Interrelationships among quality enablers, service quality, patients’ satisfaction and loyalty in hospitals

Hamid AB. Strategies to improve patient loyalty and medication adherence in Syrian healthcare setting: The mediating role of patient satisfaction

The purpose of this study is to empirically examine the relationships between service quality, patient satisfaction, patient loyalty and medication adherence in the Syrian healthcare setting from a patient's perspective. Based on random sampling technique, data collection was conducted in six hospitals located in the Syrian capital Damascus. The reliability and validity of the theoretical model had been confirmed using quantitative analyses SmartPLS software. The study indicated that our proposed model can significantly explain (35) per cent of patient satisfaction, (55) per cent of patient loyalty and (46) per cent medication adherence in a statistically manner. Our results highlighted that patient satisfaction mediated the relationship between patient loyalty and service quality (assurance, reliability and financial aspect). Besides, patient satisfaction had mediation effect on the relationship between medication adherence and service quality (reliability and financial aspect). Financial aspect had the highest impact on patient satisfaction (β = 0.242) and medication adherence (β = 0.302). In addition, reliability was the only dimension of service quality that had a significant direct impact on patient satisfaction, patient loyalty and medication adherence. To increase patient loyalty in Syrian hospitals, healthcare professionals should place a greater emphasis on the reliability and responsiveness elements of service quality. To the author's knowledge, this is the first study conducted during the COVID pandemic to evaluate the mediating role of patient satisfaction in the relationship between service quality, patient loyalty and medication adherence in the Syrian healthcare sector.

Triggering a patient-driven service innovation to foster the service ecosystem well-being: a case study

Purpose

The aim of this paper is to understand if service innovation (Helkkula et al., 2018), based on artificial intelligence (AI) systems, may guarantee healthcare service ecosystem (H-SES) well-being (Frow et al., 2019; Beirão et al., 2017), taking into account that many doubts relieved in terms of transparency may compromise the patients' perceived quality of health services provided through AI systems.

Design/methodology/approach

A literature review on service innovation, detected in terms of value co-creation, and service ecosystem, investigated in terms of well-being, is drawn. To analyze the implications of service innovation on a H-SES well-being, through the technology acceptance degree and predisposition to use by actors, a case study based on TAM-model 3 determinants as categories is carried out.

Findings

AI-based service innovation archetypes in healthcare may be considered as antecedents of the service ecosystem well-being conditions as long as they enable actors to co-create value. To make it possible, a patient-driven service innovation is necessary in order to mitigate the risks of its inactivity due to fears in terms of transparency.

Originality/value

Service innovation and service ecosystem well-being may be studied in an integrated way, with a multidisciplinary approach, and are linked by value co-creation, because only thanks a patient-driven service innovation is possible to foster service ecosystem well-being in healthcare.

Health Services and Patient Satisfaction in IRAN during the COVID-19 Pandemic: A Methodology Based on Analytic Hierarchy Process and Artificial Neural Network

The aim of this study is to identify and classify the most important factors affecting patient satisfaction in the COVID-19 pandemic crisis considering economic effects. This is an analytical study using the analytic hierarchy process (AHP) method and ANN-MLP (Artificial neural network based on multilayer perceptron model as a supervised learning algorithm) as an innovative methodology. The questionnaire was completed by 72 healthcare experts (N = 72). The inter-class correlation (ICC) coefficient value was confirmed in terms of consistency to determine sampling reliability. The findings show that interpersonal care and organizational characteristics have the greatest and least influence, respectively. Furthermore, the observations confirm that the highest and lowest effective sub-criteria, respectively, are patient safety climate and accessibility. Based on the study’s objective and general context, it can be claimed that private hospitals outperformed public hospitals in terms of patient satisfaction during the COVID-19 pandemic. Focusing on performance sensitivity analysis shows that, among the proposed criteria to achieve the study objective, the physical environment criterion had the highest difference in private and public hospitals, followed by the interpersonal care criterion. Furthermore, we used a multilayer perceptron algorithm to assess the accuracy of the model and distinguish private and public hospitals as a novelty approach. Overfitting results in finding an MLP model which is reliable, and the accuracy of the model is acceptable.

The effect of multidimensional service quality on word of mouth in university on-campus healthcare centers

Purpose

The purpose of this paper is to investigate the impact of multidimensional service quality on word of mouth (WOM) in university on-campus healthcare centers.

