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International Journal of Health Care Quality Assurance Service quality, patient satisfaction and loyalty in the Bangladesh healthcare sector Selim Ahmed, Kazi Md. Tarique, Ishtiaque Arif,
Article information: To cite this document: Selim Ahmed, Kazi Md. Tarique, Ishtiaque Arif, (2017) "Service quality, patient satisfaction and loyalty in the Bangladesh healthcare sector", International Journal of Health Care Quality Assurance, Vol. 30 Issue: 5, pp.477-488, https://doi.org/10.1108/IJHCQA-01-2017-0004 Permanent link to this document: https://doi.org/10.1108/IJHCQA-01-2017-0004
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Users who downloaded this article also downloaded: (2009),"Factors affecting patient satisfaction and healthcare quality", International Journal of Health Care Quality Assurance, Vol. 22 Iss 4 pp. 366-381 <a href="https:// doi.org/10.1108/09526860910964834">https://doi.org/10.1108/09526860910964834</a> (2016),"Measuring patients’ healthcare service quality perceptions, satisfaction, and loyalty in public and private sector hospitals in Pakistan", International Journal of Quality & Reliability Management, Vol. 33 Iss 5 pp. 538-557 <a href="https://doi.org/10.1108/ IJQRM-06-2014-0074">https://doi.org/10.1108/IJQRM-06-2014-0074</a>
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Service quality, patient satisfaction and loyalty in the Bangladesh healthcare sector
Selim Ahmed Faculty of Management Sciences (ISIAM),
Universiapolis – International University Agadir, Agadir, Morocco, and Kazi Md. Tarique and Ishtiaque Arif
School of Business Studies, Southeast University, Dhaka, Bangladesh
Abstract Purpose – The purpose of this paper is to investigate service quality, patient satisfaction and loyalty in Bangladesh’s healthcare sector. It identifies healthcare quality conformance, patient satisfaction and loyalty based on demographics such as gender, age and marital status. It examines the differences between public and private healthcare sectors regarding service quality, patient satisfaction and loyalty. Design/methodology/approach – The authors distributed 450 self-administered questionnaires to hospital patients resulting in 204 useful responses (45.3 per cent response rate). Data were analysed based on reliability analysis, exploratory factor analysis, independent samples t-tests, ANOVA and discriminant analysis using SPSS version 23. Findings – Findings indicate that single patients perceive tangibles, reliability, empathy and loyalty higher compared to married patients. Young patients (⩽ 20 years) have a higher tangibles, empathy and loyalty scores compared to other age groups. The authors observed that private hospital patients perceive healthcare service quality performance higher compared to patients in public hospitals. Research limitations/implications – The authors focussed solely on the Bangladesh health sector, so the results might not be applicable to other countries. Originality/value – The findings provide guidelines for enhancing service quality, patient satisfaction and loyalty in the Bangladesh healthcare sector and other countries. Keywords Bangladesh, Healthcare, Service quality, Patient satisfaction, Patient loyalty Paper type Research paper
Introduction and background There has been an unprecedented growth and development in the service industries. In many developed countries, service sectors are the largest contributor (more than 50 per cent) to GDP (Bateson and Hoffman, 1991). Developing countries are following in the same footsteps by introducing initiatives to boost their service industries. Healthcare is a key service sector that can attract significant revenue from local and international sources. East Asian countries, such as Thailand and Singapore, successfully attracted several health tourists. Many patients from developing countries like Bangladesh, India and Pakistan frequently visit those countries for quality treatment. It does not mean that the healthcare sector in those countries (i.e. Bangladesh, India and Pakistan) is poor, rather in most cases it is a service quality issue.
