SERVICE QUALITY DIMENSIONS AND PATIENT SATISFACTION IN HOLY CROSS

ORTHODOX MISSION HOSPITAL IN UGANDA

BY

NANDUGGA PROSSY

18/MBA/WKD/KLA/0089

A DISSERTATION SUBMITTED TO THE SCHOOL OF MANAGEMENTSCIENCE

INPARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF
MASTER’S DEGREE OF BUSINESS ADMINISTRATION OF
UGANDA MANAGEMENT INSTITUTE (UMI)

OCTOBER, 2022
 DECLARATION

I, Nandugga Prossy, hereby declare that this dissertation is my original work. It has never

been submitted to any University, College or School for an award of any degree, diploma,

masters and or any other academic purposes. The information contained in this dissertation is

my own to the best of my understanding.

Signed:…………………………………………….. Date:…………………………………
NANDUGGA PROSSY

18/MBA/WKD/KLA/0089

i
 APPROVAL

This is to certify that this dissertation was carried out with my supervision and has been

submitted with my approval for an award of a Master’s Degree in Business Administration.

Signed:……………………………………………… Date:…………………………………

Dr. Lazarus Nabaho

Supervisor

Signed:……………………………………………… Date:…………………………………

Mr. Jude Tibemanya Rwemisisi

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 DEDICATION
This Thesis was made possible by the ALMIGHTY GOD who watched over me, gave me

good health, wisdom, and providence without which, completion would have been

impossible; I dedicate it to my family and more especially my beloved family for their

support both financially and physical support; Especially My mother Mrs. Nakibugwe

Moureen Kaweesa, Sisters Lillian, Annet and Josephine, Brothers Ssaku for all the help you

have accorded. My the Almighty reward you more than ever.

My husband Mr. Muwulya Musa for the love, moral support, encouragement and time

necessary for this successful completion.

My Children Precious Dinna, Trinah, Rayan, Darian and Luciana Nana who beared this

project period.

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 ACKNOWLEDGEMENT
I wish to acknowledge a number of people whose technical and moral support has been the

driver for this study.

I am grateful to my supervisors, Dr. Lazarus Nabaho and Mr. Jude Tibemanya Rwemisisi

for their professional guidance and support in the completion of this study.

I wish to appreciate the support the academic staff of Uganda Management Institute,

especially the department of higher Degrees for the support offered to me during this

research. Many thanks to the staff of UMI Library, Resource center and Documentation

center for their efforts in providing the required reading materials whenever I required them.

I must in a special way thank my employers of Holy Cross Orthodox Mission Hospital who

allowed me to carry out my research at the hospital.

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 TABLE OF CONTENTS

DECLARATION...............................................................................................................................i

APPROVAL......................................................................................................................................ii

DEDICATION.................................................................................................................................iii

ACKNOWLEDGEMENT..............................................................................................................iv

TABLE OF CONTENTS.................................................................................................................v

LIST OF FIGURES..........................................................................................................................x

LIST OF ACRONYMS AND ABBREVIATIONS.......................................................................xi

ABSTRACT.....................................................................................................................................xi

CHAPTER ONE...............................................................................................................................1

INTRODUCTION............................................................................................................................1

1.0 Introduction...................................................................................................................................1

1.1 Background to the study...............................................................................................................1

1.1.1 Historical Perspective................................................................................................................1

1.1.2 Theoretical Perspective..............................................................................................................3

1.1.3 Conceptual Perspective..............................................................................................................5

1.1.4 Contextual Perspective..............................................................................................................7

1.2 Problem Statement........................................................................................................................8

1.3 Purpose of the study......................................................................................................................8

1.4 Specific objectives........................................................................................................................8

1.5 Research questions........................................................................................................................9

1.6 Hypotheses of the study................................................................................................................9

1.7 Conceptual Frame of the study.....................................................................................................9

1.8 Justification of the study.............................................................................................................10

1.9 Significance of the study............................................................................................................10

1.10 Scope of the study.....................................................................................................................11

