A Comparison of Service Quality between Private and Public Hospitals in Thailand

Transcription

1 International Journal of Business and Soial Siene Vol. 4 No. 11; September 2013 A Comparison of Servie Quality between Private and Hospitals in Thailand Khanhitpol Yousapronpaiboon, D.B.A. Assistant Professor College of Graduate Study in Management Khon Kaen University Thailand William C. Johnson, Ph.D. Professor Emeritus Huizenga Shool of Business & Entrepreneurship Nova Southeastern University USA 1. Introdution Quality has beome important for ustomers when deiding on a servie or produt and it has been onsidered as a strategi advantage for organizations to gain and maintain suess in the business world (Irfan & Ijaz, 2011). Servies are intangible and diffiult to measure, so servie quality depends on ustomer pereptions and expetations. The healthare setor today has a highly ompetitive. The pereptions and expetations of patients are onsidered to be the major indiator to assess the servie quality of healthare organization (Cronin & Taylor, 1992; Irfan & Ijaz, 2011) and quality of servie delivered to the patients should meet or exeed their pereptions and expetations (Parasuraman, Zeithaml & Berry, 1985, 1988; Zeithaml, Berry & Parasuraman, 1993). Hospitals in Thailand are the part (one) of healthare setor and in order to prepare for Asean Eonomi Community (AEC) membership (ira 2015) and to support the government poliy to reate a medial hub of Asia., servie quality will beome a key fator. Presently, the majority of both the private and publi hospitals in Thailand are to gearing up for likely inreased ompetition by enhaning both servie quality and medial staff quality. The main purpose of this study was to ompare the differene in servie quality between the publi and private hospitals in Thailand to determine the readiness to ompete in this expanding Asian healthare marketplae. The paper proeeds by first reviewing the related literature, followed by the methodology used, the study findings, and finally, a disussion of the results and onlusions 2. Literature Review Servie quality Servie quality is defined as the disrepany between ustomer s pereptions of servies offered by a ompany and their expetations about offering servies of the ompany. The ustomers expetations are derived from their pereption of the ideal are standards of their previous experienes in the use of servies. Aording to Grönroos (2001), servie quality is the differene between ustomer expetations and pereptions as it is being reeived by the ustomer (Parasuraman et al., 1988; Irfan & Ijaz, 2011). Thus it is neessary for healthare providers to monitor how well the ustomers expetations have been met after delivering the servies (Zarei, Arab, Froushani, Rashidian, & Tabatabaei, 2012). Previous researhers developed various oneptualizations for servie quality inluding Grönroos (1984) who identified servie quality s two dimensions namely funtional quality how the servie was performed and tehnial quality the atual outome of the servie that an be objetively measured. 176

2 Center for Promoting Ideas, USA Garvin (1988) determined quality along 8 dimensions performane, features, reliability, onformability, durability, servieability, aesthetis, and pereived quality. Finally, Parasuraman, Zeithaml and Berry (1985) oneptualized servie quality using a disonfirmation model that ompared ustomer expetations and pereptions from data gathered in retail banking, finanial servies, and produt repair and maintenane industries from whih they developed the gap model (Zeithaml, Bitner, Gremler, 2012). The first gap is alled the listening gap, whih is the differene between ustomer expetations of servie and ompany understanding of those expetations. The seond gap is alled the servie design and standards gap represents the differene between a ompany s understanding of ustomer expetations and the development of ustomer-driven servie designs and standards. The third gap is alled the servie servie-performane gap whih to be disrepany between the development of ustomer-driven servie standards and atual servie performane. Next, the fourth gap is the servie delivery external ommuniations gap whih is based on the firm s apability to deliver what is promised and ompletely inform onsumers. Finally, the fifth gap is the expeted servie-pereived servie gap involves the differene between ustomers overall expetations and pereptions of servie quality (Akter, Upal & Hani, 2008). Measurement of servie quality has been onduted in various servie organizations