Service Quality in Private Hospitals in Delhi NCR : A SERVQUAL Analysis
Sharad Khattar, Associate Professor, Amity International Business School, Amity
University, Noida
Prof. (Dr.) Gurinder Singh, Group Vice Chancellor, Amity Universities, Director
General, Amity International Business School
Abstract
The service industry in the recent two decades has gone through an un-precedent
change. Because of the vast competition in nearly all the various different service
industries the focus has shifted to the customer who rules and decides the success
of any service organization. Health care industry has also been affected in a similar
way. In India, the main stay of this industry is the hospitals which are either under
the government control or in private hands. Delhi NCR with population of over 46
million has a number of world class hospitals both in the government and private
control. With positive policies on medical tourism, these hospitals also cater for
patients from neighboring countries and countries from South East Asia, Middle
East and Africa. Healthcare businesses to gain a competitive advantage, aim to
build a long term relationship with its patients. This translated means ensuring
customer satisfaction and loyalty with the services provided to ensure repeat use
of the service. SERVQUAL model as advocated by Parsuraman , Zeithamal and
Berry (1988) which measures the service expectations and perceptions to evaluate
the perceived service quality has been used to determine the service quality in
hospitals of Delhi National Capital Region (NCR).
International Journal of Pure and Applied MathematicsVolume 119 No. 17 2018, 727-752ISSN: 1314-3395 (on-line version)url: http://www.acadpubl.eu/hub/Special Issue http://www.acadpubl.eu/hub/
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Keywords: SERVQUAL, healthcare, service quality, customer satisfaction
1. Introduction
The well-being and health of people is one of the most important aspects of life
and society. The need and the demand for health related services have seen
tremendous growth in past years. The World Health Organization (WHO, 1948 )
has given the definition of health as: “a state of complete physical, psychological
and social well-being and not the absence of disease”.
That‟s not just all to what health really is, instead health is a broader concept and
can also constitute to other things. Health in the marketing perspective clearly
means to identify and seek to meet people who are healthy and not only to that but
also to continue and want to keep on being healthy. Health marketing is equally
essential in many ways: It is global and competitive, societal in nature and
overflowing with regulations.
The application and aspects of health care are different in all the countries and
this basically depends upon the socio-economic and political forces of the country
and the society. There are basically there broad categories of provisions: First,
there are countries in which the state provides the finance, provision and
administration of services but there are private interests in the form of individual
practice, hospitals and other supportive services. Second, there are countries where
the state is the one that provides medical care and no private hospital provides such
services. Third, there are countries which completely rely on the market for the
availability of services.
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2. Healthcare in India since Independence
One of the earliest policies related to health services at the time of independence
of the country was the resolutions of the National Planning Committee on the
report of the Sub-Committee on National Health. It envisaged setting up of a
Health organization giving a broad idea of the organization at various levels that is
at state and district level. In addition they recommended the enactment of
consolidated public health acts by the Central and Provincial Legislatures. The
Bhore committee of 1946 known as Health survey and Development committee
laid emphasis on curative and preventive medicines at all levels. It made
recommendations of remodeling of health services in India. It emphasized the
organizational aspect, the development of health centres and the way ahead of
medical education.
The Government of India has in last so many years since independence drafted a
number of policies related to health services in India. Two such policies drafted in
year 1983 and 2002 as part of five year plans served fairly well. After 2002
because of changes in the context of how health services are looked at; namely
change in health priorities , emergence of health care industry with private players
, increasing cost of availing health services and rising economic growth has given
inputs for formulation of a new Health Policy of 2017.
The primary aim of the National Health Policy (NHP), 2017, is to inform,
clarify, strengthen and prioritize the role of the Government in shaping health
systems in all its dimensions - investments in health, organization of healthcare
services, prevention of diseases and promotion of good health through cross
sectoral actions, access to technologies, developing human resources, encouraging
International Journal of Pure and Applied Mathematics Special Issue
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medical pluralism, building knowledge base, developing better financial protection
strategies, strengthening regulation and health assurance.
NHP 2017 builds on the progress made since the last NHP 2002. The
developments have been captured in the document “Backdrop to National Health
Policy 2017 - Situation Analyses”, Ministry of Health & Family Welfare,
Government of India.
