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International Journal of Healthcare Management

ISSN: 2047-9700 (Print) 2047-9719 (Online) Journal homepage: http://www.tandfonline.com/loi/yjhm20

Measuring patient's satisfaction of healthcare


services in the UAE hospitals: Using SERVQUAL

Hamda S. Al-Neyadi, Salam Abdallah & Mohsin Malik

To cite this article: Hamda S. Al-Neyadi, Salam Abdallah & Mohsin Malik (2016): Measuring
patient's satisfaction of healthcare services in the UAE hospitals: Using SERVQUAL, International
Journal of Healthcare Management, DOI: 10.1080/20479700.2016.1266804

To link to this article: http://dx.doi.org/10.1080/20479700.2016.1266804

Published online: 16 Dec 2016.

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Download by: [UAE University] Date: 10 November 2017, At: 02:53


Measuring patient’s satisfaction
of healthcare services in the UAE
hospitals: Using SERVQUAL
Correspondence to:

Hamda S. Al-Neyadi, Salam Abdallah, Mohsin Malik Salam Abdallah College of


Business, Abu Dhabi
College of Business, Abu Dhabi University, Abu Dhabi, UAE University.
salam.abdallah@adu.ac.
ae.ae

Abstract
The purpose of this paper is to evaluate the quality with technologically advanced gadgets for the diag-
of healthcare services by investigating the factors nosis and treatment of various diseases to sustain
affecting patient satisfaction in private and public the optimum quality of health and wellbeing of
hospitals in the UAE based on five service quality the population. Likewise, healthcare facility admin-
dimensions of the SERVQUAL namely; tangibles, istrators sought to ensure that employees rendering
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reliability, responsiveness, assurance, and empathy. healthcare services meet the expectations of the cri-
A modified SERVQUAL questionnaire was used to teria set by the health authorities which prescribe
gather the research data. The respondents of the the qualifications and competences of healthcare
study consisted of 127 patients who have been professionals. These, among others, are just some
admitted within the last 6 months prior to the of the few measures undertaken by healthcare provi-
onset of the investigation. The results of the study ders to demonstrate effectiveness and efficiency in
revealed that the perceived healthcare services in delivering healthcare services. But still, the satisfac-
private hospitals and public hospitals do not signifi- tion of patients continues to pose a challenge for
cantly vary. Although patients were more satisfied healthcare providers to seek better ways of upgrad-
with nursing care, the perceived satisfaction of ing the quality of services rendered to third party
patients with the quality of services provided by payers and consumers.
physicians and nurses as well as the quality of the Patient satisfaction with healthcare services is an
hospital environment do not significantly vary in important performance measure for healthcare pro-
both public and private hospitals. The dimension viders.1 In fact, it is one of the universal goals of
of assurance was rated the highest while responsive- healthcare providers as patient satisfaction directly
ness was perceived as the least important of the five reflects the status of any healthcare facility.
SERVQUAL dimensions. The five dimensions of the Meeting patient satisfaction is complicated due to
SERVQUAL appeared to be a consistent and reliable the ever changing demands and healthcare needs
scale for measuring healthcare service quality in the of patients but it remains a generally accepted yard-
United Arab Emirates context. The modified stick that equates satisfactory patient feedback to
SERVQUAL may be used to contribute in enhancing hospital success. In addition, patient satisfaction is
the quality of healthcare services in UAE and in one of most important indicators in determining
other similar environments. patient health outcomes.2 Sustaining patient satis-
faction is one of the desired outcomes of care
Keywords: Patient satisfaction, Service quality,
which in itself is a crucial element of the of health
SERVQUAL, Private and public hospital, Emerging
status. All this establishes the importance of the sat-
countries
isfaction or dissatisfaction of patients for the quality
of provided care.3
Based on the United Arab Emirates Health Care
Overview,4 there are 70 hospitals in the UAE that
Introduction
are categorized as either private or public insti-
Over the last decade, process improvement has been tutions. Twenty nine of these institutions are
one of the most important concerns of healthcare managed by the government. The same report
providers in the United Arab Emirates (UAE). depicted that patient satisfaction is low in the
Healthcare facility administrators took measures to Emirate of Abu Dhabi. Accordingly, only 25–30%
ensure that their respective facilities are equipped of the total patients admitted were satisfied with

