International Journal of Health Care Quality Assurance

College clinic service quality and patient satisfaction

Pankaj Deshwal Vini Ranjan Geetika Mittal
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International Journal of Health Care Quality Assurance, Vol. 27 Iss 6 pp. 519 - 530
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Service quality
College clinic service quality and and patient
patient satisfaction satisfaction
Pankaj Deshwal
Management Division, Netaji Subash Institute of Technology,
New Delhi, India, and
519
Vini Ranjan and Geetika Mittal Received 18 August 2012
Electronics & Communication Division, Netaji Subash Institute of Technology, Revised 13 June 2013
Accepted 10 January 2014
New Delhi, India

Abstract
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Purpose The purpose of this paper is to identify the service quality dimensions that play an
important role in patient satisfaction in campus clinics in Delhi; assess student satisfaction with
service; and suggests ways to improve areas of dissatisfaction.
Design/methodology/approach A questionnaire was distributed to students who had completed
at least two consultations at the college clinic. Convenience sampling was used to approach
respondents. The questionnaire uses modified SERVQUAL and other instruments, including original
dimensions and those constructed through detailed discussions. Factor analyses, reliability tests
and the Kaiser-Meyer-Olkin measure of sampling adequacy were conducted. The final sample had a
total of 445 respondents.
Findings After factor analysis, the authors found that the dimensions affecting patient satisfaction
are: staff professionalism; clinic staff reliability; clinic accessibility and basic facilities; tangibles;
cleanliness; awareness of the clinic/diseases and how clinic staff deals with emergencies. Most
students were satisfied with the professionalism of the clinic staff. More than 70 percent of the
respondents reported that the clinic staff paid good attention to them. The campus clinic was deemed
reliable by more than 50 percent of respondents. The students found the clinics location convenient,
with more than 50 percent supporting its location. However, there was dissatisfaction among the
students regarding the tangibles of the clinic, with more than 50 percent favoring upgrading. There
was satisfaction among the respondents regarding the availability of the doctor after clinic hours, but
contact details for the clinic staff were not easily accessible on campus. More than 60 percent of
respondents were satisfied with the cleanliness of the campus clinic. More than 50 percent felt that the
campus clinic was not equipped to deal with emergencies efficiently. At the same time, 90 percent of
respondents reported the availability of referral facilities in case of emergencies.
Originality/value The authors believe that this is the first study conducted to assess patient
satisfaction in the campus clinics of engineering institutes in Delhi region. This paper provides
valuable information to college clinic administrators.
Keywords Satisfaction, Service quality, Students, Questionnaires, Clinics, Patients
Paper type Research paper

Introduction
Indian healthcareis a US$65 billion industry and expected to reachUS$100 billion by
2015 (Overseas Indian Facilitation Centre, 2012). The Indian government will spend
2.5 percent of the countrys gross domestic product on healthcare during the 12th
Five Year Plan (2012-2017), up from 1.4 percent today (OIFC, 2012). However, Indian
healthcare is in a nascent development stage compared to other countries. Every Indian International Journal of Health Care
consumer has several choices where services are concerned; e.g., college students Quality Assurance
Vol. 27 No. 6, 2014
may use college clinics for treatment and shift to private clinics if college services are pp. 519-530
unsatisfactory. Thus, it is essential for campus clinic staff to provide quality services to r Emerald Group Publishing Limited
0952-6862
students and campus residents to retain their customers. DOI 10.1108/IJHCQA-06-2013-0070
 IJHCQA Our research was conducted in several Delhi engineering colleges offering
27,6 under- and post-graduate courses. The college campuses we surveyed had residential
facilities where clinic staff provide non-critical healthcare to college students and staff
members through appointment and walk-in services (treated on a first-come, first-serve
basis). Services include general physical examination, tuberculosis testing, blood sugar
checks, nebulizers, wound care and electrocardiograms. Immediate first aid is provided
520 to emergency and critical cases following which they are referred to hospital. Clinic
staff includes a full-time medical officer, registered nurse, receptionist, pharmacist,
ambulance driver and security staff. The doctor resides on or near the campus. College
managers also invite specialized medical practitioners such as cardiologists, eye
surgeons, homeopathic consultants, nutrition experts and gynecologists once a week.
Improving clinic service quality will have a positive impact on the colleges
overall image, especially those with hostels. Studies have looked at hospitals/clinics
in India (Bhattacharya et al., 2003; Singh et al., 2005; Duggirala et al., 2008; Sharma,
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1999; Sharma et al., 2011) but none develops and validates perception-based service
quality instruments for college clinics. Our study, therefore, focusses on students
college clinic service-quality perceptions and aims to:
(1) identify the service quality dimensions that play an important role in Delhi
college clinic user satisfaction;
(2) assess student satisfaction; and
(3) suggest ways to improve areas where users are dissatisfied.

