Service Escape and SEM

See discussions, stats, and author profiles for this publication at: https://www.researchgate.
net/publication/320024123
Structural equation modelling to predict patient perception of services cape

and its relation to customer satisfaction and behavioral intention
Article · January 2017
CITATION READS
1 49
4 authors, including:
Sweta Dcunha Sucharitha Suresh

Father Muller Medical College Father Muller Medical College
11 PUBLICATIONS 4 CITATIONS 37 PUBLICATIONS 136 CITATIONS
SEE PROFILE SEE PROFILE
Some of the authors of this publication are also working on these related projects:
A Comparative Study of Efficacy of Topical Phenytoin vs Conventional Wound Care in Diaabetic Ulcers View project
atient Satisfaction: A study in General and Private Wards of a Multispecialty Hospital View project
All content following this page was uploaded by Sweta Dcunha on 06 October 2017.
The user has requested enhancement of the downloaded file.

ASIAN JOURNAL OF MANAGEMENT RESEARCH
Online Open Access publishing platform for Management Research
© Copyright by the authors - Licensee IPA- Under Creative Commons license 3.0
Research Article ISSN 2229 – 3795
Structural equation modelling to predict patient perception of services cape

and its relation to customer satisfaction and behavioral intention
Sweta DCunha1, Vijaya Kumar2, Veena Angadi3, Sucharitha Suresh4
1- Research scholar, REVA University, Bangalore and Professor, Fr Muller Medical College
2- Associate Professor A. J. Institute of Management Studies
3 – Professor, REVA University, Bangalore
4 - Research scholar, REVA University and Assistant professor, Fr Muller Medical College
sweta.dcunha@gmail.com
ABSTRACT
The purpose of this paper is assessing the three factors influencing service scape and to
explore the relationship between servicescape, customer satisfaction and behavioral intention.
The data for this research were acquired from 150 outpatients visiting a tertiary care
multispeciality hospital. Confirmatory factor analysis (CFA) and structural equation
modeling (SEM) were used to analyse the relationships between perceived quality of
servicescape, customer satisfaction, and behavioral intentions and to evaluate the hypotheses
regarding relationships among model constructs. The findings of the study demonstrate that a
direct relationship exist among the variables: servicescape, service quality and behavioral
intention.
Keywords: Servicescape, Perceived quality, Behavioral intention, Hospital.
1. Introduction
Creating superior customer experience is a vital necessity in today’s service industry. Kotler
was the first to recognize the significance of service environment and considered the
possibility of physical environment as an crucial part of the service experience. Kotler (1973)
introduced the term atmospherics for the intentional control and manipulation of
environmental cues in the service environment. Bitner (1992) coined the term ‘servicescapes’
in regard to the physical surroundings contrived by service providers to promote the service
offering to consumers. It is now widely recognized that both tangible (buildings and
furniture) and intangible (temperature, colour, scent and music) elements constitute the
service environment and contribute to the final service experience.
According to Bitner, physical environment has the potential to influence customer’s

behaviors and create an impression. For customers in a service setting, who as they
experience service and are involved in both consumption and production process of the
service, it is the physical environment will affect the perception of their experience.
According to Wall and Berry (2007) services marketing research has shown that inseparable
nature of services which require both the customer and service provider to be present, such as
those found in restaurants, the physical environment where the service is performed
influences customers’ perception of service quality. Mechanic clues (factors in physical
environment) are especially important in services marketing because the intangibility of the
ASIAN JOURNAL OF MANAGEMENT RESEARCH 293

