CHAPTER I

INTRODUCTION, LITERATURE REVIEW & RESEARCH

METHODOLOGY
1.1. Introduction
The prerequisite of health care varies across countries and the scope and nature of
such provisioning is governed by the socio-economic and political norms in a given
society. Even though the nature of government intervention in health care varies from
mere regulator to service provider from country to country broad classification can be
done on basis of government intervention into 3 types namely regulatory, supportive and
limited role. In case of regulatory framework which exists in many countries the role of
government is merely framing policies and regulations governing the sector whereas in
case of supportive role government involves itself up to a certain extent only and in both
cases private interest are allowed. In some countries which follow the third model the
state owns the entire liability of providing healthcare to its subject and no private interest
are allowed.
Though the role of state as welfare and socialist nation is a popular notion, but
also given the fact that the financial exchequer put constraints on the ability of state to
cater to the health care demands of its subject through its own resources, makes the role
of private sector imperative especially in developing countries like India. Over the last
decade privatization has gained a central place in determining directions in health policy
world over. This is a result of the restructuring of the welfare state whereby the role of
the state has been minimized and there is a greater reliance on the market for service
provision. The ‗World Bank‘ and the ‗International Monetary Fund‘ (IMF) have been
pushing this agenda as a part of the structural adjustment program in several developing
countries. However, the nature and direction of privatization varies across countries,
depending on the type of public-private mix that exists.
The Indian service sector accounts for a large part of the Indian economy in terms
of employment potential or its contribution to the national income. The Indian economy
has been one of the world‘s star growth performers in recent decades. ―Growth has been

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supported by market reforms, huge inflows of FDI, rising foreign exchange reserves, both
an IT and real estate boom, and a flourishing capital market‖1 (Singh & Cortuk, 2010).
Economic development has historically been associated with structural changes in the
national economies. The most common structural change that had been observed
historically, followed a sequence of shift from agriculture to industry and then to
services. Thus, a predominant share of agriculture characterizes an underdeveloped
economy. ―With development the share of industry increases and that of agriculture
declines, and subsequently after reaching high level of development, the service sector
increases in importance, becoming a major component of the economy. This pattern has
not only been observed historically, but also holds across the countries with different
levels of development‖2 (Gangabai, 2011). Service sector is growing at very fast pace
since last two decades, especially in 1991 – a decade of major trade and industrial
reforms in India. During 1981-90, service sector output grew at a rate of 6.6 percent per
annum. During 1991-2000, the growth of services, industry and agriculture sector was 7.5
percent, 5.8 percent and 3.1 percent per annum respectively3 (Banga and Goldar, 2007).
Healthcare is one of India‘s largest service sectors, in terms of revenue and employment,
and one can well witness the sector to expand rapidly. With the fast growing purchasing
power, Indian patients are willing to pay more to avail health care services of
international standard. In the era of globalization and heightened competition, it has been
observed that delivery of quality service is imperative for Indian healthcare providers to
satisfy their indoor as well as outdoor patients
1.2 Scenario of the Indian Healthcare Industry
In the Indian context, privatization of medical care is a complex phenomenon
because the private sector has not grown independently of the public sector. Since
independence, the Indian state has invested in infrastructure, training of medical and
paramedical personnel and medical research. This has provided the base for the growth of
the private sector and is therefore interrelated to the public sector at several levels. The
share of services in India‘s gross domestic product (GDP) at factor cost (at current prices)
has expanded from 33.3 per cent in 1950-51 to 56.5 per cent in 2012-13 as per Advance
Estimates (AE). Following are the important highlights of healthcare industry in India

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 1. India‘s healthcare industry is currently worth Rs 73,000 crore which is roughly 4
percent of the GDP. The industry is expected to grow at the rate of 13 percent for
the next six years which amounts to an addition of Rs 9,000 crores each
year. During 2008-20, the market is expected to record a CAGR of 16.5 per cent.
The total industry size is expected to touch US$ 160 billion by 2017 and US$ 280
billion by 2020.
2. The population to bed ratio in India is 1 bed per 1000, in relation to the WHO
norm of 1 bed per 300.
3. In India, there exists space for 75000 to 100000 hospital beds.
4. Private insurance will drive the healthcare revenues. Considering the rising
middle and higher middle income group we get a conservative estimate of 200
million insurable live.
5. Healthcare industry is growing at a tremendous pace owing to its strengthening
coverage, services and increasing expenditure by public as well private players.
6. As per the Ministry of Health, development of 50 technologies has been targeted
in the FY16, for the treatment of disease like Cancer and TB.
7. Indian healthcare delivery system is categorized into two major components -
public and private. The Government, i.e. public healthcare system comprises
limited secondary and tertiary care institutions in key cities and focuses on
providing basic healthcare facilities in the form of primary healthcare centers
(PHCs) in rural areas. The private sector provides majority of secondary, tertiary
and quaternary care institutions with a major concentration in metros, tier I and
tier II cities.
8. India's competitive advantage lies in its large pool of well-trained medical
professionals. India is also cost competitive compared to its peers in Asia and
Western countries. The cost of surgery in India is about one-tenth of that in the
US or Western Europe.
1.3 Statement of Problem
Hospitals are increasingly realizing the need to focus on service quality as a
measure to improve their competitive positions in today‘s highly competitive

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environment. Their competition mainly based on service pattern, service quality, and
patient‘s expectation. Many Hospitals are far from the advantageous position because
scrawny ability to identifying the gaps between the expectations and perception of
patients. If they are not able to identify that gaps effectively service organization will not
sustained in the stiff competition. Understanding service user encounters from a
consumer‘s perspective is highly relevant in healthcare. ―Providers can establish a
partnership rather than a paternalistic approach to their customers if expectation and
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perception differences are made clearer and addressed properly‖ (Crosby P, 1979).
Quality healthcare is imperative for individuals, organization and overall society. It is
also essential for the organization staff providing these services. Failing to meet or
exceed customers‘ quality needs is not an option for any organization, but particularly in
a healthcare provider‘s case this could only lead to a disaster. Therefore, developing a
measure that systematically gauges health service quality could significantly contribute
towards service improvement
The main issues addressed in this research are service quality and patient
satisfaction using the SERVQUAL model in Hospital context which is mainly focus on
expectation of patients. The dimension of service quality from the patient‘s perspective
by assessing their expectations and perceptions of service quality is understood. The
research work would like to answer the following questions in our study;
• How do Patients perceive service quality in Hospital?
• Are Patients satisfied with service quality offered by Hospitals?
• Are the perceived services matching with the patient expectations?
This is why we chose to use the SERVQUAL instrument to enable us to assess
service quality in Hospital. This model seeks to know the difference between consumers‘
expectations of how Hospital services should be like and their perceptions in terms of
performance in Hospital using various dimensions (tangibles, reliability, responsiveness,
assurance and empathy). Trying to meet or exceed Hospital expectations helps Hospital
to maintain a high quality image. This shows the relevance of knowing much about the
patient‘s perceptions of Hospital in order to survive in a competitive environment

