International Journal of Quality and Service Sciences

Emerald Article: Primary health care services quality in Spain: A formative measurement approach using PLS path modeling Francisco J. Miranda, Antonio Chamorro, Luis R. Murillo, Juan Vega

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To cite this document: Francisco J. Miranda, Antonio Chamorro, Luis R. Murillo, Juan Vega, (2012),"Primary health care services quality in Spain: A formative measurement approach using PLS path modeling", International Journal of Quality and Service Sciences, Vol. 4 Iss: 4 pp. 387 - 398 Permanent link to this document: http://dx.doi.org/10.1108/17566691211288368 Downloaded on: 12-01-2013 References: This document contains references to 39 other documents To copy this document: permissions@emeraldinsight.com This document has been downloaded 14 times since 2012. *

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Primary health care services quality in Spain

A formative measurement approach using PLS path modeling
Francisco J. Miranda and Antonio Chamorro
Business Management and Sociology Department, Faculty of Economics and Business Management, University of Extremadura, Badajoz, Spain, and

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Luis R. Murillo and Juan Vega

Applied Economy Department, Faculty of Economics and Business Management, University of Extremadura, Badajoz, Spain
Abstract
Purpose Service quality is an elusive and abstract construct, so that particular effort is required to establish a valid measure. Patients perceptions of health services seem to have been largely ignored by health care providers. The purpose of this paper is to propose a modied approach to the measurement of service quality in a primary health care setting. Design/methodology/approach Through the use of the HEALTHQUAL scale adapted from the SERVQUAL scale to the context of primary health care centres, the authors measure the perceptions of service quality reported by both users and health centre managers in Spain. Taking service quality to be a construct of a formative nature, the authors propose a modication for its measurement using partial least squares (PLS) path modelling, as recommended in the literature for the modeling of formative constructs. Findings It is found that the model provides health centre managers with a tool for the measurement of functional quality in their organization. The results reveal the importance of health staff attributes and efciency measures for the perception of health centre quality. Research limitations/implications The model can also be used to measure how health care centre managers believe that patients perceive the quality of their service. This allows the potential gap between the providers view and the customers view to be assessed and monitored. Originality/value The paper extends the previous literature in two directions. First, based on SERVQUAL, it presents a general framework for measuring primary health care service quality as a construct of a formative nature. Second, it is the rst application of PLS path modeling to the simultaneous examination of both users and health centre managers perceptions in a European context. Keywords Spain, Health care, Health services, HEALTHQUAL, Patient perception, Service quality Paper type Research paper

1. Introduction The past few decades have seen considerable effort directed towards improving systems of quality management in the health care systems of a number of countries.
This work was supported with funds provided by the Extremadura Health Department (Junta de Extremadura).

International Journal of Quality and Service Sciences Vol. 4 No. 4, 2012 pp. 387-398 q Emerald Group Publishing Limited 1756-669X DOI 10.1108/17566691211288368