Design/methodology/approach

Data were collected from self-administered questionnaires involving a sample of 407 currently enrolled student-patients visiting the on-campus university healthcare centers in the Jordanian capital, Amman. Non-probability convenience sampling was performed in this study. Factor analysis and multiple and hierarchical multiple regression methods were used to analyze the data and test the proposed relationships.

Findings

The results show that the primary dimensions (administration quality, interpersonal quality and technical quality) had a significant and positive impact on WOM, with administration quality appearing as the most influential factor leading to WOM. At the subdimensions level, the findings of this study revealed that interaction activity had the most significant predictive value on WOM compared to the other service quality subdimensions. An insignificant relationship between atmosphere, tangibles, relationship activity and WOM was found.

Practical implications

This study suggests that university administrators and managers of other high-contact service sectors (e.g. hospitality and travel services, tourism education services, financial and insurance services and public services) ought to take into consideration both service quality subdimensions and satisfaction as significant strategic endpoints, as these inputs provide a roadmap for administrators to elicit positive WOM from customers with regard to their businesses.

Originality/value

This study provided its contribution by presenting a comprehensive model of WOM formation and offering specific insights for the on-campus healthcare centers in higher education institutions. This is also the first study conducted in the Middle East, particularly in Jordan.

Examining the behavioural intention of inpatients in Indian government hospitals

PURPOSE

The purpose of this research is to examine the impact of perceived service quality (PSQ) on the behavioural intention (BI) of patients in Indian government hospitals. The underlying mechanism of trust and patient satisfaction (SAT) is examined as multiple mediating effect.

DESIGN/METHODOLOGY/APPROACH

Data from 510 respondents were collected using structured questionnaires. Six government hospitals, namely, S.M.S. Hospital, J.L.N. Hospital, New Medical College Hospital, Maharana Bhupal Medical Hospital, Mathuradas Hospital and P.B.N. Hospital, were selected from the cities of Jaipur, Ajmer, Kota, Udaipur, Jodhpur and Bikaner, respectively. The data were collected from adult patients (>18 years old) who spent at least two nights in a government hospital between 1 October, 2020 and 30 December, 2020. PSQ formed as a reflective-formative model was analysed using the repeated indicator approach. Structural equation modelling (SEM) using SMART-PLS software was used to test the hypothesised model(s) derived deductively from literature.

FINDINGS

The findings support the following conclusions: (1) the positive relationship between PSQ and BI is significant; (2) SAT mediates the PSQ and BI relationship; (3) trust mediates the PSQ and BI relationship; (4) the mediation effect of SAT is stronger than that of trust.

PRACTICAL IMPLICATIONS

The results indicate that, in order to enhance the positive BI of patients towards government hospitals, it is necessary for the hospitals to work on strategies to enhance the service quality provided to patients. The outcome of this study will enable state government hospitals to get a better understanding of the different dimensions of service quality and will help in observing the factors that contribute to patients' satisfaction and trust in building long-term relationships by encouraging a positive BI.

ORIGINALITY/VALUE

There is a dearth of research in India that evaluates the relationships between the constructs PSQ, trust, BI and SAT in the context of healthcare service. This empirical study is an attempt to fill this gap by focussing on the government hospitals in India.

Antecedents and outcomes of patient satisfaction in healthcare: A conceptual model

This study develops a conceptual model and establishes the relationships between the variables, both influencing and affected by patient satisfaction. The authors conducted a thorough search for peer-reviewed articles obtaining a final sample of 64 studies. Service quality was found to be the only antecedent influencing patient satisfaction, while patient satisfaction was found to impact trust, loyalty and word of mouth, also mediating the influence of service quality on these variables. While the study integrates the scattered literature, from a practical standpoint it exhibits how increased patient satisfaction plays a key role in influencing patient trust, loyalty and word-of-mouth.

Obstetrics services in Malaysia: factors influencing patient loyalty

Purpose

This study aims to investigate the link of functional service quality (hospital’s reputation, administrative procedures, trustworthiness, patient-care provider relationship and waiting time), satisfaction and patient loyalty on the obstetrics services in private health-care in Malaysia.

Design/methodology/approach

A total of 419 mothers who had obtained obstetrics services had participated in this study in a continuous and coordinated manner. The study was conducted in 10 private hospitals in Malaysia throughout April 2018.