As a unique service industry, patients demand high-quality services. The service provided by hospital staff affects patients, family and friends. Any misjudgement or error can have fatal consequences. A report published by the Institute of Medicine in 1999 entitled “To err is human: Building a safer health system” revealed that in the USA, 98,000 people die owing to medical errors annually (McDonald, 2013). In a similar study, the Journal of Patient Safety reports that annually, 210,000-400,000 patients die in US hospitals owing to preventable adverse events (Allen, 2013). The above examples suggest paying maximum attention to healthcare quality. Service quality or SERVQUAL has become a buzz word in today’s competitive business world as it is considered a critical factor for survival and
International Journal of Health Care Quality Assurance
Vol. 30 No. 5, 2017 pp. 477-488
© Emerald Publishing Limited 0952-6862
DOI 10.1108/IJHCQA-01-2017-0004
Received 21 August 2016 Revised 6 January 2017
Accepted 25 February 2017
The current issue and full text archive of this journal is available on Emerald Insight at: www.emeraldinsight.com/0952-6862.htm
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success. SERVQUAL, coined by Parasuraman et al. (1985) to evaluate service performance, is based on five dimensions:
(1) Tangibles refer to physical facilities, tools or equipment used to provide services and staff appearance. The physical facilities such as signs, comfort, accessibility, spaciousness, functionality and cleanness (D’Cunha and Suresh, 2015). This factor is a critical service quality dimension to improve quality performance in the service industry (Rad et al., 2010). Additionally, this factor is primarily associated with service verities to meet customer expectations (Caruana and Berthon, 2002).
(2) Reliability involves service consistency and dependability, which refers to the ability to deliver the service dependably and accurately that customers desire (Parasuraman et al., 1985). Providers deliver the service at the right time and honours their promises, especially billing accurately, keeping records correctly and delivering the service to the customer at the designated time (Kondasani and Panda, 2015). If service providers keep their promises, then customer satisfaction increases and their confidence in the service provider increases because the provider’s performance gradually improves and consistently meet customer expectations (Rad et al., 2010).
(3) Responsiveness concerns service provider’s willingness or readiness to offer a prompt service (Parasuraman et al., 1985). It deals with timeliness, such as providing quick services to the customer, setting-up appointments as soon as possible, immediately sending the transaction slip to the customer so that s/he does not form the wrong impression and calling the customer quickly (Calisir et al., 2014). If service providers increase their response to customers, then it is likely to have a positive effect on customer satisfaction (Parasuraman et al., 1985; Rad et al., 2010).
(4) Assurance refers to employee knowledge, courtesy and the ability to convey trust and confidence. Employees should have the necessary knowledge and skills to provide the best service to their customers. Courtesy means politeness, respect, consideration and friendliness, such as consideration for the customer’s/consumer’s property. Conveying trust and confidence means trustworthiness, believability and honesty. It involves having the customer’s best interests at heart such as contact personnel characteristics (Kitapci et al., 2014).
(5) Empathy refers to caring, knowing customer demands and individualised attention provided to customers. Capacity to understand customer needs refers to the ability to respond to them such as recognising regular customers and learning their specific requirements (Parasuraman et al., 1985). Provider empathy and customer relationship has a positive influence on customer satisfaction (Fitzpatrick, 1991; Zarei et al., 2012).
Researchers show increasing interest in examining the link between SERVQUAL and customer satisfaction, customer loyalty, positive word of mouth, costs and organisational profitability (Shi et al., 2014; Orel and Kara, 2014). Much service quality performance research concludes that SERVQUAL significantly influences patient satisfaction and loyalty in healthcare organisations (Shabbir et al., 2016; Park et al., 2016). Our aim, therefore, is to: investigate service quality, patient satisfaction and loyalty in Bangladesh; and identify provider conformance to healthcare service quality standards, patient satisfaction and loyalty based on demographics (i.e. gender, age, marital status and hospital type).
According to Parasuraman et al. (1988), service quality represents perceived quality, which influences customer judgement/decision about an entity’s overall excellence. The authors also mentioned that organisational service quality consistently meet customer/consumers external and internal needs, wants and expectations to fulfil personal desires. Also, service quality is
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the capability to meet and exceed the results that service provider and customer/consumer mutually defined at the service encounter (Dedeke, 2003). Service quality dimensions include: technical service quality, which refers to performance that the customer/consumer receives in the service encounter; and functional service quality, which relates to subjective perception of how the service is delivered and defines customers’ interactions during service delivery (Gronroos, 1990). Good service quality always leads to high customer satisfaction (Subramanian et al., 2014). To achieve high customer satisfaction, managers must be concerned with four service characteristics (Kotler et al., 2006):
(1) Intangibility: buyers or customers normally cannot see, feel, smell, hear or taste a service before they make an exchange agreement with a service provider.
