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PREDICTING PATIENT LOYALTYAND SERVICE

QUALITY RELATIONSHIP: A CASE STUDY OFCIVIL HOSPITAL,AHMEDABAD, INDIA

Hardeep Chahal

Purpose: In an era of heightened competition to sustain patient loyalty, quality of interpersonal experiences

with the staff, operational quality of hospital operations and overall satisfaction and quality of the healthcare

services, in general are to be understood in-depth in both public as well as private organisations. The

concept of service quality has led to the growing research on various concepts such as total qualitymanagement, market orientation, learning orientation, strategic orientation along with invigorating focus

on the customer loyalty and relationship management. The outcomes of service quality (customer relationship

management and loyalty), end means for the organisational success, are most significant performance

measurement tools in the present competitive market. The present study is an effort in this regard to identify

the factors in sustaining customer longevity. Till today few studies in the developing settings were conducted

to understand the types of relationship that exists between patient-loyalty and service quality. This study

analyses the suitability of customer loyalty concept in the government hospitals through using a case study

of one of the biggest hospitals operating in India.

Methodology and Tools Applied: The research work is the case study of Civil Hospital Ahmedabad. The

data is collected from 205 indoor patients of four departments namely general medicine, orthopedic,

pediatrics, obstetric and gynecology. Inter and intra relationship among the measures of service quality and

patient loyalty were analysed by using relevant statistical tools to draw out inferences.

Findings: Among the three patient loyalty components, using provider again for the same services is found

to be more significant followed by using provider again for different services and recommending providers

to others in relation to overall service quality as dependent variable, and beta values are figured out as

0.15, 0.12 and 0.09 respectively. The 35% R Square value for the model service quality patient loyalty

model indicate weak predictive power of this model. However at the same juncture the study found that no

significant difference in the patients perceptions with respect to patient loyalty and quality and per se, may

be concluded that both are identical measures. Alternatively the more satisfied the patients are with the

quality of their interactions with staff, the more likely they are going to take treatments for similar and

different medical problems and would recommend the provider to their relatives and friends.

Key Words: Patient Loyalty, Service Quality, Physician Performance, Nursing Performance,Operational Quality

INTRODUCTION

CONSUMER loyalty is an indispensable

performance measurement tool for profit as well

as non-profit organisations to sustain

competitive advantage (Kotler, 1998) and to enhance

business/service performance measures. The

hardwearing competitive scenario and mushrooming

growth of service organisations have invigorated the

need to look beyond customer satisfaction towards the

customer retention and loyalty. As such the

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VISIONThe Journal of Business Perspective l Vol. 12 l No. 4 l OctoberDecember 2008

46 l Chahal

organisations are incessantly striving to redesign and

reinvent their operational activities through building

strong and effective organisation culture to have a focus

on the consumer loyalty and relationship management.

Like all other service sectors, the healthcare sector,particularly private healthcare units, have recognised

the importance of relationship marketing and are movingbeyond patient satisfaction and perceived quality of

care, to build mutually committed relationships and

loyalty with the stakeholders (Peltier, Boyt and

Schibrowsky, 2000) to develop better understanding

of patient-provider relationships and establish long-term

patient-provider bond. The organisation s effort to

measure relationship and patient loyalty offers number

of potential economic advantages such as sustaining

competitive pressures, reducing defections, lessening

the need to compete solely on price basis, and bringingnew patients through referrals to them. Such exercise,

consequently will also help the consumers indeveloping stronger and more comfortable relationship

with the providers, instill more confidence in them

towards providers, avoid seeking out and evaluating

other providers and enhance delivering service quality

as they may be more willing to disclose personal

information and more likely to seek preventive advice.

On the flip side, healthcare customers typically associate

excellence with the perceptions of human factor and

behavioural characteristics including friendliness,

timeliness and the staffs perceived knowledge

(Ostwald, Turner, Snipes and Butler, 1998). Thus, it is

imperative that healthcare industry makes genuineefforts to have better understanding of how to develop

and nurture long-term patient-provider relationships.

It is in this context that this study is taken up to assess

significant factors contributing to the development of

long term relationship between the users and the

providers through focus on the patient loyalty and

service quality.

