Service Quality Assessment of Hospitals in Asian Context: An Empirical Evidence From Pakistan

Examining Soft and Hard Attributes of Health Care Service Quality and Their Impacts on Patient Satisfaction and Loyalty

BACKGROUND AND OBJECTIVES

Many studies have confirmed the influences of various service quality dimensions on patient satisfaction and loyalty, but no existing theoretical model accounts for variation in how different types of patients evaluate service quality's soft and hard attributes. This research gap may cause problems for administrators needing to decide how to distribute resources appropriately across multiple departments. Therefore, this study establishes a theoretical model of the differences between inpatients' and outpatients' evaluations of hard and soft qualities and compares such evaluations' influences on patient satisfaction and loyalty. Also, to supplement statistical analysis and respond to scholars' calls for more mixed-methods studies of health care quality, this research incorporates analysis of online reviews to provide a holistic, close to real-time picture of patients' service experience perceptions.

METHODS

This study's survey sample comprised 292 inpatients and 137 outpatients from a Taiwanese hospital. We used partial least squares structural equation modeling to test the hypothetical model and importance-performance map analysis to identify factors that were significant to the service process but performed poorly. Finally, we used a text-mining technique to scrape 536 reviews posted on Google Maps, and Leximancer Portal to perform automated content and sentiment analyses on those data, as a means of mapping the critical concepts and themes that influenced patient experiences.

RESULTS

This study's analyses support the ideas that both hard and soft qualities are critical dimensions of service quality, and that each has different influences on inpatients' and outpatients' satisfaction and loyalty. Specifically, the sampled inpatients strongly valued the hard qualities of the hospital but were not satisfied with it. On the other hand, soft qualities attracted outpatients' attention and influenced their satisfaction and loyalty. In addition, content analysis revealed that soft qualities were the main reason patients left comments, whether positive or negative. Waiting time emerged as another critical element in triggering patients' unfavorable reviews.

CONCLUSIONS

Patient population type, whether inpatient or outpatient, has been found to impact perceptions of service quality within health care institutions. As such, health care administrators should be cognizant of this phenomenon and make informed and tailored decisions when addressing quality within their respective services. Emphasis on the development of both interpersonal and professional skills among health care personnel may prove beneficial in enhancing the patient experience and ultimately fostering positive online reviews.

Assessing the Gap Between Women's Expectations and Perceptions of the Quality of Intrapartum Care in Jordan: A Two-Stage Study Using the SERVQUAL Model

INTRODUCTION

Although Jordan has made significant progress toward expanding the utilization of facility-based intrapartum care, prior research highlights that poor service quality is still persistent. This study aimed to identify quality gaps between women's expectations and perceptions of the actual intrapartum care received, while exploring the contributing factors.

METHODS

Utilizing a pre-post design, quality gaps in intrapartum care were assessed among 959 women pre- and postchildbirth at a prominent tertiary hospital in northern Jordan. Data were gathered using the SERVQUAL scale, measuring service quality across reliability, responsiveness, tangibles, assurance, and empathy dimensions.

RESULTS

The overall mean gap score between women's expectations and perceptions of the quality of intrapartum care was -0.60 (±0.56). The lowest and highest mean gap scores were found to be related to tangibles and assurance dimensions, -0.24 (±0.39) and -0.88 (±0.35), respectively. Significant negative quality gaps were identified in the dimensions of assurance, empathy, and responsiveness, as well as overall service quality (p < 0.001). The MLR analyses highlighted education (β = 0.61), mode of birth (β = -0.60), admission timing (β = -0.41), continuity of midwifery care (β = -0.43), physician's gender (β = -0.62), active labour duration (β = 0.37), and pain management (β = -0.33) to be the key determinants of the overall quality gap in intrapartum care.

CONCLUSION

Our findings underscore the importance of fostering a labour environment that prioritizes enhancing caregivers' empathetic, reassuring, and responsive skills to minimize service quality gaps and enhance the overall childbirth experience for women in Jordan.