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Recently, increased emphasis on primary health care funding and service delivery has led to a sharper focus on the development of performance and quality indicators in primary health care. Indeed, because of the proliferation of ad hoc performance measures and sets of indicators, often lacking any sound theoretical basis for their selection, various authors have felt it necessary to put forward precise denitions and criteria to help in the development of evidence-based indicator sets suitable for a primary health care setting (Perera et al., 2007). Rapid movement towards systems of managed care and integrated delivery networks has led health care providers to recognize that they face real competition. To be successful, or even just to survive in this hostile environment, it is crucial to provide health care recipients with service that meets or exceeds their expectations. At the same time, it is important to know which dimensions of health care services physicians believe are necessary for excellence in the service. It is also crucial when shaping a health care delivery system to have a clear understanding of the service quality perceptions possessed both by recipients and by providers (Lee et al., 2000). Health care centre managers may consider that they are delivering a service of good quality after analysing a group of attributes of this service. But it may happen that the patients themselves evaluate these attributes differently, or that they consider a different group of attributes when reporting their perception of the service delivered. In this case, managers will not have a true picture of the quality of the service that is offered, and may make errors when they come to dene improvements to that service. For the success of health care organizations, accurate measurement of health care service quality is as important as understanding the nature of the service delivery system. Without a valid measure, it would be difcult to establish and implement appropriate tactics or strategies for service quality management. The most widely known scale for measuring service quality is SERVQUAL (Parasuraman et al., 1988). This scale has been applied to the health care eld in numerous studies (Babakus and Mangold, 1992; Brown and Swartz, 1989; Carman, 1990; Headley and Miller, 1993; Walbridge and Delene, 1993). However, with a few exceptions, these studies did not systematically examine the psychometric properties of the scale because their remit was to deal with pragmatic and managerial issues for health care services. Indeed, the validity of the SERVQUAL scale seems yet to be fully established. Therefore, the purpose of the present article is to propose a modication of this scale for service quality measurement based on the conceptualization suggested by Parasuraman et al. (1988). In doing so, we take account of recent criticisms of SERVQUAL. In particular, we agree with the notion of Rossiter (2000, p. 315) that service quality is a construct of a formative nature. In considering whether a construct is formative or reective, we re-conceptualize service quality as a second-order formative index[1]. We use partial least squares (PLS) path modeling as the most appropriate method for second-order formative constructs (Roy et al., 2012). This communication thus extends the existing literature in two directions. First, it presents a general framework based on SERVQUAL for measuring primary health care service quality as a construct of a formative nature. Second, it is the rst application of PLS path modeling that simultaneously examines both users and health centre managers perceptions in a European context. At the practical level, we assessed the representativeness of the SERVQUAL items as they relate to health care centre services. Unlike prior studies with similar objectives,

the present work considered a wide range of attributes to reect the most relevant dimensions in this type of service. In addition to the appropriateness of the content, that of the length of the scale was also a major consideration given the population under study. The potential usefulness of the results was enhanced by the fact that health care practitioners were actively involved in the research process. The rest of the paper is structured as follows. First, we analyse the different service quality measurement scales proposed in the literature. Next, we describe the methodological approach taken to measuring the perceptions of users and managers of health care centres. We then analyse the main results of our study, and nish with a section of conclusions and nal reections. 2. Literature review The quality of health care has been dened as the ability to achieve desirable objectives using legitimate means (Donabedian, 1988, p. 173), where the desirable objectives imply an achievable state of health. Thus, quality is ultimately attained when a physician properly helps his or her patients to reach an achievable level of health, and they can thus enjoy a healthier life. Because patients in general are unable to properly assess the technical quality of the health care services they receive, they are led to rely more heavily on other dimensions, such as credibility or tangibility, to infer the quality of a health care service (Bowers et al., 1994). Although service recipients perceptions towards service is valuable for improving health care service quality, it is as important to understand physicians perceptions of service quality when designing and improving the health care delivery system. A system cannot be designed and operated effectively unless the quality of the product or service can be understood or correctly measured. One major advance towards developing quantitative measures of service quality was made by Parasuraman et al. (1988), and their SERVQUAL scale was the consequence of this effort (Parasuraman et al., 1988). However, the conceptual foundation and empirical implementation of SERVQUAL measures have been the subject of criticism. Carman (1990), for instance, questioned its methodology, and found a need to expand or add certain dimensions that are important across different services. He further questioned the differences in the perception and expectation items. Babakus and Boller (1992) agreed with Carman, and suggested that the perception and expectation items should be combined into one scale. According to Cronin and Taylor (1992), SERVQUAL confounds service satisfaction with quality, which should be measured as an attitude, and they developed their SERVPERF scale based on performance items instead of expectations. While acknowledging the contributions of Parasuraman et al., Cronin and Taylor (1992) emphasized the importance of service quality and its relationship with consumer satisfaction, service value, and purchasing behaviour and intentions. For a number of reasons, questions have also been raised about the usefulness of the SERVQUAL model. First, empirical studies led to inconsistent results regarding whether expectations should be included as a variable in measuring perceived service quality. Second, various studies (Cronin and Taylor, 1992; Finn and Lamb, 1991; Babakus and Boller, 1992; Carman, 1990) failed to conrm the generic nature of the service quality dimensions suggested by Parasuraman et al. (1988) when applying the SERVQUAL scale to different industries. Nevertheless, despite widespread criticism

