Patient satisfaction has become the most popular topic in healthcare from last two decades.
Various researches had defined the satisfaction construct. (Umar) stated that patient satisfaction tends to be treated as consumer attitudes in evaluating goods or services.
Patient satisfaction is a high priority aspect of private/public healthcare service providers and also a very significant achievement in the competitive environment. Several patient satisfaction indciators are: getting a good experience, satisfied service, service received in accordance with the cost incurred and services that exceed the patient's expectations (Hassan 2011). Patient satisfaction refers to the psychological state of the patient and involves their positive or negative feelings or attitudes toward their experience and some specific aspects in the service encounter.
It is a key to the long term success of the business, which is a major factor in shaping the patient's intentions for future repurchase (Abba 56).
Patients have levels of satisfaction and dissatisfaction after having or experiencing each service according to how far their expectations are fulfilled or exceeded. Expectation is an internal
standard used by patients to judge a quality of service experience. A hospital should maintain the
quality of service provided to its patients. If the service quality received by patients is the same
or higher than what they perceive, the patients tends to buy the service again. However, if the
perceived service is lower than the expected service, they will be disappointed and stop their relations with the concerned hospital (Alex 2020). (Dayyab 6) patient satisfaction can be conceptualized in two perspectives
transaction specific satisfaction and cumulative satisfaction. Transaction specific satistaction is
defined as assessment on the experience and consumer's reactions to a specific healthcare encounter. Whereas cumulative satisfaction refers to the patient's overall evaluation of patronage experience from inception to date.
The concept of patient satisfaction has drawn the interest of academics and research scholars for more than three decades and the fact is that patients are the primary source of any organizatịons' revenue. Patient satisfaction is a necessary precondition for patient loyalty, which is in turn a key driver of profit growth and performance (Sani 2020). (Veronica 2020) defined patient satisfaction as an outcome of purchase and use resulting from the buyers' comparison of the rewards and costs of the purchase in relation to the anticipated consequences.
According to (Fearson), patient satisfaction can be studied in the context of their overall experience in a healthcare, as service is difficult to evaluate, so patient leverage on the service dimension to evaluate the service provided. The role of patient satisfaction in the healthcare industry is very significant, as it leads to positive results, such as hight patient
retention rates and loyalty, positive word-of-mouth publicity and increased profits (). The satisfaction level of patients and their accompanying persons or relatives is a very effective indicator to analyze the performance of a hospital setup, so it is required by the hospital management to take the necessary efforts to retain old patient, as it is very difficult to gain new ones ().
Service Marketing
All products, whether goods, services or ideas, are to some extent intangible. A service is an
intangible product involving a deed, a performance or an effort that cannot be physically possessed. Services are usually provided through the application of human and /or mechanical effort directed at people or objects. () explained that services can also involve the use of mechanical efforts directed at people (air transportation) or object (freight transportation). A wide variety of services, such as healthcare and banking industries, involve
both human and mechanıcal efforts. Although many services entail the use of tangible such as tools and machinery. the primary difference between services and goods is that a service is
dominated by the intangible portion of the total product (). Services consist of the elusive activities that take place between service receiver and service provider to solve patient problems ().
Service Quality
Service offering is a Crucial component of a business function, which is the way hospitals
communicate and deliver service to patients and the tangibles maintained for patient comfort,
atraction and organizational performance. So, developing and offering excellent quality of service is undoubtedly an important input for meeting and exceeding patient expectation and needs, which in turn positively influence the loyalty behavior of patient and enhance
organizational performance and image and accelerates the sales and growth of a haspital in the
increasingly competitive market environment (). Thus, looking at the
competitive environment, hospitals are required to develop their strategies to differentiate them from another that can only be achieved via the delivery of excellent quality of service. The highl evel of service quality determines the patient's satisfaction and patient satisfaction signiacantly leads hospitals to reap a sustainable competitive advantage in the volatile market.
Adams dvocated two aspects of service quality in the healthcare sector, techrical and interpersonal skills. The technical is related to routine working procedures, operating hours and the expertise of doctors. Interpersonal skills are related to the service providers and patient affairs, their complications, communication and giving complete information. But for patient, interpersonal skills are very imperative, as they are not aware of the technical skills, because it is very hard to judge the technicality of doctors since internal things are not exposed to patient.
Factors Influencing the Knowledge Gap
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.
.jpeg)
.jpeg)
