EFFECT OF QUALITY HEALTHCARE SERVICES ON PATIENTS ...€¦ · SATISFACTION IN PUBLIC HOSPITALS IN...

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EFFECT OF QUALITY HEALTHCARE SERVICES ON PATIENTS’

SATISFACTION IN PUBLIC HOSPITALS IN KANO METROPOLIS,

NIGERIA

Ahmed Audu Maiyaki1

Maimuna Abdulkarim Halliru1

Sirajo Danhassan Yakubu1

Abstract

This study examines the level of patient satisfaction with the perceived

quality of healthcare services received at a public hospital within the Metropolitan area of Kano state. A cross-sectional survey was conducted using

215 clients attending the General out-patient clinics of Murtala Muhammad

Specialist Hospital. The results revealed that empathy was the most important determinant of patient satisfaction while tangibility was the least important

determinant. The results further showed that the adjusted R2 of 0.334 shows that

33.4% of variance in customer satisfaction can be predicted by the quality of

service delivered by the healthcare personnel. Based on these findings, a change in health professional training curriculum is recommended to focus on the

development of skills which will enable empathic patient-healthcare provider

interaction; and provision of doctors with basic management training is also recommended to enable a paradigm shift towards making healthcare service

delivery more patient-oriented.

Keywords: Service quality, Healthcare, Patient satisfaction, Public hospitals.

Introduction The enjoyment of good health is one of the fundamental rights of

every human being without the distinction of race, religion, political beliefs,

economic or social condition (Olani & Kurz, 2004). In the realization of the right to health by their citizens, governments make healthcare available,

accessible, acceptable and of good quality (Adeniji, 2014; Pakdili & Harwood,

2005). Thus, healthcare sector is considered to be the major service sector for a

country as it plays a vital role to develop and maintain a healthy human capital to achieve national goals. In many countries around the globe, the healthcare sector

has also become a highly competitive and fast growing service industry (Irfan,

Ijaz & Farooq, 2012). A hospital is a healthcare institution that provides treatment to the sick and ailing with specialized staff and equipment. In history

1 Department of Business Administration and Entrepreneurship, Bayero

University, Kano

African Journal of Management (Vol.3, No.5 2018), Business Admin. University of Maiduguri


past, hospital care was usually provided by missionaries or by volunteers

(Solayappan, Jayakrishnan &Velmani, 2011). In addition, hospital is an organization that provides a service. It is a

complex service organization as it is a true people-based service industry

(Azizan & Mohamed, 2013). Customers are the key evaluator that plays a

significant role in measuring the quality of services or product. In the healthcare sector, customers are the patients and their perceptions are considered to be the

main indicator while assessing the service quality (Cronin Jr. & Taylor, 1992).

Hence, Evans and Lindsay (1996) defined the quality of healthcare service as “all characteristics of the service related to its ability to satisfy the given needs of

its customers”. Therefore, a survey of patients’ opinions regarding the provided

service is one of the main tools to measure the quality of healthcare services. There is a general agreement that patient satisfaction is an essential outcome of

service quality (Chimed-Ochir, 2012). The services being offered in hospitals

involve a high degree of intangibility, inseparability of production and

consumption. It is a highly interactive encounter between the patient and the service provider; and is taking place at the same time (Azizan et al., 2013). In

order to receive the service, a patient has to be present in the service process and

the successful delivery of healthcare service requires a patient’s cooperation both during and after the encounter. Therefore, the hospital service quality is viewed

as a very important factor that has an effect on patient satisfaction (Dagger,

Sweeny & Johnson, 2007). Furthermore, patient satisfaction is an element of health status and a

measure of the outcome of care widely used in evaluating distinct dimensions of

patients' healthcare (Umeano-Emenuoh, Onwujekwe, Uzochukwu & Ezeoke,

2014). This could be considered in the context of contentment with services, and expectations in healthcare. Seeking the patients’ opinion while providing

treatment improves their responses to the respective treatment been provided. It

also ensures continued accessing of healthcare in the healthcare facility, return for other healthcare assessments and even paying out of their pocket for services

offered to them without grudges (Umeano-Emenuoh et al., 2014). The

importance of incorporating the perspective of the patient when evaluating and

designing healthcare programs is now widely recognized and patient-based assessments of medical care are being used to measure the quality of healthcare

(Babatunde, Aiyenigba, Awoyemi, Akande, Musa & Salauddeen et al., 2013).

