1 Critically evaluate service quality as a determinant factor for patient satisfaction in gaining patient loyalty. A case study of Travancore Medical College Hospital Kerala, India. BY ANEESH POOCHAPANDIYIL VELAYUDHAN PRASANNAN SUPERVISOR : MR. CILLIERS DIEDERICKS WALES ID : 1092227390326 KCB ID : 15040 Submitted in fulfilment of the requirements of the Taught Masters Dissertation to the University of Wales, for the degree of Masters in Business Administration (MBA).
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1
Critically evaluate service quality as a determinant factor
for patient satisfaction in gaining patient loyalty.
A case study of Travancore Medical College Hospital Kerala, India.
BY
ANEESH POOCHAPANDIYIL VELAYUDHAN PRASANNAN
SUPERVISOR : MR. CILLIERS DIEDERICKS
WALES ID : 1092227390326
KCB ID : 15040
Submitted in fulfilment of the requirements of the Taught Masters Dissertation to the
University of Wales, for the degree of Masters in Business Administration (MBA).
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DECLARATION
This research work is purely the author’s own effort where the ideas of other
scholars and authors are referenced using the Harvard Referencing style. It has not
been previously accepted in substance in any degree and in not being concurrently
submitted in candidature in any degree
This dissertation is the result of my own investigation, except where otherwise
state, where correction services have been used, the extent and nature of the
correction is clearly marked in footnote(s). The ethical issues have been kept into
consideration during the preparation of this report and the responses of the
individuals to the research survey are kept confidential.
I hereby give consent for my work, if accepted to be available for
photocopying and for inter-library loan, and for the title and summary to be made
available to outside organizations.
Signed ……………………………………………………….. (Candidate)
Date: 14/02/2012
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Table of contents Page No.
1. Introduction 1
1.1 Research background 2
1.2 Research Aim 4
1.3 Objectives 4
1.4 Rationale for choosing the research topic 5
1.5 Company profile 6
1.6 Conclusion 7
2. Literature review 7
2.1 Introduction 7
2.2 Aims and objectives 7
2.3 Literature Review 8
2.4 Service Quality Conceptualization 8
2.5 Dimensions of service quality 11
2.6 Measuring Service quality 12
2.6.1. Gap Model 13
2.6.2 SERVQUAL Model 15
2.6.2.1 Advantage of SERVQUAL Model 18
2.6.2.2 Criticism of SERVQUAL Model 18
2.6.3 SERVPERF Model 20
2.7 .Patient satisfaction 20
2.8. Patient satisfaction and its dimensions 23
2.9 .Theories of customer satisfaction 24
2.10. Measure of customer satisfaction 24
2.11. Patient Loyalty 25
2.12 Importance of custom loyalty 26
2.13 Measurement of patient loyalty 27
2.14 Service quality and customer satisfaction relationship. 29
2.15 Service quality and customer loyalty relationship 29
2.16 Customer satisfaction and customer loyalty relationship 29
2.18 Conclusion 30
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3. Research Methodology
3.1 Introduction 31
3.2 Aims and objectives 31
3.3 Research Methodology 31
3.4 Research Design 32
3.4.1 Exploratory Research 33
3.4.2 Descriptive research 33
3.4.3 Explanatory research 33
3.4.4 Justification for research design 33
3.5 Research Philosophy 34
3.5.1 Epistemology 34
3.5.2 Positivism 34
3.5.3 Realism 34
3.5.4 Interpretivism 35
3.5.5 Ontology 35
3.5.5.1 Subjectivism 35
3.5.5.2 Objectivism 35
3.5.6 Axiology 35
3.5.7 Justification of research philosophy 36
3.6 Research approach 36
3.6.1 Justification of research approach 37
3.7 Research Strategy 38
3.7.1Quantitative data 38
3.7.2 Qualitative data 38
3.7.3 Justification of research strategy 38
3.8 Source of data 38
3.8.1 Primary data 39
3.8.2 Justification of primary data 40
3.8.3 Secondary data 40
3.8.4 Types of secondary data 41
3.8.5 Justification of secondary data 41
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3.9 Sampling 42
3.9.1 Probability sampling or Representative sampling 42
3.9.2 Non Probability Sampling or judgemental sampling 42
3.9.3 Justification of sampling 42
3.10 Conclusion 42
4. Research findings and Analysis
4.1 Introduction 43
4.2 Aim and Objective 43
4.3 Analysis of primary data 44
4.4 Comparing primary data with secondary data 65
4.5 Conclusion 67
5. Conclusion and Recommendation
5.1 Introduction 69
5.2 Aim and Objective 69
5.2.1 Achievement of objective 1 69
5.2.2 Achievement of objective 2 70
5.2.3Achievement of objective 3 72
5.2.4 Achievement of objective 4 72
5.3Conclusion 73
5.4Research limitation 73
5.5Recommendations 74
5.5.1 Recommendation 1 74
5.5.2 Recommendation 2 77
5.5.3 Recommendation 3 80
5.5.4 Recommendation 4 82
5.5.5 Recommendation 5 82
5.5.6 Recommendation 6 84
5.5.7 Recommendation 7 84
5.5.8 Recommendation8 84
6. Reflective summary 85
