CHAPTER 1

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Maintaining a safe environment reflects a level of compassion and vigilance

for patient welfare that is as important as any other aspect of competent health
care. The way to improve safety is to learn about causes of error and use this
knowledge to design systems of care to “… make errors less common and less
harmful when they do occur”. As a result, researchers, policymakers, and
providers have intensified their efforts to understand and change
organizational conditions, components, and processes of health care systems
as they relate to patient safety.

Besides the noticeable harm to patients, avertible adverse health care events
linked to patient safety have main financial penalties for the patient, the
provider, the insurer, and frequently the family and/or caregivers. Use of
Agency for Healthcare Research and Quality (AHRQ) patient safety pointers,
researchers assessed the excess span of stay for postoperative sepsis to be
roughly 11 days at a cost of almost $60,000 per patient. While in some cases
there is extra payment made by brokers to hospitals for these hostile events, it
has been projected to be substantially less than the total cost of the resources
used.

Furthermore, with increased discussions about pay-for-performance and

mandatory reporting of certain adverse patient safety events, providers may
have increased financial as well as other incentives to improve patient safety.
Therefore, understanding organizational aspects that promote patient safety is
also very important.

1
A number of safety climate scales have been developed in the fields of
occupational health and patient safety. In occupational health, attributes of a
safe climate in hospitals have been found to include senior management
support for safety programs, absences of hindrances to safe work practices,
availability of personal protective equipment, minimal conflict, cleanliness of
work site, good communication, and safety-related feedback. An optimistic
safety climate has been suggestively correlated to condensed risk of work
injury and exposure. In patient safety, attributes of a safe hospital environment
have been identified as a positive work environment, supportive
supervisor/manager, improved interdisciplinary communications, and
increased safety event reporting. Obviously these microclimates overlap.
Additionally, they should be synergistic and correlate with the overall
organizational climate. Indeed, a positive organizational climate is most likely
an essential antecedent to the development of a strong safety climate.

Customer hopes are views about the service that oblige as standards or
reference points contrary to which quality is judged. Whether or not these
expectations are encountered by the service provider will have a critical
bearing on their professed service quality. It should be noted though, that the
expectations between two individuals are not necessarily identical, even if the
service delivery is absolutely identical. The seeming service quality of the
service is therefore also not essentially matching. Changing personal
circumstances such as income levels, educational achievement or increasing
aspiration levels may also change an individual’s expectations over time.
Expectations are also affected by the interaction of a person with for instance,
the media, the service provider, other customers and observation of specific
situations.

SERVQUAL is a multi-dimensional research tool, intended to capture

consumer expectations and insights of a service along the five magnitudes that
are believed to characterize service quality. SERVQUAL is built on the
2
expectancy-disconfirmation paradigm, which in simple terms means that
service quality is understood as the extent to which consumers' preconception
expectations of quality are confirmed or disconfirmed by their authentic
discernments of the service involvement. It has become the foremost
measurement scale in the zone of service value. In spite of the long-standing
interest in SERVQUAL and its myriad of context- specific applications, it has
attracted some criticism from researcher’s reliability, assurance, tangibles,
empathy and responsiveness are the five dimensions that are thought to
represent the dimensions of service quality across a range of industries and
settings.

Businesses use the SERVQUAL instrument (i.e. feedback form) to measure

likely service quality hitches and the model of service quality to help detect
possible reasons of the problem. The model of service quality is constructed
on the expectancy-confirmation architype which suggests that consumers
distinguish quality in terms of their observations of how well a given service
delivery meets their expectations of that delivery. Thus, service quality can be
conceptualized as a simple equation:

SQ = P- E
Where;
SQ is service quality
P is the individual's perceptions of given service delivery
E is the individual's expectations of a given service delivery
When customer expectations are greater than their perceptions of received
delivery, service quality is deemed low. As soon as perceptions surpass
expectations at that moment service quality is high.

