Service Quality Perception and Behavioural Intention: A Study of Indian Private Hospitals

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1 Article Service Quality Perception and Behavioural Intention: A Study of Indian Private Hospitals Journal of Health Management 18(1) Indian Institute of Health Management Research SAGE Publications sagepub.in/home.nav DOI: / Rama Koteswara Rao Kondasani 1 Rajeev Kumar Panda 1 Abstract Private health care organizations are increasingly realizing the need to focus on service quality as a tool to improve their position in the highly competitive health care sector. Patients perception about health care services seems to have been largely ignored by health care providers in Indian private hospitals. The objective of the research is to analyze how customers service quality perception leads to positive behavioural intention towards service providers. For this purpose, the data were collected from a sample of 475 customers from Indian private hospitals. The analysis was used to analyze the customer service quality perception and behavioural intention. The findings indicate that service seeker and service provider relationship, quality of facilities and the interaction with supporting staff have a positive effect on customer perception. This piece of research may help the health care managers and organizations to formulate effective strategies for ensuring better quality of services to the customers. This study may further facilitate them in building positive behavioural intention of customers towards the health care services, thereby attracting and gaining more number of customers. Keywords Private health care, customer s perception, behavioural intention, service quality Introduction Service quality has become an important topic in view of its significant relationship to profit, cost saving and market share (Devlin & Dong, 1994). A sound health scenario of a country and its economic growth are complementary to each other as one without the other cannot progress. While the economic development in India is gaining momentum over the past few decades, our health system is at crossroads today (Ramani & Dileep, 2006). The growth of India s medical tourism is gaining momentum but it is still behind some established medical tourism destination of south-east Asia in particular. The private health care sector 1 School of Management, National Institute of Technology (NIT), Rourkela, Odisha, India. Corresponding author: Rama Koteswara Rao Kondasani, School of Management, National Institute of Technology (NIT), Rourkela , Odisha, India. ramatnitrkl@gmail.com

2 Kondasani and Panda 189 in India is expanding its reach offering a gamut of super speciality services and arrangements for attacting foreign medical tourists. A report of Price Water Coopers House (2012) has predicted the Compound Annual Growth Rate (CAGR) of Indian health care industry to be 15 per cent, is expected to touch US$ 250 billion by Past research has linked service quality to customer satisfaction (Taylor & Baker, 1994) and purchase intentions (Zeithaml, Berry & Parasuraman, 1996). Donabedian (1996) suggested that customers perception of service quality is a key determinant of a health care organization s success due to its primary role in achieving patient satisfaction and hospital profitability. However, there is no consistent finding in the literature across different services industries. Hence through this research we attempt to analyze customers service quality perception and behavioural intention in Indian private hospitals. In today s highly competitive health care environment, particularly private hospitals are continuously sought to improve their functions and increase their competitiveness. This necessitates determining both their financial (costs, revenues and profitability) and non-financial performance (quality of their services). Patient perception of service quality is a key determinant of a health care organization s success due to its primary role in achieving patient satisfaction and hospital profitability (Williams & Calnan, 1991). In private healthcare sustainable competitive advantage can only be achieved by offering superior service quality that leads to enhance efficiency. The construct of service quality has therefore been a subject of great interest to service marketing researchers. Several research studies have examined and defined the constructs of service quality, customer satisfaction and behavioural intentions from diverse perspective viz. industries, cultures etc. Grönroos (1984) has defined service quality as a perceived judgement and an outcome of the assessment process where customers compare their expected service with perceived service. There is ample evidence in the literature suggesting a strong relationship between service quality and perceived value, customer satisfaction and behavioural intentions including word of mouth (WOM), loyalty, recommendation and willing to pay more (WPM) (Baker & Crompton, 2000). The objective of the research is to analyze how customers service quality perception leads to positive behavioural intention towards service providers. Review of Literature Over the last three decades, research on service quality has grown extensively and comprehensively. The service quality model adopted by Parasuraman et al. (1985) has gained a lot of attention. This model famously known as the SERVQUAL model had given a thorough insight of service quality with an instrument to measure perceived service quality, and provide pragmatic implications. It has been widely accepted in the literature that premium service quality particularly in private healthcare enables a hospital to create competitive advantage and enhance efficiency (Olorunniwo, Hsu & Udo, 2006). There are numerous definitions of service quality but the most fitting definition for healthcare sector is the one given by Grönroos (1984) which says the perceived service quality is the result of the consumers an evaluation of expected service with his perception of the service received. Relating this to health care the hospital service quality may be comprehended to be the discrepancy between customers perceptions of services offered by a particular hospital and their expectations about hospitals offering such services (Aagja & Garg, 2010). Another study conducted by Eleuch (2011) has concluded that the perceived service quality in healthcare is an absolute evaluation of whether the service performed for a patient was the most appropriate to produce the best result that could be reasonably expected by the