The Health Policy also gives importance to AYUSH systems of healthcare –
Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy. A separate
department of Indian system of Medicines and Homeopathy was established in
1985 to promote its development. Aim is to promote Indian and other traditional
systems of medicine in modern healthcare.
Healthcare industry in India is witnessing an immense growth. The growth is
very rapid in terms of revenues. It is also providing substantial opportunities in
terms of employment. Healthcare industry comprises mainly of the hospitals,
medical investigations, medical insurance, medical tourism and the related
equipment. The manpower comprises of doctors, nursing staff, technicians and
support staff. The total industry size is expected to touch USD160 billion by end of
2017 & USD280 billion by 2020. In India the categorization of medical services
can be done in two categories; Public and Private.
Growth drivers of this industry are
Increasing health awareness and disposal incomes.
Increasing penetration of health insurance.
Increasing ageing population in India.
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Exponential growth in medical tourism.
The public health care system is not capable of taking care of entire population
of the country. This aspect has given a fillip to the development of private hospitals
in India. It has become the dominant sector of the two and almost 80 % of the total
spending comes from this sector. Some of the major players in India are Apollo
Hospitals and Escorts Group, Fortis healthcare, Max healthcare, Wockhardt and
Manipal Health Systems.
4. Healthcare in Delhi NCR
The Delhi government has a separate ministry known as Ministry of Health and
Family Welfare responsible for health care of citizens under its jurisdiction.
Hospitals form part as an integral unit in administering health care services. The
Delhi government has about 38 government hospitals under it
(.http://www.delhi.gov.in/wps/wcm/connect/doit_health/Health/Home/Hospitals/).
Besides these, hospitals under the Central government like the All India Institute of
Medical Sciences (AIIMS), Safdarjung Hospital, Deen Dayal Upadhyay Hospital ,
New Delhi , Ram Manohar Lohia Hospital, New Delhi , are some of the important
and well known hospitals in Delhi NCR.
There are a large number of private hospitals in Delhi NCR .The private
hospitals in Delhi are either of multi-specialty types – Apollo Hospitals, Vedanta
Hospitals, Max Health care Hospitals, Fortis Hospitals or they are of super
specialization types – Centre for Sight Hospitals for eye , RG stone Clinic for
Urology and related medical ailments.
Some of these private hospitals in Delhi NCR are world class; besides catering
to local patients attract a number of patients from neighboring countries like
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Pakistan, Afghanistan, Nepal, and the Middle East countries. Besides patients also
come form Europe and North America.
The healthcare services in Delhi NCR are therefore a mix of both public and
private hospitals which caters for the populations residing in Delhi and neighboring
cities like Gurgaon, Noida, Faridabad, Noida and Ghaziabad which constitute the
Delhi NCR region.
5. Service Quality.
Quality is an important part of our lives in each and every aspect. People and
consumer keep looking for the quality of services and products that they consume.
Due to these changing demands, quality has become an extremely important factor
to be considered by the product and services provider both in terms of production
and delivery. Quality is what provides the competitive advantage to the service
provider. Paying attention to quality by improving it, results in reducing waste,
rework, delays, lower costs, higher market share, and brand image which
ultimately leads to productivity and profits. That is why, it is very important to
define, measure and improve quality of healthcare services.
Definitions of Quality, due its nature and intangible characteristics; vary
depending on whose perspective is taken and within which context it is considered.
No single universally accepted definition exists. Quality, therefore, has been
defined in most simplest of terms as „ the degree of excellence of something‟.
Researchers have conceptualized service quality in two different ways. The first
is the Nordic perspective proposed by Gronoos, 1982, 1984. The service quality
dimensions are defined in terms of functional and technical quality. These
dimensions were found to be generically applicable to all services. While the
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technical aspect deals with „what‟ is provided by the service and the functional
aspect deals with „how‟ the service is provided.
The second perspective is the American perspective. This perspective brings
out the abstractness and the elusive nature of this construct on account of three
unique factors which are intangibility, heterogeneity and inseparability of
production and consumption of the nature of the service (Parsuraman, Zeithaml
and Berry 1985). Parsuraman et, al., 1985, differentiates perceived quality and
objective quality. The former being a customer‟s judgement about an entity‟s
overall excellence and the latter being a form of the attitude.
It is generally agreed that service quality is a higher order construct and is
multidimensional in nature (Grönroos, 1984; Parasuraman, Zeithaml, & Berry,
1995).