Researchers of service marketing have developed nineteen service quality models during the period from 1984 to 2003. These models share a single

primary goal to offer managers insight into the components of service quality for

improving organizational offerings (Seth, Deshmukh & Vrat, 2005). The service quality model “SERVQUAL” ranks as the most popular and most widely tested

of these models (Seth et al., 2005). It is based on the assumption that service

quality is a function of differences (gaps) between customers' expectations and

perceptions along five quality dimensions: reliability, responsiveness, tangibles, assurance and empathy (Parasuraman, Zeithaml & Berry, 1985, 1991).

Effect of Quality Healthcare Services on Patients’ Satisfaction in Public Hospitals in Kano

Metropolis, Nigeria


To this end, this study will investigate the level of patient satisfaction

with the healthcare services been offered at public hospitals within Kano Metropolis by examining the five dimensions of service quality namely;

tangibility, assurance, responsiveness, reliability and empathy; and in turn,

determine which service quality domain has the greatest impact on this

satisfaction.

Literature Review

Service The American Marketing Association defines services as- ‘Activities,

benefits and satisfactions which are offered for sale or are provided in

connection with the sale of goods’ (Adedeji, 2014). The defining characteristics of a service are:

Intangibility: Services are intangible and do not have a physical existence.

Hence service cannot be touched held, tested or smelt. This is most defining

feature of a service and that which primarily differentiates it from a product.

Also it poses a unique challenge to those engaged in marketing a service as

they need to attach tangible attributes to an otherwise intangible offering.

Heterogeneity/Variability: Given the very nature of services, each service offering is unique and cannot be exactly repeated even by the same service

provider While products can be mass produced and be homogeneous the same

is not true of services. However, the same is not true of the services rendered by the same counter staff consecutively to two customers.

Perishability: Services cannot be stored, saved, returned or resold once they

have been used. Once rendered to a customer the service is completely

consumed and cannot be delivered to another customer. Inseparability/Simultaneity of production and Consumption: This refers to the

fact that services are generated and consumed within the same time frame

Moreover; it is very difficult to separate a service from a service provider (Adedeji, 2014).

Service Quality

Service quality can be defined as “conformance to customer

specification” (Berry, Lefkowith & Clark, 1988). According to Parasuraman et al (1985), service quality is the difference between customer perceptions and

expectations. According to Zeithmal, Parasuraman & Berry (1990), however,

service quality is based upon the perception of the customer regarding services delivered by the service provider and how these services meets or exceed their

expectations and it is purely based on customer judgment.

In today’s world of intense competition, the key to sustainable competitive advantage lies in delivering high quality services that will in turn

result in satisfied customers, therefore, there is not even an iota of doubt

concerning the importance of service quality as the ultimate goal of service

providers throughout the world (Allahham, 2013). Some researchers often use the terms “customer satisfaction” and

“service quality” interchangeably; however, a number of clear distinctions exist.



First of all, satisfaction is a post-transaction customer experience while service

quality is not; secondly, expectations are reflective of anticipated performance in satisfaction while in the concept of service quality, expectations are

conceptualised as a benchmark for future wants and therefore, as identified by

Churchill and Seprenant in 1982, perceived service quality is a direct predictor of

customer satisfaction (Angelova & Zekiri, 2011; Beneke, Hayworth, Hobson & Mia, 2014).

