Improvement in Customer Service in Healthcare - Part 6

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5. Customer service quality models

The SERVQUAL model was found to have the capability to explain the dimensions of service quality that are important for customers. The dimensions of service quality that are critical include the tangible aspects of the service, the reliability of the service provider, the responsiveness of the service process, the clearness of the communication between the service provider and the potential customers, the credibility of the service provider, the security offered by the service provider to the clients, the competence of the service provider in the delivery of the promised services, the courtesy afforded by the service provider to the customer, the level of understanding of the customer’s needs and wants, and finally, the access to or accessibility of the services provided (Parasuraman, et al., 1998). A refinement of the SERVQUAL model reduced these components to five components due to some overlapping. The final components of the SERVQUAL model are tangibility, reliability, responsiveness, assurance, and empathy. The tangibles are those items that can be seen, felt, touched and heard. Tangibles include the physical facilities of the service provider (such as the office of a retail bank), the equipment they utilize in the provision of services (such as the elegance of the cutlery in an expensive restaurant), and the appearance of the service provider. Reliability is defined as the ability to deliver the proposed services to the customers at a consistent and accurate way. For example, a service provider is reliable if the customers always get what they pay for. If an electricity provider always issues warnings for power outages, then that service provider has a very low level of reliability. Responsiveness is defined as the service provider’s capability of providing prompt assistance to customers. A towing service that gets to the motorists in as short a time as possible exhibits a high degree of service responsiveness. Assurance is exhibited when the service providers shown courtesy and knowledge about their services such that customers are inspired. Assurance also helps customers develop trust and confidence in their service providers. A doctor that provides practical, thoughtful and accurate medical advice develops a trusting relationship with his or her patients. Lastly, empathy is defined as the attention and care that the business organization provides its customers (Parasuraman, et al., 1998).

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SERVQUAL is a good model because it captures the intangible aspect of service delivery and the human aspects of service delivery. The human aspects are encapsulated in the elements of responsiveness, reliability, assurance and empathy. Therefore, SERVQUAL is a very good scale or model for measuring service quality performance in the service industry sectors. The SERVQUAL model appropriates the important dimensions of service and provides reliable results that can be validated through further research.

Several researchers have utilized the SERVQUAL model. The SERVQUAL model was used in analyzing retail banking, retailing, telecommunications, airline, education, hotel and hospitality, even local government services. The service quality is important in these sectors because service quality is correlated with costs and profitability. In these industries, the quality of service provided is a large factor in making corporate decisions, especially since service quality directly affects the business organization’s overall viability. SERVQUAL therefore, is an ideal model to use in determining the level of service quality that a business organization delivers.

Customer satisfaction is the next aspect of service delivery that has received a lot of attention from scholars and management experts. Customer satisfaction relates to the overall feeling of the customer towards a product or service delivered. In the study conducted by Cronin and Taylor in 1992, the level of customer satisfaction was determined using a single scale item. In the SERVQUAL model, the level of customer satisfaction is determined using a multiple scale measure. The use of a multiple scale measure means that the level of customer satisfaction is as important as the measure of service quality.

Customer satisfaction is a function between the perception of performance and the customer’s expectation of performance. Therefore, customer satisfaction takes on a disconfirmation approach (Tse & Wilton, 1988). According to a study conducted by Magi and Julander in 1996, the construction of the customer satisfaction concept is similar to the construction of the service quality concept.

It is no surprise that there is a real link between customer satisfaction and service qualities. There are several studies that determine the linkage between customer satisfaction and service quality from different perspectives that differ according to the terms of the relationship of the two. For example, studies conducted by McDougall and Levesque in 1996 and 2000, and by Negi in 2009 indicate that the customer’s perception of service quality determines the customer’s satisfaction. A study conducted by Cronin and Taylor in 1992 however, states that the customer satisfaction leads to a higher level of service quality. Other scholarly work indicates that the relationship between service quality and customer satisfaction may be driven by other factors such as attitude. According to Parasurman, both customer satisfaction and service quality are transactional in nature. The transactional nature of these two concepts means that there is a judgement or attitude towards customer satisfaction and service quality that influences how the customer views both concepts. In a study by Negi in 2009, service quality is associated with the overall level of satisfaction. According to the study, the higher the level of service quality, the higher the overall level of satisfaction the customer achieves. If a customer has a large collective experience set of service experiences, then the customer will be able to make a better assessment of the level of customer satisfaction achieved.

These studies point out the correlation between service quality and customer satisfaction and proves that quality is defined when customer satisfaction is regarded by the business organization as significant. The correlation between the service quality and customer satisfaction significance is supported by a study conducted by Wicks and Roethlein in 2009.

Despite the advancements in determining the relationship between service quality and customer satisfaction, there seems to be no exact measure of the relationship between customer satisfaction and service quality level. According to a study conducted by Asubonteng in 1996, there are similarities between service quality level and customer satisfaction level that can be measured to determine the relationship between the two concepts. SERVQUAL is an instrument that is equipped to measure the level of service quality and the level of customer satisfaction.

