Measurement of Quality of Hospital Services via SERVQUAL Model: Case

study of ESIC hospital, Kidwai Nagar, Kanpur

Ankit Bajpai & Nawaneet Chauhan

Keywords: SERVQUAL, Perceived, expected, satisfaction, service quality, ESIC

Abbreviation: ESIC (Employees' State Insurance Corporation)

Abstract
In todays environment, the performance of hospitals has become key planning concern.
Government is taking various steps to improve the quality of services provided by the
government hospitals. National Health policy 2017 is one of the prime indicators of the fact.
The sample consists of 50 patients selected randomly in ESIC hospital kidwai nagar. The
questionnaire used in the study consists of service quality dimensions and is termed as
SERVQUAL questionnaire. The gap in the quality dimension is indicated by the difference
between the quality of service perceived and expected by the patient. The gaps are as follows:
reliability -1.612, responsiveness -1.468, assurance -1.828, empathy -1.576, and tangibility
-2.42. Deploying better facilities will reduce gap between patients perceived & expected
service. The result of this study demonstrates the usefulness of SERVQUAL model in
monitoring and measuring the quality of service given by the hospital.

1. Introduction
In todays cut throat competitive environment both production and service organizations the
quality of service delivered is becoming important parameter, it implies more to the sectors
where there is more of customer interaction like financial and health care. The hospital
industry is one of the largest and the fastest growing industry in the world, consuming
considerable amount in GDP for developing nation. India spent a total of Rs. 4.5 lakh crore
on healthcare in 2013-14 at 4 per cent of the GDP, of which Rs. 3.06 lakh crore came from
households [1].

In India, hospital industries run by central and state governments, provides facilities free of
cost or at subsidized rate to lower income group families in both rural and urban areas. The
health care infrastructure in India is growing because of healthy economy and favorable
government policies. Indian government expenditure on Health care is the highest amongst
all the developing countries. The expenses of this industry comprise 5.25% [2].

In service organizations the quality is divided in to two types: technical and functional [3]. In
order to assure that medical procedure are best from the view point of the expert (technical
quality) but they are also match patients expectation (functional quality). Thus, it becomes
necessary to measure what is expected and what is delivered.

With the help of SERVQUAL model customer satisfaction can be measured by comparing
patients expectation and perception. If services provided are better than what is expected
than those services are excellent and if services provided are not what was expected than
 Measurement of Quality of Hospital Services via SERVQUAL Model: Case study of ESIC hospital, Kidwai
Nagar, Kanpur

there is a chance of improvement. Therefore, patients perception is crucial in considering

service quality. A questionnaire has been designed in order to examine all service quality
dimensions in SERVQUAL model. The aim of the study was to find that if there is any
gap between what service is perceived and expected by the patients of the ESIC
hospital, kidwai nagar.

2. Literature
According to Merriam Webster Dictionary, satisfaction is a happy or pleased feeling because
of something that you did or something happened to you. It can be concluded that satisfaction
is a consequence of a mental assessment and evaluation of what clients experience and the
resulting outcome of the services provided.

Kotler defined satisfaction as: a persons feelings of pleasure or disappointment resulting

from comparing a product are perceived performance (or outcome) in relation to his or her
expectations. According to Hansemark and Albinsson (2004), satisfaction is an overall
customer attitude towards a service provider, or an emotional reaction to the difference
between what customers anticipate and what they receive, regarding the fulfillment of some
need, goal or desire. Parasuraman explained satisfaction in relation to service quality.

To identify and prioritize performance improvements that are required or to ensure that
patients' needs and expectations are being met, both perceptions and expectations of service
are needed to be measured [4]. Parasuraman et al., (1988) designed the SERVQUAL
instrument to specifically measure functional service quality using both the gap concept and
service quality dimensions. The questionnaire has 25 pair questions whose responds are
recorded on 7 point Likert scale and the questionnaire is divided into five categories [5]:

Reliability: deals with the ability to perform the promised service dependably and
accurately.
Responsiveness: considers the willingness to help customers and provide prompt
service.
Assurance: talks about the knowledge and courtesy of employees and their ability to
inspire trust and confidence
Empathy: ability to provide caring and individualized attention to customers, and
Tangibles: describes the appearance of physical facilities, personnel and equipment.

Each statement appears twice. One measures customer expectations and the other measures
the perceived level of service provided by an individual organization in that industry. The
twenty-two pairs of statements are designed to fit into the five dimensions of service quality.
The scale for measuring was made up of a seven-point scale starting from "strongly agree"
(7) to "strongly disagree" (1) accompanies each statement. The "strongly agree" end of the
scale is designed to correlate with high expectations and high perceptions (Parasuraman et al.,
1985, 1988). Service quality occurs when expectations are met (or exceeded) and a service
gap materializes if expectations are not fulfilled. The gap score for each statement is

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 Measurement of Quality of Hospital Services via SERVQUAL Model: Case study of ESIC hospital, Kidwai
Nagar, Kanpur

computed as the perception score minus the expectation score. The presence of a positive gap
score means that expectations have been met or exceeded and a negative score also implies
that expectations are not being met. Gap scores for each individual statement can be analyzed
and aggregated to give an overall gap score for each dimension. Potentially, this allows an
organization to assess where key gaps in performance, from the perspective of the customer,
are occurring.