Volume 7 Issue 4, 2017
Structural equation modelling to predict patient perception of services cape and its relation to customer
satisfaction & behavioral intention
Sweta DCunha, Vijaya Kumar, Veena Angadi, Sucharitha Suresh
offering leads customers to rely on tangibles to evaluate the experience. The mechanic clues
in the service environment assist customers in understanding and interpreting the service.
Hartline and Jones (1996) mention that studies of the relative importance of intrinsic and
extrinsic factors have shown that extrinsic factors become more important to consumers in
judging quality when intrinsic factors are not available or when evaluation of intrinsic factors
is difficult.
In this era of fierce competition and increasing patient consumerism in the healthcare market,
it is important for providers of healthcare to understand what patients experience in their
premises, how they perceive service quality, and how these perceptions can be influenced in
order to satisfy and exceed patients’ wants and needs. A growing need for patient-centered
healthcare has been a driving force for healthcare service scape design. The importance of
servicescapes or the physical environment, in moulding the service experience of its patients
and families has now been acknowledged by healthcare industry. Business strategies are now
being developed in order to offer patient-centered care and a wide range of research
approaches have been implemented including servicescapes, design thinking, and service
design. (Lee, 2012).
In the past, focus was more on patient care functions and effectiveness of the clinical care
than on the design and layout of healthcare buildings. But the tide is gradually turning. More
and more importance is given to the viewpoint of the patient and his wellbeing. Gradually
over time, the providers are growing increasingly aware that of the positive effect of physical
environment health and wellbeing of patients, staff and visitors. Scientific research has
contributed to the fact the perceived value of buildings and the impact (direct or indirect) of
the physical environment on its users is given more serious attention. It has also been
rationalized that there is a more strategic importance to the increased attention for built
environment. Due to heavy competition and consumerism, healthcare providers now want to
distinguish themselves more expressly by their quality. It is very delightful to potential
customers and staff members to be in a appealing hospital where they enjoy their stay and
also contributes positively to healing process. Therefore, from business perspective, it is
profitable, when constructing new hospital buildings, to give detailed attention to design early
in planning of the physical environment. (Report, 2008)
Various researchers have proposed models for evaluating the sevicescape. Bitner (1992)
proposed three dimensions: ambient conditions; spatial layout and functionality; and signs,
symbols, and artifacts to evaluate servicescape. Rosenbaum and Massiah (2011) worked on
expanding Bitner’s service scape framework, applied an extended service scape framework
that shows that a perceived service scape encompasses physical, social, socially symbolic,
and natural environmental dimensions. Hightower. and Shariat (2009) introduced and tested
a hierarchical factor structure research model that proposed service scape construct contains
three component sets - ambient, design, and social factors. Design dimension has a sub
dimension that is functional and aesthetics; Social includes sub dimensions employees and
other customers.
Numerous studies have proved the significant relationship between service scape
characteristics, customer satisfaction and perception of service quality. In a study of leisure
activities by Wakefield and Blodgett, 1996 facility aesthetics and cleanliness have been
shown to positively impact the customer’s perception of quality. Bitner,1992 also found that
spatial layout and functionality are particularly salient in complex self-serve settings, and that
layout in discount stores facilitates the fulfillment of functional needs. Similarly, Wakefield
and Blodgett 1996, suggested that interesting and mood-altering layouts have been found to
amplify customers’ pleasure-fulfillment in the service setting, and another study by Morin et
al., 2007 found music to positively moderate customer perception of service attitude, an
antecedent to service evaluation (as cited in Miles, Miles, Cannon, 2012).
2. Studies on hospital servicescape
Arneill and Devlin, 2002 scrutinized the association between the physical environment in the
clinic’s waiting rooms and perceived quality of care from patients who receive care from the
doctors in those spaces. They learned that for patients in waiting rooms that were nicely
furnished, well-lighted, contained artwork, and were warm in appearance, the perceived
quality was greater than for patients in waiting rooms that had outdated furnishings, were
dark, contained no artwork and were cold in appearance.
Harris, McBride, Ross, and Curtis, 2002 conducted a study to investigate how environmental
satisfaction contributes to overall satisfaction with the experience of stay in the hospital in
comparison to other factors; to identify the sources of environmental satisfaction in the
hospital; and to scrutinize the differences in the level and sources of satisfaction among
different hospitals and different departments. It was observed that environmental satisfaction
ranked third in predicting overall satisfaction. Open-ended responses were elicited and
analyzed which indicated five major factors associated with satisfaction with the inpatient
room: interior design features, architectural features, housekeeping and maintenance related
primarily to the cleanliness of the room; social features of the room and the ambient
environment.
Ulrich et.al, (2004) carried out a project, in which research teams reviewed several thousand
scientific articles and shortlisted around 600 studies that establish how clinical outcomes can
be impacted by hospital design. The team found scientific studies that record the influence of
a range of design characteristics, such as single-rooms versus multi-bed rooms, reduced noise,
improved lighting, better ventilation, better ergonomic designs, supportive workplaces and
improved layout that can help reduce errors, reduce stress, improve sleep, reduce pain and
drugs, and improve other outcomes. Certain studies that link physical environment to patient
and staff outcomes were identified by the researchers in four areas: Reduction in staff stress
and fatigue and increased effectiveness in delivering care, improving patient safety, reduction
of stress and improvement of outcomes and improvement in overall healthcare quality.
It was observed that certain changes in the general layout, color scheme, furniture, floor
covering, curtains, and providing informational material and information displays in a
traditional reception of a neurology clinic ensued in more positive appraisal of environmental,
improved mood, transformed physiological state, and greater satisfaction among waiting
patients (Leather, Beale, Santos, Watts, and Lee, 2003). In comparison of patients in well-
decorated and appealing rooms Vs patients in standard rooms of the same hospital, the former
rated the hospital services better than the latter. They expressed positive behavioral intention,
such as intention to use the hospital again and recommend it to others (Swan, Richardson,
and Hutton, 2003).
Lee (2012) in his study examines the design of ambulatory healthcare from a service design
perspective. It focuses on service scape of healthcare facilities and developed a conceptual
framework that indicates service scape features, perceived servicescape, users’ emotional and
physiological status, and attitudes towards the healthcare (the perceived quality of care,
behavioral intentions). The study inclued a list of service scape features that include ambient
conditions and also the serviceability of servicescapes, which could exert influence on
patients’ experiences. Perceived physical conditions included acoustics, lighting, air quality,
temperature, comfortable furniture, and visual attractiveness. Perceived serviciablity included
wayfinding/ accessibility, privacy, communication with staff, convenient building layout,
Samah, Ibrahim and Wahab (2013) conducted a study in order to understand the preferences,
and expectation of the patients and their family members regarding the physical design of
healthcare facilities. The study was carried out in an outpatient unit in Malaysia. It focused on
the following factors of interior design characteristics such as space planning, ergonomics,
accessibility, way finding, material and furnishes, colour, lighting, furniture and safety. The
techniques used in the study adopted post occupancy evaluation that included a combination
of baseline analysis, walkthrough observation methods and occupancy survey. The
respondents gave a moderate score to the facility on all interior design criteria. None of the
respondents assessments showed a scoring “good” for the facility in terms of their interior
quality. This is suggestive of the need for improvement in the facility under study.
Fatih et.al, (2014) investigate service environment as a moderating variable on the