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The use of customer perception studies are helpful for service oriented organizations because it helps develop strategies that address issues pertaining to customer satisfaction (Saravanan & Rao, 2007). In a study conducted by Gummesson in 1994, there is a notable shift in the mindset of business organization in terms of focus on the importance of goods and services. Originally, business organizations focus on goods and did not emphasize the importance of services. This perspective has changed which led to the perspective of putting higher priority on services rather than goods (Gummesson, 1994). The paradigm shift brings service marketing to the forefront of the competitive business landscape. According to Magi and Julander, the significance of service marketing for service-oriented industries is due to the perceived increase in service quality if services are marketed.

Service quality measurements are of a great interest to management professionals because of the need for a valid methodology for measuring a business organization’s performance from the perspective of the organization’s customers. The search for an appropriate measurement was studied by Parasuraman in 1988, by Gronroos in 1984 and by Cronin in 1992, having established the linkage between service quality and other outcomes of the business organization’s processes.


Service quality can be measured in a variety of ways. According to a study conducted by Gilbert in 2004, there are several methods for measuring quality, which includes the expectancy-disconfirmation approach, the performance-only approach, the technical and functional dichotomy approach, the service quality versus the service satisfaction approach, and the attribute importance approach.

The expectancy-disconfirmation approach looks at the expectation of the customer versus what the customers actually experience. The expectancy disconfirmation approach looks into the customer’s expectations versus the service that the customer received. The customer simply recalls the level and quality of service provided to him or her after the fact.

The performance-only approach looks into the level of customer satisfaction immediately after the service is delivered to the customer. The procedure merely asks the customer about their satisfaction levels.

The technical and functional dichotomy approach looks into the components of the service provided. The first of the two components is the technical quality of the service. This component includes product characteristics such as how durable the product is, how secure the services provided are, etc. The second component is the functional quality. The functional quality looks into the service provider’s relationship with the courtesy and the manner by which the service is delivered. This component includes how courteous, fast, timely and helpful the service provider is in rendering the particular service.

The service quality versus service satisfaction approach looks into two inter-related components, as well. The first of the two components is the transition-specific assessment. This component evaluates the quality features of the assessment. This second component is the overall assessment, which evaluates the overall quality of the service. This measurement is taken immediately after the service is rendered.

Perceived quality looks into the attributes of the service that is rendered to the customer with respect to the control of the business organization over those attributes. This is measured by comparing the consumer’s expectations with the consumer’s own assessment of the service rendered.

The final method of measure is the attribute importance approach. This approach looks into the relative significance of consumer attributes. The higher the overall grade is for each particular attribute, the more satisfied the consumer is.

The SERVQUAL model utilizes these measurements for understanding service level quality and customer satisfaction. The model uses the gap between customer expectations and customer perceptions. SERVQUAL works because respondents are forced to answer questions about both their expectations about the delivered service and their perceptions about service quality. SERVQUAL correlates these factors to come up with meaningful results. By looking into both factors, SERVQUAL measures the attitude effect that customers carry regarding a delivered service, which approximates that of customer satisfaction (Parasuraman, et al., 1998).

A study conducted by Kumar et al in 2009 shows the conceptual SERVQUAL framework. The diagram shows that the expectation of the customers is influenced by external factors. These external factors are controllable by the provider of the service in question. The difference between the customer’s perception and the customer’s expectation is a gap called the perceived service quality (Kumar, et al., 2009).

Figure 4 the SERVQUAL Model

Because of the validity of using the SERVQUAL model for measuring customer satisfaction and service quality levels, this model will be used in determining the customer relationship management effectiveness of healthcare institutions. The SERVQUAL model will be used to determine the main service quality dimensions that result to a perceived level of service quality. This will be analysed throughout the customer relationship management strategies that are implemented by various healthcare institutions in the target area. In addition, the study will follow the quality dimension measurements that have been utilized in the previous scholarly works conducted for quality measurements in different service industries.

The SERVQUAL model with the dimensions of tangibility, reliability, responsiveness, assurance and empathy shall be used to determine the service quality gap in healthcare organizations throughout the target area. Measuring the service quality gap is an indicator of the effectiveness of the customer relationship management strategies that these health organizations implement.

The conceptual framework shown in the Figure 4 the SERVQUAL Model is the model that is applicable to this research. The SERVQUAL model is suitable because it was used in other service quality and customer satisfaction studies. However, SERVQUAL must be modified to fit the intended use and nature of the service industry. The complexities of this type of research necessitates that a modified SERVQUAL model is used.

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Modifying the SERVQUAL model means that the service quality and levels of customer satisfaction are measured in related terms. Based on the findings in the preceding sections, we understand that customer satisfaction is a prerequisite of service quality. By using SERVQUAL, the study can integrate the objectives of determining both service quality and customer satisfaction (Negi, 2009).

However, the original SERVQUAL model has 22 variables. The listing of 22 variables is not applicable for each and every case of service quality determination. Thus, the modification to the SERVQUAL model begins with the reduction in the variables under study. The purpose however, stays the same. The SERVQUAL model is utilized to determine the overall level of service quality from the perspective of the consumer. The SERVQUAL model can be further modified to determine the items that are most important to customers for achieving customer satisfaction.

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