© 2016 Informa UK Limited, trading as Taylor & Francis Group


DOI: 10.1080/20479700.2016.1266804 International Journal of Healthcare Management 2016 1
Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services

the healthcare services provided in both public and Healthcare Overview 4 give contrary evidence by
private hospitals. This satisfaction rating raises a red reporting that the patients still appear to be dissatis-
flag considering that the hospitals in Abu Dhabi are fied with the healthcare services.
well equipped with modern and highly advanced
technological facilities and manned by highly quali- Satisfaction in the healthcare setting
fied and competent healthcare professionals. Satisfaction is meeting the needs and wants of the
Despite the UAE being ranked as one of the emer- end users. For many years patient satisfaction has
gent countries in the world, there remains to be a been a major objective of healthcare business organ-
dearth of studies that evaluate the quality of health- izations, since it has been considered to affect custo-
care services rendered to patient based on their sat- mer retention and the companies’ market share.
isfaction. To help bridge this research gap, this study Therefore, achieving high level of patient satisfac-
was undertaken to evaluate the quality of healthcare tion in the healthcare service is vital.7 It is important
services by investigating the factors affecting patient for every healthcare system to be aware of their hol-
satisfaction in private and public hospitals in the istic healthcare service performance level and pro-
UAE. The result of this research can contribute sig- gress through patient satisfaction and comparative
nificant insights and knowledge to decision- analysis in order to sustain a competitive level in
makers in the health authority as well as in the the market.
various healthcare institutions in the country and Previous studies dedicated to satisfaction in the
elsewhere. On the whole, the study contributes to healthcare setting focused on getting a better knowl-
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enhancing the quality of healthcare services ren- edge of the doctor–patient relationship and how it
dered to patients by answering following questions: affects patient satisfaction on healthcare services.8
To what extent the inpatients are satisfied with On the other hand, enhancing patients’ experiences
physician care, nursing care, and the hospital has become a challenge for healthcare management
environment in the public and private healthcare as they tend to see patient as ordinary consumers
facilities in Abu Dhabi? rather than healthcare services consumers. Quality
Basheti et al.39 showed that many patients in of patient care provided by primary healthcare
the Middle East seek medical remedies in phar- showed a declining level specifically in the public
macies, rather than visiting healthcare facilities healthcare system. These healthcare services pro-
despite the state of the art healthcare facilities in grams need to be reconstructed while others indi-
many GCC countries. The authors opined that cated that the government should be accountable
the patients seemed to value the advices given for improving the quality of healthcare.9
at pharmacies more compared to the option of Patient satisfaction is a vital healthcare outcome
going to hospitals for consultation. This may indi- that can be used to measure the performance of
cate that patients are not satisfied with the ser- healthcare providers and facilities in general. The
vices provided by hospitals in the Middle East feedback that healthcare facility receives are utilized
region in general. for the development of plans to continuously
In a high-income country such as the UAE, health- improve the quality of service. Likewise, this feed-
care facilities are well equipped and the healthcare back keeps them on-track on their level of competi-
staff are qualified and competent physicians.5 tiveness in the market. Patient satisfaction in
Moreover, the competitive and mandatory medical healthcare is more significant than ever since the
insurance entails the residents to accessible health- industry is now considered competitive especially
care services. The UAE government also continues for the private owned hospitals.9
to invest in the healthcare sector to ensure that
healthcare professionals are well trained and Patient expectations
quality healthcare services are delivered. The Abu Patients’ perception on the quality of services is an
Dhabi Economic Vision 2030 is a stepping stone essential indicator utilized to measure the per-
for the Emirate’s economic progress. So one of the formance of a healthcare facility.10 In most cases,
identified priorities of Abu Dhabi government is the patient’s perception affects the satisfaction
premium education, healthcare, and infrastructure level as expectations on how the services should
assets (General Secretariate of the Executive be delivered develops within their own view.11
Councel, Department of Planning & Economy, Commonly, interaction between the primary care-
Abu Dhabi Council Development, 2015). While giver and the patient during the delivery of health-
some studies report reasonable health services care services plays an important factor in patient
within the UAE and credit the state health policies satisfaction. A study concluded that if healthcare
for this,6 the findings in the United Arab Emirates management would like to increase patient