PATIENT OR PUBLIC CONTRIBUTION

This paper is a collaborative effort involving women with lived experiences of childbirth, midwives, and obstetrics and gynaecologist physicians. The original idea, conceptualization, data generation, and coproduction, including manuscript editing, were shaped by the valuable contributions of stakeholders with unique perspectives on intrapartum care in Jordan.

Cross-Cultural Adaption and Validation of SERVPERF Tool for Measuring Healthcare Quality in an Oncology Public Hospital, Vietnam

SERVPERF (Service Performance) tool needs to be adapted to the context and the usage purpose. Our study aimed to validate the context adapted SERVPERF tool in an Oncology public hospital in Vietnam. A study was conducted in 2020 with 227 in-patients as respondents the modified SERVPERF tool. Data collected were analyzed for tool assessment (reliability and validity). The new order in 5 factors in the modified tool were: (1) Responsiveness; (2) Empathy; (3) Reliability; (4) Tangible and (5) Assurance. The modified tool has a high Cronbach's alpha of .94. The tool validity was confirmed by Confirmatory Factor Analysis (CFA) where the healthcare service quality item corresponds as χ²/df = 3.79, Comparative Fit Index (CFI) = 0.85, Tucker Lewis Index (TLI) = 0.83, and Root Mean Squared Error of Approximation (RMSEA) = 0.08 are good fit indices. The modified tool SERVPERF with high reliability and validity could be applied for measuring the clients' perceptions about healthcare service quality in other Oncology public hospitals in Vietnam.

Patient satisfaction with quality of care in public hospitals in Albania

Healthcare service quality and hospitalized patient satisfaction in Albania have never truly received the necessary attention. The aim of this study is the assessment of key elements of service quality and their relationship with patients' satisfaction with receiving healthcare at public health institutions in Albania. The study examines five key dimensions of quality such as responsiveness, reliability, assurance, tangibles, and staff empathy to assess properly the healthcare quality and patient satisfaction in Albania based on the SERVQUAL instrument, which measures the differences between patient's perceptions of service quality received, and their expectations in terms of these five dimensions. A total of 800 randomly selected patients were interviewed in the main cities of Albania in public hospitals. A respective literature review was also a necessity to determine not only the appropriate methodology to be applied, together with the right quality dimensions to use but also for a better understanding of the link between service quality and patient satisfaction. The determination of the main quality factors which contribute to patient satisfaction, as well as, their order of importance, is another key aspect of the study, which finalizes with appropriate recommendations that might help quality improvement in future. The analysis shows that overall patient satisfaction is affected in public hospitals by all dimensions of service quality. Therefore, patients' perspective is extremely important in assessing healthcare service quality and should be taken into consideration by healthcare managers and policymakers in Albania, whenever significant reforms will be undertaken to improve the quality of services in this sector.

Evaluation of the Satisfaction of Patients Seen in the Dermatology Department of a Spanish Tertiary Hospital

Patient satisfaction is of great importance and is a key factor in the quality of care. The most commonly used measure of this factor is satisfaction surveys. This study used the modified SERVQHOS healthcare quality survey model, which adapts the SERVQUAL survey. The main objective was to determine the degree of satisfaction of patients seen in the outpatient department of the Dermatology Service, as well as to describe and detect those aspects that could be improved to offer better quality care. A total of 250 patients responded to the survey. The mean Likert scale score for the 19 items on the perceived quality of care was 4.17 ± 0.796 points. Up to 92.8% were satisfied or very satisfied with the care received. All items were statistically correlated with overall satisfaction (p < 0.001). In the multivariate study, the variables with predictive capacity in relation to overall satisfaction (p < 0.05) were “the technology of the medical equipment”; “the directions to the consultation”; “the confidence that the staff transmits”; “the state of the consultation”; and “the interest of the staff in solving problems”. Satisfaction was significantly higher in men (p < 0.05), with a level of education up to primary school (p < 0.05) and no work activity (p < 0.001). The final mean score in the degree of perceived satisfaction was very high, indicating that the expectations of the patients were exceeded, and showing that satisfaction is closely linked to the qualities and skills of the staff in their relationship with the patient.