(2) Perishability: a service must be consumed or encountered on the spot before it expires. This service cannot be kept or stored for a long time. Therefore, service providers must service their customers on the spot.
(3) Inseparability: services are produced and consumed at the same time and that they cannot be separated from their providers, whether the providers are people or machines.
(4) Heterogeneity: services are performed at various levels and quality performance is different: from one organisation to another; from one service provider to another and for the same performer at contrasting times.
According to Gummesson (1992), service quality differs between service organisations and manufacturing organisations. Service managers believe that service quality can be managed through product quality. Providers find that service quality is more difficult than product quality to manage and it is difficult to measure because services are intangible; whereas, product quality is tangible and measurable by inspecting possible defects in the product. Several defects in a product indicates inferior quality (Buyukozkan et al., 2011). In the early 1970s, service quality was researched for its capacity to measure service quality performance.
Healthcare service quality Since 1997, healthcare analysts have been applying the SERVQUAL model to measure patient satisfaction and loyalty. SERVQUAL helps healthcare service providers to identify the gap between service delivery and patient expectations (Al-Borie and Sheikh Damanhouri, 2013; Zarei et al., 2015). Once providers identify their service problems they can immediately improve their quality performance for the patient’s benefit (Kondasani and Panda, 2015). According to Buyukozkan et al. (2011), healthcare service quality can be measured in six ways: tangibles, responsiveness, reliability, assurance, empathy and professionalism. Based on their research, empathy is the most important healthcare service quality factor in Turkey. Their research also found that professionalism and reliability are equally important for hospital service quality performance. Butt and Run (2010) research in Malaysian private healthcare service quality. They explored service quality gaps between service expectations (SEREXP) and service perceptions (SERPER) in a Malaysian private healthcare context. They found that the Malaysian private healthcare SERPER is higher than SEREXP. Andaleeb (2001) stated that it is not necessary to measure tangibles, responsiveness, reliability, assurance and empathy in specific service situations. He suggested that quality dimensions are modified to evaluate specific service situations. In 2001, he studied service quality perceptions and patient satisfaction in Bangladesh. He measured patient satisfaction using five dimensions: responsiveness, assurance, communication, discipline and baksheesh (service tips). His results show that all five dimensions have a considerable influence on patient satisfaction. Manaf and Nooi (2009) researched Malaysian public hospital service
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quality and its effect on patient satisfaction. Patient satisfaction measurement was based on clinical (staff, treatment and information) and physical (cleanliness, environment and visiting) dimensions. Both dimensions have a positive and major influence on patient satisfaction in Malaysian public hospitals.
Patient satisfaction Patient satisfaction is widely used in the healthcare sector to determine service quality (Fenton et al., 2012; Shabbir et al., 2016). Azizan and Mohamed (2013) studied service quality and patient satisfaction at a public hospital in Pahang, Malaysia. Hospital service quality was significantly influenced by three factors: administrative service; medical and nursing care. Hospital infrastructure and interaction have an insignificant relationship with service quality. Leiter et al. (1998) conducted an empirical study in Canadian hospitals. They observed that patient satisfaction is significantly influenced by nurses, doctors and information. These elements led to high patient satisfaction. Manaf et al. (2012) studied the International Islamic University Malaysia Health Centre. Almost half (46.4 per cent) the patients were satisfied with service quality, whereas 7.3 per cent were dissatisfied. In Bangladesh, Andaleeb (2001) looked at patient satisfaction in private and public healthcare sectors using five dimensions: responsiveness; assurance; communication; discipline; and baksheesh. All, except baksheesh, had a noteworthy influence on Bangladeshi patient satisfaction.