and in different servie setors, the SERVQUAL model proposed by Parasuraman et al. (1985, 1988) has been used in a wide variety of studies to assesses both the ustomer s servie expetations and pereptions of the provider s performane (Zarei et al., 2012; Ladhari, 2009; Pakdil & Aydin, 2007). Aording to Parasuraman et al. (1985), the SERVQUAL sale was based on the fifth gap and the original ten dimensions were further onsolidated into five dimensions of servie quality namely Tangibles, Reliability, Responsiveness, Assurane and Empathy. These dimensions are desribed as follows: (1) Tangibles physial failities, equipment, appearane of personnel and ommuniation materials. (2) Reliability the ability of the servie provider to perform the promised servie responsibly and aurately. (3) Responsiveness the willingness of employees to help and provide prompt servie to ustomers. (4) Assurane the knowledge, ourtesy and ompetene of employees and their ability to inspire trust and onfidene in the ustomer towards the servie provider. (5) Empathy the aring, individualized and personalized attention provided to ustomers. Polsa, Spens, Soneye and Antai (2011) argued that the SERVQUAL model is appliable for researh in healthare setting in terms of the following harateristis: reliability the trustworthiness of servie delivery, i.e., keeping promises being sympatheti and reassuring, and keeping reords aurately; responsiveness the exat delivery of servie, willingness to help, and effiient alloation of time; assurane safeness of diagnoses, politeness, and and relevant speialized knowledge; empathy the ability of personnel to reflet the pereived needs of the patients; and tangibles the physial environment of the hospital as well as the funtional quality of diagnoses, and effiient ommuniation with nurses and dotors, and the understanding of diagnoses (Polsa, Spens, Soneye & Antai, 2011). The SERVQUAL sale ontained 22 pairs of items spanning aross five dimensions overing key issues of servie quality. It omprises two sets of similar statements; the first is a ustomer expetations measure (E) and the seond is a measure of ustomer pereptions as to the atual servie delivered by the provider (P). The instrument measures the quality as the differene between expetations and pereptions (E - P). This tool has been widely applied by researhers in a diversity of servie settings, inluding hospitals to assess the differene in servie quality between the publi and private hospitals (Andaleeb, 2000; Arasli, Ekiz & Katirioglu, 2008; Irfan & Ijaz, 2011; Polsa et al., 2011; Taner & Antony, 2006) Several studies to assess servie quality have been undertaken in both the private and publi hospital setors in various ountries. Andaleeb (2000) studied on private and publi hospitals in urban Bangladesh. The study found that the private hospitals provide better servies than publi hospitals on responsiveness, ommunity, disipline and assurane (medial proedures), but the both groups offered poor evaluations regarding rooms, skills of the staff and general professionalism. 177

3 International Journal of Business and Soial Siene Vol. 4 No. 11; September 2013 (Arasli, Ekiz and Katirioglu (2008) studied servie quality in publi and private hospitals in Northern Cyprus finding that the private hospitals were pereived better servie than the publi hospitals onerning the physial quality of equipment and failities), quality of the servie provide by dotors and nurses, and faility-related ativities, i.e., building infrastruture and new equipment. Irfan and Ijaz (2011) studied hospitals in Pakistan, where the results of study indiated that private hospitals were delivering better servie quality to their patients as ompared to publi hospitals, espeially on the dimensions of empathy; tangibles assurane, responsiveness. Polsa et al. (2011) examined the pereived quality of private and publi hospital servies in Nigeria. The study results showed that servie in private hospitals was onsidered to be superior to those of publi hospitals, inluding having up-to-date environment, appearane of hospital employees, aurate storage of reords, exat delivery of servies, employees providing trust, politeness of employees, speialized knowledge and personal attention of hospital. Taner and Antony (2006) studied the differenes in servie quality between publi and private hospitals in Turkey, finding that patients in the private hospitals were more satisfied regarding the assurane dimension, inluding dotors, nurses and supportive servies than their ounterparts in the publi hospital. 