Definition as proposed by Hung, Huang & Chen 2003, „the degree to which an
event or experience meets an individual‟s needs or expectations‟, is consistent with
that of Parasuraman, Zeithaml & Berry, 1988.
As per Morrison-Coulthard , 2004, the key performance metrics in many a service
organizations are perception of quality by a customer and their satisfaction.
The service quality model as conceptualized by Parasuraman, Zeithaml, & Berry
, 1985, concurred on the fact that service quality is a comparison between the
expectation and performance of the service. There are a number of gaps which
have been identified and these are highlighted in subsequent paragraphs.
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The Service Quality model has a total of five gaps
Gap1. This gap is about the fact that management is not always correct in
understanding the exact nature of requirement of the customer wants.
Gap 2. This gap is on account of inability on part of management to ensure
provision of standards to customers having understood their needs.
Gap 3. This gap is on account of inability of the service personnel to provide the
service as per laid down quality standards because of poor training, lack of
education etc.
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Gap 4. This gap is on account of the customer‟s expectations getting affected by
external communication i.e., advertisements word of mouth etc.
Gap 5. Perceived service quality is defined in the model as the difference between
customer expectations and perceptions. This gap is termed as gap 5, which depends
on the size and direction of the four gaps associated with the delivery of service
quality on the marketer‟s side.
This paper offers insights in to consumers‟ perception on service quality.
6. SERVQUAL Model
Parasuraman, Zeithaml and Berry, 1988, developed a SERVQUAL model which
could be used across a number of services for evaluating the service quality. The
SERVQUAL is a concise multiple item scale with good reliability and validity that
can be used to better understand the service expectations and perceptions of
consumers and, as a result, improve service. Parasuraman et al., suggest five-
dimension framework of service quality that encompasses tangibles, reliability,
responsiveness, assurance and empathy to analyze service quality with a total of 22
items as part of these dimensions. This resulted from an initial 10 dimensions
having 97 items. This 97 item instrument was refined with a single aim of
developing a concise instrument which would be reliable and meaningful in
assessing in a variety of service applications. This is a tool that finds applicability
across wide range of services. It is basic framework through the expectation –
perception format that encompasses the five service dimensions.
The five dimension having 22 items is often referred to as RATER Model.
The RATER refers to service quality dimensions such as Reliability, Assurance,
Tangibility, Empathy and Responsiveness. The concise definitions as suggested by
this paper are Tangible: Physical facilities, equipment, and appearance of
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personnel. Reliability: Ability to perform the promised service dependably and
accurately. Responsiveness: Willingness to help customers and provide prompt
service. Assurance: Knowledge and courtesy of employees and their ability to
inspire trust and confidence. Empathy: Caring, individualized attention the firm
provides its customers.
Further amplifying the meaning of these dimensions.
Reliability refers to a providers‟ ability to perform the promised service
dependably and accurately. Perceptions of reliability are also lessened with doctors
who do not provide correct treatment at the first time (accusation that doctors
recommend unnecessary medical tests, irregular supervision of patients by care
providers and specialists are unavailable). Patients expect hospital staff to respond
promptly when needed. It is the willingness and promptness of responding to the
patients. They also expect the experts and required equipment to be available,
functional and able to provide quick diagnoses of diseases.
Assurance is the knowledge, skill and courtesy of the service provider that
inspire trust and confidence in consumers‟ mind. In the health care setting,
assurance is reflected by competencies of diagnosis, skills to interpret laboratory
report, provide appropriate explanations to queries. Well-trained nurses and other
support staffs also play vital roles in providing support to patients‟ feelings of
assurance and safety.
Tangibility is the attribute of being easily detectable with the senses. Appearance
(tangibility) of the physical facilities, equipment, personnel and written materials
affects patients‟ satisfaction. A systematized, ordered and clean appearance of
hospital premises, restrooms, equipment, wards, beds and the whole construction
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or infrastructure can influence patients‟ impressions about the hospital. Tangibles
are the physicals representations of intangible service that create the image in
customer‟s mind.
Empathy represents the sympathy of service provider. Health care providers‟
should have sympathy and understanding of customers‟ wants and expectations.
This is the factor to provide individualized care and attention to customers.
Generally, a good customer/employee relationship can be established when the
employee understands the personal needs and values of the customer.