Healthcare service quality

Cardozo (1965) conducted the first consumer satisfaction study. Since then, several
related articles have been published in trade and academic journals (Peterson and
Wilson, 1992). Customer satisfaction studies gained pace in healthcare after the UKNHS
Management Inquiry (1984) focussed on involving consumers in healthcare processes
(Sharma et al., 2011). Customers are more concerned with perceived quality compared to
objective quality as they value a product using what they receive (product volume,
convenience, quality) and what they give (money, time) (Zeithaml, 1988). In healthcare,
perceived is more important than objective service-quality as patients judge healthcare
providers on what they observe or perceive. With many options available, consumers
can easily switch to different providers if they are not satisfied with the current service.
Customer satisfaction is preceded by service quality, which has a significant impact on
customer intentions to purchase more (Cronin and Steven, 1992). Happier and satisfied
employees lead to satisfied and loyal patients who then return to the same clinic (Atkins
et al., 1996). As health care providers increase, service quality and patient satisfaction
become crucial. Patients recommend a healthcare provider only if they are satisfied and
feel that employees empathise with them (Ioannis and Lymperopoulos, 2009). Patient
satisfaction is among any healthcare providers top priorities; i.e., ways to enhance
patient loyalty and satisfaction. Physicians, for example, can augment user satisfaction
by increasing the time they spend with patients, talking about non-medical issues and
answering questions after they explain test results (Gross et al., 1998).

Hospital and clinic service quality

College clinic staff must maintain service quality or risk losing their significance in the
college if service quality is poor. Before we developed our service quality dimensions,
 we reviewed other hospital/clinic dimensions and held extensive talks with clinic staff. Service quality
Items were added after questioning students about clinic notices and opening hours. and patient
Following our literature review and discussion with students and clinic staff, seven
constructs and 43 items were generated (Table I). satisfaction

Methodology
Our study was conducted between January and February 2012. The authors 521
developed the questionnaire and selected a convenience sample; i.e., only those
students using clinic facilities at least twice were nominated, since one visit would
have been insufficient for users to have a denite opinion about clinic services. The
objectives were explained to the respondents, privacy and condentiality were
assured. Reluctant or unwilling students were not included. Any doubts among
respondents were clarified on the spot to ensure maximum quality response.
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Consequently, questionnaires were given to 500 students. Each was checked and
445 fully completed questionnaires were retained. We used a ve-point Likert scale
from strongly agree to strongly disagree and the questionnaire concluded with one
open-ended question about ways in which clinic service quality could be improved.
These open-ended questions provided an opportunity for respondents to voice their
concerns about other areas not covered in the instrument. We used SPSS 16.0 to
analyze our data.

Validity
Two Delhi educational institute doctors and three professors checked the instruments
content validity and suggested changes. The instrument was given to 20 under-and 20
post-graduate engineering students to test the instruments face validity.

Findings
Descriptive analysis
In all, 100 respondents were female; Table II shows that 139 respondents were post-and
306 were under-graduate students. Most respondents were aged 20-25.

Sampling
A Kaiser-Meyer-Olkin test was used to measure sampling adequacy, generating an
0.783 index, which is appropriate for factor analysis (Tabachnick and Fidell, 1996).

Construct Relevant literature

Staff professionalism Camilleri and OCallaghan (1998), Ovretveit (2000), Huseyin et al. (2008),
Sharma et al. (2011)
Clinic reliability Parasuraman et al. (1985), Tomes and Ng (1995), Walters and Jones (2001)
Clinic accessibility and Tomes and Ng (1995), Camilleri and OCallaghan (1998), Carman (2000),
basic facilities Rose et al. (2004), Sharma et al. (2011)
Clinic tangibles Parasuraman et al. (1985), Tomes and Ng (1995), Duggirala et al. (2008)
Clinic awareness Sharma et al. (2011) Table I.
Clinic cleanliness Carman (2000), Hasin et al. (2001) Clinic service quality
Emergency services Weinerman (1966), He et al. (2011) potential constructs
 IJHCQA Gender
27,6 Characteristics Male Female Total

Course
Graduate 241 65 306
Post-graduate 104 35 139
522 Age
15-20 75 23 98
20-25 245 56 301
Table II. 25-30 25 21 46
Respondent demographics Gender 345 100 445

