

 ACKNOWLEDGEMENT

My last outstanding assignment is to acknowledge all those people who played a role to the work
explained in this thesis. The acknowledgement is very important part of any thesis, specified the
various people that have helped to intend, execute, apply, criticize and evangelize the work. I am
going to try anyway, and if anyone’s name is not listed, rest certain that my appreciation is not
less than for those programmed below.

All my thanks are due to my guide and supervisor, Muhammad Labib, Department of
Commerce, The Islamia University of Bahawalpur. I feel a great sense of gratefulness for his
enthusiastic, intellectual and sincere guidance.

I am happy that my friend finally can now read about what I have been doing. At the end I want
to thank my family for all the support they provide me during the period I have been working on
this thesis.

Umer Saleem
Roll No. 86
BS(Hons)Commerce
Session 2010-2014
 DEDICATED

TO

ALMIGHTY ALLAH,

HOLY PROPHET (PBUH)

MY LOVING FAMILY

AND

MY RESPECTED TEACHERS
 DECLARATION

I said Umer Saleem Roll No.86 student of BS(Hons)Commerce session 2010-2014, herby
undertake that, I have written this thesis entitle “Patient’s perception towards healthcare
services” by myself under the guidance of my supervisor Muhammad Labib. I have read it
carefully and take all the responsibilities of the mistakes.

Umer Saleem
Roll No. 86
BS(Hons)Commerce
Session 2010-2014
 CERTIFICATION

This thesis submitted by Umer Saleem on topic “Patient’s perception towards healthcare
services” is accepted in this present form by the Department of Commerce, The Islamia
University Bahawalpur as satisfying the thesis requirements for the degree of BS.

Supervisor:

Muhammad Labib

Head of Department:

Dr. Abdul Majid Makki

 APPROVAL CERTIFICATE

Internal Examiner: ____________________________

Head of Department: _____________________________

Department of Commerce
The Islamia University of Bahawalpur
Contents
Chapter 1 Introduction
Abstract
Purpose……………………………………………………………………………………………………………………….1
Design/Methodology/approach…………………………………………………………………………………..1
Findings……………………………………………………………………………………………………………………….1
1. Introduction
1.1Objective of Study

Chapter 2 Literature view

2. Literature view
2.1. Patient Perception..................................................................................................…...6
2.2. Service Quality………………….…………………………………………………………………………………….....8
2.3. Factors Effecting the Patient Perception …………………………………….…………………………….….. 11
2.3.1. Empathy ………………………………………………………………………………………………………….……11
2.3.2. Assurance……………………………………………………………………………………………….…………...12
2.3.3. Tangible……………….……………………………………………………………..………………………….…..13
2.3.4. Responsiveness ………………………………………………….……………………………………………….15
2.3.5. Reliability……………………………………….…………………………………………………………………...16
2.3.6. Patient’s Trust………….………………………………………………………………………………………....18

Chapter 3 Theoretical Model

Theoretical Model……….…………………………………………………………………………………………20
Hypothesis……………………………………………………………………………………………………………21

Chapter 4 Research Methodology

4. Research Methodology…………………………………………………………………………………………..22
4.1. Data Collection……………………………………………………………………………………………………….22
4.2. Sample Size Determination…………………………………………………………………………………….22
4.3. Research instrument………………………………………………………………………………………………22
4.4. Data analysis………………………………………………………………………………………………………….22

Chapter 5 Findings and Analysis

Findings………………………………………………………………………………………………………………..….28

Chapter 6Conclusion
Conclusion…………………………………………………………………………………………………………….....30
References…………………………………………………………………………………………………………..……32
 Patient Perception towards Health Care Sevices

ABSTRACT

The purpose of this study is to measure the factors affecting the patient’s perception towards
healthcare services by discussing variables such as empathy, assurance, responsiveness, tangible,
reliability and patient’s trust. Being descriptive study, survey method was adopted for data
collection to find out the factors. A sample of 150 people was selected for the survey. Data was
analyzed by using Cronbach‟s Alpha, correlation and regression in SPSS software. All the
independed variables including empathy, assurance, responsiveness, tangible, reliability and
patient’s trust have a great influence on the depended variable patient’s perception towards
healthcare services.
CHAPTER 1 INTRODUCTION

Balanced birth and also death rates, in addition to the low occurrence connected with disease
refers to a healthy population and also fundamental for the growth along with success of a
nation. Healthy population along with prosperity is actually completed by provide quality of
health care towards an individual successfully in correct management of the disease, as well as
can be available towards large majority of the population at an reasonable cost. Thus, quality
patient-care should be the keys to press tip of any nation’s health system(Anantharaman.N et al.,
2008). The level of Patient Perception delivered their beneficiary population concerned because
of the Policy makers around the department involving Defense Military Health System
(MHS).(Mangelsdorf & Finstuen, 2003).

Different reviews examining Patient Perception levels exclusively throughout military treatment
services around the USA(Mangelsdorf & Finstuen, 2003; Mangelsdorff, Finstuen, Larsen, &
Weinberg, 2005). Cost as well as demand with regard to healthcare providers tends to be
increasing in the United States with the alarming rate. Expenses of healthcare have increase from
$28 billion, or maybe 5.2% of Gross Domestic product (GDP) in 1960, in order to $1,878
trillion, in addition to 16% regarding GDP in 2004(Henry J. Kaiser Family Foundation [KFF],
2007). We can define the perceived service quality as consumer’s decision information about the
product’s overall excellence or even advantage, on the basis of perceptions of what we obtained
and also what we given(Zeithaml, 1988).

The main person who receives the advantages of a good health-care system is obviously the
patient. It could be the patient that would be the focus of an health care delivery system, as a
buyer associated with health care(Anantharaman.N et al., 2008). According to Milakovich,
(1995) in a healthcare business, your patient as well as the patient’s family must be accepted as
clients throughout a clear definition of a buyer on the healthcare process. Based on O’Connor
along with Shewchuk, (2003) the patient’s consumption regarding health care services is a very
tough along with complex phenomenon this is likely influenced by many details beyond a
patient’s control or maybe understanding.
Most of these exogenous details were identified just as convenience involving location,
organizational ownership as well as size, satisfaction level of employee, turnover, job tenure,
training, levels associated with service orientation, as well as patient’s health status in addition to
socioeconomic status. The service sector is usually becoming extremely competitive and also
expanding with increasing rate(Chen et al., 1994; Akter et al., 2008).Akter et al., (2008)
proposed that the provides connected with services sector widely have differing functions
particularly inside health care, which deals throughout different other services just like hospital
services, diagnostic services, physicians’ consultancies along with different emerging fields.
Based on Puay and also Nelson (2000) to acquire service superiority hospitals must struggle
pertaining to zero defections, retaining every customer that the business can profitably serve.