The following gaps have been identified between customer expectation and the actual
services provided at different stages of service delivery [6]:

The Customer Gap: The Gap between Customer Expectations and Customer
Perceptions
The Knowledge Gap: The Gap between Consumer Expectation and Management
Perception
The Policy Gap: The Gap between Management Perception and Service Quality
Specification
The Delivery Gap: The Gap between Service Quality Specification and Service
Delivery
The Communication Gap: The Gap between Service Delivery and External
Communications

According to this model, the service quality is a function of perception and expectations and
can be modeled as:
k
SQ= ( Pij Eij )
i=1

SQ = overall service quality; k number of attributes.

Pij= Performance perception of stimulus i with respect to attribute j.

Eij= Service quality expectation for attribute j that is the relevant norm for stimulus i.

CONSUMER

Past
Word of Personal
Experience
mouth Needs
communicati 3
 Measurement of Quality of Hospital Services via SERVQUAL Model: Case study of ESIC hospital, Kidwai
Nagar, Kanpur

Expected
Service

Gap

Perceived
Service

MARKETER

Service Delivery Gap

External
(Including pre- and communicatio
post-contacts) ns to

Gap

Translation of
perception into
service quality
Specs

Gap

Management
perception of
consumer
expectation

Figure 1: A Conceptual model of service quality Source: Parasuraman et al., (1985) [7]

3. Methodology

The well documented Service Quality Model of Parasuraman et al. (1985) was used as a
conceptual framework for measuring service quality delivery in Health Care Services.

The SERVQUAL instrument contains 25 pairs of Likert scale questions designed to measure
patients expectation of a service and the patients' perception of a service provided by Health
Care Services. To assess a service quality, the gap for each question is calculated based on
comparing the perception score with the expectation score. The positive gap score means that
patient's expectations are met or exceeded, while the negative score means the opposite.

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 Measurement of Quality of Hospital Services via SERVQUAL Model: Case study of ESIC hospital, Kidwai
Nagar, Kanpur

ESIC hospital kidwai Nagar was selected for study and the research was conducted in March
2017. On the basis of simple random sampling response from 50 patients was recorded.

4. Analysis and Discussion

Following the collection of the questionnaires, the data were extracted and the information
gained was analyzed. To analyze data, descriptive statistical methods such as tables, graphs
calculation were used.

The service quality dimension gap score (Table 1) which represents the difference between
patients perceived and expected service. The study revealed that negative gap occurs in all the
five dimensions employed in the study.

Service quality Perceived score Expected Score Gap Score

dimension (P) (E)
Reliability 4.488 6.1 -1.612
Responsiveness 4.64 6.108 -1.468
Assurance 4.268 6.096 -1.828
Empathy 4.512 6.088 -1.576
Tangibles 3.664 6.087 -2.423

Table 1 Service quality dimension gap score

Item Gap Score Description

23 -3.96 Fresh water supply in ward
13 -2.74 Friendly security staff and safe parking
17 -2.66 Employees give dedicated attention
8 -2.36 Provide good communication of service right the first time
24 -2.24 Cleanliness of each ward

Table 2 Survey items contributing most to negative gap score

The mean expected score ranges from 6.02-6.16, while the mean perceived score ranges from
2.14-5.46.

5. Conclusion

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 Measurement of Quality of Hospital Services via SERVQUAL Model: Case study of ESIC hospital, Kidwai
Nagar, Kanpur

The understanding and measurement of service quality and patients satisfaction as seen by
the patient is equally important to health care delivery because it is a concept integral to the
provision of a better, more focused quality service for patients. In order to achieve this, it is
clearly necessary to capture information on patient needs, expectations and perceptions so as
to assess their satisfaction about the service they receive. This will then help health
professionals identify where service improvements are needed.

6. References
[1] http://www.thehindu.com/data/Indians-spend-8-times-more-on-private-hospitals-
than-on-govt.-ones/article14593186.ece
[2] A STUDY ON PATIENTS PERCEPTION AND EXPECTATION TOWARDS
THE SERVICE RENDERED BY GOVERNMENT RAJAJI HOSPITAL, MADURAI
DISTRICT, TAMIL NADU, pg 10, P.LAKSHMI PRABA
[3] Measurement of Quality of Hospital Services via SERVQUAL Model Zohreh
Anbari, Yaser Tabaraie
[4] Assessing Patients Satisfaction Using SERVQUAL Model: A Case of Sunyani
Regional Hospital, Ghana Augustine Awuah Peprah
[5] Production and operations management, pg 434, kanishka Bedi
[6] https://brainmates.com.au/brainrants/the-customer-service-gap-model/
[7] A Parasuramana, Valarie A. Zeithanal & Leonard L. Berry, A conceptual model of
service quality & its implication for future research