Findings

Results show that providing excellent service had increased the level of patient satisfaction and achieved patient loyalty. Patients tend to switch to other obstetricians if they are unhappy with the current services that are being offered. The findings showed that patient satisfaction was found to be mediating the relationship between hospital reputation and patient loyalty; trustworthiness and patient loyalty; patient care relationship and patient loyalty; and waiting time and patient loyalty. However, this study also found that administrative procedures do not influence patient satisfaction significantly.

Practical implications

The outcome of this study able to assist the management of the private hospitals to have more operational and practical strategies that would enhance their service quality for the betterment in their services for their patients in this competitive industry.

Originality/value

This paper provides patients’ perception of their loyalty towards obstetrics services offered by private hospitals in Malaysia.

Does healthcare service quality affect outbound medical tourists’ satisfaction and loyalty? Experience from a developing country

Purpose

Poor quality of services in the health-care sector of the developing countries like Bangladesh forces affluent patients to seek advanced medical treatment from abroad. The purpose of this study is to explore the outbound medical tourists’ satisfaction and loyalty on the basis of the quality of the health-care service provided by foreign medical institutions.

Design/methodology/approach

The medical tourists from Bangladesh who have got medical services from Indian medical institutions were taken as a sample by applying a purposive sampling technique. For the measurement of outbound medical tourists’ satisfaction, the dimensions of the HEALTHQUAL model were adopted. A self-administrated questionnaire was the major tool for collecting data from the respondents. Using partial least square-structural equation model multivariate statistical technique and with the aid of SmartPLS software, primary data collected from 218 final respondents were analyzed.

Findings

The findings of this study reveal that four dimensions of the HEALTHQUAL model, namely, empathy, tangibility, efficiency, and safety have a significant positive impact on building medical tourists’ overall satisfaction, and then the overall satisfaction also has a positive level of significance on building loyalty towards foreign medical service providers.

Practical implications

The findings of this study can be a helpful instrument for the developing countries to rethink and reshuffle their own existing health-care system for providing quality medical services and at the same time, the medical tourists importing countries to sharpen their existing service quality as well as to attract more medical tourists in the future.

Originality/value

A handful of research has been carried out, especially focused on health-care service quality measurement and the relationship of health-care service quality with satisfaction and loyalty from the perspective of developing countries outbound medical tourists. Thus, this research work will give a flavor to think of health-care service quality in a different dimension.

TQM implementation practices and performance outcome of Indian hospitals: exploratory findings

Purpose

This paper explores and interprets the linkage between total quality management (TQM) practices and organizational performance measures for improving the healthcare firms’ performance. Indian healthcare firms are aware of TQM practices and their benefits, but the awareness level varies among the firms and staff. The study looks into the effectiveness of quality awareness to meet quality performance in Indian hospitals.

Design/methodology/approach

A questionnaire based on previous research was circulated among the managers and medical staff. The model linking TQM and organizational performance is analyzed with structural equation modelling and confirmed the hypotheses stated. Interpretations to improve hospital performance are made.

Findings

The study identified ten relevant TQM factors and confirmed their importance towards the improved organizational performance of Indian hospitals. Top management initiative, continuous process improvement and team work are the most contributing TQM factors. Differences in the awareness levels by the management staff and medical staff are attributed. The managers and medical staff are aware of the benefits of TQM towards firm performance, but it is to be improved further.

Research limitations/implications

Cross-validation and interpretation are affected due to the limited sample size. Longitudinal study is recommended to explore the individual hospital as specific cases. Larger sample size is suggested as an extended work to overcome the demographic and infrastructural limitations of the firms included.

Practical implications

The management is more interested in TQM, but there is lack of awareness among the staff. The quality awareness and customer focus by medical staff are the most weakly loaded factors, and the weaknesses can be remedied by the lead role by the hospital management in providing proper training and thereby improving the attitude of the medical staff.

Social implications

Effectiveness of hospital operations is highly dependent on customer focus. Properly communicated, committed and trained staff with good-quality awareness can better implement TQM and thereby improve hospital performance. Lead role by the management is very important, and the paper lists ways to attain these outcomes.

Originality/value

Very little is reported from the Indian healthcare sector linking TQM and outcome performance. The quality awareness, customer focus, communication and learning by the medical staff are to be improved, and the paper suggests ways to link TQM more effectively to improve the performance in hospitals. These findings may be useful to the managers, medical staff and researchers in healthcare to bring better results.