relationships between firm reputation, perceived service quality and consumer trust within the
context of healthcare industry. For the research, data was collected by convenient sampling
of 243 patients who obtained service from a few private hospitals situated in Turkey. It was
found that, the relationship between perceived service quality and consumer trust is
significantly enhanced by service environment. The important factors that affect the
perceived service quality are hospital facilities, buildings, design and convenience, attitudes
of support staff, attendance and competence of healthcare personnel (doctors, nurses) and
technical infrastructure, which in turn influences consumer trust.
Pai and Chary (2013) in their study identify the factors that determine health scape and
secondly examine the difference among the inpatient and outpatient in their perception on
items of health scape. The findings of the study indicate there is difference among the
inpatient and outpatient in their perception on items of health scape. out of the fifteen
variables examined for the health scape, outpatients displayed higher mean scores in all the
fifteen variables when compared to inpatients of which seven were statistically significant -
‘modern and up to date equipment’, ‘Infection free environment and treatment’, ‘Adequate
hygienic care and procedures’, ‘Employees dressed neatly’, ‘Availability of required drugs’,
‘Comfortable ambient conditions and proper lighting’, ‘Sufficient waiting areas for patient
and patient party’ signifying that outpatients have good amount of time to understand the
service environment compared to the inpatients.
Pai and Chary (2014) were inquiring into the aspect of physical facilities in hospitals which
he refers to as ‘health scape’ and check its impact on service quality and behavioral intentions
which have been studied in other service settings. In this study an attempt was made to
demonstrate the relationship between three constructs health scape, service quality and
behavioral intentions from a developing countries perspective. The data was collected from
295 patients from three teaching hospitals in Karnataka. The results indicated health scape
strongly effects behavioral intention than the overall service quality.
2.1 Conceptual framework

