A Fuzzy Framework to Evaluate Service Quality in the Healthcare Industry

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A fuzzy framework to evaluate service quality inthe healthcare industry: An empirical case of

public hospital service evaluation in Sicily

ARTICLE in APPLIED SOFT COMPUTING DECEMBER 2015

Impact Factor: 2.81 DOI: 10.1016/j.asoc.2015.12.010

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Toni Lupo

Universit degli Studi di Palermo

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Please cite this article in press as: T. Lupo, A fuzzy framework to evaluate service quality in

the healthcare industry: An empirical case of public hospital service evaluation in Sicily,

Appl. Soft Comput. J. (2015), http://dx.doi.org/10.1016/j.asoc.2015.12.010. (IN PRESS)

1

A fuzzy framework to evaluate service quality in the healthcare industry: an empirical case of

public hospital service evaluation in Sicily

Toni Lupo*

Dipartimento di Ingegneria Chimica, Gestionale, Informatica, Meccanica (DICGIM),

Universit degli Studi di Palermo,

iale delle Scien!e, "#$%&, Palermo, Ital'

Corresponding author *el+ -" "$ %-&.$&/"

0mail+ tonilupo1unipait

Abstract

2 novel fu!!' evaluation frame3or4 is applied in this stud' to evaluate service 5ualit' in the pu6lic

healthcare sector In particular, the proposed frame3or4 is 6ased on the Serv7ual disconfirmation

paradigm and incorporates the 2nal'tic 8ierarch' Process (28P) method to elicit relia6le

estimations of service 5ualit' e9pectations Moreover, degrees of uncertaint', su6:ectivit' and

vagueness on the part of sta4eholders are addressed via linguistic evaluation scales parameteri!ed

6' triangular fu!!' num6ers ;ith reference to nine relevant pu6lic hospitals in the Sicilian


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2

the stringent constraints 8o3ever, the gap 6et3een these t3o often conflicting aspects ma' 6e

6ridged 6' an element, ie 5ualit', a6le to compensate for the distorting potential inherent in an

un3ar' or ill@advised overemphasis merel' on costs and 6udgets A$, %, -, B

8ealthcare 5ualit' has 6een defined as the a6ilit' to achieve desira6le o6:ectives using legitimate

meansE 3here6' the desira6le o6:ective implied is an achieva6le state of healthE A= Similarl',

healthcare 5ualit' ma' 6e conceived as an approach to achieve improved health outcomes for

consumers A. Fevertheless, necessar' prere5uisites of 5ualit' healthcare also include appropriate

technolog', timel' treatment, ade5uac' of the offer of services 3ith regard to the demand, as 3ell

as guaranteeing accepta6le standards of medical practice A/ 2ll the more, from a corporate

vie3point, healthcare 5ualit' constitutes a relia6le means for e9tending the client 6ase, so as to gain

a competitive edge, thus assuring economic via6ilit' and long@term profita6ilit' A&, ", $#

*o all intents and purposes, pu6lic healthcare 5ualit' can 6e vie3ed as a multi@dimensional entit'

affected 6' various interacting aspects and actors+ institutions 3hich organi!e and finance

healthcare, healthcare providers and professionals in the front line of service tending to patients?

needs in terms of diagnosis, treatment and, in recent 'ears, reha6ilitation as 3ell ast 6ut not least,

there are the citi!ens e9periencing the clinical outcomes, 6ut 3hose 6ottom line also comprises a

4een e'e for certain aspects of the services provided, such as human relationships, hospitalit' and

the regard for their dignit' and privac' Hig $ sho3s the three main dimensions of healthcare service

5ualit' A$$


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3

Hig $+ Multi@dimensionalit' of healthcare 5ualit'