2 International Journal of Healthcare Management 2016


Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services

satisfaction, they should focus primarily on the dissatisfied if healthcare providers insist on them
enhancement of nursing and staff care to achieve high level of independence and projects lesser
optimum improvement.12 level of assistance.
Waiting time plays an important role in the Patients show a high level of dissatisfaction due to
satisfaction level among clientele. The length of accessibility problems with healthcare services.
time by which patients that are to be attended Availability of appointments and geographical
gives them the impression of being cared for or access to the healthcare facilities leads to a low
neglected, thus directly affecting patient satisfac- patient satisfaction rating. Thus, the concepts of sat-
tion. Length of waiting time is determined by isfaction and dissatisfaction do not capture the
several factors: emergency department capacity complex feelings, beliefs and values that patients
and current load which result in slower phase of expressed about their illness and its treatment.17
service. The high number of patients compared to
the limited ward capacity ends up in delivering The UAE healthcare sector
low quality of service.13 Since its unification in 1971, the UAE enjoys a
Patients value the presence of nurses and any remarkable advancement in all aspect of progress
other form of attention healthcare providers give including healthcare services.18 The approximately
as measures of how caring and concerned they are. 8.2 million residents of the country enjoy the utiliz-
This is based on the expectation of patients that ation of high standard healthcare facilities. The said
they should always have nurses by their side. On facilities were established favorably due to the coun-
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the other hand, a patient who expects some delay try’s oil deposits and sustained security environ-
will have no problem waiting for laboratory ment. But the growing population of UAE
results, admission, or discharge. increases the demand for further growth in the
healthcare sector. This in turn increases the
Reason for dissatisfaction demand for healthcare personnel and facilities
Language barrier and differences in cultural prac- which is expected to drive the country’s healthcare
tices result to a wide range of dissatisfaction market to Dh 3.5 billion to Dh 4 billion by 2018.19
ratings by patients who come from different As of 2009, UAE had a total of 26 public hospitals,
countries. In a study conducted on patient satisfac- with 4100 total bed capacity, excluding 28 private
tion in the United States of America (USA), healthcare facilities. The ministry of health is
Hispanic patients expressed lower satisfaction in encouraging the establishment of more private hos-
the medical services rendered to them as opposed pitals with the provision of operating within the set
to white English speakers.14 Language barrier rules and policies of the ministry to maintain health-
leads to communication breakdown between the care standard. This initiative is to satisfy the objec-
patient and healthcare providers resulting in tive of creating a competitive environment that
patient dissatisfaction.10 Another study stated that will boost the quality of healthcare services within
some patients were not able to express themselves the country.18 In addition, the UAE government
while healthcare providers could not freely commu- has established 106 primary healthcare centers in
nicate with the patient essential information. its aim to bring healthcare service closer to the
Information needed to be communicated carefully population.20 All of this led to UAE being ranked
and accurately to patients include facts about pro- 27th out of 191 countries in terms of quality health-
cedures and the duration of their treatment and its care service, according to the World Health
associations with health status. Likewise, infor- Organization (WHO).
mation about health insurance or the absence Private hospitals are able to offer healthcare ser-
thereof, and care limitations for low income patients vices at a lower cost with the aim of acquisition of
are to be discussed with the patient.15 new clients through feedback collection. This
A study conducted in Boston showed that make an impression that patient receives higher
English-speaking patients were less satisfied with quality of healthcare, development of trust, and a
the courtesy shown by the staff as compared to feeling of better satisfaction. This makes the
Spanish speaking patients who were happy with private hospitals the preferred care providers for
the gestures in the emergency department.16 the patients as compared to their public or govern-
Cultural norms and values affect patient dissatisfac- ment counterparts.21
tion. American culture promotes independence,
hence, if healthcare provider tends to be overly assis- Differences between private and public hospitals
tive leads to dissatisfaction. On the contrary, Patients in private and public hospitals both experi-
American with Hispanic ancestry tends to be ence dissatisfaction. The reason behind the said