Evaluation of energy-saving retrofit projects of existing rural residential envelope structures from the perspective of rural residents: the Chinese case

The existing residential envelope in rural areas has low energy efficiency, with low energy utilization and serious energy waste for winter heating. However, in recent years, farmers have not undertaken energy efficiency retrofit projects for existing buildings in rural areas. This study proposed an evaluation model based on the logistic-AHP-TOPSIS method from the perspective of farmers. First, this study conducted a questionnaire survey of 208 rural households and used logistic models to determine which existing evaluation indicators significantly impact farmers' willingness to participate in energy efficiency retrofit projects. Second, the weights of the eight indicators were determined using AHP. Finally, this study evaluated the retrofit program of a case in Gansu Province using the TOPSIS method. In the analysis, total investment, annual winter heating costs and energy efficiency improvements were found to be the most important factors for farmers. The highest score for existing buildings was 0.3747 because there is no additional investment required; the option of partial retrofitting according to the actual needs of households scored 0.3350 because it balances economic performance with energy efficiency performance; The entire retrofit program has the highest investment and a long payback period, and its score is the lowest with 0.2904. Furthermore, the study recommended that a self-build and self-repair organization led by village collectives be developed to unify the retrofit design and construction and lower renovation costs. Bulk purchases could enable farmers to increase their power in negotiations.

The Servqual Method as an Assessment Tool of the Quality of Medical Services in Selected Asian Countries

Introduction: The Servqual (an acronym from the words “service” and “quality”) method is used to assess the quality of provided services on the basis of standardised evaluation parameters. This method is based on five gaps resulting from the discrepancy between expected and received service quality. The aim of this meta-analysis and the systematic review was to view and assess the major differences in the five dimensions of the Servqual method used to evaluate the quality of delivered health care services in selected Asian countries. Another goal of the study was to confirm the use of the Servqual method as a suitable tool for assessing the quality of health care services. Methods: This study followed the PRISMA guidelines for systemic reviews and meta-analyses. The following electronic databases for medical publications were used: PubMed, Medline, Scopus, and Cochrane were searched for articles published from January 2000 to April 2020. The databases were explored with original search queries containing the following terms: “Servqual”, “service quality”, “Servqual model”, “servqual questionnaire”, “health service quality”, “health care services”, “patients’ expectation”, “patients’ perception”, “expectation”, “perception”, and “health care services”, in combination using “AND” and “OR”. In order to minimize bias, two researchers (PK and DK) independently performed an online search for peer-reviewed papers, using the combinations of the above-mentioned words. In addition, references of eligible publications were checked. All disagreements, regarding the inclusion or exclusion of specific studies, were resolved through consultations among all the authors. Results: A total of 96 reports were identified and submitted to a preliminary screening selection. As a result of the pre-screening stage, 64 papers were qualified to further evaluation. The output of the evaluation brought 15 reported studies, meeting the pre-defined inclusion/exclusion criteria. The total number of participants was 5903 (ranging from 20 to 439 in individual reports), and 54% of them were women. Eight studies (53%) were from Iran, two from Pakistan (13%) and one each from Arabia, Malaysia, South Korea, Bangladesh, and Iraq (each-about 7%). The results showed gaps between patients’ expectations and perceptions in all five dimensions of Servqual in almost each analysed study. The highest and lowest values of the gaps in quality scores were associated with the dimensions of reliability, tangibility, empathy, and responsiveness, respectively. Conclusions: The study demonstrated that the method of Servqual is broadly used in various medical sectors to assess the quality of medical services provided. In addition, the study demonstrated that patients had significantly higher expectations of the medical services offered in the five dimensions studied. The results, obtained through the Servqual method, may help improve and monitor the quality of services provided by different institutions.