Service Quality in the Healthcare Sector

Healthcare services are those services produced by medical and related health professions for the prevention, treatment and management of illness and

the preservation of mental, social and physical wellbeing. They help to maintain

good health among individuals and in the community as a whole thereby decreasing the morbidity and mortality especially when these services are

utilized. Services are intangible in nature and thus it is difficult to assess and

measure as compare to physical products as it is an elusive and abstract concept

and same goes for the service quality (Irfan et al., 2012). Patient satisfaction and service quality are becoming a critical objective

in healthcare delivery systems. Patients demand more information than ever and

do not hesitate to switch to another healthcare provider if they are not satisfied. As a result, the provision of quality service and improvement of patient’s

satisfaction are key strategies and are crucial to the long-run success and

profitability of healthcare providers (Oyatoye, Amole & Adebiyi, 2016). In general, service quality, to which the health sector is no exception, is divided into

two main components; namely they are: technical and functional quality

(Grönroos, 1984). Technical quality (quality of clinical services) is defined as the

technical diagnosis and procedures while functional quality refers to the manner of delivering the services to the patients (Dursun & Cerci, 2004). Because most

patients lack medical expertise for evaluating the technical attributes, the service

marketing approach which focuses on functional quality as perceived by patients has been widely used to evaluate the health services.

A comprehensive literature review about the service quality was done by

Seth, Deshmukh and Vrat (2005); and their findings pointed out twenty (20)

service quality models to measure the service quality of which; Grönroos: technical and functional quality model, Cronin Jr. et al: performance only model

(SERVPERF) and Parasuraman et al: Gap Model; are frequently found in the

literature respectively. However, among all these service quality models, the SERVQUAL model was the only model that is frequently used in almost all type

of service industries; like banks and credit cards companies (Jabnoun & Al-

Tamimi, 2003), hospitality industry (Saleh & Ryan, 1991), airline industry (Frost & Kumar, 2001), libraries (Nitecki 1996) and healthcare sector (Pakdili et al,

2005, Irfan et al, 2012, Dagger et al, 2005). It has been observed from the

literature that SERVQUAL is also considered as the most adoptable model for

measuring the service quality of healthcare services (Pakdili et al, 2005). In the earlier versions of the SERVQUAL model, service quality was

measured by comparing customer expectations with customer perceptions on the


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basis of ten dimensions which includes; reliability, tangibility, communication,

security, credibility, competence, understanding, access, understanding/knowing customers, responsiveness (Dagger et al., 2007). After Parasuraman et al

proposed SERVQUAL, James Carman adapted the original SERVQUAL

instrument for use in the hospital industry and the original 22 questions were

extended to 34 questions (Seth et al., 2005). The determinants of service quality were broken down into two main categories, namely tangible factors, which refer

to technology, physical facilities, personnel, and communication material etc.,

and intangible factors, which consist of five sub-factors, namely Reliability, Responsiveness, Assurance, Courtesy, and Empathy (Solayappan et al., 2011).

Reliability refers to the ability to perform the promised service

dependably, consistently and accurately. Responsiveness is the degree of the service provider’s willingness to help customers and provide prompt service.

Assurance is about knowledge, skills and expertise of the employees involved in

delivering services and the ability to create trust and confidence among the

customers. Courtesy refers to the kind behaviour of employees to the customer. Empathy refers to caring, individualized attention the firm provides its customer.

Tangibles refer to the physical facilities like infrastructure, labs, equipment and

human resources involved in delivering the services (Irfan et al., 2012; Seth et al., 2005).

Empirical Review of Client Satisfaction in the Health Sector

Ross and Venkatesh (2015) randomly sampled over 200 patients, staff and administrators from the corporate hospitals in Tamil Nadu, India in an

empirical study on the factors influencing the quality of healthcare and its effects

on patient satisfaction. Their questionnaire specifically addressed the patient’s

perception towards quality in services, factors influencing patient satisfaction, role of hospital administrators in providing quality services. They concluded

from their findings that from the patients’ perspective, tangibles namely the

physical facilities available were the most important factor impacting on healthcare quality, followed by responsiveness and empathy of the staff.