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in the literature, SERVQUAL and its afliated conceptualizations of the service quality construct still constitute an important approach to service quality measurement for academics and practitioners alike (Cuganesan et al., 1997). Various researchers have criticized SERVQUAL for its use of difference scores, for its measurement of expectations, for its positively and negatively worded items, and for the instability of the dimensionality of the service quality construct, and have proposed appropriate conceptual and methodological modications (Cronin and Taylor, 1992; Brown et al., 1993; Teas, 1993; Brady and Cronin, 2001; Finn and Kayande, 2004). Other criticism pertains to the lack of a clear link between satisfaction and perceived service quality (Duffy and Ketchard, 1998; Philip and Hazlett, 1997). Consequently, Parasuraman et al. (1994) rened the original SERVQUAL model in later contributions. Unresolved problems still remain, however. Our review of the literature showed that these problems fall into three main categories: (1) the unstable dimensionality of the service quality construct; (2) an ambiguous conceptualization of that construct; and (3) problems of item measurement using difference scores. In order to resolve these problems, we propose a modication of SERVQUAL basing the measurement of service quality on its nature as a formative construct, and using the technique of PLS path modeling. By having a xed index structure, our approach holds the promise of overcoming the problem of the lack of stability of the dimensionality. Although the SERVQUAL items clearly indicate that it is a formative conceptualization, it seems mostly to have been treated as if it were a reective model. In particular, a valid overall index of service quality would be the sum of the evaluations of all service quality dimensions to which the individual responds, a denition which suggests a formative nature of the construct, as has indeed been noted in recent studies (Elias-Almeida et al., 2012). Therefore, in our model, we shall conceptualize and treat service quality as a second-order index with a formative structure. Most researchers have also found that the use of single measures outperforms the original SERVQUAL scale in terms of reliability and validity (Babakus and Boller, 1992; Cronin and Taylor, 1992; Brown et al., 1993; Dabholkar, 1993). The present work accepts this notion, measuring all items by using single, satisfaction-oriented, measures. 3. Methods and results To ensure that SERVQUAL was tailored to the research needs that are characteristic of the health care environment (Brown and Swartz, 1989; Carman, 1990; Walbridge and Delene, 1993; Miranda et al., 2010), an initial evaluation of the scale was undertaken before beginning with the main data collection effort. Input was provided both by academics and health care centre managers. Decisions to modify the instrument were based on the relevance of the items to health care services and on the ability of patients to respond to the questions without experiencing confusion or undue frustration. The scale was then administered to a small sample of patients to gather further input. This pre-test showed respondents to perceive some of the items as redundant. Considering that such redundancy could lead to frustration with the questionnaire and hence low response rates, the researchers decided to further reduce the number of items. The nal scale consisted of 25 perception items representing all the dimensions of service quality (Table I).

HQ 1 HQ 2 HQ 3 HQ 4 HQ 5 HQ 6 HQ 7 HQ 8 HQ 9 HQ 10 HQ 11 HQ 12 HQ 13 HQ 14 HQ 15 HQ 16 HQ 17 HQ 18 HQ 19 HQ 20 HQ 21 HQ 22 HQ 23 HQ 24 HQ 25

Facilities cleanliness Centres equipment Centres location Health staffs cleanliness Health staffs professionalism Health staffs kindness and courtesy Trust Personalized service Communication with health staff Health staffs attention to patients problems Health staff interest in the resolution of patients problems Health staff understand patient problems Medical staffs prestige No health staff cleanliness No health staff professionalism No health staff kindness and courtesy No health staff attention to patients problems No health staff interest in the resolution of patients problems Ease of making an appointment Level of bureaucracy Waiting times before entering the consulting room Speed of complementary tests Complaint resolution Time to focus on each patient Health care centres schedule