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7 Reference 86
8 .LIST OF FIGURES
1. Fig 2.1 Gap Model 14
2. Fig 2.2 Measurement of patient loyalty 27
3. Fig 2.3 Patient loyalty and service quality model 28
4. Fig 2.4 The relationship between service quality,
Customer satisfaction and customer loyalty. 30
5. Fig 3.1 Research onion 32
6. Fig 3.2 Source of Data 39
7.Fig 3.3 Primary data 40
8.Fig 3.4 Secondary data 41
9. List of Tables
1. Table 2.1 22 Items of SERVQUAL instruments 17
2. Table 2.2 Customer Benefits 26
3. Table 3.1 Types of Research Design 33
4. Table 3.2 Research Approach 37
5.Table 4.22 Patient satisfactory 65
6. Table 5.1 Gantt Chart of ERP 76
7. Table 5.2 Gantt Chart of recruitment of HR trainers 79
8. Table 5.3 Gantt chart of CCTV 81
9.Table 5.4 Gantt chart of purchase of medicines 83
9.List of Charts
1. Chart 4.1 Distribution of sample size according to age and sex 44
2. Chart 4.2 The reason for choosing hospital 45
3. Chart 4.3 The receptionist was friendly and courteous 46
4. Chart 4.4 The staff respects the patient with respect ,dignity and were
Courteous in the hospital 47
5. Chart 4.5 There is a lot of paper work for admission 48
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6. Chart 4.6 The service cost for hospital is affordable. 49
7. Chart 4.7 All the staffs were in correct uniform 50
8. Chart 4.8 Hospital is visually attractive 51
9. Chart 4.9 Hospital is a convenient location 52
10 Chart 4.10 Hospital has good directional science 53
11. Chart 4.11 Hospital provides services at allocated time 54
12. Chart 4.12 Hospital department is working effectively 55
13 Chart 4.13 You felt ease during your appointment 56
14 Chart 4.14 Doctors listen carefully and adhered to your needs 57
15 Chart 4.15 Hospital addresses the patient complaint quickly 58
16 Chart 4.16 Do you think staff responded immediately 59
17 Chart 4.17 Hospital employee are sympathetic and re assuring 60
18 Chart 4.18 Hospital doctor prescribes affordable medicine 61
19 Chart 4.19 Average waiting time in the hospital 62
20 Chart 4.20 Charges of TMC hospital is affordable 63
21 Chart 4.21 Recommending hospital to the friends and relatives 64
10. 1 Appendix 1 92
2. appendix 2
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Chapter 1
Introduction 1 Introduction
All business organisations including health care organisation are interested in
achieving long term financial success (Al Hawary et al., 2011). Healthcare is one of
the most important elements of life and people always demand a better quality of
health to have a healthy life. This patient centric approach and consumer satisfaction
became the fundamental requirement for healthcare providers (Desai, 2011).In the
recent years the number of private and public hospitals had been increased
tremendously. In order to gain competitive advantages in the health care industry
and improve the operative efficiency the hospitals have adopted quality improvement
measures (Yasin et al., 2011) . Likewise Bullet (1996) had identified service quality
as a corporate market strategy and financial performance driver and had stated that
the hospitals can achieve competitive advantage and operational efficiency by
adopting service quality as a strategic tool. According to Shaktivel et.al (2005)
customer satisfaction is one of the critical factors that judges the service quality
delivered to the customers (Shaktivel et.al (2005); cited by Ooi et al., 2011).Impact of
patient satisfaction in choosing hospitals are important. Research had shown that
there are links between patient satisfaction and healthcare quality (Kessler & Mylod,
2011). Woodruff in 1997 had pointed out that service providers consider customer
loyalty as a competitive advantage. Many researches had proved that enhanced
customer loyalty increase profitability of the organisation (Woodruff (1997); cited by
Wang & Wu, 2012). On the other hand Strasser et.al in 1995 had stated that
negative word of mouth can cause hospitals a revenue loss of 6000$ to 400,000 $
(Naidu, 2009).With the increasing no of private and public hospitals the completion to
be the top health care provider is intense. The private hospitals compete with each
other to provide the best healthcare. According to Lim and Tag (2000) the public
awareness and rising literacy rate in the population made healthcare providers to
provide high quality treatment to the patient. Every patient have expectations what
their health care centre is going to provide them .Every healthcare centres should
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give attention to reduce the gap between what patients actually expects and the
service that is actually delivered. (Lim and Tag (2000); cited by Suki et al., 2011). In
this research the author will be evaluating service quality as a determinant factor for
patient satisfaction in gaining patient loyalty.