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1.10.1 Content Scope:.......................................................................................................................11

1.10.2 Geographical Scope:..............................................................................................................11

1.10.3 Time Scope:...........................................................................................................................11

1.11 Operations Definitions:.............................................................................................................11

CHAPTER TWO............................................................................................................................13

LITERATURE REVIEW..............................................................................................................13

2.0 Introduction.................................................................................................................................13

2.2 Theoretical review......................................................................................................................13

2.3 Conceptual Review.....................................................................................................................14

2.3 Review of related literature........................................................................................................16

2.3.2 Reliability of service and patient satisfaction..........................................................................17

2.3.3 Responsiveness and patient satisfaction..................................................................................19

2.5 Summary of the Literature review..............................................................................................20

METHODOLOGY.........................................................................................................................22

3.1 Introduction.................................................................................................................................22

3.2 Research Design.........................................................................................................................22

3.3 Study Population.........................................................................................................................23

3.4 Sample Size................................................................................................................................23

3.5 Sampling Techniques..................................................................................................................24

3.5.1 Simple Random Sampling.......................................................................................................24

3.6 Data Collection Methods............................................................................................................24

3.6.1. Questionnaire Survey..............................................................................................................24

3.6.2 Interviews................................................................................................................................24

3.6.3 Document Review...................................................................................................................25

3.6.4 Document Review Checklist...................................................................................................25

3.7. Data Collection Instruments......................................................................................................25

3.7.1 Self-Administered Questionnaire............................................................................................25

3.7.2 Interview Guide.......................................................................................................................25

3.8 Quality Control of data...............................................................................................................26

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3.8.1 Validity of instruments............................................................................................................26

3.8.2 Reliability of instruments........................................................................................................27

3.9 Data Collection Procedure..........................................................................................................28

3.10. Data Analysis Technique.........................................................................................................28

3.10.1 Quantitative data analysis.....................................................................................................28

3.10.2 Qualitative data analysis.......................................................................................................28

3.11 Measurement of Variables........................................................................................................28

3.12 Ethical Considerations..............................................................................................................29

CHAPTER FOUR..........................................................................................................................30

DATA PRESENTATION, ANALYSIS AND INTERPRETATION.........................................30

4.1 Introduction.................................................................................................................................30

4.2 Response Rate.............................................................................................................................30

4.3 Background Characteristics........................................................................................................30

4.3.1 Gender of respondents.............................................................................................................30

4.3.2 Age of respondents..................................................................................................................31

4.3.3 Education of respondents.........................................................................................................32

4.3.4 Experience of respondents.......................................................................................................32

4.3.5 Responsibility of respondents..................................................................................................33

4.4 Empirical findings......................................................................................................................34

4.4.1 Tangibility of services and patient satisfaction.......................................................................34

4.4.1.1: Simple linear regression analysis for tangibility of services and patient satisfaction.........37

4.4.2 Responsiveness and patient satisfaction..................................................................................37

4.4.2.1 Simple linear regression analysis for responsiveness and patient satisfaction.....................39

4.4.3: Service reliability and patient satisfaction..............................................................................40

4.4.3.1 Simple linear regression analysis for service reliability and patient satisfaction.................41

4.4.5: Patient Satisfaction in Holy Cross Orthodox Mission Hospital.............................................42

CHAPTER FIVE............................................................................................................................46

SUMMARY, DISCUSSION, CONCLUSION AND RECOMMENDATIONS........................46

5.1 Introduction.................................................................................................................................46
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5.2 Summary of findings..................................................................................................................46

5.2.1 Tangibles and patient satisfaction............................................................................................46

5.2.2 Responsiveness on patient satisfaction....................................................................................46

5.2.3 Service reliability and patient satisfaction...............................................................................46

5.3 Discussion...................................................................................................................................47

5.3.1 Tangibility Service Quality Dimension and Patient Satisfaction............................................47

5.3.2 Reliability Service Quality Dimension and patient satisfaction..............................................47

5.3.3 Responsiveness Service Quality Dimension and Patient Satisfaction.....................................48

5.4 Conclusion..................................................................................................................................49