Zero defections require continuous efforts to increase the quality of services system(Zaim et al.,
2010). Perceptions of service quality inside hospitals is usually improved from improving
communication between patients in addition to service providers(John, 1991).Patient Perception
is usually a idea that have been obtaining growing attention reflecting a rising focus with the
service-oriented health care market (Umar, 2011). Understanding satisfaction along with health
care quality continues to be familiar just like significant in order to developing many
development approaches(ACHE, 2006). Timely delivery of service throughout minimum waiting
time has become crucial predictor involving quality to its patients.

Waiting is actually considered in the same way inactive through the patients, wasted or even lost
opportunity time(Katz 1991, Dansky 1997). Like ones some other service organizations;
healthcare sector has also become a highly competitive as well as rapidly growing industry
around the world(Babkus & Mangold, 1992). In healthcare, perceptions of patients are usually
consider greatest indicator to assess service quality of the healthcare organization(Cronin &
Taylor, 1992; O’Connor et al., 1994). It means that patients satisfaction would be the most
important device intended for essential decision making in selecting a healthcare services(Gilbert
et al., 1992) and quality of services delivered to the buyers should meet their
perceptions(Parasuraman et al., 1985, 1988; Reidenbach and Sandifer-Smallwood, 1990;
Babakus and Mangold, 1992; Zeithaml et al., 1993).

In Pakistan almost all of population living within rural areas as well as small proportion is
usually living throughout urban areas(Imran et al., 2006). The population within rural place
especially along with the populations inside urban place to some extent tends to be deprived
associated with fundamental rights: especially healthcare services such as majority of public in
addition to private hospitals usually are located in big cities (Irfan et al., 2011). John (1992)
furthermore suggests that health care service providers usually are increasingly using higher
levels connected with service quality for satisfy patients. Within the Western world, there exists
evidence the people are tending to pay extra with regard to care from quality institutions which
can be better disposed in order to satisfy client requirements(Boscarino, 1992).

The emerging health care literature propose that Patient Perception is a leading concern this can
be tangled with strategic decisions at the health companies(Gilbert, Lumpkin & Dant, 1992).
The quality connected with service, both technical and functional is really a most important
ingredient in the success connected with service institutions(Grönroos, 1984). Technical quality
within health care is usually defined mainly towards basis of the technical accuracy of a
diagnosis as well as procedures(Sohail.S.M, 2003). Facts and information relating to technical
quality is not generally exhibited towards public, and also remains on the purview of health-care
professionals along with administrators(Bopp, 1990).

Based on Sohail.S.M, (2003) functional quality, on the other hand, relates towards manner
involving delivery connected with health-care services. With competitive pressures plus the
increasing requirement to provide Patient Perception, the fundamentals of quality control, quality
regarding service, and efficiency of medical treatment have possibly be significantly
ticks(Friedenberg, 1997). Various reviews have displayed that provision associated with high-
quality services is usually directly linked to increase in profits, market share, as well as cost
savings(Devlin & Dong, 1994). Many reports have that critical variation exists between patient
expectation associated with treatment quality along with the perceived service quality of an
treatment received, and that this can be due to several factors linking to the service quality of a
treatment delivered(Strasser et al., 1995; Butler et al, 1996; Kandampully, 1997).

In addition, favorable client perception connected with service quality will have a positive
relationship with total customer satisfaction in addition with turn the behavioral intention; repeat
purchase as well as willingness to suggest the service to others(Parasuraman et al., (1985, 1988,
1991). Thus, providing high service quality to customers, gives a business an opportunity for
distinguish it’s self in addition to gain a good competitive advantage for the market (Wang et al,
2003). Satisfactions level of patients is usually depending upon their perceptions throughout
utilization of healthcare services(Sitzia, J. as well as N. Wood, 1997; Baker, R as well as J.
Streatfield, 1995; Baltussen, R., et al., 2005). This can be additionally evident that hospitals are
usually providing same type of services to the patients but they are not able to deliver same
quality involving services(Youssef, F.N., 1996).

On the basis of statistics division of Pakistan (2010), the population of country was 169.6 billion
and Pakistan is the 6th largest populated country of the world as well as obtaining highest growth
rate. Therefore, in order to deliver healthcare facilities to this rapidly growing population, it takes
concurrent planning, developing techniques and allocation associated with sufficient budget by
the government agencies to be able to promote the healthcare system(Irfan.M.S et al., 2012).
Increasingly, health care stakeholders such as governments, health authorities in addition to
customers usually are attaching importance to health care quality(Lapsley, 2000; Smith et al.
2006). Patients’ satisfaction is known as necessary factor for the evaluation associated with
health care quality (Derose et al. 2001; Donabedian, 1992).

1.1 Objective of the Study:

The objective of this study is to measure the factors affecting the patient perception towards
health care services by discussing variables such as Empathy, Assurance, Tangible,
Responsiveness, Reliability and Patient trust.
CHAPTER 2 LITERATURE REVIEW

