Impact of Service Quality on Patient Satisfaction of Pun Hlaing Silom Hospital

Impact of Service Quality On Patient Satisfaction of Pun Hlaing Silom Hospital, Yangon, MyanmarChapter 2Literature ReviewTraditionally, health care quality has been evaluated from the point of view of service provider CITATION Ber97 l 1033 (Berwick, 1997) CITATION Kra97 l 1033 (Kramer, 1997). Because many health care professionals accepted that patients did not have enough knowledge and intelligent level to evaluate the quality of health care CITATION Ber97 l 1033 (Berwick, 1997) CITATION Dec99 l 1033 (Decker, 1999). In recent years, the evaluation has focused to patient’s perception of care delivery quality because it is accepted that health care service quality indicators are the most influential determinants of patient satisfaction (Batbaatar et al., 2016). By monitoring and evaluating patient satisfaction, health care providers are able to identify service factors that need further improvementCITATION Aha93 l 1033 (Aharony & Strasser, 1993). 2.1 Dependent VariablesPatient SatisfactionSatisfaction is demonstrated as a state of mind that felt by a person when experienced performance or an outcome that fulfill his or her expectation CITATION Kot87 l 1033 (Kotler & Clarke, 1987). This definition has been supported by another author who stated that customer satisfaction is the customer’s emotional response towards services and products, their opinion on compliance with requirements and feelings related to acquisition of goods and service CITATION Bis09 l 1033 (Biseok & Jolanta, 2009). In healthcare settings, patient satisfaction is widely used in determination of service quality. Naidu( 2009) found that the relationship between patient satisfaction and health-care quality is significant. Patient satisfaction mainly reflected a hospital’s functional service quality rather than technical outcome CITATION Hal88 l 1033 (Hall & Dornan, 1988) CITATION Pas83 l 1033 (Pascoe, 1983) CITATION Ros97 l 1033 (Rosenthal & Shannon, 1997). Shabbir et al (2016) has demonstrated that there is a positive association between health care service quality and patient satisfaction. Another study has found that service quality has a significant relationship with patient satisfactionCITATION Kes11 l 1033 (Kessler & Mylod, 2011). According to the studies of Oliver (1997) and Zeithaml & Bitner (2000), customers are said to be satisfied if perceived performance is greater than their expectations while if it does not, then the customers are said to be dissatisfied. In addition, it is recognised that patients and their satisfaction are seen as the most basic point in the organising, execution and appraisal of service delivery CITATION Bad09 l 1033 (Badri, Attia, & Abdulla, 2009). Patient satisfaction is one of the critical determinants in healthcare care setting because it measures the quality of services provided by the hospital CITATION Sal05 l 1033 (Salisbury , et al., 2005).2.2 Independent VariablesService QualityLewis and Booms suggested that “service quality is a measure of how well the service level delivered fulfills the customers’ expectations CITATION Lew83 l 1033 (Lewis & Booms, 1983). Health care service can be broken down into two quality dimensions: technical quality and functional quality CITATION Gro84 l 1033 (Gronroos, 1984). Research has shown that consumers tend to evaluate the quality of the health care services by focusing on more functional issues like physical facilities, interactions with receptionists or brochures rather than hard-to evaluate technical aspects of the service delivery CITATION Swa89 l 1033 (Swartz & Brown, 1989) CITATION Gro84 l 1033 (Gronroos, 1984). Pollack (2008) demonstrated that there is a direct relationship between health care service quality and patient satisfaction. It is shown that the more the significant the health care service quality improve, the more the prominent will be the patient satisfaction. Cronin Jr & Taylor (1992) have also suggested a solid causal relationship between the positive service quality and satisfaction. Parasuraman, Zeithaml, & Berry (1988) stated that there are five service quality dimensions that affect customers’ satisfaction: Reliability is related to ability to perform the promised service dependably and accuratelyResponsiveness is related to willingness to help customers and provide prompt service.Assurance is related to knowledge and courtesy of employees and their ability to convey trust and confidence Empathy is related to caring, individualized attentionTangibles is related to physical facilities, equipment and appearance of personnel.2.2.1 ReliabilityReliability indicates that the employees are able to provide the