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What are the gaps in the expectations and perception of patients from private
hospitals in Ahmednagar on account of various parameters of service quality?
The problem is intended to address key questions such as what are the important
parameters for hospital selection, what are patient expectations from good hospitals and
have these hospitals exceeded patient expectations on any parameter of service quality
such as reliability, responsiveness etc. Moreover this shall also throw light on which gap
of service quality needs to be addressed by these hospitals.
1.4 Relevance of Study
In the globalized and liberalized business environment, service sector is
encountering stiff competition to meet the requirements of the profitable ways of
business. This is reflected in an organization‘s survival in terms of return on investment,
retention of customers, acceptance of service and service qualities, development and
augmentation of brand image. It appears that the driving force towards success in service
business is the delivery of high quality services.
―In the health care sector, customer satisfaction is also an important issue as in
other service sectors‖ 5 (Shabbir S, 2010). Service organizations have begun focusing on
the customer perceptions of service quality because it helps in developing strategies that
lead to customer satisfaction6 (Saravanan R., 2007). According, to (Gummesson E,
1994), there has been a shift from the focus on goods without much emphasis on services
to a focus on services though paying attention on the goods7. This stresses the importance
of service marketing to most service industries. The purpose of the study is to
determine the dimensions of service quality in Indian hospitals, from the
perspectives of patient availing healthcare services in selected hospitals.
But, there is no in-depth study was conducted in Ahmednagar District for
measuring quality of the services in Private Hospitals. The study would enable hospital
managers to understand how patients and their attendants evaluate the quality of
healthcare provided in respect of every dimension. A comparison of perceptions between
patients and attendants would aid to allocate resources to various aspects of healthcare.
This study would help Hospital administrators to use the instruments proposed to obtain

5
feedback on their performance on service quality parameters so that they can benchmark
themselves with their competitors.
This study shall help the service providers in health care industry to have clear
insights regarding the issues related to provision of quality health care in rural areas.
Especially the study is able to highlight major gaps in perceived service quality which
can be readily addressed.

1.5 Objectives of the Study

The objectives are as follows
1. To study the scenario of healthcare sector in general and private hospitals in
particular those are operational in Ahmednagar District
2. To study the patient expectation from private hospitals on various parameters of
service quality.
3. To identify the patient perception regarding the service quality and facilities
provided by private hospital on various parameters of service quality.
4. To identify the gaps in the service quality received by patients in private hospitals.
5. To understand the correlations of the gaps in the service quality with various
hospital Parameters such as type of hospitals & department
6. To identify the correlation between various gaps in service quality with patient
attributes such as duration of stay & socio economic attributes.
1.6 Hypothesis of the study
The present study is guided by testing of the following hypotheses:
Ho1: There is no significant difference in service quality gap of private hospitals in
Ahmednagar district
Ho2: There is no significant difference in service quality expectations according to patient
and hospital attributes
Ho3: There is no significant difference in service quality experience according to patient
and hospital attribute
Ho4: There is no significant difference in service quality gap according to patient or
hospital attribute

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1.7 Scope and Limitations of the Study
The scope of this research is restricted to Service quality of Private hospitals with
100 or more beds in Ahmednagar district and its impact on customer satisfaction. The
suggestions may be applicable to other areas of the India or any part of the world. The
study shall help to identify key gaps on account of various service parameters that shall
help private hospitals to live up to the expectations of patients by zeroing on these gaps.
Moreover further studies could investigate the other service quality gaps that are
prescribed in the literature. The study presently deals with gaps between the patient
expectations and actual service quality perceived by patients. Auxiliary vital aspects of
perceived service quality, expected service quality and critical inquiry of this gap in
relation to hospital attributes and individual attributes are studied and reported.
Limitation: One of the major limitations of this study that it has included only
private hospitals and excluded Government Hospitals. Secondly only those hospitals with
a bed size of more than 100 beds are presently included in this study whereas in rural and
semi urban areas of Ahmednagar many private hospitals having bed size of less than 100
cater to patient health care needs. Moreover the administration of the questionnaire, the
patient understanding of the same and his psychological condition may also influence his
ability to record unbiased opinion of the services availed which could have been
addressed through a cross sectional study.
Researcher has selected 11 private hospitals. Infrastructure and facilities, expert
team, services provided, patient‘s expectations, perceptions, actual service quality and
other important aspects are covered in this research.

1.8 Class of Respondents

The sampling unit was patients admitted in the hospital or IPD patient for the
reason being such patients spend considerable duration in the hospital and are well verse
with the various administrative system of the hospital. The data was collected from
relative of such a patient who may not be in a position to participate in the survey
especially those patients who are critically ill.

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1.9 Working Definition
1. Service Quality: Service quality is a comparison of expectations with performance
.A business with high service quality will meet customer needs whilst remaining
economically competitive. Improved service quality may increase economic
competitiveness. This aim may be achieved by understanding and improving
operational processes; identifying problems quickly and systematically; establishing
valid and reliable service performance measures and measuring customer satisfaction
and other performance outcomes
2. SERVQUAL Model: SERVQUAL, later called RATER, is a quality management
framework. SERVQUAL was developed in the mid-1980s by Zeithaml,
Parasuraman & Berry to measure quality in the service sector.
3. Customer Satisfaction: It is a measure of how products and services supplied by a
company meet or surpass customer expectation. Customer satisfaction is defined as
"the number of customers, or percentage of total customers, whose reported
experience with a firm, its products, or its services (ratings) exceeds specified
satisfaction goals.
4. Private Hospital: A private hospital is a hospital owned by a profit company or a
non-profit organization and privately funded through payment for medical services
by patients themselves, by insurers, Governments through national health insurance
schemes, or by foreign embassies.
5. Patient: able to accept or tolerate delays, problems, or suffering without becoming
annoyed or anxious.
6. Perception: As per the Cambridge dictionary perception is the way in which
something is regarded, understood or interpreted.
7. Expectation: According to oxford dictionary expectation is strong belief or
conviction about something will happen.

1.10 Respondents contacted & Places Visited

Following are the places visited to collect response from the patients
Ahmednagar, Kokamthan, Loni, Shevgaon, Shirdi, Shrirampur of Ahmedngar District
because of the 100 or more bed private hospitals were located. The IPD patients in these
hospitals were contacted for soliciting their responses.