This chapter reviews the two related construct, perceived service quality and Patient Perception.
2.1 Patient Perception:
One of the most mouse clicks quality elements and most important for success indicators in
health care can be patient perception(Pakdil & Harwood ,2005). Zineldin, (2006) states that
perception is the emotional response from the customers for any product or service. Perception
of the patient has become an significant aspect in order to quantify the potential of any health
system worldwide(Sajid.M.S et al., 2007). Satisfaction can be consider the attitudinal response to
value judgments that made by patients about their medical encounter(Kane et al., 1997).
According to Vinagre and Neves, (2008) satisfaction is usually observed as being a global
consumer feedback of which consumers reflect at the level of happiness. Different reviews
shows that whether hospital expenses are usually perceived high subsequently Patient Perception
can be lower(Andaleeb, 1988).
If physical facilities, including: cleanliness, recent tools, and the general feeling that this hospital
is actually within a good physical condition, usually are effectively perceived after that patient
perception increases(Andaleeb, 1988). While perceived service quality can be updated with each
detailed transaction as well as service experience, This tends to be able to last longer in
comparison with satisfaction, which will be understood just as being short-term as well as only
reflecting a specific service experience(Vinagre&Neves, 2008).Priporas, et al., (2008) described
that a patient’s expectations and also perceptions are usually not effortlessly connected
considering that the a medical or perhaps health service is not exactly comprehensive.
Consequently patients usually are incapable to have a unambiguous idea of their expectations
with an clinical setting.
Over the past 25 years, the role of consumer satisfaction has gained extensive identification to be
a measure involving quality in many public sector services(Sajid.M.S et al., 2007). As outlined
by Sajid.M.S et al., (2007) for the service provider to meaningfully determine the experience in
addition to perceptions associated with patients plus the community after that research must be
conducted to recognize actions in addition to terms in which those patients perceive in addition
to evaluate service quality. Specifically, Patient Perception can be defined as an evaluation
involving distinct healthcare extents(Linder-Pelz, 1982). Hospital image enhances by patients
satisfaction, this good image shows increased service use in addition to market share(Andaleeb,
1988). Satisfied buyers tend to be likely in order to exhibit positive behavioral intentions, which
can be beneficial for the healthcare provider’s long-term success.
Patient Perception is usually predicted by points related to caring, empathy, reliability along with
responsiveness(Tucker as well as Adams, 2001). In line with (Bowers et al., 1994) human
involvement for the service situation with feelings and emotions approaching love for patient
along with positive patient outcomes just like pain relief, life saving in addition to dealing with
anger or even disappointment throughout life after medical involvements also are included in
literature. As outlined by Butler et al.’s (1996) quality of facility in addition to a workforce
performance throughout study explained 66 percent of variance throughout patients’ service
quality perceptions. Communication would be the degree in order to which the patient is heard,
have information in the course of understandable terms, afforded friendly relations and time in
the course of consultation along with provided psychological and also non-technical facts and
information(Tucker, 2002).
Staff behavior also possesses the major impact on client satisfaction. The manner in which staff
communicates with patient as well as a staff sensitivity for the patient’s own experience seems to
be significant(Andaleeb, 1988). If communication is good, which contains information from
service provider for the patient on the type of care he or maybe she will probably receive,
thereby alleviating uncertainty which increases his or her knowledge as well as sensitivity about
what to be able to expect, in that case Patient Perception will be higher(Andaleeb, 1988).
Regardless of whether service provider’s capability will be perceived high and then levels
regarding satisfaction will be increase. Competence strongly influences patients’ service quality
judgments(Andaleeb, 1988).
Boshoff and also Gray (2004) proposed that satisfaction with specific service extents similar to
nursing staff, charges as well as foods were found to exert positive influence with increasing
Patient Perception, more strongest being satisfaction with nursing staff. However, satisfaction in
administration, reception in addition to television services were rejected as items which have
influence on customer satisfaction(Boshoff & Gray, 2004). Physical setting in which products
and services are usually delivered has become found to influence consumer service performance
evaluations, like buyer satisfaction(Bitner, 1990, 1992; Parasuraman et al., 1985, 1988). It has
found in healthcare studies that physical facilities usually are the element regarding patient
healthcare evaluations(Woodside et al., 1989).
Younger, less educated, straight down ranking, married, poorer health and high-service use were
linked to lower satisfaction(Tucker, 2002). Earlier reviews showed satisfaction differences
between health service users and observers(Strasser et al., 1995). Earlier studies suggests this
patient’s expectations as well as priorities vary among nations as well as tend to be highly relates
to cultural background and also towards healthcare system(Eiriz along with Figueiredu, 2005).
Quality will be positively correlated throughout satisfaction; however, the trend in addition to
strength of predictive relationship between quality and satisfaction persists unclear(Naidu.A,
2009). Satisfied clients will certainly express positive feelings and information about their
service experience as well as may behave or maybe plan in order to behave with the future
positively. Customers who evaluate their service experience negatively will probably show
negative patterns of behavior(Etgar.M et al., 2009).
2.2 Service Quality:
As outlined by Lewis, (1993) service quality focus on fulfill customers’ requirements as well as
wants along with how nicely the service distributed matches customers’ expectations. Service
quality identified just as exceeding client expectations(Reeves along with Bednar, 1994). Reeves
and also Bednar, (1994) proposed that perceived service quality results coming from
comparisons via customers connected with expectations associated with service throughout the
perceptions regarding real service performance. The differentiation in scores defines the amount
of service quality(Zaim et al., 2010). Johnson.C et al., (2013) proposed that it is believed that the
expectations are wants regarding customers; what they think and feel about a service which must
be provide by the service provider. The customers’ judgment of any service provider refers to
perceptions.
Therefore, regardless of whether the service is greater than the customers’ expectations, service
provider offers quality service(Johnson.C et al., 2013). The idea involving service quality is
refers to expectancy disconfirmation theory(Oliver, 1980). If the expected service exceeds the
perceived service, perceived service quality is usually less in comparison with satisfactory.
Quality is usually consider rejected if there will be a negative discrepancy between expected and
perceived service increases. If the expected service is less than the perceived service, perceived
service quality will be greater than satisfactory. In conclusion, service quality will be just
satisfactory when expected service exceeds the perceived service(Johnson.C et al., 2013). As
outlined by Norman, (1984) service is consider to be a social act that takes place directly
between buyers as well as agents of a service company.
The degree and also direction associated with discrepancy between customers’ service
perceptions as well as expectations is called service quality(Parasuraman et al., 2006). The
growing identification involving perceived service quality have been recognized because of its
positive effects towards satisfaction along with behavioral intentions, which in turn influence on
corporate business performance, including profitability and also market share(Rust & Zahorik,
1993; Zeithaml, 2000). Healthcare quality can be further complex to define in comparison with