Patient loyalty Anbori et al. (2010) defined patient loyalty as a strategic service plan to retain customers in the long term by providing better service quality. To achieve patient loyalty, providers must fulfil patient needs and expectations (Aliman and Mohamad, 2016). Anbori et al. (2010) mentioned that if providers know what service quality aspects are most important to patients and have mechanisms to prioritise and ensure that these are in place, then this will lead to patient satisfaction and willingness to reuse medical services. The authors looked at private hospital patient satisfaction and patient loyalty in Sana’a, Yemen. Reliability, empathy and assurance significantly influence patient willingness to return. However, their results show that tangibles and responsiveness do not have a significant impact on patient loyalty. Mortazavi et al. (2009) conducted research on patient satisfaction and patient loyalty in four Iranian private hospitals using six dimensions: nursing care; operating room; admission and administration services; meals; expenses; and patient rooms. They found that patient satisfaction and loyalty are significantly correlated, and both factors have significant relationships with nursing care, operating room, admission and administration services, and patient room. Hu et al. (2011) measured patient satisfaction and patient loyalty in Taiwan’s hospitals and found that patient satisfaction did not have a considerable influence on patient loyalty in Taiwan. Fornell (1992) argued that loyal customers are not necessarily satisfied, but satisfied customers must be loyal customers; i.e., loyalty is not exclusive, absolute and/or permanent (Roberge et al., 2001). To achieve patient loyalty, providers need to communicate regularly with patients to understand their needs and expectations (Roberge et al., 2001).
Methodology We collected data using a three-part self-administered questionnaire. Section A pertained to respondent demographics (gender, age, marital status and hospital type). Section B measured five service quality dimensions: tangibles, reliability, responsiveness, assurance and empathy. Section C connected Bangladeshi patient satisfaction and loyalty. Both B and C had 29 items and used a five-point Likert scale. Purposive sampling was used and research questionnaires
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were distributed to the respondents in various Bangladeshi places. In total, 450 questionnaires were distributed to respondents who experienced Bangladesh healthcare service quality. In total, 204 responses were received (45.3 per cent response rate). Reliability analysis and exploratory factor analysis (EFA), independent samples t-test, one-way ANOVA and discriminant analysis were undertaken using SPSS version 23.
Data analysis Demographic profile Most (52.9 per cent) respondents were female. Patients ⩽ 20 years totalled 7.4 per cent; 21-30 years, 28.9 per cent; 31-40 years, 26 per cent; 41-50 years, 18.6 per cent; 51-60 years, 11.3 per cent; ⩾ 60 years, 7.9 per cent. Most (64.7 per cent) respondents were married. In total, 116 patients (56.9 per cent) were from Bangladesh private hospitals (Table I).
Reliability and validity Reliability can be analysed in four ways: test-retest; split-half; alternative form and the most popular method, internal consistency (Cronbach’s α). Hair et al. (2010) said that internal consistency applies to consistency among variables in a summated scale. The rationale for internal consistency is that scale items or indicators should all be measuring the same construct and thus be highly intercorrelated. This method was introduced by Kuder and Richardson in 1937 to measure internal consistency using Cronbach α, which we used to measure 29 items covering tangibles, reliability, responsiveness, assurance, empathy, patient satisfaction and patient loyalty. Scores range from 0 to 1, with values close to 1 indicating high consistency. If Cronbach’s α is greater than 0.7, then the item scales are regarded as reliable (Hair et al., 2010). Table II illustrates our Cronbach’s α for seven dimensions, which range from 0.81 to 0.9, exceeding the 0.70 requirement; i.e., the overall instruments were deemed reliable for this study. We used 204 responses to perform EFA. The Kaiser-Meyer-Olkin (KMO) value was 0.93, indicating that research data were suitable for principal component analysis (Table II). Hair et al. (2010) say that factor analysis can be performed when KMO and Bartlett’s test are significant. Our results indicated that factor analysis is appropriate. After confirming research constructs, principal components analysis and the varimax rotation method
Description Frequency Percentage
Gender Male 96 47.06 Female 108 52.94
Age group 20 years or below 15 7.35 21-30 years 59 28.92 31-40 years 53 25.98 41-50 years 38 18.63 51-60 years 23 11.27 Above 60 years 16 7.85
Marital status Single 72 35.29 Married 132 64.71
Type of hospital Public 88 43.14 Private 116 56.86
Table I. Demographic profile
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were specifically used to extract factors from 29 items. Hair et al. (2010) and Sharma (1996) recommend that each item’s factor loading must be more than 0.5. Values above 0.6 are considered highly significant. In total, 29 items fell into seven sub-variables: tangibles; reliability; responsiveness; assurance; empathy; patient satisfaction; and patient loyalty, explaining 72.5 per cent of the total variance. The EFA results also indicated that 0.53 was the minimum factor loading, which makes all factors acceptable for further analysis.