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1.11 Research Methodology
1.11.1 Research Design
The present research design is descriptive for the reason that present study
describes the characteristics or phenomenon observed regarding the service quality gaps.
Descriptive research is used to describe characteristics of a population or phenomenon
being studied. It does not answer questions about how/when/why the characteristics
occurred.
1.11.2 Collection of Data
A) Primary Data: -
In order to get first hand and authentic data the researcher has used the following method.
Research Technique: Survey Method
Survey tools: Questionnaire method
Questionnaire Method: - The researcher has systematically framed the questionnaire to
collect the data. The information sought from them by objective type questions through
multiple choices. The structured questionnaire was preferred for following obvious
reasons
 Low cost
 Ability to reach multiple patients through volunteers
 Higher efficiency
 Low interviewer bias
The sample size of the study is fixed according to the average bed size in the
selected hospitals and the average occupancy ratio of these hospitals. The name of the
hospitals, their bed capacity and the average IPD occupancy ratio are maintained to
determine the sample size from each of these hospitals. The sample size of 303* was
selected. (*Determining the sample size : Krejcie, Robert V., Morgan. Daryle W.)

B) Secondary Data:-
The various published sources such as reference books, journals, Newspapers,
reports, records are helpful to collect secondary data.

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 Secondary data necessary for successful completion of the study will be collected
from the various reports of government, statutory apex bodies, various journals,
magazines and books related to quality of services in private hospitals, various published
and unpublished research work. Also the web Based data and information on Private
Hospitals would be duly referred.
1.11.3 Selection of sample
a) Universe of Hospitals:
All those hospitals which are registered with competent government authorities
such as District Medical Officer and those which have capability to admit patients for
medical treatment are included in the universe.

Table1.01: Taluka wise Breakup of Hospitals for Ahmednagar District.

Sr. Speciality Maternity Available
Taluka Hospital Clinics
no Hospitals Home Beds
1 Akole 21 0 46 16 152
2 Sangamner 42 0 49 33 338
3 Kopargoan 23 2 63 22 295
4 Rahata 26 1 59 25 266
5 Shrirampur 31 0 126 23 256
6 Newasa 24 0 66 26 278
7 Shevgoan 18 0 67 16 173
8 Pathardi 11 0 49 11 146
9 Nagar 96 0 368 89 2723
10 Rahuri 19 0 39 19 186
11 Parner 16 0 38 15 170
12 Shrigonda 24 0 36 25 241
13 Karjat 19 0 29 16 169
14 Jamkhed 20 0 28 18 173
Total 390 3 1063 354 5566

(Source: District Statistical Authority, Ahmednagar)

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 From the above table it can be noticed that 390 hospitals, 3 specialty hospitals,
1063 clinics and 354 maternity home which in total provide 5566 beds available in
district. Nagar taluka amongst all talukas has highest number of beds and the least
number of beds are accessible in Akole taluka.

b) List of Private Hospitals and selection of sample

The list of hospitals in Ahmednagar having bed capacity of more than 100 is
available with District Medical Officer and from this sampling frame top hospitals having
bed size more than 100 and those which have been operational more than 10 years are
selected.
The details are revealed below:

Table 1.02: List of Private Hospitals with their Bed Capacity and selection of sample
Sr Type of Bed Sampling Sample
Hospital
No Hospital Capacity Method Size
Affiliated
Pravara Medical Trusts
1 Medical 800 80
Hospital,Loni Tal:Rahata
College
Dr. Vikhe Patil Memorial Affiliated
2 Hospital & Med. Medical 700 70
College,Ahmednagar College
Charitable
3 St Luke Hospital,Shrirampur 210 Convenience 20
Trust
Sampling
Charitable
4 Shri Sai Baba Hospital,Shirdi 220 10% of 21
Trust
population
Charitable
5 Shri Sainath Hospital,Shirdi 220 21
Trust
Anandrushi Charitable
6 174 17
Hospital,Ahmednagar Trust
Fairbank James Friendship
Charitable
7 Memorial Hospital Hospital 160 16
Trust
,Vadala

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 Sakhar Kamgar Charitable
8 160 16
Hospital,Shrirampur Trust
Charitable
9 Nityaseva Hospital,Shevgaon 160 16
Trust
10 Noble Hospital,Ahmednagar Private 130 13
Atma Malik Hospital
Charitable
11 Om Gurudev Rural Hospital & 100 10
Trust
Research Centre,Kokamthan
Total 3030 303

(Source: [Link] (Inventory of Hospitals having

100 beds and above)
In the present study convenience sampling is used for the reason that at times
patient may not be in a position to participate in the survey owing to their poor health and
hence only those patients who have expressed their willingness to participate in spite of
their health have only been included in the survey. The hospitals included in the present
study are few of the largest hospitals in the area of study

c) Sample Size:
The sample size forms a crucial factor when analysing results as it is expected that
sample size should be representative of population and obviously with increase in sample
size the chances of under representing the population may decrease but at the expense of
increasing cost of research. Further the standard formulations of calculating the accurate
sample size prove useful if the mean of the population are known which is not case in
particular study and hence it is imperative to take help of scientific and proven tools such
as Morgan table which prescribes sample size for specified population. The Morgan table
specifies that for a population of more than 3000 a sample size of 341 is specified which
is about 13-14% of the population. In the given study with the specified bed capacity the
population is 3030 and hence 400 patients were approached and rounded of 303 usable
responses could be solicited which are included for final analysis.

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1.11.4 Data Collection Instrument
A structured closed ended questionnaire was used for recording the responses of
respondent. The questions included multiple choice questions, dichotomous questions
and also questions based on a 7 point Likert scale. The data and information for the study
is collected through primary as well as secondary sources. In the primary source,
structured questionnaires are used to collect the information on various aspects of service
quality from selected patients. Questionnaires have been divided into three parts for
patients as follows.
a) General Information
b) Service Quality Expectations.
c) Service Quality Perceptions
In the general information along with name his/her qualification, profession,
contact details, age and gender, these attributes are covered. The questionnaires is based
on seven point Likert scale.

1.12 Presentation of Data

The data through questionnaire is properly presented so as to give comparative
self-explanatory and easy to understand summarizing picture. For the presentation
purposes following diagrammatic technique were used.
1) Vertical Bar Diagram
2) Horizontal Bar Diagram
3) Multiple Bar Diagram
4) Pie Chart
5) Histogram
1.13 Techniques of Analysis of Data
The various statistical techniques like Chi-square test, percentile method have
been used for the analysis, testing the set hypothesis in this study. Factor analysis is used
to classify the various attributes. Correlation statistics including chi Square, Kruskals
lambda were used to explain correlation between various demographic variables
and strength of such relationship.