3 190 Journal of Health Management 18(1) patient. In developing country context the studies carried out by few researchers (Andaleeb, 2001; Baltussen et al., 2002; Haddad et al., 1998) on patient perception have identified that knowledge and awareness of customers ato assess structural, process and outcome of a perceived service. There have been significant research studies which may differ in their approach and content but all of them have agreed to a singular fact of customers centric evaluation of health services quality represents the most important perspective (O Connor, Shewchuk & Carney, 1994). This has been the platform for our research as there is enough confirmation studies that suggest perceived service quality to be the most important variable to influence customer s perceptions of value and intention to adopt more services (Zeithaml et al., 1996). Service Quality Perception in Health Care Providing superior service quality is an essential requirement in heath care sector because it results in customer satisfaction, and ultimately customer loyalty. Superior quality is the customers perceptions of comprehensive judgements about the relative weakness or superiority of the organization and its services (Bitner & Hubbert, 1994). Perceived service quality is the consumer s evaluative judgement regarding the superiority of service performance (Zeithaml, 2000). In health care a patient s perception of service quality is a key determinant of growth for the hospital, because quality has an important role in obtaining patient satisfaction (Choi et al., 2004). A customer can be satisfied or dissatisfied only when they have perceived or experienced services (Lee et al., 2000). This leads to the fact that service quality evaluation is followed by customer satisfaction. Hence, perceived service quality is an antecedent for customer satisfaction. In the literature several methods have been adopted for measuring of service quality in the hospital service sector. In health care settings, the two dimensions are popular to assess service quality in a number of service categories, such as, technical quality (or outcome quality) and functional quality (or process quality). Technical quality is focussed on the accuracy of procedures and medical diagnoses while functional quality refers to the way health services are provided to the patients. Since most patients lack the needed knowledge for assessing the technical quality of services, their evaluation of quality is based on quality of the process of care. Customer assessment provides inputs for the case health care organization to improve its service quality attributes (D Souza & Sequeira, 2012). Thus, perceptions provide the basic measurement tool in which individuals evaluate the attractiveness and/or desirability of the product or service. Behavioural Intention This research study proposes behavioural intentions to be the dependent variable as this indicates whether a customer will return to a hospital or not. Behavioural intentions are the most important indicators of customer future behaviours. Zeithaml et al. (1996) grouped behavioural intentions into favourable behavioural intentions positive WOM, recommending, remaining loyal and pay more and unfavourable behavioural intentions negative WOM, switching to another organization, complaining to external agencies and less business with company. Meanwhile, word-of-mouth communications is defined as a customer will inform about the positive experience relationship to their friends, relatives, and others (Donio et al., 2006; Høst & Knie-Andersen, 2004). Positive WOM communication is one of the strongest predictors for change the consumers behaviours in favour of the organization. It encompasses various ways like oral, person-to-person communication between sender and receiver as non-commercial activity (Buttle, 1998). In the context of the health care if a customer is satisfied with a hospital he will recommend the