Service quality, patient satisfaction and loyalty We analysed seven dimensions: tangibles; reliability; responsiveness; assurance; empathy; patient satisfaction; and loyalty using independent samples t-test, ANOVA and discriminant analysis (Tables III-VI). Independent samples t-tests were used to identify
Item No. Variables
Factor loading Cronbach’s α
Tangibles (EV ¼ 14.400, PV ¼ 48.000, CV ¼ 48.000) 0.901 TAN1 Hospital have modern equipment 0.0713 TAN2 Hospital have visually appealing facilities 0.763 TAN3 Hospital staffs have a professional appearance 0.722 TAN4 Hospital have visually appealing materials associated with the service 0.792 Reliability (EV ¼ 1.809, PV ¼ 6.032, CV ¼ 54.032) 0.883 REL1 Hospital provide services as promised 0.528 REL2 Hospital staff show sincere interest to solve patients’ problem 0.538 REL3 Hospital perform the service right the first time 0.635 REL4 Hospital perform the services at the time it promises 0.565 REL5 Hospital maintain error-free records 0.694 Responsiveness (EV ¼ 1.683, PV ¼ 5.276, CV ¼ 59.308) 0.811 RES1 Hospital staffs inform me when the services are ready 0.710 RES2 Hospital staffs provide prompt services to their patients 0.608 RES3 Hospital staffs are willing to help their patients 0.554 Assurance (EV ¼ 1.415, PV ¼ 3.717, CV ¼ 63.025) 0.807 ASS1 Hospital is capable to handle your medical problems 0.680 ASS2 Doctors can assure you regarding the better treatment 0.855 ASS3 Doctors are well-manner and courteous 0.668 ASS4 Doctors are knowledgeable to answer your questions 0.714 Empathy (EV ¼ 1.357, PV ¼ 1.357, CV ¼ 66.547) 0.886 EMP1 The hospital gives individual attention to the patient 0.702 EMP2 The hospital has convenient consultation hours 0.750 EMP3 Doctors deal with patients in a caring fashion 0.791 EMP4 Hospital staffs have patients’ best interest at heart 0.651 EMP5 Hospital staffs understand patients’ specific needs 0.634 Patient satisfaction (EV ¼ 1.253, PV ¼ 3.176, CV ¼ 69.724) 0.854 PS1 I was satisfied with medical treatment of the hospital 0.865 PS2 I was satisfied with service of the hospital staff 0.860 PS3 I was satisfied with the hospital facilities 0.567 Patient loyalty (EV ¼ 1.133, PV ¼ 2.777, CV ¼ 72.500) 0.884 PL1 Will say positive things about the hospital treatment to my relatives 0.641 PL2 Willing to recommend the hospital treatment to my relatives 0.787 PL3 Will continue to use the hospital service in the future 0.709 PL4 Willing to do further medical treatment at this hospital 0.633 PL5 Will continue the hospital service even if the cost is higher 0.870 Kaiser-Meyer-Olkin (KMO) 0.927 Notes: EV, eigenvalue; PV, per cent of variance; CV, cumulative variance
Table II. Reliability and validity
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the differences or conformance between patient perceptions on five service quality dimensions, Bangladesh patient satisfaction and loyalty based on gender and marital status (Tables III and IV). There is no significant difference between male and female respondents on service quality, patient satisfaction and loyalty (Table III). However, Table IV indicates there are four significant differences between single and married respondents. Single patients: tangibles ( µ ¼ 3.7791, df ¼ 173, p ¼ 0.001), reliability ( µ ¼ 3.5674, df ¼ 173, p ¼ 0.017), empathy ( µ ¼ 3.3521, df ¼ 173, p ¼ 0.031) and loyalty ( µ ¼ 3.6465, df ¼ 173, p ¼ 0.008) to be better compared to married patients. Jubelirer and Jividen (2011) observed that single patients are more satisfied with nurse interpersonal skills (empathy) and hospital access (reliability) compared to married respondents.