3. Methodology Method A ross-setional study was onduted between February and Marh 2012 in Bangkok, the apital of Thailand. Survey instrument The study questionnaire was omposed of 2 parts; the first part assessed demographi harateristis of the hospital patient, suh as gender, age, inome and eduation. In the seond part, the SERVQUAL questionnaire was used to assess the patients expetations and pereptions of servie quality that inluded 21 items aross 5 dimensions: tangibles (5 items), reliability (5 items), responsiveness (3 items), assurane (4 items) and empathy (4 items). The SERVQUAL sale was translated into the Thai and bak-translated into English from Parasuraman et al. (1991). A 7-point Likert-type sale was used, ranging from strongly disagree (1) to strongly agree (7) to aess the level of expetations and pereptions of patient servie quality. The reliability of the sale was tested using Cronbah s alpha. The alpha values obtained were 0.91 and 0.93 for expetation sores and pereption sores respetively. These results indiate good internal onsisteny (Arasli et al., 2008) as Cronbah Alpha values greater than 0.70 are deemed aeptable (Nunnally, 1978). Sample design and data olletion A self-administrated questionnaire was administered to ollet empirial data from patients from hospitals loated in Thailand. Aording to the statistis issued by the Ministry of Health of Thailand (2010); total number of patients was 37,463,060. Thus, the sample size was determined using the following formula of Yamane (1967). n = N / Ne2 + 1, Here; N= 37,463,060, e2 = 0.05 n = The sample size of 400 was hosen beause other sale developers in marketing have also drawn similar sized samples: Arasli et al. (2008); Rohini and Mahadevappa (2006). In order to ollet quantitative data for the study, a total of 400 questionnaires were printed and distributed for the purpose of data analysis. A total of 10 hospitals were seleted as part of the sampling as they were deemed to be part of the medial hub of Asia. A onveniene sampling method was followed in selet individual patients and the patients were assured that their responses would be kept onfidential. 178

4 Center for Promoting Ideas, USA The demographi distribution of the outpatients indiated the following: Gender 62.5% were female; eduation-- 43% had bahelor degree; and inome % had inome of 30,000 baht or higher. In terms of ages-- 33% were 51 years or higher, followed by 31 to 40 years (24.8%), 41 to 50 years (23.5%), 21 to30 years (17.3%), and lower than 21 years (1.5%). Ethis This study was approved by the hospital ethis ommittee and the hospital administrative offier 4. Results The SPSS 17.0 for Windows was used to analyze data. The mean sores for the expetations and pereptions of the five dimensions are presented in Table1to 5 for both publi and private hospitals with the mean servie quality gaps sore alulated using Servie quality (SQ) = Pereption (P) Expetation (E)and results of servie quality between publi and private hospitals differenes on the five servie quality dimensions. The results are shown in Table 1 to 6 as follows: 4.1 Tangibles Expetations: Table 1 shows the mean expetation sores for all 5 items representing the tangibles dimension for private hospitals were above 6.30 ranging from the highest 6.68 (2 items) for up-to-date equipment and onvenient timing of servies offered to patients to the lowest 6.37 for visually appealing physial failities at the hospital. On the other hand, the mean expetation sores for all items in publi hospitals were above 5.50 ranging from the highest 6.34 for up to-date equipment to the lowest 5.58 for visually appealing physial failities at the hospital. Table 1 Mean expetation (E), pereption (P), pereption, gap sores and group differenes (gap sore) tests of tangibles E P Gap sore Tangibles Privat Privat Privat F-value Sig e e e Up-to-date equipment * Appearane of hospital personnel * Convenient timing of servies for * patients Visually appealing hospital environment Visually appealing physial failities at hospital Pereptions: the mean pereption sores for private hospitals were above 5.90 ranging from the highest 6.09 for onvenient timing of servies offered to patients to the lowest 6.00 for visually appealing physial failities at the hospital. On the other hand, the mean pereption sores for all items in publi hospitals were above 4.45 ranging from the highest 6.09 for up to date equipment to the lowest 4.70 for item of visually appealing physial failities at the hospital. Gap sores: the mean gap sore values are positive meaning that expetations fall short of pereptions on three items in private hospitals. The gap sore of both the private and publi hospitals was the largest for visually appealing physial failities at the hospital, i.e., and respetively. The results for items measuring tangibles indiate that three items showed a signifiant differene revealing that private hospitals provided better up-to-date equipment ; appearane of hospital personnel ; and onvenient timing of servies offered to patients as ompared to the publi hospitals. 179