5.4.1 Tangibility Service quality and Patient Satisfaction................................................................49

5.4.2 Reliability Service quality dimension and Patient Satisfaction...............................................50

5.4.3 Responsiveness Service quality dimension and Patient Satisfaction......................................50

5.5. Recommendations......................................................................................................................50

5.5.1 Tangibility Service quality dimension and Patient Satisfaction..............................................50

5.5.2 Reliability Service quality dimension and Patient Satisfaction...............................................50

5.6 Limitations of the Study.............................................................................................................51

5.7 Areas for Further Study..............................................................................................................52

REFERENCES...............................................................................................................................53

APPENDIXI: QUESTIONNAIRE FOR THERESPONDENTS..................................................l

Appendix II: Interview Guide.........................................................................................................v

Appendix III: Document review checklist....................................................................................vii

LIST OF TABLES

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Table 3.1: Sample size and sampling techniques.....................................................................23

Table 3.2: Results of Content Validity for research tools........................................................26

Table 3.3: Results of Reliability Test.......................................................................................27

Table 4.5: Gender of respondents.............................................................................................31

Table 4.6: Descriptive statistics on tangibility.........................................................................36

Table 4.7: Regression Model Summary...................................................................................38

Table 4.8: Descriptive results of responsiveness......................................................................39

Table 4.9: Regression Model Summary...................................................................................40

Table 4.10: Descriptive results of service reliability................................................................41

Table 4.11: Regression Model Summary.................................................................................42

Table 4.12: Descriptive statistics on patient satisfaction in Holy Cross Orthodox Mission

Hospital....................................................................................................................................43

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 LIST OF FIGURES
Figure 1.1: Conceptual framework showing the relationship between service quality

dimensions and patient satisfaction..........................................................................................10

Figure 4.2: Age of respondents................................................................................................32

Figure 4.3: Education of respondents.......................................................................................33

Figure 4.4: Working experience of respondents......................................................................34

..................................................................................................................................................34

Figure 4.5: responsibility of respondents.................................................................................35

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 LIST OF ACRONYMS AND ABBREVIATIONS
AIDS : Acquired Immuno Deficiency Syndrome

CSAT : Customer Satisfaction

HCOH : Holy Cross Orthodox Mission Hospital

HIV : Human Immune Virus

HRM : Human Resource Management

MoH : Ministry of Health

NGO : Non-Government Organization

NMS :National Medical Store

PFP : Private For Profit

PNFP : Private Not for Profit

SPSS : Statistical Package for Social Scientists

TQM :Total Quality Management

UNMHCP :Uganda National Minimum Health Care Package

UOC :Uganda Orthodox Church

WB : World Bank

WHO : World Health Organization

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 ABSTRACT
The study examined the effect of service quality dimensions on patient satisfaction in holy

cross orthodox mission hospital in Uganda. The study was guided by the following objectives

to determine the extent at which, to establish the effect of and to determine the effect of

service quality dimensions on patient satisfaction. The study adopted a cross sectional

research design, with a population of 100 respondents and a sample size of 80 respondents.

The findings revealed that majority of the respondents strongly agreed with staffs being well

dressed appropriately, easily understood and identified written materials, updated technology

and staffs are courteous especially on tangibility. Findings revealed that, majority of the

respondents strongly agreed that, whenever, there was a problem the hospital staff responds

to it quickly with maximum attention. The research concluded that tangibility entails physical

and modern looking amenities coupled with clean and convenient layout which interests

patients look at as well as service reliability made them acquire services on a timely basis.

The study recommended that, the HCOH management should develop programmes which

align the organizational goals and values with patients’ needs to ensure prompt customer

satisfaction, regularly assess patient perceptions and satisfactions through surveys, improve

the quality of health care and over all patient satisfaction management should implement

training programmes based on improving communication at all levels within the hospital,

provide employees with incentives to ensure health professionals attracted and retained.