Based on literature review especially the Hierarchical factor model of Hightowerand Shariat
(2009) and Pai and Chary (2014) the following theoretical framework was formulated to
explain the relationships between perceived quality of service scape, customer satisfaction
and behavioral intention.
Figure 1: Conceptual model
2.2 Hypothesis
On the basis of review of existing literature, the following hypothesis were developed:
H1 – there is an significant association between ambient, design and social factors each with
perceived quality of service scape
H2 – there is an significant association between perceived quality of service scape and

customer satisfaction
H3 - there is an significant association between customer satisfaction and behavioral
intentions
3. Research methodology
The research approach adopted in the study is descriptive cross sectional type. The study is
conducted in a selected tertiary care teaching hospital. Data was collected from from the
primary source i.e., 150 respondents availing services of the outpatient department. A
convenience sampling method was followed.
The tool comprised of a questionnaire that was administered to the respondents. The first part
of the questionnaire included questions intended to elicit demographic data of respondents.
Questions regarding ambient (7 items), design (which comprises of aesthetic 4 items and
functional 5 items) and social criteria (which includes healthcare employees 3items and other
customers 2 items), opinion of overall percieved service scape (1 item), satisfaction (1 item)
and behavioral intentions (3 items) were elicited in the second part of questionnaire. The
items for measuring service scape were considered from the studies on the topic. The
respondents were asked to rate on a Likert five-point scale.
The reliability of the tool was measured by calculating Cronbach’s alpha which was found to
be 0.86 which is an acceptable value.
4. Results

From the sample of respondents it is observed that 64% are female, 38% are in the age of 20-
29 years and 26% are between 40-49 years. 40% are graduates and 38% are postgraduates.
46% have income of above 8000 to 15000 rupees. The respondents (52%) have visited the
selected hospital more than one time and upto 3 times. 60% have also visited private hospitals
Table 1: Demographic profile of the patients

Demographic Details Percentage
Age
20-29 38%
30-39
20%
40-49
26%
50-59
16%
>60 0
Gender
Male 36%
Female
64%
Education SSLC
12%
PUC
10%
Graduate
48%
Postgraduate
30%
Income level(Rs) <1500
4%
1501-5000
2%
5001-8000
10%
8001-15000
46%
15001-30000
28%
>30000
10%
Number of previous visit 1-3
52.0
3-5
20.0
5-10
28.0
Types of hospital visited Private
60%
Public
14%
Corporate 8%
Charitable 18%
The analysis was composed of two steps. The first step was to confirm the factor structure of
measurement items assessing servicescape. The second step investigated the relationship
between the endogenous latent variables (i.e., ambient, design and social) and the exogenous
overall variable (i.e., percieved quality of servicescape) and its relation to customer
satisfaction and behavioral intention. The measurement and structural models were tested
using the SPSS 16 and AMOS 16.0 structural equation analysis package. The maximum
likelihood method of estimation was used to analyse the data.
Confirmatory factor analysis (CFA) was conducted to assess the construct validity of the
model. The CFA results provide overall fit indices chisquare (χ2 = 26.293), degree of
freedom = 11, RMSEA (root mean square error of approximation) = 0. .0965, GFI (goodness
of- fit) = 0.961, AGFI (adjusted goodness-of-fit) = 0.874, CFI (comparative fit index) = 0.980,
RFI = 0.917 and NFI (normed fit index) = 0 .967.
Table 2: Goodness of fit results of the study.
χ2 Df χ2/df P RMSEA GFI AGFI NFI RFI CFI
Overall
26.293 11 2.390 .0058 0 .096 0.961 0.874 0 .967 0.917 0.980
model
Table 3: Regression weights

Estimate (β) S.E. C.R. P
Perceived_quality <---
.554 .068 9.17 <0.001
Ambient
Design<---
.385 .039 4.75 <0.001
Perceived_quality
Social<---
.270 .059 3.25 <.01
Perceived_quality
Design_functional<---
.638
Design
Design_esthetics<---
.676 .174 7.70 <0.001
Design
Social_customers<---
.823
Social
social_employees<---
.803 .102 11.96 <0.001
Social
Satisfaction<---
.753 .062 13.99 <0.001
Perceived_quality
Behavioural_intention <---
.413 .072 5.79 <0.001
Satisfaction

