1.7.1 Overview of the service sector
The service sector is that section of economic activities
that provides intangible goods. It can range from communication, insurance,
administrative, electricity generation, banking, retail trades and health care
services. Unlike the manufacturing sector, the service sector employs intensive
human capital rather than natural capital (Fernandes, 2009:469). In the modern
economy, the service sector has grown considerably
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compared to other sectors in the world economy. Over two
thirds of economic activities in the globe are comprised of services. In
European and Asian countries, service sector has considerably increased. The
sector encompasses more labour force than any other sector, and this has led to
economic growth and a decrease in the poverty level (World Bank, 2006:6).
The World Bank (2008:2) report shows a positive relationship
between efficiency in services and economic expansion in most parts of the
world. Increasing activities in the
service sector have progressively led to enhancing aggregate
productivity and
efficiency of other sectors in most countries'
economies.
1.7.2 Service marketing in health care
organisations
Service marketing in the hospital industry refers to the
planning, implementation and control of medical services delivery designed to
target patients' needs through the use of an effective, price conscious,
communication and distribution strategy (Dosen, 2009:205). Services marketing
has become the focus point of most health care organisations and hospitals are
willing to invest in service marketing. Services that meet patients'
expectations often result in a positive word-of-mouth, patient loyalty,
hospital profitability and patient satisfaction with medical care (Olusoji,
2009:7).The importance of sustaining a marketing strategy in hospitals has
arisen from the rise of rivalry, when there is a growing number of medical
institutions in the same region or when resources and customers become scarce,
for instance. Another driving force to sustain a marketing strategy is where
hospitals spending on services exceed their limited financial support (Dosen,
2009:206).
Because of the limited financial resources in both private
and public hospitals, health care executives have ventured to be more
interested in services marketing. Services marketing can promote effective
partnership between all the associates in the medical network such as patients,
potential associates, medical staff and executives. This aspect is vital to the
success of an organisation (Zainuddin, Previte & Russell-Bennett,
2011:364). In addition, health care services result from a high level of
interactions between medical staff and patients. Therefore, medical
professionals should exercise services marketing know-how and their expertise
to effectively inform patients and
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address their health concerns. This is critical to enhance
service quality in health care (Dosen, 2009:206).
Furthermore, patients in the new millennium are well informed
about services quality; this has resulted from the expansion of the Internet.
Patients can today review, evaluate and compare services from one service
provider to another. Hospitals are currently required to improve their services
marketing in order to remain competitive (Dosen, 2009:207).
1.7.3 Service quality
Service quality is a complex approach due to its intangible,
heterogenic, inseparable and perishable characteristic. Measuring service
quality should be closely associated with the user's perceptions and
expectations of services provided (Naik, 2010).In health care settings, quality
care that meets patient expectations will often lead to satisfaction compared
to those that do not (Al Sharif, 2008:2).
Achieving service quality has become a central vision in most
health care organisations, since superior services can lead to patient loyalty
and retention (Olusoji, 2009:7). Services marketing has become a new tool as it
can significantly influence the behaviour of health care services users and
improve service quality provided in hospitals (Revere, 2010:39). Most hospitals
use the Internet as a services marketing tool for instance to market their
services to patients. The latter usually access the Internet to have
information about the type of service provided in health care (Revere,
2010:39).The Internet can enable interactions between services providers and
patients, who regularly assess and compare quality care in hospitals. Patients
can post, suggest or rate service quality performance via the Internet. This
has led hospitals to capitalise patients' views and expectations on medical
services and to improve quality (Revere, 2010:40).
1.7.4 Service quality and patient
satisfaction
Services quality is strongly correlated to patient
satisfaction in health care. Superior services often lead to a high degree of
patient satisfaction, patients' retention and loyalty (Olusoji, 2009:7). As a
result, a positive word-of-mouth is observed as patients will refer the medical
facility to friends and family (Kyle, 2010:3).
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Kim (2008:6) explained in his research on childbirth that a
decline in service quality experienced by women after childbirth in Home Health
Agency in the United States, led to a decline in women satisfaction with
services provided. This study confirms that the level of services provided in
medical care is a predecessor of satisfaction or dissatisfaction. As a result,
patient satisfaction with services is regarded as a fundamental condition to
adherence and fidelity. Another study showed that patients value services in
health care more on functional quality, instead of on technical quality
(Yesilada & Direktor, 2010: 963). Technical quality relates to the
precision of the medical process that leads to cure, while functional quality
refers to the way medical services are administered to patients, such as care.
This leads patients to value more interpersonal relationships with medical
staff. Functional quality is seen to be positively linked to patients'
satisfaction or dissatisfaction with services provided in health care. In this
regard, patients often rely more on attitudes such as `care' of the service
provider as an indicator of service quality, rather than the `curing
performance' in health care (Mekoth et al., 2012: 17-18).