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Table I. HEALTHQUAL items

The pre-test also showed the existing mixture of negatively and positively worded statements to create confusion, and hence frustration, on the part of the respondents. For the present application therefore, to avoid such confusion and the consequent inaccuracy of some of the responses adversely affecting the quantity and quality of the data, the negatively worded statements in the scale were inverted to positive wording. Due to its extensive area (41,634 km2) and low population density (26.18 inhab/km2), the Region of Extremadura in Southwest Spain has structured its health care system into two territorial administrative levels of aggregation: health areas and basic health zones. There are eight health areas, each consisting of a number of basic health zones. In 2008, the total population of 1,081,845 inhabitants was covered by 105 basic health zones, with the corresponding health care centre being the main provider of primary health care services for each zone. Questionnaires were mailed to 20,000 patients who had used the health care services of Extremadura within a period of one month. We also provided an on-line version of the questionnaire for users who preferred to complete it through the web. There were 2,556 returns, for a 12.78 percent response rate and 1.9 percent sample error. Questionnaires were also mailed to the 105 Extremadura health centre managers. There were 88 returns, yielding a 4.2 percent sample error. The studys technical data sheet is presented in Table II. One section of the questionnaire contained the modied SERVQUAL scale, with 25 statements relating to patients perceptions of the quality of service actually delivered. The instrument also contained some questions about the patients overall

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Target population Geographical area Sample size Sample error (%) Condence level Sample design Period of data collection

Users Users of Extremadura health service Extremadura (Spain) 2,566 questionnaires 1.9 95%, z 1.96, p q 0.5 Stratied random sampling (proportional to the users of each health care centre) 10 September 2008 to 15 January 2009

Managers Managers of Extremadura health service 88 questionnaires 4.2 Entire population

392
Table II. Studys technical data sheet

perceptions of health care centre quality. A nal set of questions pertained to the respondents social-demographic characteristics. Comparison of the respondents gender and age composition with those of the targeted population showed no signicant differences between the groups, consistent with the absence of non-response bias. The demographic prole of the respondents is presented in Table III. The largest group of respondents (60.15 percent) were aged . 65 years. The next largest group (28.2 percent) were aged 30-45 years. Female respondents represented a little more than 60 percent of the survey population. In contrast with conventional studies on service quality, we conceptualized our focal construct as a second-order formative index instead of as a reective construct. We followed the guidelines for constructing formative scales proposed by Diamantopoulos and Winklhofer (2001). Those authors identify four issues that are critical for successfully constructing such scales: (1) Content specication. (2) Item specication. (3) (Lack of) item collinearity. (4) External validity. (1) Content specication. We sought to capture the full range of service quality using the traditional components of health service quality. According to previous studies (Miranda et al., 2010), primary health service quality is regarded as a formed attribute with four components, each of which is also a formed attribute. These components are health staff service quality, no health staff service quality, facilities, and efciency measures. (2) Item specication. For the design of valid scales, the choice of items is crucial because they must capture the entire scope of the latent construct. We applied a multi-item scale which we derived directly from SERVQUAL due to the latters extensive use among health researchers (Babakus and Mangold, 1992;