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 CHAPTER ONE

INTRODUCTION

1.0 Introduction

Service quality has a bearing effect on patient satisfaction and hence it has grown to be with

importance within health care sector continuously seeking for new and innovative ways to

offer patient satisfaction, and differentiate their service offerings as a competitive edge to

attract, retain customers and make a profit offering high quality service in terms of being

responsive, reliable and tangible and delivered in timeliness, with personal touch and

compliant management (Jamaluddin & Ruswanti, 2017). service quality to be measured

technical and functional quality, where technical quality in the health care sector is

defined primarily on the basis of the technical accuracy of the medical diagnoses and

Procedures, or the conformance to professional specifications, while functional quality

refers to the manner in which the health care service is delivered to patients.”

Implying that, quality service could defined based on the process and method in which

the service is being delivered to the customer service quality to be measured as technical

and functional quality, where technical quality in the health care sector is defined

primarily on the basis of the technical accuracy of the medical diagnoses and

procedures, or the conformance to professional specifications, while functional quality

refers to the manner in which the health care service is delivered to patients.”

Implying that, quality service could be defined based on the process and method in

which the service is being delivered to the customer (Jamal, Akoi, Fadel & Sardar,

zhilwan, 2021). This study examined the effects of Service Quality and Patient Satisfaction at

Holy Cross Orthodox Mission Hospital Namungoona. Service Quality is conceived as

independent variable in the study while “Patient Satisfaction” is the dependent variable. This

chapter presented the background to the study, statement of the problem, study purpose,

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general objectives, specific objective, research questions, hypotheses, justification, and

significance, conceptual frame of the study and scope of the study.

1.1 Background to the study

This background to the study consists of the historical, theoretical, conceptual, and

contextual perspectives of the study.

1.1.1 Historical Perspective

Globally, customer satisfaction is important factor, since one might not get an opportunity to

redo the service, if the experience is identified by a consumer’s as unsatisfactory (Meesala &

Paul, 2018). Sarkar and Islam, (2021) argued that organizations can only provide satisfactory

consumer service, if standards, procedures, and policies for service quality exist in the

business. This is because the quality of service plays a great role in achieving and improving

customer satisfaction.

During the past two decades service quality has become a major area of attention to

practitioners and managers in different organizations owing to its strong impact on business

performance, lower costs, customer satisfaction, customer loyalty and profitability

(Srivastava, 2015). As companies became larger and increasingly multinational, they turned

to integrated strategies that emphasized boosting service quality and customer satisfaction

and as the 2000s progressed, another strand of service quality and customer satisfaction was

developed; it involved the growth of customer relationship management (CRM), which

started a move towards a single view of the customer (Maqsood, Maqsood, Kousar, Jabeen,

Waqas, & Gillani, 2017).

In Africa, Admirable customer service is key factor to success in Africa’s business sector.

Today’s customers are clearly more focused on the products they receive from these safari

companies. It is worth noting, however, that while financial stability fell into second stage as

a critical reason for maintaining business, and it remains a crucial factor for almost a 25% of

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Africa’s customers. However, it is also being driven by increased awareness of customer

rights greater competition between players. At the same time, Africa’s diaspora and business

travelers are returning home with increased expectations from safari companies based on

their international experience (Su & Yin, 2022). Tessera et al. (2016) used the SERVQUAL

model to evaluate the impact of service quality on customer satisfaction in the Ethiopian hotel

industry. The data was collecting using questionnaire from 130 participants through snowball

sampling technique and analyzed using descriptive statistics, frequencies, Pearson correlation

analysis, as well as multiple regression analysis. The results reveal that tangibility,

responsiveness, and empathy have strong positive and significant impacts on customer

satisfaction, unlike reliability and assurance dimensions. However, there was no evidence in

the Namibian context.