PATIENT LOYALTY

Patient loyalty measure is basically the surrogate of the

customer satisfaction and service quality measures asunderstanding these processes is the first step in

improving patient-provider relationship. Alternatively,

satisfaction is a measure of what people say and loyalty

is a measure what they actually do ( Lee, 2003) and as

such there is always strong reason associated with loyalty

and its okay good type of response if patient is satisfied.

It is being studied in terms of attitudes, satisfaction,

resistance to changing providers, future intentions,

consistent use of same providers, word of mouth, and

actual behaviour and as such there is little consensus on

the best means of measuring patient loyalty ( MacStarvic,

1994).

The patients in general develop loyalty towards

providers based upon the significant interpersonal

experiences they have with the doctors and nurses, and

about the operational quality of the hospital. Therefore,

while patients do form overall global impressions of their

experience, they also evaluate the quality of each of their

interpersonal experiences and about the administrational

operations of the hospitals. Thus, it is important to

determine the most meaningful way of tracking patient

perceptions over the time as well as diagnosing where

care delivery needs to be improved.

Based on the study conducted by Peltier, Boyt and

Schibrwsky (1999) and experience, the present study

has used three patient loyalty measures viz, using provideragain for same treatment (UPAS), using same provider

again for different treatment (UPAD) and referring

providers to others (RPO) ( figure 1). The first variable

using provider again for same treatment reflects

willingness of patients to reuse the same healthcare unit

for a previously received service. The level of patient

satisfaction and perceived service quality influence the

patients willingness to visit the same unit. The

willingness of patients to visit the same unit but for

different treatment (UPAD) is considered to be the second

explicit long-term measure of patient loyalty. The

strongest measure of loyalty is associated with thepositive referrals (RPO) as it is free from any external

Figure 1: Patient Loyalty

Referring Providers to other patients (RPO)

Using provider again for different treatment(UPAD)

Using provider again for same treatment(UPAS)

Patient Lo alt

pressures, and depends solely on the patients own

knowledge base and experience.

Thus patient loyalty concept used here signify the

perceptions of care received by the patients during their

hospital stay, affect and the perception of care received

from the staff later on as well as the overall impressions

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VISIONThe Journal of Business Perspective l Vol. 12 l No. 4 l OctoberDeceber 2008

Predicting Patient Loyalty and Service Quality Relationship: A Case Study of Civil Hospital l 47

and intentions to recommend the hospital. In other

words, how the nurses and doctors treat the patients

affect how patients perceive treatment from them as

well as how they view their overall experience. As

specifically mentioned in the literature, first impressions,

even if only brief can have an enduring impact on the

patient perceptions and if negative, may reduce theimpact of highly positive experiences, a patient has

subsequently with other staff at the hospital. Patientsgenerally use associated facilities and human factors

related to the quality measures to gauge the quality of

hospital services and influence customer satisfaction

(Ostwald, Turner, Snipes and Butler, 1998). Per se, the

study has also used four other variables namely, physician

service performance, nursing service performance,

operational quality (figure 2) and overall service quality

to supplement the patient loyalty measure to have better

insight into the process.

government healthcare service with other private

healthcare big hospitals like Rajasthan Hospital,

Shahibaug, SAL Hospital, Thaltej, Vadilal Hospital,

Memnagar etc. seems to be very high.

MEASURES

The measures namely, service quality (quality of physician

care services, nursing care services, operational quality

and facilities), patient loyalty (UPAS, UPAD and RPO)

and overall service quality of the hospital, based on seven-

point scale were used ( appendix). For the patient loyalty

measure, the study has modified the patient loyalty

measures used by Peltier, Boyd and Schibrowsky (2003)

and included the items pertaining to atmospheric

conditions, operational quality in addition to the items

focusing only on nurses and physician performance.

Eight each statements were used for the three loyalty

measure. The service quality measure included pre-testeddimensions under all the four different variables (Chahal

and Sharma 2004). The factor analysis with varimax

rotation was used (Hair et al., 2005) for identifying

significant service quality statements. The KMO value

equal to and greater than 0.5 and degree of correlation

coefficient equal to or greater than 0.3 were used as

criteria for the selection of items. This application resulted

in identifying 14, 14, 10 and 8 statements under the

physician care services, nursing care services,

operational quality and overall service quality respectively.