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1.14 Analysis of Data
Data presentation gives only the comparative overview of the information but for
figurative comparison sound analysis is required. In the present study the data is analyzed
into two steps.
1) Descriptive summary statistics.
2) Advanced statistical techniques.
In descriptive summary statistics, mean, mode, variance, standard deviation are
calculated as follows.

Mean:
If X1, X2 X3……. Xnis set of observation then Mean = X = ∑ Xi / n
Mode: The observation with maximum frequency is treated as mode.
Variance: To measure the dispersion or variation in the data variance is given by
σ2 =1/n ∑ (Xi – X) 2= 1/n∑ Xi2 - X2
Standard Deviation: Standard deviation is positive square root of variance

a) Advanced Statistical Techniques

In the advanced statistical technique Chi square test of independence, test for
equality of proportions and Factor Analysis are used. The collected data is cross
tabulated. Chi square test is used .The details of the Chi square test are as follows.
Suppose factor ‗A‘ is classified into r groups say A1, A2…Ar. Similarly factor B is
classified into ‗C‘ groups like B1, B2… BC, then the observed frequency of this
classification is tabulated as follows.
A1\ B B1 B2 ………….. BC Total
A1 O11 O12 …………..O1c (A1)
A2 O21 O22 …………..O2c (A2)
…. …. …. ………….. …..
Ar Or1 Or2 …………..Or c (A r)
Total (B1) (B2) ………….. (BC) N

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 In the table Oij means observed frequency for AiBj Cell, (Ai) denote total
frequency of (Bj) Cell and N denote grand total. Under the hypothesis of independent of
factor A and B the expected frequencies for (I, j)th cell is computed as
eij= (Ai)(Bj)/ N I = 1,2 ……….r, j = 1, 2 ……… c
The test statistics is
r c
χ 2 = ∑ ∑ Oij/ E ij- N ~ χ 2(r-1) (c-1)
I=1 j=1
The table value of χ 2 (r-1) (c-1) at α % of significance is say χ2 tab then decision rule is
If χ2cal < χ2tab  independence of A and B is accepted.
If χ2cal > χ2tab  independence of A and B is rejected.10
b) Factor Analysis
As the first step we conducted an exploratory factor analysis, a principal
component analysis, in order to determine the underlying dimensions service Quality.
The chosen solution with five principal components was constructed using the direct
oblimin rotation technique and can explain per cent of the total variance. Different
opinions concerning what constitutes a high loading are found in the literature, e.g. 0.3.
Here, the rotated factor loading of 0.5 was chosen as a threshold. (Gaur S, 2009)
Kaiser‘s criterion and scree plot were selected as technical criteria to determine
the number of factors. The Kaiser‘s criterion (Eigen value greater than 1) was chosen
here as the minimum requirement. Additionally the Scree test, which plots the Eigen
values against the number of components, suggested in this case five substantive factors.
The ranking of factor 1 to 5 reflects the declining Eigen values.
1.14.1 Analysis of Variance ANOVA
Analysis of Variance is used to test the homogeneity of means of different
samples. The following definition was given by [Link]; analysis of Variance is
separation of variance ascribable to one group of causes from the variance ascribable to
other groups. The technique of ANOVA essentially consists of portioning the total
variation in an experiment into components of different sources of variation. These

15
sources of variation are due to controlled and uncontrolled factors. The ANNOVA
technique is mainly based on linear model which depends upon type of data used in linear
model. (Gaur S, 2009) Post hoc tests are used to verify anywhere the differences transpire
between groups with ANOVA results.

1.14.2 Use of Software

For presenting the data effectively with different types of graphs, charts and
diagrams, MS-EXCEL is used. For applying chi square test, cluster analysis and other
statistical techniques Minitab software and SPSS is used.

1.15 Literature Review

In this section an attempt is made by the researcher to present a comprehensive
and systematic view of the relevant studies in the literature. The studies have been
compiled according to their importance and context in the present study.

1.15.1 Journals (National & International)

(LiMin [Link], 2015), assessed the patient‘s perception of service quality of
hospitals in nine cities of China. The authors summed the findings that the overall
perceptions with quality was found to be satisfactory. ―Gender and city did not have any
significant impact on the dimensions of quality. All five dimensions of service quality of
SERVQUAL scale had a positive correlation. Patients close to the age of sixty were more
satisfied as compared to the patients in the age bracket of forty‘s specifically for
measures of reliability, assurances and empathy. The criteria of reliability and tangibility
have a greater impact on service quality as compared to the other three dimensions‖8.
There was greater satisfaction posed by outpatients as compared to inpatients with
responses in relation to tangibility and reliability. Responses city wise, showed marked
difference in relation to service quality measures which was due to the nature of
technology used, date of establishment, capability of medical professionals, lack of
resources, location disadvantages and shortage of clinical staff and overcrowding of
patients. The authors concluded that hospitals at China in general need to be more
professionalized and should enlarge the scope; for ensuring patient‘s satisfaction.
(Rahman R, 2013), attempted to identify the satisfaction of patients from ten
private hospitals in the city of Dhaka. He concluded that patients were highly satisfied

16
with assurance and neutral with communication, responsiveness and empathy and were
satisfied by the balance quality dimensions.9 The maximum impact on customer
satisfaction was through reliability followed by responsiveness and empathy while cost
was the least. Hence quality dimension need to be managed well at private hospitals.
(Thangaraj B, 2016), reported that that priority to private corporate hospitals was
given as they were better equipped with modern technology. The other parameters ranked
for the preference was quality, followed by responsiveness and infrastructure which was
described in the research paper titled ―A study on patient‘s perception towards service
quality of private hospitals in Coimbatore city‖.10
(Dave, 2014), examined the factors for choice of any hospital and the satisfaction
and loyalty of customers in the city of Vadodara and concluded that perception plays an
important part in service quality.‖ Primarily, family influenced the choice of hospitals.
The following criterion played an important part in the choice, which were reputation of
the hospitals, additional facilities, knowledge of doctors and proximity to the house.61%
patients showed loyalty to the hospitals and were keen on referral.‖11
(Aghamolaei, 2014), determined the service quality gap from all the ninety six
patients, of a hospital in southern Iran. ―The quality gap was predominant in general and
maximum for responsiveness dimension and the minimum gap was attributed to
assurance. The demographic characteristics of patients were also gathered which were
analyzed using Kruskal-Wallis test showing that there was no relationship between
demographic features and quality services.‖12 The author portrayed an overview of
service quality of hospital which was found to be average.
(Augustine P, 2014) , reviewed the quality assessment at a public hospital in
Ghana to understand the patient‘s perception and satisfaction. He suggested that effective
communication between the health care services and patients bridges the gap between the
stakeholders and takes care of maximum dimensions of quality. ―Highly satisfied
customer increases the scope of business for any health care provider hence the gaps were
to be identified and measures needed to be taken for improvement. In the same light, the
overall satisfaction was to the tune of 73.4% and 38 patients had a very positive response
in relation to the quality. Except for empathy and tangibility which had a positive ranking
from the patients, responsiveness, assurance, communication and reliability; four out of