3
1.2 NEED AND SIGNIFICANCE OF THE STUDY

Patients’ perceptions about health services seem to have been largely ignored
by health care providers in developing countries, especially in India. Such
perceptions, specifically about service quality, might outline confidence and
successive behaviours with regard to choice and practise of the existing health
care facilities is replicated in the fact that numerous patients’ avoid the system
or avail it only as a measure of last resort. Those who can pay for it seek
support in other countries, while precautionary care or early detection merely
falls by the wayside. Patients’ voice must begin to play a greater role in the
design of health care service delivery processes in the developing countries.

1.3 PROBLEM STATEMENT

Present scenario of health care environment face very big challenges due to
pathetic situation prevailing in the global environment. In India health care
industries face much more challenges and issues in satisfaction of the patients.
Moreover, India’s health care system and polices are very poor when
compared to the developed nation with respect to both technological aspect
and infrastructure facility. The most important concern for today’s hospitals is
patient satisfaction. Thus the problem addressed through this study is patient
satisfaction in healthcare sector with special reference to private sector
hospitals in Trivandrum.

1.4 OBJECTIVES
The main objective is to identify the relationship between the ambient
conditions, tangibles and social factors with the trustworthiness of the hospital
according to the patients’ point of view.

• To examine how ambient conditions are related to service quality of

private healthcare sector

4
• To evaluate how well tangibles improve the service quality environment
of private healthcare sector
• To examine what is the role of social factors to improve the service
quality environment of private healthcare sector

1.5 SCOPE OF THE STUDY

This study investigates patient’s perceptions about service quality in private
hospitals in Trivandrum and the study is undertaken in private hospitals using
SERVQUAL dimension. Health care service quality ought to be solely
assessed by the patients. This study indicates on Service Environment Quality
and its relationship with ambient conditions, tangibility, social factors and
trustworthiness of the hospital and how much importance patients give to such
factors to improve the quality of the health care sectors in Trivandrum.

1.6 LIMITATIONS OF THE STUDY

▪ Samples are collected from only 124 respondents due to lack of time
▪ Primary data collected from respondents can cause personal bias

▪ Respondents seem to be highly scattered.

5
 CHAPTER 2

LITERATURE REVIEW

Neetu Kumari, Sandeep Patyal (2000) tried to prove that tangible, ambient
conditions and social factor are the main dimensions of service environment
quality and there is a significant difference that exists between perception and
expectation of male and female patients while evaluating the significant
dimension if hospital service environment quality. This study was useful for
me to identify how these factors affect the service environment quality of
private healthcare sectors.

Mosadeghrad (2014) explains that the main purpose of this study was to
identify factors that influence healthcare quality in the Iranian context. The
major results were quality in healthcare is a production of cooperation
between the patient and the healthcare provider in a supportive environment.
Personal factors of the provider and the patient, and factors pertaining to the
healthcare organization, healthcare system, and the broader environment
affect healthcare service quality. Healthcare quality can be enhanced by
supportive visionary leadership, appropriate planning, education and training,
6
availability of resources, operative management of resources, employees and
processes, and association and teamwork among benefactors. This study
helped me to identify the importance of environmental factors in determining
service environment quality of healthcare sectors.

Gupta & Rokade (2016), in this study they tend to identify what all are the
factors which are more important for a patient to make them satisfied about
the quality of services provided by the healthcare sectors. They identifies
customer satisfaction is the major key of success for any health care sector.
This study helped me to identify how consumers are satisfied about the quality
of health care sectors and the major factors behind it.

Talib et al. (2015) says that the purpose of this study was to develop an
extensive and systematic literature search on healthcare quality, SQ,
development and application of SERVQUAL and to understand the link
between SQ and patient satisfaction. The paper additionally recognises the
healthcare quality scopes and models for HCEs. Finally, it was settled that
further research is required to develop conceptual sustaining and analytical
models based on numerical studies. This study helped me to identify the
aspects of SERVQUAL model in a wider manner.