4 Kondasani and Panda 191 hospital to other patients. If a patient is highly satisfied with the paper work like admissions formalities, discharge documentations and other processes, it will lead to patients returning to the hospital (Kessler & Mylod, 2011). In India peer groups and family members have high influence on customers when it comes to making decisions to patronize a services institution and particularly hospitals. In this context if a customer has a stronger bond with a specific health care service provider will be willing to pay more otherwise called as WPM. WOM and WPM are considered to be post-consumption effects. Several studies investigated the direct effect of service quality and satisfaction on behavioural intentions. Researches findings indicate that service quality and satisfaction have a direct relationship with WOM and WPM (Hanzaee & Shojaei, 2011; Ladhari, 2009). Research Methodology One of the primary concerns of this research is to assess the vital parameters affecting customers perceived service quality for private health care. To achieve this convenience sampling method was used and a questionnaire survey was conducted. The questionnaire was finalized using focus group discussion with different stakeholders of the private health care sector (see Appendix). We have chosen the sample population unit to be the patients who had been admitted and received services from the private hospital recently. Only private non corporate hospitals were chosen to conduct the survey. The patients were approached with utmost caution and questions were communicated clearly. The questionnaires were written in both Odiya language and in English so that respondents do not face difficulty in answering them. The questionnaire had two segments; demographic segment comprising of six questions and other segment with 55 questions about how respondents perceive service quality and develop behavioural intention towards private health care provider. Five-point Likert scale was used with 5 means strongly agree, 3 is neutral and 1 means strongly disagree. Demographic characteristics of the respondents were clearly described in Table 1. Scale Development To develop a scale for analyzing service quality perception and behavioural intention involved two steps: variables or items taken from previous research studies (Aagja & Garg, 2010; Andaleeb, 2001; Bigné et al., 2008; Boulding et al., 1993; Cronin & Taylor, 1994; Lam, 1997; Parasuraman et al., 1988; Ramsaran-Fowdar, 2008; Sower et al., 2001; Sureshchandar, Rajendran & Anantharaman, 2002; White & Yu, 2005; Youssef, Nel & Bovaird, 1996) undertaken for perception of service quality and behavioural intention from hospitals, second one was insights from the in-depth interviews. Before distributing the final questionnaire a pilot study was done ensure that the format, number of questions and sequencing of questions were appropriate. During this stage, feedback was obtained from approximately four hospital users to analyze the quality research. Data Analysis The primary date collected was analyzed through various statistical analyses using Statistical Package for the Social Sciences (SPSS) 20 version to have an insight into the responses collected. The procedure used for the scale involved calculating Cronbach s alpha statistic and using factor analysis alternatively

5 192 Journal of Health Management 18(1) Table 1. Demographic Characteristics (N = 475) Variable Frequency % Gender Male female Type of treatment Inpatient Outpatient Residence Rural Urban Education Primary level Secondary level Graduates Above Postgraduation Hospital visit First visit Repeat visit Employment status Unemployed Housewife Government employee Private employee Self-employed Retired to reduce the number of items. Prior to factor analysis Bartelett s test of sphericity and the Kaiser Meyer Olkin (KMO tests were performed. The construct validity of the scales was verified with the help of Kaiser-Meyer-Olkin (KMO). The dependabilty of items was assessed by computing the coefficient alpha (Cronbach, 1951) that measures the internal consistency of the items. Coefficient alpha should be above 0.7 (Nunnally, 1978). In the present study, Cronbach s alpha of indicates good consistency among the items. The results are shown in Tables 2a, 2b and 2c. The factor analysis was carried out using the principal component extraction method with varimax rotation. In the initial application, the number of variables was reduced from 55 to 41 and then these variables were classified under seven dimensions based on their factor-loading score. The sorted rotated values of factor loading with a minimum value of 0.45 or more are considered and are shown Table 2a. KMO and Bartlett s Test Kaiser Meyer Olkin Measure of Sampling Adequacy Bartlett s Test of Sphericity Approx. Chi-Square 17, df 990 Sig.