Factor and reliability analyses

We used a principal component extraction technique with Varimax rotation (Lewis,
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1984); consequently, some items were deleted using the following criteria:
(1) if item to item correlation was below 0.35; and
(2) if factor loading was below 0.45 (Hatcher, 1994).
Six items were eliminated leaving seven factors with 37 items:
(1) staff professionalism (eight items);
(2) staff reliability (six items);
(3) accessibility and basic facilities (eight items);
(4) clinictangibles (four items);
(5) clinic awareness (four items);
(6) cleanliness (four items); and
(7) emergency care (three items).
Cronbachs a, used to test reliability, ranged from 0.7 to 0.83, which shows high internal
consistency (Cronbach and Shavelson, 2004). Total variance explained by all seven
factors was 78.6 percent (Table III).

Participant satisfaction
According to 83 percent of the respondents, the clinic doctor allotted sufficient time
throughout treatment. More than 62 percent said that staff provided services correctly
at the time they promised. Nearly 75 percent said that staffs were interested in their
questions, which shows a positive attitude among staff, further enhancing patient
satisfaction. More than 60 percent reported that staff gave them personal attention
and nearly 60 percent said that staff responded to patient requests all the time. Good
communication with patients is essential during diagnosis and treatment, and our
findings show that staff communicated well with patients, which give a positive
impression. However, a little o50 percent said that staff told them when they would
perform services. More than 55 percent felt that staff wanted to solve their problems
and a similar percentage said that staff performed the service correctly the first
time (Table IV).
More than 65 percent said that medicines prescribed were good quality.
According to 75 percent, doctors had the required knowledge to perform their
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Factor loadings
Items Statements 1 2 3 4 5 6 7

(15) Sufficient time given during treatment 0.60

(16) The clinic staff are punctual 0.56
(17) Doctors and staff take an interest in patient questions 0.64
(18) Doctors and staff give personal attention 0.78
(32) Doctors and staff respond to requests all the time 0.61
(33) Clinic employees tell you exactly when the services are performed 0.49
(34) When you have a problem, clinic staff show a sincere interest in solving it 0.77
(5) Clinic staff perform the service right the first time 0.47
(10) The medicine given by the doctor was good quality 0.49
(11) Doctors had the required knowledge to perform their duties 0.72
(12) Doctors are competent enough in performing their duties 0.71
(13) Staff are competent enough in performing their duties 0.60
(14) Doctor services were excellent 0.74
(19) Staff services were excellent 0.52
(20) Basic requirements like water, fans, lights, etc., were available 0.57
(25) Adequate space is available in the waiting area 0.65
(26) Adequate space is available in the examination room 0.60
(27) Washrooms are adequate 0.56
(28) Parking area near the clinic 0.71
(29) Sufficient parking space available 0.77
(31) The directions to the clinic are clear 0.66
(30) Clinic location is convenient 0.49
(1) Modern equipment is available 0.84
(2) Visually appealing physical facilities 0.75
(3) Sufficient chairs for patients 0.69
(continued)
satisfaction
and patient

analysis
principal component
Service quality

Modified SERVQUAL
Table III.
523
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27,6

524

Table III.
IJHCQA

Factor loadings
Items Statements 1 2 3 4 5 6 7

(4) Adequate beds are available in the clinic 0.63

(21) Notices regarding preventing seasonal diseases like dengue, malaria, etc., are displayed regularly 0.59
(22) Clinic hours are convenient for day and hostel students 0.63
(23) Doctors are available during holidays 0.57
(24) Information regarding staff contact details is well displayed in hostels and campus notice boards 0.70
(6) Washrooms are clean 0.58
(7) Examination room is clean 0.63
(8) Waiting area is clean 0.71
(9) Parking area is clean 0.64
(5) Clinic ambulance is well equipped with basic devices to deal with emergencies 0.53
(36) Clinic staff are trained to provide first aid in emergencies simultaneously in female and male hostels 0.56
(37) Referral facilities are available during emergencies 0.62
 Strongly Strongly
Service quality
Statements agree Agree Neither Disagree disagree and patient
satisfaction
(15) Sufficient time given during your treatment 16.85 66.30 6.74 10.11 0
(16) The clinic provides its service at the time it
promises to do so 16.33 46.07 18.88 17.97 1.12
(17) Doctors and staff members take an interest in 525
patients questions 10.11 64.04 15.73 10.11 0
(18) Doctors and staff members gave you
personal attention 7.87 59.55 14.61 17.97 0
(32) Doctors and staff members respond to
requests all the time 10.11 48.31 20.22 17.97 3.37
(33) Employees in the clinic tell you exactly when
services are performed 5.61 43.82 29.21 16.85 4.49
(34) When you have a problem, the clinic staff
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show a sincere interest in solving it 2.25 55.05 20.22 21.35 1.12 Table IV.
(35) Clinic staff performs the service right the Satisfaction with staff
first time 4.49 55.05 20.22 19.1 1.12 professionalism (%)