Figure 2a: Final model
Figure 2b: Final SEM model
As shown in the table, the path coefficients and the associated significance levels, the
influence of perceived quality of service scape on ambient factors (β = 0.55, t= 9.18), design
factors (β = 0.39, t= 4.76),and social factors (β = 0.27, t= 3.25) were found to be significant at
the .01 level.
The regression weight of perceived quality of service scape to customer satisfaction (t =

13.99; p< .01), and satisfaction to behavioral intention (t = 3.363; p< .01) were significant.
This indicated that perceived quality of service scape and customer satisfaction had
significant direct effect on behavioral intention.
The estimation results in Table 3 indicate that the three hypothesis, H1 (ambient, design and
social factors each to perceived quality), H2 (perceived quality to satisfaction), and H3
(satisfaction to loyalty), are strongly supported.
The studied service scape construct is significantly influenced by the 3 factors namely
ambient, design and social factors. The results are consistent with the findings of Lee (2012);
Arneill and Devlin (2002); Harris, McBride, Ross, and Curtis (2002) who in their studies
tried to evaluate the role of physical environment in overall perceived quality by the patients.
The results of this study show that the perceived quality of service scape in the selected
multi-speciality hospital is a factor that significantly affects the customer satisfaction. The
findings support the hypothesis. The results are consistent with the findings of (Leather,
Beale, Santos, Watts, and Lee, 2003) Fatih et.al, (2014) Pai and Chary (2014). It has been
seen that the environment in which the patients are, influences the way they feel and creates
an impression about the way organization values them. The study also indicates that customer
satisfaction leads to positive behavioral intentions. Some studies such as Swan, Richardson,
and Hutton (2003); Lee (2012); Pai and Chary (2014) support the findings.
5. Conclusion
These findings suggest that healthcare providers should pay more attention to revamp the
physical environment (servicescape) dimension. As consumers of healthcare find it difficult
to assess the quality of clinical service, they judge and compare the services which they can
easily perceive. A pleasing service scape which offers comfort and contributes to the patients
sense of well being in the hospital enhances the quality of their stay and increases preference
for the hospital in future. Even after the consumption of the service, the customers usually
remember the service scape and consider it while making their future decisions. It becomes
pertinent that healthcare managers must realize service scape is one of the service attributes
that influences perceived quality and must improve upon it to create satisfactory service
experiences.
5.1 Future work
This present study has only considered the perspective of Out- patients in the hospital. We
need to assess the perception of other healthcare customers such as the inpatients. Hence
future studies such as Inpatient perspective of servicescape, a comparison of out-patients and
inpatients perception of service scape can also be conducted. Studies can be conducted to
explore and assess the perception across various settings of healthcare delivery such as
corporate hospitals, public hospitals, nursing homes in order to get a complete understanding
of role of service scape in influencing healthcare customer behavior.
6. References
1. Arneill, A., and Devlin, A., (2002), Perceived quality of care: The influence of the waiting
room environment. Journal of environmental psychology, 22, pp 345-360

2. Bitner, M.J., (1992), Servicescapes: The impact of physical surroundings on customers and
employees, Journal of marketing, 56(2), pp 57-71.
3. Fatih KOÇ, Volkan Özbek, Esra Alniaçik., (2014), The moderating role of service
environment on the effects of firm reputation and perceived service quality on consumer trust:
a study in the healthcare industry, Journal of global strategic management, 8(2), pp 117-126.
4. Harris, McBride, Ross, and Curtis., (2002), A place to heal: Environmental sources of
satisfaction among hospital patients. Journal of applied social psychology, 32(6), pp 1276-
1299
5. Hartline, M. D., and K. C. Jones., (1996), Employee performance cues in a hotel service
environment: Influence on perceived service quality, value, and word-of-mouth intentions.
Journal of business research, 35, pp 207-15.
6. Hightower Roscoe, Jr. and Shariat Mohammad., (2009), Servicescape’s hierarchical factor
structure model. Global review of business and economic research, 5(2), pp 375-398.
7. Kotler, P., (1973), Atmospherics as a marketing tool, Journal of retailing, 49(4), pp 48-64.
8. Leather, P., Beale, D., Santos, A., Watts, J., and Lee, L., (2003), Outcomes of environmental
appraisal of different hospital waiting areas. Environment and behavior, 35(6), pp 842-869.
9. Lee Seunghae., (2011), Evaluating serviceability of healthcare servicescapes: Service design

