Role of Service Quality on Deciding Customer Satisfaction: A factor in Health Care Services

Customer satisfaction as well as loyalty are considered to be very important by the scholars who have written on services due to their relation to profitability of services.(Anderson et al., 1994; Reichheld & Sasser Jr, 1990;Rust & Zahorik, 1993). Customer satisfaction also has an important role to play in determining the bond that a customer forms with an organization. Through this paper I want to analyse the perceptions made by the service quality on determining the satisfaction of customer when it comes to health care services. This analyses could then be used by service organizations in developing methods to strengthen customer relationships. As the hospitals that are not able to grasp the importance of service quality and customer satisfaction are probably inviting possible loss of patients. (Andaleeb,1998; Padma et al., 2010).

Service quality has been defined as ―the global overarching judgement or attitude relating to the overall excellence or superiority of the service‖, which tells about perceptions of customer about service firm‘s performance. (Parasuraman et al,1988). There are two forms of service quality that are relevant to organizations that provide services, these are functional and technical quality. (Gronroos,1984).The manner in which a particular service is provided to the patient is the functional quality, whereas the aspect that associates with diagnosis and procedure is technical one. Functional quality is normally said to be primary factor that effect the perceptions that the customers have about quality of service as it is very hard for customers to accurately assess the technical aspects to lack of knowledge and information. (Kovner, 1978; Donabedian, 1980, 1982). Administrators of organization and health care professionals mostly have technical knowledge under their purview (Bopp, 1990). Traditionally, the approach was to look at health care quality from perspective of government, health care providers or other care takers, while neglecting the perspective of patients in the analysis. Interestingly, even when the opinion of patients are very different from the concept of quality as being maintained by health care providers and authorities, they are still becoming important when it comes to evaluation of health care quality (Calnan, 1988).

If the perspective of patient is not taken seriously or is ignored, it can in affect reduce the reliability of quality assessment. Some works have acknowledged that when compared to other methods, perceptions of patient has many advantages, when it comes to evaluating service quality, these advantages include: it is not expensive; it can be quickly assessed after delivery of care; it is independent of quality of data present in medical records; it also is sensitive to quality difference when compared to other indicators including morality rates and complication rates. (Rosenthal & Shannon, 1997; Haddadet al., 2000). The most important factor in determining the value perceived by the consumer is his perception (Babakus & Mangold, 1992). The future purchase intentions of the consumer are

Perception of service quality by a consumer is result of his evaluations of overall performance of a particular service provider (Parasuraman, Zeithaml, & Berry, 1988). This perception of service quality could also be seen as an ‗attitude‘, basing it on the well-known ‗disconfirmation paradigm‘, where, by comparing expectation of customers to the perception they have of performance, formation of perceived service takes place(Grönroos, 1984; Parasuraman, Zeithaml & Berry, 1985).The technical quality, which is representative of what the customer is actually receiving from the particular encounter of service or from result of the service which are analysed after the delivery of service, and functional quality, which , as already discussed, shows the way in which the customer is perceiving the interaction that he has when the service is delivered, are the broad aspects on which customers make judgments regarding quality level of the service (Grönroos, 1982; Mels, Boshoff, & Nel, 1997). Now, as most customers are unable to assess technical quality properly, due to lack of ability and mostly basing in only on the functional aspects, lot of research relating to service quality conceptualization is making quality of service to be one-dimensional instead of being multi-dimensional focusing only on its functional quality element. (Cronin, Brady, & Hult, 2000), (Brady, Knight, Cronin, Hult, & Keillor, 2005; Cheng, Lai, & Yeung, 2008). This is normally measured with help of SERVQUAL instrument (Parasuraman, Zeithaml, & Berry, 1985). Although, in the span of last decade, there have been increasing researchers who have considered it fine to adopt the two-dimensional approach to service quality in different contexts, considering both technical and functional aspects (Kang,& James, 2004; Chen, & Wang, 2009; Lundahl, Vegholm, & Silver, 2009; Han, Kim, & Hyun, 2011; Chen,& Cheng, 2012; Tam, 2012). Still, separating technical and functional aspects of evaluating service quality for a comprehensive evaluation is an important step when we further our knowledge of understanding of how the perceptions are formed by customers regarding service quality (Lovelock, 1983).