Irfan et al (2012) in an attempt to investigate the quality of services

delivered to patients by public hospitals in Pakistan used a questionnaire which

was developed based on a modified SERVQUAL model using five service quality dimensions, namely; empathy, tangibles, timeliness, responsiveness and

assurance. A total of 369 responses were collected from the patients availing

services from the public hospitals located in Lahore, Pakistan. Results of their study indicated that public hospitals were not making visible efforts to deliver

quality services to their patients and were not making any visible efforts to meet

the patient’s needs and wants. In a study covering three district hospitals in Ulaanbaatar, Mongolia,

Chimed-Ochir (2012) using a SERVQUAL-based questionnaire, collected data

from 157 patients which showed that patients who had been admitted in hospital

for the first time had lower perceptions on, and were less satisfied with the overall healthcare services. Patients who had been admitted more than 12 times

had better perceptions regarding overall healthcare services and were more



satisfied with service. Furthermore, patient satisfaction significantly depended on

empathetic services such as nursing care, respectfulness of nurses, helpfulness of nurses and attentiveness of doctors to patients. The level of comfort in the

patients’ room also had a great influence on patient satisfaction. It was thus

evident from their findings that, the empathy dimension, which significantly

influences patient satisfaction, shows a large quality gap; employee satisfaction in concert with patient satisfaction might be crucial because satisfied employees

provide more empathetic services.

Based on the application of a modified SERVQUAL instrument, Choi (2005) found a significant relationship between service quality dimensions and

patient satisfaction in the South Korea healthcare system. In particular, ‘staff

concern’ followed by ‘convenience of the care processes’ and ‘physician concern’ dimensions were the most determinants of patients’ satisfaction. In

Bahrain, Ramez (2012) conducted a study on 235 patients of hospitals and

medical centres using a modification of the SERVQUAL model- SERVPERF.

The study results showed that, the responsiveness, empathy and tangible dimensions had the largest influence on the overall service quality. Positive and

significant relationships were found between overall service quality, patients'

satisfaction, and their behaviour intention42

. In attempting to examine the service quality and determinants of

customer satisfaction in Turkish hospitals, Zaim, Bayyurt and Zaim (2015)

showed that, while tangibility, reliability, courtesy and empathy were significant for customer satisfaction, responsiveness and assurance were not. In an attempt

to examine the impact of service quality perception on patient satisfaction and

determine which of the 5 dimensions (tangible, reliability, responsive, assurance,

and empathy) has the greatest impact on patient satisfaction in the public hospitals situated in Southern Saudi Arabia, Alghamdi (2014) showed that,

patient satisfaction was influenced by health service quality, with the empathy

dimension having the greatest influence on patient satisfaction. He thus concluded that it should be considered a priority by government hospitals to train

doctors in interpersonal relationship skills to enhance the doctor-patient

relationship.

Nyongesa, Onyango and Kakai (2014) in Nairobi, Kenya carried out a research in Pumwani Maternity Hospital in Nairobi. Client’s perception on the

quality of maternity services offered to them was determined using structured

Likert scale questionnaires to assess respondents’ satisfaction with the services provided. While most of the patients sampled felt the health staffs were

generally friendly during their service encounter and that they had a positive

attitude, there was a lack of empathy especially from the labour ward nurses. Furthermore, their findings showed that long waiting time was a major

determinant of patient dissatisfaction.

Using the 22-item SERVQUAL instrument developed by Parasuraman et

al (1985), Nyandoro (2012) conducted a field survey at a private hospital in Pretoria to understand service quality in private hospitals through patients’

perception of how well a service met or exceeded their expectations. The results


Metropolis, Nigeria


of the study revealed that there was a statistically significant relationship

between each of the five service quality dimensions and satisfaction, with assurance displaying the highest predictive power.