some other services the reason is that in healthcare quality the buyer himself plus the quality
associated with buyer’s life is evaluated(Eiriz along with Figueiredu, 2005). A number of authors
propose the idea that the healthcare quality is actually evaluated from give importance to
observer, observer includes friends in addition to family perceptions. These types of observer
groups represent potential future buyers – main influencers connected with patient healthcare
options(Strasser et al., 1995; Naidu, A., 2009).
Most important essentials of an service quality analysis can be the ability to identify the relative
importance of 5 dimensions throughout influencing patients' overall quality perceptions(Lim et
al., 1999). The service quality tool have been empirically evaluated in addition to found to
become reliable in addition to valid with regard to hospital use(Babakus as well as Mangold,
1992). Different definitions associated with service quality are change only in wording but
normally require determining whether perceived service delivery meets, exceeds or fails to fulfill
customer expectations(Cronin as well as Taylor, 1992; Oliver, 1993; Zeithaml et al., 1996).
According to Parasuraman et al., (1988) service quality can be define as the degree and also
trend connected with discrepancy between customer’s perceptions as well as expectations, or
even the extent in order to which a service fulfill as well as exceeds customer expectations.
Quality of any service depends on that service constantly meets the customers’ expectations(Witt
and also Steward, 1996). The service quality which is higher must be increase consumer
satisfaction and this will be lead to improved long run relationships between the service
provider along with the service beneficiary(Cronin and also Taylor, 1992). Higher evaluations of
the quality involving healthcare services still have an important role to be able to customer
satisfaction along with in order to improving customer interests(Donabedian, 1966; Davies and
also Ware, 1988).
Parasuraman et al., (1985) stated that service quality is defined in the same way the difference
between predicted, or even expected, service (buyer expectations) and perceived service (buyer
perceptions). Expectations are usually wants of the customers that they think service provider
should provide. Perceptions can be define as customers’ judgments of the service provider(Lim
& Tang, 2000). A medical service encounter attains quality in perception when this medical
service meets as well as exceeds the level of patients’ expectations(Lam, 1997). The buyer’s
complete satisfaction through the service companies is actually based on all the encounter
experiences of the buyers with the company(Sureshchandar et al., 2002).
According to Fleming, (1991) we can reduces the operating costs by improving the quality level.
Breedlove, (1994) studies that hospital financial managers believe on the improvements of
quality programs as being an important aspect to survival. Customer satisfaction is actually
considered to be more dependent with patient expectations compared to patient
perception(Rosenthal in addition to Shannon, 1997) and also does not essentially reflect the
perception intended for service quality(Cleary, 1998). Studies conducted in Cameroon (Litvack
as well as Bodard, 1993) in addition to Nigeria (Akin et al., 1995) found positive impact
associated with quality care on demand. Similarly, researches within Bangladesh (Andaleeb,
2000), Srilanka (Akin & Hutchison, 1999) assist this statement.
Having a strong healthcare method throughout place will certainly enable healthcare providers in
order to deliver superior quality and value to patients(Radhika et al., 2007). Babakus in addition
to Mangold, (1992) proposed that patients’ experience would be the single approach to verify the
medical care offers has fulfilled quality anticipation. Desombre & Eccles, (1998) states that
corporations should give emphasis to quality management in the years to be able to survive.
Furthermore, the continuously along with speedily changing technology used via health care
organizations, new medicines, medical tests, along with methods stress the importance involving
gathering facts and promoting and also using current knowledge continually to make sure that
high quality in medical services in long-run(Bellou.V, 2010).
2.3 Factors Effecting the Patients Perception:
Literature reviews the following factors affect the patients’ perception for healthcare service
quality.
2.3.1 Empathy:
Empathy is usually regarding the care delivered to the buyers by the service provider as well as
the human resource along with the person’s attention(Farooq.M.M et al., 2012). According to
Ijaz.A et al., (2011) empathy shows the individual concern involving doctors, staff, nurses along
with the management pertaining to patients to provide relief to patients. In the starting
Parasuraman et al., (1985) designed a scale consisted ten dimensions which customers used to
check company’s service, after that according to (Berry et al., 1992) these dimensions were
reduced into several main dimensions tangibles, reliability, responsiveness, as well as empathy.
The factor associated with empathy is actually identified in the way that service provider
attention given to the patients, calling them through their preferred name and also representing a
good caring behavior with patients(Sajid.S.M et al., 2007).
Individual healthcare quality methods include followings(Donabedian, 1986):
. Structure – Fixed capabilities of medical delivery system such as staff number, types,
qualifications as well as facilities.
. Process – What is accomplished to and for its patient just like treatment.
. Outcomes – changes in the patients’ current along with future health attributed to precursor
medical care.
According to Naidu.A, (2009) in the situation associated with healthcare, a research found that
nurse empathy has positive influence on loyalty. It is also found satisfaction with meals, service
fees and also television services have positive influence on loyalty(Boshoff & Gray, 2004). Ware
et al., (1978) proposed that physicians’ affective behavior can be seen to become more satisfying
to patients. Empathy includes the provision involving caring, individual attention to customers.
Empathy contains access, communication, and also understanding the consumers(Etgar.M et al.,
2009). Caring from service provider, individualized attention given to buyers can be define as
empathy(Edura.W et al., 2009). The perceived service quality can be affected by atmosphere via
improving the quality of service as well as via makes it worse, which have influence on quality
involving health(Akdag˘.C.H et al., 2010).
Based on Akdag˘.C.H et al., (2010) quality regarding atmosphere involves things relates to
politeness of physicians, second in addition to third highest loadings had equal loads, that were
concerning politeness of nurses in addition to ability connected with information about your
condition. Tomes as well as Ng, (1995) designed a measurement scale to be able to assess the
quality regarding service delivered by the hospitals in the United States. They proposed that
empathy, relationship regarding mutual respect, dignity, understanding of illness and religious
prerequisites were intangible features, though food in addition to physical environment were
tangible elements connected with services provided. Nursing care, outcome in addition to
physician care comprises technical care whereas, food, noise, room temperature, privacy,
cleanliness along with parking are parts of social care(Padma.P et al ., 2010).
Boshoff and also Gray, (2004) research the relationship between service quality of hospitals as
well as patients’ procuring intentions through the dimension involving empathy of nursing staff.
Otani as well as Kurz, (2004), in their research on hospital services in the United States, found
the process of admission, physician care, nursing care, empathy to family and friends, agreeable
nature associated with surroundings along with the process of discharge to the significance
dimensions of service quality.
2.3.2 Assurance:
Assurance is actually about knowledge, skills and also expertise of an staff member which
involved in providing services and the ability to make trust along with generate confidence
among consumers(Farooq.M.M et al., 2012).Assurance contains qualified nurses along with
supporting staff, doctors expertise in addition to skills as well as know-how in regards to the
field of specialization, perfect lab in addition to medical test results, accessibility connected with
