JURNAL Mutu
JURNAL Mutu
JURNAL Mutu
RESEARCH ARTICLE
Open Access
Abstract
Background: Providing services to patients according to their expectations and needs is necessary for the success
of an organization in order to remain in the competitive market. Recognizing these needs and expectations is an
important step in offering high quality services. This study was designed to determine the service quality gap of the
main hospital of Hormozgan province.
Methods: This cross sectional study was conducted in 2013 in Bandar Abbas ShahidMohammadi Hospital in the
south of Iran. All 96 participants of this study were provided by SERVQUAL questionnaire. Data was analyzed by
Wilcoxon and Kruskal-Wallis tests.
Results: Service quality gaps were seen in all five service quality dimensions and the overall quality of service. The
mean of quality perception score and quality expectation score was 3.44 0.693 and 4.736 0.34, respectively. The
highest perception was in assurance dimension and the highest expectation was in Responsiveness and assurance
dimensions. Also, the lowest perception was in responsiveness dimension and the lowest expectation was about
empathy. In this study, 56.1% of participants defined the quality of services as average.
Conclusion: According to the results, this hospital was not able to meet patients expectations completely.
Therefore, action must be taken to decrease the gap between the perception and expectation of the patients.
Keywords: Hospital, Quality, SERVQUAL, Patients, Iran
Background
Nowadays, quality is becoming a burden to organizations in order to satisfy their customers. Quality of
services is an important factor for the growth, success
and persistence of an organization and is becoming an
important factor for forecasting the organizations
perspective [1].
In the health sector the importance of health services
and their relation with human life, quality assurance and
quality promotion have increasingly caught the attention
of tax payers having increasing expectations from hospitals and other health providing organizations. Because of
the importance of health care services, improving their
* Correspondence: kahnooji56@gmail.com
3
Social Determinants for Health Promotion Research Center, Hormozgan
University of Medical Sciences, Bandar Abbas, Iran
Full list of author information is available at the end of the article
2014 Aghamolaei et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public
Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this
article, unless otherwise stated.
procedures. On the other hand, functional quality is related to non-clinical aspects [6].
Since most of the patients have no knowledge towards
the assessment of technical services, the functional quality is used to evaluate the quality of healthcare services
[5]. In order to assure that medical procedures are effective not only from the experts viewpoint (technical
quality) but also having the ability to satisfy the functional quality patients expectations must be considered
in health system delivery; hence it is essential to evaluate
services explicitly and implicitly based on consumers
viewpoints [6]. Providing the services according with
patients needs and expectation is essential for survival
and success of the organization in the competitive environment of the health care market [7].
The expectations of consumers are related to their
previous expectations, attitude and perception towards
the competitive markets. Also, after providing services
the organization managers must measure the amount of
expectations that have been met [8].
Usually there is an imbalance between the patients
real needs and discernments and awareness of managers
from perceptions of the patients which decreases the
quality of services [9].
(One of the most important reasons is that direct relation with the customer is not available. Therefore the
managers will not be able to determine the priorities and
cannot answer the expectations which lead to quality
gaps [10].
However, recognizing the expectations and perceptions
of costumers regarding the quality of services will facilitate prioritizing and strategic resource allocation and will
decrease quality gaps [11].
There are different methods for determining the expectations of patients. SERVQUAL is one of the best
and most used models in this regard [12]. This questionnaire was reviewed many times and is now summarized
in 5 dimensions of perceptions: responsiveness, assurance, reliability, empathy and tangibility [13].
This tool is used in order to measure the quality of
service, which has 5 dimensions and 22 components for
measuring the expectations and perceptions of the patients on the dimensions of the service qualities [14].
SERVQUAL assesses the exact insight of the patients
from the services they receive and compares it with their
ideal expectation. Parasurman believes that the quality of
services is related to their expectations before and during
purchasing and its perceived quality after purchasing. He
also defines service gap as the difference between customer expectation and their perceptions. This model is
also recognized as the gap analyzer model and is the
strongest tool in assessing the quality of services [15].
This study follows the aim of determining the different
dimensions of the quality of the services being provided
Page 2 of 5
Methods
The study population consisted of all the patients who
were hospitalized in ShahidMohammadi Hospital of
Bandar Abbas in south of Iran during the spring of
2013. Only children under age of 15 yrs were admitted
because of surgical, orthopedic or neurosurgical problems or major burns. The patients were assured their information would be kept confidential and an informed
consent was obtained. For the children younger than
15 years the consent was filled out by their guardians or
parents. This hospital has 21 wards and 450 beds.
