Assignment Service marketing

Service quality and customer loyalty in Rajashekar hospital using GAP model and SERQUAL approach

By, Swetha M 3rd Semester MBA Reg No :10VWCMA061

1. INTRODUCTION

In the current socioeconomic context, the service sector has become increasingly more important, revealing the need to know and study the particularities of its operations and to institute specific management methodologies that fit its context and specificity. But it is necessary to understand that service processes are different from manufacturing processes, especially due to their intangible nature and the direct participation of clients. Aiming to make clients loyal, companies have made every effort to meet their needs and exceed their expectations. The SERVQUAL scale is one of the tools that can help in this sense. According to Oliver, SERVQUAL is the method that assesses client satisfaction as a result of the difference between expectation and the performance obtained. According to Zeithaml, Parasuraman and Berry, SERVQUAL is universal and can be applied to any service organization to assess the quality of services provided.

With in-creasing awareness among consumers about their rights, the patient, as a consumer of health services, expect and demand quality health care. The health care customer is changing qualitatively. The rising literacy rate, higher levels of income and increasing awareness through deeper penetration of the media, has brought the Indian consumer closer to demand quality health care. All these factors have not only contributed to the growth of health care sector in India but also for quality health care services. In the light of these developments, health care providers need to have a closer look at the perception of their patients and try to provide quality medical and health services to meet their expectations. It is the professional excellence, personaltouch-in-service, humanitarian approach and ethical values of the employees that play a significant role in the satisfaction of patients. The study of service quality perceptions from the patient viewpoint provides a basic feedback to the hospitals in the light of their patient-oriented and patient-centric efforts in attracting and satisfying the patients. In view of the above, an attempt is made in the study to examine how well the Rajashekar hospital in Bangalore is meeting the customers expectations on the service quality dimensions.

2. LITERATURE REVIEW
A brief theoretical review will be presented below about Service Management, Quality Management and SERVQUAL.

2.1. Service Management

According to Lovelock, services are economic activities that create value and provide benefits to the client at specific times and in specific places as a result of a desired change in, or on behalf of, the one that receives the service. According to Meirelles a service is essentially intangible and only assessed when combined with other functions, that is, with other tangible productive processes and products. This intangible nature is associated with this process, which priori cannot be touched. In other words, the providing of a service tends to occur simultaneously with consumption. Production occurs starting the moment the service is ordered and it finishes as soon as the demand is met. Services have some specific characteristics that differentiate them from the manufactured goods. Gianesi and Corra say the following special characteristics of service operations are the main ones: intangibility, client participation and simultaneous production and consumption. According to Coelho, "in service management it is important to understand how clients assess the quality of the service provided, that is, how quality is perceived by the client".

2.2 Healthcare service

Healthcare is one of Indias largest sectors, in terms of revenue and employment, and the sector is expanding rapidly. During the 1990s, Indian healthcare grew at a compound annual rate of 16%. Today the total value of the sector is more than $34 billion. This translates to $34 per capita, or roughly 6% of GDP. By 2012, Indias healthcare sector is projected to grow to nearly $40 billion. The private sector accounts for more than 80% of total healthcare spending in India. Unless there is a decline in the combined federal and state government deficit, which currently stands at roughly 9%, the opportunity for significantly higher public health spending will be
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limited. The public healthcare delivery system consists of a large number and a variety of institutionsdispensaries, primary healthcare institutions, small hospitals providing specialist services, large hospitals providing tertiary care, medical colleges, paramedic training schools, laboratories, etc. Despite the size and reach of the public healthcare system, however, India scores poorly on most generally accepted health indicators. This may, in part, explain the growing role of the private sector in addressing Indias healthcare needs. Public-private partnerships have also emerged as one viable method of growing the healthcare sector while
keeping public goals in mind. The main objectives of public-private partnerships are to improve quality, accessibility, availability, acceptability, and efficiency of healthcare services. While different states in India have had different levels of success with implementation of such initiatives, it is expected that the private sector will continue to take on an increasing role in Indias healthcare system.

The quality and availability of specialist medical care varies greatly among the different socio economic groups and by geography, i.e. urban vs. rural. Despite a high annual output of medical specialist graduates, specialist medical care has traditionally been very poor in India due to brain drain, or the phenomena of highly educated Indians immigrating to western countries. Recently, however, specialist care for the middle- and upper-classes has improved due to more private hospitals, better private hospital infrastructures and equipment, and higher salaries/incentives (mostly a result of increased demand from the growing middle-class).