Service Quality for Sports and Active Aging in Japanese Community Sports Clubs

(1) Background: This study aims to examine the association between service quality for sports and active aging and the impacts on different age cohorts; (2) Methods: This cross-sectional study used a convenience sample of 545 Japanese community sports club (CSC) members over 60 years old, recruited from across eight CSCs in Japan between 2012-2013. A self-administered questionnaire was used to measure the self-reported health status of the elderly, evaluations to CSCs, demographic characteristics, and information on sports programs; (3) Results: The results of multiple logistic regression showed that domains of general evaluation for sports (OR = 1.942 and 95% CI 1.336~2.824), benefits of sports (OR = 1.659 and 95% CI 1.344~2.047), and management in sports (OR = 1.273 and 95% CI 1.011~1.603) were important for club members aged 60-64, the young-old, and the old-old, respectively. With a reduced model for elderly members, stratified analyses showed a significant impact of service quality for sports on active aged people in the benefits and management domains, regardless of sociodemographic information or club participation behavior; (4) Conclusions: The findings suggest that the services encountered in sports are key to promoting health in a community. Service quality in age segmentation should be considered to promote and manage active aging in the future.

Quality function deployment: exploiting interrelationships for progressive prioritization

Purpose

The purpose of this paper is twofold: to incorporate the symbolic relationships among the attributes of customer requirements (CRs) and engineering characteristics (ECs) as well as to factor in the values numerically to enhance the prioritization process for an improved, comprehensive quality function deployment (QFD) analysis. The aim is to develop the concept of assimilating and factoring in the often-ignored interrelationships among CRs and ECs utilizing the weighted average method for the CR and EC correlations with overall calculations.

Design/methodology/approach

After a brief literature review of the methods utilized, the research paper discusses the framework for the correlation triangle challenge and introduces a novel mathematical solution utilizing triangle values in conjunction with computed initial raw weights for CRs and initial priority scores for ECs. The capability and applicability of the proposed model are demonstrated with a real-life example.

Findings

Through the proposed technique, the roof and the interrelationship triangle's signs and symbols are translated into numerical values for each permutation of ECs and CRs, and then the prioritization values are processed and finalized. The proposed model successfully modifies and removes vagueness from an otherwise overlooked part of the QFD process.

Practical implications

The illustrated case study aptly proves that the proposed methodology yields more revealing and informative outcomes for engineers and designers, thus adding much-needed reliability to the outcome and its analysis. The validation conducted through the rank comparison endorses the premise, and the results obtained reflect the strength and accuracy of the progressive QFD as a product planning tool.

Originality/value

The research article proposes a fresh and unique QFD approach that solves typical procedural complications encountered in a regular QFD. Whereas the traditional methods neglect the interrelationships among CRs and ECs, this new methodology employs them in an improved, numerical way by incorporating them in quantitative analysis, which leads to judicious and improved decision-making.

Logistics service quality and customer satisfaction in B2B relationships: a qualitative comparative analysis approach

Purpose

This study aims to investigate the logistics service quality (LSQ) from a supply chain quality perspective. The purpose is twofold: (1) to investigate how business customers perceive the LSQ dimensions in business-to-business (B2B) relationships, with a particular focus on the role of logistics service providers and (2) to analyse the manner in which such dimensions, when combined, lead to high levels of customer satisfaction.

Design/methodology/approach

Data collected through a survey of a sample of Italian food companies are analysed using a qualitative comparative analysis approach. The analysis explores ways of achieving customer satisfaction through different combinations of LSQ dimensions and not only via a “single recipe,” as in most symmetrical methods.

Findings

The study describes how seven dimensions of LSQ lead to achieve customer satisfaction, particularly highlighting and discussing how the different LSQ constructs lead to gain high customer satisfaction via different configurations. This approach is unique in identifying not only linear relationships among variables as traditional statistical methods do, via a configurational approach.

Research limitations/implications

Most academic studies in the related literature investigate service quality from a quality management and a supply chain management perspective. This study fills the existing gap in the analysis of B2B relationships, focusing on the role of third-party logistics (3PL) service providers.

Practical implications

The study presents useful implications for practitioners, describing several ways in which 3PL service providers can combine LSQ dimensions to perform a continuous improvement of customer experience and to gain higher levels of customer satisfaction.

Originality/value

This study fills the existing gap in the analysis of B2B relationships, using the lens of quality management and supply chain management perspectives, and focusing on the role of 3PL service providers.