In detail+

management quality, concerns efficient and effective resource utili!ation and management

to deliver services a6le to satisf' sta4eholders? needs *he evaluation of this 5ualit'

dimension ta4es into consideration the managerial measures and methods adopted

professional quality, includes perspectives of healthcare e9perts and professionals regarding

medical aspects of healthcare *his 5ualit' dimension is directl' characteri!ed 6' in@house

medical s4ills and hospital facilities

Stakeholder perceived quality, consists of citi!enspatients perceptions 3ith reference to

healthcare aspects involving accessi6ilit', responsiveness, human relationships, hospitalit'

and other service features

*his latter 5ualit' dimension is considered the most significant one since it e9erts a direct influence

on the perceived value of the hospital and its image and, as such, it is regarded as a 4e' measure of

the service effectiveness, as 3ell as of the patient satisfaction A$%, $-, $B 2dditionall', this 5ualit'

dimension also indirectl' impacts on patients? 6ehavior in the sense that, satisfied patients do not

tend to see4 healthcare services else3here and, moreover, the' more li4el' recommend the same

Management 5ualit'

#rocedures

and methods

Professional 5ualit'Sta4eholder

perceived 5ualit'

$edical equipment

and skills

Service relational

and facility aspects #erceived quality

Social

quality

#rovided

quality%&ALT%'A(&

S&()"'&


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4

hospital to other potential patients A$=, $. Hor such reasons, the s'stematic implementation of

procedures and approaches to evaluate sta4eholder satisfaction represents a fundamental aspect

in toda'?s healthcare conte9t A$/

In the literature, a num6er of methods have 6een proposed to assess sta4eholder satisfaction in the

healthcare field Jasicall', the' can 6e classified into three fundamental groups+ Stated Importance

Methods (SIMs), Derived Importance Methods (DIMs) and the Multi@Criteria Decision@Ma4ing

(MCDM)@6ased approaches 2s regards SIMs A$&, $", %#, sta4eholders are as4ed to fill out a detailed

5uestionnaire related to 6oth e9pectations and perceptions on fundamental service 5ualit' aspects

Kn the contrar', DIMs A%$, %% re5uire a significantl' simplified 5uestionnaire given that

sta4eholders are as4ed to assess onl' perceptions on service 5ualit' aspects and to provide their

overall satisfaction degree as s'nthesis of the perceived service 5ualit' 7ualit' e9pectations are

statisticall' derived in a second phase, after the surve', on the 6asis of relations among the collected

perceptions and the overall satisfaction degree Hinall', MCDM approaches are 6ased on the general

principle that the attitude of customers to3ards a given service is 6ased on their assessment of

service aspects on the 6asis of the importance assigned to them A%- ;ith this recognition, MCDM

methodologies such as the 2nal'tic 8ierarch' Process (28P) method A%B, the Ise4riteri:ums4a

optimi!aci:a I LKmpromisno


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5

healthcare service 5ualit' Specificall', such a frame3or4 is 6ased on the Serv7ual disconfirmation

paradigm A-- and incorporates the 28P method to point out relia6le estimates of 5ualit'

e9pectations A-B, -=

Serv7ual is the most commonl' used conceptual model for stud'ing and anal'!ing the 5ualit' of

services A-. *he large emplo'ment of its paradigm is 3idel' 3itnessed 6' the large amount of

scientific literature produced over the 'ears in different service fields, such as car rental industr'

A-/, financial services A-&, transportation A-", higher education AB#, 5ualit' certification AB$,

hotel services AB%, B-, online 6usiness ABB, B=, B. Kn the contrar', 28P is one of the most

esta6lished MCDM methods for facing a 3ide variet' of decision situations, in fields such as

government, 6usiness, industr', healthcare, ship6uilding and education AB/ *his fact is pro6a6l'

due to some aspects characteri!ing such method, such as+ possi6ilit' to integrate 6oth 5uantitative

and 5ualitative and also conflicting criteria, opportunit' to conduct sensitivit' anal'sis on o6tained

results and, moreover, it is 3ell supported 6' user@friendl' computer soft3are Hurthermore, the

advantageous mathematical structure characteri!ing 28P and its easiness in ac5uiring the re5uired

data allo3 to overcome man' critical issues, namel' the 3ell@documented respondents tendenc' to

select the central categor' of the evaluation scale to e9press their :udgments AB&, the influence in

the evaluation process of the categories num6er of the evaluation scale, the form and the t'pe of

related linguistic varia6les AB", =#

Hinall', a fu!!' evaluation environment is considered to deal 3ith the inherent uncertaint',

su6:ectivit' and vagueness characteri!ing sta4eholders in e9pressing their o3n :udgments on service