Al-Abri & Balushi (2012) , this article investigates in-depth a number of

research studies that critically discuss the relationship of dependent and
independent influential attributes towards overall patient satisfaction in
addition to its impact on the quality improvement process of healthcare
organizations. There was a mutual salient defining factor between the studies
which was interactive skills in terms of courteousness, respect by healthcare

7
providers in addition to communication skills, elucidation and clear
information, which are more essential and influential than other technical
skills such as clinical competency and hospital equipment. Hence this study
helped me to identify what are the main important factors that increase
patient’s satisfaction in a healthcare sector.

Shou-Hisa et al. (2003) explains major result of this study was interpersonal
skills were as influential as or more influential than clinical competence on
patient satisfaction for three of the four disease categories. In distinction,
technical competence was a more persuasive predictor for reference for
patients in all four disease classes. In this study I got to understand that patient
satisfaction itself does not provide high level of recommendation but it can
create a way for recommendations of the healthcare sector.

Elaine et al. (2002) explains the measurement of patients' satisfaction with

nursing is particularly important since nursing service is often a primary
determinant of overall satisfaction during
a hospital stay. This article reports on a study intended to update and revise the
explanation of patient satisfaction for application with ambulatory medical
patients. This study helped me to identify different nursing service factors
influence the patient satisfaction in healthcare sector.

Anna et al. (2012) says that the purpose of the study was to discover an
aligned or combined perception of healthcare service quality from patients’
and healthcare service providers’ perspectives. Common perception of quality
would give opportunity to focus on improvement of aspects that are essential
for the core stakeholders of healthcare organizations. This study helped me to

8
identify the factors affecting service environment quality in the healthcare
centers according to both patients and doctors.

Andaleeb (2001) says that this study is, patient-centered and identifies the service
quality factors that are important to patients; it also examines their links to patient
satisfaction in the context of Bangladesh. A field survey was conducted.
Assessments were found from patients on several scopes of perceived service
quality including receptiveness, guarantee, communication, discipline, and
baksheesh. Using factor analysis and multiple regressions, significant associations
were found between the five dimensions and patient satisfaction. This study
helped me to identify how the survey should be conducted and how to take
dependent and independent variables in the study.

Appalayya (2018), in this study they had given importance towards customer
satisfaction and loyalty in hospitals. This study implies whether the customer
satisfaction can contribute towards the service quality. Hence this study helped
me to find out various aspects that can improve customer (patient’s)
satisfaction in a healthcare sector.

Olgun Kitapci et al. (2014) The aims of this study are investigating the effect
of service quality (SQ) dimensions on satisfaction, identifying the effect of
satisfaction on word of mouth (WOM) communication and repurchase
intention (RI) and searching a significant relationship between WOM and RI.
Improving CS and distributing SQ help service providers to distinguish the
offering. Thus our motive is to find out that the statement is true for healthcare
industry. This study has adopted the work of Parasuraman et al.’s
SERVQUAL variables. A structural equation model (SEM) that utilizes data
from 369 patients facing a range of services issued and finds that empathy and

9
assurance dimensions are positively related to customer satisfaction. However,
customer satisfaction has a significant effect on WOM and RI which are found
highly related. This study helped me to identify more about the service quality
dimensions.

Lorin Purcărea (2013) explains that the objective of this paper is to explore
the application of the original SERVQUAL scale in the context of public
health care services in Romania. More precisely, we employed the
SERVQUAL scale in order to unearth whether it fits as the original version or
modifications should be done and to describe the demographic profiles of
health care consumers who use public services in Romania. They have
selected our sample respondents from a list of gynecological health care
forum members, namely women from Bucharest who should have posted
messages on the chosen forum no more than three months before the study
was conducted and the messages should have comprised their experiences
with certain physicians. The internal consistency, validity and reliability of the
SERVQUAL SCALE were assessed with the Cronbach’s alpha values and
factor analysis. The perceived service quality was measured as the difference
between perceptions and expectations known as the gap. Results showed that
the major gap score was recorded by the tangibles dimension followed by
receptiveness dimension and reliability dimension. This study helped me to
identify the methods that can be used to measure the service quality.

Gronroos (2013) says that this study’s main purpose is to explain about the
service quality model and its marketing implications. I got to know how the
service quality model can be helpful for the healthcare sectors to improve their
marketing activities.