Using a multistage sampling technique, a modified SERVQUAL

questionnaire was used to interview 400 respondents in a study on client

perception of service quality at an out-patient clinic in a Lagos state general hospital (Ogunnowo et al, 2015). After linear regression, the authors reported

that the assurance domain was the most important predictor of the overall

perceived service quality (p< 0.001). In trying to assess clients’ perception of quality of primary health services and its predictors in Rivers state, Ogaji,

Ekechuku, Agbayi, Dekpen and Mezie-Okoye (2016) used an Outpatient

Assessment of Healthcare questionnaire, to obtain feedback from 423 adult patients visiting three randomly selected primary health centres representing the

three senatorial districts in Rivers State. They found that although majority of the

respondents were satisfied with the overall care they received at the health

centres, quite a number of them were dissatisfied with the quality of information they received regarding their prescriptions.

Adebayo, Adesina, Ahaji and Hussein (2014) using an un-weighted

SERVQUAL tool, tried to determine the difference between expectations and perceptions of patients. Overall, among the 5 dimensions of quality, there were

marked statistically significant quality gaps in assurance and tangibles. Their

study showed that there was a need for greater attention to be paid to assurance, tangibles and reliability dimensions of service quality to improve patient

perceptions.

Iloh et al (2012) in their study to evaluate patents’ satisfaction with the

quality of care provided at the NHIS clinic in a tertiary hospital in Rivers state of South-Eastern Nigeria, found that overall patients satisfaction with the services

provided was very good with patient-provider relationship been rated highest and

patient waiting time the lowest respectively. Hospital bureaucracy and long waiting times were the major determinants of patient dissatisfaction. Their study

showed that there was a need to improve on the current level of patients’

satisfaction while efforts should be made to address the identified domains of

dissatisfaction. In Kano, Iliyasu et al (2010) conducted a study on patients’ satisfaction

with the services obtained from Aminu Kano Teaching Hospital. Their study

findings showed that, majority of the patients were satisfied with patient provider relationship, in-patient services, hospital facilities and access to care. Waiting

time and cost of treatment were the major dissatisfiers. Patients and their

relatives complained about delayed appointments, missing folders, missing laboratory results and long appointments for ultrasound and other radiological

investigations. They thus concluded that, health workers need to consider

patients as customers by being friendly and reducing waiting time for

consultation and investigations. In Ogun state of South-Western Nigeria; Oyatoye, Amole and Adebiyi

(2016) studied patients’ perception of quality service delivery of public hospitals



in Nigeria using the Analytical Hierarchy Process (AHP). Their results showed

that the most important factor to patients was the reliability dimension followed by the responsiveness dimension, assurance dimension, and the least determinant

factor was the empathy dimension respectively. Based on their results, they

called for policy formulation and implementation in the healthcare sector for

workers’ capacity building towards better service delivery. Using the Analytical Hierarchical Process, Amole, Oyatoye and Kuye

(2015) investigated the determinants of patients’ satisfaction towards service

delivery in six public teaching hospitals located in southwest Nigeria. The study adopted a cross-sectional survey research design adopted with the aid of an AHP

based questionnaire to obtain primary data from 326 respondents. Results of the

study using the AHP model revealed that the empathy dimension of service quality had the greatest impact of 16.46% on determinant of patients’ satisfaction

towards hospitals services, followed by the tangibility dimension of 16.19%,

followed by responsiveness dimension with 15.62% and waiting time dimension

had the least impact of 6.9% on determinant of patients satisfaction towards teaching hospital services in southwest Nigeria. Their results thus presented

managers of government hospitals with feedback on service quality dimensions

that could be improved upon to enhance competitiveness, thus improving the entire service delivery in the Nigerian health sector. This being the findings in

the Northwest Nigeria, it could be different from Northern Nigeria given the

contextual difference, hence this research.

Research Method

Research Method and Hypotheses

Based on the preceding literature, customer satisfaction with the quality of services offered is crucial to the success of any organization and the same has

been shown to be true for hospitals. The dimensions of service that have been

theorised to determine satisfaction based on the SERVQUAL model (Parasuraman et al; 1985,1991) are: Responsiveness, Assurance, Reliability,

Tangibles and Empathy.