Uganda is ranked by the World Bank to be the number 90 th healthcare services provider in

the world (World Bank Report, 2020). There are 6,937 health facilities in Uganda, 45.16

percent (3,133) of health facilities are government owned, 14.44 percent (1002) are Private

and Not for Profit (PNFP) while the remaining 40.29 percent (2,795) are Private for Profit

(PFP) and 0.10 percent (7) community owned facilities having a total capacity of 16,894

beds. MOH hospitals accounted for 38% of these (6,419 beds). The private sector has a total

of 12,276 beds (MOH Annual statistical report 2019/2020). The country has witnessed

development in the field of health, especially in the establishment of public and private

hospitals. The Ministry of Health, since its establishment has taken all necessary measures

and procedures continuing to provide medical and nursing services at acceptable level and

with high efficiency in the affiliated hospitals. Holy Cross Orthodox Mission Hospital is one

of the private/ NGO hospital in covering the boundaries of Kampala and Wakiso districts

and was established in 1963. It provides medical care to government employees and their

dependents, underprivileged families in Namungoona and neighboring communities, and

patients who are referred from healthcare centers in other parts of the country. It has semi
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advanced technology and is serviced by knowledgeable doctors. Hospital management aims

to provide high quality health services and medical education, design to meet the needs of

our community. The hospital vision is to provide quality, sustainable, patient oriented health

services effectively and efficiently based on Orthodox Church teachings without

discrimination.

Currently, it is equipped with beds & has 96 employees (Holy Cross Orthodox Hospital

Annual Report, 2020). The upgrading of the quality of services provided in public hospitals

is a demand from hospitals management, health workers and patients at the same time.

However, like many other private/ NGO healthcare systems around the country the private

not for profit hospitals face its share of problems. A major challenge for the public hospitals

is to meet the growing expectations and demand for health services due to population

growth, increases in cases of chronic health condition and the presence of refugees in the

country. Especially patients’ satisfaction with hospital emergency departments (EDs) is

negatively correlated with the lack of necessary help, insufficient explanation of medical

conditions, long waiting periods, inadequate explanation of prognosis, lack of accessible and

comprehensible explanations of test results, and the inability to determine and schedule

checkup visits (Fatima, Malik, & Shabbir, 2018). In addition to the expected rise in the

proportion groups of young people and the elderly, rising healthcare costs and the increasing

rate of brain drain mainly to within the MOH and regional government employees due to

low salaries, lack of incentives and regulations, and long working hours (MOH Report,

Annual Health Sector Performance Report 2020/ 2021).

Service quality has become an important topic in view of its significant relationship to

service quality dimensions plus other considered issues such as profit, cost saving and

market share. The interest in health care service quality is increasing. There is a growing

consensus that patient satisfaction is an important indicator of health care quality and many

4
hospitals are searching for ways to change the delivery of patient care through quality

improvement initiatives.

1.1.2 Theoretical Perspective

This study was guided by “SERVQUAL Model” which was first introduced by

Parasuraman and colleagues in1985 in the United States. Since its inception “SERVQUAL”

has become a popular method for measuring service quality (Bojanic and Rosen, 1993). In

the original paper Parasuraman et al. (1985) identify the 10 core components of service

quality as reliability (consistent performance and dependability),responsiveness

(willingness /readiness to serve), competence (possessing knowledge and skills),

access(approachability and ease of contact), curtsy (politeness, consideration and friendliness

of staff), communication (updating and listing to customers), credibility (trustworthy and

reputable, with customer interest and listing to customers), security(freedom from danger and

risk), customer knowledge (understanding needs and personalized attention), as well as

tangibles (facilities and physical features). In subsequent research (Parasuraman et al., 1988,

1991, 1994), the service dimensions are collapsed into five categories tangibles, reliability,

responsiveness, assurance, and empathy.

The “SERVQUAL Model” is based on the assumption that it proposes the need to offer

quality service, which is reliable, responsive to satisfy the clients, assumes that when

hospitals pursue quality service tend to achieve competitive advantage through providing a

high-quality service to their existing customers in a severely competitive environment,

leading to a continued focus on quality service lead to customer satisfaction, customer

retention, customer loyalty, improved corporate image, gains/financial performance, and

positive word-of-mouth. Service organizations/ hospitals have a role of ensuring service

quality throughout all the networks whether new or old. On contrary, the existing

5
customers/users and the new require equal treatment of high service quality, because “once a

customer, always a customer” as stated by Daffy.

