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Questionnaire

I, Rina Dave, Lecturer in commerce and Management , am undergoing research work on


Private Health sector of Gujarat. Kindly answer the following questions for the same purpose.
The information furnished by the respondent will be kept confidential and will be used for the
academic purpose.
1.

Name of the Hospital .....................................................................................................

2.

Name of the Patient

3.

Suffering from (Ailment) ...............................................................................................

4.

Coming from (Place) .......................................................................................................

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

1. Who makes the decision of choosing the hospital?


Self ______________

Spouse________________

Joint________________

Family ________________

2. How did you come to know about hospital? (Please put  )


1. Advertisement
2. Family
3.

Friends

4. Recommended by family doctors


5. Any other
3. Is this your first visit to Hospital ?
1. Yes

2. No

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4. Following are the factors influencing the selection of the hospital [Rate the factors as
per your preference on a scale of 1 to 5.
Factors

Least

Most

preferred

Preferred

Doctors of the hospital are qualified.


Doctors are experienced.
Reputation of the hospital.
The hospital has facilities. (Equipment,
Infrastructure etc.)
The hospital is recommendation by others.
The doctors give proper

guidance and

diagnosis .
The hospital has good ambience.
The hospital gives extra facilities like
canteen ,pharmacy store and phone is easily
available.
The hospital is located in nearby area.
The

hospital

has

excellent

Troma/

Emergency services.
The hospital is recommended by other
doctors.
The hospital provide facilities to patients
like rooms, stretchers ,wheelchair ,food.
The doctors of the hospital give accurate
and true information every time.
The hospital gives one click access facilities
(Laboratory for tests are available in
hospital) is being provided by the hospital.
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The hospital gives food and accommodation


to the patients relative.
The hospital is neat and tidy.
The hospital offers easy payment system.

5. Prioritize the following objectives of patient in order of their importance[Rank them


in order of 1 to 3 . give rank 1 to most important objective and 3 to least important
objective]
I want the best treatment

I want to have clean and hygienic place

I want perfect diagnosis

6. Based on your experience as a customer of private hospital , think about the kind of
Hospital that would deliver excellent quality of services. Please show the extent to which
you think that a Hospital should possess the features described . If you strongly agree
that Hospitals should possess please circle 5. If you strongly disagree that Hospitals
should possess the feature, then circle on 1 .If your views are not strong circle one of the
number in the middle.
Sr.

Strongly

Strongly

no

Disagree

Agree

1
1

Excellent hospital will have modern looking


equipment.

Excellent

hospital

will

have

visually

appealing physical facilities.


3

Excellent hospital will have dressed hospital


staff

Excellent hospital will be clean and tidy


hospitals.

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Excellent hospital will have sufficient number


of Operation theaters.

Excellent hospital will be at appropriate


location.

When patient has problem the excellent


hospital staff will show interest in solving
patients problems.

Excellent hospital gives timely services


without delay.

Excellent will maintain error free records.

10

Excellent hospital doctors Willing to help


customers.

11

Excellent hospital staff never show too busy


to respond. patients request.

12

Excellent hospital staff will build confidence.

13

The staff of excellent hospital will be


courteous and polite .

14

Excellent hospital staff has knowledge to


answer patients problems.

15

Excellent hospital will make patients feeling


safe and secure.

16

Excellent hospital nurses will give individual


attention.

17

Excellent hospital will have convenient


operating hours.

18

Excellent hospital will under stands patients


specific needs.

19

Excellent

hospital will make information

available and clear .


20

Excellent hospital will offer variety of


services under one roof.

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21

Excellent hospital will provide exact and


reliable information of the patients from time
to time.

22

Excellent hospitals Visitors hours will be


convenient.

23

The attitude of excellent hospitals front line


staff will be courteous.

7. Listed below are five features pertaining to hospitals and the service they offer. We
would like to know how important each of these features is to you when you evaluate the
service offered by a hospital. Please allocate a total of 100 points among the five features
according to how important each feature is to you - the more important a feature is to you,
the more points you should allocate to it. Please ensure that the points you allocate to the five
features add up to 100.
1.

The appearance of the hospitals physical facilities,


equipment, personnel and communication materials.

2.

The hospitals ability to perform the promised service


dependably and accurately.

3.

_____ points

The hospital is willingness to help patients and provide


a prompt service.

4.

_____ points

The knowledge and courtesy of the hospital personnel


and their ability to convey trust and confidence.

5.

_____ points

_____ points

The caring, individualised attention the hospital


provides to its patients.

_____ points

TOTAL points allocated

100

points

8. The following statements are related to your feelings about the hospital whose
services you have taken. Show the extent to which you think that the hospital has
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features described by each statement below. The scoring system is if you strongly agree
that hospitals should possess the feature please circle 5. If you strongly disagree that
Hospitals should possess the feature, then circle on 1 .If your views are not strong circle
any one between 2 to 4.
Sr.

Strongly

Strongly

no

Disagree

Agree

1
1

Hospital has modern looking equipment.

Hospital has visually appealing physical


facilities.

The personnel in the hospital are neat in


appearance.

Hospital has well dressed up staff.

Hospital has sufficient number of


operation theaters.

Hospital is at the appropriate location.

When patient has problem hospital staff


show

interest in solving patients

problems
8

Hospital staff gives services at a time


when they promise to do so.

Hospital insists error free records.

10

Hospital doctors are Willing to help


customers.

11

Hospital staff never show too busy to


respond patients request.

12

Hospital staff build confidence in


patients.

13

The staff of hospital is courteous and


polite .

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14

Hospital staff has knowledge to answer


patients problems

15

Hospital doctors has made patients


feeling safe and secure

16

Hospital nurses gives individual


attention to the patient.

17

Operating hours of the hospital is


convenient..

18

Hospital staff and doctors understand


patients specific needs.

19

Hospital makes all the required


information clear and available.

20

The hospital offers all allied services


under one roof.

21

Hospital provides exact and reliable


information of the patients from time to
time.

22

Hospitals Visitors hours are


convenient.

23

The attitude of the front line staff is


courteous.

9. Following are the factors which shows your loyalty for the hospital which you have
selected [Rate the factors from highly satisfied 5 to highly dissatisfied.]
Sr.

Strongly

Strongly

no

Disagree

Agree

1
1

I will come back to this hospital for sure


if needed.

I will never switch to other hospital for


the same problem.

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I would recommend the same to others


for the same purpose.

Demographic Profile:
Sex

Male 

Female 

Marital Status

Married

Unmarried

31 yrs- 40 yrs 

Age:

21 yrs- 30 yrs
41 yrs- 50 yrs 

51 yrs- 60 yrs 

61 and above 
Educational qualification: H.S.C. 


Post graduate

Graduate

Professional Degree

Others (please specify.....................)


Occupation

Agriculture

Govt. Employee 
House Wife

Business
Pvt. Employee 

Unemployed 

Self-employed

Other (please specify.......................

Monthly Family Income:


Rs. 10,000- Rs. 20,000/- 

Rs. 20,0001- Rs. 30,000/- 

Rs. 30,001- Rs. 50,000/- 

Rs. 50,0001 -100000

Rs.100001-200001

Rs.200000 and above

Thank You

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