Service quality of student services and student satisfaction: the mediating effect of cross-functional collaboration

Purpose

The purpose of this paper is twofold: first, to examine the interaction of tangibles, reliability, assurance, responsiveness and empathy dimensions of the service quality (SERVQUAL) and student satisfaction (SS), and second, to explore the mediating role of cross-functional collaboration (CFC) on these relationships.

Design/methodology/approach

The structural equation modelling was used to examine the direct and mediated effect models using data collected through a survey of 352 students from 18 higher education institutes (HEIs) in Oman.

Findings

The statistical analysis confirms our main hypotheses. First, the centrality of tangibles, reliability, assurance, responsiveness and empathy dimensions of the service quality was established in the direct effect model, while the importance of tangibles and responsiveness was not confirmed in the mediated effect model. Second, it approved the partial mediation effect of CFC on the five dimensions of SERVQUAL and satisfaction.

Research limitations/implications

Service quality, level of CFC and relative SS in higher education could be subjected to contextual verification and evaluation of these internal and external contextual factors should be considered.

Practical implications

Several implications are highlighted for the effective development of the service quality of student affairs departments (SADs), the development of CFC for effective management, development and deployment of various student affairs initiatives.

Originality/value

This paper satisfies the need to validate the SERVQUAL model in different contexts such as SADs, and the need to investigate the possible mediating effect of other factors on SERVQUAL dimensions and satisfaction to show how the latter can be achieved.

The Client Capital in Nursing Management in Hospitals

Abstract Objective: To analyze how the components of the client's capital are used in the management of nursing in hospitals. Method: A qualitative research carried out in five public hospitals, four private hospitals and three philanthropic hospitals in the period from October 2014 to May 2015. Data were collected through a semi-structured interview with twelve nursing managers and analyzed according to content analysis. Results: The components of the Client's Capital were used by the nurses when performing the management of the client service to promote changes and improve the service after evaluating the satisfaction of the nursing care through active systematic search, with its own evaluation tools and the ombudsman's information and in the interaction with suppliers of materials, equipment and services. Conclusion and implications for practice: The managers use managerial actions for the development of the client's capital of organizations. In order to improve them, they must evaluate the nursing care in a continuous and strategic process to satisfy the clients, throughout their trajectory in the organization, since clients are permanent sources of innovation that affect professional and organizational development and productivity.

Prevalence and factors associated with health insurance coverage in resource-poor urban settings in Nairobi, Kenya: a cross-sectional study

OBJECTIVE

To determine the prevalence of health insurance and associated factors among households in urban slum settings in Nairobi, Kenya.

DESIGN

The data for this study are from a cross-sectional survey of adults aged 18 years or older from randomly selected households in Viwandani slums (Nairobi, Kenya). Respondents participated in the Lown scholars' study conducted between June and July 2018.

SETTING

The Lown scholars' survey was nested in the Nairobi Urban Health and Demographic Surveillance System in Viwandani slums in Nairobi, Kenya.

PARTICIPANTS

A total of 300 randomly sampled households participated in the survey. The study respondents comprised of either the household head, their spouses or credible adult household members.

PRIMARY OUTCOME MEASURE

The primary outcome of this study was enrolment in a health insurance programme. The households were classified into two groups: those having at least one member covered by health insurance and those without any health insurance cover.

RESULTS

The prevalence of health insurance in the sample was 43%. Being unemployed (adjusted OR (aOR) 0.17; p<0.05; 95% CI 0.06 to 0.47) and seeking care from a public health facility (aOR 0.50; p<0.05; 95% CI 0.28 to 0.89) was significantly associated with lower odds of having a health insurance cover. The odds of having a health insurance cover were significantly lower among respondents who perceived their health status as good (aOR 0.62; p<0.05; 95% CI 1.17 to 5.66) and those who were unsatisfied with the cost of seeking primary care (aOR 0.34; p<0.05; 95% CI 0.17 to 0.69).

CONCLUSIONS

Health insurance coverage in Viwandani slums in Nairobi, Kenya, is low. As universal health coverage becomes the growing focus of Kenya's 'Big Four Agenda' for socioeconomic transformation, integrating enabling and need factors in the design of the national health insurance package may scale-up social health protection.

Ranking model of total quality management enablers in healthcare establishments using the best-worst method

Purpose

Recent years have witnessed a significant rise in Indian healthcare establishments (HCEs) which indicate that there is a constant need to improve the healthcare quality services through the adoption and implementation of TQM enablers. The purpose of this paper is to identify such enablers and then propose a ranking model for TQM implementation in Indian HCEs for improved performance.