Applicability of healthcare service quality models and dimensions: future research directions

Purpose

The purpose of this study is to explore the literature of healthcare service quality for identifying and analyzing the healthcare service quality models and dimensions and to present future research insights pertaining to the applications of these models and dimensions.

Design/methodology/approach

A literature review of healthcare service quality has been performed on 59 relevant studies after applying inclusion and exclusion criteria. Google Scholar and Scopus are the primary sources to find the relevant documents. Search was limited to keywords of “service quality,” “healthcare,” “models” and “dimensions.”

Findings

The results revealed that different models and dimensions have been evolved and developed after SERVQUAL in healthcare service quality literature. There is still a need to develop new models, add new contextual dimensions and items in existing models on different aspects of healthcare services. There is also a need to incorporate the perspective of service providers as respondents. Moreover, healthcare service quality models can be devolved or narrowed down at department and individual levels.

Originality/value

This study presents valuable research insights for the researchers and practitioners in ways that healthcare service quality models and dimensions can be developed, modified and tested further in different research contexts and settings. Besides, the literature on healthcare services can be enhanced and enriched.

Satisfaction in population-based cancer screening in a Chinese rural high-risk population: the Yangzhong early diagnosis and treatment of upper gastrointestinal cancer

BACKGROUND

Screening for upper gastrointestinal cancer (UGC) effectively reduces morbidity and mortality in gastric and esophageal cancers. It is considered one of the effective measures for cancer control in China, but studies on its functional quality are lacking. Our study assessed the quality of screening service funded by Upper Gastrointestinal Cancer Early diagnosis and treatment (UGCEDAT) and its correlation in Yangzhong People's hospital, China.

METHODS

A cross-sectional study was conducted among 516 screening users at a screening centre in Yanghzong People's hospital from April to July 2021. The service quality questionnaire (SERVQUAL) based on the service quality gap (SQG) model was adopted. We calculated the mean scores of perceptions and expectations and their gap. To determine the association between overall SQG and related features of participants, we used a multivariate logistic regression.

RESULTS

The average scores of screening service users' perceptions and expectations were 4.05 and 4.55, respectively. The SQG of five dimensions (tangibles, reliability, responsiveness, assurance and empathy) were negative, and the overall SQG was -0.51. The responsiveness dimension had the largest gap, and tangibles had the smallest gap. Occupation status (AOR: 0.57; CI: 0.37-0.89), health self-assessment (AOR: 4.97; CI: 1.35-18.23), endoscopy experience (AOR: 0.55; CI: 0.38-0.81), distance from screening hospital (AOR: 1.85; CI: 1.25-2.73) and frequency of visit (AOR: 1.65; CI: 1.10-2.46) were associated with the overall SQG.

CONCLUSIONS

We observed a negative gap between perceptions and expectations of the function quality of screening service, implying a high dissatisfaction across different dimensions. Service providers should take adequate measures to bridge the dimension with the largest quality gap. Meanwhile, attention should be paid to identifying the influencing factors of the overall SQG and the characteristics of dimensional expectations and perceptions to improve the effectiveness of the screening program.

Hospital Facebook Reviews Analysis Using a Machine Learning Sentiment Analyzer and Quality Classifier