Table III. Prole of surveyed users

Gender Age

Male: 39.85% , 30 years: 9.6% 45-64 years: 24.98%

Female: 60.15% 30-45 years: 28.23% . 65 years: 60.15%

Brown and Swartz, 1989; Carman, 1990; Headley and Miller, 1993; Walbridge and Delene, 1993; Lee et al., 2000). (3) Item collinearity. Since formative latent variables are dened by their items, systems of linear equations are applied as measurement models. Hence, if no precautionary steps are taken, any substantial collinearity among the items could affect the stability of their coefcients. In our case, however, none of the 25 items of the four service quality dimensions or sub-factors showed any problems of collinearity. (4) External validity. The very nature of formative measurement renders conventional assessments of convergent validity and individual item reliability irrelevant (Hulland, 1999, p. 201 et sequation). The best one can do is to examine how well the index relates to measures of other variables. As customer overall satisfaction and perceived service quality are two closely related, albeit different, constructs (Dabholkar, 1993), customer overall satisfaction is a good indicator for measurement validity. Satisfaction is perceived as a more general or inclusive construct, since quality is one of the aspects on which satisfaction is based (Oliver, 1993; Zeithaml and Bitner, 2000). We used the SmartPLS (partial least squares) software package to estimate the path coefcients, composite reliability, average variance extracted (AVE), and R 2, applying bootstrap re-sampling. The PLS technique is based on an iterative combination of principal components analysis and regression. The objective is to explain the variance of a models constructs. Its advantages are that it simultaneously estimates all the path coefcients and individual item loadings in the context of a specied model, and thus enables researchers to avoid biased and inconsistent parameter estimates. The technique is gaining popularity in consumer and service research. Recent work (Chin et al., 2003) has shown that, by reducing type II errors, PLS is an effective analytical tool for testing interactions. By creating a latent construct which represents the interaction term, a PLS approach signicantly reduces the type-II error problem by accounting for the measure-related error. In particular, PLS models are based on prediction-oriented measures, not on covariance tting as are covariance structure models (or the LISREL program). As Roy et al. (2012) suggest, the PLS approach lends itself well to modeling formative constructs. This is primarily for three reasons. First, using PLS, a researcher can test a formative latent variable in isolation. Second, there are less stringent constraints on sample size, residual distributions, or assumptions about the normality of the data. And third, the recent availability of software based on the PLS approach (such as PLS Graph, VisualPLS, SMARTPLS, SPADPLS) has led to better understanding of the associated requirements and issues. The adequacy of the measurement scale is assessed by evaluating the reliability of the individual items and the discriminant validity of the constructs (Hulland, 1999). In the present case, the factor loadings of each item were above 0.707, indicating that more than 50 percent of the variance in the observed variable is explained by the construct (Carmines and Zeller, 1979). Figure 1 shows the results of the structural model. The standardized path coefcients are shown alongside the corresponding causal arrows. The bootstrap re-sampling technique, considering 500 sub-samples, was applied to assess the t-test values and

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HQ1 HQ3

. . .

Facilities 0.0883

394

HQ4 HQ13

. . .

Health Staff Quality

0.4817 Perceived Quality 0.8683 Satisfaction R2 = 0.7539 0.2725 . . .

Sat1 Sat3

HQ14 HQ18

. . .

No Health Staff Quality

0.2963

HQ19

Figure 1. Structural results

. . .

Efficiency

HQ25

determine whether or not each causal order was signicant. All the path coefcients were found to be signicant at the 0.001 level, with signs in the expected direction. The quality of the t was good as evaluated by the overall goodness-of-t index proposed by Tenenhaus et al. (2005) (GoF 0.77). The model also demonstrated a high level of predictive power since the modeled constructs explained 73.4 percent of the variance in satisfaction. To investigate the possibility of discrepancies between patients and health centre managers perceptions of service quality, we performed a parametric analysis using an m n 2 degrees-of-freedom t-test (m patient sample size, and n manager sample size). This test uses the path coefcients and the standard errors of the structural paths as calculated by PLS with the samples of the two groups, using the following expression (Chin, 2004):

bPatients 2 bManagers p S p x 1=m 1=n s m 2 12 n 2 12 Sp xSE 2 xSE 2 Patients Managers m n 2 2 m n 2 2

t Table IV lists the standardized path coefcients of the structural model for the two samples (patients and health centre managers). Health staff quality and efciency were more important for managers than for patients, while no health staff quality and facilities were more important for patients than for managers. The t-test result showed only the perception of the facilities dimension to be signicantly different between patients and managers (at a critical t-value of 1.960) (Table V). In particular, in their perception of quality, managers value the importance of facilities less than users do.