The tool is also usable along each of the five service dimensions by averaging
the difference scores on items making up the dimension. It is also able to give an
idea on overall measure of service quality in form of an average score across all
five dimensions. It also is able to determine the relative importance of the five
dimensions in influencing customer‟s overall quality perceptions .
The SERVQUAL model has also its demerits and concerns (Asubonteng,
McCleary, & Swan, 1996; Buttle ,1996 ; )
7. Patient’s Satisfaction
Satisfaction is basically when the expectations of a person are met and the needs
that were arising in a human are also fulfilled. In a hospital if the patients‟
expectations about the treatment are fulfilled he is satisfied but if they are not then
he is dissatisfied. Everyone‟s main objective today is to satisfy its own customer to
sustain and to grow. Patients that are highly satisfied create a very personal
connect with the healthcare providers. Satisfaction is a complex area to understand
because it is personal area of thought and emotions.
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Also the patients‟ judge the significant indicators of the quality of care,
accuracy of diagnoses and the effectiveness of treatment. So satisfaction could
broadly means the ability to identify what a person wants and then giving it to that
person.
Patients or the customer satisfaction has been defined as „the customer‟s overall
feeling of contentment with a customer interaction‟ (Harris, 2010).
In many countries today, the healthcare management sector, places a lot of
emphasis on patient satisfaction. Evidence can be found from the frequency of
observed recent academic publications related to satisfaction. Furthermore, surveys
about patient satisfaction have used some data as dependent variables to evaluate
SERVQUAL on the assumption that patient satisfaction depends on the structure,
process and outcome of care available at the time of delivery.
Many different scales are used to measure patient‟s satisfaction. All these scales
differentiate by using different dimensions. Zyzanski , Hulka and Cassel ,1974,
used dimensions such as professional competence , personal qualities and cost /
convenience. Baker,1990, focused on three dimensions ; professional care, depth
of relationship and perceived time. Reidenbach , Sandifer – Smallwood (1990)
made use of seven dimensions for evaluating customer‟s satisfaction . These were
patient confidence, business competence, treatment quality, support services,
physical appearance, waiting time and empathy. Some studies use qualitative
methods to analyze hospitals. Examples of this are Structural Equation Modelling
used by Marley, K. A., Collier, D.A., and Goldstein, S.M., 2004; and by Doughlas
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& Fredendall, 2004. Strong Advocates of SERVQUAL model are Asubonteng,
McCleary, and Swan, 1996.
Service Quality also contributes towards the aspect of customer satisfaction as
indicated in these papers. (Bolton & Drew, 1991; Carman, J., 1990.; Mosahab, R.,
Mahamad, O., & Ramayah, T., 2010. ).
Churchill & Suprenant, 1982, have concluded that service quality is one of the
most important contributors towards customer satisfaction . This is ably supported
by Kettinger & Lee, 1994.
8. Objectives of the Research paper
Objective
The main objective of this research paper is to analyze the Service Quality in
Private Hospitals in Delhi NCR using the SERVQUAL instrument.
Methodology
Research Methodology can be defined as s scientific way to analyze a research
problem and draw meaningful conclusions. The information has been got by
administering a questionnaire to those people who have availed of the private
hospitals services as a patient. In case of patients who were unable to fill the
questionnaire on account of any constraint say unable to understand on account of
age, language etc.; help of personnel accompanying the patient was taken. A total
of 300 questionnaires were distributed and a total of 228 patients responded.
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Sampling and Data Collection Method.
The questionnaire was distributed to only those people who have availed the
services of private hospitals in Delhi NCR. A self-administered questionnaire was
used for this. The questionnaire was divided into two parts. The first part consisted
of 23 questions for the expectations of the patients from the hospital they are likely
to use the services. These 23 questions were divided under 5 dimensions with 6
items part of Tangible dimension, 4 items part of Reliability dimension, 5 items
part of Responsive dimension, 4 items part of Assurance dimension and 4 items
part of Empathy dimension. The second part consisted of similar questions
differently worded for the perceptions of the patients based on the experience after
availing the services in the hospitals. Each question was assessed on a 5 point
Likert scale.
Questionnaire Statements for Patient‟s
S.
No.
