City University EJournal Of Academic Research (CUeJAR)
City University eJournal of Academic Research (CUeJAR)e-ISSN : 2682-910XCUeJAR Homepage: https://www.city.edu.my/CUeJAROPENACCESSReceived: 24th July 2020 Revised: 14th August 2020 Accepted: 28thAugust 2020The relationship between medical service quality and patient satisfaction in thespecialist clinics of a Malaysian Government hospitalAnandkanadasan Pathmathasana, Jayaraman MunusamybaCentre for Postgraduate Studies, Open University Malaysia,bFaculty of Business, City University MalaysiaAbstractIntroduction: The service quality delivered by a healthcare service provider influences patients’satisfaction level which enhances positive feelings among patients and also enhances the firm’scorporate image. This paper used the variables of reliability, assurance, tangibles, empathy andresponsiveness of the SERVQUAL model to examine the relationship between service quality andpatient satisfaction in specialist clinics in a public hospital in Malaysia.Methodology: A quantitative approach was deployed to test five hypotheses that were developedfrom the variables identified from the literature review. A questionnaire survey was administeredto 223 respondents who were selected via a systematic random sampling method from the specialistclinics in a public hospital in Malaysia. Pearson correlation and regression analyses were usedfor data analysis.Results: Pearson correlations and regression analysis were conducted for this study and it wasidentified that all the dimensions of SERVQUAL were supported; and therefore, all the factorscontribute to patients’ satisfaction in the specialist clinics. The service quality model whichcomprised of reliability, assurance, tangibles, empathy and responsiveness has a good fit and it isrobust.Conclusion and recommendations: The findings suggest some implications for the public hospitalauthorities to constantly improve service quality dimensions such as reliability, assurance,tangibles, empathy and responsiveness, so that patients’ satisfaction could be maintained at alltimes. Since this was a cross sectional study, it is recommended that a longitudinal study beconducted as organizational service quality delivered may be inconsistent with times.Keywords: Patient satisfaction, service quality, public hospital, healthcare provider, SERVQUAL105CUeJAR Volume 2 Issue 1 2020
City University eJournal of Academic Research (CUeJAR), 2(1) 2020; 105-1151. IntroductionThe service industry plays a crucial role in developing the economy of Malaysia and it has becomeone of the fastest growing sectors (Zaim, Bayyurt & Zaim, 2010). Service quality has attractedmuch investigation by both academics and practitioners (Narayan, Rajendran & Sai, 2008; Prabha,Naidoo & Nundhall, 2010). The relationship between service quality and customer satisfaction hasbeen extensively examined in the literature, in both developed countries (Carman, 2000) anddeveloping countries (Tuan, 2012; Zaim et al., 2010). In the healthcare industry, research on therelationship between service quality and patient satisfaction has gained much attention (Choi, Lee,Kim & Lee, 2005; Nana, Nwankwo & Dason, 2010; Zaim et al., 2010). Service quality is the coreelement for patient’s satisfaction in healthcare in both the Government and private hospitals.Service quality extends beyond quality treatment and quality medication. Good services, includingthe tangibles, also play a vital role in generating patient satisfaction. Although every MalaysianGovernment hospital has a unit especially for quality of services, there are numerous complaintson quality of services provided relating to facilities and the attitudes of doctors and medical staff.Al-damen (2017) reported that there is a growing consensus that patient satisfaction is an importantindicator of healthcare quality and many hospitals are moving in that direction. The reviewedliterature were silent on public policies supporting the delivering of quality services in MalaysianGovernment hospitals. In order to address this research gap, this paper examined the service qualitydelivery and patients’ satisfaction at the 12 specialist clinics of a large Malaysian Governmenthospital by using the SERVQUAL model.2. Literature ReviewThere is a strong correlation between service quality and customer satisfaction (Webster, 1992).Service quality, which focuses on the dimensions of services, can be defined as “the customersoverall impression of the relative inferiority – superiority of the organization and its services((Bitner & Hubbet, 1994: 77)”. In service industries, including medical services, service qualityhas static and dynamic dimensions (Day & Peters, 1994). The dynamic dimensions of quality relateto the activities involved in service delivery. They offer opportunities for the customers to besatisfied by the extra efforts made by staff to meet their specific needs (Ingram, Tear, Ridley &Ferrone, 1997). Parasuraman, Zeithaml and Berry (1985) developed the SERVQUAL model withthe five dimensions of service