duties. More than 60 percent reported that the clinic doctor and staff were competent.
This demonstrates the faith students have in clinic staff. More than 50 percent were
satisfied with clinic services (Table V).
More than 60 percent said that basic facilities like fans, lights, water, etc., were
available in the clinic and 40 percent reported that space in the waiting area and
examination room was adequate. However, about 30 percent were unaware that a wash
room existed in the college clinic. About 55 percent reported that parking was available
and around 48 percent felt parking was sufficient. However, o50 percent reported that
directions to the clinic were sufficient. More than 60 percent agreed that clinic location
was convenient (Table VI).
Patients were not satisfied with clinic facilities. More than 40 percent said that their
clinic lacked modern equipment, sufficient chairs and beds and that facilities were not
visually appealing (Table VII).
More than 50 percent were unaware of notices regarding seasonal diseases,
implying that information relating to dengue, malaria, etc., was not displayed properly.

Strongly Strongly
Statements agree Agree Neither Disagree disagree

(10) The medicine given by the doctor was good

quality 13.48 52.8 19.10 12.36 2.25
(11) Doctors had the required knowledge to
perform their duties 19.10 57.3 15.73 7.87 0
(12) Doctors are competent enough in performing
their duties 10.11 53.9 19.10 14.61 2.25
(13) Staff are competent enough in performing
their duties 3.37 59.5 21.35 12.36 3.37 Table V.
(14) Doctors services were excellent 2.25 48.3 24.72 21.35 3.37 Satisfaction with
(19) Staff services were excellent 4.49 46.1 28.09 16.85 4.49 clinic reliability (%)
 IJHCQA Strongly Strongly
27,6 Statements agree Agree Neither Disagree disagree

(20) Basic requirements like water, fan, light, etc. 4.49 58.43 26.97 6.74 3.37
(25) Adequate space is available in the waiting
area 3.37 44.94 23.6 23.6 4.49
526 (26) Adequate space is available in the
examination room 5.61 58.43 19.1 13.48 3.37
(27) Adequate washrooms 2.25 30.34 30.34 25.84 8.99
Table VI. (28) Parking area near clinic 7.87 49.44 21.35 19.1 2.25
Satisfaction with clinic (29) Sufficient parking space available 6.74 42.7 26.97 21.35 2.25
accessibility and basic (31) Directions to the clinic are sufficient 4.49 43.82 21.35 20.22 10.11
facilities (%) (30) Clinic location is convenient 6.74 56.18 8.99 20.22 7.87
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Statements Strongly agree Agree Neither Disagree Strongly disagree

(1) Modern equipment 1.12 16.85 29.21 41.57 11.23

Table VII. (2) Visually appealing physical facilities 3.37 15.73 29.21 42.7 8.99
Satisfaction with (3) Enough chairs for patients 1.12 30.34 23.60 37.08 8.99
tangibles (%) (4) Adequate beds available in the clinic 6.74 16.85 21.35 44.94 10.11

About 50 percent felt that clinic hours were convenient for both resident and day
students. More than 60 percent reported that the doctor was available during holidays.
However, most students said that the information regarding doctor, clinic staff
and ambulance services were not displayed in hostels and on campus notice boards
(Table VIII).
More than 40 percent were satisfied with wash room cleanliness and about 75
percent were satisfied with examination room cleanliness; whereas more than 60
percent said the clinic waiting area was clean. A similar percentage reported clean
clinic-parking areas (Table IX).
Most students felt that their clinic could not provide emergency services. More than
50 percent said that the clinic ambulance was not equipped with basic devices to deal
with emergencies and a similar percentage reported that the clinic staff was not
equipped and trained to deal with emergencies. However, around 90 percent were
satisfied with the referral facilities (Table X).