5ualit' A=$, =%, =- *he fu!!' set theor' has 6een successfull' applied in man' fields of the

management science as decision@ma4ing A=B, service performance evaluation A==, =., information

retrieval A=/, =&, and so on In the field of healthcare service 5ualit' evaluation, several recent

applications are descri6ed in A=", .#, .$ Hig % summari!es the architecture of the evaluation

frame3or4 developed


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6

Hig %+ 2rchitecture of the frame3or4 adopted, including fu!!' service 5ualit' evaluation and anal'sis modules

*he frame3or4 herein proposed see4s to support healthcare@decision ma4ers and managers in their

choice of effective and efficient strategies aimed at service 5ualit' improvements Hor e9ample, it

can facilitate the rational prioriti!ation of interventions, such as allotting additional resources for

those service aspects that prove to 6e inade5uate, in order to achieve improved levels of

performance

*he remainder of the present paper is organi!ed as follo3s Section % contains a detailed description

of the frame3or4 Section - illustrates the strategic service 5ualit' anal'sis focusing on the pu6lic

healthcare service of Sicil' (Ital') Hinall', conclusions Section comprises a summar', suggestions for

service 5ualit' improvements and directions for future research

! The novel fuzzy evaluation framework

2s mentioned 6efore, the devised evaluation frame3or4 includes fu!!' service 5ualit' evaluation

and anal'sis modules In Sections 6elo3, such modules are in detail descri6ed

2.1 Fuzzy service-quality evaluation module

Service 5ualit' perceptions and e9pectations are assessed under a fu!!' evaluation environment,

ta4ing into account the service aspects of the service 5ualit' structure (Hig -)

Fuzzy service quality evaluation

module

Service quality

analysis module

Hu!!' service 5ualit'

e9pectations

Hu!!' service 5ualit'

perceptions

Hu!!'

28P

Serv7ual

paradigm


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7

Hig -+ Service 5ualit' structure

In order to compute linguistic varia6les used to represent sta4eholders? perceptions and

e9pectations, several methods are availa6le in the literature *he method hereafter descri6ed is

commonl' adopted in the service 5ualit' evaluation field for its ease of use and effectiveness A.%,

.-, .B and, thus, is emplo'ed in this stud' In particular, 5ualit' perceptions are assessed using a

five@point linguistic scale parameteri!ed 6' *riangular Hu!!' Fum6ers (*HFs) A.=, .. In detail, the

mem6ership function of a *HF B~

is ( )xB~ + R A#, $ and it can 6e represented 6' the set of 05s

($), 3here lN mN u *he parameter mcorresponds to the ma9imum value of ( )xB~ , 3hereas l

and uare the lo3er and upper limits of the definition interval, respectivel' A./

=

otherwise

uxmformu

xu

mxlforlm

lx

x BBBB

B

BB

BB

B

B

0

)(~ ($)

Hig B sho3s the five@point fu!!'@linguistic scale utili!ed herein to assess perceptions

Kverall Customer

Satisfaction

Service Criteria

Service Items

Criterion $

(!$)

Criterionn

(!n)

Criterion%

(!%)

S"$,$

S"$,%O

O

S"$,m


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8

Hig B+ Hive@point fu!!' perceptions scale

7ualit' perceptions of sta4eholders are evaluated 6' the procedure reported 6elo3

Considering the generic kthservice criterion (k $, %, O, n), let ( )kikiki PPPki

umlP,,,

,,~

, = denote the *HF

3hich measures the aggregate perception characteri!ing its ithservice item (i $, %,O, !k) o6tained

via the arithmetic mean, as reported 6elo3+

( ) ( ) ( ), , , , , , , , ,

1 1 1

1 1 1; ;

i k i k j i k i k j i k i k j

J J J

P P P P P P

j j j

l l m m u uJ J J= = =

= = = (%)