10
Ilyas (2018) explains that this study was designed to investigate the mediating
role of customer satisfaction between service quality and brand loyalty,
corporate image and brand loyalty, perceived value and brand constancy in the
four discrete service divisions of Pakistan i.e. hospitals, educations, banks and
hotels. The data were collected by using non probability sampling and
snowball sampling from the students for determining educational sectors
results and customers of other sectors to examine their results. The results
stipulate that service quality, corporate image and perceived value are the key
drivers in enhancing brand loyalty when customer satisfaction arbitrated in
their relationship. The results confirm the intermediating role of customer
fulfilment in the relationship of service quality and brand loyalty, corporate
image and brand loyalty, perceived worth and brand loyalty. This study was
helpful to identify what are factors contribute more to brand loyalty of the
patients.

Irfan & Ijaz (2012) explains that the objective of this study is to compare the
quality of healthcare services delivered by the public and private hospitals to
gain patient satisfaction in Pakistan. For this purpose ‘SERVQUAL’
instrument was used to measure the patient’s perception about service quality
delivered by these hospitals. Five service quality dimensions; empathy,
tangibles, assurance, timeliness and assurance were used in order to measure
the patient’s perceptions about the service quality of public and private
hospitals located in the 2nd largest city Lahore, Pakistan. Results displayed that
private hospitals are delivering improved quality of services to their patients
as associated to public hospitals. This study was helpful to find out what
patients expect more from private healthcare sector compared to public
healthcare sector.

11
 CHAPTER-3
RESEARCH METHODOLOGY

3.1 OBJECTIVES
The main objective is to identify the relationship between the ambient
conditions, tangibles and social factors with the trustworthiness of the hospital
according to the patients’ point of view.

• To examine how ambient conditions are related to service quality of

private healthcare sector .
• To evaluate how well tangibles improve the service quality environment
of private healthcare sector .
• To examine what is the role of social factors to improve the service
quality environment of private healthcare sector .

12
3.2 HYPOTHESIS

Hypothesis 1
• Ho: There is no significant relationship between ambient conditions and
service quality of private healthcare sector
• H1: There is significant relationship between ambient conditions and
service quality of private healthcare sector

Hypothesis 2
• Ho: There is no significant relationship between tangibles and service
quality of private healthcare sector
• H1: There is significant relationship between tangibles and service
quality of private healthcare sector

Hypothesis 3
• Ho: There is no significant relationship between social factors and service
quality of private healthcare sector

• H1: There is significant relationship between social factors and service

quality of private healthcare sector
3.3 SOURCES OF DATA

This part of study defines all the process of data collection. When it comes to
data collection, there are two methods in general used by researcher to collect
data, primary and secondary method.

3.4 PRIMARY OR SECONDARY DATA

Primary method includes observation method, interview/questionnaire

method. Secondary method is the process in which previously collected data is
used. The study uses both primary and secondary data. Primary data collection

13
is done through a descriptive survey submitted online to sampling units. It
consists of both demographic as well as questions asking specific shopping
variables.

3.5 SAMPLE DESIGN

(a)Population: The study is based on customer responses in the Alappuzha

area; We need to select random respondents to use the test method with no
probability to identify respondents. A sample size of 150 is used to make the
study as accurate as possible within the study.

(b)Sample size: In this project work, sample unit means ‘a single person’.
There are 150 sample units in this project.

From this sample size the calculation of simple percentages per variable is
done.

CHAPTER 4

DATA ANALYSIS

4.1 ANALYSIS OF RESPONDENTS BASED ON AGE AND

GENDER

Table 4.1 Age of respondents

Age No.of respondents Percentage
18-25 87 70.16
25-35 19 15.32

14
 35-45 13 10.48
Above 45 6 4.83
Total 124 100

100
90
80
70
60
50 No.of respondents
40 Percentage
30
20
10
0
18-25 25-35 35-45 Above 45

Figure:4.1 Age of Respondents

Interpretation:

In this study 70 percent of respondents are between the ages of 18-25. Almost
15 percent of respondents are between the ages of 25-35. Respondents are of
ages between 35 and 45 were almost 10 percent. Above 45 of ages there were
6 percent of respondents.