While experts have recognised the significance and necessity of social media integration in healthcare, no systematic method has been devised in Malaysia or Southeast Asia to include social media input into the hospital quality improvement process. The goal of this work is to explain how to develop a machine learning system for classifying Facebook reviews of public hospitals in Malaysia by using service quality (SERVQUAL) dimensions and sentiment analysis. We developed a Machine Learning Quality Classifier (MLQC) based on the SERVQUAL model and a Machine Learning Sentiment Analyzer (MLSA) by manually annotated multiple batches of randomly chosen reviews. Logistic regression (LR), naive Bayes (NB), support vector machine (SVM), and other methods were used to train the classifiers. The performance of each classifier was tested using 5-fold cross validation. For topic classification, the average F1-score was between 0.687 and 0.757 for all models. In a 5-fold cross validation of each SERVQUAL dimension and in sentiment analysis, SVM consistently outperformed other methods. The study demonstrates how to use supervised learning to automatically identify SERVQUAL domains and sentiments from patient experiences on a hospital's Facebook page. Malaysian healthcare providers can gather and assess data on patient care via the use of these content analysis technology to improve hospital quality of care.

Patient Satisfaction and Hospital Quality of Care Evaluation in Malaysia Using SERVQUAL and Facebook

Social media sites, dubbed patient online reviews (POR), have been proposed as new methods for assessing patient satisfaction and monitoring quality of care. However, the unstructured nature of POR data derived from social media creates a number of challenges. The objectives of this research were to identify service quality (SERVQUAL) dimensions automatically from hospital Facebook reviews using a machine learning classifier, and to examine their associations with patient dissatisfaction. From January 2017 to December 2019, empirical research was conducted in which POR were gathered from the official Facebook page of Malaysian public hospitals. To find SERVQUAL dimensions in POR, a machine learning topic classification utilising supervised learning was developed, and this study's objective was established using logistic regression analysis. It was discovered that 73.5% of patients were satisfied with the public hospital service, whereas 26.5% were dissatisfied. SERVQUAL dimensions identified were 13.2% reviews of tangible, 68.9% of reliability, 6.8% of responsiveness, 19.5% of assurance, and 64.3% of empathy. After controlling for hospital variables, all SERVQUAL dimensions except tangible and assurance were shown to be significantly related with patient dissatisfaction (reliability, p < 0.001; responsiveness, p = 0.016; and empathy, p < 0.001). Rural hospitals had a higher probability of patient dissatisfaction (p < 0.001). Therefore, POR, assisted by machine learning technologies, provided a pragmatic and feasible way for capturing patient perceptions of care quality and supplementing conventional patient satisfaction surveys. The findings offer critical information that will assist healthcare authorities in capitalising on POR by monitoring and evaluating the quality of services in real time.

How to improve patient satisfaction behavioral compliance and hospital image through nurse caring: Strategizing for healthcare during COVID-19

We investigated the impact of nurse caring on patient satisfaction, behavioral compliance, and organization image from a patient's perspective in the private healthcare sector in the Syrian capital-Damascus. The conceptual model can significantly explain 40, 64, and 49% of satisfaction, compliance, and organization image, respectively in a statistical manner. Responsiveness had more influence on patient satisfaction than communication skills. Friendship behavior had no significant effect on satisfaction, and behavioral compliance. The most important aspect that influenced the organization's image was the nurse's communication skills followed by responsiveness and service friendship behavior.

Assessing Patient-Perceived Hospital Service Quality and Sentiment in Malaysian Public Hospitals Using Machine Learning and Facebook Reviews

Social media is emerging as a new avenue for hospitals and patients to solicit input on the quality of care. However, social media data is unstructured and enormous in volume. Moreover, no empirical research on the use of social media data and perceived hospital quality of care based on patient online reviews has been performed in Malaysia. The purpose of this study was to investigate the determinants of positive sentiment expressed in hospital Facebook reviews in Malaysia, as well as the association between hospital accreditation and sentiments expressed in Facebook reviews. From 2017 to 2019, we retrieved comments from 48 official public hospitals' Facebook pages. We used machine learning to build a sentiment analyzer and service quality (SERVQUAL) classifier that automatically classifies the sentiment and SERVQUAL dimensions. We utilized logistic regression analysis to determine our goals. We evaluated a total of 1852 reviews and our machine learning sentiment analyzer detected 72.1% of positive reviews and 27.9% of negative reviews. We classified 240 reviews as tangible, 1257 reviews as trustworthy, 125 reviews as responsive, 356 reviews as assurance, and 1174 reviews as empathy using our machine learning SERVQUAL classifier. After adjusting for hospital characteristics, all SERVQUAL dimensions except Tangible were associated with positive sentiment. However, no significant relationship between hospital accreditation and online sentiment was discovered. Facebook reviews powered by machine learning algorithms provide valuable, real-time data that may be missed by traditional hospital quality assessments. Additionally, online patient reviews offer a hitherto untapped indication of quality that may benefit all healthcare stakeholders. Our results confirm prior studies and support the use of Facebook reviews as an adjunct method for assessing the quality of hospital services in Malaysia.