First of all the author begins with the research background then the author had
discussed about research aims and objectives then the author had talked about
about the reason for choosing this research topic, the company’s background and
finally will conclude by summarizing the entire research research.
1.1 Research background
India has been witnessing increasing demand for quality healthcare after
globalization. Urbanization had improved quality of life which in turn had demanded
quality health care. Service quality has been chosen as an important element by
consumers for selecting hospitals (Dr.Vanniarajan & Arun, 2010).India has now
become a medical hub and the patients from the Western countries and other parts
of Asia and Africa use undergo treatment due to due to low cost and high quality
treatment. According to KGMP report of 2011 the healthcare industry in India will
grow from USD 79 Billion in 2012 to 280 Billion in 2020 (KMPG, 2012).Eventhoug
the health care spending in India is significantly low as compared to the developed
countries and other emerging countries. The average CAGR for the healthcare
industry in the next 10 years is 21%. . In India more than 50 percent of healthcare
expenditure comes from the individual against the state level government
contribution of less than 30 percent (Padma et al., 2010) .According to the WHO
health statistics 2010 private sector contributes approximately 75 % of the health
sector. The key factors for the growth of healthcare sector are Increase in
population, rising disposable income of the population, rising literacy rate,
demographic changes by 2026 there will be an increase in geriatric population from
current 96 million to 126 million which means that there will be an increased
dependence on hospitals, increase in lifestyle related diseases like cardiovascular
disease, diabetes. The health care industry in India is also facing many challenges
like lack of manpower and infrastructure. The healthcare infrastructure in India lags
behind the global average .India has only .6 doctors per 1000 population against the
global average of 1.3 it is evident from this finding that there is a gap of man power.
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The no of bed available per the 1000 population is only 1.27 which is less than the
global average of 2.6%.However in the last decade there was an increase
participation of private sector in the healthcare industry. In the coming years the
healthcare sector will be facing stiff competition due to increased no of private
hospitals and because of the government policies allowing 100 % FDI in hospital
sector .In order to have a competitive advantage in this highly competitive
environment the hospitals should improve their quality standards in lieu with their
counterparts. Hospitals should implement healthcare accreditations like JCI (Padma
et al., 2010).
Despite of the growth of the healthcare industry the hospitals and other health
care organisations are struggling to deliver quality healthcare in this competitive
environment (Avgar et al., 2011).The service delivery system in the recent years
have been restructured and is now patient centric (Desai, 2011).Moreover the
studies done by Sahay (2008) shows that there is a need for improvement for
customer service (Padma et al., 2009). In recent years concern for service quality
had gained unprecedented levels. Service quality had now become an important
distinguishing factor between services to gain competitive advantage (Rashid &
Jusoff, 2009). According to Taner and Antony (2006) health care service has a
unique position among other service due to its very nature of highly involved risk.
This makes measuring service quality and patient satisfaction in healthcare setting
more important and more complex (Taner & Antony, 2006; cited by Rashid & Jusoff,
2009)
According to Kotler in 1998 customer loyalty is an indispensable tool for profit and
non profit organisation to sustain competitive advantage and to enhance business or
service measures (Chahal, 2008). The research done by many researchers like
Berry et .al (1989) had emphasised the fact that “good service quality leads to the
retention of customers and attraction of new ones, reduced cost ,enhanced
corporate image, positive word of recommendation increases profitability of an
organisation”. Service quality has become an important element in selecting
hospitals by people (Berry et .al (1989) ;Reichheld and Sasser (1990);Rust and
Zahorik (1993) ;Cronin et.al (2000);Kang and James (2004) ;Yoon and Suh
(2004); cited by Dr.Vanniarajan & Arun, 2010).According to Analeeb (1998) was in
the point of view that hospitals who don’t give importance to customer satisfaction
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may be inviting extinction. Service quality are of great importance for the service
marketers because they are under the direct control of the service providers and its
consequence may improve service satisfaction and it will influence the buyers
behavioural intention which will lead to use the service again .This will ultimately lead
to customer loyalty (Padma et al., 2010).By doing this research the author can find
the gaps in the service provided by the hospital and can recommend the hospital to
reduce the gap between the customers expectation and the actual service delivered
so that they can increase patient satisfaction and gain patient loyalty .
1.2 Research Aim
Critically evaluate service quality as a determinant factor for patient satisfaction in
gaining patient loyalty. A case study of Travancore Medical College Hospital Kerala,
India.
1.3 Objectives
1. To review literature on service quality, patient satisfaction and patient loyalty.
2. To investigate the current service quality measures adopted by Travancore
Medical College Hospital
3. To evaluate the service quality offered by Travancore Medical College
Hospital and its effect on patient satisfaction in gaining patient loyalty.
4. To recommend Travancore Medical College Hospital to improve the service
quality so that they can increase patient satisfaction and gain patient loyalty.
1.4 Rationale for choosing the research topic
Service quality is an important determinant to appraise the triumph of any entity as
success in meeting the client’s expectation is the definitive objective of business.