6 Kondasani and Panda 193 Table 2b. Case Processing Summary N % Cases Valid Note: a. List-wise deletion based on all variables in the procedure. Excluded a Total Table 2c. Reliability Statistics Cronbach s Alpha N of Items in Table 3. Based on the results of factor analysis, the variables are classified into seven dimensions, which are suitably named. The dimensions and the corresponding variables are shown below. Factor loading signifies the explanation of how much a factor explains a variable. When the loading tends to be on the higher side it indicates that the factor strongly influences the variable and vice versa. Assuming a factor loading of more than 0.70 as having high impact on the variables, it is concluded from Table 3 that some variables, which are less than 0.70, need attention for the service quality improvement in the Indian private hospital context. Eigenvalues measure the amount of variation in the total sample accounted for by each factor. Eigenvalues are calculated and used in deciding how many factors to extract in the factor analysis. In our research seven factors have more than 1 (eigenvalue) and total variance was per cent. Eigenvalues and variance of the each factor was shown in Table 4. Dimensions Variables Physical Setting (X1) variables 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 Dependability (X2) variables 12, 13, 14, 15, 16, 17, 18 Cordial Staff (X3) variables 19, 20, 21, 22, 23 Information and Communication (X4) variables 24, 25, 26, 27, 28, 29, 30 Sensitivity (X5) variables 31, 32, 33, 34 Security and Privacy Concern (X6) variables 35, 36, 37, 38 Behavioural Intention (X7) variables 39, 40, 41 Results and Analysis Physical Setting The physical setting of the hospital encompasses infrastructure, equipments, hospital s functional activities, physical facilities such as medical devices and instruments, exterior features like appearances of medical staff neatness, cleanliness etc. It also includes serenity of a patient s ward as it is of utmost

7 Table 3. Rotated Component Matrix a Variable No Variable Definition V1 Hospital is well equipped with all necessary medical equipment s 0.67 V2 Physical facilities are visually appealing 0.63 V3 Staff are neat in appearance 0.58 V4 Materials related to outpatient services are visually appealing 0.57 V5 The different departments, divisions and labs are easily recognized 0.52 V6 Hospital has regular supply of basic amenities like water and electricity 0.51 V7 Hospital staff and public can be easily differentiated 0.51 V8 Hospital wards, cabins, corridors and toilets/washrooms are regularly cleaned 0.50 V9 Hospital provides holistic environment 0.50 V10 Sufficient visitor waiting rooms 0.47 V11 The hospital environment, as a whole, generates a favourable impression about it 0.45 V12 Hospital has doctors with a good reputation 0.77 V13 Tells customers exactly when services are provided 0.76 V14 Gives prompt services to customers 0.68 V15 Hospital s staff always willing to help 0.63 V16 Staff are never too busy to respond to customer s requests 0.56 V17 Customers made to feel safe in their interaction with staff 0.54 V18 Hospital food is hygienic, healthy and homely 0.50 V19 Provides services at the customer convenient time 0.75 V20 The staff are dependable in handling customers 0.70 V21 Prompt service without appointment 0.62 V22 Competent in providing accurate service 0.60 V23 Medical staff that instil confidence in customers 0.52 Component F1 F2 F3 F4 F5 F6 F7 V24 Doctors give adequate information on treatment 0.77 V25 Adequate explanation of tests is provided 0.63

8 V26 Physicians are willing to listen and answer questions 0.60 V27 Health condition information/reports are intimated timely 0.58 V28 Medical staff are effectively listening to patient s requests/problems 0.51 V29 Hospital personnel well explain the discharge process to the patient and his family members 0.49 V30 It was difficult to connect with the doctor 0.47 V31 Giving customers personal attention 0.80 V32 Staff that treat customers with warm and caring attitude 0.64 V33 Staff that are understanding towards customers feelings of discomfort 0.58 V34 Operation hours that are convenient to customers 0.47 V35 Hospital provides confidentiality in medical treatment 0.77 V36 Hospital not misusing your information 0.73 V37 Hospital located in safe and secured place 0.55 V38 Customers feel safe in the hospital premises 0.53 V39 I will recommend the Indian private hospital to others who seek my advice 0.61 V40 If I feels sick, I will go to the same private hospital where I have taken treatment 0.60 V41 Encourage my friends and relatives for treatment in private hospitals Source: Extraction Method: Principal Component Analysis. Rotation Method: Varimax with Kaiser Normalization. a. Rotation converged in 16 iterations.