Design/methodology/approach

The study identifies 20 TQM enablers through comprehensive literature survey and expert’s opinion, and classifies them into five main categories. The prominence of these enablers is established using a recently developed novel multi-criteria decision making (MCDM) method, i.e. best-worst method (BWM). The importance of the various main category and sub-category enablers is decided on the basis of their weights which are determined by the BWM. In comparison to other MCDM methods, such as analytical hierarchy process, BWM requires relatively lesser comparison data and also provides consistent comparisons which results in both optimal and reliable weights of the enablers considered in this paper. Further, a sensitivity analysis is also carried out to ensure that the ranking (based on the optimal weights) of the various enablers is reliable and robust.

Findings

The results of this study reveal that out of five main category enablers, the “leadership-based enablers (E1)” and the “continuous improvement based enablers (E5)” are the most and the least important enablers, respectively. Similarly, among the 20 sub-category enablers, “quality leadership and role of physicians (E14)” and “performing regular survey of customer satisfaction and quality audit (E52)” are the most and the least dominating sub-category enablers, respectively.

Research limitations/implications

This study does not explore the interrelationship between the various TQM enablers and also does not evaluate performance of the various HCEs based on the weights of the enablers.

Practical implications

The priority of the TQM enablers determined in this paper enables decision makers to understand their influence on successful implementation of the TQM principles and policies in HCEs leading to an overall improvement in the system’s performance.

Originality/value

This study identifies the various TQM enablers in HCEs and categorizes them into five main categories and ranks them using the BWM. The findings of this research are quite useful for management of the HCEs to properly understand the relative importance of these enablers so that managers can formulate an effective and efficient strategy for their easy and smooth implementation which is necessary for continuous improvement.

Prioritizing customer requirements in a product-service system (PSS) context

Purpose

Product-service systems (PSSs)’s popularity has expanded significantly throughout recent years. The purpose of this paper is to integrate products and services to achieve functional results that augment the offering’s value. Nevertheless, the intangibility of services hinders the diffusion of PSSs: services are characterized by imprecisions and ambiguities that render the assessment and prioritization of customer requirements problematic. An inadequate evaluation of the latter leads to an inconsistent PSS design that results in the customer dissatisfaction.

Design/methodology/approach

To address these concerns, the paper proposes an approach integrating the quality function deployment for product-service systems (QFDforPSS) method with Thurstone’s Law of Comparative Judgments. This approach was tested at a manufacturer in the medical sector seeking to improve his market stance through a PSS model.

Findings

Although the case study is based on a limited sample, the results achieved highlight the importance of the flow of information between the PSS provider and the customers (i.e. the PSS receivers) in the healthcare sector. The proposed approach can facilitate the company in collecting information even in the case of incomplete answers to surveys and questionnaires providing a practical method to handle the uncertainty due to incomplete data.

Originality/value

The study represents one of the first applications of the PSS approach in the healthcare sector, introducing a novel integration of easy-to-use management tools to augment the understanding of customer needs and expectations.

Hospital service quality as antecedent of patient satisfaction – a conceptual framework

Purpose

The purpose of this paper is to explore dimensions of perceived service quality in hospitals and to develop a conceptual framework showing relationship between hospital service quality, patient satisfaction and their behavioural intention.

Design/methodology/approach

This paper is based on extensive review of existing literature on hospital service quality, patient satisfaction and behavioural intention. Critical analysis of these literature studies has resulted in determining and defining the dimensions of perceived service quality and establishing relationship between hospital service quality, patient satisfaction and behavioural intention.

Findings

This study has identified six major areas through which patients perceive quality of service in hospitals. These six areas are technical quality, procedural quality, infrastructural quality, interactional quality, personnel quality, social support quality. Further 20 dimensions of hospital service quality are identified under these 6 major areas. These are clinical procedure, quality of outcome, admission, discharge, waiting time, patient safety, billing and price, follow-up, ambience, availability of resources, accessibility, food, staff attitude, personalised attention, information availability, staff competency, trustworthiness, staff diversity, hospital image and social responsibility. The conceptual framework proposes direct relationship between service quality, patient satisfaction and behavioural intention.

Originality/value

Though many studies have been conducted on hospital service quality, none of them has been able to project all the possible dimensions to measure the same. The “6-Q framework” developed by this study explores all the possible dimensions of perceived service quality in hospitals.