5 International Journal of Business and Soial Siene Vol. 4 No. 11; September Reliability Table 2 Mean expetation (E), pereption (P), pereption, gap sores and group differenes (gap sore) tests of reliability E P Gap sore Reliability Privat Privat Privat F-value Sig e e e Performane of servies prompt every * time Solving problems * Performane of servies right the first time Inform about operating hours Hospital s servie within agreed time Expetations: Table 2 indiates that the mean expetation sore for private hospitals were above 6.30 ranging from the highest 6.62 to the lowest On the other hand, the mean expetation sores for publi hospitals were above 5.50 ranging from the highest 5.89 to the lowest Pereptions: the mean pereption sores for private hospitals were above 5.90 ranging from the highest 6.33 for performane of servies prompt every time to the lowest 5.65 for informing patients about operating hours. On the other hand, pereption mean sores for publi hospitals were above 4.30 ranging from the highest 5.38 for performane of servies promptly every time to the lowest 4.37 for hospital s servie performed within agreed time item. Gap sores: the largest mean gap sore in private hospitals was for informing patients about operating hours. While the largest mean gap sores in publi hospitals was for hospital s servie performed within agreed time. In testing for results of eah item measuring reliability, two items had signifiant differenes in the ase of private hospitals when it ame to performane of servies promptly every time ; and solving problems as ompared to publi hospitals. 4.3 Responsiveness Table 3 Mean expetation (E), pereption (P), pereption, gap sores and group differenes (gap sore) tests of responsiveness Responsiveness Willingness of personnel to provide servie Readiness of personnel to provide servie Fast and effiient servie of personnel E P Gap sore Priva te Priva te Priva te F- value Sig * * Expetations: Table 3 indiates that the mean expetation sores for private hospitals were above 6.30 ranging from the highest 6.53 to the lowest On the other hand, the mean expetation sores for publi hospitals were above 5.50 ranging from the highest 5.88 to the lowest Pereptions: the mean pereption sores for private hospitals were above 5.80 ranging from the highest 6.34 for willingness of personnel to provide servie to the lowest 5.86 for fast and effiient servie of personnel. 180

6 Center for Promoting Ideas, USA On the other hand, the mean pereption sores for all 3-items in publi hospitals were above 4.50 ranging from the highest 4.97 (2 items) for willingness of personnel to provide servie and readiness of personnel to provide servie to the lowest 4.58 for fast and effiient servie of personnel. Gap sores: the largest mean gap sores of both the private and publi hospitals were and respetively for fast and effiient servie of personnel. In testing for results for eah item measuring responsiveness found that two items had signifiant differene when it ame to private hospitals willingness of personnel to provide servie and readiness of personnel to provide servie as ompared to publi hospitals. 4.4 Assurane Table 4 Mean expetation (E), pereption (P), pereption, gap sores and group differenes (gap sore) tests of assurane Assurane E P Gap sore Privat e Privat e Privat e F-value Sig * Personality and experiene of hospital personnel Hospital personnel have knowledge * Sense of trust personnel provide * Politeness of hospital personnel * Expetations: Table 4 shows that the mean expetation sores for private hospitals on the assurane dimension were above 6.40 ranging from the highest 6.66 for politeness of hospital personnel to the lowest 6.48 for hospital personnel have knowledge. On the other hand, the mean expetation values for all items in publi hospitals were above 5.90 ranging from the highest 6.34 for personality and experiene of hospital personnel to the lowest 5.92 for politeness of hospital