quality namely tangibles, reliability, responsiveness, assurance andempathy. These dimensions are examined in the context of the selected Malaysian Governmenthospital.Reliability and patient satisfactionReliability is the ability to perform the promised service dependably and accurately (Kotler &Keller, 2016; Khalifa & Fawzy, 2017). Parasuraman, Zeithaml and Berry (1988) examinedreliability and found a positive relationship between service quality and customer satisfaction.Lee, Lee and Yoo (2000) reported that reliability refers to the services or treatment rendered orsupposed to be provided for achieving a patient’s satisfaction. Zeithaml, Bitner and Gramler(2006) viewed reliability as the ability to perform dependably and accurately the servicesrendered according to promises made. Reliability is a critical factor that determines customer’ssatisfaction in training industry of Malaysia (Munusamy & Vong, 2008). Reliability affectscustomer’s satisfaction in banking industry of Malaysia (Munusamy, Chelliah & Hor, 2010).Additionally, reliability has the ability to perform the promised service dependably andaccurately (Rajasekhar, Janardhana & Anjan, 2013).106CUeJAR Volume 2 Issue 1 2020
City University eJournal of Academic Research (CUeJAR), 2(1) 2020; 105-115Recent studies on service quality highlighted that reliability has greater impact on patients’satisfaction in both private and public hospitals (Alghamdi, 2014; Kamyar Mahmood, Seyed &Shadi, 2014; Al-damen, 2017; Javed & Ilyas, 2018; Javed & Liu, 2018; Mohamud, et al., 2017;Binnawas, et al., 2019; Myo, et al., 2019). The findings of a study by Yousapronpaiboon andJohnson (2013) on outpatients in Thailand’s private hospitals revealed that reliability influencedthe overall patients’ satisfaction. Shan et al. (2016) verified that lack of trust was a sort of patientdissatisfaction with hospital inpatient care in Heilongjiang, China. Devi and Muthuswamy (2016)investigated service quality perception in multispecialty hospitals in India and their findingsindicated that reliability is one of the important dimension of hospital service quality as perceivedby patients. Another study by Zamil, Areiqat and Tailakh (2012) on the impact of health servicequality on patients’ satisfaction in private and public hospitals in Jordan revealed that reliabilityimpacted on patient's satisfaction. Diab (2012) found that Government hospitals in Jordan appliedthe medical service dimension of reliability at a high level from the perspective of patients andstaff. Ajarmah, Balqees and Hashem (2015) compared accredited and non-accredited hospitals inrelation to patient's satisfaction in Jordan and they found that accreditation improves patients'satisfaction. The results suggested that reliability is an important variable that affects patients’satisfaction. Accordingly, the first hypothesis is framed as:H1: Reliability influences patient’s satisfaction in the specialist clinics of aMalaysian Government Hospital.Assurance and patient satisfactionAssurance is the knowledge and courtesy of employees and their ability to convey trust andconfidence (Kotler & Keller, 2016). It is a dimension of SERQUAL that measures concepts thatrelate to trust. Assurance has a positive relationship towards service quality and customersatisfaction (Parasuraman et al., 1988). Assurance is the employee’s knowledge and courtesy andthe effort and ability of the service provider to build and inspire trust and confidence (Zeithaml etal., 2006). Therefore, assurance is the courtesy and knowledge to inspire trust and confidence inpatients to enjoy the service provided in the hospital dependably and accurately. Huppertz andSmith (2014) contended that consumers were of the view that hospitals should collate and maintaindata on service quality based on patient feedback and to incorporate the patient comments in theirdecision-making process. The assurance of effective management of acute pain contributed to amore positive patient outcome and increased patients’ satisfaction (Glowacki, 2015).The findings of recent studies revealed that the variable of assurance influenced patient satisfactionpositively in private and public hospitals (Alghamdi, 2014; Kamyar et al., 2014; Al-damen, 2017;Javed & Ilyas, 2018; Javed & Liu, 2018). The findings of the study by Yousapronpaiboon andJohnson (2013) on outpatients in private Thailand hospitals found that assurance is stronglyassociated with overall patient satisfaction. Zamil et al. (2012) investigated the impact of healthservice quality on patients’ satisfaction in private and public hospitals in Jordan. The resultsindicated that assurance impacted on patients’ satisfaction. In Jordan Government hospitals, thepatients and staff perceived that assurance is practiced on wider scale compared to the otherdimensions of medical services (Diab, 2012).Better quality of healthcare services contributes to building satisfaction and loyalty among patients.Privacy and safety which are elements of assurance, positively relate with patient loyalty (Ilyas,Malik & Shabbir, 2018). As the findings of the reviewed studies revealed that assurance is animportant variable that affects patients’ satisfaction, the second hypothesis is framed as:107CUeJAR Volume 2 Issue 1 2020