3here ( ), , , , , ,

, ,i k j i k j i k jP P P

l m u denotes the *HF measuring the perception of the#thevaluator (# $, %,

O,$)

Hinall', the relative crisp perception can 6e o6tained 3ith reference to the confidence level %(%@

cut) A.., 3hich includes evaluators? uncertaint' over their :udgments, and the optimism degree&

on fu!!' results A.&, 6' the follo3ing relationship+

( )

[ ]

k

ki

Ci

nk

luPkiPkiP

...,,2,1

...,,2,1

1,0

1,,

,

=

=

+=

(-)

in 3hich,

#

#%

#B

#.

#&

$

$ % - B =

er' Poor

Poor

Good

er' Good

Medium


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9

)

( )[ ]1,0

,,,,

,,,,

+=

=

kiPkiPkiPkiP

kiPkikikiP

llml

muuu PP

(B)

2 larger %value is considered 3hen evaluators are confident in choosing a crisp value to represent

their :udgments, 3hereas &+ R A#, $ reflects evaluators? attitudes to3ards ris4 on fu!!'

assessment results A." 0valuators are inclined to prefer higher or lo3er crisp values, derived from

fu!!' assessments, according to 3hether the' are optimistic or pessimistic, respectivel'

Conversel', 28P is considered to assess e9pectations of sta4eholders on the healthcare service

5ualit' *he emplo'ed procedure is composed 6' the follo3ing fundamental steps+ i) pair3ise

comparisons of service aspects, ii) structuring of the fu!!' comparison matri9, iii) computing of fu!!'

e9pectations and, finall', iv) calculating crisp e9pectations Such steps are descri6ed 6elo3

i) *erms used to e9press the relative importance of each pair of service aspects, at the

same level of the service 5ualit' structure (Hig -), are 5uantified 6' *HFs Hig = sho3s

the fu!!'@linguistic importance scale adopted comprising *HFs (Hig =a) and their

reciprocal values (Hig =6)

#

#%

#B

#.

#&

$

$ % - B = . / & "

05uall' important Moderatel' more important

Strongl' more important er' strongl' more important

09tremel' more important

a+

b+


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10

Hig =+ Hu!!' importance scale (a) and relative reciprocal values (6)

ii) Considering the service criteria $, %, O, n, of the service 5ualit' structure, the fu!!'

comparison matri9 A~

is defined as+

=

1......~

............

~...1~~...~1

~

1,

,21,2

,12,1

n

n

n

a

aa

aa

A (=)

3here the generic termwkwkwk aaawk

umla,,,

,,~, = denotes the *HF measuring the relative importance

of the kth vs the 'thservice criterion Particularl',wkwkwk aaa

uml,,,

,, are the minimum value, most

plausi6le value and ma9imum value, respectivel', o6tained 6' aggregating evaluators? assessments

via the geometric mean A/#+

, , , , , , , , ,

1 1 1

1 1 1

, ,k w k w j k w k w j k w k w j

J J JJ J J

a a a a a a

j j j

l l m m u u= = =

= = =

(.)

3here ( ), , , , , ,

, ,k w j k w j k w ja a a

l m u indicates the *HF measuring the assessment e9pressed 6' the #th

evaluator (# $, %, O,$)

#

#%

#B

#.

#&

$

#$ #% #- #B #= #. #/ #& #" $


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11

iii) Hrom the fu!!' comparison matri9 A~

, fu!!' e9pectations are computed via the

logarithm least@s5uares method A/$, 3hich is selected herein for its effectiveness In

particular, the e9pectation level e9pressed in fu!!' form for the kthservice criterion kE~

,

can 6e o6tained as follo3s+

( ) nkumlEkkk EEEk

,..,2,1,,~

== (/)

in 3hich+

{ }umls

s

s

sn

k

nn

wi

a

nn

i

a

E

wk

wk

K,,

1

1

1

1

,

,

=

= =

= (&)

iv) *he related crisp e9pectation can 6e o6tained 3ith referring to the confidence level %

and the optimism degree&6' the follo3ing relationship+

( )