experts and special attention for emergency patients(Ijaz.A et al., 2011). It believes as ethical
responsibility connected with health care providers to assuring good quality associated with
health care services.
Researchers have observed that good quality also provide practical advantages for
patients(Zineldin.M, 2006). Interviews conduct in Chile with client shows that good-quality
health care services minimized patients’ fears, increase their assurance for the care received,
along with created loyalty towards the clinic(Vera, 1993). The factor involving assurance can be
around the trust of patients for doctor and also hospital staff, along with the assurance with their
qualification and skills(Sajid.S.M et al., 2007). In the situation regarding healthcare, a research
proposed that assurance has positive influence on loyalty(Naidu.A, 2009).
Based on Naidu.A, (2009) researchers state that clients appear to consider for decided that
doctors usually are effectively trained as well as highly skilled. Assurance contains the
knowledge and also courtesy connected with service providers and also their ability to deliver
trust along with confidence. So assurance includes skills, courtesy, credibility in addition to
security(Etgar.M et al., 2009). Technical quality means the basis involving technical accuracy in
addition to procedures. In health care situation, it can be defined on the basis of technical
correctness of any medical diagnoses and also methods or the fulfillment of professional
prerequisites(Lam, 1997).
Technical quality in addition describe as competence of staff just like they go to performing their
routines. these contains the medical and also working skills of doctors, the nurses’ awareness
about the administration regarding drugs along with the laboratory technicians’ expertise with
performing tests on blood samples(Tomes & Ng, 1995). Assurance can be define as the
knowledge and courtesy connected with workers and the ability to encourage trust in addition to
confidence(Edura.W et al., 2009). Assurance feature included components just like skill of
physicians attending you, professional appearance connected with physicians as well as nurses,
responsiveness of the physicians to patient’s requirements(Akdag˘.C.H et al., 2010).
In health care systems the service includes a number of relating elements, such as technology and
also social interactions with health professionals and administrative employees(Darby as well as
Daniel, 1999). Vandamme as well as Leunis, (1993) proposed that assurance, quality of nursing
staff in addition to personal beliefs along with values are the dimensions associated with health
care service quality. Parasuraman et al., (1985) developed use of assurance, empathy in addition
to responsiveness dimensions for signify the quality of personnel. Rao et al. (2006) also proposed
that interpersonal skill regarding medical employees is the essential predictor associated with
Patient Perception.
2.3.3 Tangible:
Physical facilities such as infrastructure, labs, machines as well as human resources involved
with providing the services usually are think to be tangibles(Farooq.M.M et al., 2012).Hygienic
conditions, sterilization of tools, favorable environment, waiting facility for patients, healthy in
addition to clean environment, availability of labs along with pharmacy around the hospital
building are usually include in tangibles(Ijaz.A et al., 2011). Cleanliness for the health facility,
use of clean instruments as well as tools and recognized procedures for the facility and lastly the
prescription for any kind of medication must be easy to realize for the patients known as
tangibles features(Sajid.S.M et al., 2007).
Tangible involves physical facilities, instruments and tools along with appearance regarding
personnel(Edura.W et al., 2009). In the literature of healthcare, a common judgment is that
physical facilities are generally an important factor connected with patient healthcare
assessments(Woodside et al., 1989). Swan et al., (2003) recent research proposed that the room
appearance have an effect on patient perceptions as well as satisfaction. Their research contrast
patients’ evaluations involving rooms that ranged in quality.
Room appearance has influence on healthcare dimensions these dimensions are:
. Physician skill along with proficiency
. Physician as well as nurse courtesy, it means answering the patients’ questions, listening to
concerns
. Food (overall satisfaction, obtaining what was ordered, temperature)
. General hospital evaluations
. Motivation to use hospital again and
. Suggest the hospital to others.
The physical setting in which services are usually provided positively affect the customer service
performance evaluations, like buyers satisfaction(Bitner, 1990, 1992; Parasuraman et al., 1985,
1988). A major difference, in contrast, proposed on facility quality aspect, where consumers
criticized the hospital’s tangible functions in excess of observers (Butler et al., 1996). Income
has great influence on Patient Perception; higher income consumers appeared extra concerned
with personalized health providing just like solutions they get from medical queries, waiting time
with regard to appointments in addition to health care.
Consumers who have lower income, in contrast, considered to be more sensitive about in
addition to overall physical facilities, representing value orientation(Naidu.A, 2009). Based on
Naidu.A, (2009) with the situation connected with healthcare, a research found that tangibles
have positive effect on loyalty. Tangibility which contains the appearance of physical
conveniences, such as the tool and instruments, personnel, and communication
materials(Etgar.M et al., 2009). Within the health care system, patients usually interested in
functional characteristics which includes facilities, cleanliness, quality of hospital food, hospital
personnel’s behavior rather than technical characteristics for service quality evaluation(Edura.W
et al., 2009).
The provider may support customers to recognize the quality of a particular service through
influencing the tangible characteristics like appearance of service provider, physical service
surroundings and the charges of a service(Berry, 1980; Shostack, 1981). Service quality in the
situation of healthcare does not only rely on the quality associated with physicians but also
comprises the staff, nurses, building, waiting room, technical equipment, equipment used within
care, etc(Akdag˘.C.H et al., 2010). Reidenbach and also Smallwood, (1990) performed factor
analysis in addition to operationalized service quality in relation to patient confidence, company
competence, treatment quality, support services, physical appearance, waiting time as well as
empathy.
Vandamme in addition to Leunis, (1993) proposed that the tangibles are the significant aspect
associated with medical service quality. Lam, (1997) found that patients treated physical
facilities to as the slightest important. Rao et al., (2006) research involved medicine availability,
medical information, staff attitudes, doctor behavior in addition to hospital infrastructure as
elements regarding perceived quality of hospital services. Infrastructure contains the tangible
characteristics of a service provided it including equipment, appearance of the firm or facility,
signage, availability associated with resources, etc(Padma.P et al., 2010).
2.3.4 Responsiveness:
According to Sajid.S.M et al., (2007) responsiveness also means that the service is delivered
throughout a courteous behavior as well as which the patient is checked in regard to treatment
choices. In accordance with Farooq.M.M et al., (2012) responsiveness may be the degree
connected with willingness in order to help as well as facilitate the consumers through providing
fast services to the buyers. Ijaz.A et al., ( 2011) proposed that how the doctors, nurses and also
supporting employees take action in order to patient call along with availability connected with
feedback system and also how the management answer to patient complaints all are included in
the responsiveness.
Responsiveness can be describe in the way that all patients irrespective their basis, status and
background find prompt and equal concentration from the hospital staff(Sajid.S.M et al., 2007).
Thus we can categorized the healthcare in three methods(Donabedian, 1986):
(1) Technical aspects – how nicely physicians diagnose in addition to treat problems.
(2) Interpersonal component – provider responsiveness, kindliness and care.
(3) Amenities – medical care facility appeal as well as comfort.
Lovdal along with Peerson, (1989) discovered that doctors’ along with medical personnel’s