personnel. Pereptions: the mean pereptions sores for private hospitals were above 6.40 ranging from the highest 6.63 for hospital personnel have knowledge to the lowest 6.42 for sense of trust personnel provide. On the other hand, the mean pereption values for all 4-items in publi hospitals were above 5.60 ranging from the highest 5.86 for personality and experiene of hospital personnel to the lowest 5.62 for politeness of hospital personnel. Gap sores: the results show some positive values, meaning that expetations fall short of pereptions, e.g., on the item in private hospitals for hospital personnel have knowledge. The largest mean gap sore of both the private and publi hospitals was and respetively for politeness of hospital personnel item. The results in testing for eah item measuring assurane found that all 4 items had signifiant differene when it ame to private hospitals as ompared to publi hospitals. 4.5 Empathy Table 5 Mean expetation (E), pereption (P), gap sores and group differenes (gap sore) tests of empathy E P Gap sore Empathy Privat Privat Privat F-value Sig e e e Understand speifi needs * Follow up patients individually * Take the patients best interests to * heart Giving personal attention

7 International Journal of Business and Soial Siene Vol. 4 No. 11; September 2013 Expetations: Table 5 shows the expetation mean sores for all 4- items representing the empathy dimension for private hospitals whih were above 6.40 ranging from the highest 6.56 for follow up patients individually to the lowest 6.45 for giving personal attention. On the other hand, the means expetation values for 4-all items in publi hospitals were above 5.30 ranging from the highest 5.91 for understand speifi needs to the lowest 5.36 for giving personal attention. Pereptions: the mean pereption values for all 4-items in the pereption sore for private hospitals were above 5.90 ranging from the highest 6.22 for follow up patients individually to the lowest 5.95 for take the patients best interests to heart. On the other hand, the mean pereption values for all 4-items in publi hospitals were above 4.60 ranging from the highest 5.16 for understand speifi needs to the lowest 4.64 for giving personal attention item. Gap sores: the largest mean gap sore in private hospitals was for follow up patients individually item, while the largest mean gap sore in publi hospitals was for giving personal attention. The results in testing for eah item measuring empathy found three of the four items showed signifiant differene for private hospitals when ompared to publi hospitals. 4.6 Overall servie quality Table 6 Mean expetation (E), pereption (P), gap sores and group differenes (gap sore) tests of overall servie quality E P Gap sore Priva Priva Priva F- Sig te te te value Overall servie quality * Tangibles * Reliability * Responsiveness * Assurane * Empathy * Expetations: Table 6 shows that the overall mean values of servie quality expetations for the private and publi hospitals were 6.50 and 5.88 respetively. Among the five dimensions, the private hospitals expetation was highest for assurane (6.56); followed by tangibles (6.54), reliability (6.52), empathy (6.50) and responsiveness (6.40). On the other hand, mean values for publi hospitals were the highest for assurane (6.09); followed by tangibles (6.07), responsiveness (5.81), reliability (5.76), and the lowest for empathy (5.66). Pereptions: the overall mean values of servie quality pereptions for the private and publi hospitals were 6.27 and 5.21 respetively. Among the five dimensions, the private hospitals expetation mean values were highest for assurane (6.55); followed by tangibles (6.47), responsiveness (6.14) reliability (6.09), and empathy (6.09). On the other hand, mean pereption values for publi hospitals were highest for tangibles (5.58); followed by assurane (5.70), empathy (5.00), reliability (4.96), and responsiveness (4.84). Gap sores: the overall mean values of servie quality gap sore for the private and publi hospitals were and respetively. The largest gap mean sore in private hospitals was for reliability dimension followed by empathy; responsiveness; tangibles; and assurane dimensions. In addition, the largest mean gap sore in publi hospitals was for responsiveness dimension followed by reliability; empathy; tangibles; and assurane. The results in testing for all 5 dimensions measuring servie quality were signifiant for private hospitals when ompared to publi hospitals. 182

