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The Effects of Perceived Service Quality on Patient Satisfaction in the Practitioner Clinic.


The services industry, especially those involving human-based services, has shown a dramatic increase since last time (Meesala and Paul, 2018). Many earlier researchers focused on the telecommunications, bank, and other highly-oriented industries of the organization. However, only a few studies are relevant to the field of medical care in Malaysia. Customers are seen as important assets in a business (Tan and Shen, 2000). Parasuman, Zeithamal and Berry (1988) emphasize that with the changing market conditions, fierce competition in service trade, improved competitiveness and yields depend on effective, active and improved service quality. Quality has become an icon for both the quality of the service or the product. Therefore, the quality of service directly affects customer satisfaction. The same goes for the medical services industry. The department of medical administration in hospitals or any other medical area should focus on customer's claims for consistency and fulfillment of requirements, to obtain clear roots and roots to improve the quality of services which in turn enhances the quality of treatment and after-care services to customers (Lu and Wu, 2016; Meesala and Paul, 2018).

The human services industry for developing countries such as India has recorded a relatively high rate of development and its administration takes the views of both parties outpatient and staff in connection with quality improvements from time to time; Even the quality of the doctor's placement is also taken into account in ensuring the quality of health services is maintained (Burns, 2014). Quality development can be supported in some time to come (Meesala and Paul, 2018). In medical treatment, clients are their patients and their perceptions over the past decades, are considered to be the main indicators while evaluating growth in the services sector around the world. The quality of service and patient satisfaction depends on their perceptions during the use of services that also focus on delivering services that meet customer health care services. Instead, it is also important to keep customers happy (Chaabouni and Abednnadher, 2014). Therefore, the quality of public health clinic services is seen as a very important factor affecting patients' satisfaction (Chaabouni and Abednnadher, 2014; Schaal, Schoenfelder, Klewer, and Kugler, 2017). In an effort to understand the relationship between the quality of health care services, a number of specific questions about prior service quality relationships, the perceived service quality and patient satisfaction need to be answered. Quality service delivery will create customer's happiness. It is very important for any organization to ensure its customers are satisfied to ensure that the organization is able to maintain its competitiveness in the marketplace.

From a strategy perspective, quality can keep the organization name for a long term period. It can also be a measurement in increasing the size of the market as a whole. It also supports the overall advantages and prospects of long-term survival of the organization. There is extensive art on customer satisfaction and service quality. Satisfaction revealed patient assessment. While art quality satisfaction in the field of health differs from business, empirical validation of interrelated major factors appears to be limited. Better service quality improves the relationship between customers and organizations and this is a two-way flow value (Ojo, 2010), which means employees as suspended bridge depend on customers and organizations, thereby showing valuable exchanges among them. Mortazavi, Williams, McCue, Schaeffer, and the World (2008) describe customer satisfaction as a key business strategy for a large number of organizations in strengthening their market position.

Literature Review

Service Quality Antecedents

Factors that contribute to the quality of service in health care services are composites and there is no compromise among researchers. The SERVQUAL scales developed by Parasuraman et al. (1988) have contributed to significant progress from the point of understanding and measurement of service quality. The most recognized framework for the quality of healthcare services has been developed by Donabedian (2005). This framework consists of structures, processes, and results dimensions. Structure comprising the properties of facilities, equipment, personnel, and organizations where care is provided; this process includes activities that occur between healthcare providers including those relating to treatment of patients receiving treatment; and results that constitute the final health condition resulting from the treatment process (Donabedian, 2005). Studies have shown that the three categories of quality evaluation, quality / process quality work are the most direct and most relevant in the context of health care services (Choi et al., 2004). Hence, the quality of the process or the quality of functionality delivered by doctors, nurses and other healthcare providers is an important factor in evaluating the quality of health care services. Technical quality is focused on the quality of nursing care and nursing care provided; it refers to the accuracy and basic technical procedures, which are defined based on technical accuracy of diagnosis and medical procedures or compliance with professional specifications. Chaabouni & Abednnader (2014); Lambooij, Drewes, & Koster (2017) refer to the quality of service as staff competence as they carry out their routines (Guyatt, Briel, Pauli-, & Niederha, 2018; Hoque, Kumari, Ruseckaite, Romero & Evans, 2016). Patients often rely on functional aspects such as infrastructure, interaction, and administrative construction from technical aspects when assessing the quality of health care services. According to Chaabouni & Abednnadher, 2014, Chan, Wong, Cheung, & Lam, 2018; Schaal et al., 2017) based on the quality assessment of healthcare services on the quality of the interpersonal factors and the environmental factors of the profession are considered less important. Quality of priority in healthcare sees infrastructure, interaction, medical care and nursing care contributing to the quality of the organization's services. These processed products contribute to customer satisfaction as a patient. Therefore we formulate the hypothesis as below:

H1: There is a positive relationship between tangible and patient satisfaction

H2: There is a positive relationship between communications and patient satisfaction

H3: There is a positive relationship between medical care and patient satisfaction

The theoretical framework for healthcare service quality was developed. It shows the service quality antecedents, namely, infrastructure, interaction, administrative, medical care, perceived service quality, and patient satisfaction constructs. All the constructs have been briefly explained in the above section.


The concept of infrastructure is an indirect measure for the quality of care. Infrastructure includes the tan-giblet features of a service delivery, which is related to equipment, furniture, the physical appearance of the clinic, facilities, availability of resources, and environment. It is also referred to as manmade organization's physical facility or servicescapes, which include exterior attributes such as parking, 10 and the signage and interior attributes such as design, layout, and equipment (Zeithaml et al., 2009; Sureshchandar et al., 2002). Since the tangible is a concept that is quite stable and has a significant relationship with quality of care, therefore, it can affect the performance of the healthcare system, that is, it affects patient perception toward healthcare service quality delivered.

C ommunication

In providing effective health services, communication between service providers is crucial to contributing to customer satisfaction. This situation contributes to the broader interaction and communication between service providers and patients. Therefore, in health care services, interactions between patients and care providers are essential (Hausman, 2004; Zineldin, 2006). Communication is defined as a patient's affair with doctors and nurses during their attendance at the clinic. (Agarwal & Singh, 2016; Chaabouni & Abednnadher, 2014) based on a sample of respondents who developed and tested the five-factor model of public clinical service quality, three out of five dimensions, "staff competence", and "staff attitude" Research has found that two of the dimensions, the competence of clinical staff and their attitudes have a strong impact on the quality of service and patient satisfaction. Communication between patients and healthcare providers has the effect of patient perceptions on patients' quality of care (Giovanis & Athanasopoulou, 2018; Lu et Wu, 2016; Meesala & Paul, 2018) The idea is supported by Chan et al., 2018), in systematic research, they emphasize that patients interact with healthcare providers and these interactions reflect their overall perceptions of the quality of service available.

Medical Care

Medical care is a major factor contributing to customer satisfaction with hospital services. Although medical treatment has the highest priority among patients, evaluation of medical care is generally not understood by their majority. Therefore, researchers have used a measure of treatment by a proxy. Therefore, damson medical treatment is also known by different terms: including doctors compositions (Lambooij et al., 2017), clinical quality (Hoque et al., 2016; Schaal et al., 2017); doctor's concern (Lu & Wu, 2016; Choi et al., 2004, 2005); and technical training (Agarwal & Singh, 2016) (Ridgely, Greenberg, Pillen, & Bell, 2016). Medical care describes the services received by patients from medical personnel comprising doctors, nurses, officers and hospital administrators (Agarwal & Singh, 2016). The study conducted by Aiken (2018), shows that the quality of nurses who care for patients is also part of the measured medical care to determine the high quality of services available at the Hospital. Patients will feel satisfied when their health care is well served. Medical care through quality continues to be emphasized, will enhance patient satisfaction with the services offered at the clinic. Even the increased quality of expertise, tools, skills, patient care is very satisfying for patients.


This study adopts a cross-sectional approach in data gathering appropriately design to meet the objectives of the research and assist towards the findings. The unit of analysis in this study is an individual who had experienced being received treatment from the general practitioner clinic. Patients are suitable to be the respondents in a healthcare service quality study because of the treatments they received from the clinic representative with salient experiences and it is not easily forgotten (Andaleeb, 2008; Andaleeb, 2000). From the absence of reliable lists, purposive convenience sampling methods were used. The survey questionnaires were distributed to the potential respondents during working day by the researcher. All 201 respondents are involved in this survey. The potential respondents were first filtered by asking them a few questions regarding their experience going to the clinic before they were given the set of the survey questionnaires. Confidentiality was ensured as the subjects were not required to state their names or other particulars on the survey form. This study analyzes the level of patient satisfaction in general practitioner clinic in Kuantan Pahang, the main location, for outpatient services.