Statement for Patient‟s Expectation
of Service Quality
Statement of Patient‟s Perception
of service Quality
Tangible Dimension Tangible Dimension
1 Hospitals to be equipped with best
and latest modern equipment
Hospital has the best and latest
modern equipment
2 Hospitals to have good aesthetics
and customer friendly environment
Hospital has good aesthetics and
customer friendly environment
3 Hospitals to have smartly dressed
staff at all such places where
patients contact them
Hospital has smartly dressed staff
at all such places where patients
contact them
4 Hospitals to give maximum Hospital gives maximum priority
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priority to cleanliness and tidiness to cleanliness and tidiness
5 Hospitals to have adequate number
of medical facilities like MRI , CT
scan, OT‟s etc
Hospitals has adequate number of
medical facilities like MRI , CT
scan, OT‟s etc
6 Hospital is to be located at a
convenient place
Hospital is located at a
convenient place
Reliability Dimension Reliability Dimension
7 Hospital staff is concerned about
your wellbeing and not only do lip
service.
Hospital staff is concerned about
your wellbeing and not only does
lip service.
8 Hospital services are to be rendered
within the acceptable time limits
Hospital services are rendered
within the acceptable time limits
9 Documentation and record keeping
is integral to good practices by the
hospital
Good Documentation and record
keeping is practiced by the
hospital
10 Information about any aspect of the
hospital e.g., treatment, facility,
financial is to be made available
and in clear terms
Information about any aspect of
the hospital e.g., treatment,
facility, financial is made
available in clear terms
Responsive Dimension Responsive Dimension
11 Doctors are more than willing to
help the patients in the hospital
Doctors are more than willing to
help the patients in the hospital
12 Responsiveness to patient‟s needs
is an important trait of employees
of the hospital
Employees are responsiveness to
patient‟s needs
13 The staff of the hospital is The staff of the hospital is
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knowledgeable in aspects related to
patient‟s queries
knowledgeable to answer
patient‟s queries
14 Hospital operating hours are
convenient to patients
Hospital operating hours are
convenient to patients
15 The hospital on its own will
provide accurate and reliable
information of the patient
whenever asked for
The hospital provides accurate
and reliable information of the
patient
Assurance Dimension Assurance Dimension
16 Interacting with hospitals staff
builds confidence in patients
Hospitals staff instills confidence
in patients
17 The employees and staff of the
hospital are polite and courteous
The employees and staff of the
hospital are consistently polite
and courteous with you
18 Patients feel safe and secure at the
hospital
Patients feel safe and secure at the
hospital
19 The doctors and nurses give
individual attention to patients
The patient gets individual
attention from the doctors and
nurses
Empathy Dimension Empathy Dimension
20 Every specific and individual need
is understood by the hospital staff
The hospital staff understand‟ s
every specific and individual
needs of the patients
21 All possible medical services are
available within the hospital
All possible medical services are
available within the hospital
22 Visiting hours are convenient for Visiting hours are convenient for
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the visitors the visitors
23 The front line staff of the hospitals
are courteous
The attitude of the front line staff
of the hospital is courteous
Demographic Analysis
Table No 1
S .
No.
Demographic
Aspect
Numbers Percentage
1 Gender Male 126 55.3%
Female 102 44.7%
2 Age Below 25 yrs 24 10.5%
25-50 yrs 78 34.3%
50-75 yrs 88 38.5%
Above 75 yrs 38 16.7%
3 Educational
qualifications
Primary level 34 14.9%
Senior
Secondary level
45 19.7%
Graduation 87 38.2%
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Post-Graduation
and above
62 27.2%
4 Marital status Married 211 92.5%
Unmarried 17 7.5%
5 Occupation Unemployed/
dependent
16 7.1%
Business 67 29.3%
Agriculture 23 10.1%
Private Service 77 33.8%
Government
Service
45 19.7%
6 Income Levels
of family
(monthly)
Rs 10,000 and
below
15 6.6%
Rs 10,001-Rs
25,000
46 20.2%
Rs 25,001- Rs
50,000
43 18.8%
Rs 50,001 and
above
124 54.4%
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744
Findings and Analysis
The questionnaire was self-administered and received back. From a total of 300
questionnaires given to the patients, 228 responded. Out of these 126 (55.3%) were
males and 102 (44.7%) were females. As far the age demographics, 24 (10.5%)
patients were below 25 years of age, 78 ( 34.3%) were between 25 and 50 years ,88
(38.5 %) were between 50 and 75 years of age and 38 (16.7%) were above 75
years of age. Regarding the educational qualifications of the patients 34 (14.9%)
studied till the primary level, 45 (19.7%) patients studied till the Secondary level,
87 (38.2 %) were graduates and 62 (27.2%) were post graduates and above.