9 196 Journal of Health Management 18(1) Table 4. Dimensions Variance Dimensions Eigenvalue % of Variation Cumulative % Physical Setting Dependability Cordial Staff Information and Communication Sensitivity Security and Privacy Concern Behavioural Intention importance pertaining to the health condition of the patient. As a patient need to stay till the day of release, to address his food and auxiliary service requirements, tangibles in form of choices of menu and other related services also add to the physical setting. A high factor loading (0.67) variable (hospital is well equipped with all necessary medical equipments) indicates that the factor strongly influences the variable and has high impact on the variables. Dependability The dependability of a health care setting refers to the ability of service personnel to offer the promised service thoroughly, precisely and in a more dependable manner. The main criteria of the dependability are availability of doctors on a real-time basis. The issues related to promptness of service, speedy registration procedure, equity and accuracy of treatment, medicines prescription and recommendation are also part of dependability factor. The ability of a doctor s accurate diagnosis and the timely service of supporting staff are essential to create customer satisfaction. In this dimension, the high factor loading (0.77) variable indicates that the factor strongly influences the variable. The private health care managers must address these issues to sustain customer loyalty and positive word of mouth. Cordial Staff Cordial staff refers to the hospitals employees direct reflection of the dedication, care for customers and hard work that employees display every day. The friendly environment of the hospitals coupled with superior quality and compassionate care of customers are other contributing variables. A factor loading of 0.75 for variable (provides services at the customer convenient time) indicates that the private hospitals provide services at the chosen time of the customer. It indicates staffs of the hospitals are more concerned towards their customers. Information and Communication It refers to providing timely information and communication to the customer, carefully listening to their problems so that they will gain confidence. It also takes into account the proper counselling by doctors, supporting staff like nurses and other personnel and the reciprocal response involved in the treatment mechanism. Effective treatment can only take place when the doctors make sincere attempt to understand the patient s problem or the cause of his/her disease and the patient clearly spell out his/her problem/ disease. This is possible through two-sided effective communication. The customers are required to communicate properly for availing the right treatment. In this dimension, the high factor loading (0.77) variable (doctors give adequate information on treatment) indicates that private hospital doctors are

10 Kondasani and Panda 197 communicating with customers in good way. It helps to increase customer perception and positive behavioural towards private hospitals in India. The lowest factor loading (0.47) in this dimension is difficult to connect with doctor. It indicates customers of hospitals are feeling shy/nervous when communicating with doctors. Hospital managers and doctors should communicate well with the customers. Sensitivity Sensitivity can be defined as the result that may be achieved when institutions and institutional relationships are designed in such a way that they are cognisant and respond appropriately to the universally legitimate expectations of individuals. Sensitivity is the ability to develop the technical tools to assess, monitor and raise awareness of how people are treated and the environment in which they are treated when seeking health care. It upholds, as part of the equity ream, a particular focus on inequitable treatment associated with social status. Sensitivity can be viewed from two angles. First, the user of the health care system is often portrayed as a consumer, with greater responsiveness being perceived as a means of attracting consumers. Second, sensitivity is related to the safeguarding of rights of customers to adequate and timely care. In this dimension, the high factor loading (0.80) variable (service providers giving customers personal attention) is the highest factor loading of our research. This variable indicates service providers are highly responsive from their heart with customers. This is the good sign for service providers for period of positive behavioural intention. Security and Privacy Concern Security and Privacy concern of the health care system is defined as the avoidance or reduction to acceptable limits of actual or potential harm from health care management or the environment in which health care is delivered. Patient safety practices have been defined by Institute of Medicine, 2004 as those that reduce the risk of adverse events related to exposure to medical care across a range of diagnoses or conditions. In this dimension, the high factor loading (0.77) variable (hospital provides confidentiality in medical treatment) indicated service providers providing security and privacy concern to their customers and also customers feeling safe in Indian private hospitals with the safety and security measures provided by service providers. Correlation Analysis In order to find the degree of association between the dimensions identified, correlation analysis was applied. The correlation coefficients between the various dimensions were calculated and are shown in Table 5. In order to find the degree of association between the dimensions identified, correlation analysis was applied. The correlation coefficients between the various dimensions were calculated and are shown in Table 5. We detect the highest degree of significant positive correlation between behavioural intention (X7) and physical setting (X1). Interestingly a high degree of significant positive correlation was found between sensitivity (X5) and behavioural intention (X7), information and communication (X4) and behavioural intention (X7). In the correlation analysis we have not found any negative co-relation between variables in the co-relation analysis. Regression Analysis Regression analysis is an important statistical technique that helps to estimate the strength and direction of the relationship between two or more variables. In this case we have used it to gain a concrete knowledge of the relationship between the service quality perception and behavioural intention in Indian private health care sector. The independent variable and the dependent variable used in the regression analysis are as follows.