DATA COLLECTION

The study is part of the major research project to assess

and validate patient satisfaction scale for reputed national

healthcare services. The data was collected from the

indoor patients availing healthcare services from four

departments primarily general medicine, orthopedic,

pediatric, obstetric and gynecology as these

departments in general constitute majority of the bed

occupancy rates. Out of 730 total bed strength in the

four departments (table 1), 300 patients were selected

according to the simple random sampling technique

using SPSS software on the basis of bed numbers.300 respondents are considered to be quite adequate

for generalisation of the study results based upon simple

random sampling method. Further, selection of indoor

patients from the hospital itself is considered more

objective and rational in comparison to random selection

of respondents from different localities of the city as

indoor patients are more knowledgeable and experienced

in comparison to outdoor patients. Secondly indoor

Figure 2: Patient Loyalty and Service Quality Model

Overall

Service

Quality

Patient

Loyalty

PhysicianPerformance

NursingPerformance

Operational

Quality

UPAS

UPAD

RPO

RESEARCH STUDY

To understand the relevance of patient loyalty in

delivering superior services more effectively and

competitively in the government hospitals, the study was

taken up in one of the biggest public hospitals of India in

Asia. The present study is the part of the major research

project sponsored by UGC to develop and validate the

patient satisfaction scale for big public national hospitals

to the level of AIIMS and PGI. The hospital was

specifically selected as it attracts people from all over

the western and central region of India. With more than

1500 beds and 44 wards for the indoor patients, itprovides multifaceted facilities and treatments to above

6.5 lakh outdoor and 70,000 indoor patients annually. It

is a vast medi-city, well equipped with the modern

apparatus. All types of treatments and investigations are

provided at free of charge and very few investigations

cost some nominal charges (Annual Report, 2003).

Importantly, being a government hospital, it has to work

under the limited budget. The competition of the

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48 l Chahal

patients respond according to the latest service

interaction experience which is not possible in the case

of consumer or household selection from different

localities. Thirdly, the indoor patients represent people

not only from Gujarat state but also from other nearby

states. The schedule was filled in by personally

contacting 205 sample patients from June 2004 toJanuary 2005, giving a response rate of 68.3%. The

empty beds and patients who were not in a position toanswer constitute non-response rate. The demographic

profile of the respondents according to gender,

education, income and occupation characteristics is

given in table 2. The sample consisted of 51 percent

males and 49 percent females, 25 percent illiterates,

20 percent matriculates, 35 percent graduates, 20

percent post-graduates and 37 percent, 24 percent, 20

percent and 19 percent patients under four monthly

income groups of below $250, between $250-$500,

$500-$750 and above $750 respectively.

RELIABILITY AND VALIDITY

The values of reliability, based on the split-half

consistency (table 3), found to be 0.9726 (Sample),

Table 2: Demographic Profile of the Sample

Demographic Groups %

Characteristics

GenderMale 51

Female 49

Illiterate 25

EducationMatriculates 20

Graduates 35

Post Graduates 20

Below $250 37

Monthly Income$250-$500 24

$500-$750 20

Above $750 19

Table 1: Number of Indoor Patients and Bed Strength of the

Departments Selected

S.No Departments IPD B ed Strength

1 General Medicine 13603 300

2 Orthopedic 4884 100

3 Pediatric 13263 150

4 Obstetric and Gynae 15459 180

Total Annual 47209

Month 3934

Sampling Frame 730

Sample 300

Response Rate 68.33%

Table 4: Correlation and Mean Score values for Convergent Validity Analysis

Good Administration Overall Satisfaction Overall Mean

CSM AMM. PSP NSP OQ UPAST UPADT RPO

Correlation r .131 .342 .249 .113 .061 .198 .025 .132

Significance level p .099 .304 .000 .106 .383 .005 .72 .059

Mean Score 4.42 4.44 4.28 4.22 3.99 4.55 4.37 4.38

Overall Mean 4.43 3.98 4.49

Note: CSM : Canteen Services Management, AMM: Adequate Medicine Management,PSP: Physician Service Performance, NSP:

Nursing Service Performance,OQ: Operational Quality, UPAST: Using Provider Again for Same Treatment,UPADT: Using

Provider Again for Different Treatment,RPO: Recommending Provider to Others

0.9742 (sub-sample 1) and 0.9527 (sub-sample2)

suggest the internal consistency of the sample used.