17
six dimensions had a negative score in the gap analysis. This gives room for hospital
services to improve further.‖13
(Punnakitikashem P, 2012), threw light on the quality dimensions in a hospital in
Thailand which was highly quality conscious having received the Lean certificate for
quality. The authors hence took the same as a case study to understand the gap between
patient‘s perception and expectations and suggested that overall the patient‘s perception
and expectation was average.‖ In terms of tangibility the gap was positive while negative
was assurance. Tangibility, assurance and reliability were the foremost priorities under
patient‘s expectation. Instead of assurance, empathy had a significant rating under
patient‘s perception. Tangibility scored the maximum both in patient‘s perception and
expectation.‖ 14
(Nadi A, 2016), proved that that perceptions of patients and the dimensions of
perceptions had a favourable remark from all the concerned patients. Assurance criteria
faced the maximum gap and the least gap was for reliability. The authors summarized
that the overall perceived service quality of the sampled hospitals did not meet the mean
expectations of the patients; therefore all capabilities need to be strengthened with time to
ensure that patients are satisfied.15
(Acharyulu, 2007), identified four gaps from the perspective of the hospital which
gave rise to the fifth gap between consumer expectations and perceptions. The findings
depicted that authorities had to lay great stress on reliability and responsiveness which
had the highest gap. Delivery aspects were given profound importance as compared to the
tangibles at the hospitals, followed by assurance. Patients expected that the doctors were
knowledgeable and technology savvy. The authors focused on continual service
assessments and accreditation for hospitals which would strengthen the service quality
aspects, much in demand by quality centered patients in the present times.16
(Jager J, 2007), determined the service quality in government hospitals at Gauteng
by interviewing and placing questionnaire to five hundred and eighty three in and out
patients. The findings depicted that expectation on tangibility dimension was high,
especially for cleanliness. In totality the appearance of staff was perceived good both in
in and out patients. Parking was of least priority for all type of patients. ―Not much
difference in ranking within the tangibility construct was found between in and out

18
patients. Increased expectations were observed in the entire assurance construct
especially for safety, courteous staff and effective communication. Perceived
understandable communication was rated high. Gap between perceived and expected was
highest for cleanliness.‖ The author suggests that variables of assurance dimension needs
to be paid attention by the management.17
1.15.2 Dissertations and Thesis
(Pansiri J),considered the high efficiency and performance oriented reforms
implemented by the Botswana Government in health care sector and other sectors which
unfortunately have not given the desired results.‖ The prominent findings were that
expected quality and perceived quality had a big mismatch. The wide gap between the
customer‘s perception and expectation was due to assurance followed by responsiveness.
The least gap was observed for empathy and tangibles. Hence the study demonstrated that
in spite of funding and reforms the patient‘s expectations are yet to be achieved.18
(Odgerel C, 2010), thesis on ―The perceived quality of health care service and
patient‘s satisfaction in district hospitals, Ulaanbaatar, Mongolia city‖ observed the need
of holistic improvement in health care industry owing to the fact that the customers of
today are highly aware and demanding for quality services. The cross sectional
quantitative study had been conducted in district hospitals as the occupancy rate is
relatively high, hence the need to conduct the research which was patient centric.
Perceptions and expectations on all dimensions had a large mismatch as per the effect
size calculated. Findings suggested that the gaps between perception and expectation
were extremely high for empathy and nursing care. Assurance was rated as the highest
under the expectation category followed by accountability and empathy from the patients
end. Perceptions and expectations scored highest for knowledgeable and capable doctors
and staff. Satisfaction level of new entrants was lower than those who had been admitted
to the hospital umpteen times. Higher perception of patients showed higher satisfaction
level amongst patients and greater degree of recommendation to others. The author
suggested that a patient hearing by the patiently was necessary for improvement in the
quality of hospitals.19
(Taner, 2006), compared the service quality of private and public hospitals in
Istanbul, Turkey. The research was conducted by administering two questionnaires to

19
evaluate the expectations and perception of two hundred customers to the hospital
services which was achieved through two questionnaires stipulating forty quality
dimensions using the SERVQUAL measure. The author concluded that the patients had
higher expectations and perceptions regarding the assurance dimension of the service
quality. Further private hospitals score lower on responsiveness dimension followed by
lower score on tangibles including food, parking etc. The author further noted that no
significant differences in regards to perceptions in public hospitals as compared to private
hospitals. Empathy, assurance and responsiveness gained a positive score in the gap
analysis in private hospitals. Empathy was rated lowest in public hospitals. Reliability
and tangibles had the maximum gap score in private and public hospitals respectively.20
Both private and public hospitals were using high end technology, knowledgeable
doctors and staff. Other support services needed improvements, although due to low cost
public hospitals were equally preferable.
(Kavitha, 2012), addressed the issues of service quality in the city of Salem in two
hospitals one being private and the other public. Findings suggested that perception of
patients was high for all dimensions although physical facilities scored the highest.
Private and public hospital management were well aware and high of the patient‘s
expectations in both type of hospitals.21
(Zaim, 2010), addressed the relationship of customer satisfaction with
SERVQUAL measure in twelve different hospitals in the city of Turkey. The future
intention, perception and evaluation of service quality were analysed from the patient‘s
viewpoint. The author concluded that responsiveness and assurance were not important
for customer satisfaction unlike tangibility, empathy, reliability and courtesy.22
(Ramez, 2014), conducted a research on the perception, expectations and
satisfaction of patients in Bahrain and comparing service quality of private and public
hospital. He reported that in spite of Baharin being a predominantly welfare state
providing free medicare to its subjects in public hospitals, private hospitals rank better
than public ones and are preferred by the higher income group. The findings showed that
quality of service provided by private hospitals compared much better as to public
hospitals of Bahrain, hence the perception of patients which stood higher for private
hospitals held true. Unfortunately, the service dimensions for public hospitals were found