According to Hair et al. (2010), ANOVA is a statistical technique for testing the hypothesis that there is no significant difference between two or more population means. We used one-way ANOVA to investigate significant differences among age groups. We observed that there are significant differences among our age groups on tangibles (F ¼ 3.889, df ¼ 5, p ¼ 0.002), empathy (F ¼ 3.278, df ¼ 5, p ¼ 0.007) and patient loyalty (F ¼ 2.337, df ¼ 5, p ¼ 0.043). The results also indicated that respondents aged 20 and below
Variables Marital Status n Mean t-value p-value
Tangibles Single 72 3.7791 3.291 0.001 Married 132 3.2500
Reliability Single 72 3.5674 2.405 0.017 Married 132 3.2424
Responsiveness Single 72 3.4574 1.410 0.160 Married 132 3.2525
Assurance Single 72 3.6919 1.285 0.200 Married 132 3.5379
Empathy Single 72 3.5721 2.172 0.031 Married 132 3.2591
Satisfaction Single 72 3.3566 0.955 0.341 Married 132 3.2121
Loyalty Single 72 3.6465 2.662 0.008 Married 132 3.2758
Table IV. Independent samples
t-test on marital status
Variables Gender n Mean t-value p-value
Tangibles Male 96 3.3644 −1.085 0.279 Female 108 3.5071
Reliability Male 96 3.3255 −1.112 0.268 Female 108 3.4509
Responsiveness Male 96 3.2766 −1.384 0.168 Female 108 3.4371
Assurance Male 96 3.6011 −0.076 0.939 Female 108 3.6085
Empathy Male 96 3.3404 −0.940 0.348 Female 108 3.4509
Satisfaction Male 96 3.2660 −0.239 0.812 Female 108 3.2956
Loyalty Male 96 3.3894 −0.220 0.826 Female 108 3.4151
Table III. Independent samples
t-test on gender
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have better perception towards hospital tangibles ( µ ¼ 4.2857) and also better patient loyalty ( µ ¼ 3.9143) compared to other age groups (i.e. 21-30 years, 31-40 years, 41-50 years, 51-60 years and above 60 years). They also perceive doctor and nurse empathy to be better ( µ ¼ 3.9714) compared to other age groups (Table V).
Hair et al. (2010) explains that discriminant analysis is an appropriate statistical technique where the dependent variable is categorical (e.g. male vs female, married vs single and high vs low) and the independent variables are metric (e.g. five-point Likert scales or 6 and 7 points rating scales). Discriminant analysis can handle either two or more groups. Our two-group ( public hospital (0) and private hospital (1) discriminant analysis explored seven dimensions. We found significant difference between public and private hospitals regarding staff appearance hospital equipment (Wilks’ λ ¼ 0.646, F ¼ 108.699, p ¼ 0.000),
Variables Groups n Mean F-value p-value
Tangibles 20 years or below 15 4.2857 3.889 0.002 21-30 years 59 3.3771 31-40 years 53 3.2783 41-50 years 38 3.4671 51-60 years 23 3.1591 Above 60 years 16 3.8393
Reliability 20 years or below 15 3.8000 1.925 0.092 21-30 years 59 3.3559 31-40 years 53 3.3132 41-50 years 38 3.3737 51-60 years 23 3.1909 Above 60 years 16 3.8000
Responsiveness 20 years or below 15 3.6667 1.741 0.127 21-30 years 59 3.2373 31-40 years 53 3.3019 41-50 years 38 3.4561 51-60 years 23 3.2121 Above 60 years 16 3.7857
Assurance 20 years or below 15 3.9286 1.450 0.208 21-30 years 59 3.4831 31-40 years 53 3.5896 41-50 years 38 3.6842 51-60 years 23 3.5000 Above 60 years 16 3.8036
Empathy 20 years or below 15 3.9714 3.278 0.007 21-30 years 59 3.3186 31-40 years 53 3.3434 41-50 years 38 3.4789 51-60 years 23 3.0091 Above 60 years 16 3.7714
Patient satisfaction 20 years or below 15 3.5000 1.150 0.336 21-30 years 59 3.1412 31-40 years 53 3.2956 41-50 years 38 3.4035 51-60 years 23 3.0909 Above 60 years 16 3.5714
Patient loyalty 20 years or below 15 3.9143 2.337 0.043 21-30 years 59 3.3288 31-40 years 53 3.3585 41-50 years 38 3.5158 51-60 years 23 3.0636 Above 60 years 16 3.6000
Table V. One-way ANOVA tests on age groups