However, precautions are to be used to generalise thefindings. The validity of the instrument was checked by

using construct and convergent validities. The correlation

coefficient was determined between good administration

and two statements viz, canteen management and

medicine management, overall satisfaction, and UPAS,

UPAD and RPO and also for overall satisfaction and

physician satisfaction, nursing satisfaction and operational

quality. The majority of the values support the validity

of the instrument (table 4). The KMO values for the

variables used found to range from .49 to .64 (table 5)

and as such signify moderate construct validity of the

instrument (Hair et al., 1995).

Table 3: Cronbach Alpha Values for Reliability Analysis

Sa mpl e Sub- Sub-

sample 1 sample 2

Alpha Values .9726 .9742 .9527

No. of Respondents 205 103 102

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The mean score values of UPAS Measure varies

between minimum of 3.01 and maximum of 4.45, UPAD

between 3.54 to 4.04 and RPOs between 3.54 to 4.05

connote average degree of patient loyalty. The overall

mean values for UPAS, UPAD and RPO come out to be

3.71, 3.81 and 3.98 respectively. The 35% R Square

value for the model service quality patient loyalty modelindicate weak predictive power of this model. UPAS

variable is found to be more significant followed by UPADand RPO as beta values are figured out as .15, .12 and

.09 for UPAS, UPAD and RPO respectively. Overall,

average picture has been found for the eight variables

used for assessing UPAS, UPAD and RPO (table 7).

Table 7: Multiple Regression Values for Patient Loyalty

Model

Beta Values t- Values R Square Value

UPAS .15 .003

UPAD .12 .023 36%RPO .09 .004

Physician Service Performance

Initially, correlation analysis between physician service

performance variables and overall physician service

quality variable was determined to explore the

relationship. Table 8 displayed the correlation coefficients

for each of the physician service performance variables

and overall service satisfaction. Out of 14 statements 7

statements are found to be significantly correlated tooverall service quality, the coefficients then were ranked

in order of their relative strength of the relationship. The

top most highly correlated service performance variables

were found to be friendliness, helpfulness, queries,

explanation power, availability, control and change mind.

The factors like communication with nurses and other

staff, honesty with their profession, listening to problems,

clearing doubts etc. are found to be insignificant in

assessing the service quality.

Next, step-wise regression model was used to assess

the extent to which overall physician satisfaction could

be predicted by physician service variables. As shown intable 4, about 54 % of the variance of overall quality of

care was explained by four significant service

performance variables: friendliness, availability,

explanation capability and helpfulness.

Lastly using regression, the predictive power of the

physician satisfaction variable with regard to the three

patient loyalty measures was assessed. The predictive

RESEARCH FINDINGS

Patient Loyalty

The patient loyalty measure UPAS, UPAD and RPO was

assessed by using eight significant predictors- overall

satisfaction with the physicians and nurses, overall

physician and nurses quality, overall cleanliness, overall

administration, atmospheric environment and technical

services. The mean, correlation and regression values

were used to explore the patient loyalty-service quality

relationship (table 6). The correlation coefficients are

determined between overall components of service

quality viz, physicians, nursing staff and operational

quality and their respective items to find out specifically

the association of specific items with respective service

quality component. To further support the results and

to determine the item-wise predictive power for service

quality components multiple regression is used.

Table 5: Construct Validity : KMO Values and Variance

Explained

S.NO Measures KMO Variance

Values Explained

A Service Quality Predictors

1. Physician Performance .62 22%

2. Nursing Performance .59 21%

3. Operational facilities and quality .64 9%

4. Overall Service Quality .63 7%

Overall 59%

B Patient Loyalty Predictors

1. UPAS .49 23%

2. UPAD .54 17%

3. RPO .53 15%

Overall 55%

Table 6: Patient Loyalty and Overall Service Quality: Mean

Score Values

Determinants Patient Loyalty O verall

UPAS UPAD RPO Service

Quality

Overall Nurse Satisfaction 3.45 3.56 4.09 3.40

Overall Nursing Quality 3.01 4.01 3.54 3.52

Overall Physician Satisfaction 3.25 3.87 3.98 3.97

Overall Physician Qual ity 3 .05 3 .87 3 .56 4 .02

Cleanliness Condition 3.78 3.54 4.02 3.80

Atmospheric Environment 4.34 3.65 4.05 3.78

Technical Services 4.45 3.98 4.54 4.30

Administration 4.40 4.09 4.05 4.98

Mean 3.71 3.81 3.98 3.97

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to explain overall nurse satisfaction was found to be

53%. The four most important nurse care variables for

predicting satisfaction include friendly, understanding,treating friends and relatives and control. The relative

impact that nurse satisfaction has on predicting the three

patient loyalty behaviours show divergent findings. The

nurse variable has significant but weak impact on the

intent to repeat usage of public healthcare services (8%)

and intent to use other healthcare services at the hospital

(7%), patient referral was the best predictive model for

loyalty measure as it explained about 15. 5 variance.