From the above theoretical framework, it can thus be hypothesised that:

H1: there is a positive relationship between the service quality dimensions ‘tangibles’ and patient satisfaction.


Metropolis, Nigeria


H2: there is a positive relationship between the service quality dimension

‘assurance’ and patient satisfaction. H3: there is a positive relationship between the service quality dimension

‘reliability’ and patient satisfaction.

H4: there is a positive relationship between the service quality dimension

‘responsiveness’ and patient satisfaction. H5: there is a positive relationship between the service quality dimension

‘empathy’ and patient satisfaction.

H6: Patients are satisfied with the quality of healthcare services received at public hospitals’ in Kano Metropolis.

Sample and Data

The study population was made up of clients attending the male and female outpatient clinics in Murtala Muhammad Specialist Hospital, Kano state.

In 2015, 578,160 patients were attended to at the outpatient clinics of Murtala

Muhammad Specialist Hospital (Kano State Hospitals’ Management Board,

2016) which gives an estimated 48,180 patients seen per month in that year. The sample size was determined based on this estimated study population.

Sample size was calculated using the formula for finite populations as developed

by Krejcie and Morgan (1970): s = X

2 NP(1 − P) ÷ d

2 (N −1) + X

2 P(1 − P).

Where;

s = required sample size. X

2 = the table value of chi-square for 1 degree of freedom at the desired

confidence level = 3.841.

N = the population size.

P = the population proportion; [client satisfied with service = 83%=0.83(Iliyasu et al., 2010)].

d = the degree of accuracy expressed as a proportion (0.05).

Therefore; s = X

2 NP(1-P) ÷ d

2 (N-1) + X

2 P(1-P).

S= 3.841 x 48,180 x (1-0.83) ÷ (0.05)2 x (48,180-1) + 3.841 x 0.83 (1-0.83)

N= 215.

A multi-stage sampling method was used for the study. In stage one, the out-patient department was purposively chosen as it is patronised by both routine

out-patients and former in-patients who are on follow-up following discharge

from the wards where they had been admitted for a period of time. In stage two, a convenience sampling method was used as there was no patient list available.

To eliminate sampling bias, every second respondent was sampled (n=2).

A modified SERVQUAL questionnaire was used for the study which had been validated for use in the health sector (Cronin et al., 1992; Nyandoro, 2012). The

questionnaire was divided into three sections; section A documented the socio-

demographic characteristics of the respondents. Section B documented the

patient’s perception of the quality of service received based on the SERVQUAL tool while section C documented the overall satisfaction score of the

respondents.



The SERVQUAL framework utilises five criteria in assessing service quality

specifically tangibles, reliability, responsiveness, assurance and empathy (Allahham, 2013; Ogunnowo et al., 2015). Tangibles refer to the general

environment, physical facilities, equipment and appearance of personnel.

Reliability refers to the service provider’s ability to perform promised service

dependably and accurately. Responsiveness is the willingness to help consumers and provide prompt service as and at when needed. Assurance is the knowledge

and courtesy of service providers and their ability to inspire trust and confidence.

Empathy refers to the caring, individualised attention that is provided to consumers (Allahham, 2013).

The modified SERVQUAL questionnaire for assessing client satisfaction

in the healthcare sector is made up of a set of 21 questions. The questionnaire used in this study was adapted from the study conducted by Nyandoro (2012) in

Pretoria, South Africa who had validated the research instrument. Patient

perceptions of the quality of healthcare services based on the service quality

dimensions were determined five-point Likert scale questions which allowed respondents to rank their responses in terms of the following statements: 1-

strongly agree, 2-agree, 3-neutral, 4-disagree, and, 5-strongly disagree.