[ ]1,0

..,,2,1

1

=

+=

nk

luEkk EEk

(")

in 3hich,

( )

( )[ ]1,0

+=

=

kEkEkEkE

kEkkk

llml

muuu EEE

($#)

2lso in this case, the %inde9 reflects the degree of uncertaint' in choosing a crisp value, on the part

of the evaluators, to represent their :udgments and the&inde9 is considered to reflect evaluators?

attitudes to3ards ris4 on fu!!' assessment results


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12

Hinall', 6' follo3ing such a procedure, e9pectations of service items are o6tained 6' multipl'ing

their importance 3eights, 3hich can 6e o6tained via the a6ove descri6ed procedure, 6' the

e9pectation level of the related service criterion

2.2 Service quality analysis module

2s 6efore said, the healthcare service 5ualit' is herein anal'!ed 6' means of the Serv7ual paradigm

*he latter is 6ased on the e9pectations disconfirmation approach, also defined as disconfirmation

paradigm, to identif' dissatisf'ing service aspects and reasons of such dissatisfactions In particular,

3ith reference to the generic ithservice aspect, seven fundamental service discrepancies (ie gaps)

are defined+

(api$) represents the discrepanc' 6et3een 3hat customers actuall' 3ant and

3hat managers perceive customers to 3ant>

(api%) denotes the discrepanc' occurring 3hen managers fail to design service

standards that meet customers? e9pectations>

(api-) occurs 3hen the service deliver' s'stem, that is emplo'ees, technolog' and

processes, fails to deliver according to specified standards>

(apiB) occurs 3hen the communication to customers is misleading, promising

service 5ualit' levels unfulfilled 6' emplo'ees, technolog' and processes>

(api=) represents the discrepanc' 6et3een customers? perception (*i) and their

e9pectation (+i)>

(api.) indicates the difference 6et3een 3hat customers actuall' 3ant and 3hat

emplo'ees assume customers to 3ant>

(api/) e9presses the divergence 6et3een 3hat emplo'ees assume customers to

3ant and 3hat managers thin4 the' 3ant

2ccording to the Serv7ual paradigm, the (api= value represents a direct measure of customers?

satisfaction (!Si), that is+

iii EPCS = ($$)


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14

In response to the a6ove conte9t, three t'pes of evaluations are currentl' performed in the Sicilian

healthcare s'stem+

@ evaluations of technical and scientific 5ualit', performed 6' professionals and academics as

dictated 6' evidence@6ased medicine>E

@ evaluations of organi!ational 5ualit', mainl' performed 6' consultants, concerning

voluntar' accreditation and certification procedures>

@ evaluations of perceived healthcare 5ualit', according to a variet' of techni5ues (customers?

satisfaction, focus groups, civic audits, etc)

;ith reference to the latter, no3ada's in Sicil' sta4eholder perspectives on healthcare 5ualit' are

considered a necessar' and indispensa6le dimension to evaluate healthcare effectiveness

Currentl', surve's on perceived healthcare 5ualit' comprise the most numerous and significant

means of evaluation

Given the premises a6ove, an empirical evaluation stud' of service 5ualit' in the pu6lic healthcare

sector in Sicil' has 6een underta4en In particular, the investigation has 6een focused on " relevant

pu6lic hospitals, covering the entire Sicilian territor' and over -#Q of the healthcare demand,

namel' St Giovanni di Dio (2grigento), St 0lia (Caltanissetta), Canni!!aro (Catania), 0nna 8ospital

(0nna), St Martino (Messina), Di Cristina e Jenfratelli (Palermo),


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15

Hig .+ Kverall healthcare service 5ualit' structure

Su6se5uentl', in order to simplif' the 5uestionnaire to 6e adopted in the surve', this

comprehensive list of service 5ualit' aspects has 6een narro3ed do3n to a set of fundamental

healthcare aspects of services delivered in Sicil' In particular, the latter have 6een derived 6' using