Operational Quality and Facilities

The correlation between operational quality measure andoverall operational administration found to be significant

for 8 variables viz; admission (r=.65), billing(r=.62),

queue management (r=.62), conducive internal

atmosphere (r=.59), blood bank (r=.54), good lab

models were found to be relatively weak. The predictive

model for UPAD only explained about 28% of the

variance. The predictive models for UPAS and RPOexplained about 22% and 13% respectively.

Nursing Care Performance

The same data analysis procedure was used to assess

the relationship between the nurse service satisfaction

and overall service quality. As can be seen from table 9,

significant association was found between overall nursing

satisfaction and six nursing performance variables out

of the fourteen, namely care (r=.69 and MS=3.98),

helpfulness (r=.62 and MS=.87), found time to be with

patients (r=.57 and MS=3.99), willingness to listen (r=.57and MS=4.01), communication with doctors ( r=.54

and MS=3.56) and explanation power (r=.47 and

MS=3.76).

The ability of the nurse service performance variables

Table 8: Correlation, Mean Score and R Square Values of Physician Satisfaction Variable

Physician Performance Correlation Mean Physician Performance Variables Beta Values R Square

Variables Values and Overall Physician Performance Value

Friendliness 0.62 3.66 Friendliness of Doctors .21

Helpfulness 0.60 3.75 Availability .17 54 %

Queries 0.59 3.89 Explanation Capability .12Explanation Power 0.59 3.79 Helpfulness .04

Availability 0.56 3.96 Patient Loyalty and Overall

Physician Performance

Control 0.54 3.86 UPAS .22 43%

Change Mind 0.49 3.91 UPAD .19

RPO .13

Overall 3.83

Table 9: Correlation, Mean Score and R Square Values of Nursing Satisfaction Variable

Nursing Performance Correlation Mean Nursing PerformanceVariable Beta Values R Square

Variables Values Value

Care .69 3.98 Friendly .20

Helpfulness .62 3.87 Understanding .15 53%

Found time for Patients .57 3.99 Treating Friends and Relatives .10

Willingness to Listen to Patients .57 4.01 Control .08

Communication with Doctors .54 3.56 Patient Loyalty and Overall

Nursing Performance

Explanation Capability .47 3.76 UPAS .0.08 16%

UPAD .007

RPO .155

Overall 3.86

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facility(r=.53), interactive atmosphere (r=.52) and

surgical operations (r=.51) (table 10). This is the first

variable which is explaining about 68% variance. The

significant indicators were found to be good operational

environment, availably of medicine and blood bank,

proper que management, emergency services and

admission. The predictive ability of operational quality

measure is found to be 17, .23 and .25 for UPAS, UPAD

and RPO respectively.

Overall Service Quality

Like patient loyalty, overall service quality was assessedfor eight dimensions namely overall satisfaction with

physicians and nurses, overall physician and nurses

quality, overall cleanliness, overall administration,

atmospheric environment and technical services. The

level of satisfaction was found to be less than average

for overall nursing satisfaction and quality (MS= 3.40

and 3.52), overall physicians satisfaction (MS=3.97),

cleanliness condition (MS=3.8) and atmospheric

environment (MS= 3.78) and more than average for

variables viz, overall physicians quality (MS=4.02),

technical service (MS= 4.30) and administration (MS=

4.98). The grand mean score is found to be 3.97 almostsame as that with loyalty measures.

DISCUSSION

Delivering service quality consistently creates and fosters

the feeling of being cared and lead to patient satisfaction

and loyalty. Holistically, how the doctors, nurses and

supportive staffs treat patients affectively, and how

patients perceive treatment from the unit vis--vis level

of satisfaction and loyalty and consequently overall

image. Like the findings of Peltier, Boyd and

Schibrowsky (2003), the patient loyalty measure is found

to move parallel with the physicians, nurses and

operational quality and overall quality measures. The study

found that no significant difference in the mean values

of patient loyalty measures and quality measures and

per se, may be concluded that both are identical measures.