Table 4.2 Gender of respondents

Gender No. of respondents Percentage
Male 86 69.35
Female 38 30.65
Total 124 100

15
 100
90
80
70
60
50 No. of respondents

40 Percentage
30
20
10
0
Male Female

Figure 4.2 Gender of Respondents

Interpretation:
A total of 124 responses were recorded during the study and it was found that
69.35 percent of respondents were male and 30.65 percent of respondents
were female in this study.

4.2 ANALYSIS OF SERVICE QUALITY BASED ON

DIFFERENT FACTORS

This survey deals with your opinions of Service Quality based on different
factors like ambient condition, tangibles and social factors. These factors are
considered to be independent factors effects service quality. Data analysis is
shown below:

Table 4.3 Cleanliness and comfort (e.g. well- ventilated, with minimal noise level)
of your ward-room and toilet

16
 Cleanliness 1 2 3 4 5 6 7 Total
and
comfort
(e.g. well-
ventilated,
with
minimal (Strongly (Mostly (Somewhat (Neither (Somewhat (Mostly (Strongly
noise level) Disagree) Disagree) Agree nor Agree) Agree) Agree)
Disagree)
of your Disagree)
ward-room
and toilet
No. of 3 3 6 7 29 49 27 124
respondents
Percentage 2.41 2.41 4.82 5.12 24.1 38.5 21.17 100

140

120

100

80
No. of respondents
60 Percentage

40

20

0
1 2 3 4 5 6 7 8

Figure 4.3 Ambient conditions

Interpretation: Almost 87 percent of respondents are agreeing to the fact that

cleanliness and comfort contributes to service environment quality

Table 4.4 Adequacy of overall security prevalent in the

hospital

17
Adequac 1 2 3 4 5 6 7 Tot
y of al
overall
security
prevalenti
n
thehospit (Strong (Mostly (Somew (Neithe (Somew (Mostl (Strong
al ly Disagre hat r Agree hat y ly
Disagre e) Disagree nor Agree) Agree Agree)
e) ) )
Disagre
e)
No. of 0 3 9 13 32 46 21 124
responde
nts
Percent 2.419 10.4 37.0 10
age 0 3 55 7.25 8 25.8 9 16.9 0

140

120

100

80
No. of respondents
60
Percentage
40

20

0
1 2 3 4 5 6 7 8

Figure 4.4 Adequacy of overall security prevalent in the hospital

Interpretation: Almost 80 percent of respondents agree to the fact that

adequacy of overall security prevalent in the hospital contributes to
improvement of service environment quality of private healthcare sector.

18
 Table 4.5 Timely and proper placements of beds in wards
and rooms
Timely 1 2 3 4 5 6 7 Tot
and of al
beds in
wards and (Strong (Mostly (Somew (Neithe (Somew (Mostl (Strongl
rooms ly Disagre hat r Agree hat y y
Disagre e) Disagree nor Agree) Agree) Agree)
e) ) Disagre
e)
No. of 0 4 9 18 36 41 16 124
responde
nts
Percen 0 3.22 7.25 14.5 29 30 33.06 100
tage

140

120

100

80
No. of respondents
60 Percentage

40

20

0
1 2 3 4 5 6 7 8

Figure 4.5 Timely and proper placement of beds in rooms and wards
Interpretation: Timely and proper placements of beds in wards and rooms
contributes mostly to improving service environment quality in the healthcare
sector and 90 percent of respondents agreed the same .