The SERVQUAL model involves the creation of a questionnaire that, on one hand, measures

the performance of a particular company in the eyes of the service user, and on the other,

measures the "ideal" customer expectations of the service they used. This results in

discrepancies between performance and expectations, which can then be compared to a

"world-class company" or another benchmark in the same business. The SERVQUAL model

is a widely accepted model used in the business and final consumer markets, in the for-profit

and nonprofit sectors, as well as in various service industries. Veloso, Ribeiro and Alves

(2018) focused on measuring the dimensions of SERVQUAL analysis in the retail sector in

Portugal. The authors stated 22 questions. The SERVQUAL questionnaire statements can be

reduced to three dimensions, and can be applied reliably to traditional forms of retail. In

addition, the conclusion of this research is that the SERVQUAL model can be seen as a tool

for improving the quality of service offered in traditional retail stores and, through increased

customer satisfaction, and lead to better organization and greater profitability.

But to survive and grow in this volatile market today, Service providers cannot always

depend upon the conventional ways to manage and grow the business by only going after the

sales. Rather, we need to search for the innovative measures for effectively catering the

customers which will provide sustainable competitive advantage over a period of time. Due

to the diminishing physical, financial and psychological barriers resulting from Globalization

phenomena, the taste and preference of customers have transformed greatly in the recent past

(Samal et. al 2018). In a developing country like India, the opening of markets in the mid-90s

has made the customers more demanding (Dzever & Jaussaud, 2004). This change has also

affected the emerging sector of hospitality business for which, we need to keep a constant

6
vigil in the market to observe and adopt innovative ways of customer service that will make

us different than the others (Samal et. al, 2017).

1.1.3 Conceptual Perspective

The key concepts are Service Quality and Patient Satisfaction. Service is an ambiguous and

complex concept, owing to the characteristics of services being heterogeneous, intangible

and perishable terms of production and consumption (Bracinikova, 2017).

Quality is the total features and characteristics of a product or services that bear on its ability

to satisfy stated or implied needs (Kotler & Armstrong 2017). It is clear that Quality is

understood from two perspectives which is internal perspective (Objective Quality), focuses

on the standards of service and external perspective (Subjective Quality) focuses on quality

as satisfaction of user’s expectations.

Quality is a comprehensive customer evaluation of a particular service and the extent to

which it meets their expectations and provides satisfaction (Salman Elias, Azhar Naima M

2019).

“Quality” is fitness for purpose ensures consumers receive a bundle of benefits from the

consumption of a particular service which leads to customer satisfaction, repeat purchases,

and customer loyalty since consumers prefer high quality services that is affordable and

meets their taste and preference hence front-line nurses/physicians/managers can use process

indicators to supervise/monitor activity at their facilities and to improve day-to-day decision-

making (Saunders et al., 2009) which includes many attributes such as the quality of the

internal competence and skills, know-how, experience., motivation, attitudes, technology,

internal relationships, internal resources and activities and most important how these

activities are managed, cooperated and coordinated tends to influence customer satisfaction.

Quality Management and assessment is one of the pivotal instruments used to satisfy needs

of customers within an organization. It can achieved when there is compatibility between

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customer expectations and perceptions especially in service providing organizations where

services are intangible, inspirable, perishable and heterogeneous (Handayani PW, et al 2015).

In this study, Service Quality refers to tangible, responsiveness and reliability. Service

Quality is the degree and direction of discrepancy between patient’s expectations and

perceptions. Considering both expectations and perceptions of patients will provide a

meaningful way to measure overall hospital service quality. Service Quality of hospitals have

been studied into two domains; technical and functional (Al Fraihi Kj, Latif SA, 2016).