Measurement of Service Quality Gaps in Dental Services using SERVQUAL in Public Hospitals of Rawalpindi

Objectives

To measure service quality gaps in dental services provided at public hospitals of the district, Rawalpindi.

Methods

A cross-sectional survey was conducted in two of the public hospitals of the district, Rawalpindi from April to October 2019. Non-probability consecutive sampling was used to include a total number of 400 patients, equally divided between Rural health center (RHC) and Tehsil headquarter (THQ). Face to face interviews were done using a 32-item SERVQUAL in the form of a structured questionnaire where one part of the questionnaire was filled before the treatment and the other after the treatment. Cronbach's alpha coefficient was found to be 0.90. It was analyzed using SPSS version 25 with descriptive and parametric tests, and further multiple linear regression was done.

Results

The quality of services provided to patients was significantly lower than their expectations in both RHC (-14.48 ± 7.96) and THQ (-9.97 ± 7.97). Independent t-test showed a significant difference in service quality between both the hospitals (-4.41), with a better quality of services in THQ. Association of service quality gap was statistically significant with gender, education, occupation, monthly income, and the number of visits to the hospital with p-value < 0.05. The type of hospital was the strongest predictor (ß = 4.12) of the outcome variable.

Conclusion

The findings reveal that patients' expectations exceed their perception of dental services provided in public hospitals. THQ provided a better quality of services compared to RHC.

Ascertaining service quality and medical practitioners' sensitivity towards surgical instruments using SERVQUAL

Purpose

Service quality (SQ) has become an essential and indispensable component in healthcare and many other industries. SQ can deliver guaranteed stakeholder value and consequent consumer delight in the healthcare sector. The purpose of this study is to identify the relationships of various SERVQUAL elements with respect to the SQ of surgical instrument suppliers among surgeons.

Design/methodology/approach

Data were collected from a sample of 112 surgeons working in the USA using the “snowball sampling” technique. A few standardised questionnaires, including SERQUAL, were used to collect the data. R-programming was used to perform structural equation modelling (SEM) analysis on the collected data.

Findings

The research study identified that service delivery factors and the SQ of surgical instruments contribute significantly towards medical practitioner sensitivity in the US healthcare industry. Word of mouth (WOM) did not have any significant impact on the medical practitioners' sensitivity.

Originality/value

A review of related literature revealed that studies that examine the surgeon's perspectives of SQ are scarce. Thus, the present study is directed towards this gap in literature. The findings of the study are significant in nature and have made a substantial contribution to management literature.

Hospital service quality based on HEALTHQUAL model and trusting nurses at Iranian university and non-university hospitals: a comparative study

Background

Establishment and improvement of patients’ trust in healthcare organizations like hospitals necessitate delivery of high-quality services by nurses, as the largest group of healthcare providers. The present study aimed to compare hospital service quality based on the HEALTHQUAL model and trusting nurses at university and non-university hospitals in Iran.

Methods

This comparative cross-sectional study was conducted on 990 patients admitted to university and non-university hospitals located in Bushehr Province, southern Iran, who were selected using the stratified random sampling method. The data were collected through the HEALTHQUAL questionnaire and the Trust in Nurses Scale, and then analyzed via the SPSS Statistics software (version 22) as well as the General Linear Model (GLM) univariate procedure and the Chi-square test with a significance level of 0.05.