International Journal of Healthcare Management 2016 3


Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services

dissatisfaction may differ. A comparison between It also showed that leadership is the most important
public owned hospitals in Quebec, Canada, and factor that affects patient satisfaction. Another
California showed that there was no clear distinction study indicated that the demand for quality ser-
between private and public healthcare institutions vices started taking shape a few decades ago,
in terms of patient satisfaction.22 Likewise a study when hospitals started paying more attention
in the Middle East Region showed that patients of to their patients and their respective needs.31
both public and private hospitals similarly were Hospitals that offer excellent quality of services
served adequately.23 Regardless of public or were found to record higher patient satisfaction32
private hospital, an adequate service leads to a with good experience for the patient due to the
higher level of patient satisfaction. availability of competent nurses that directly
Another study indicated that patients who took increases patient satisfaction compared to other
treatment from private hospitals recorded higher hospitals that performed average that resulted to
satisfaction compared to public hospitals. Data patients recommendation of the healthcare provi-
showed that only one percent (1%) could not be der to other people.32
served by medical specialists and consultants in
private hospitals. In another study, results indicated Service quality in healthcare
that only 40% of patients from a public hospital Every healthcare provider has its own way of pro-
would prefer to see a consultant rather than a clini- viding services, contributing to the variability in
cian.24 A recent study by Bishop et al.25 revealed that the services quality of provided healthcare ser-
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the service provision in private and public health- vices.33 Patients either in or outpatient receive
care facilities differ in terms that private hospitals several services in medical care and their judgment
offered greater opportunities and treatment of the quality of services delivered to them
options. Private hospitals likewise offered services varies.34 Patient satisfaction is a valid indicator for
by appointment system with high level of flexibility measuring service quality. Service quality has two
even within a short notice to respond to clients dimensions: (a) technical i.e. the core service pro-
demand leading to a better level of patient satisfac- vided and (b) functional dimension, i.e. how the
tion compared to public hospitals.26 service is provided. Satisfaction with these dimen-
For profit-making hospitals to receive enough sions indicate the success of service organizations.35
clients, they have to offer competitive services to However, most of the patients focus on functional
ensure that patients revisit the facilities or rec- quality to evaluate the health services as they lack
ommend them to family and friends.27 However, of medical expertise for evaluating the technical
another study found contradicting result which attributes.36
showed that public hospitals were significantly A SERVQUAL instrument has been used in
more efficient with relatively fewer resources. The different type of services industries as healthcare
study reflected that public hospitals ensure industry, hotels, and dentistry, education, travel,
optimum utilization of their limited resources that and construction services. The SERVQUAL has
result to productivity. Certain percentage of five dimensions: responsiveness, reliability, assur-
private hospitals tends to compromise the quality ance, tangibles, and empathy which are assessed
of services in the efforts of maintaining profitability on the basis of customers’ expectations and percep-
and high net income.28 Evidently, the efficiency of tions.37 Arasli and Salih38 define these dimensions
hospitals translates to better services, which lead as follows:
to patient satisfaction.
A comparison between the services offered by (1) Tangibles – facilities, equipment, and the
public and private hospitals in the UAE showed sig- presence of personnel;
nificant difference in terms of service quality. The (2) Reliability – ability to perform the promised
study has shown that the public hospitals outscored service responsibly and accurately;
private hospitals on tangibles and reliability. The (3) Responsiveness – willingness to provide help
study recommended a careful design of patient- and a prompt service to customers;
oriented programs and procedures to improve (4) Assurance – the knowledge and courtesy of
patient satisfaction within private hospitals to employees and their ability to inspire trust
attain competitive level with their public and confidence; and
counterparts.29 (5) Empathy – caring and understanding, which
A study on the UAE healthcare facilities30 ident- a company provides and/or offers its custo-
ified that patients were generally satisfied with the mers in terms of its individualized and per-
quality of service rendered by their chosen hospitals. sonalized attention