4. Conclusion In this communication, we have proposed a modied approach to the measurement of service quality. This approach is based on the conceptualization of service quality suggested by Parasuraman et al. (1988). A review of the literature rst showed that there seems to have been no published SERVQUAL study of primary health care in Europe, and second identied various problems associated with the measurement of service quality using that scale. To resolve these problems, we developed an alternative measurement approach in which service quality is conceptualized as a second-order formative index instead of a reective construct as has before been the case in research. Unlike previous studies with similar objectives, in the present work, a wide range of attributes was considered to reect the most relevant dimensions in this type of service. The model comprised four interrelated dimensions: health staff quality attributes, efciency measures, no health staff quality attributes, and facilities. The path values resulting from the use of PLS path modeling provided a direct assessment of the importance of each of these service quality dimensions. Our model also provides health centre managers with a tool for the measurement of functional quality in their organization. The results show the importance of health staff attributes and efciency measures for the perception of quality in health centres. One of our measurement models major contributions to the health care industry will be its capacity to identify symptoms of underlying problems, and to provide a starting point from which to examine how they might be inhibiting the provision of quality services. In order to promptly identify and correct service quality problems, managers need to understand patients perceptions of the quality of the service that is delivered. To this end, the measurement of patient perceptions provides invaluable insight into how patients assess this quality. Our model can also be used to measure how health care centre managers believe that patients perceive the quality of their service. This allows the potential gap between the providers view and the customers view to be assessed and monitored (Parasuraman et al., 1988).
Patients Efciency ! perceived quality Health staff quality ! perceived quality No health staff quality ! perceived quality Facilities ! perceived quality Perceived quality ! satisfaction 0.2725 0.481 0.296 0.088 0.868 Managers 0.301 0.673 0.140 2 0.046 0.863

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Table IV. Patients vs managers perceived quality

SE patients Efciency ! perceived quality Health staff quality ! perceived quality No health staff quality ! perceived quality Facilities ! perceived quality Perceived quality ! satisfaction 0.0190 0.0228 0.0160 0.0122 0.0325

SE managers 0.1333 0.1223 0.0877 0.0904 0.0564

SP 0.9732 1.1552 0.8085 0.6249 1.6222

b patients-b managers 2 0.0285 2 0.192 0.156 0.134 0.005

t-test 2 0.2701 2 1.5331 1.7798 1.9779 0.0284 Table V. Multigroup analysis

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No research ndings are without limitations. In the present case, rst the results should be contrasted with new data that might or might not conrm them. Second, the data came from a sample based on health care centres in Spain. The results should be contrasted with studies in other countries so that the measurement instrument can be generalized to other contexts. The ndings have clear implications for managing primary health care centres. The study showed that the perceived quality of a health care centre depends mainly on dimensions closely linked to: . the health personnel who are in direct touch with the customer; and . certain efciency measures. From the practical point of view, managers of health care centres should use the measurement model periodically to evaluate their users service quality perceptions so as to help orient their practices to providing user satisfaction. The information obtained from the model will constitute an indicator of the perceived levels of service quality. Good management of the dimensions established in this study could lead to improvement in the levels of patient satisfaction. In this line, it would be useful to carry out further studies to obtain evidence on how such management actually affects user satisfaction. Finally, it should be borne in mind that the present model is designed to measure functional quality only (dened as the manner in which the health care service is delivered to the patient). However, functional quality in a health care setting cannot be sustained without accurate medical diagnoses and procedures. Hence, to understand the real institutional value of practices such as quality management in health care, technical dimensions also need to be taken into account. The long-term success of a health care organization will require the effective management of both its functional and its technical quality.
Note 1. Practical guidelines exist to assist researchers in the development and evaluation of reective and formative constructs (Jarvis et al., 2003; MacKenzie et al., 2005). A simple exercise discussed in Chin (1998) asks the question: Is it necessarily true that if one of the items (assuming all coded in the same direction) were to suddenly change in a particular direction, the others will change in a similar manner? If one answers no to this question, the construct is formative. References Babakus, E. and Boller, G.W. (1992), An empirical assessment of the SERVQUAL scale, Journal of Business Research, Vol. 24, pp. 253-68. Babakus, E. and Mangold, W.G. (1992), Adapting the SERVQUAL scale to hospital services: an empirical investigation, Health Services Research, Vol. 26, February, pp. 767-86. Bowers, M.R., Swan, J.E. and Taylor, J.A. (1994), Inuencing physicians referrals, Journal of Health Care Marketing, Vol. 14, Fall, pp. 42-50. Brady, M.K. and Cronin, J.J. (2001), Some new thoughts on conceptualizing perceived service quality: a hierarchical approach, Journal of Marketing, Vol. 64, July, pp. 34-49. Brown, S.W. and Swartz, T.A. (1989), A gap analysis of professional service quality, Journal of Marketing, Vol. 53 No. 4, pp. 92-8.