Results

The study findings revealed that the mean values of real quality (perceptions) and ideal quality (expectations) were 3.89 ± 0.69 and 4.55 ± 0.47, respectively. The gap between the real and ideal quality (− 0.64) was also larger at non-university hospitals from the patients’ viewpoints. Comparing various dimensions of service quality, the largest gap at university and non-university hospitals was associated with “environment” (− 0.13) and “empathy” (− 0.18), respectively. Additionally, the mean scores of the patient trust in nurses at university and non-university hospitals were 10.34 ± 5.81 and 8.71 ± 4.05, respectively, being a statistically significant difference (p <  0.001).

Conclusion

The study results demonstrated that hospital service quality and trusting in nurses were at higher levels at the university hospital than the non-university one; however, hospital service quality was at a lower level than what the patients had expected. Accordingly, hospital managers and policy-makers were suggested to focus on patients to reduce gaps in service quality, to promote service quality, and to provide better healthcare services to patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-020-00513-y.

Evaluation of Service Quality From the Patients’ Viewpoint in the Oncology Setting of a University Hospital in Iran

Background: Hospitals are one of the most important units in providing healthcare services. The assessment of the quality of provided services is essential in these settings. Patient satisfaction is one of the key indicators of service quality in healthcare organizations. Objectives: This study aimed at investigating the gap between the perceptions and expectations of service recipients in Shohada-e-Tajrish Hospital (Tehran, Iran), using the SERVQUAL model in 2020. Methods: This cross-sectional study was conducted on patients with cancer, who were upon discharge from Shohada-e-Tajrish Hospital. Patients (> 18 years) with a cancer diagnosis, who were being discharged from the oncology ward of the hospital, were included in this study. The sample size was estimated at 118. The required information was collected, using the modified SERVQUAL questionnaire. Statistical analyses were performed in SPSS version 20, using a paired t test and one-sample t-test. Results: The results showed that the quality of the provided services from the patients’ perspective was significantly lower than their expectations. The mean gap between the expectations and perceptions of patients was significantly above zero (P < 0.001). The most influential factor in improving patient satisfaction with the quality of services was assurance, followed by reliability, while the least effective factor was empathy. The correlation coefficient between the general status of provided services from the patients’ point of view and loyalty was 0.740 (P < 0.001). Conclusions: The findings of the present study indicated that patient expectations were higher than their satisfaction. Therefore, hospital authorities should take major steps to improve the quality of services, especially reliability and responsiveness, through proper planning, prioritization of services, and review of processes contributing to patient expectations. The existing gaps can also be addressed by considering the perspectives of patients as the clients of healthcare organizations.

What Factors Affect Patient Satisfaction in Public Sector Hospitals: Evidence from an Emerging Economy

Patient satisfaction can identify specific areas of improvement in public sector hospitals. However, the Pakistani healthcare system, and quality of service delivery is rarely assessed through the perspective of patient satisfaction. Our study demonstrated the performance of public healthcare systems in Pakistan by interacting with physical services (tangible and environmental), doctor⁻patient communication, and pharmacy and laboratory services based on patient satisfaction. Primary data were collected from the patients by using a random sampling method. Patients who participated in the study were visitors of public hospitals' outpatient departments. A total of 554 questionnaires were circulated, and 445 were received. The confirmatory factor and multiple regression analyses were employed to analyze the collected data. The results revealed that laboratory, as well pharmacy services, had positive significant effects (p = 0.000) on patient satisfaction, while doctor⁻patient communication (p = 0.189) and physical facilities (p = 0.85) had an insignificant relationship with patient satisfaction. Therefore, it is suggested that a significant communication gap exists in the doctor⁻patient setting, and that Pakistan's healthcare system is deprived of physical facilities. Consequently, such services need further improvements.