Alternatively the more satisfied the patients are with the

quality of their interactions with the staffs the more likely

they are going to UPAS, UPAD and RPO. Thus

satisfaction and loyalty cues formed are based on theircommon significant interactions patients have at the

hospital. Additionally, same type of behaviour is also

observed among the variables in the satisfaction and

loyalty constructs. Those who evaluate the doctors

favourably tend to evaluate doctors and operational

quality favourably as well. The more satisfied the patients

are with the quality of their interactions with the staffs

the more likely they are going to UPAS, UPAD and RPO.

These experiences form the basis of one of the most

important marketing tools for the hospitals and the

positive interpersonal experiences, which patients

communicate to other potential patients. This may resultin at least in part to the staffs general level of

commitment to providing a certain standard of care.

Besides, the study has also identified interpersonal

experience of patients with doctors quite appreciative in

terms of their helpfulness, friendliness, satisfactory

answers for queries, caring attitude towards the patients

and their relatives and friends as significant contributors

Table 10: Correlation, Mean Score and R Square Values of Operational Quality

Operational Quality Correlation Mean Operational Quality Beta Value R Square

Values Value

Admission .65 4.71 Operational Environment .21 68%

Billing .62 4.04 Availability of Medicine .17

Queue Management .62 3.56 Blood bank .12Conducive Internal Environment .59 3.87 Queue Management .09

Blood Bank .54 3.99 Emergency Services .06

Lab facility .53 4.01 Admission .03

Interactive Atmosphere .52 3.91 Patient Loyalty and Overall

Operational Performance 21%

Surgical Operations .51 3.87 UPAS .170

UPAD .023

RPO .025

Overall 3.995

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REFERENCES

Annual Report (2003), New Civil Hospital , Ahmedabad.

Chahal, Hardeep and R.D. Sharma (2004), Managing Healthcare

Service Quality in a Primary Healthcare Center,

Metamorphosis, 3.2, pp.112 131.

Hair, Joseph F., Rolph E. Anderson, Ronald L. Tatham andWilliam C. Black (2003), Multivariate Data Analysis, Pearson

Education (Singapore) Private Limited, Delhi.

Kotler, Philip (1988), Marketing Management: Analysis,

Planning, Implementation and Control , Prentice Hall of India,

New Delhi.

Lee, Fred (2003), To Build Loyalty, Hospitals Need to Exceed

Customers Expectation, Marketing Health Service ,

Summer, pp.33 - 37.

MacStarvic, Scott (1994), Patient Loyalty to Physicians,

Journal of Healthcare Marketing , Winter, pp.53 - 55.

MHS Staff (2002), Facing the Future, Marketing Health

Services, Fall, pp.24 - 27.

Paula, Adam Di, Roe Long and Dan E Wiener (2002), Are your

Patients Satisfied, Marketing Health Services , Fall, pp.29 -

32.

Peltier, James W, Thomas Boyt and John A Schibrowsky (2000),

Obstetrical Care and Patient Loyalty, Marketing Health

Services, Fall, pp.5 - 12.

Ostwald, Sharon L, Douglas E Turner, Robin L Snipes and Daniel

Butler (1998), Quality Determinants and Hospital

Satisfaction, Marketing Health Services , Spring, pp.19 -

22.

