Assessing health care service quality using customer gap model

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


Movements of quality improvement in health care are growing world over. Health policies of many countries have incorporated the concept of quality improvement in their documents. This is true for the developed nations and some of the developing nations. In Pakistan, about 71% of total health care expenses are from the private sector, but there is no system on record to check the quality of these services. However, for the rest of the health care expenditure by the public sector, the recently released health policy of 2001 has, as its key feature, emphasized on good governance to achieve quality health care. But the country has to struggle hard to achieve quality of care goals. Pakistan is in a state of health sector reforms and devolution of health services at district level is in process. In such circumstances it is the ripe time to work for quality improvement in both public and private sectors. For service quality assessment, among many researchers, the work of Parasurman, Zeithaml and Berry, stand high since they have identified after extensive research, dimensions for service quality assessment, which are equally applicable in different types of service organizations. The dimensions of service quality determined by them are: Reliability, Responsiveness, Assurance, Empathy and Tangibles. They have propounded "Customer Gap Model" which identifies difference between customer perceptions and expectations. Customer perceptions are subjective assessments of actual service experiences, while customer expectations are the standards of or reference point for performance against which service experiences are compared and are often formulated in terms of what a customer believes should or will happen. This pilot study was attempted to assess service quality through the use of customer gap model in a secondary health care facility. A cross-sectional survey was conducted among adult patients visiting an out-patient department (OPD) of a Taluka hospital in Hala, district, Hyderabad. Each patient was Interviewed twice, first at the reception for his expectation level about the service quality and at his exit for his perception level' Spearman's correlation coefficient was calculated between expectation and perception for each item for the five service dimensions. The correlation coefficients calculated between expectations and fulfilled expectations (perceptions) for all the items in all the dimensions were less than +0'60' implying that there were not complete agreement between expectations and fulfilled expectations for these items. This indicated that there were gaps between expectations and fulfilled expectations for all items for all the dimensions. These gaps however varied relatively for different items. The correlation coefficients for the items in the dimension of reliability were relatively lower than all items for the rest of the dimensions. It indicated that these items have relatively wider gap between expectations and fulfilled expectations of patients and hence poorer service quality for the items in the dimension of reliability. The correlation coefficient for expectations and fulfilled expectations for all items for all the dimensions except reliability were significant and relatively higher. It indicated that the gap between expectations and fulfilled expectations was relatively less and hence the service quality for all the items in the given dimensions (responsiveness, assurance, empathy and tangible), were relatively better. The study results suggested that there is a need for more inquiry into the unexplored paradigm of customer focus in Pakistan. This pilot study needs to be verified with more detailed study in to gaps model of service quality. The results gave some indication of better service quality for some dimensions of service quality. These results need to be further verified and complemented with some more qualitative and participatory investigations. Since the study indicated poorer service quality for the dimension of reliability, which is considered as the most important dimension of service quality, the study recommended that steps should be taken to improve the quality of services up to the satisfaction of the consumers at the Taluka hospital.

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