11 198 Journal of Health Management 18(1) Table 5. Co-relation Analysis X1 X2 X3 X4 X5 X6 X7 Pearson Correlation Sig. (2-tailed) Pearson Correlation Sig. (2-tailed) Pearson Correlation Sig. (2-tailed) Pearson Correlation Sig. (2-tailed) Pearson Correlation Sig. (2-tailed) Pearson Correlation Sig. (2-tailed) Pearson Correlation Sig. (2-tailed) 1 X1 X2 X3 X4 X5 X6 X ** ** ** ** ** ** ** ** ** ** ** Note: **Correlation is significant at the 0.01 level (2-tailed) ** ** ** ** ** ** ** ** ** ** 1 Independent Variables (X) Through factor analysis we have identified the following seven dimensions out of which six dimensions are treated as independent variables for the regression analysis. These are: physical setting (X1), dependability (X2), cordial staff (X3), information and communication (X4), sensitivity (X5), and security and privacy concern (X6). Dependent Variable (Y) The last dimension identified by factor analysis and as rated by respondents to be behavioural intention of service quality perception is taken as the dependent variable of the study. Multiple linear regression attempts to model the relationship between two or more explanatory variables and a response variable by fitting a linear equation to observed data. The mathematical representation of the regression equation can take the form as follows: Y = b0 + b1 X1 + b2 X2 + b3 X3 + b4 X4 + b5 X5 + b6 X6 (1) In the above multiple regression equation, every value of the independent variable x is linked with a value of the dependent variable y. b0 is constant or intercept and it gives the value of dependent variable when the values of all the independent variables are zero. b1 b6 are coefficients that represent the estimated change in mean value of dependent variable for each unit change in the independent variable values. Now, considering the values from Table 6a and 6b, the regression equation will be in the following form: Y = X X X X X X6 (2) It is observed from Table 7 that the relationship between the behavioural intention (Y) and the various dimensions (X1 X6) is more or less statistically significant at 95 per cent confidence level (p < 0.05). In addition, the adjusted R 2 value is found to be depicting a statistically significant relationship. It is also identified that the statistically significant (p < 0.05) dimensions are physical setting (X1),

12 Kondasani and Panda 199 Table 6a. Model Summary Model R R Square Adjusted R Square Std. Error of the Estimate a Note: a. Predictors: (Constant). Table 6b. ANOVA a Model Sum of Squares df Mean Square F Sig. 1 Regression b Residual Total Note: a. Dependent variable: behavioural intention. Table 7. Coefficients a Model Unstandardized Coefficients Standardized Coefficients B Std. Error Beta 1 Constant X X2* X X X X6* Note: a. Dependent variable: behavioural intention. t Sig. cordial staff (X3), information and communication (X4) and sensitivity (X5). Dimension such as physical setting (X1) has the greatest influence on behavioural intention followed by cordial staff (X3) and sensitivity (X5). We have also identified lack of statistical significance in, dependability (X2) and security and privacy concern (X6), which calls for careful management and proper administration by the health care managers. Conclusion Better understanding of customer behaviour will enable health care managers and marketers to develop appropriate marketing strategies to attract new patients and retain their existing customers. The article explores the customer perceived service quality in Indian private hospitals towards behavioural intention