Multiple regressions are used to explore the relationship between one continuous dependent variable and a number of independent variables or predictors. Multiple regression allows a more sophisticated exploration of the interrelationship among a set of variables. In this case, multiple regressions are used to see the relationship between patient satisfactions in perceived service quality in the practitioner clinic. Multiple regressions are an extenuation of bivariate correlation and used when the independent variables are correlated with one another and with the independent variable examples as the table below shows the descriptive statistic for TGB, COM, MC and PS.

The R column shows that there was correlation between the independent and dependent variable. The result shown HIGH correlation between predictors (constant) R = 0.387. That means 13.2% variance in independent variable which is significant. This indicated that the combination of the predictors significantly predict patient's satisfaction.

Table 2 coefficients show the estimated regression, and the factors relation between constants. PS 1.890 (p = 0.001) + TGB 0.102 (p = 0.060) + COM 0.157 (p = 0.019) + MC 0.222 (p = 0.001).

Discussion and Conclusion

This study is related to patients' satisfaction to perceive service quality factor in the practitioner clinic in Kuantan. This study tested a model of patient satisfaction for the practitioner clinic. The results suggest that the model has satisfactorily explains the patients' satisfaction on communications and medical care, but there tangible is not given any effect to patient satisfaction. Based on the result, the standardized values, we are able to see that the quality of service has the most impact on the patient satisfaction. Based on the results for the standardized values, we are able to see that tangible, communication and medical care of perceived service quality factors are key factors affecting patient satisfaction with adjusted [R.sup.2] = 0.132 or 13.2% of the factor contribute to patient satisfaction. The results showed that the layout of the clinic, infrastructure and tools and machine which are categorized in tangible are not really important factors in satisfying the patient. The importance and the needs are there for describing or defining the physical environment by identifying those elements or dimensions that make up the physical environment. Therefore, in the questionnaires several elements have been defined such as cleanliness, lighting, noise, and furniture arrangements.

Communication has a significant correlation with patients' satisfaction, the result shows a significant correlation in patient satisfaction. This result is align with previous study done by Chan et al. (2018); Meesala and Paul (2018); Ridgely et al. (2016) communication is important part that being valued by the patient as a service quality. The dimension of communication is holistic such as the language, the body language, tone, intonation and clear sound. While medical care has a significant correlation with patient satisfaction whereby patients will feel satisfied when their healthcare is being addressed. Medical care through the quality that is continuously emphasized will increase patient's satisfaction with the services offered at the clinic. Even the enhancement of the quality of the doctor's expertise, tools, skills, patient care have great impact on patient's satisfaction.


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Norizan Yusof (*)

Faculty of Business and Management, Widad University College, Kuantan, Pahang, Malaysia


Noorazizah Noorashid

Faculty of Education and Social Sciences, Widad University College, Kuantan, Pahang, Malaysia

Muslina Md Muis

Widad University College, Kuantan, Pahang, Malaysia

Nur Nazihah Mohd Nazir

Widad University College, Kuantan, Pahang, Malaysia

Mohd Asyraf Kamarol Bahrin, Kasturi Sivabalan

Widad University College, Kuantan, Pahang, Malaysia
Table 1: Descriptive Statistic Model Summary

Model  R     R Square  Adjusted R Square  Std. Error of the Estimate

1      .387  .150      .132               .33760

(a.) Predictors: (Constant), MC, COM, TGB b. Dependent Variable: PS

Table 2: Coefficients

Model     B      t      Sig (p)

Constant  1.890  5.008  .000
TGB        .102  1.892  .060
COM        .157  2.361  .019
MC         .222  3.486  .001
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Author:Yusof, Norizan; Noorashid, Noorazizah; Muis, Muslina Md; Nazir, Nur Nazihah Mohd; Bahrin, Mohd Asyra
Publication:Global Business and Management Research: An International Journal
Geographic Code:9MALA
Date:Apr 1, 2018
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