Customer contentment has been considered as significant success factor in today’s
spirited business milieu, as they facilitate in retaining customers and maintaining
market share. It is also not different in case of hospital. It is one of the imperative
benchmark used to measure the patient satisfaction in gaining fidelity towards the
hospital. Because the totality of services rendered by the hospital to its patients is
the input en route for the patients and the contentment derived is the output.
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Escalating customer satisfaction is vital for customer allegiance. Service providers
should always manage to improve customer satisfaction it is one of the factor by
which the patient measures the quality of the medical services offered. Hence an
attempt has been done to articulate to evaluate service quality as a determinant
factor for patient satisfaction in gaining patient loyalty, for which a case study was
done in Travancore Medical College Hospital, one of the leading private sector
hospitals in Kerala, India.
1.5 Company Profile
Travancore Medical College Hospital Kerala, India. The TMCH consists of 800
bedded multi speciality hospital with state of the art facilities. It is a unit of Quilon
medical trust started with the view to promote medical education and health care to
the minorities of the society with the motto “service with love”. The hospital has a
highly qualified doctor, dedicated nursing staff and a technically sound paramedical
staff. The hospital has unique facilities like 15 bedded medical ICU unit, 15 bedded
emergency ICU unit, 6 bedded neuro ICU unit. There are about 10 operation
theatres in the hospital along with other laboratory units such as biochemistry It is
one of the premier medical facility for trauma, emergency, critical care and
ambulatory care. TMCH is one of the reputed medical emergency care centres in the
south Kerala region, and receives most complicated referral cases from many other
hospitals. The administration and medical team are highly qualified based on
education training. The hospital is equipped with the most advanced high technology
instruments to provide the best treatment available. The hospital has a dedicated
highly experienced nursing staff to avoid mal practice. They have a medical college
and a nursing college attached to the hospital .TMCH is the leading medical
education provider in Kerala. They admit nearly 100 students each year. The
hospitals have the best infrastructure available and the best available medical
teachers in India. The hospital has 22 department with the most experienced and
eminent doctor of Kerala. As a part of the social commitment the hospital was
providing free treatment for the patients hospitalised in the ward. The hospital also
has satellite centres in the interior parts of the kerala where there are no hospitals
and the patients around that place fully depend on these hospitals. As a part of the
professional development in career the hospital proves continuing medical education
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programmes on regular basis so that all the doctors in the hospital can participate
and be updated (Travancore medical college, 2012).
1.6 Conclusion
The author had divided the dissertation into 5 chapters. In Chapter 1 the author
gives a brief overview of the entire research which includes the research aim and
objective a brief back ground of the health care industry and the hospital selected .
In Chapter 2 the author critically reviews all available literature which are in the forms
of journals, books, website and newspaper which forms the secondary data. In
Chapter 3 the author forms a framework for the primary analysis .The author then
discuss about the various methods adopted in research which include research
strategy, research approach, research philosophy, sample size and the sampling
method used. In Chapter 4 The author will be analysing the primary data,
questionnaire that were distributed to the patients of the TMC hospital and then the
author will be comparing the findings with the secondary research. In Chapter 5 the
author draws a conclusion from the primary and secondary research and the author
put forwards some suggestions that can improve the service quality standards of
TMCH to improve patient satisfaction so gain patient loyalty.
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Chapter 2
Literature Review 2 .1 Introduction
In the present chapter author reviews the literature related to Service Quality,
Patient satisfaction and Patient loyalty get a deep insight and understanding of these
topics and to form the basis of future primary research .All the data’s that we collect
both the primary and the secondary should be compared so that the researcher can
draw conclusions from it and suggest recommendation for improving the present
situation. The author can suggest good recommendation’s only if the author has
done a strong secondary research. So the author had made use of all the available
data to frame a strong foundation for the research.
First of all the author begins the chapter by restating the aim’s and objective
and then begins reviewing the literature by discussing about the conceptualization of
service quality then about the dimensions of service quality. The author had also
discussed the different models of service quality used to measure them.
The author then had focused on patient satisfaction its dimensions and theories.
The discussion then moves on to patient loyalty, importance of patient loyalty and
measurement of patient loyalty. Finally the chapter had concluded by discussing the
relationship between service quality and customer loyalty, relationship between
customer loyalty and customer satisfaction and the relationship between customer
satisfaction and customer loyalty.
2.2 Aim and objective
Critically evaluate service quality as a determinant factor for patient satisfaction in
gaining patient loyalty. A case study of Travancore Medical College Hospital Kerala,
India.
1. To review literature on service quality, patient satisfaction and patient loyalty.
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2. To investigate the current service quality measures adopted by Travancore
Medical College Hospital
3. To evaluate the service quality offered by Travancore Medical College
Hospital and its effect on patient satisfaction in gaining patient loyalty.