Regarding the marital status 211 (92.5%) were married and 17 (7.5%) unmarried.
As regards occupation of the patients, 16 (7.15%) were either unemployed or
dependents, 67 (29.3%) had their businesses, 23 (10.1%) were having profession in
agriculture related areas, 77(33.8%) were employed in private service, and 45
(19.7%) were government employees. Regarding the income level of the patients
15 (6.6%) had monthly family income less than Rs 10,000/-, 46 (20.2%) patients
had their income level between Rs 10,000/- and Rs 25,000/-, 43 (18.8%) has
income levels between Rs 25,000/- and Rs 50,000/- and 124 (54.5%) patients
earned over Rs 50,000/-.
Score on Expectation / Perception on Various Dimensions
S. No. Dimensions of
Service Quality
Service
Expectation
(SE)
Service
Perception
(SP)
Service gap
(SE-SP)
1 Tangible 4.27 4.29 0.02
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2 Reliability 4.15 4.25 0.10
3 Responsiveness 4.27 4.23 -0.04
4 Assurance 4.09 4.15 0.06
5 Empathy 4.12 4.09 -0.03
Average 4.18 4. 20
The widest positive gaps in the order of decreasing values are „Reliability‟
(0.10), „Assurance‟ (0.06), and „Tangible‟ (0.02). However in case of
„Responsiveness‟ and „Empathy‟, both have a negative gap of -0.04 and -0.03
respectively. These results bring out fact that patients are very optimistic as regards
dimensions of reliability, assurance and tangibility. In all these three cases the
service expectations exceed the service perceptions though in case of tangible the
difference in very minimal (0.02). As regards the dimension of responsiveness and
empathy is concerned the patient‟s expectations exceed their perception and get
much less than what they expect. The responsiveness dimension is related to
willingness of doctors to help, responsiveness to patient‟s needs, knowledge of
staff, convenience of operating hours for patients and providing of reliable and
accurate information to patient‟s whenever needed. The empathy dimension is
related to understanding of patient‟s needs by the hospital staff, availability of
medical services within the hospital, convenience of visiting hours by the visitors
and courtesy shown by front line staff. The negative service gap in case of these
two dimensions can negatively impact the customer satisfaction.
International Journal of Pure and Applied Mathematics Special Issue
746
The management should pay additional attention to the dimensions of
responsiveness and empathy by analyzing the reasons for the gap between the
expectation and perception in order to further increase the customer satisfaction.
While the positive service gaps in other three dimensions are very assuring to the
management regarding their policies, procedures and steps taken in private
hospitals towards patient care including the fact that the average score of
perception (4.20) is greater than the expectation score (4.18); they should look into
those areas where further improvement can be undertaken to give a „wow‟ feeling
to its patients. The government policy regarding impetus to medical tourism has
been very encouraging in the recent past. The hospitals in Delhi NCR already
attract a sizeable number of patients from neighboring countries, countries of the
Middle East ,African countries and also from Europe and North America. It
therefore becomes all the more important for the hospitals to ensure that all factors
contributing towards higher levels of service quality are given the desired
importance.
Conclusion
The service industry worldwide has undergone a sea change in the last 20 years.
The healthcare industry would by 2020 be an US $8.7 trillion industry worldwide.
In India this industry would be worth US $ 280 billion by 2020. The main stay of
the industry are the private hospitals which have mushroomed all over India in the
past. The hospitals initially in the domain of the government control have now seen
entry of the big private players. Delhi NCR home to a vast population is catered for
by these hospitals. For gaining completive advantage it is therefore a must to
ensure that the patients who are the customers, are satisfied with services
rendered. SERVQUAL model is one of the tools to measure the gap between
expectations and perceptions to arrive at perceived service quality measure. The
International Journal of Pure and Applied Mathematics Special Issue
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private hospitals in Delhi NCR score well in three dimensions of service quality
namely reliability, assurance and tangibility. However in the dimension of
responsiveness and empathy the score is negative. The management should study
this aspect and take measures to overcome any shortcomings.
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