Relationships

Healthcare staff

Support services

Accessibility

Tangibles Responsiveness

Stakeholder

satisfaction

26ilit' of doctors to

understand patients? needs>

26ilit' of nurses tounderstand patients? needs>

Capacit' to 3or4 as a team>

2ppearance of service

personnel>

Communication s4ills>

S3iftness of registration and

admission procedures>

2dministrative 5ualit'>

;aiting time for test results>

;aiting time for medical

records>

Kutpatient 3aiting time for

medical treatment>

Confidentialit' 6et3een

doctor and patient>

Confidentialit' among all

healthcare staff>

Cooperation and helpfulness

of administrative staff>

8umani!ation of

relationships>

7ualit' of food R 6everages

for patients>

Securit' 3ithin hospital>

Cleanliness of facilities and

premises>

Cleanliness of the restrooms>

entilation and h'giene on

the 3ard>

Gighting conditions on the

3ard>

Par4ing area for patients and

visitors>

Suita6ilit' of rooms forpatient>

Suita6ilit' of 3aiting area for

famil'visitors>

Procedures regarding in@patient services>

Hacilities for famil'visitors>

8ospital 3e6site>

2vaila6le information on

facilities>


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16

the Critical Cases method A/& after a consultation involving several healthcare service e9perts

(healthcare service managers, medical staff and nurses), academics and a limited num6er of

sta4eholders (in@patients, out@patients and their families) *he resulting fundamental healthcare

service 5ualit' structure is sho3n in Hig /

Hig /+ Hundamental structure of healthcare service 5ualit' in Sicil'

Such a fundamental structure 3as considered to perform the anal'sis reported 6elo3

.2 ealthcare service quality evaluation

*he surve' 3as conducted over a five@month period, 6et3een anuar' and Ma' of %#$B Hor each

considered hospital, a6out .# respondents 6et3een in@patients and out@patients, as 3ell a6out %#

among managers, doctors and nurses 3ere intervie3ed via internet 6' the 5uestionnaire form

reported in 2ppendi9 2 *otall', . 5uestionnaires 3ere selected for their completeness from

a6out /-# returned forms Moreover, for 6oth % and&indices a value of #= 3as assumed 7ualit'

perceptions and e9pectations for each esta6lished core service item 3ere calculated 6'

relationships (-) and ("), respectivel' Hig & summari!es the o6tained results


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17

Hig &+ 7ualit' perceptions and e9pectations of pu6lic healthcare in Sicil'

(% #=>& #=)

More in detail, for all the esta6lished service items, 5ualit' perceptions varied onl' slightl' 3ithin a

narro3 range (##=B> ##&-), 3hereas for 5ualit' e9pectations the degree of variation 3as

significantl' 6roader (##-.> #$%$), as sho3n in Hig & In particular, service items 3ith high

e9pectation levels 3ere S"$,$, S"$,%, S"$,-, S"%,$, and S"%,% Instead, the service items S"-,%,S"-,-, S"-,B, S"B,$,

S"B,%and S"B,-proved to 6e less important

. ealthcare service quality analysis

2s previousl' mentioned, the Serv7ual paradigm 3as herein adopted to anal'!e the healthcare

5ualit' *o this aim, sta4eholder satisfaction (!Si) for an' core service item 3as evaluated via the

corresponding relationship ($$) o6taining the results sho3n in Hig "

####

##-#

##.#

##"#

#$%#

#$=#

SI$,$

SI$,%

SI$,-

SI$,B

SI%,$

SI%,%

SI%,-

SI%,BSI-,$

SI-,%

SI-,-

SI-,B

SIB,$

SIB,%

SIB,-

: #erception

: &-pectation


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18

Hig "+ Sta4eholder satisfaction indices !Si

(% #=>& #=)

2s one can o6serve, service items 3hich points representative of their !Sifall 3ithin the red area

represent the dissatisf'ing service aspects *hus, S"$,$, S"$,%, S"$,-, andS"%,$represent those healthcare

aspects 3ith 3hich respondents 3ere strongl' dissatisfied Kn the contrar' S"%,B, S"-,%, S"-,-, S"-,B, S"B,$,

S"B,%, and S"B,-3ere considered ver' satisf'ing healthcare aspects

Hinall', perceptions of sta4eholder needs 3ere also collected from healthcare managers and staff

vie3points via 5uestionnaire to elicit the reasons underl'ing sta4eholder dissatisfaction and, thus,

the (apsi $ and . 3ere evaluated In detail, positive values of such discrepancies indicate an

underestimation of the related service aspects 6' healthcare managers and staff respectivel',

3hereas service aspects characteri!ed 6' negative values of such discrepancies are overestimated

Hig $# sho3s the o6tained values

@##.