4. To recommend Travancore Medical College Hospital to improve the service
quality so that they can increase patient satisfaction and gain patient loyalty
2.3 Literature Review
In the last few decades the hospitals are thriving to provide the highest possible
service quality to its patients at a lowest possible cost. Morris and Bell (1995) had
stated that the issue of defining, measuring and monitoring the quality of healthcare
had been addressed from ancient times (Morris and Bell,1995; cited by Sivakumar &
Srinivasan, 2010).According to Youseff et.al (1996) all hospitals in healthcare sector
provides same type of service but different quality of service (Youseff et.al, 1996
cited by; Suki et al., 2011). According to Berry et al (1988) with the constant increase
in customer and increasing competition service quality is the key factor that major
service companies have (Berry et.al, 1988 ; cited by Sainy, 2010).It is easy to see
that with the rising income of people and literacy rate of people they demand high
quality healthcare.. In a patients view point service quality is ultimately how they
judge the service they had encountered in the hospital which includes the interaction
with the doctors , nurses the staffs of the hospital outcome of the service. There fore
service quality of hospitals can be the key deciding factor for the selection of
hospitals
2.4 Service Quality Conceptualization
First of all there are different concepts for service quality to begin with initially
Takeuchi and Quelch (1983) had assessed the service quality of healthcare by six
dimensions namely reliability, service quality, prestige, durability, punctuality and
ease of use (Takeuchi and Quelch, 1983; cited by Dr.Vanniarajan & Arun, 2010), Gravin (1984) had established 5 categories or approaches to the concept of quality
namely transcendent based on degree of excellence, product based which involves
measurable characteristics of products, User based which involves meeting the
needs of the user, manufacturing based on the conformance with design or
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specification and finally value based which involves how much of something is
related to price (Gravin ,1984; cited byAl Hawary et al., 2011).
Similarly Gonroos (1984) had stated “that the perceived service quality is an
evaluation process where the customer compares his expectation with the service
that he had received ’’. He had proposed that there are two types of service quality
the functional ‘’service quality’’ and ‘’technical service quality’’. The functional service
quality is that the manner in which serve quality is delivered and technical service
quality is what actually the customer received from the service ( Gonroos 1984;cited
by Alrubaiee & Feras, 2011). Later in 1990 Gonoroos had added image of service
providers as a third dimension which acted as a filter in consumers perception of
quality (Padma et al., 2009).However Lehitmere and Jukka (1985) had presented a
holistic view to measure, monitor and operational customer perception of service
quality in health care organisation (Lehitmere and Jukka,1985; cited by
Dr.Vanniarajan & Arun, 2010).
Bopp (1986) had developed a “medical service quality active satisfaction model”.
The mode evaluates the service quality in consumption stage of patients purchase
cycle”. The finding of the study revealed that the factors that that played a role in
patient evaluation include expressive caring, expressive professionalism and
expressive competence of the service interaction. The study results emphasised that
staff’s with expressive caring, professionalism and physicians expressive caring has
a significant effect on patient satisfaction. (Bopp, 1986; cited by Sivakumar &
Srinivasan, 2010)
According to Parasuraman (1988) “service quality is defined as a global
judgement or attitude, relating to overall superiority of the service’’ (Parasuraman
1988; cited by Blery et al., 2011).John (1987) had developed an instrument to
measure the construct the “perceived service quality”. The findings of the study were
encouraging for other researchers by revealing that the measure of perceived
service quality is a multi dimensional construct containing variables namely
Q 12. Does the hospital provide services at the allocated time?
Chart 4.11 Does the hospital provide services at the allocated time
Author (2012)
From the Table 14.12 (appendix1) and Chart 14.11 .It is interesting to note that 78
patients (27.63% males and 25.89% females) have observed that the status
“strongly disagree” about the timely service at the time of appointment.
From the Table 14.12 (appendix1) it can also be seen that the chi-square
value (0.19) there is no significant association in the distribution of sample for the
opinion about the timely service at the time of appointment and gender wise group of
patients in the hospital. It means that the difference in the opinion about the timely
service at the time of appointment in the hospital and gender wise group of patients
is not significant and not associated. The analysis of the findings shows that the patients cannot expect a timely service from the hospital at the time of appointment.
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Appendix 1
Tabular column for the questionnaires for the research
1. About you
Table 4.1:- Distribution of sample size according to age and sex
Status
Male
Female
Total
No % No % No %
<25 Age 22 14.47 15 10.79 37 12.71
25-40 Age 20 13.15 32 23.02 52 17.86
41-50 Age 36 23.68 27 19.42 63 21.64
51-64 Age 42 27.63 29 20.86 71 24.39
>65 Age 32 21.05 36 25.89 68 23.36
Total 152 52 139 48 291 100
χ2test 7.43
Table value for df 4at 0.05 level 9.49
Source: Author(2012)
Cross tabular column for age and sex
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3. Are you employed?
Table 4.2:- Earners and Non-earning dependents in the sample
Status
(No.)