manners were essential determinants associated with patients’ attitudes for a hospital as a whole.
Patients require behavior that really is helpful, friendly, caring, practical and also attentive
(Lovdal & Peerson, 1989). Responsiveness that includes the willingness to help out the
customers as well as to deliver the quick response(Etgar.M et al., 2009). Competitiveness among
healthcare firms is depended on patient’s satisfaction, that is created by using a combination of
responsiveness towards the patient’s observtions in addition to requirements, along with nonstop
development of healthcare services, as well as continuous enhancement of the total doctor-
patient relationship(Zineldin, 2006).
Vandamme along with Leunis, (1993) discovered that health care responsiveness is the important
dimension regarding hospital service quality. In accordance with the research conducted by
Hasin et al., (2001) in Thailand, communication, responsiveness, courtesy, cost and also
cleanliness are the constituent dimensions of service quality in health care organizations. Boshoff
& Gray, (2004) conduct research on relationship between hospital service quality along with
patients’ buying plans. They operationalized service quality through the dimensions,
communication, tangibles, empathy regarding nursing staff, assurance, responsiveness of
administrative staff, safety and also physician responsiveness. The health care organizations
must be delivered the quick services along with provided with waiting room with magazines,
televisions, etc to make patients more relaxed when they are waiting(Padma.P et al., 2010).
2.3.5 Reliability:
Farooq.M.M et al., (2012) proposed that reliability can be defined as the capability to fill out the
promised services time after time and accurately. In accordance with Ijaz.A et al., (2011)
reliability contains as outlined by appointment patients’ remarks, provide reports to patients on
time and also availability of doctors based on promised time. Reliability of the services can be
defined as delivered services whenever patient demand the service in addition to that they obtain
treatment which is proper intended for patient’s disease perceived by the patient(Sajid.S.M et al.,
2007). According to Bakar.C et al., (2008) hospital staff must delivered services on time along
with employees should show the caring in addition to helpful behavior, health care organizations
should precisely charge the bill to patients when patients are in trouble.
Reliability involves ability to provide the promised service reliable in addition to
perfectly(Edura.W et al., 2009). There are four most significant factors of service quality in the
diagnosed patient’s case: reliability, honesty, functionality and comfort(Naidu.A, 2009). The
research offers healthcare managers a great chance to make advancements including superior
emergency care, establishing a 24-hour phone consultation, etc(Ho et al., 1998). Goodman et al.,
(1997) discovered that specific service utilize can be increased through availability. Reliability
includes the ability to complete the promised service consistently and also perfectly(Etgar.M et
al., 2009).
It is usually hard to assuring quality within health care, just like the process of production
connected with medical care contains patient-employee relations, making it hard to make sure
stability in addition to reliability(Jun et al., 1998). Boshoff as well as Gray, (2004)
operationalized service quality with the dimensions, communication, tangibles, empathy
involving nursing staff, assurance, responsiveness connected with administrative employees,
safety and also physician responsiveness. Duggirala et al., (2008) proposed that hospital service
quality contains eight dimensions which are, infrastructure, staff members quality, method of
medical care, administrative processes, security indicators, overall experience associated with
health care in addition to societal responsibility.
According to Ramsaran-Fowdar, (2008) in a research on private hospitals, reliability along with
fair and unbiased treatment is the most vital service quality element effect the level of Patient
Perception within Mauritius healthcare services. It is expected that the employees providing
services are usually responsive, reliable, friendly, honest as well as experienced through the
consumers. Friendly and also polite employees can improve patients’ perceptions of a
hospital(Padma.P et al., 2010).
Baldwin along with Sohal, (2003) involves safety, reliability, technical ability as well as skills
regarding dental practitioners in the element “skill and ability”. Corporations be required to make
their workers and also consumers feel secure as well as protected, the reason is that if consumers
or workers threatened, it puts a incredible psychological impact on both(Padma.P et al., 2010). In
a Asian country, Butt as well as Cyril de Run, (2010), & Sohail, (2003) discovered five
dimensions existed in order to evaluate hospital service quality those five dimensions were
tangibles, reliability, responsiveness, assurance, and empathy.
2.3.6 Patient’s Trust:
According to Sirdeshmukh et al., (2002) trust can be expectations of customers which are depend
on service provider to provide its services. Trust is the belief of one person that his demands will
be satisfied in future from actions which are perform by other person(Anderson as well as Weitz,
1989). According to Morgan and also Hunt, (1994) trust is usually existed there when one party
has belief on partner’s trustworthiness and honesty. Based on Mishra et al., (2008) four
dimensions involving trust are existed, these are reliability, openness, skilsl, along with concern
and also states that communication is essential regarding representing almost all features
associated with trust(Alrubaiee in addition to Alnazer, 2010).
In the viewpoint associated with healthcare, trust associated with healthcare faults and patient
harm i.e. patient protection(Alrubaiee.L et al., 2011). Practical function demonstrates that the
shortage of concreteness associated with services high within trustworthiness characteristics
increases the significance of observed efficient service quality in set up person trust(Glen, 2002;
Doney in addition to Cannon, 1997; Sharma & Patterson, 1999). Trusting patients are usually
attentive its elaborate trust cannot be easily a unclear expectation as well as thinking
optimistically, patients should be alert for faults in the care with the health service
provider(Entwistle and also Quick’s, 2006).
Several consider healthcare quality must be studied with the patient’s viewpoint. We can obtain
suitable as well as unique information regarding the quality associated with care from
patients(Ware along with Stewart, 1992). Hall, (2005) clarifies that those exactly who trust have
a great expectation which the trusted individual will probably behave with goodwill to them and
with proficiency for the domain that he or perhaps she is actually trusted or with caring to
throughout which he or perhaps she can be entrusted. According to Naidu.A, (2009) essential
principles summarized in healthcare researches involve followings:
1- Trusting patients usually are vigilant. It means trust is actually not simply an unclear hope or
thinking positively; health service providers should keep patients attentive to mistakes with the
course regarding their care. Some checking through patient is proper even any time there is trust
mainly while truthful errors usually are possible, that might be easily covered and corrected.
2- Patients will progress to trust continuously even no matter whether harmed.
3- Healthcare provider’s belief on their patients can positively influence healthcare familiarity
along with results.
Iyer along with Muncy, (2004) believed that the level connected with trust patients had on
service providers differentiate across patient types as well as division the patients on the bases of
trust level they had towards the service provider. According to Balasubramanian et al., (2003)
“perceived trustworthiness” is a factor regarding online service that might be the determinant of
consumer satisfaction. Ramsaran-Fowdar, (2008), during researching on Mauritian private
hospitals, discovered that reliability, as well as fair in addition to reasonable treatment is the
significant service quality dimension which has influence on Patient Perception. Healthcare
service quality perception is based on patient conclusion of services delivered by hospital, for
instance, the relationship between patients and nurse, doctor and employees(Martinez Fuentes,
1999).
 CHAPTER 3 THEORETICAL MODEL