Table 4.6 Infection-free environment/treatment provided by the

hospital during your stay

19
 Infection-free 1 2 3 4 5 6 7 Tot
environment/treat al
ment provided by
the hospital (Stron (Mostl (Somew (Neith (Somew (Mos (Stron
during your stay gly y hat er hat tly gly
Disagr Disagr Disagre Agree Agree) Agre Agree
ee) ee) e) nor e) )
Disagr
ee)
No. of 2 5 13 10 29 34 31 12
respondents 4
Percentage 1.6 4.03 10.48 15.33 23.38 27.03 25 10
0

140

120

100

80
No. of respondents
60 Percentage

40

20

0
1 2 3 4 5 6 7 8

Figure 4.6 Infection free environment provided by the hospital during stay

Interpretation: Almost 76 percent of respondents agreed to the fact that

infection free environment/ treatment contributes more to improving service
environment quality in the private healthcare sector.

Table 4.7 Extent to which physical facilities and infrastructure in hospital

are visually appealing

20
 Extent to 1 2 3 4 5 6 7 Tot
which al
physical
facilities
and
infrastruct
ure in
hospital are
visually

appealing (Strong (Mostl (Somewh (Neithe (Somew (Mostl (Strong

ly y at r Agree hat y ly
Disagre Disagre Disagree) nor Agree) Agree) Agree)
e) e) Disagre
e)
No. of 0 6 14 27 31 29 25 124
respondent
s
Percenta 0 4.8 11.2 21.77 25 23.33 30 100
ge

140

120

100

80
No. of respondents
60 Percentage

40

20

0
1 2 3 4 5 6 7 8

Figure 4.7 Extent to which physical facilities and infrastructure in hospital are
visually appealing

21
Interpretation: 78 percent of respondents were agreed to the fact that visual
appealing contributes to improve the service environment quality of a private
healthcare sector

4.3 HYPOTHESIS

Hypothesis 1
• Ho: There is no significant relationship between ambient conditions and
service quality of private healthcare sector.
• H1: There is significant relationship between ambient conditions and
service quality of private healthcare sector.

Table 4.8 Chi-Square Tests

Value df Asymptotic Significance (2-sided)
Pearson Chi
Square 217.653a 72 .000

Likelihood
Ratio 168.164 72 .000

Linear-by-
Linear
Association 2.070 1 .150

N of Valid
Cases 124

Interpretation:
From the above table, it is clear that after performing the chi-test to find the
relationship between ambient conditions and service quality of private
22
healthcare sector, it was found that p-value is 0.00 which is less than α=0.05,
so we can reject the null hypothesis and accept the alternate hypothesis which
means that there is significant relationship between ambient conditions and
service quality of private healthcare sector

Hypothesis 2
• Ho: There is no significant relationship between tangibles and service
quality of private healthcare sector
• H1: There is significant relationship between tangibles and service
quality of private healthcare sector

Table 4.9 Chi-Square Tests

Value df Asymptotic Significance (2-sided)
Pearson
ChiSquare 23.945a 6 .001

Likelihood
Ratio 25.165 6 .000

Linear-by-
Linear
Association 6.399 1 .011

N of Valid
Cases 29

From the above table, it is clear that after performing the chi-test to find the
relationship between tangibles and service quality of private healthcare sector,
it was found that p-value is 0.001 which is less than α=0.05, so we can reject
the null hypothesis and accept the alternate hypothesis which means that there

23
is significant relationship between tangibles and service quality of private
healthcare sector

Hypothesis 3
• Ho: There is no significant relationship between social factors and service
quality of private healthcare sector

• H1: There is significant relationship between social factors and service

quality of private healthcare sector

Table 4.10 Chi-Square Tests

Value df Asymptotic Significance (2-sided)
Pearson
ChiSquare 23.945a 6 .001

Likelihood Ratio
25.165 6 .000

Linear-by-Linear
Association 6.399 1 .011

N of Valid Cases
29

Interpretation:

From the above table, it is clear that after performing the chi-test to find the
relationship between social factors and service quality of private healthcare
sector, it was found that p-value is 0.001 which is less than α=0.05, so we can
reject the null hypothesis and accept the alternate hypothesis which means that
there is significant relationship between social factors and service quality of
private healthcare sector

24
 CHAPTER 5
FINDINGS

• If the private healthcare sector has good ambient conditions then it will
improve the service environment quality

• Availability of natural light in the private healthcare sectors does not

much contribute to improving service environment quality

• Presence of mechanisms together patients’ information does not

contribute any affect towards improving the service quality environment

• Good housekeeping facilities contributes maximum for improving the

service environment qualities in private healthcare sector in Cochin

• Availability of drugs and oxygen services at time shows the higher

service environment quality given by private healthcare sector
25
• Social factors have direct connection with service environment quality
prevailed in healthcare sector. If the healthcare sector follows the social
factors then it will increase their service environment quality according to
patients ‘perception.