It is also important to consider the role of emotional satisfaction of the customer when looking at complete customer satisfaction. This particular factor has recently become worthy of attention for the researchers of service marketing (Bigné, Mattila, & Andreu 2008; Wong, 2004; Ladhari, Souiden, & Ladhari, 2011). When service providers have a knowledge regarding the things affecting the emotions of their customers during the encounter of service, and about including emotional reaction of customers in their respective models of evaluating service experience and loyalty. Emotion during consumption of service is present along with other factors that helps in judgment of production of satisfaction (Oliver,1997). Satisfaction can also be considered along with service experience as something attached to a response that is based on emotions (Landhari, et al. 2008).

Another important factor which is usually neglected in many studies relating to customer satisfaction and service quality is the waiting time. Time plays a central role in many services and it is advised more attention be paid to decipher how consumers look at budget, service and value time (Lovelock & Gummesson, 2004). There have been many researches that are focusing around the relationship among waiting time and customer satisfaction (Hui & Tse, 1996; Pruyn & Smidts, 1998). Perishability of service raises many problems for service providers, which are particularly intensified when there is a fluctuation in demand of service. Thus in order to tackle this, many strategies to match capacity and demand are adopted by service providers (Bateson &Hoffman, 1999; Lovelock & Lapert, 1999; Zeithaml & Bitner, 2002). For this, first approach that is taken is to increase or change capacity in order to meet the demand. During the periods when the demand is high, service providers expand their capacity by bringing in additional resources such as workers, equipment etc. Another things that companies try to do is smooth demand by motivating consumers by having more attractive offers when there is less demand, though this would not be possible for health care services completely, this can still be done when the case is not of emergency. Anyway, there are difficulties in reducing the delay even if there is booking. When it is not possible to align demand and capacity, there can still be some waiting line strategies. Waiting line strategies can include making waiting time fun and tolerable, making customers into groups and then properly configuring them (Zeithaml &Bitner, 2002), this is being seen as we see television and other things installed in waiting areas in hospitals and health care centres. Still, after all this, if the waiting time remains long, consumers may still be dissatisfied with service providers.

Customer satisfaction refers to meeting the expectations that the customers have regarding products and services by having a comparison with

the perceived performance matches customer expectations; they are dissatisfied if it does not (Oliver, 1997; Zeithaml & Bitner, 2000).According to the disconfirmation theory, primary factor that determines consumer satisfaction is disconfirmation (Oliver, 1997; Patterson, 2000; Wirtz & Lee, 2003; Wirtz & Mattila, 2001). This is implicative of the fact that satisfaction tells the amount of positive feelings that a consumer feels while in possession of and using a service, having its basis on disconfirmation paradigm in process theory. Still, the perception that the customers have of disconfirmation remains to the minimum as the performance almost always remain with acceptable ranges (Kim et al., 2008; Wirtz &Mattila, 2001; Zeithaml et al., 1993).It is also suggested that the satisfaction of patients is based on his personal beliefs and values regarding a hospital along with the expectations which they had about a hospital (Linder-Pelz, S. 1982). In case of health care industry, the theories of transgression and discrepancy explain that the orientation of patient and the provider conditions are different things, also that if these conditions and orientation of patients are matched according to expectation of patients, it would lead to satisfaction of patients, but otherwise patients would probably be dissatisfied (Fox & Storms, 1981; Gill & White, 2009). Thus in the hospital and health care industry, it is important to look at satisfaction of patients to measure the quality of care and possibility of continuation of services (Grogan et al., 2000).

Consumer satisfaction is considered very important by the service providers as this has direct impact on profitability of the service. Service quality has a major role to play when it comes to consumer satisfaction, especially the functional quality of service and not the technical aspect, this is because that is what a patient directly relates to, also due to his lack of technical knowledge. Thus in order to better understand the effect of service quality on customer satisfaction, we need to look at service quality more form the perspective of the patients then that of administrators and medical professionals, because it is the patients that can better understand what they think they are receiving via the service. As most important factor that determines value for a customer is his perception of service. As such, service providers need to give utmost care to the factors that are related to the perception of the patients. This first of all includes, his perception of service quality as discussed above. Another factor that is equally important is the emotional satisfaction of the customer. If a customer has positive emotional response towards a particular service, that particular customer is more likely to have positive response to service quality and have more satisfaction. Waiting time is another important factor that effects the perception of service quality by a customer. If a patient has to wait in lines to get an appointment to a doctor, or for a room in hospital, this will obviously have a negative impact on his perception of service quality. Thus it becomes important for service providers that the waiting time for customers is reduced as much as possible, and to give them some activity to make waiting time more enjoyable if the waiting time cannot be reduced further. Customer satisfaction is achieved when a customer has a better or same perception of a service as what he had expected.

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Research Scholar, Institute of Hotel & Tourism Management, M.D. University, Rohtak