services accurately, consistently and dependably CITATION LeB97 l 1033 (LeBlanc & Nguyen, 1997). The reliability is the most important contributor in guaranteeing both customers’ satisfaction and dissatisfaction CITATION Par88 l 1033 (Parasuraman, Zeithaml, & Berry, 1988). The service reliability is the most significance variables in the SERVQUAL model CITATION Par88 l 1033 (Parasuraman, Zeithaml, & Berry, 1988). The research by Al-Damen (2017) has shown tha the reliability dimension had the greatest influence on patient satisfaction in the healthcare industry.2.2.2 ResponsivenessAnother important factor that has an influence on customer satisfaction is responsiveness. Responsiveness refers to how fast an organization can react to customer demand or changes in the marketplace, to bring about or maintain competitive advantage. CITATION Kri99 l 1033 (Kritchanchai & MacCarthy, 1999). Responsiveness has a positive relation with customer attitudes in terms of customer satisfaction (Loke et al, 2011). This statement has also been supported by another study which stated that responsiveness had a positive outcome in customer activities which leads to satisfaction CITATION Pan11 l 1033 (Pandey & Devasagayam, 2011). Regarding to healthcare service industry, hospital responsiveness had a strong effect on overall patient satisfaction, therefore hospitals should not only focus on clinical aspects of care, but also consider including efforts to responsiveness improvement in their strategic plans CITATION Zar17 l 1033 (Zarei & Daneshkohan, 2017).2.2.3 AssuranceAssurance can be known as the organization offers the credible and secure service to its customers (Donnelly et al, 1995). In healthcare service industry, perceived competency of health professionals have significant contribution on the variations in patient satisfaction (Cheng et al, 2003) CITATION And98 l 1033 (Andaleeb, 1998). Assurance has the strongest association with overall patient’s satisfaction CITATION You13 l 1033 (Yousaprompaiboon & Johnson, 2013).2.2.4 EmpathyEmpathy plays a critical interpersonal and societal role, enabling sharing of experiences, needs, and desires between individuals and providing an emotional bridge that promotes prosocial behavior. CITATION Rie17 l 1033 (Riess, 2017). Furthermore, providers’ communication skills and listening skills were found to be positively associated with level of patient satisfaction. CITATION Xia08 l 1033 ( Xiao & Barber, 2008). Most of the variables that have been found to affect satisfaction with health care can be positively influenced by doctors’ and nurses treating patient with courtesy and respect, being helpful, listening, explaining understandably and spending time with their patients. CITATION Bra02 l 1033 (Braunsberger & Gates, 2002). Uncompassionate care and treatment devoid of empathy results in dissatisfied patients who are unlikely to follow through with treatment recommendations CITATION Rie17 l 1033 (Riess, 2017).2.2.5 TangiblesTangibles can be defined as the physical evidence in the industry. CITATION Par88 l 1033 (Parasuraman, Zeithaml, & Berry, 1988). The setting of the facility greatly determines quality and customer satisfaction and this can create a sustainable competitive niche for the healthcare organisation CITATION Tay94 l 1033 (Taylor, 1994) . The physical setting in which services are delivered has been found to influence customer service performance evaluations, including customer satisfaction.CITATION Bit90 t l 1033 (Bitner, 1990)CITATION Bit92 t l 1033 (Bitner, 1992) CITATION Par88 l 1033 (Parasuraman, Zeithaml, & Berry, 1988).Chapter 3Research FrameworkThe chapter divides up the detail of conceptual framework, research hypotheses and operationalization of independent and dependent variables.3.1 Conceptual FrameworkThe conceptual framework consists of independent variables and dependent variable. In this research, the independent variables (reliability, responsiveness, assurance, empathy and tangibles) have been selected from the theoretical frameworks and showed that these variables have an influence on patient satisfaction hence hypotheses (H1 to H5) have been produced.Independent VariablesDependent Variables2040813219106H100H1018415ReliabilityResponsivenessAssuranceEmpathyTangiblesPatient SatisfactionReliabilityResponsivenessAssuranceEmpathyTangiblesPatient Satisfaction202496420642H200H22039620134462H300H32105533201519H400H42103679315951H500H53.2 Research HypothesisBased on the conceptual framework, different hypothesis for this research has been developed. There are a total of five hypotheses which focuses on the influence of different independent variables (reliability, responsiveness, assurance, empathy and