Sampling
Page 3 of 5
Expectation
Moderate
Weak
Very important
Relatively important
Tangibility
29
32.6
51
57.3
10.1
86
96.6
3.4
Reliability
32
36
52
58.4
5.6
86
96.6
3.4
Responsiveness
34
38.2
48
53.9
7.9
87
97.8
2.2
Assurance
39
43.8
43
48.3
7.9
86
96.6
3.4
Empathy
26
29.2
56
62.9
7.9
84
94.4
5.6
Total quality
32
36
50
56.1
7.9
86
96.6
3.4
Results
The mean age of the participants was 32.9 10.05 and
most of the participants were male (64%). Most of them
were unemployed (58.4%) and the education level of
55.1% was below high school.
As shown in the Table 1 based on the perceptions of
the patients, 56.1% of the participants recognized the
total quality as average and Based on their expectations
96.6% of the patients believed that quality was the most
significant aspect of services. Also, none of the patients
recognized any of the services as not important (96.6%)
(Table 1).
Based on our findings, the mean expectation score was
high. It was 4.87 for the cleanliness status and 4.62 for
the neat and well-dressed personnel status of hospital
employees. Among the five dimensions of quality, the
highest expectation score was related to responsiveness
and assurance (4.76) and the lowest score was related to
empathy (4.69 0.47). The mean score of perception
varied from 3.92 (neat employees and well-dressed
personnel) to 3.02 (cleanliness of hospital environment).
The highest perception score was associated with
Discussion
This study was designed to determine the quality gap of
services according to the perception and expectations of
patients in an educational hospital in south of Iran, furthermore to aid health policy makers in suitable programming for appropriate hospital medical services.
According to the patients perceptions the quality of
services in ShahidMohammadi hospital was in average.
The lowest perception was related to correct performance of the services at the first time, willingness of
personnel to help patients, attending of personnel whenever called, telling when services will be performed; that
was constituent responsiveness dimension. Which was
parallel with results of Laus study in Malaysia [16] and
Lims study in Singapore [17].
Also the highest expectation score was related to responsiveness dimension. Since the highest expectations
and the lowest perceptions was in responsiveness dimension and that low perceived responsiveness threatens the
hospitals ability to achieve patients satisfaction, if the
hospital is looking for improvement of hospital services
and increasing the patients satisfaction, in the first
instance training of staff on patient requirements is essential. And it is also recommended that hospital
Page 4 of 5
Table 2 Mean score of perception, expectation and quality gap of services provided by Shahid Mohammadi Hospital
Perception
Expectation
Quality gap
Tangibility
3.42 0.83
4.73 0.40
1.30 0.96
7.73
P value
<0.001
Reliability
3.49 0.72
4.72 0.43
1.22 0.87
7.72
<0.001
Responsiveness
3.34 0.81
4.76 0.38
1.42 0.91
7.81
<0.001
Assurance
3.56 0.86
4.76 0.47
1.20 0.96
7.78
<0.001
Empathy
3.39 0.8
4.69 0.47
1.31 0.96
7.78
<0.001
Total quality
3.44 0.69
4.73 0.34
1.29 0.81
8.06
<0.001
Conclusion
The results of this study showed that the quality of services is in average and there were negative gaps between
patients perceptions and expectations in all of dimensions of service quality provided. So, to achieve the ideal
level, proper planning and effective efforts should be
implemented.
Competing interests
The authors declare that they have no competing of interest.
Authors contributions
TA: Developed the concept. Designing the study. TEE: Technical and
Scientific editing of the manuscript. SR: Analyzed the Data. KK: Developed
the Main Concept, interpreted the data. Writing the manuscript SA:
Reviewed the literature. MES: Translated the manuscript. Review of the
literature. AK: preparing the draft. SHH: Data collection. All authors read and
approved the final manuscript.
Acknowledgement
Authors wish to thank the staff of Shahid Mohammadi hospital for their
participation in the study and Research Deputy of Hormozgan University of
Medical Sciences for the financial support.
Author details
1
Department of Public Health, Social Determinants for Health Promotion
Research center, Hormozgan University of Medical Sciences, Bandar Abbas,
Iran. 2Shahid mohammadi Hospital Clinical Research Development Unit,
Hormozgan University of Medical Sciences, Bandar Abbas, Iran. 3Social
Determinants for Health Promotion Research Center, Hormozgan University
of Medical Sciences, Bandar Abbas, Iran. 4Department of Management,
University of Sistan and Baluchistan, Zahedan, Iran. 5Research Committee,
Hormozgan Universtiy of Medical Sciences, Bandar Abbas, Iran. 6Islamic Azad
University of Rafsanjan, Rafsanjan, Iran. 7Health information management
Research Center, Hormozgan University of Medical Sciences, Bandar Abbas,
Iran.
Page 5 of 5
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effectiveness of quality management approaches. TQM Mag 2001,
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doi:10.1186/1472-6963-14-322
Cite this article as: Aghamolaei et al.: Service quality assessment of a
referral hospital in Southern Iran with SERVQUAL technique: patients
perspective. BMC Health Services Research 2014 14:322.
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