This document starts with a brief background of the quality of healthcare services rendered by public and private hospitals from patient’s perspective, followed by reviews of literature on the following related subjects: the importance and benefits of measuring healthcare services’ quality for healthcare delivery system; development and evolvement of SERVQUAL Model which is a historical tool used to measure the service quality internationally; and understanding the patients’ perspective on healthcare service quality of public and private hospitals from published literature. The last part of this document summaries the implications of literature for healthcare services quality and how it can support the results of this study and identifies the gaps in understanding the importance of patient’s perspective regarding the quality of healthcare services in Eastern Province – SA.2.1.
Background Measuring quality objectively is generally difficult and includes multiple affecting factors to be considered. According to the marketers1 in 1983, measuring quality of products was possible and tangible through several means such as establishing quality standards and product specifications in contrary to measuring the quality of services which was undefined and ambiguous due to its intangibility and subjectivity. Some researchers1 in 1985 tried to identify a framework or model to measure the service quality from customer perspective in the most reasonable manner and they called it SERVQUAL Model, this model will be discussed in details in the next subject as it will be used to be the data collection method for this study. On the other hand, quality concept varies in accordance to distinctions among private and public sectors. Major distinctions identified via literature were ownership as public organizations mainly controlled by governmental and political forces while private sector usually managed by stakeholders and entrepreneurs; funding where the public sector depends on the governmental support in the time where the private sector uses the customer’s fees as main profits; and control and power, in which regulations and laws enactment might be wide and diverse for public agencies as they have unlimited number of leadership2 in comparison with private organizations. Therefore, this study needs to take into account all previously mentioned points during building this paper as they may have direct effects on the findings. 2.
2. The Importance and Benefits of Measuring Healthcare Services’ Quality Providing quality healthcare services became a crucial element in the Saudi Vision 2030 that paved the way to introduce the project of healthcare privatization throughout the kingdom3. Understanding the level of quality of healthcare services can contribute directly and indirectly in increasing profitability4, gaining competitive advantage, meeting community needs, and enhancing reputation5. One of this study aims is to clarify the public opinion regarding healthcare delivery system in Saudi Arabia and justify the reasons behind governmental intentions for privatization of Ministry of Health from customer perspective.2.3. Development and Evolvement of SERVQUAL Model SERVQUAL Model is first developed in 1983 by some researchers for marketing purposes to measure the quality of services from costumer’s perspective1.
The model constructed mainly on five dimensions the developers considered them to be comprehensive and encompass the basic merits for customer satisfaction6. Those dimensions were Reliability, Assurance, Tangibility, Empathy, and Responsiveness7. Several studies raised and argued the various aspects of this model, one researcher mentioned that those five dimensions can be merged into two categories: core services and augmented services8. Another study discussed whether SERVQUAL Model was sufficient to measure the quality of services due to its dependence on customer’s expectations and perceptions instead of using performance measures which had more objectivity9. The functionality of the model is through measuring customer’s expectations and perceptions regarding service and identify the level of quality based on the gap of scores resulted from subtracting perceptions from expectations10, negative scores mean that the quality is high and vice versa10. However, many researchers over the time used this model in different industries11 to develop their data collection tool (mostly questionnaires) with some modifications to make the model fit for their current situation and measured the reliability of this model to accurately reflect the quality level of services. 2.4.
Understanding the Patient’s Perspective on Healthcare Services’ Quality of Public and Private Hospitals Several studies conducted in healthcare industry to measure and compare service quality among private and public sectors through using SERVQUAL model. In 2001, one researcher presented the level of quality of health services in Bangladesh and he found that all SERVQUAL dimensions measured – that were satisfaction, responsiveness, assurance, communication, discipline, and baksheesh – were statistically significant with service quality rendered and discipline had the greatest impact among them on quality12. In 2003, researchers conducted a study in UAE to compare service quality between public and private hospitals and they reached that public sector had better results for SERVQUAL dimensions used – which were empathy, tangibles, reliability, administrative responsiveness, and supporting skills – than private sector13. In Turkey, two studies were completed in 2006 and 2010, respectively, in two different areas to measure and compare service quality among public and private hospitals and all of them found that private services had higher level of quality regarding SERVQUAL dimensions measured than public services14,15.
In 2009, two researchers from Malaysia performed a study to test SERVQUAL Model on Malaysian private hospitals and they reached that a modified model can be appropriate to measure the level of service quality, while the private hospitals had moderate negative scores on SERVQUAL dimensions used16. In Yemen, some researchers used SERVQUAL Model to measure the level of patient loyalty for private hospitals and they found that loyalty level was high with reliability, assurance, empathy, and cost dimensions while there were no significance differences among loyalty and tangibility and responsiveness. In 2011, researchers from Pakistan discussed the level of service quality among private and public hospitals in one area of Pakistan and they reached to private care had lower gaps in SERVQUAL dimensions – which were empathy, tangibles, assurance, timeliness, and responsiveness – than public care in general17.
The most recent research published on SERVQUAL model and measuring services’ quality were in 2013 by Saudi researchers who identified that healthcare services provided by private hospitals had slightly higher level of quality than public hospitals, but they mentioned that one of the study limitations was resources and sample size to generalize the results on whole Saudi Arabia. For that, this study will focus on hospitals of Eastern Province – SA only18. 2.5. Summary and implicationsThe results of the previously discussed studies differed according to the healthcare environment and modifications applied on SERVQUAL Model used, but, most of them agreed generally upon that private hospitals had better results in SERVQUAL dimensions than public ones depending on different reasons. Due to the limited number of researches conducted in Saudi Arabia regarding service quality, this study aims to identify the level of service quality provided by public and private hospitals in Eastern Province – SA, by calculating the differences among patient expectations and perceptions that detected using the original SERVQUAL Dimensional Model – dimensions include Tangibles, Reliability, Responsiveness, Assurance, and Empathy – and comparing the results of both hospital types.
The findings may support or interfere the governmental decision towards healthcare privatization project.