Theoretical Model:

Empathy

Assurance

Tangible

Service Quality Patient Perception

Responsiveness

Reliability

Patient’s Trust
Hypothesis:

H0: there is no relationship between service quality and patients perception.

H1: there is a relationship between service quality and patients perception.

H0: there is no relationship between empathy and patients perception.

H2: there is a relationship between empathy and patients perception.

H0: there is no relationship between assurance and patients perception.

H3: there is a relationship between assurance and patients perception.

H0: there is no relationship between tangible and patients perception.

H4: there is a relationship between tangible and patients perception.

H0: there is no relationship between responsiveness and patients perception.

H5: there is a relationship between responsiveness and patients perception.

H0: there is no relationship between reliability and patients perception.

H6: there is a relationship between reliability and patients perception.

H0: there is no relationship between patient’s trust and patients perception.

H7: there is a relationship between patient’s trust and patients perception.

CHAPTER 4 RESEARCH METHODOLOGY
The current research is descriptive in its nature. Descriptive research can be explained as telling
something, some phenomenon and any particular situation. Descriptive researches are those
researches that describe the accessible situation instead of interpret and making judgment
(creswell 1994).

4.1. Data Collection:

The respondents of the study are the general people of Bahawalpur. The self-administered
Questionnaires were given to collect data. The main goal of the research is confirmation of the
developed hypothesis that reflects the current situation.

4.2. Sample Size Determination:

Simple random sampling was used to collect data. The 150 questionnaires were distributed. Out
of which 100 questionnaires were received and are finally used for data analysis.

4.3. Research Instrument:

Data was collected by using questionnaire adopted from different studies. The questionnaire
consists of 21 questions related to our variables. The respondent of this study were asked to rate
on five point Likert scale 1 being strongly agree and 5 being strongly disagree.

4.4. Data Analysis:

Data was entered, edited and analyze by using software SPSS version 16 and Microsoft excel by
applying the following techniques; Cronbach’s alpha, correlation and Regression.
CHAPTER 5 FINDINGS AND ANALYSIS

Cronbach’s Alpha:
To check the internal reliability of the instrument, Cronbach‟s alpha was run. Here are the results
of the Cronbach‟s alpha of all the variables.

Patient’s Perception:

Reliability Statistics

Cronbach's
Alpha N of Items

.584 4

Its reliability is .584 which shows that the patient’s perception is reliable and we can run other
tests on this instrument.

Empathy:

Reliability Statistics

Cronbach's
Alpha N of Items

.590 3

Empathy has influence on patient’s perception and the result proved and backed our hypothesis.
As the reliability of empathy is .590 which is greater than .50 which is minimum limit for a
variable to be reliable.
Assurance:

Reliability Statistics

Cronbach's
Alpha N of Items

.590 4

The reliability of assurance is .590 and it has influence on patient’s perception.

Tangible:

Reliability Statistics

Cronbach's
Alpha N of Items

.761 3

Tangible has positive influence on patient’s perceptionthis was our hypothesis about tangibles.
And the results are proving our hypothesis. The reliability of our variable tangible is .761 which
shows that it is reliable and we can confidently implement other statistical tests to this variable.
And it interprets results very well.
Responsiveness:

Reliability Statistics

Cronbach's
Alpha N of Items

.553 3

Our hypothesis about responsiveness has positive influence on patient’s perception and it is
proved. Results proved our hypothesis. Responsiveness is reliable enough to interpret results
very well and we can then put other statistical tests to this instrument as it is reliable.
Reliability:

Reliability Statistics

Cronbach's
Alpha N of Items

.720 2

Reliability has influence on patient’s perception. It is our hypothesis about relaibility towards the
customer perception. The reliability of variable reliability is .720 which means it is reliable and
we can implement other statistical tests on it and can interpret results confidently.
Patient’s Trust:

Reliability Statistics

Cronbach's
Alpha N of Items

.955 2

Patient’s trust variable has greater influence on patient’s perception. Our hypothesis about
patient’s trust and patient’s perception is accepted as alternative. The reliability of patient’s trust
is .955 which is very well and it means it is reliable and we can implement other statistical tests
on it and can interpret results confidently.
 Correlations Analysis
Patient Responsiven
Perception Empath Assurance Tangible ess Reliability Patient trust

Patient Perception Pearson

1 .550** .538** .501** .582** .236** .276**
Correlation

Sig. (2-tailed) .000 .000 .000 .000 .004 .001

N 150 150 150 150 150 150 150

Empath Pearson
.550** 1 .567** .483** .521** .232** .129
Correlation

Sig. (2-tailed) .000 .000 .000 .000 .004 .116

N 150 150 150 150 150 150 150

Assurance Pearson
.538** .567** 1 .465** .425** .153 .217**
Correlation

Sig. (2-tailed) .000 .000 .000 .000 .062 .008

N 150 150 150 150 150 150 150

Tangible Pearson
.501** .483** .465** 1 .473** .321** .196*
Correlation

Sig. (2-tailed) .000 .000 .000 .000 .000 .016

N 150 150 150 150 150 150 150

Responsiveness Pearson
.582** .521** .425** .473** 1 .306** .288**
Correlation

Sig. (2-tailed) .000 .000 .000 .000 .000 .000

N 150 150 150 150 150 150 150

Reliability Pearson
.236** .232** .153 .321** .306** 1 .184*
Correlation

Sig. (2-tailed) .004 .004 .062 .000 .000 .024

N 150 150 150 150 150 150 150

Patient trust Pearson

.276** .129 .217** .196* .288** .184* 1
Correlation

Sig. (2-tailed) .001 .116 .008 .016 .000 .024

N 150 150 150 150 150 150 150

**. Correlation is significant at the 0.01 level (2-tailed).

*. Correlation is significant at the 0.05 level (2-tailed).