2.3. Quality Management

Quality management is a broad theme that encompasses every sort of organization, multinational or national, eastern or western, large or small, services or manufacturing and public or private. According to Oliveira its concept depends on the context in which it is applied, in face of the subjectivity and complexity of its meaning. Bateson says quality is generally considered an attribute in consumer choices. Quality in services can be defined as a customer satisfaction index for any service, and this satisfaction can be measured by any criteria. Quality in services provides a competitive factor for continued consumption, especially when intangibility relations are tightened between quality and the services. Responsibility and trust, two of the dimensions of service quality grouped by Parasuraman, Zeithaml and Berry (1985), generated by prior experience, and are important factors for determining perceived quality by clients. Quality is
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judged according to perceived satisfaction. According to Grnroos

perceived quality is

determined "by the gap between expected quality and experienced quality", that is, it is the difference between client perceptions and expectations. Satisfying the clients immediate and explicit expectations should be sought in the short term. However, in the mid and long term, it is important to develop competences to achieve their real needs, even those that are not explicit or are unconscious. According to the same author, quality is only measured at the end of the process, that is, when the service has been concluded, and there is no way to change client perception regarding the service received.

2.4. SERVQUAL According to Parasuraman, Zeithaml and Berry, regardless of the type of service, consumers basically use the same criteria to assess quality. Service quality is a general opinion the client forms regarding its delivery, which is constituted by a series of successful or unsuccessful experiences. Managing gaps in service will help the company improve its quality. But gaps are not the only means clients use to judge a service. They can also use five broad-based dimensions as judgment criteria: reliability, tangibility, responsibility, security and empathy. These dimensions are briefly commented below (BATESON and HOFFMAN, LOVELOCK):

- Reliability: is the company reliable in providing the service? Does it provide as promised? Reliability reflects a companys consistency and certainty in terms of performance. Reliability is the most important dimension for the consumer of services; - Tangibility: how are the service providers physical installations, equipment, people and communication material? Since there is no physical element to be assessed in services, clients often trust the tangible evidence that surrounds it when making their assessment;

- Responsibility: are company employees helpful and capable of providing fast service? It is responsible for measuring company and employee receptiveness towards clients;

- Security: are employees well-informed, educated, competent and trustworthy? This dimension encompasses the companys competence, courtesy and precision; and
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- Empathy: this is the capacity a person has to experience anothers feelings. Does the service company provide careful and personalized attention? These elements clearly have a highly subjective factor linked to the person who perceives the service. In reality, according to Kilbourne , every type of service can have determining factors that are considered more important than others, which will depend on environment characteristics or type of activity. It is difficult to measure the quality of service operations because they have the characteristic intangibility. Aimed at solving this problem, Parasuraman, Zeithaml and Berry developed a methodology in which there is a comparison between several orders of expectations and perceptions of service quality by the consumer. These differences between perceptions and expectations are addressed in the quality in service model shown in Figure 1. This model seeks to help managers understand the sources of problems in quality and how they can improve them.

Figure 1: Quality in services model SERVQUAL is an instrument to measure quality that stems from this model and works with the difference in scores (gaps) in the form of a questionnaire. The models five gaps and factors affecting it are Key factors contributing to the gaps. GAP 1: Not knowing what customers expect:

Lack of marketing research orientation Inadequate upward communication Too many levels of management
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GAP 2: The wrong service quality standards:

Inadequate management commitment to service quality Perception of infeasibility Inadequate task standardization Absence of goal setting

GAP 3: Service performance gap:

Employee role ambiguity Employee role conflict Poor Employee job fit Poor Technology job fit Inappropriate evaluation and reward systems Lack of empowered service employees Lack of teamwork

GAP 4: When promises do not match delivery:

Inadequate horizontal communication Tendency to overpromise

GAP 5: customer satisfaction:

Depends on gap 1-4 The greater the gap the lower the customer satisfaction, because expectation and perception do not match.

RESEARCH METHODOLOGY

3.1 Research Title

Service quality and customer loyalty in Rajashekar hospital using GAP model and SERQUAL approach

3.2 Objective of the Study

To understand the service quality provided at Rajashekar hospital. To know the customer loyalty.

3.3 TYPE OF STUDY

It is a descriptive research to understand Service quality and customer loyalty in Rajashekar

hospital. The main goal of this type of research is to describe the data and characteristics about what is
being studied. Although this research is highly accurate, it does not gather the causes behind a situation. Descriptive research is mainly done when a researcher wants to gain a better understanding of a topic.