Overall patient satisfaction with the quality of care received based on the gap between expected and perceived quality was assessed using a 5-point Likert

scale question. This set of questions allowed respondents to rank their level of

satisfaction in terms of the following statements: 1-very dissatisfied, 2-dissatisfied, 3-neutral, 4-satisfied and, 5-very satisfied respectively.


Metropolis, Nigeria


Statistical analysis was done using the Statistical Package for Social

Science (SPSS Inc, Chicago, Illinois) software version 19.0 for Windows. Assessed variables were displayed using appropriate tables and figures. The

mean of the various domains of service quality was calculated. Multiple

regression analysis was used to assess the strength of the association between the

service quality domains and patient satisfaction.

Results

Reliability of the Research Instrument To measure the reliability of the SERVQUAL instrument used in this

study, Cronbach alpha was calculated which measures the reliability of the data.

The analysis showed that the reliability for the subscales ranged from 0.672-0.753; while the summed SERVQUAL scale used in this study showed a 0.872

coefficient. Hence, the internal consistencies of the survey’s scale are deemed

acceptable. These findings are depicted on table 1.

Socio-Demographic Profile of the Respondents Over a third (33%) of the respondents ages were between 31-40 years

while only 2.3% were less than 20 years of age. The mean age was 38 years with

a standard deviation of 13.5years. Majority of the respondents were females (72.6%) were females while almost two-thirds were Muslims (66%). Over half

of the respondents were married (52.1%) and majority of them belonged to the

Hausa/Fulani ethnic group (75.8%). Almost half of the respondents (47.4%) had secondary education as the highest educational qualification while nearly half of

the respondents (48.8%) were unemployed. These findings are depicted on table

2.

Table 2: Sociodemographic characteristics of the respondents in the study

Correlation among Service Quality Domains Measurement of the correlation among the service quality domains was

carried out using the Pearson correlation. A strong relationship was established

between all the five (5) domains with the strongest relationship; 57.0%, been

established between the ‘empathy’ domain and the ‘tangibles’ domain respectively. These findings are depicted in table 3. Table 3: Correlation relationship as between the service quality domains

Assurance Reliability Responsiveness Empathy Tangibles

Assurance 1

Reliability 0.426* 1

Responsiveness 0.482* 0.452* 1

Empathy 0.480* 0.524** 0.562** 1



Tangibles 0.558** 0.533** 0.312* 0.570** 1

**Correlation is significant at the 0.01 level (2-tailed); *Correlation is significant at the

0.05 level (2-tailed).


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Regression Analysis

To test the study hypothesis, multiple linear regression analysis was carried out. The multivariate statistical technique was performed to assess the

impact of the service quality dimensions on the likelihood that the respondents

would report that they were satisfied with the healthcare services rendered at the

public hospital. Table 9 below shows the results of the regression analysis on the hypotheses of the present study.

Analysis of variance showed that the overall result was deemed

statistically significant (p= 0.000). The ‘empathy’ domain with a β-weight of 0.669 was the most important predictor of perceived overall service quality in the

hospital and thus, customer satisfaction. This was followed by the assurance

domain with a β-weight of 0.616. The tangibles domain with a β-weight of 0.125 had the least impact on perceived quality of care. These findings are as shown in

the table below. Table 4: Regression Analysis

Service Quality

Domain

Unstandardised

Coefficients

Standardised

Coefficients

t Sig.

B Std.

Error

Beta (β)

(Constant) 7.054 0.808 8.733 0

Assurance 0.286 0.095 0.616 3.02 0.033**

Reliability 0.619 0.104 0.455 6.413 0.003**

Responsiveness 0.729 0.082 0.323 7.553 0.004**

Empathy 0.279 0.085 0.669 2.137 0.001**

Tangibles 0.378 0.141 0.251 1.985 0.042**

R R2 Adjusted

R2

F Sig

0.591 .349 .334 45.254 .000

** P-value <0.05 considered significant

Patient Satisfaction with Service Quality Only 13% of the respondents said that they were very satisfied with the

overall service quality while 29.3% said they were satisfied. About a third of the



respondents (30.7%) were dissatisfied based on the perceived quality of services

that they had received while 16.3% were very dissatisfied. Some respondents (10.7%) remained neutral with regards to their level of satisfaction with services

received (see figure 1). Thus overall, 42.3% were satisfied while 57.7% were

dissatisfied/neutral with regards to the perceived quality of healthcare services

they had received at the hospital.