20
to be below average as portrayed by the findings. The expectations of patients of both
private and public hospitals were far below than expected. Patients were dis-satisfied
with both private and public hospitals however the level seemed to have dipped
southwards more in the case of public hospitals. The main criterion assigned was the
response from the hospital staff, empathy as a dimension needed serious attention.
Providing competent services was suggested to improve the quality of both private and
public hospitals. 23
(Kavitha, 2012), addressed the issues of service quality in the city of Salem in two
hospitals one being private and the other public. Findings suggested that perception of
patients was high for all dimensions although physical facilities scored the highest.
Private and public hospital management were well aware and high of the patient‘s
expectations in both type of hospitals. 24
(Ramez W, 2012), opined the superiority of SERVPERF over SERVQUAL
measures. The authors found that the responsive parameter was the most significant in the
tangible segment. Reliability, responsiveness and assurance scored high in the other
parameters. It was observed that there was a positive co-relation between overall service
quality and overall patient satisfaction and further a satisfied patient would be a referral
to others.
(Sohail S, 2003), described the increasing awareness of patients towards high
quality health care services in Malaysia which is dominated by public sector accredited
hospitals; gaining one of the highest budgets by the Government. ―Service quality in
hospitals: more favourable than you might think,‖ the research paper by the author
conducted a survey through questionnaire placed with fifteen patients across private
hospitals. SERVQUAL measure with Likert scale was used to score the quality of non-
clinical aspects. T test was used and it was found that reliability, assurance, empathy and
responsiveness did not feature into the positive note from the patients view point. The
physical features were rated much higher by the patients. Hospitals in Malaysia fare far
better in service quality as compared to Turkey and Hong Kong was observed by the
authors.25
(Kazemi, 2013), co-related the satisfaction of patients with hospital service
quality Through gap analysis it was observed by the authors that responsiveness had the

21
greatest gap and assurance the least .Undoubtedly, high service quality had a positive
impact on satisfaction of the patients.26
(Caha H, 2007), applied the Kara model to analyse the loyalty of patients to the
hospital in terms of quality and satisfaction of customers through a modified
SERVQUAL model having higher number of elements through a questionnaire. The
authors conclude that though service quality was satisfactory of the private hospitals but
needed much improvement in terms of waiting time as the physical and human facilities
were inadequate. This was essential as patient‘s had the option of other alternatives in
the private segment.27
(Tomes A, 1995), suggested that unfilled expectations surfaced were physical
environment and relationship of mutual respect. Most important finding was the lack of
communication between patients and doctors which needed attention from the viewpoint
of hospitals. There was a need to infuse huge amount of finance in the hospitals; was
suggested by the authors to improve the service quality.28
(Parasuraman A., 1985), initiated and conceptualized a model for service quality
taking four businesses in consideration. Quality being intangible in the service sector,
difficult to measure; the need was felt as there was no concreted measure for service
quality in the service sector which was poised to grow in the near future. ―A conceptual
model of service quality and its implications for future research‖ takes into consideration
the perception which is the expectation and the performance difference obtained by the
customer in the service industry. The model was conceptualized by interviewing
executives of four services namely banking, brokerage, credit card and product repair and
maintenance. Twelve focus group interviews of customers across various regions
considering the demographic characteristics in relation to identifying the key attributes of
service; the perception and the expectations of customers and to understand the
distinction in the term ―quality‖ from the point of view of both were held. The authors
stated propositions for four core gaps, which were identified at the marketer‘s end which
would hamper providing the requisite quality. Accordingly, the service quality model was
conceptualized taking ten determinants into consideration.29
(Jain P., 2015), reviewed and critically examined the various service models
applied from 1992 to 2010in various service sectors. ―Service quality models: A review‖

22
was undertaken due to the dynamic competitive environment where customers‘ needs are
to be met. A brief of each model has been detailed with its applicability and limitation as
per their development after a thorough literature review of sixteen industries. It was
concluded that with changes in the expectations of customers and technology over a
period of time, various models with further refinement have been put forward. However,
no uniform model can be made applicable to all service industries.30
(Amjeriya D, 2012), highlighted a case study of a hospital at Ujjain, and stated 6
dimensions that warrant attention. The six dimensions which were most significant were
3 C‘s i.e. competence, credibility and courtesy and tangibility, reliability and assurance,
the least were empathy and security while the other four were identified to be semi-
critical. Most of the factors were correlated to each other and the overall service quality
was just about average showing that much needed to be done to keep the human capital
healthy.31
(Irfan S, 2011), concluded that holistically service quality of private hospitals are
far better than the public hospitals. Except where patients felt, that the assurance
dimension was greater in public hospitals as doctors are highly knowledgeable and are
related to the teaching fraternity. The perception of patients for private hospitals ranked
higher for empathy, tangibility, assurance, timeliness and responsiveness in private
hospitals in relation to public hospitals.32 Being sensitive to customers‘ needs and
competition the private hospitals in Pakistan are on the road of continual improvement.
(Brahmbhatt M, 2011), concluded that amongst all the above mentioned
dimensions, except for reliability private hospitals scored better than public hospitals.
Encounter –responsiveness scored the least in public hospitals. ‖Adapting the
SERVQUAL scale to hospital services: an empirical investigation of patient‘s
perceptions of service quality‖ the authors concluded that in Gujarat, the service quality
of private hospitals surpassed the public hospitals.33
(Kumaraswamy S, 2012), stated that the most prominent determinants of service
quality were Physician Behavior, Supportive Staffs, Atmospherics and Operational
Performance. The most significant perceived quality factor from the patient‘s perspective
was Physician Behavior in corporate and non- corporate hospitals, while Operational
Performance in corporate hospitals and Atmospherics in non –corporate hospitals was