Total members 291
Earners 133
Non-earning members 158
Proportion of earners to total members 45.83
Ratio of Earners to non-earning
members
84:1
Average number of earners in the
household
2.18
Average number of non earners in the
household
1.85
Source: Author(2012)
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4. Why did you choose this hospital?
Table54.3:- The reason for choosing the hospital
Category Males Females Total
No % No % No %
Cost 46 30.26 51 36.69 97 33.33
GP 28 18.42 27 19.42 55 18.90
Consultant 38 25 33 23.74 71 24.39
Referrals 25 16.44 21 15.10 46 15.80
Previous visit 15 9.86 7 5.03 22 7.56
152 52 139 48 291 100
χ2test 3.31
Table value for df 4 at 0.05 level 9.49
Source: Author(2012)
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5 The receptionist was friendly and courteous?
Table 4.4:- The receptionist was friendly and courteous?
Males Females Total
No % No % No %
Strongly Agree 37 24.34 43 30.39 80 27.49
Agree 42 27.63 37 26.61 79 27.14
Neutral 23 15.13 26 18.70 49 16.83
Disagree 27 17.76 21 15.10 48 16.49
Strongly Disagree 23 15.13 12 8.63 35 12.02
Total 152 100 139 100 291 100
χ2test 28.37
Table value for df 4 at 0.05 level 9.49
Source: Author (2012)
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6. The staff treated you with respect, dignity and was courteous in the hospital?
The staffs treated you with respect, dignity and were courteous in the hospital
Table 4.5
Males Females Total
No % No % No %
Strongly Agree 29 19.07 15 10.79 44 15.15
Agree 34 22.36 32 23.02 66 22.6
Neutral 23 15.13 27 19.42 50 17.18
Disagree 32 21.05 29 20.86 61 20.96
Strongly Disagree 34 22.36 36 25.89 70 24.05
152 100 139 100 291 100
χ2test 4.47
Table value for df 4 at 0.05 level 9.49
Source : Author (2012)
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7. There is a lot of paper work for admission?
Table 4.6 :Opinion about the paper work for admission
Males Females Total
No % No % No %
Strongly Agree 36 23.68 28 20.14 64 21.99
Agree 23 15.13 25 17.98 48 16.49
Neutral 28 18.42 29 20.86 57 19.58
Disagree 31 20.39 34 24.46 65 22.33
Strongly Disagree 34 22.36 23 16.54 57 19.58
152 48 139 52 291 100
χ2test 2.79
Table value for df 4 at 0.05 level 9.49
Source: Author (2012)
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8. The service cost of hospital is affordable?
Table 4.7: The service cost of hospital is affordable
Status
Males Females Total
No % No % No %
Strongly Agree 47 30.92 36 25.89 83 28.52
Agree 38 25 35 25.17 73 25.08
Neutral 27 17.76 23 16.54 50 17.18
Disagree 25 16.44 22 15.82 47 16.15
Strongly Disagree 15 9.86 23 16.54 38 13.05
152 100 139 100 291 100
χ2test 3.20
Table value for df 4 at 0.05 level 9.49
Source :Author( 2012)
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9. All Staff were in correct uniform
Table 4.8:- All Staff were in correct uniform
Males Females Total
No % No % No %
Strongly Agree 43 28.28 39 28.05 82 28.17
Agree 34 22.36 35 25.17 69 23.71
Neutral 22 14.47 21 15.10 43 14.77
Disagree 26 17.10 24 17.26 50 17.18
Strongly Disagree 27 17.76 20 14.38 47 16.15
152 100 139 100 291 100
χ2test 0.78
Table value for df 4 at 0.05 level 9.49
Source : Author (2012)
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10. The hospital is visually attractive?
Table 4.9: The hospital is visually attractive?
Status Males Females Total
No % No % No %
Strongly Agree 42 27.63 39 28.05 81 27.83
Agree 36 23.68 32 23.02 68 23.36
Neutral 24 13.78 26 18.70 50 17.18
Disagree 27 17.16 23 16.54 50 17.18
Strongly Disagree 23 15.13 19 13.66 42 14.43
152 100 139 100 291 100
χ2test 2.44
Table value for df 4 at 0.05 level 9.49
Author (2012)
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11. Is the hospital in a convenient location?
Table 4.10 Is the hospital in a convenient location?
Status Males Females Total
No % No % No %
Strongly Agree 29 19.07 22 15.82 51 17.52
Agree 26 17.10 27 19.42 53 18.21
Neutral 23 15.13 25 17.98 48 16.49
Disagree 36 23.68 31 22.30 67 23.02
Strongly Disagree 38 25 34 24.46 72 24.74
152 100 139 100 291 100
χ2test 37.86
Table value for df 4 at 0.05 level 9.49
Source: Author (2012)
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12 Does the hospital have good directional signs?