Strongly Strongly
Statements agree Agree Neither Disagree disagree

(21) Notices regarding seasonal diseases like

dengue, malaria etc., are displayed 7.87 19.10 32.58 25.84 14.61
(22) Clinic hours are convenient for day and
resident students 7.87 49.44 12.36 14.61 15.73
Table VIII. (23) Doctors are available during holidays 32.60 34.7 23.5 9.10 0.10
Satisfaction with the (24) Information regarding staff contact
awareness about details is well displayed in hostels and
clinic/disease (%) campus notice boards 2.25 23.60 20.22 32.58 21.35
 Conclusions Service quality
We infer that most respondents are satisfied with staff professionalism; however, staff and patient
can improve service quality by responding promptly to patient requests. Although
more than 50 percent rated their college clinic and its services reliable, half did not satisfaction
feel that services were excellent. Every patient wants to be heard whenever s/he visits
the clinic, which forms a crucial aspect of patient satisfaction. Thus, it is important
for healthcare providers to respond to patient requests. Such improvements can 527
advance patient satisfaction. Half the respondents did not approve clinic facilities;
i.e., patients felt that clinic equipment was not up-to-date or visually appealing. Old
equipment and inadequate beds created a negative impact. Some students used
healthcare providers outside the campus whenever they could as they did not have
faith in clinic equipment. Upgrading equipment, therefore, is imperative as staff must
win the students trust.
The general impression was positive, as most respondents stated that clinic hours
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were convenient, but doctor availability during holidays or after hours was limited and
only those who had a staff telephone number were able to make contact. It is crucial for
patients to know that medical help is just a call away during an emergency. Thus, clinic
staff contact details must be displayed on campus and hostel notice boards.
Unclean premises can lead to health problems and diseases. Most participants were
satisfied with clinic cleanliness, which is positive. Every healthcare center must be
equipped to deal with emergencies as they are crucial healthcare services and can
mean life and death for patients. Most students lacked confidence in the staffs ability
to deal with emergencies a setback for college clinic staff who should be trained to
deal with emergencies. Moreover, the medical equipment required for emergencies
must be present in the clinic along with an ambulance for transporting patients to the
nearest hospital in case their condition deteriorates. An open-ended question was
framed for the respondents to suggest improvements; often mentioned were:
. Clinic staff contact details should be prominently displayed on campus and in
hostels notice boards.

Statements Strongly agree Agree Neither Disagree Strongly disagree

(6) Washrooms are clean 2.25 40.45 38.20 16.85 2.25

(7) Examination room is clean 2.25 74.16 16.85 4.49 2.25 Table IX.
(8) Waiting area is clean 4.49 62.92 13.48 14.61 4.49 Satisfaction with
(9) Parking area is clean 10.11 48.31 22.47 14.61 4.49 cleanliness (%)

Strongly Strongly
Statements agree Agree Neither Disagree disagree

(5) Ambulance is well equipped with basic

devices to deal with emergencies 2.25 14.61 29.21 28.09 25.84
(36) Clinic staff are trained to provide first aid
in case of emergencies 4.49 26.97 23.6 25.84 23.6 Table X.
(37) Referral facilities are available in an Satisfaction with
emergency 30.5 59.4 6.50 2.40 1.20 emergency care (%)
 IJHCQA . Specialists should visit regularly, especially dentists, ophthalmologists,
27,6 dermatologists and dieticians. Visiting hours should be displayed in the clinic,
on campus and hostel notice boards.
. Clinics need more sophisticated and better instruments like x-ray machines,
more spacious and improved examination rooms.

528
. Students wanted better ambulance service to deal with emergencies along with
better first-aid facilities in hostels to deal with mishaps.
. Students wanted greater cleanliness; more hygienic facilities and direction
boards specifying clinic locations.
Our results can be integrated into managers strategic planning processes with respect
to budgeting for quality improvement projects. Survey outcomes indicate areas where
clinic staff must invest. Other measures that can improve college clinic services are:
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. regular interaction with students to determine what services they desire;

. at least fort nightly staff meetings to discuss student suggestions, upgrading
facilities or issues regarding clinic maintenance;
. holding interactive sessions with students to educate them on common diseases;
. providing facilities so that students can discuss their problems anonymously;
. training clinic employees to put patients at ease; and
. educating students about the clinics latest facilities.

Further study
College clinic studies can be useful for college administrators, who can use conclusions
to improve clinic standards. Moreover, such studies can be conducted at state, country
and international levels to compare campus clinic facilities and outcomes can be
compared with this study, which may lead to enhanced college clinic standards and
better treatment. Our questionnaire can be used to develop instruments for other clinic-
based research.

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530 Corresponding author

Pankaj Deshwal can be contacted at: pankajdeshwal@gmail.com
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