3.4 Source of Data

Data is collected through both,

Primary Sources: The data for the study was collected with the help of a questionnaire with a sample size of 15. Secondary sources: official websites, articles and journals.
In order to collect information questionnaire will be used.

3.5 Tools for Data Collection 3.6 Sampling Plan

(i) (ii)

Sampling unit patients in Rajashekar hospital. Sampling method The sampling method used for the study is Non probability convenience sampling.

(iii)

Sampling size - 15

3.8 Limitations of the Study

The data required to be collected would be based on the opinions of the patients which are liable to change with time, hence the findings may require, being reviewed before using them for further studies. Time being a limitation, there could be a possibility that some data can get over looked, though maximum effort would be made to see that all relevant data are included.

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4. Service quality and GAP Model of Healthcare 4.1 Service Quality in Rajashekar Hospital
The following aspects were examined under the SERQUAL dimensions.

Tangibility

Empathy

Assurance

SERQUAL Dimensions

Courtesy

Responsiveness

Reliability

Fig 2: SERQUAL dimensions

Tangibility:
They should have up to date equipment& technology. Their physical facilities should be visually appealing. Bathroom should be very clean. Room should be clean. Meals should be attractive. Food should have right temperature. Nurses should respect privacy. Room should be quiet. Parking should be convenient.

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Assurance:
Food should be delivered by a certain time. When staff of the institutions promises to do something by a certain time, they should do it. They should keep patients' records accurately. Hospital charges should be accurate

Responsiveness:
They should be expected to tell their customer exactly when services will be performed. Patients who will be discharged should expect prompt service from employees of the hospital for the discharging operations. Patients should expect prompt services from nurses when the patient needs to them. Patients who come to hospital should expect prompt service from employees of the hospital for the admission operation. Employees of the hospital should always be willing to help their patients. Employee of the hospital should address customers' questions appropriately about the discharging process. Employee of the hospital should address customers' questions appropriately about any procedure. Treatment should be explained to the patient very clearly. Discharge should be explained to the patients' family.

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Reliability:
Customer should be able to trust nurses of the hospital. Patient should be positive that they have recovered well before they are discharged. Patient should be able to trust billing. Patients should be able to feel safe in their transactions with these institutions' employees. Patients should be able to feel safe that nurses are knowledgeable.

Courtesy:
Employees should be polite during admissions procedure. Employees should be polite during housekeeping process. Nurses' behavior should be very polite to customers. Nurses should be cheerful. Visitors should be treated well.

Empathy:
Patients should expect employees to know what they need from them. Patients should expect nurses to give them their personal attention.

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4.2 GAP model of service quality in health care

Expected service

Patients

Perceived service

Hospital

Service Delivery Gap 4 Gap 3 Patient driven service design and standards Gap 2 Hospital perceptions on patients expectations

External communication to customers

Gap 1

Fig 3: GAP model of service quality in health care

Above Fig 3 Conveys a clear message that the key to closing the Patient gap is to close gaps 1 through 4.To the extent that one or more of gaps 1 through 4 exist, perceive service quality shortfalls. Provider (Hospital) gap 1: Not Knowing what the patients expects Provider gap 2: Not selecting the right service designs and standards Provider gap 3: Not delivering to service standards Provider gap 4: Not matching performance to promises Customer (Patient) gap 5: Not Knowing what the Hospital delivers The basic Objective of the hospital is to develop the strategies in such a way that it can influence the patients expectations and perceptions so that all the four gaps that take place due to differences in expectations and perceptions can be filled up.
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Let us diagnose the specific causes for each of the gaps as shown in the fig 1 Gap-1: Services expected by Patients minus hospital perception of patients expectations. Causes for Gap 1: Lack of interaction between the patient and doctor Unwillingness to ask patients about expectations Unpreparedness to address the expectations Gap-2: Inability to set the right type of standards Causes for Gap 2: Lack of patient driven service standards Absence of Process (delivery of services) management to focus on patients requirements Absence of formal system for setting service quality Inadequate administration commitment towards the services No systematic process for the development of new services to be offered. Failure to connect services offered to patients Gap-3: Patients-driven service designs minus service delivery Causes for Gap 3: Ineffective staff to provide good service Failure to match supply and demand Failure to smooth peaks and valley of demand Over reliance on government funds Gap-4: Service delivery minus external communications to Patients Causes for Gap 4: Ineffective management of patients expectations. Over or under promising about the quality of service Inadequate horizontal communications. Tourists Gap -5: patients expectations of service minus Patients perceptions of service Causes for Gap 5: The central focus of the gaps model is the Patient gap, the difference between patient expectations and perceptions. Expectations are the reference points patients have coming in to a service experience. Perceptions reflect the service as actually received.
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5. Data Analysis and Interpretation