Table 4.11 Does the hospital have good directional signs
Status Males Females
Total
No % No % No %
Strongly Agree 31 20.39 29 20.86 60 20.61
Agree 26 17.10 27 19.42 53 18.21
Neutral 29 19.07 32 23.02 61 20.96
Disagree 32 21.05 24 17.26 56 19.24
Strongly Disagree 34 22.36 27 19.42 61 20.96
152 139 291
χ2test 1.61
Table value for df 4 at 0.05 level 9.49
Source Author (2012)
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13 Does the hospital provide services at the allocated time?
Table 4.12 Does the hospital provide services at the allocated time
Status Male Female Total
No % No % No %
Strongly Agree 23 15.13 20 14.38 43 14.77
Agree 27 17.76 26 18.70 53 18.21
Neutral 24 15.78 23 16.54 47 16.15
Disagree 36 23.68 34 24.46 70 24.05
Strongly Disagree 42 27.63 36 25.89 78 26.80
152 100 139 100 291 100
χ2test 0.19
Table value for df 4 at 0.05 level 9.49
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14 The department is running effectively?
Table 4.13 The departments are running effectively
Status
Males Females Total
No % No % No %
Strongly Agree 43 28.28 39 28.05 82 28.17
Agree 34 22.36 31 22.30 65 22.33
Neutral 25 16.44 27 19.42 52 17.86
Disagree 27 17.76 23 16.54 50 17.18
Strongly
Disagree 23 15.13 19 13.66 42 14.43
152 100 139 100 291 100
χ2test 0.53
Table value for df 4 at 0.05 level 9.49
Source Author (2012)
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15 You felt ease during your appointment?
Table 4.14 You felt ease during your appointment
Status
Male
Female
Total
(No) % (No.) % (No) %
Strongly Agree 32 21.05 22 15.82 54 18.55
Agree 31 20.39 29 20.86 60 20.61
Neutral 36 23.68 25 17.98 61 20.96
Disagree 27 17.76 29 20.83 56 19.24
Strongly Disagree 26 17.10 34 24.46 60 20.61
Total 152 100 139 100 291 100
χ2test 4.47
Table value for df 4 at 0.05 level 9.49
Source Author (2012)
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16 Doctors listen carefully and adhered to your needs?
Table 4.15 Doctors listen carefully and adhered to your needs?
Status
Males
Females
Total
(No) % (No) % (No) %
Strongly Agree 22 14.47 19 13.66 41 14.08
Agree 25 16.44 23 16.54 48 16.49
Neutral 32 21.05 29 20.86 61 20.96
Disagree 36 23.68 33 23.74 69 23.711
Strongly Disagree 37 24.34 35 24.46 72 24.74
152 100 139 100 291 100
χ2test 0.06
Table value for df 4 at 0.05 level 9.49
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17 Do you think the hospital address the patient complaint quickly?
Table 4.16 Do you think the hospital address the patient complaint quickly?
Males Females Total
(No) % (No) % (No)
%
Strongly Agree 26 17.10 19 13.66 45 15.46
Agree 25 16.44 26 18.70 51 17.52
Neutral 34 22.36 27 19.42 61 20.96
Disagree 28 18.42 33 23.74 61 20.96
Strongly Disagree 39 25.65 34 24.46 73 25.08
152 139 291
χ2test 2.08
Table value for df 4 at 0.05 level 9.49
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18 Do you think the staff responded immediately when called?
Table 4.17 the staff responded immediately when called?
Status
Male Female Total
(No) (%) (No) (%) (No) (%)
Strongly Agree 32 21.05 31 22.30 63 21.64
Agree 33 21.71 32 23.02 65 22.33
Neutral 28 18.42 27 19.42 55 18.90
Disagree 31 20.39 32 23.02 63 21.64
Strongly Disagree 28 18.42 17 12.23 45 15.46
152 100 139 100 291 100
χ2test 2.18
Table value for df 4at 0.05 level 9.459
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20 Do you think that the hospital employees are sympathetic and reassuring?
Table 4.18 Hospital employees are sympathetic and reassuring
Status
Males
Females Total
No (%) No (%) No (%)
Strongly Agree 24 15.78 23 16.54 47 16.151
Agree 31 20.39 27 19.42 58 22.22
Neutral 29 19.07 25 17.98 54 20.68
Disagree 33 21.71 31 22.30 64 21.99
Strongly Disagree 35 23.02 33 23.74 68 18.55
152 139 291 100
χ2test 0.13
Table value for df 4 at 0.05 level 9.49
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21 Do you think in the hospital doctor prescribes affordable medicines?
Table 4.19
Opinion about the attitude of doctors in prescribing affordable medicines to patients.