City University eJournal of Academic Research (CUeJAR), 2(1) 2020; 105-115H2: Assurance influences patient’s satisfaction in the specialist clinics of a MalaysianGovernment Hospital.Tangibles and patient satisfactionTangibles refer to the appearance of physical facilities, equipment, personnel and communicationmaterials (Kotler & Keller, 2016). Tangibles are physical appearance of equipment, facilities,written materials and staff (Zeithaml et al., 2006). Cong and Mai (2014) also suggests that tangiblesare items or physical evidence which are related directly to the facility concerned. Therefore,tangibles are basically the appearance of equipment used, the staff or employees and the writtenmaterials for the patient’s use and convenience in the hospital dependably and accurately. Physicalfacilities, equipment and appearance of personnel are elements of tangibles and they impact onservice quality (Rehaman & Husnain, 2018). Tangibles have a positive relationship with customersatisfaction level (Parasuraman et al., 1988).The findings of studies on service quality suggested that tangibles have a positive correlation withpatient satisfaction in private and public hospitals (Alghamdi, 2014; Kamyar et al., 2014; Aldamen, 2017; Javed & Ilyas, 2018; Javed and Liu, 2018). Punnakitikashem, Buavaraporn,Maluesril and Lellartapin (2012) found that the biggest gap between patients’ perception andexpectation is in term of tangibility. Tangibles is the highest expectation of outpatients in theprivate hospitals of Iran (Zarei, Arab, Froushani, Rashidian & Tabatabaei, 2012). A studyconducted on outpatients in private Thailand hospitals found that tangibles impact patientsatisfaction (Yousapronpaiboon & Johnson, 2013). A subsequent study by Devi and Muthuswamy(2016) on service quality perception in multispecialty hospitals in India also found that tangibilityis an important dimension of hospital service quality as perceived by patients. Alasad and Muayyad(2003) found that patients in surgical wards had lowest levels of patients’ satisfaction with nursingcare at a major teaching hospital in Jordan. Zamil et al. (2012) investigated the impact of healthservice quality on patients’ satisfaction in private and public hospitals in Jordan and they also foundthat tangibility impacts on patient's satisfaction. Diab (2012) found that Government hospitals inJordan applied medical service dimensions of tangibility at high level from patient and staffperspective. Ilyas et al. (2018) also contended that better quality of healthcare services inclined tobuild satisfaction and loyalty among patients. The healthcare service quality aspects, such asphysical environment and communications, are elements of tangibles and these positively relatewith patient loyalty. As the results suggested that tangibles are an important variable that affectspatients’ satisfaction, the third hypothesis is framed as:H3: Tangibles influences patient’s satisfaction in the specialist clinics of a MalaysianGovernment Hospital.Empathy and patient satisfactionEmpathy is the provision of attention, caring and respect shown to every individual customer(Kotler & Keller, 2016). Empathy is an important dimension of SERQUAL model that measuresthe relationship and understanding between patients and employees of the hospital (Lee et al.,2000). Empathy has a positive relationship between service quality and customer satisfaction(Parasuraman et al., 1988). Empathy is the attention that is given caringly and individually to afirm’s customers, there are several ways of displaying empathy including knowing the customernames, needs and preferences, which help to provide customized service and competitiveadvantage over larger firms (Zeithaml et al., 2006). In hospitals, empathy refers to patientsbenefiting from dependable and accurate attention provided by the hospitals. Kim, Kaplowitz and108CUeJAR Volume 2 Issue 1 2020
City University eJournal of Academic Research (CUeJAR), 2(1) 2020; 105-115Johnston (2014) also said that patients’ perceptions of physicians’ empathy has the ability tosignificantly influence patient satisfaction through factors such as information exchange,interpersonal trust, partnership and perceived expertise.A study by Kamyar et al. (2014) on patients’ satisfaction in two public hospitals in Malaysia foundthat respect and caring impacted on patients’ satisfaction. Patient satisfaction is most stronglyrelated to empathy in public sector (Javed & Ilyas, 2018). Studies on service quality conducted inPakistan and Jordan highlighted that empathy determined the level of patient satisfaction in privateand public hospitals (Alghamdi, 2014; Al-damen, 2017; Javed & Liu, 2018). A study conductedby Yousapronpaiboon and Johnson (2013) on outpatients in private Thailand hospitals found thatempathy affected patient satisfaction. Zamil et