Thus, care is regarded to be positively linked to patient
satisfaction. Medical doctors often concentrate on providing the correct
treatment to patients and they think this is the main concern of patients. As a
result, patients' views of services quality may deviate from the services
providers'. This may lead to patients' dissatisfaction with services provided,
as the latter may usually require more attention and care from physicians
(Yesilada & Direktor, 2010: 963).
1.7.5 Measuring service quality using the SERVQUAL
instrument
Service delivery in health care has significantly improved in
recent years. Competition among health care service providers has forced
medical services to review their service delivery systems. Health care policies
have shifted towards providing services that satisfy the needs and desires of
patients. This new approach emphasises the views and needs of patients in
contrast to the former approach that focused on preferences and decisions of
medical employees (Desai, 2011: 40).Various studies have indicated a positive
relationship between service quality in hospitals, patient satisfaction and
loyalty (Olusoji, 2009:7).Quality often leads to patient satisfaction.
Satisfied patients are more likely to repeat purchases and remain faithful,
which leads to a positive word-of-mouth
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and an increase in hospital profitability (Desai, 2011:41). In
order to understand satisfaction in health care, researchers have investigated
different service quality dimensions considered to influence patient
satisfaction (Desai, 2011:40).
They developed the SERVQUAL instrument to evaluate service
quality. The model has been used and adapted to a broader range of service
industries, including in hospital settings. SERVQUAL is used to assess the gap
between patients' perceptions, expectations of services and the actual service
performance. (Yesilada & Direktor, 2010:963).The model is composed of 22
pairs of Likert-scale statements built around five service quality elements
such as tangibility, reliability, responsiveness, assurance and empathy to
evaluate quality in health care (Desai, 2011:42). These service quality
dimensions are reviewed by patients and considered to influence patient
satisfaction (Desai, 2011: 40).
Tangibility: It encompasses the physical evidence of
a service (Holder, 2008:47).This refers to variables ranging from physical
environment, biochemistry laboratories, hospital rooms, cleanliness in
hospitals, to equipment like scanners, X-rays, tread- mills, computers,
appearance and uniforms of medical personnel. Tangibility is crucial in the
delivery of services in hospitals as it can reduce the gap between patients'
expectations and the actual delivery of service (Holder, 2008:23). It provides
a picture of what is inside a hospital and can influence patients' choice when
selecting a health service provider (Zeithaml, Bitner & Gremler,
2006:319).Tangibility is viewed to significantly influence patients'
satisfaction level with services provided (Rohini, 2006:68).
Reliability: It entails providing regular
performance and dependability (Holder, 2008:47). It refers to the ability of
medical staff to honour their promises and provide the promised services to
patients timely and correctly (Rezaei, Rezaei, Alipour & Salehi, 2011:486).
Such services may include casualty, emergency service and prompt treatment for
instance (Rohini, 2006:68). Reliability is perceived to influence patients'
satisfaction level with care, and constitutes one of the major factors by
patients when selecting a medical service provider (Rohini, 2006:68).
Responsiveness: It is an important constituent of
service quality dimensions. It refers to the readiness of the medical personnel
to assist patients and to offer prompt service (Hernandez et al., 2009:1174).
Such services may include patients' admission, discharge, and excellent
reception. Patients' satisfaction often results from hospitals where employees
are kind, helpful and available to provide quick answers to their
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needs. Responsiveness is perceived to have an effect on
patients' satisfaction level with services, and is highly regarded to influence
their choice with care in hospitals (Rohini, 2006:69).
Assurance: It involves integrity, trustworthiness
and credibility of medical personnel. It refers to the ability of medical
employees to have patients' best concern at heart (Holder, 2008:47). Assurance
leads to providing trust and confidence to the recipient of the service. This
may result from expertise of medical personnel like their qualifications,
trainings, educational level and their ability to effectively provide services
and interact with their patients in hospitals. Assurance is seen to determine
patients' choice with services, and to considerably influence their
satisfaction level with medical care (Rohini, 2006:69).
Empathy: It refers to the ability of medical staff to
provide care, assistance and attention to patients. Physicians should be able
to assist patients during the process of care, and should be able to understand
their needs, listen to and notify them about their health concerns (Markovic
& Raspor, 2010: 197).
As a result, the level of attention and emotional support
experienced by patients in health care can impact on their satisfaction level
with services. This can in turn influence their choice when selecting a
hospital (Rohini, 2006:69).
These five dimensions of quality are known to be linked to
patients' satisfaction and to influence their choice when selecting a medical
facility in general (Desai, 2011: 41). However, there is no clear understanding
of which dimension is mainly influencing patient satisfaction and choice for
the selected hospital in this current study.
