Assessment of the Quality of Healthcare Services Using SERVQUAL Approach: A Letter

Dear Editor, Quality of service is recognized as a key determinant of an organization's success and any decline in customer satisfaction due to poor service quality causes concern. Among the service sub-sectors, the health sector has a special place because any mistake, even the smallest one, is not allowed in this section (1). Protecting the community is the task of this sector and effective action is particularly important to improve customer service and customer satisfaction in this sector (2). Evidence shows that there is a relationship between the quality of medical services and patient satisfaction. According to Parasuraman et al. study, service quality is a comparison between expectation and performance, and service providers must compare expected and perceived services to understand the quality and identify of the gaps between expected and perceived data on service quality (3). One of the most commonly used comprehensive methods to assess the quality of expected and perceived services is the SERVQUAL model (4). Given that one of the most important groups in assessing the quality of health care services is clients, this study aimed to assess the quality of healthcare services using SERVQUAL Approach in Ahwaz Health centers. This cross-sectional study was conducted in Ahwaz in 2016. The study population consisted of the people under the coverage of the Health centers in the west of Ahwaz City who were selected via quota sampling method. Using the Cochran formula, the sample size was determined to be 384 persons. The data were collected using the SERVQUAL questionnaire developed by Parasuraman et al. This questionnaire has 22 questions and 5 dimensions: physical and tangible dimension (4 questions), reliability (5 questions), responsiveness of service providers (4 questions), service assurance (4 questions), and staff empathy (5 questions). The questionnaire was used in two stages. The score of total quality varied from 1 to 7. The validity and reliability of this questionnaire were confirmed by Zarei et al. (5, 6). The data analysis was conducted using the SPSS 16 software, paired t-test, t-test, and ANOVA. The significance level was considered lower than 0.05. The highest percentage of the subjects were in the age group of 18 - 29 years. Moreover, 328 (85.4%) were female and 56 (14.6%) were male. Based on the findings of the study, there were differences between the mean score of perception and expectation in all dimensions of quality: tangibility (-0.6), reliability (-0.53), responsiveness (-0.73), assurance (-0.66), empathy (-1.04), overall quality (-0.68) (P < 0.0001). No significant difference was found between perceptions and gender (P = 0.30) and expectations and gender (P = 0.30). According to the one-way analysis of variance (ANOVA), no significant difference was found between perceptions and variables of age (P = 0.272) and education level (P = 0.354) and between expectations and variables of age (P = 0.171) and education level (P = 0.457). The study results indicated that there were general quality differences in all five service dimensions, and the differences were negative. This result was consistent with similar studies (7, 8). The highest quality difference in the present study was observed in the empathy dimension. In one meta-analysis in which Teshnizi et al. (9) aimed to assess the quality of health services in Iran, tangibility and empathy had the largest gaps. Since dissatisfied patients are less likely than other patients to comply with medical instructions and the process of recovery is slower than others, medical centers need to continually evaluate the quality of their services. Furthermore, given that the highest difference in service quality was observed in the empathy dimension, it seems essential to hold workshops in order to polish employees’ communicative skills.