4 International Journal of Healthcare Management 2016


Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services

This paper tested the following hypotheses: ranging from 1 = strongly disagree to 5 = strongly
agree.
(1) There are no differences between public and
private concerning hospital service quality. Results
(2) There are no differences between public and
A total of 160 questionnaires were distributed to the
private concerning physicians’ care, nursing
respondents who were convenience selected from
care and hospital’s environment.
private and public hospitals Out of this total
number, 127 valid responses were obtained repre-
senting a response rate of 79.37% – a percentage
Methods deemed acceptable by the researcher. Of the total
respondents, most (72%) belonged to the 18– 35
The quantitative approach was used to assess
age range, majority of whom are males (58%) as
patient satisfaction levels from the feedback of
shown in Tables 1 and 2.
adult inpatient. To this effect, adult inpatients
Employing the SERVQUAL scale was useful for
between the ages of 18–66 both male and female,
measuring inpatient satisfaction. The mean values
expatriates and UAE nationals, comprised the
depicted in Table 3 generally shows that inpatients
respondents of the study.
in public hospitals were satisfied with the services
This exploratory research used quantitative analy-
provided in terms of tangibles, reliability,
sis in determining the influence of the different
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empathy, and assurance but were uncertain of


factors that affect patient satisfaction in the UAE
their satisfaction regarding the responsiveness of
healthcare sector. The items of the SERVQUAL
such services. On the other hand, the inpatients in
were rephrased in both wording and contextual
private hospitals were very satisfied with the assur-
applications to suit the purpose of the study.
ance of the services provided; satisfied with the tan-
Therefore, we primarily developed a modified
gibles, reliability, and empathy dimensions of the
SERVQUAL scale for public and private hospitals
services; and uncertain regarding the responsive-
in the Emirates of UAE aiming to compare service
ness of the services.
quality in both types of hospitals in terms of their
The data were further analyzed using ANOVA to
effectiveness in meeting the expectation of their
determine whether the observed numerical differ-
inpatients. The Likert scale was used with close
ences in the means statistically varied or not.
ended questions to facilitate discovery of the poten-
Considering the sensitive nature of construct
tial relationship between inpatient satisfaction as
( patient satisfaction) investigated, size of the
dependent variable and other independent vari-
sample and the units of analysis ( perceptions),
ables. The survey questionnaire designed in both
English and Arabic versions to cater to the language
Table 1 Gender of respondents
preferences of the respondents.
The instrument used in this study was tested for Valid Cumulative
validity and reliability to ensure a high-quality F % percent percent
measure. Cronbach Alpha was used for the
Valid Male 61 48.0 58.1 58.1
purpose of reliability measurement. The modified Female 44 34.6 41.9 100.0
questionnaire has 40 components with 37 statements Total 105 82.7 100.0
making up the five dimensions to be investigated: Missing System 22 17.3
Tangibles (9); Reliability (9); Responsiveness (7); Total 127 100.0
Safety (5); and Empathy (6). Cronbach’s Alpha
yielded r = 0.944 which reflected reasonable val-
idity of the scale and the high internal reliability of Table 2 Age of respondents
the individual constructs. This indicated that the
Valid Cumulative
questionnaire was suitable for the purpose of F % percent percent
study as r = 0.944 is considered as excellent.
The SERVQUAL assessed the five dimensions of Valid 18–25 21 16.5 21.0 21.0
26–35 51 40.2 51.0 72.0
service quality attributes. It measured the study par-
36–45 20 15.7 20.0 92.0
ticipants’ perceptions of the actual healthcare service 46–55 4 3.1 4.0 96.0
performances along the various attributes. Multiple 56–65 4 3.1 4.0 100.0
comparison tests and regression analysis were used Total 100 78.7 100.0
to analyze the data using SPSS. Responses to all Missing System 27 21.3
items were elicited on a five-point Lickert scale Total 127 100.0

International Journal of Healthcare Management 2016 5


Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services

Table 3 Differences in perceived level of satisfaction

Dimensions Hospital n Mean Std. deviation F Sig.