@##B

@##%

#

##%

##B

##.

SI$,$

SI$,%

SI$,-

SI$,B

SI%,$

SI%,%

SI%,-

SI%,BSI-,$

SI-,%

SI-,-

SI-,B

SIB,$

SIB,%

SIB,-


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19

Hig $#+ (apsi$ and . values

(% #=>& #=)

*he results reveal that managers? perspectives on healthcare 5ualit' tend to overestimate service

aspects of the criterion !%and underestimate those of the service criteria!$and !- Kn the contrar',

importance of service aspects of the criterion !Bare correctl' understood 6' managers since the'

are characteri!ed 6' almost !ero (api$ values Hinall', according to staff vie3points, ver' important

service aspects are those relating to the criterion !$, service aspects of the criterion !B are

underestimated, 3hereas the criteria !%and !-are correctl' perceived

.! 'onclusions and su//estionsIn the present paper, the pu6lic healthcare sector of the Sicil'


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20

to 'ork as a team,/ility of doctors to understand patient needs, Staff relia/ility andS'iftness of

registration and admission procedures. Conversel', the o6tained discrepancies characteri!ing

managers? vie3points on service 5ualit' highlight that the importance of the service criteria

Responsiveness, ealthcare staffand Relationshipsis not correctl' perceived 6' them *hus, actions

should 6e primaril' focused on improvements in mar4eting researches, direct interactions 6et3een

managers and sta4eholders and 6ottom@up internal communications to correctl' understand 3hat

sta4eholders actuall' 3ant Hurthermore, effective internal communications of achievements in

service 5ualit' should reduce the discrepancies 6et3een sta4eholders? needs and ho3 staff perceive

those needs Huture research development 3ill regard the improvement of the herein adopted

assessment frame3or4 6' considering MCDM procedures to comparativel' evaluate the 5ualit' of

healthcare service alternatives

Acknowled/ments*he 2uthor than4s the t3o anon'mous referees for their remar4s, 3hich helped

to significantl' improve the paper


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21

(eferences

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%-(-) (%#$#) %#-T%%#

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Soft Computing\ %#$ Springer erlag, 8eidel6erg German' (%##.) %B/@%/B ISJF+ -@=B#@--=$.@

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Appendi- A

Healthcare staff 0C+ er' poor Poor Hair Good er' good

26ilit' of Doctors to understand patient needs

Capacit' to 3or4 as a team

Staff relia6ilit'

Staff availa6ilit'

Responsiveness 0C+

S3iftness of registration and admission procedures

2dministrative 5ualit'

;aiting time for tests results

;aiting time for medical records

Relationships 0C,+

Confidentialit' 6et3een doctor and patient

Confidentialit' 6et3een all healthcare staff

Cooperation and helpfulness of administrative staff

8umani!ation of relationships

Support services 0C.+

7ualit' of food R 6everage for patients

Securit' 3ithin hospital

Cleanliness of facilities and premises

*a6le 2$+ 7uestionnaire form to collect perceptions of healthcare service


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Please, mar4 in the 5uestionnaire form reported 6elo3 the letters related to 'our :udgments+

%ow important is:

8ealthcare staff


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Appl. Soft Comput. J. (2015), http://dx.doi.org/10.1016/j.asoc.2015.12.010. (IN PRESS)': ery strongly important b: Strongly less important

2: Strongly important c: ery strongly less important

A: oderately important d: +0tremely less important

3: +qually important

*a6le 2%+ 7uestionnaire form to collect e9pectations of healthcare service

A Fuzzy Framework to Evaluate Service Quality in the Healthcare Industry

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