tangibles) on dependent variables (patient satisfaction).H1a: Reliability has a significance influence on patient satisfaction. H1o: Reliability has no significance influence on patient satisfaction.H2a: Responsiveness has a significance influence on patient satisfaction. H2o: Responsiveness has no significance influence on patient satisfaction.H3a: Assurance has a significance influence on patient satisfaction. H3o: Assurance has no significance influence on patient satisfaction.H4a: Empathy has a significance influence on patient satisfaction. H4o: Empathy has no significance influence on patient satisfaction. H5a: Tangibles has a significance influence on patient satisfaction. H5o: Tangibles has no significance influence on patient satisfaction. 3.3 Operationalization of independent and dependent variablesVariables Concept of variables Operationalize Components Sources Measur-ement ScaleReliabilityReliability indicates the employees are able to provide the services accurately, consistently and dependably CITATION LeB97 l 1033 (LeBlanc & Nguyen, 1997) CITATION Par88 l 1033 (Parasuraman, Zeithaml, & Berry, 1988)Pun Hlaing Silom hospital performs service and procedures correctly as they promised.Pun Hlaing Silom Hospital provides services within time.Pun Hlaing Silom Hospital is consistent in its performance. (Their service quality is the same at every visit)Pun Hlaing Silom Hospital keeps the medical record properly and error free.The patients feel confident when receiving treatment. CITATION Soh03 l 1033 (Sohail, 2003) CITATION AlD17 l 1033 (Al-Damen, 2017)CITATION But10 l 1033 (Butt & Cyril de Run, 2010) CITATION Soh03 l 1033 (Sohail, 2003) CITATION AlD17 l 1033 (Al-Damen, 2017)Interval ScaleResponsiveness The meaning of responsiveness is the willingness to help the customers, to provide prompt and well service to the clients, problem resolution when the customers faced and complaint handling. CITATION Rei90 l 1033 (Reichheld & Sasser, 1990). 24 hrs Helpline from Pun Hlaing Silom Hospitals are easy to contact and offer prompt response.At the hospital, the staff meet promptly the patients’ needs.Patients are observed according to the appointmentsDoctors/staff efficiently respond to the patient’s requests. Researcher CITATION AlD17 l 1033 (Al-Damen, 2017) CITATION AlD17 l 1033 (Al-Damen, 2017) CITATION AlD17 l 1033 (Al-Damen, 2017)Interval ScaleAssurance  Assurance shows the knowledge that the employees posses and how the employees conveys the trust and confidence CITATION Par88 l 1033 (Parasuraman, Zeithaml, & Berry, 1988)The patients trust Doctor’s expertise and skillsThe patients trust Nurses and other staffs expertise and skills.The doctors and other employees from Pun Hlaing Hospital are courteous at all time.At the hospital, the patients feel secure in using its service. CITATION AlD17 l 1033 (Al-Damen, 2017) CITATION AlD17 l 1033 (Al-Damen, 2017) CITATION Soh03 l 1033 (Sohail, 2003) CITATION AlD17 l 1033 (Al-Damen, 2017)Interval ScaleEmpathy Empathy is described as a provision of caring, individualized attention to customer CITATION AlD17 l 1033 (Al-Damen, 2017). Patients are given individual attention at Pun Hlaing Silom Hospital.Doctors and nurses deal with patients in caring fashion.( Understand their special needs and Explain the diagnosis and give informed treatment)The hospital prioritize the interest of patients. Sohail (2003)Sohail (2003) CITATION AlD17 l 1033 (Al-Damen, 2017)Interval ScaleTangibles  Tangibles is the physical facilities and equipment, employees’ appearance, physical representations of services and the physical environment CITATION Par88 l 1033 (Parasuraman, Zeithaml, & Berry, 1988).  Pun Hlaing Silom Hospital has modern equipment for diagnosis and treatment.Pun Hlaing Silom Hospital has visually appealing facilities and infrastructure.Pun Hlaing Silom Hospital have clean and healthy environment.Doctors and other employees from Pun Hlaing Silom Hospital have professional appearance. CITATION Soh03 l 1033 (Sohail, 2003) CITATION Soh03 l 1033 (Sohail, 2003)Researcher CITATION Soh03 l 1033 (Sohail, 2003)Interval ScalePatient Satisfaction Patient satisfaction is referred to patients’ emotion, feelings and their perception of delivered healthcare services CITATION Moh11 l 1033 (Mohan & Saikumar, 2011)I’m satisfied with the reliability of Pun Hlaing Silom Hospital.I’m satisfied with the responsiveness of Pun Hlaing Silom Hospital.I’m satisfied with the assurance of Pun Hlaing Silom Hospital.I’m satisfied with the empathy of Pun Hlaing Silom Hospital.I’m satisfied with the tangibles of Pun Hlaing Silom Hospital. ResearcherResearcherResearcherResearcherResearcherInterval Scale

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