23
identified. While the patient‘s in corporate hospitals were moderately satisfied with the
overall performance and attitude, the same was not the case found at non- corporate
hospitals. Education and nature of patients impacted the association with the expectations
and perception on various service quality factors at corporate hospitals. At the non-
corporate hospitals, associating profile variables were education, income, location and
nature of patient. Findings suggested that corporate hospitals were far superior in terms of
service quality in relation to non-corporate hospitals.34
(Zarei A, 2012), assessed the service quality of eight private hospitals of Tehran.
Tangibles was rated the highest and empathy the lowest in the expectations and
perception category. Wilcoxon test showed that the gap between expectations and
perception was visible especially in the empathy dimension which was huge. Gap further
existed amongst patients who had their first visit, were highly educated, duration of stay
was short and were enjoying good health. Women had higher expectations than men. The
authors in the ―Service quality of private hospitals: The Iranian patients‘ perspective,‖
concluded that satisfactory results were obtained by using the SERVQUAL measure for
assessing the service quality of the hospitals at Iran.35
(Bisschoff, 2014), assessed the service quality management of private hospital at
Gauteng, South Africa. The authors showed that the overall satisfaction was good, around
60 % though not excellent. Responsiveness, followed by tangibility was the significant
dimensions of quality from the point of view of the patients. Patients were exceedingly
satisfied with assurance and reliability. No prominent difference between perceived
quality between males and females surfaced. The author emphasized on strategic thinking
to enhance the service quality of hospitals and focussed on trainings for the staff.36
(Sower V, 2001), in ―The dimensions of service quality for hospitals:
development of KQCAH scale‖ have identified and developed the key quality
characteristics for hospitals both for the service providers and takers. The instrument was
developed as a strategic intent for continuous development for assessment of hospitals.
After an extensive literature review, a blend of qualitative and quantitative methodologies
have been applied by collecting data through focus groups from the patient‘s and their
families, doctors and staff on the other end. From the data a questionnaire was drafted
with seventy five elements considering the sixty characteristics identified. The whole was

24
summed up in nine theoretical dimensions and five empirical dimensions for content and
constructs which were tested for reliability and validity and were found positive.37
(Adil, 2013), attempted to identify the most popular and important service
measure used in banking industry. This has been done through secondary searches and
sources. SERVPERF was found to be superior due to its efficiency and the scaled down
number of items to half that of SERVQUAL. Additionally, the attention of both pre and
post needed to be caught of the patients for the latter. The authors opined that in the
context of Indian scenario SERVPERF has been a superior measure as compared to
SERVQUAL38
(Chakraborty R, 2011),‖ stated the need to understand customer expectations of
quality, development of quality measures, SERVQUAL its importance and applicability.
Critical reviews of the SERVQUAL model have been highlighted along with the
modifications brought in by other authors have also been narrated.39
(Babakus E., 1992), conducted research by health practioners on a mid-size
hospital in USA; determined the application of SERVQUAL scale to verify the quality
perceptions and expectations of patients. Through extensive review of literature and the
management inputs, a pilot study was initiated on all the five dimensions of the
SERVQUAL scale to test the validity of the questionnaire. Findings suggested that
perceptions of patients with regard to empathy from the staff were under rated. The study
concluded that SERVQUAL measure was found appropriate by the authors to measure
the functional quality characteristics of hospital services which would give insight to the
management, administrators and other related staff to improvise the lacunas found and
serve the patients more efficiently.40
(Seth N, 2004), critically assessed the service quality models available for
hospitals. The paper ―Service Quality models: a review‖ is based on secondary data by
extensively reviewing critically the nineteen service models since 1984 to 2003 and
establishing an interrelationship amongst them. The same was taken up in the light of the
dynamicity of the environment and the impact of technology in the service industry
which was discussed in depth and elucidated the positives and negatives of each model.
Most of them used the SERVQUAL model or a modified version which did not use the
gap model. The research further highlighted the inter dependence of satisfaction of

25
internal customers; in turn to satisfy the patients and the participation of the top
management to fill the objective of superior quality in the competitive environment. Most
important, to measure and associate the impact of enhanced quality on the financial
performance of the hospitals.41

1.15.3 Articles & Reports

(Najar A., 2012), enlarged the scope of SERVQUAL model to the family
physicians of rural areas of Iran. Results showed that there existed a huge gap between
the perception and expectations in relation to all quality dimensions of the SERVQUAL
model. Empathy had the least gap but the area of concern was tangibility where the
discrepancy was very high followed by responsiveness. The authors have recommended
that continual focus on quality at the health centres for all quality dimensions was
imperative in order to have satisfied patients.42
(Rishard M, 2008), conducted a case study at a teaching hospital in Sri Lanka to
analyse the service quality dimensions through collection of both qualitative and
quantitative data by multiple techniques in nine wards out of eleven wards of the hospital.
Findings revealed that huge quality gaps existed for all types of patients. The lowest
service gap was found between the patients and the doctors and nurses in line with other
theories. Assurance was rated to have the lowest gap from the patient‘s end while
acceptance the highest. Reliability had the highest gap with respect to the internal
customers due to bureaucracy red tapism prevalent within the hospital. Amongst the
different wards Gynaecology and Obstetrics was found to have the lowest gap while Post
natal department had the maximum gap signalling towards lowest perceived quality. The
author concluded that hospital was unable to meet the service quality expectations of all
the three stakeholders considered in the case study. Since responsiveness and reliability
dimensions were found to be at the lowest rung hospital authorities need to be more
sensitive to these dimensions in particular and service quality as a whole.43
(Farid, 2008), showed that ‗SERVPERF‘ was ranked as the most ideal service
quality measure to be applied in hospitals. Using the weighted SERVPERF measure
interactive methodology was most recommended for evaluating the service quality of
hospitals.

26
 Eight sub-constructs were identified and the relationship between them and the
constructs could be established. Housekeeping and tangibles had the maximum impact on
the perception of overall service quality of the hospitals. Correlation between variables
and the outcomes, value for money were also established. Under the demographic
characteristics, it is only the income which makes a difference on the variables of the
research.44
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) is one
of the tools applied for measuring patient satisfaction with quality of care. According to
Agency for Healthcare Research and Quality (2009), CAHPS is an internationally
validated tool to be anchored on a specific episode of contact between the patient and
healthcare professional. CAHPS focuses on assessing the actual experience of patients
during care process instead of measuring patient‘s perception. As per the CAHPS
Methodology, patients are asked to indicate if they receive any specific quality of care.
1.15.4 Electronic sources including website
(Hye-Young Shim, 2014), proposed to suggest a service model for each stage of
the cancer disease. The research was undertaken to focus on the customer satisfaction of
patients at different stage of cancer diseases which were segregated into the diagnostic
stage, low risk, and high risk treatment stage and stabilized stage. The authors have
categorized the service elements into INFRAS which comprise physical facilities, human,
processes and systems. It was concluded, that higher satisfaction is achieved when
uncertainty is low which could be inferred from the highest score attributed during
stabilized stage. Tangibles were given priority in the initial stage but fade out over a
period of time. Physical facilities were the least important, human factor i.e. knowledge
and trust was the predominant criteria for customer satisfaction at all stages.45
(Rishard M, 2008), conducted a case study at a teaching hospital in Sri Lanka to
analyse the service quality dimensions through collection of both qualitative and
quantitative data by multiple techniques in nine wards out of eleven wards of the hospital.
Findings revealed that huge quality gaps existed for all types of patients. The lowest
service gap was found between the patients and the doctors and nurses in line with other
theories. Assurance was rated to have the lowest gap from the patient‘s end while
acceptance the highest. Reliability had the highest gap with respect to the internal