Discussions of Major Findings

In this study, the service quality domain shown to have the most impact

on perceived service quality was the empathy domain followed by the responsiveness domain, assurance domain, reliability domain and least, the

tangibility domain. These findings are in similar to those reported by Amole et al

(2015) in Nigeria and Alghamdi (2014) in Saudi Arabia. However, the reports from studies by Nyandoro (2014) in South Africa and Zaim et al (2010) in

Turkey showed that the assurance domain had the greatest influence on patient

satisfaction. On the other hand, Ramez (2012) in Bahrain showed that while the responsiveness domain had the greatest influence on patient satisfaction, this was

followed very closely by the empathy domain.

Nigeria is a developing country where most patients’ still do not place

emphasis on the qualifications of the care-giver or the sophistication of the equipment used in their management. More emphasis is placed on the quality of

the interaction and care received. As a result, most people in such developing

countries often resort to alternative medicine after encountering bottlenecks in seeking orthodox medical care because in the latter arena, the providers are more


Metropolis, Nigeria


patient and empathic in their approach. On the other hand, in developed

countries, patients are enlightened and therefore, pay more attention to caregiver qualifications and tangibles.

Other studies such as Iloh et al (2012), Iliyasu et al (2010), Umeano-

Emenuoh et al (2014), Amole et al (2015) and Oyatoye et al (2016) have

assessed service quality; however, various tools and methodologies were utilised different from the SERVQUAL tool. This would make comparison of their

findings with those of this study inappropriate. Interestingly, the ability of the

service provider to perform the service accurately and dependably (reliability), as well as the material depictions of a service (tangibles), had the lowest influence

on patient satisfaction in this study. This is in agreement with some studies also

carried out in public hospitals (Alghamdi, 2104; Amole et al., 2015). While the effects of the reliability and tangibles domains were comparatively lower than

the empathy and assurance domains, this does not imply that they are not

important and should be overlooked in improving service quality in public

hospitals. The results of this study only further emphasize the greater gains in patient satisfaction that can be realised by attending to the empathy and

responsiveness domains in public hospitals.

A strong relationship was established between all the five (5) domains with the strongest relationship; 56.0%, been established between the ‘empathy’

domain and the ‘tangibles’ domain respectively. These findings show that these

domains are inter-connected with each playing a role on patient satisfaction which is dependent on the other domains. Especially, the results showed that,

with the development of tangibles, an enabling working environment is created

which will promote employee motivation and in turn make them more empathic

towards their clients- in this case, patients. These findings are supported by those of Ogunnowo et al., 2015 in Lagos and Irfan et al., 2012 in Pakistan.

Conclusion This study aimed to assess the impact of perceived quality of care

received in a hospital on patient satisfaction using the modified SERVQUAL

tool. All the service quality dimensions have significant influences on the overall

patient satisfaction; with the ‘empathy’ dimension having the strongest influence on overall patient satisfaction; followed by assurance, then reliability,

responsiveness and tangibles in that order.

Recommendations

Based on the above conclusion, the following recommendations are

hereby offered: i. The empathy dimensions which was found to have the greatest impact on

the overall patients satisfaction should be reinforced by policy makers and

educators through training the health workers on listening and

communicational skills ii. Modern executive management development programmes should be

introduced in medical schools for the “health managers”.



iii. Periodic patients satisfaction survey should be institutionalised to provide

feedback for continuous quality improvement.

Suggested Areas of Future Research

Further research in this environment should be encouraged and extended

to involve the private health sector.

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