8 Center for Promoting Ideas, USA 5. Disussions and Conlusions An investigation of servie quality between private and publi hospitals in Thailand was onduted using data from 400 patients drawn from a onveniene sample. As the findings indiate, differenes in servie quality exist, as private hospitals were pereived by patients as better than the publi hospital on most of the indiators of assurane dimension inluding knowledge, personality and experiene, sense of trust by the personnel, and polite of hospital personnel (Polsa et al., 2011); followed by tangibles dimension suh as appearane of hospital personnel, onvenient timing for patients, and up-to-date equipment (Arasli et al., 2008); followed by responsiveness, empathy and reliability dimensions. These differenes suggest that private hospitals are playing a meaningful role in soiety, and higher pereived servie quality will only inrease demand for their servies (Andaleeb, 2000). This supports prior researh by Taner and Antony (2006) who studied the servie quality in both private and publi hospitals in Turkey, onfirming that private hospitals were pereived higher in servie quality with regard to assurane with and onfidene in the dotors, nurse and supportive servies than the publi hospitals. A similar finding was reported in a study by Irfan and Ijaz (2011) whih examined servie quality in hospitals of Pakistan and found that private hospitals were delivering better servie quality to their patients as ompared to publi hospitals, espeially on the dimensions of empathy and tangible fators, followed by assurane and timeliness of the servie. The findings from this study suggest that the poor servie quality delivered to patients by publi hospitals as ompared to the private hospitals are due to five dimension of servie quality inluding: responsiveness, reliability, empathy, tangibles, and assurane, respetively. These dimensions are affeting the servie quality of publi hospitals and represent areas for government administrators to fous on in order to improve and develop more high servie quality publi hospitals in Thailand. (Irfan & Ijaz, 2011). Moreover, the results of the study show that some servie quality dimensions in private hospitals were not provided as effiiently as the publi hospitals and the both groups an and should makes improvements. Andaleeb (2000) reported that servie quality improvement in private and publi hospitals in urban Bangladesh needed to make improvement on the assurane dimension for rooms and the skills of the staff, along with professionalism. Thus, the findings of the present study have managerial impliations for Thai private and publi hospital administrators as to servie quality improvement and enhanement as follows. Regarding tangibles, both hospitals group an improve in the visually appealing environment and physial failities within hospital. Next, on the reliability dimension, improvements an be made by delivering servies performed right the first time whih orresponds to patient expetations, e.g., hospitals should inform patients and family about operating hours and to provide servie within the agreed time. As to the responsiveness dimension, it is imperative for both hospital groups personnel to offer faster and more effiient servie to patients. Finally, empathy an be improved by offering personalized attention to patients. Additionally, hospital management needs to gather systemati feedbak from patients and to set up visual and transparent omplaint proedures and protools so that the omplaints of patients an be addressed effetively and effiiently (Arasli et al., 2008). 6. Limitations and Further Researh Impliations The limitations to this study were based on the SERVQUAL instrument and five servie quality dimensions. Perhaps future researh should onsider adding more dimensions. Next, the questionnaire inluded the both expetation and pereption questions. It may be prudent that future studies should separate the expetation and pereption setions, ontating patients just before their treatment and just before they are disharged from hospital. Finally, future studies should investigate the effets of servie quality dimensions on other variables suh as ustomer satisfation, ustomer behavioral intentions (i.e. would reommend the hospital to a friend or relative), and the overall pereived servie value reeived. Referenes Akter, M. S., Upal, M., & Hani, U. (2008). Servie quality pereption and satisfation: A Study over sub-urban publi hospitals in Bangladesh. Journal of Servies Researh, Speial Issue,

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