Reliability Public 58 3.6130 0.85593 3.490 0.065
Private 46 3.9372 0.90711
Total 104 3.7564 0.88944
Empathy Public 57 3.4812 0.62715 1.615 0.207
Private 45 3.6635 0.82187
Total 102 3.5616 0.72154
Tangible Public 56 3.7421 0.71824 1.234 0.269
Private 48 3.9028 0.75555
Total 104 3.8162 0.73650
Assurance Public 59 3.8508 0.89873 4.582 0.035
Private 47 4.2085 0.79559
Total 106 4.0094 0.86910
Responsiveness Public 24 2.6667 0.70826 0.070 0.792
Private 33 2.7186 0.74444
Total 57 2.6967 0.72345

the researcher set a more rigorous significance level inter-correlated except for responsiveness which
(α = 0.01) in verifying the research hypothesis.
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only correlates significantly with empathy. This


Accordingly, the results obtained in comparing indicates that the patients perceived the responsive-
public and private hospitals showed P = P ≥ 0.01 ness of the service more on the basis of the care pro-
in all the dimensions of service quality indicating vided to them. It has to be noted in Table 3 that
that there is no significant difference in the per- patients were satisfied with the empathy they
ceived level of satisfaction among patients regarding experienced but were uncertain about their satisfac-
the services provided in public and private hospitals tion with the responsiveness of services provided.
along the five dimensions. On the basis of the correlation, the perceived respon-
Hence, the type of hospital where the patients siveness of the services provided could be consider-
were admitted was not a discrimination factor for ably improved by showing more care and giving
differentiating their satisfaction. On the whole, it more attention to patients.
can be claimed that regardless of hospital, inpatients The study also looked into how physicians,
were typically satisfied with the tangibles, empathy, nurses, and the hospital environment influenced
reliability, and assurance dimensions of the services patient satisfaction in public and private hospitals.
provided but were similarly uncertain regarding the Accordingly, the mean values depicted in Table 5
responsiveness of such services. On the basis of the shows that patients were generally satisfied with
foregoing findings, Hypothesis 1 stating that there is the quality of care provided by physicians and
no difference between public and private hospitals nurses as well as the quality of the hospital environ-
in terms of service quality is hereby accepted. ment in both public and private hospitals. To this
The degree of relationship of the five service effect, the ANOVA was used to determine statistical
quality dimensions was also examined using variance in the mean values observed. Accordingly,
Pearson Correlation. Accordingly, Table 4 shows the P values obtained in comparing public and
that all the SERVQUAL dimensions are significantly private hospitals showed P ≥ 0.005 for the care

Table 4 Correlation of the service quality dimensions

Reliability Empathy Tangible Assurance


Empathy Sig. (2-tailed) 0.791** – – –
N 100 – – –
Tangible Sig. (2-tailed) 0.794** 0.673** – –
N 101 99 – –
Assurance Sig. (2-tailed) 0.873** 0.742** 0.762** –
N 104 103 103 –
Responsiveness Sig. (2-tailed) −0.083 0.358** 0.141 0.006
N 57 54 54 57
**r = 0.50.

6 International Journal of Healthcare Management 2016


Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services

Table 5 Differences in the perceived satisfaction of factors

Factors Hospital N Mean Std. deviation F value Sig.