CHAPTER 6

SUGGESTIONS

• More factors affecting the service environment quality like safety

measures, infrastructure, administrative procedures, corporate image
etc. were included in this study, the study could have been more
accurate.

• The sample size is way too less for this study. At least 100 samples are
required to conduct this study

• More questions should have included under each factor in order to get
more accurate information

26
 • This study only concentrated on private healthcare sector, so it could
have widened its scope if study had concentrated on public healthcare
sector too

CHAPTER 7
CONCLUSION

Patients’ perceptions about health services seem to have been largely

ignored by health care providers in developing countries. That such
observations, especially about service quality, might outline confidence and
successive behaviours with regard to choose and usage of the existing
health care facilities is replicated in the fact that many patients avoid the
system or avail it only as a measure of last resort. Those who can afford it
pursue help in other countries, while preventive care or primary detection
merely falls by the verge. Patients’ voice must begin to play a greater role in
the design of health care service delivery processes in the developing
27
 countries, especially in India. This study is, therefore, patient-centred and
identifies the service quality factors that are important to patients; it also
examines their links to patient satisfaction in the context of private
healthcare sectors in Cochin, Kerala. A field survey was conducted.
Evaluations were obtained from patients on several dimensions of perceived
service quality including ambient conditions, tangibles, social factors and
trustworthiness of the hospital. Using WarpPLS 5.0 and percentage method,
significant associations were found between the 4 dimensions and patient
satisfaction. This study also helped to identify the relationship between
independent factors and dependent factor. Here independent factors of
service environment quality were ambient conditions, tangibles and social
factors and dependent factor was trustworthiness of the hospital.

REFERANCECO

REFERENCES

Websites

1) https://en.wikipedia.org/wiki/Healthcare_industry

2) https://www.ibef.org/industry/healthcare-india.aspx

3) https://www.ibef.org › Industry ›Healthcare

4) www.indianmirror.com › Indian Industries

https://health.economictimes.indiatimes.com ›
Journals

1. Neetu Kumari, Sandeep Patyal. (2017) –International

journal of applied marketing and management 2017 -

28
 Gender in evaluation of service environment quality of
public health care services

2. Ali Mohammad Mosadeghrad. (2014) – International

journal of health policy and management 2014 Jul;
3(2): 77–89 -Factors
influencing healthcare service quality

3. Khushboo Sabharwal Gupta, Varsha Rokade. (2016) -

Journal of health management Volume: 18 issue: 1,
page(s): 84-94, March 6, 2016- Importance of Quality
in Health Care Sector: A Review

4. Faisal Talib, Mohammed Azam and Zillur Rahman.

(2015) - International Journal of Behavioural and
Healthcare Research 5(1/2):1-24 , August 2015-
Service Quality in Healthcare Establishments: A Literature
Review

5. Rashid Al-Abri* and Amina Al-Balushi. (2014) -

Oman medical journal 2014 Jan;29(1): 3–7- Patient
Satisfaction Survey as a Tool Towards
Quality Improvement

6. Shou-Hisa C, Ming-Chin Y, Tung-uang C. (2003) -

International Journal for Quality in Health Care, Vol
2003;15(4):345-355- Patient satisfaction with and
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7. Elaine Y, Gail CD, Richard R. (2002) -Journal Nurse

Care Quality, Vol: 16,NO.4, PP: 23–29 - The
Measurement of Patient Satisfaction
8. Anna Globenko, Zinaida Sianova. (2012) - Umeå
School of Business and Economics, Master
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and providers’ perspectives