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reliability (Wilks’ λ ¼ 0.677, F ¼ 94.417, p ¼ 0.000), responsiveness (Wilks’ λ ¼ 0.739, F ¼ 70.107, p ¼ 0.000), assurance (Wilks’ λ ¼ 0.833, F ¼ 39.809, p ¼ 0.000), empathy (Wilks’ λ ¼ 0.643, F ¼ 109.779, p ¼ 0.000), patient satisfaction (Wilks’ λ ¼ 0.761, F ¼ 62.145, p ¼ 0.000) and patient loyalty (Wilks’ λ ¼ 0.737, F ¼ 70.606, p ¼ 0.000). Discriminant analysis also indicates that private hospital patients perceive staff appearance and hospital equipment ( µ ¼ 3.9189), reliability ( µ ¼ 3.7842), responsiveness ( µ ¼ 3.7251), assurance ( µ ¼ 3.8487), empathy ( µ ¼ 3.8281), patient satisfaction ( µ ¼ 3.6520) and patient loyalty ( µ ¼ 3.7684) to be better compared to public hospital patients (Table VI).
Conclusions Service quality, patient satisfaction and loyalty data can be used in quality management, thereby enabling service managers to monitor and maintain service quality. Service providers can better understand how various dimensions and items affect overall service quality, and to design service delivery processes efficiently. By identifying service quality strengths and weaknesses, providers can allocate resources to services and ultimately enhance their service quality. Our findings show significant differences between single and married patients regarding their perception of tangibles, reliability, empathy and loyalty. Single patients perceive tangibles, reliability, empathy and loyalty more favourably compared to married patients. Young patients (20 years or below) generally have more favourable perceptions than other age groups. We examined the differences between public and private healthcare sectors regarding service quality dimensions, patient satisfaction and loyalty. Private hospital patients perceive healthcare service quality performance more positively compared to public hospital patients. Private hospital patients are more satisfied and are more loyal compared to the public hospital patients. Though Bangladesh’s private hospitals managers charge more than their public hospital counterparts, staff ensure that quality health services are provided. Public hospital staff fail to provide the best medical services to their patients owing to a poor healthcare system, corruption and duplication (Chaudhury et al., 2006; Andaleeb, 2000). To improve healthcare service quality, patient satisfaction and loyalty, public healthcare providers should design service standards that promote reliable consist services and not promise more than what they can deliver. Both public and private healthcare organisations need to focus on the married patient loyalty and their service quality perceptions. They need to fulfil married patient needs, patient satisfaction and loyalty. Public healthcare providers need well-planned strategies to strengthen service quality that improves their patients’ perceptions. Our findings provide insights for Bangladeshi healthcare organisation and managers in other countries, which will help to improve service quality towards patient satisfaction and loyalty.
Dependent variable group means l Group means equality testa
Independent variables Group ¼ 0
Public hospitals (n ¼ 88) Group ¼ 1
Private hospitals (n ¼ 116) Wilks’ λ F-value p-value
Tangibles 2.8052 3.9189 0.646 108.699 0.000 Reliability 2.8721 3.7842 0.677 94.417 0.000 Responsiveness 2.8798 3.7251 0.739 70.107 0.000 Assurance 3.2820 3.8487 0.833 39.809 0.000 Empathy 2.8302 3.8281 0.643 109.779 0.000 Patient satisfaction 2.7907 3.6520 0.761 62.145 0.000 Patient loyalty 2.9186 3.7684 0.737 70.606 0.000 Note: aWilks’ λ (U-statistics) and univariate F-ratio with 1 and 198 degrees of freedom
Table VI. Discriminant analysis between public and
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Corresponding author Selim Ahmed can be contacted at: selim.research@gmail.com
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