Physicians Public 58 3.6103 0.60804 1.181 0.280
Private 46 3.7522 0.72257
Nurses Public 26 3.4615 0.54677 5.324 0.025
Private 32 3.7882 0.52751
Hospital Environment Public 56 3.6265 0.75143 2.678 0.105
Private 45 3.8796 0.79843

provided by physicians and nurses and the quality The t-test was used to further determine the stat-
of the hospital environment. This indicates that istical variance in the observed means.
there is no significant difference in the level of satis- Accordingly, the P values in both public and
faction of inpatients regarding the quality of phys- private hospitals showed P = P ≥ 0.005 for the
ician and nursing care as well as the quality of the three inpatient attitudes. This indicates that there is
hospital environment in both public and private no significant difference in the attitudes of patients
hospitals. This means that regardless of the type of toward both public and private hospitals in terms
hospital, the quality of physician, nursing care, of physician and nursing care and hospital environ-
and the hospital environment quality were similarly ment. This means that the type of hospital was not a
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perceived to have satisfied the inpatients. discriminating factor in differentiating the attitudes
On the whole, the satisfaction of inpatients on the of the patients. This invariably implies that the per-
quality care provided by physicians and nurses as ceived quality of physician and nursing care as well
well as the quality of the environment could not as the quality of hospital environment do not vary in
be discriminated on the basis of the type of hospital both public and private hospitals. On the whole,
where they were admitted. As a corollary, the results inpatients have equally similar attitudes toward
invariably show that the services provided by phys- the services provided by physicians and nurses
icians and nurses as well as the quality of the regardless of the hospital where they are admitted.
environment do not significantly vary according to
the type of hospital. On the basis of the foregoing
findings, Hypothesis 2 stating that there is no differ- Discussion
ence between public and private hospitals in terms of On the whole, the results of the study do not affirm
physician care, nursing care, and hospital environment, the findings of previous studies particularly indicat-
is accepted. ing low levels of satisfaction with healthcare facili-
As a follow-up to the aforementioned findings, ties and services in the UAE19 nor the greater
the overall perceived satisfaction of the patients reliance on pharmacies rather than hospitals
was determined together with their perception on typical to patients in the Middle East.39 The study
whether their expectations were met and whether neither supports the findings that language and
they would recommend the hospital to a friend or cultural barriers can be causes of patient dissatisfac-
family member. Accordingly, the results depicted tion10,14 since the respondent of the study consisted of
in Table 6 shows that the inpatients in both public both nationals and expatriates suggesting that they
and private hospitals all agreed that they were satis- are multi-lingual and multi-cultural. Furthermore,
fied with the services provided; their expectations results of the study showing a significant difference
were equally met; and that they would recommend in service quality among hospitals in the UAE29 is
the hospital to a friend or family member. not supported by the findings of this study.

Table 6 Attitudes toward services provided

Std. Sig.
Hospital n Mean deviation (2-tailed)
I would recommend the hospital to a friend or family Public 59 3.6441 1.06290 0.026
member Private 50 4.1000 1.03510
Overall I am satisfied with quality of service provided by Public 59 3.7966 0.94284 0.260
the hospital Private 50 4.0200 1.11557
The services I received at the hospital have met my Public 59 3.5763 1.03729 0.092
expectations Private 50 3.9200 1.06599

International Journal of Healthcare Management 2016 7


Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services

Compared to the foregoing studies, the results Going back to what was earlier stated that any
obtained in this study can be on account of several form of dissatisfaction among patients can either
factors. First, the tremendous improvement of point to failure or the opportunity for improvement,
healthcare in Abu Dhabi for the past 2 years. It has it appears that the aspect of failure does not apply
to be noted that the low level of patient satisfaction within the context of the study on the basis of the
in Abu Dhabi was reported in 2013. With the current findings obtained. However, there is still room for
findings, this can only imply that the countless improvement. The results particularly show that
improvements that have been implemented since inpatients are generally satisfied with the five
then have contributed to increasing the satisfaction service quality dimension with the exception of
of patients in public and private hospitals. Second, assurance in private hospitals which patients were
the greater trust placed by patients on the healthcare very satisfied with. This can serve as a benchmark
system. In the past, nationals had the tendency to for the other dimensions which means that improv-
seek medical treatment abroad however, the influx ing tangibles, reliance, empathy, and responsiveness
of both technology and foreign expertise into the on the part of hospitals can still raise the bar of sat-
healthcare system is slowly changing the picture. isfaction among patients.
Today, more and more patients trust the expertise,
services, and technology in local hospitals. One Limitations of the study
interesting finding of the study indicating this is
The findings of the study also open the potential for
the greater trust placed by inpatients on the nurse.
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future research which may focus on identifying