Brown, T.J., Churchill, G.A. and Peter, J.P. (1993), Improving the measurement of service quality, Journal of Retailing, Vol. 69 No. 1, pp. 127-39. Carman, J.M. (1990), Consumer perceptions of service quality an assessment of the SERVQUAL dimensions, Journal of Retailing, Vol. 66 No. 1, pp. 33-55. Carmines, E.G. and Zeller, R.A. (1979), Reliability and Validity Assessment, Sage, London. Chin, W.W. (1998), Issues and opinion on structural equation modeling, MIS Quarterly, Vol. 22 No. 1, pp. vii-xvi. Chin, W.W. (2004), Frequently asked questions-partial least squares and PLS-graph, available at: http://disc-nt.cba.uh.edu/chin/plsfaq.htm Chin, W.W., Marcolin, B.L. and Newsted, P.R. (2003), A partial least squares latent variable modelling approach for measuring interaction effects: results from a Monte Carlo simulation study and an electronic mail emotion/adoption study, Information Systems Research, Vol. 14 No. 2, pp. 189-217. Cronin, J.J. and Taylor, S.A. (1992), Measuring service quality a reexamination and extension, Journal of Marketing, Vol. 65, July, pp. 55-68. Cuganesan, S., Bradley, G. and Booth, P. (1997), Service quality and organizational performance indicators, in Kunst, P. and Lemmink, J. (Eds), Managing Service Quality, Vol. 3, Chapman, London, pp. 161-82. Dabholkar, P.A. (1993), Customer satisfaction and service quality: two constructs or one?, in Cravens, D.W. and Dickson, P.R. (Eds), Enhancing Knowledge Development in Marketing, American Marketing Association, Chicago, IL, pp. 10-18. Diamantopoulos, A. and Winklhofer, H.M. (2001), Index construction with formative indicators: an alternative to scale development, Journal of Marketing Research, Vol. 38, May, pp. 269-77. Donabedian, A. (1988), Quality assessment and assurance: unity of purpose, diversity of means, Inquiry, Spring, pp. 175-92. Duffy, J.A. and Ketchard, A.A. (1998), Examining the role of service quality in overall satisfaction, Journal of Managerial Issues, Vol. 10 No. 2, pp. 240-55. Elias-Almeida, A., Almeida, P. and Miranda, F.J. (2012), Customer delight as an antecedent to loyalty: analysis of ve star Hotel Spas in Portugal, working paper, Extremadura University, Badajoz. Finn, A. and Kayande, U. (2004), Scale modication: alternative approaches and their consequences, Journal of Retailing, Vol. 80 No. 1, pp. 37-52. Finn, D.W. and Lamb, C.W. (1991), An evaluation of the SERVQUAL scales in a retailing setting, Advances in Consumer Research, Vol. 18, pp. 483-90. Headley, D.E. and Miller, S. (1993), Measuring service quality and its relationship to future consumer behavior, Journal of Health Care Marketing, Vol. 13 No. 4, pp. 32-41. Hulland, J. (1999), Use of partial least squares in strategic management research: a review of four recent studies, Strategic Management Journal, Vol. 20, pp. 195-204. Jarvis, C.B., MacKenzie, S.B. and Podsakoff, P.M. (2003), A critical review of construct indicators and measurement model misspecication in marketing and consumer research, Journal of Consumer Research, Vol. 30 No. 2, pp. 199-218. Lee, H., Delenea, L.M., Bunda, M.A. and Kim, C. (2000), Methods of measuring health-care service quality, Journal of Business Research, Vol. 48 No. 3, pp. 233-46. MacKenzie, S.B., Podsakoff, P.M. and Jarvis, C.B. (2005), The problem of measurement model misspecication in behavioral and organizational research and some recommended solutions, Journal of Applied Psychology, Vol. 90 No. 4, pp. 710-30.