Source: Primary data (filled questionnaire)

response time of attending physician in emergency visit

0% 12% 4%

15 minutes 30 minutes 1 hour 84% more than 1 houe

Fig 5.1: Training as part of organization strategy

Interpretation: from the above chart it is clear that majority of the patients in rajshekar
hospital i.e, 84% of them agree that physicians attend the patients during their first visit within 15 minutes without any delay and only few of them i.e., 12% of them say that the physicians provide service lately and only 4% of them say that there is huge delay in providing service

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Source: Primary data (filled questionnaire)

SalesQuality of services
5% 35% 24% excellent good Average Poor 36%

Fig 5.2: how you rate Quality of services?

Interpretation: from the above chart it is clear that majority of the patients in rajshekar
hospital i.e,36% of them agree to average extent that service offered are not that good and 35% of them had rate the service quality as poor as they sure dissatisfied with service provided to them . Only of about 5% rate it as excellent where these patients are financially stable and service providers value for money. Therefore we can interpret that the service quality is not god in the hospital.

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Source: Primary data (filled questionnaire)

hygiene control measures

12% 32% Excellent good average 56% poor

Fig 5.3: how you rate hygiene control measure in hospital?

Interpretation: from the above chart it is clear that majority of the patients in rajshekar
hospital agree to a great extent that overall hygiene control measures in hospital in good and are satisfied with it .

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Source: Primary data (filled questionnaire)

Medical instruments used for diagnosis

5%

47% Latest 48% old outdated dont no

0%

Fig 5.4: condition of Medical instruments used for diagnosis

Interpretation: from the above chart it is clear that half of the patients believe that
instruments used might be old and rest of others dont know about it and only 5% of them say instruments used are latest .

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Source: Primary data (filled questionnaire)

safe in dealing with hospital

5 yes No 10

Fig 5.5: Dealing with hospital

Interpretation: from the above chart it is clear that half of the 10 patients believe that they
feel safe in dealing with hospital and rest disagrees to that.

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Source: Primary data (filled questionnaire)

10 9 8 7 6 5 4 3 2 1 0 yes no

Fig 5.6: whether hospital gives individual attention

Interpretation: from the above chart it is clear that half of the 10 patients believe that they get
individual attention and rest disagree to that.

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Source: Primary data (filled questionnaire)

hospitl gives prompt service

5

yes no 15

Fig 5.7: whether hospital give prompt service

Interpretation: from the above chart it is clear that half of the 15 patients believe that they
wont get prompt service and rest disagree to that.

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Source: Primary data (filled questionnaire)

personnel understan ds specific need

5

yes no 15

Fig 5.8: whether personnel in hospital understand specific need

Interpretation: from the above chart it is clear that half of the 15 patients believe that
personnel on hospital dont understand their specific needs and rest disagree to that.

Findings
In the hospital there is gap between the patients expectations and the hospital perception about patients expectations

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Annexure
Questionnaire (employee) I, Swetha.M, am a student of alliance business academy. As part of the curriculum, I am doing a survey on the effectiveness of training in Perry Johnson Outsourcing with regard to this, I request you to kindly fill in the questionnaire. I ensure that the data will be kept confidential and used only for academic purpose (Please indicate your choice by putting a tick mark in the appropriate boxes) 1. What was the response time of attending physician on your first visit in the OPD/emergency of the hospital? 15 minutes 30 minutes 1 hour More than 1 hour [ ] [ ] [ ] [

2. How do rate the quality of service in terms of paramedical staff Excellent Good Average Poor [ ] [ ] [ ] [ ]

3. How was the overall hygiene or infection control measure in hospital? Excellent Good Average Poor [ ] [ ] [ ] [ ]

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4. How was the condition of equipment/medical instrument used for diagnosis? Latest Old Outdated Dont know Disagree [ ] [ ] [ ] [ ] [ ]

5. You feel safe in your dealing with hospital Yes No 6. The hospital gives you individual attention Yes No [ ] [ ] [ ] [ ]

7. Do the personnel in the hospital give you prompt service Yes NO [ ] [ ]

8. The personnel of the hospital understands your specific needs Yes No [ ] [ ]

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