Tangible service refers is the appearance of physical facilities, equipment’s, personnel, and

communication materials and responsiveness is the willingness to help customers and to

provide prompt service, this dimension emphasizes attentiveness and promptness in dealing

with customers request, questions, complaints, and problems whereas reliability is defined as

the ability to perform the promised service dependably and accurately (Zeithaml, Bitner &

Gremler, 2006). The hospitals' structure, patients' accommodations, patients' facilities, and

activities all have a significant impact on guest satisfaction (Ahmed et al. 2021).

Service Quality is the perception of quality of service rendered or received, which is

necessary to improve the user satisfaction as well as improve the competitiveness and

viability of organizations (Jose Alvarez – Garcia 2019).

On the other hand, A patient is a person who purchases goods or services (Bhanu Prakash

2019). Patient Satisfaction is the extent to which patients are happy with their health care,

both inside and outside of the doctor’s room. A measure of care quality, patient satisfaction

gives providers insights into various aspects of medicine, including the effectiveness of their

care and their level of empathy (Akdere, Top, & Tekingündüz, 2016, Yousapronipaiboon

and Johnson, 2013).

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Patient Satisfaction may be defined as the customer’s fulfillment response to a consumption

experience, or some part of it. Customer satisfaction is not a pleasurable fulfillment response

while dissatisfaction isn’t a pleasurable one (Buttle, 2005). Customer satisfaction has been

the subject of considerable research and has been defined and measured in various ways

(A.AHamid, S B Ibrahim 2015, Kaura, 2004).

Patient Satisfaction is the result of comparison between customer’s expectations and

customer perceptions. Satisfaction and dissatisfaction are two ends of a continuum, where the

location is defined by a comparison between expectations and outcome hence customers

would be satisfied if the outcome of the service meets expectations leads to customer

satisfaction hence resulting in to customer loyalty due to the trust won. Dissatisfaction will

occur when the perceived overall service quality does not meet expectations highlighted that

customer satisfaction is the result of comparison between customer’s expectations and

customer perception. In this study Patient satisfaction is defined as timeliness, service

availability, customer complaints, and customer loyalty through Patient follow up as that

plays a big role in patient retention hence influencing customer satisfaction.

1.1.4 Contextual Perspective

Holy Cross Orthodox Hospital was founded in November 1963 by Uganda Orthodox Church

(UOC). The hospital has been involved in offering health services to the surrounding

communities of Wakiso District and Kampala District. It serves approximately 700,000

patients from these surrounding communities. It’s headed by the Archbishop of the Orthodox

Church in Uganda with the church board, executive director and human resource manager for

seeing all the activities of the hospital that is founded on the doctrines and Christian

background. The main objective of service firms is to develop and provide offerings that

would satisfy the needs and exceptions of consumers.

9
The hospital has for time ignored the serving of customers in a timely manner, with customer

expectations dropping constantly, delays in timely service delivery, non-service availability

and failure to resolving customer complaints have directly impacted customer service levels

within the hospital and poor customer relationship management over time has a posed a

challenge in meeting customer/patient service satisfaction. This has led to constant customer

complaints and variation in service delivery thus affecting the financial performance and

ability to retain customers hence affecting their satisfaction. Most of the time, the services

provided by each institution are heterogeneous; they can differ from day to day, place to

place, producer to producer and customer to customer. Even with the similar health care

setting and services, the level of satisfaction may differ from one person to another and the

time they received the services.

Service quality in treatment effectiveness holds a considerable importance between service

quality and patient satisfaction in medical service. Globally Uganda was estimated with a

population of 42,862,958 people in 2017 living on income per capita of $1,820 with a life

expectancy at birth of females 64 years and males at 62 years. Most of the 10 recorded

causes of death are basically natured by diseases such as Neonatal Disorder, HIV/AIDS,

Malaria, Lower respiratory infections, Tuberculosis, Diarrheal diseases, Ischemic heart

diseases, Congenital defects and stroke (CDC/MOH Report, 2020). In Uganda over 72% of

the Ugandan households live within 5 km from public health care facilities, 10.5% have

access to other health facilities indicating that 82.5% of the Ugandan households have access

to any health care facility within 5 km radius. Basing on this background and the objectives

of this study as to examine the impact of perceived service quality on patient satisfaction at

Holy Cross Orthodox Mission Hospital. Therefore it is important to determine which

dimension of the 3 has the greatest impact on overall patient satisfaction.