al. (2012) investigated the impact of health servicequality on patients’ satisfaction in Jordanian private and public hospitals and found that empathydoes impact on patient's satisfaction. Alghamdi (2014) indicated that patient satisfaction wasinfluenced by health service quality, with the empathy dimension as the greatest influence onpatient satisfaction in government hospitals in Southern Saudi Arabia. Ilyas et al. (2018) found thatempathy, an element of the healthcare service quality of a customer-friendly environment,positively related with patient loyalty. The factors that impacted on service quality are care andindividualized attention provided by the hospital to its customers, which are elements of empathy(Rehaman & Husnain, 2018). Kwateng, Lumor and Acheampong (2019) indicated that there ishigher level of care and attention provided at private healthcare facilities than the public healthcarefacilities. As the results of the reviewed studies highlighted that empathy is an important variablethat affects patients’ satisfaction, the fourth hypothesis is framed as:H4: Empathy influences patient’s satisfaction in the specialist clinics of a MalaysianGovernment Hospital.Responsiveness and patient satisfactionResponsiveness is the willingness to help and provide prompt services to customers when requestsare made (Kotler & Keller, 2016). This SERQUAL dimension measures how hospital staff respondto the patient’s needs (Lee et al., 2000). Parasuraman et al. (1988) stated that responsiveness has apositive relationship between service quality and customer satisfaction. Zeithaml et al. (2006)viewed responsiveness as the helpfulness and willingness of staff to provide service promptly.Therefore, in respect of hospitals, responsiveness relates to the willingness of hospital staffproviding prompt and dependable services.The findings of previous studies on service quality found that responsiveness affects patients’satisfaction in private and public hospitals (Alghamdi, 2014; Kamyar et al., 2014; Al-damen, 2017;Javed & Ilyas, 2018; Javed & Liu, 2018). A study on outpatients in private Thailand hospitalsfound that responsiveness positively correlated with patient satisfaction (Yousapronpaiboon &Johnson, 2013). In India, responsiveness is one of the important dimensions of hospital servicequality as perceived by patients (Devi & Muthuswamy, 2016). In Jordan, the responsiveness wasfound to have the lowest impact on service quality dimensions in public and private hospitals(Zamil et al., 2012). As the results suggested that responsiveness is an important variable thataffects patients’ satisfaction, the fifth hypothesis is framed as:H5: Responsiveness influences patient’s satisfaction in the specialist clinics of AMalaysian Government Hospital.109CUeJAR Volume 2 Issue 1 2020
City University eJournal of Academic Research (CUeJAR), 2(1) 2020; 105-1153. Research MethodologyThis study examined the relationship between medical service quality and patient satisfaction.Authorities draw distinctions on whether case studies should be employed as a method or used asa technique (McGuire, 1985). Perry & Coote (1994) clarified that the case study method is aprocedure of inquiry and technique used is an instrument the overall research effort for datacollection. A Malaysian Government hospital was used as a case study technique. The studyemployed a cross sectional design and quantitative approach to examine the relationship betweenthe service quality dimensions and customer satisfaction constructs. A 5-point Likert scale rangingfrom 1 being ‘strongly disagree’ and 5 being ‘strongly agree’ were used for attitude measurement.The target population for this research were the outpatients who had prior appointments with thespecialist clinics in the selected Malaysian Government hospital. A questionnaire survey wasadministered to 223 respondents who were selected via a systematic random sampling methodfrom the specialist clinics in the hospital. The Pearson correlation and regression analyses wereused for data analysis.4. ResultsTable 1: Pearson Correlation AnalysisVariableResponsiveReliabilityPatients’ Satisfaction.393**.411*Source: Developed from the survey ble 1 above shows the Pearson’s correlation for the relationship between responsiveness andpatient satisfaction. The Pearson’s correlation coefficients for the relations between responsivenessand patient satisfaction is 0.393 at 0.001 significant level (r 0.393). The Pearson correlationcoefficient for the relationship between reliability and patient satisfaction is 0.411 at 0.001significant level (r 0.411). The Pearson’s correlation coefficient between tangibles and patientsatisfaction is 0.527 at 0.001 significant level (r 0.527). The Pearson’s correlation
(2003) found that patients in surgical wards had lowest levels of patients’ satisfaction with nursing care at a major teaching hospital in Jordan. Zamil et al. (2012) investigated the impact of health service quality on patients’ satisfaction in p
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