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Miranda, F.J., Chamorro, A., Vega, J. and Murillo, L.R. (2010), Adapting the SERVQUAL scale to primary health care services in Spain: managers vs patients perception, The Service Industry Journal (in press). Oliver, R.L. (1993), A conceptual model of service quality and service satisfaction compatible goals, different concepts, in En Swartz, T.A., Bowen, D.E. and Brown, S.W. (Eds), Advances in Services Marketing and Management Research and Practice, Vol. 2, JAI Press, Greenwich, CT, pp. 65-85. Parasuraman, A., Zeithaml, V.A. and Berry, L.L. (1988), SERVQUAL a multiple item-scale for measuring consumer perceptions of service quality, Journal of Retailing, Vol. 64 No. 1, pp. 12-40. Parasuraman, A., Zeithaml, V.A. and Berry, L.L. (1994), Reassessment of expectations as a comparison standard in measuring service quality implications for future research, Journal of Marketing, Vol. 58 No. 1, pp. 111-24. Perera, R., Dowella, T., Crampton, P. and Kearns, R. (2007), Panning for gold: an evidence-based tool for assessment of performance indicators in primary health care, Health Policy, Vol. 80 No. 2, pp. 314-27. Philip, G. and Hazlett, S.A. (1997), The measurement of service quality a new P-C-P attributes model, International Journal of Quality & Reliability Measurement, Vol. 14 No. 3, pp. 260-86. Rossiter, J.R. (2002), The C-OAR-SE procedure for scale development in marketing, International Journal of Research in Marketing, Vol. 19 No. 4, pp. 305-35. Roy, S., Tarafdar, M., Ragu-Nathan, T.S. and Marsillac, E. (2012), The effect of misspecication of reective and formative constructs in operations and manufacturing management research, The Electronic Journal of Business Research Methods, Vol. 10 No. 1, pp. 34-52. Teas, R.K. (1993), Expectations, performance evaluation, and consumers perceptions of quality, Journal of Marketing, Vol. 57 No. 4, pp. 18-34. Walbridge, S.W. and Delene, L.M. (1993), Measuring physician attitudes of service quality, Journal of Health Care Marketing, Vol. 13 No. 1, pp. 6-15. Zeithaml, V.A. and Bitner, M.J. (2000), Services Marketing Integrating Customer Focus Across the Firm, 2nd ed., McGraw-Hill, New York, NY. Further reading Donabedian, A. (1980), Explorations in Quality Assessment and Monitoring, The Denition of Quality and Approaches to Its Assessment, Vol. 1, Health Administration Press, Ann Arbor, MI. Fornell, C. and Larcker, D.F. (1981), Evaluating structural models with unobservables variables and measurement error, Journal of Marketing Research, Vol. 28, pp. 39-50. Nunnally, J. (1978), Psychometric Theory, 2nd ed., McGraw-Hill, New York, NY. Corresponding author Francisco J. Miranda can be contacted at: fmiranda@unex.es

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