Nurses play an important role in enhancing
differences in expectations and perceptions of
patients’ experience within the hospital and evi-
service quality in private and public ownership as
dently, the services they provide to patients in
well as between patient and service provider percep-
both public and private hospitals are becoming
tions. The research instrument could be expanded
more patient-centric. This concurs with the con-
with new items and might include questions about
clusion of a study that healthcare management
the importance of certain variables for the patients.
would likely increase patient satisfaction if it
Additionally, public hospital ought to work on
focuses primarily on the enhancement of nursing
enhancing nursing skills as these play an essential
care to achieve optimum improvement.12 Third,
role within the hospital and considered as the
there is evidently improved communication with
main link between physician and patients.
patients hence language barriers are no longer con-
straints. This is supported by the various initiatives
Implications for future research
for improving patient experience through effective
and responsive customer service strategies. Fourth, Employing the SERVQUAL scale was useful for
the findings show that public hospitals are keeping measuring inpatient satisfaction. The findings of
up with the competition in the local healthcare the study should not be taken as a cause for public
market. The general notion is that private hospitals and private hospitals in Abu Dhabi to rest on their
provide better services. This, however, is being laurels. Rather, the findings pose the greater chal-
proven to be a questionable in the light of current lenge of enhancing and sustaining patient satisfac-
realities obtaining in the UAE particularly in Abu tion in both private and public hospital in the
Dhabi. emirate. The positive and significant correlation
The results of the study corroborate the findings among the five quality dimensions mean that the
of Pierre-Yves Crémieux et al.22 that there is no effects of these quality dimensions are intercon-
clear distinction between private and public health- nected hence a change in one dimension is likely
care institutions in terms of patient satisfaction. The to bring about a change in other dimensions. This
study also supports the findings that patients of both suggests that any improvement that needs to be
public and private hospitals in the Middle East introduced into the system has to be holistic and
region were similarly served adequately.23 should consider system-wide consequences. This
Likewise, the findings of this study concur with means not only improving technical and functional
the results of the study of Jabnoun and Rassasi16 quality but designing the improvement in such a
who found that patients are generally satisfied way that it enhances the capacity of both the hard
with the quality of service of their chosen hospitals and soft technologies of hospitals to deliver
in the UAE. The fact that the respondents of this patient-centric services.
study were inpatients makes the results more cred- To this effect, the study recommends that continu-
ible since their hospital stay allowed them to experi- ous attention be given to hospital improvement that
ence the services provided on an extended basis. is grounded on the five quality dimensions, focused

8 International Journal of Healthcare Management 2016


Al-Neyadi et al. Measuring patient’s satisfaction of healthcare services

on the medical, nursing, and environmental com- Health 2011;13(2):408–12. doi: 10.1007/S10903-009-
ponents of the hospital setting, and oriented 9275-2
15. Becker G, Newsom E. Socioeconomic status and dis-
strongly toward greater satisfaction as a universal satisfaction with health care among chronically Ill
patient experience and outcome. African Americans. Am J Public Health 2003;93(5):
742–8.
16. Carrasquillo O, Orav EJ, Brennan TA, Burstin HR.
Disclaimer statements Impact of language barriers on patient satisfaction in
Contributors None. an emergency department. J General Inter Med
1999;14(2):82–7. doi:10.1046/J.1525-1497.1999.00293.X
Funding None. 17. Coyle J, Williams B. Seeing the wood for the trees:
defining the forgotten concept of patient dissatisfac-
Conflicts of interest None. tion in the light of patient satisfaction research.
Leadersh Health Serv 1999;12(4):95–124.
Ethics approval None. 18. Badri MA, Attia S, Ustadi AM. Healthcare quality and
moderators of patient satisfaction: testing for causal-
ity. Inter J Health Care Qual Assur 2009;22(4):
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