Pearson correlation was run to check the relationship of variables with each other and whether
any observed variable has perfect covariance with any other variables, which are observed in the
study. From the above table it is observed that all relationships were found significant. The
correlation value of empathy is 0.550 which shows that empathy has large impact on the
patient’s perception towards healthcare services. There is also a very strong relationship between
assurance and patient’s perception with the correlation value 0.538 which is above than 0.5 it
shows that assurance has great impact on patient’s perception as the assurance attracts patients to
obtain healthcare service of a good hospital. Then tangible having the correlation value 0.501
which shows that reliability has greater influence on patient’s perception. Responsiveness has
correlation value 0.582 which shows responsiveness has greater influence on patient’s perception
because the value is above than 0.5.The correlation value of reliability is 0.236 which indicates
that reliability has less influence on patient’s perception. Patient’s trust has correlation value
0.276 which shows less influence of patien’st trust on patient’s perception.

Regression analysis:

Model Summary

Adjusted R Std. Error of the

Model R R Square Square Estimate

1 .702a .511 .471 .41556

a. Predictors: (Constant), Patient trust, Empath, Reliability, Tangible,

Responsiveness, Assurance

a. Predictors: (Constant), Tangible, Ease to Use, Efficiency and

Speed, Accuracy, Reliability, Convenience

As the table shows the model summary in which the value of R is 0.702 which shows that there
is strong correlation between independent and dependent variable. The value of R square is 0.511
which shows that model is good fit. Therefore our all alternative hypothesis are accepted with the
significance value less than 0.05 which shows that all independent variables have great influence
on dependent variable patient’s perception towards healtycare services.
ANOVAb

ANOVAb

Model Sum of Squares df Mean Square F Sig.

1 Regression 23.982 6 3.997 23.146 .000a

Residual 24.695 143 .173

Total 48.677 149

a. Predictors: (Constant), Patient trust, Empath, Reliability, Tangible, Responsiveness,

Assurance

b. Dependent Variable: Patient Perception

The table shows that F significance is 0.000 which is less than 0.05 which shows all independent
variables do a good job in explaining the dependent variable.

Findings:
This is a descriptive study which analysis some sort of situation. This study indicates that the
patient’s perception towards healthcare services is influenced by many factors. Healthcare
services have many benefits for patients. Healthy population along with prosperity is actually
completed by provide quality of health care towards an individual successfully in correct
management of the disease, as well as can be available towards large majority of the population
at an reasonable cost. Satisfaction can be consider the attitudinal response to value judgments
that made by patients about their medical encounter.Finding of this study indicates that there are
different factors that affect the patient’s perception towards healthcare services.
All the variables discussed in literature view have an influence on patient’s perception. And this
study explores that factors which motivates patients to use or not the services of healthcare
centers. Empathy shows the individual concern involving doctors, staff, nurses along with the
management pertaining to patients to provide relief to patients. According to this study assurance
also has influence on the patients and they took this factor into consideration while making
decision for select the best haelthcare service. Assurance includes qualified nurses along with
supporting staff, doctors expertise in addition to skills as well as know-how in regards to the
field of specialization, perfect lab in addition to medical test results, accessibility connected with
experts and special attention for emergency patients.
Physical facilities are generally an important factor connected with patient healthcare
assessments. Physical facilities such as infrastructure, labs, machines as well as human resources
involved with providing the services usually are think to be tangibles. Patients are very concious
about this factor. It was found that the responsiveness is also important for the patients. How the
doctors, nurses and also supporting employees take action in order to patient call along with
availability connected with feedback system and also how the management answer to patient
complaints all are included in the responsiveness.
Reliability possesses a positive effect on service quality of healthcare organizations. Reliability
of the services can be defined as delivered services whenever patient demand the service in
addition to that they obtain treatment which is proper intended for patient’s disease perceived by
the patient. Patient’s trust is a very important factor for healthcare services and has great
influence on patient’s perception. Healthcare service quality perception is based on patient
conclusion of services delivered by hospital, for instance, the relationship between patients and
nurse, doctor and employees.
CHAPTER 6 CONCLUSION
This study helps in understanding that how empathy, assurance, tangible, responsiveness,
reliability and patient’s trust affect the patient’s perception. How the patients react to these
factors while making decision about service quality of hospitals. The focus of this study was to
examine the factors affecting the patient’s perception about healthcare service quality. The data
was collected by a questionnaire which was distributed among the people of Bahawalpur who
have the knowledge about healthcare service quality. Three tests were applied Cronbach’s Alpha,
correlation and regression. Cronbach’s Alpha shows that questionnaire is reliable. The reliability
of all variables was up to the mark. And from the regression analysis it indicates that model is
good fit.
And by applying correlation technique all relationships were found significant. There is a strong
relationship between empathy and the patient’s perception towards healthcare service quality.
Same like that assurance has a significant impact on patient’s perception. Tangible also has great
impact on patient’s perception. Responsiveness has also significant influence on patient’s
perception. Reliability and patient’s trust has less influence on patient’s perception about service
quality of healthcare organizations. If we discuss our hypothesis in accordance with results than
we can conclude that the first variable empathy has a large influence on the patient’s perception
towards healthcare services.
As the patients adopt a healthcare service they give importance to empathy. So the empathy is
more important for the patients. They keep it into consideration while taking decisions about the
quality of healthcare service. Assurance has a great influence on patient’s perception. Good-
quality health care services minimized patients’ fears, increase their assurance for the care
received, along with created loyalty towards the clinic. Tangible factor has also great impact on
patient’s perception. The room appearance has an effect on patient perceptions as well as
satisfaction. Hygienic conditions, sterilization of tools, favorable environment, waiting facility
for patients, healthy in addition to clean environment, availability of labs along with pharmacy
around the hospital building are usually include in tangibles.
Responsiveness and reliability are important factors. Responsiveness can be described in the way
that all patients irrespective their basis, status and background find prompt and equal
concentration from the hospital staff. Reliability involves ability to provide the promised service
reliable in addition to perfectly. Friendly and also polite employees can improve patients’
perceptions of a hospital. Reliability contains patients’ remarks, provide reports to patients on
time and also availability of doctors based on promised time. Patients give more importance to
these factors. Patient’s trust is one of the most important factor to attract the patients. Four
dimensions involving trust are existed, these are reliability, openness, skills, along with concern
and also states that communication is essential regarding representing almost all features
associated with trust.
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