13 200 Journal of Health Management 18(1) from customer s perspective. We have devised a model to analyze customer perceived service quality and behavioural intention particularly in Indian private hospitals. The result of the study specified that the factors namely dependability and security and privacy concern, are not contributing significantly towards the positive behavioural intention. This finding necessarily points out the inability of the organization to live upto the expectation of the customers in this area. The research on perceived service quality in health care has not gained momentum particularly in India and relevant literature is also inadequate. Therefore, the insight gained in this study may offer a foundation for future research on service quality perception and behavioural intention. The health care service managers may get useful insights from this piece of research for improving their services. The limitation of this research is that it is confined to only perception of health services; therefore, the result should not be applied to other health care issues. As a small sample may not be the representative of the whole population and so, in future, the research can be conducted by taking a large sample to facilitate a robust examination of the service quality perception and behavioural intention. Future studies may also be conducted in order to identify further dimensions and the extension of this study may include the service providers perspective to have a better understanding of the problems in the private hospitals. The validation of model and extension of the study in other sectors are some of the future directions. Appendix: Questionnaire S. No. Variable 1 Hospital is well equipped with all necessary medical equipment 2 Physical facilities are visually appealing 3 Staff are neat in appearance 4 Materials related to outpatient services are visually appealing 5 The different departments, divisions and labs are easily recognized 6 Hospital has regular supply of basic amenities like water and electricity 7 Hospital staff and public can be easily differentiated 8 Hospital wards, cabins, corridors and toilets/washrooms are regularly cleaned 9 Hospital provides holistic environment 10 Sufficient visitor waiting rooms 11 The hospital environment, as a whole, generates a favourable impression about it 12 Hospital has doctors with a good reputation 13 Tells customers exactly when services are provided 14 Gives prompt services to customers 15 Hospital s staff always willing to help 16 Staff are never too busy to respond to customers requests 17 Customers made to feel safe in their interaction with staff 18 Hospital food is hygienic, healthy and homely 19 Provides services at the customer convenient time (Appendix Continued)

14 Kondasani and Panda 201 (Appendix Continued) S. No. Variable 20 The staff is dependable in handling customers 21 Prompt service without appointment 22 Competent in providing accurate service 23 Medical staff that instil confidence in customers 24 Doctors give adequate information on treatment 25 Adequate explanation of tests is provided 26 Physicians are willing for listening and answering questions 27 Health condition information/reports are intimated timely 29 Medical staff is effectively listening to patient s requests/problems 29 Hospital personnel well explain the discharge process to the patient and his family members 30 It was difficult to connect with the doctor 31 Giving customers personal attention 32 Staff that treat customers with warm and caring attitude 33 Staff that are understanding towards customers feelings of discomfort 34 Operation hours that are convenient to customers 35 Hospital provides confidentiality in medical treatment 36 Hospital not misusing customers information 37 Hospital located in safe and secured place 38 Customers feel safe in the hospital premises 39 I will recommend the Indian private hospital to others who seek my advice 40 If I feel sick, I will go to the same private hospital where I have taken treatment 41 Encourage my friends and relatives for treatment in private hospitals 42 Hospital provides treatment expenditure to customers 43 Hospital staff has knowledge to answer customer questions 44 Sufficient parking area available in the hospital premises 45 Hospital provides services without any delay 46 Doctors are available whenever customers need medical services 47 Hospital taking feedback from the customers after treatment 48 Hospital staff handle their customers gently 49 Hospitals maintain error-free services every time 50 Staff perform services right the first time 51 Customers feel some risk when doctors treat 52 Hospital offering all types of medical services 53 Hospital provides exact and precise service delivery 54 Sufficient number of doctors and staff available in the hospital 55 Hospital staff properly handle any problems that arise

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