perspective. International journal of design 5(2), pp 61-71.
10. Pai Yogesh, Chary Satyanarayana., (2013), Assessing health scapes – A comparison among
inpatients and outpatients, Review of integrative business and economics research, 2(1), pp
797-804.
11. Pai Yogesh, Chary Satyanarayana., (2014), The impact of health scape on service quality and
behavioural intentions, International Journal of conceptions on management and social
sciences, 2(2), pp 99 18-22.
12. Patti Miles, Grant Miles, Alan Cannon., (2012), Linking service scape to customer
satisfaction: exploring the role of competitive strategy. International journal of operations and
production management, 32(7) pp 772 – 795
13. Rosenbaum Mark S. and Massiah Carolyn., (2011) An expanded service scape perspective.
Journal of service management, 22(4), pp 471-490
14. Samah Zanariah Abu, Ibrahim Norhati, Wahab Mohd Hanif Abd., (2013), Users’ assessment
on interior environment of a hospital outpatient Unit in Malaysia. Asian journal of
environment-behaviour studies, 4(11), pp 77-89.
15. Report number 617 (2008), Quality of the physical health care environment: Status of
research on environmental variables and the effects on (sick) people. Netherlands board for
healthcare institutions.
16. Swan JE, Richardson LD, Hutton JD., (2003) Do appealing hospital rooms increase patient
evaluations of physicians, nurses, and hospital services? Health care manage revision, 28(3),
pp 254-64.

17. Wall Eileen A. and Berry Leonard L., (2007), The combined effects of the physical
environment and employee behavior on customer perception of restaurant service quality.
Cornell hotel and restaurant administration quarterly, 48(1), pp 67-72.
18. Ulrich Roger, Zimring Craig, Quan Xiaobo, Joseph Anjali, Choudhary Ruchi., (2004) The
role of the physical environment in the hospital of the 21st century: A once-in-a-lifetime
opportunity. Report to the center for health design for the designing the 21st century hospital
project. Sept

View publication stats

Service Escape and SEM

Diunggah oleh

Informasi Dokumen

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Service Escape and SEM

Diunggah oleh

Hak Cipta:

Format Tersedia

See discussions, stats, and author profiles for this publication at: https://www.researchgate.

Structural equation modelling to predict patient perception of services cape

Article · January 2017

Sweta Dcunha Sucharitha Suresh

SEE PROFILE SEE PROFILE

The user has requested enhancement of the downloaded file.

Research Article ISSN 2229 – 3795

Structural equation modelling to predict patient perception of services cape

Keywords: Servicescape, Perceived quality, Behavioral intention, Hospital.

According to Bitner, physical environment has the potential to influence customer’s

ASIAN JOURNAL OF MANAGEMENT RESEARCH 293

2. Studies on hospital servicescape

Fatih et.al, (2014) investigate service environment as a moderating variable on the

2.1 Conceptual framework

ASIAN JOURNAL OF MANAGEMENT RESEARCH 296

Figure 1: Conceptual model

H2 – there is an significant association between perceived quality of service scape and

ASIAN JOURNAL OF MANAGEMENT RESEARCH 297

Table 1: Demographic profile of the patients

Table 2: Goodness of fit results of the study.

χ2 Df χ2/df P RMSEA GFI AGFI NFI RFI CFI

Table 3: Regression weights

ASIAN JOURNAL OF MANAGEMENT RESEARCH 299

Figure 2a: Final model

Figure 2b: Final SEM model

The regression weight of perceived quality of service scape to customer satisfaction (t =

5.1 Future work

ASIAN JOURNAL OF MANAGEMENT RESEARCH 301

9. Lee Seunghae., (2011), Evaluating serviceability of healthcare servicescapes: Service design

ASIAN JOURNAL OF MANAGEMENT RESEARCH 302

ASIAN JOURNAL OF MANAGEMENT RESEARCH 303

View publication stats

Anda mungkin juga menyukai