29
9. Syed Saad Andaleeb. (2001) - Social Science and
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 15. S. M. Irfan, A. Ijaz. (2011) - Journal of Quality and
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APPENDIX

“A STUDY ON PATIENTS’ PERCEPTION TOWARDS SERVICE

ENVIRONMENT QUALITY OF PRIVATE HEALTHCARE SECTOR
IN TRIVANDRUM”

Patient Details:

2. Name of the patient/attendant:

3. Name of the hospital:

Demographic Details of
Respondents

31
1 Age Group ( Years) 1. 18-25
2. 25-35
3. 35-45
4. 45 and Above

2 Gender 1. Male
2. Female
3 Income Range 1.15000
( Monthly Family and
Income) below
2.15001-
25000
3. 25001-50000
5. More than50000
4 Employment/Occupa 1.
ti on Business 2. Other white
collar jobs
3. Student
4. Unemployed

Customers were asked to relate the following set of

statements to their feelings about perception of the service
encounter provided by the hospital, and indicate the extent
to which they agree or disagree with each statement.

This survey deals with your opinions of Service Quality based

on different factors like ambient condition, tangibles and
social factors. A seven-point scale can be used to measure
the Service Quality specification by services provider in the
hospital, do this by picking one of the seven numbers next to
each statement. If you are strongly agree circle the number
7, if you strongly
LIKERT SCALE

32
 Strongly Mostly Somewhat Neither Agree nor Somewhat Mostly Strongly
Disagree Disagree Disagree disagree Agree Agree Agree
1 2 3 4 5 6 7
disagree circle 1 and consequent scale for your opinion.

Ambient conditions
AC1 Cleanliness and comfort (e.g. well-ventilated, with minimal noise level) of your 1 2 3 4 5 6
ward-room and toilet 7

AC2 Adequacy of overall security prevalent in the hospital 1 2 3 4 5 6

7
AC3 Level of availability of natural light in the hospital 1 2 3 4 5 6
7
AC4 Timely and proper placements of beds in wards and rooms 1 2 3 4 5 6
7
AC5 Infection-free environment/treatment provided by the hospital during your stay 1 2 3 4 5 6
7
AC6 Extent to which physical facilities and infrastructure in hospital are visually 1 2 3 4 5 6
Appealing 7

Tangibles
Presence of mechanisms to gather patient’s needs (e.g. common cards, 1 2 3 4 5 6
satisfaction 7
TA7 surveys etc.)
TA8 Presence of signs and symbols in prominent places about patients’ well-being and 1 2 3 4 5 6
preventive 7
TA9 Good housekeeping facilities (eg: pillows, buckets, dressing materials, mugs, 1 2 3 4 5 6
drinking water etc.) 7
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 TA1 Level of availability of drugs and oxygen services at correct time 1 2 3 4 5 6
0 7
TA1 Well-equipped operation theatre 1 2 3 4 5 6
1 7
TA1 Investment in new technologies and innovative practices by the Hospital 1 2 3 4 5 6
2 7

Social factors
SF13 Fair medical treatment provided to you by the hospital 1 2 3 4 5 6 7

SF14 Ethical principles followed by the hospital in delivering medical care to patients 1 2 3 4 5 6 7
among different segments in the society
SF15 Provision of medical services with nominal cost to the needy patients 1 2 3 4 5 6 7

SF16 Adequacy of hygienic care and procedures (e.g. wearing gloves) followed by the 1 2 3 4 5 6 7
hospital personnel
SF17 Maintenance of patient privacy 1 2 3 4 5 6 7

SF18 Fulfillment of societal commitment 1 2 3 4 5 6 7

Trustworthiness of the hospital

TH19 Your level of confidence in the doctors who treated you 1 2 3 4 5 6 7

TH20 Presence of correct, accurate and reliable billing system in the hospital 1 2 3 4 5 6 7

TH21 Hospital provided services as promised and on timed. Extent to which the services, 1 2 3 4 5 6 7
functioning and administration of the hospital are credible
TH22 Maintenance of patient privacy and confidentiality by the hospital 1 2 3 4 5 6 7

34