Three main factors influence the gap. First, the firm's research orientation, which reflects its attitude toward conducting patient research, can dramatically influence the size of the gap. Information obtained from patient research defines consumer expectations. As the firm's research orientation increases and it learns more a about the needs and wants of its patients,
the size of the knowledge gap should decrease. The amount of upward communication is a second factor that influences the size of the knowledge gap. Upward communication refers to the fow of information from front-line personnel to upper levels of the organization. In other words, does upper management listen to and value the feedback provided by its front line personnel? Front line personnel interact with patients on a frequent basis, so they are often more in touch with patients needs than top management. Consequently, as the flow of upward commnication increases through the organization, the knowledge gap should become smaller. Finally the levels of management in the organization can also influence the size of the knowledge gap. As the organizational hierarchy becomes more complex and more levels of management are added, higher levels of management tend to become more distant from patients and the day-to-day activities of the organization. As a result, when the levels of management increase, the size of the knowledge gap tends to increase.
Standard Gap
Even if patients' expectations have been accurately determined, the standards gap open
between management's perception of patient expectations and the actual standards set for service delivery. A simple analogy would be to consider when a patient is explaining his/her health problem and the doctor really understands the problem of the patient. Let's assume that the doctor clearly understands the patient's ailments. In this case, a knowledge gap does exist. Once the doctor understands the patient's problem, he prescribed exact specifications for a nurse and pharmacies to follow. If the doctor is unable to convert the patient's problem to a prescription, a standard gap is created (Douglas & John, 2011).
Factors Influencing the Standards Gap
In many cases, management does not believe it can or should meet the patient's requrment for service. Another factor that influences the size of the standards gap is management's commitment to the delivery of service quality. Corporate leadership may set other priorities that interfere with setting standards that lead to good service.
Delivery Gap
The delivery gap occurs between the actual performance of a service and the standard set by
management. The existence of the delivery gap depends on both the willingness and the ability
of employees to provide the service according to specification. If the Nurses and phamacies do
not follow the standards set by the doctor's prescription, a delivery gap is created (Douglas &
John, 2011).
Factors Influencing the Delivery Gap
One factor that influences the size of the delivery gap is the employee's willingness to perform
the service. Obviously, the employee's willingness to provide a service can vary greatly from employee to employee and in the same employee over time. Many employees who start off
working to their full potential often become less willing to do so over time because of frustration and dissatisfaction with the organization. Furthermore, a considerable range exists between what the employee is actually capable of accomplishing and the minimum the employee must do in order to keep his/her job. Most service managers find it difficult to keep employees working at their full potential all the time.
Other employees, no matter how willing, may simply not be able to perform the service to specifucation. Hence, a second factor that influences the size of the delivery gap is enployee job fit. Individuals may have been hired for jobs they are not qualified to handle or to which they are temperamentally unsuited or they may not have been provided with sufficient training for the roles expected of them. Generally, employees who are not capable of performing assigned roles are less willing to keep trying.
Another common factor influencing the size of the delivery gap is role conflict. Wheather or not the knowledge gap has been closed, service providers may still see an inconsistency between what the service manager expects employees to provide and the service their patients actually want. Yet, another cause of the delivery gap is role ambiguity. It results when employees due to poor employee-job fit or inadequate training, do not understand the roles of their job or what their jobs are intended to accomplish. Sometimes they are even unfamiliar with the service firm and its goals. Consequently, as role ambiguity increases, the delivery gap widens. A further complication for employees is the dispersion of control, the situation in which control over the nature of the service being provided is removed from employees' hands. When employees are not allowed to make independent decisions about individual cases: without frst conferring with a manager, they may feel marginalized, alienated from the service firm and less committed to their job. Consequently, as the dispersion of control increases, the delivery gap becomes wider.
Finally, the delivery gap may also suffer due to inadequate support, such as not receiving personal training and/or technological and other resources necessary for employee to perform their jobs in the best possible manner. Even the best employees can be discouraged. If they are forced to work with out-of-date or faulty equipment, especially if the employees of competing firms have superior resources and are able to provide the same or superior levels of service with far less effort. Failure to properly support employees leads to a lot of wasted effort, poor employee productivity, unsatisfied patients, and an increase in the size of the delivery gap
Communication Gap
Communications gap is the difference between the service the firm promises it will deliver through its external communications and the service it actually delivers to its patients. If advertising or sales promotions promise one kind of service and the consumer receives a different kind of service, the communications gap becomes wider and wider. All Firms need to understand that all external communications are essentially promises the firm makes to its patients, thereby increasing the patients' expectations. When the communications gaps is wide, the firm has broken it's promises, resulting in a lack of future patient trust.
Factors Influencing the Communications Gap
The communications gap is often influenced primarily by two factors. The first, the propensity of the firm to overpromise, occurs in highly competitive business environments, as firms try to outdo one another in the name of recruiting new patients. The second factor pertains to the flow of horizontal communication within the firm. In other words, "Does the left hand know what the right hand is doing?" All too often, communications are developed at the firm's headquarters
Without conferring with decentralized regional and local service operations in the field. In some instances, new service programs are announced to the public by corporate headquartes before the local service firms are aware that the new programs exist. A lack of horizontal communication places an unsuspecting service provider in an awkward position when a patient requests the service promised and the provider has no idea what the patient is talking about.
Customer Perceived Service Quality Gap
This gap takes place when patients are getting services that are not according to their expectations. This gap is reliant on the first four gaps and if these gaps are enclosed the fifth gap will automatically be obscured. According to (), service quality can be measured by quantifying the gap. They suggested the Servqual model for the service quality measurement. Parasuraman, et al. (1985) conducted qualitative research by conducting focus group interviews and acknowledged primarily 10 service quality dimensions, which in 1988 contracted to dimensions. The dimensions identified by them are tangibles, reliability, responsiveness, assurance and empathy. The original 10 dimensions of service quality identified by them are the following:
1. Tangibles
2. Reliability
3. Responsiveness
4. Communication
5. Credibility
6. Security
7. Competence
8. Courtesy
9. Understanding/knowing the patient
10. Access
There were a 97 itemn scales planned for 10 different dimensions. Each statements was of two types of questions, one was expectation-related and the second one was perception-related.
However, Parasuraman, et al. (1988) worked again on the Servqual dimension and curtailed the 10 dimensional Servqual model to five. The first three dimensions of the traditional Servequal model remained the same. The remaining seven were dimensions amalgamated into two new dimensions of the new Servqual model. The new dimensions they proposed for the Servqual
model are the following:
1. Tangibles
2. Reliability
3. Responsiveness
4. Assurance
5. Empathy
The communication, credibility, security, competence and courtesy dimensions of the traditional Servqual model were fused into assurance and the last three dimensions of the old Servqual model, understanding and access merged into empathy.
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