Status Males Females Total
No % No % No %
Strongly Agree 36 23.68 34 24.46 70 24.05
Agree 34 22.36 29 20.86 63 21.64
Neutral 28 18.24 25 17.98 53 18.21
Disagree 28 18.24 27 19.42 55 18.90
Strongly Disagree 26 17.10 24 17.26 50 17.18
152 100 139 100 291 100
χ2test 0.14
Table value for df 4 at 0.05 level 9.49
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22 Average waiting time in the different a cross tabular questions from 22 to 25
Table 4.20
Status
Reception Consultation Pharmacy Lab
investigation
Total
No % No % No % No % No %
Less than
10 minutes 48 16.49 39 13.40 27 9.7
--
--
291
100
10-20
minutes 63 21.64 54 38.84 48 16.49
--
--
291
100
20-30
minutes 180 68.96 93 31.95 97 33.33
51
17.52
291
100
30-45
minutes -- -- 45 15.46 119 40.89
86
29.55
291
100
More than
45 minutes -- -- 60 20.96 -- --
154
52.92
291
100
Author (2012)
Cross tabular column for Question 22 to 25
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Are the charges of TMC hospital affordable when compared charges of different
Q30 Will you recommend this hospital to relatives and friends?
Table 4.22 :- Will you recommend this hospital to relatives and friends?
Status Male Female Total
No % No % No %
Strongly Agree 32 21.05 22 15.82 54 18.55
Agree 31 20.39 29 20.86 60 20.61
Neutral 36 23.68 25 17.98 61 20.92
Disagree 27 17.76 29 20.83 56 19.24
Strongly Disagree 26 17.10 34 24.46 60 20.16
Total 152 100 139 100 291 100
χ2test 4.47
Table value for df 4 at 0.05 level 9.49
Source :Author( 2012)
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Appendix 2 Questionnaires for the patients
I Aneesh .Prasannan is doing a survey questionnaire and collecting the data from the most valuable patients of the TMC hospital. Your opinion is very critical in my dissertation research. My analysis and recommendations are based on the response you give to the questioner. All the information submitted by you will be utilized for the academic purpose. Thanks for your co-operation.
Title: Critically evaluate service quality as a determinant factor for patient satisfaction in gaining patient loyalty. A case study of Travancore Medical College Hospital Kerala, India.
For the following question please tick one of the following. 1. About you
Male Female 2. Age group
Under 18 19-34 35-5 55-74 75 and above 3. Are you employed? Yes No 4. Why did you choose this hospital?
Cost GP Consultant Referral Previous visit
5 The receptionist was friendly and courteous?
Strongly agree Agree Neutral Disagree Strongly
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disagree
6. The staff treated you with respect, dignity and was courteous in the hospital?
Strongly agree Agree Neutral Disagree Strongly
disagree 7. There is a lot of paper work for admission?
Strongly agree Agree Neutral Disagree Strongly
disagree
8. The service cost of hospital is affordable?
Strongly agree Agree Neutral Disagree Strongly
disagree
9. All Staff were in correct uniform?
Strongly agree Agree Neutral Disagree Strongly
disagree
10. The hospital is visually attractive?
Strongly agree Agree Neutral Disagree Strongly
disagree
11. Is the hospital in a convenient location?
Strongly agree Agree Neutral Disagree Strongly
disagree
12 Does the hospital have good directional signs?
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Strongly Agree Agree Neutral Disagree Strongly
Disagree
13 Does the hospital provide services at the allocated time?
Strongly Agree Agree Neutral Disagree Strongly
Disagree
14 The department is running effectively?
Strongly agree Agree Neutral Disagree Strongly
disagree
15 You felt ease during your appointment?
Strongly agree Agree Neutral Disagree Strongly
disagree 16 Doctors listen carefully and adhered to your needs?
Strongly agree Agree Neutral Disagree Strongly
disagree
17 Do you think the hospital address the patient complaint quickly?
Strongly agree Agree Neutral Disagree Strongly
disagree
18 Do you think the staff responded immediately when called?
Strongly agree Agree Neutral Disagree Strongly
disagree
20 Do you think that the hospital employees are sympathetic and reassuring?
Strongly agree Agree Neutral Disagree Strongly
disagree
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21 Do you think in the hospital doctor prescribes affordable medicines?
Strongly agree Agree Neutral Disagree Strongly
disagree
22 The average waiting time in reception
Less than 10 min
10 -20 min 20-30 min 30-45 min More than 45 min
23 The average waiting time in Consultation
Less than 10 min
10 -20 min 20-30 min 30-45 min More than 45 min
24 The average waiting time in pharmacy
Less than 10 min
10 -20 min 20-30 min 30-45 min More than 45 min
25 The average waiting time in laboratory.
Less than 10 min
10 -20 min 20-30 min 30-45 min More than 45 min
26 While comparing with other hospitals the consultation fee is affordable?
Strongly agree Agree Neutral Disagree Strongly
disagree
27 While comparing with other hospitals the surgery fee is affordable?
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Strongly agree Agree Neutral Disagree Strongly
disagree
28 While comparing with other hospitals the pharmacy fee is affordable?
Strongly agree Agree Neutral Disagree Strongly
disagree
29 While comparing with other hospitals the lab investigation is affordable?
Strongly agree Agree Neutral Disagree Strongly
disagree
30 Will you recommend this hospital to relatives and friends?