Appendix : Measures Used

A: SERVICE QUALITY

Physician Care Service

S.no Statement PA SA A U D S D PD NK

1. Doctors are friendly. PA SA A U D SD PD NK

2. Physicians answer your queries satisfactorily. PA SA A U D SD PD NK

3. Physicians are always helpful and supportive. PA SA A U D SD PD NK

4. Physicians always listen to what you had to say PA SA A U D SD PD NK

5. Physicians are honest. PA SA A U D SD PD NK

6. They explain clearly about the treatment. PA SA A U D SD PD NK

7. They care a lot about all patients. PA SA A U D SD PD NK

8. They also treat your families and friends nicely. PA SA A U D SD PD NK

9. They communicate with nurses very well PA SA A U D SD PD NK

10. They communicate with supportive staff very well PA SA A U D SD PD NK

11. They give sufficient control to you PA SA A U D SD PD NK

12. They have the ability to change your mind. PA SA A U D SD PD NK

13. They are always ready to clear your doubts. PA SA A U D SD PD NK

14. They are always available on time. PA SA A U D SD PD NK

Nursing Care Services

1. Nurses give sufficient control to you PA SA A U D SD PD NK

2. They care a lot about all patients. PA SA A U D SD PD NK

3. Nurses are always helpful and supportive. PA SA A U D SD PD NK

4. They are always ready to listen to what you had to say PA SA A U D SD PD N K

5. Nurses are very friendly. PA SA A U D SD PD NK

6. They reply your queries very satisfactorily. PA SA A U D SD PD NK

7. They treat your relatives and friends very nicely. PA SA A U D SD PD NK

8. They explain clearly about the technical treatment. PA SA A U D SD PD NK

9. They spend sufficient with you. PA SA A U D SD PD NK

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54 l Chahal

10. They communicate with supportive staff very well. PA SA A U D SD PD NK

11. They communicate with physicians very well. PA SA A U D SD PD NK

12. They well understood your needs. PA SA A U D SD PD NK

13. They have the ability to change your mind. PA SA A U D SD PD NK

14. They are available at the time of need PA SA A U D SD PD NK

Operational Facilities

1. Admission process is simple. PA SA A U D SD PD NK

2. Billing system is satisfactory PA SA A U D SD PD NK

3. Proper queue management is followed. PA SA A U D SD PD NK

4. Internal atmospheric environment is attractive PA SA A U D SD PD NK

5. Blood bank service is very effective PA SA A U D SD PD NK

6. Laboratory facilities are very good. PA SA A U D SD PD NK

7. Surgery operations schedule is well planned PA SA A U D SD PD NK

8. Bedsheets/linens are changed daily PA SA A U D SD PD NK

9. There is always conducive interaction with the frontline staff. PA SA A U D SD PD NK

10. Housekeeping services and canteen facilities are good. PA SA A U D SD PD NKOverall Service Quality

1. Your expectations are fully met with regard to doctors PA SA A U D SD PD NK

2. Your expectations are fully met with regard to nurses PA SA A U D SD PD NK

3. Your expectations are fully met with regard to supportive staff PA SA A U D SD PD NK

4. Overall administration is good PA SA A U D SD PD NK

5. Overall cleanliness is maintained. PA SA A U D SD PD NK

6. Good atmospherics PA SA A U D SD PD NK

7. Good technical services. PA SA A U D SD PD NK

8. You are very satisfied with the hospital. PA SA A U D SD PD NK

Patient Loyalty

Using Provider Again ( Same treatment )

1. Overall satisfaction with nurse care. PA SA A U D SD PD NK

2. Overall quality of nurse care. PA SA A U D SD PD NK

3. Overall satisfaction with physician care. PA SA A U D SD PD NK

4. Overall quality of physician care. PA SA A U D SD PD NK


6. Overall cleanliness of the unit is excellent PA SA A U D SD PD NK

7. Good atmospherics environment is maintained. PA SA A U D SD PD NK

8. Good technical services are delivered. PA SA A U D SD PD NK

Using Other Healthcare Services Offered by Provider ( Different Treatment)

1. Overall satisfaction with nurse care. PA SA A U D SD PD NK2. Overall quality of nurse care. PA SA A U D SD PD NK







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Referring Providers to Others

1. Overall satisfaction with nurse care. PA SA A U D SD PD NK

2. Overall quality of nurse care. PA SA A U D SD PD NK







Hardeep Chahal ([email protected]) is an Associate Professor at Department of Commerce, University of Jammu ,

Jammu. She has earned Commonwealth Fellowship under British Academy Awards for International Collaboration in 2005 and Visiting

Fellowship to Gandhi Institute of Business and Technology, Jakarta, Indonesia in 1999-2001. She has participated in number of national

and international seminars and conferences. Her research works have published in the refereed national journals like Vikalpa,

Metamorphosis, Decisions, Journal of Social Work, Journal of Health Management, Journal of Services Research and Journal of RuralDevelopment and the international journals such as International Journal of Business and Globalisation and International Journal of

Indian Culture, Business and Management. She has also co-edited books on Research Methodology in Commerce and Management and

Strategic Service Marketing.
http://[email protected]/http://[email protected]/

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