27
customers due to bureaucracy red tapism prevalent within the hospital. Amongst the
different wards Gynaecology and Obstetrics was found to have the lowest gap while Post
natal department had the maximum gap signalling towards lowest perceived quality. The
author concluded that hospital was unable to meet the service quality expectations of all
the three stakeholders considered in the case study. Since responsiveness and reliability
dimensions were found to be at the lowest rung hospital authorities need to be more
sensitive to these dimensions in particular and service quality as a whole.46
1.15.5 Conference Proceedings
(Raj A), observed that most patients prefer private hospitals. The authors
concluded, that knowledge and education of doctors, expertise, precision and personal
touch, convenience, timings, nursing, environment and cleanliness across both type of
hospitals were satisfying the customers. Treatment outcome had a major while cost had
the least influence on patient‘s satisfaction. Therefore the service providers needed to be
more conscious of amenities which satisfy the patients in order to have a positive impact
on the recovery of patients.47
(Ali. M.), conducted a field study at out- patient department with two hundred
and forty six patients at Ayub Teaching Hospital Pakistan, to evaluate the correlation
between service quality dimensions and overall service quality and patient‘s satisfaction.
The results revealed that the customer‘s perceptions did not exceed their expectations.
Responsiveness and empathy had a positive response while factors reliability, tangibility
and assurance showed a huge gap and found that patients were dissatisfied on these
dimensions. Specifically, patients were satisfied with the response and were appreciative
on effective services and attention paid to patients.48
(Pai Y, 2012), conceptualized a ten dimensional model for the existing
SERVQUAL measure. In their research they critically reviewed the SERVQUAL
measure postulated by other authors through extensive literature review. On the basis of
the questionnaire drawn to analyse the perception of the patients in relation to the quality
of hospitals, a ten dimensional SERVQUAL measure was put forth by the authors. The
main parameters outlined by them have been Image, Communication, Personnel Quality,
Relationship, Trustworthiness, Physical Environment and Infrastructure, Process of

28
Clinical Care, Administrative Procedures, Support and Personalization. The authors
added that the renewed SERVQAL measure needs to be reviewed time and again.49

1.15.6 Research Gaps

Though an extensive research and contributions regarding the assessment of gaps
in service quality has been in existence and their contribution is acknowledged but at the
same time this study addresses some of the gaps in the existing study and can contribute
in the existing literature in following ways
1. The types of hospitals included in this study contribute to the uniqueness of this
study. Private hospitals that are administered by trust both for profit and not for
profit are included in the present study. Apart from the private hospitals the study
also includes those hospitals that are affiliated to medical colleges are included in
this study and an attempt is made to identify the service gaps according to motive
of these hospitals.
2. Again an interesting contribution of this study shall be to identify the service gaps
and attribute these service gaps according to different wards or departments of
hospitals as intensity of clinical procedures may differ in these departments.
3. Moreover though the original SERVQAL instrument is intensive and
comprehensive in all respect a humble is attempt is made by researcher to add a
few statements regarding the availability, approach and consideration by expert
doctors who are affiliated to these hospitals. Due to huge shortage of expert
doctors many hospitals now a day does not have expert doctors round the clock
and these doctors are affiliated to more than one hospital. The researcher tried to
address this issue especially in rural context and access this gap by investigating
the patient expectations and perception of the same.
4. Further this study corroborates and substantiates an important shift in socio
demographic context that can play a huge role in service quality gap. The
enhanced aspiration of rural masses especially the increased literacy level,
increase disposable income, engagement in organized employment and
availability of information needs to be addressed by hospitals that may be prone
in excelling at clinical ability but at the same ignoring the functional competency

29
 that needs human resource orientation. This study has detailed out the broad socio
economic attributes of the patients as one of key factors shaping the patient
expectation that further amplify the service quality gaps in addition to the hospital
attributes.
5. Lastly the study has also addressed one of the key issues that whether the duration
of stay influences the perceived service gaps amongst the patient and contrary to
the belief that patients may have growing resentment with the increased stay the
study has reported that patients may In fact may be more compassionate towards
the hospital staff which has not been dealt in previous studies.
As the gaps in the literature suggest the researcher has tried to address these issues
by incorporating the same in the present study. The present study shall contribute to the
existing knowledge in its own humble way by exploring the patient and hospital
attributes that may be crucial in shaping the patient expectation and perception towards
the services of private hospitals. Hence the researcher has tried to venture this study and
thereby present a unique perspective that shall justify the need of such study.
1.16 Chapter Scheme
Chapter 1: INTRODUCTION, LITERATURE REVIEW & RESEARCH METHODOLOGY

This introductory chapter shall deal with important aspects of study such as
overview of health care industry in the global context and emerging economies such as
India. This chapter shall also deal with need of assessment of service quality in private
hospitals and also the rationale behind the present study. The chapter shall include key
concept of research design such as method of sampling, data collection instrument,
statistical tools.
This chapter shall elaborate on the various studies conducted by researcher on the
pertaining subject. Further key limitations and gaps of these studies shall be discussed
which would further corroborate the need of the present study.
Chapter 2: Health Care Centres & Health Care Aspects of Ahmednagar District
This chapter shall present a socio economic overview of the study area which is
Ahmednagar district. The chapter shall present some key statistical figures including

30
education level, income level which may be key determinant regarding the expected
service quality from private hospitals.

CHAPTER 3: Selected Hospitals in Ahmednagar District

This chapter shall elaborate in detail about the private hospitals selected in the
study. The different aspects of the hospitals which shall influence the service quality such
as infrastructure, facilities, vision and mission of the selected hospitals is eloborted.
Moreover the brief about hospitals which are the biggest private health care centers in the
district shall give some insight to the reader regarding the state of art health care facilities
available in the district.
CHAPTER4: Consumer Perceptions and Service Quality in Private Hospitals
The conceptual background of service quality and its various attributes shall be
discussed in the present chapter. An attempt shall be made to understand the
differentiating factor with regards to service quality dimensions of health care industry
vis a vis with other service industry. Moreover the utility of the SERVQUAL model and
its critique shall also be elaborated in the present chapter.
CHAPTER5: Data Analysis
The data collected through data collection instruments shall be systematically
presented with the help of various tables and graphs. Further an attempt shall also be
made to analyze and interpret the results obtained through SPSS.
CHAPTER6: Findings, Conclusion, Hypothesis Testing and Suggestions
This chapter shall summarize the major findings and observations which are noted
through the data collection instrument and interpretations of various conclusions derived
from the data analysis.

31
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