10
1.2 Problem Statement

Service quality in health institutions is expected to facilitate service quality in terms of

quality, equity and timely manner as a whole. Service quality health systems are deliberately

aimed at improving the health service delivered to a particular community, targeted

population or person (HCOH report, 2020). Therefore the hospital in abide to attain and

regain its competitive edge in the service industry has to offer quality service through

timeliness, service availability, handled customer complaints, and ensured customer loyalty

through patient follow up which has greatly led to high levels of customer satisfaction within

the health service industry.

Despite efforts, patient satisfaction there seems to be poor quality service delivery, delays in

attending to patients, overcrowding, stock run outs and high costs of acquiring stock for

emergency medical attention, reduced customer satisfaction rates and no intentions to visit

the health facility again due to failure to match customers’ expectations while delivering

services (HCOH annual performance report, 2020). There is a weakness in responding to

customer services in a timely and responsive manner which has contributed to high customer

complaints of poor customer care, limited stocks and human resource not being resolved in

time thus causing long customer queues within the hospital facilities due to failure to develop

and provide service levels that meet customer wants. It is against this background that the

study examined the effect of service quality dimensions and patient satisfaction in Holy

Cross Orthodox Mission Hospital in Uganda.

1.3 Purpose of the study

The study examined the effect of service quality dimensions and patient satisfaction in Holy

Cross Orthodox Mission Hospital in Uganda.

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1.4 Specific objectives

i. To determine the effect of tangibility of services on patient satisfaction in Holy Cross

Orthodox Mission Hospital in Uganda

ii. To establish the effect of responsiveness on patient satisfaction in Holy Cross

Orthodox Mission Hospital in Uganda

iii. To determine the effect of service reliability on patient satisfaction in Holy Cross

Orthodox Mission Hospital in Uganda

1.5 Research questions

i. What is the effect of tangibility of services on patient satisfaction in Holy Cross

Orthodox Mission Hospital in Uganda?

ii. What is the effect of responsiveness on patient satisfaction in Holy Cross Orthodox

Mission Hospital in Uganda?

iii. What is the effect of service reliability on patient satisfaction in Holy Cross Orthodox

Mission Hospital in Uganda?

1.6 Hypotheses of the study

H1: Tangibility of services significantly affects patient satisfaction in Holy Cross Orthodox

Hospital Mission in Uganda.

H1: Responsiveness of services significantly affects patient satisfaction in Holy Cross

Orthodox Hospital Mission in Uganda.

H1: Reliability of services significantly affects patient satisfaction in Holy Cross Orthodox

Hospital Mission in Uganda.

12
1.7 Conceptual Frame of the study

Independent variable Dependent variable

Service Quality Patient Satisfaction

Tangibility
 The physical service facilities.
 Appearance of service personnel.
 Tools or equipment used to
provide the service.

Responsiveness
 Attentiveness and promptness  Satisfaction rate
 Customers request,  Customer complaints
 Questions, complaints, and  Customer referrals
problems processing

Reliability
 Consistency and dependability.
 Service provision
 price

Source: Adapted from (Parasuraman et al., 1985).

Figure 1.1: Conceptual framework showing the relationship between service quality

dimensions and patient satisfaction

From the figure above, the independent variable is service quality dimensions which are

measured in terms of tangibility with sub themes of physical service facilities, Appearance of

service personnel and Tools or equipment used to provide the service, responsiveness with

sub themes of attentiveness and promptness, customers request, and questions, complaints,

and problems processing and reliability with sub themes of consistency and dependability,

service provision price. The dependent variable is patient satisfaction which is measured in

terms of satisfaction rate, customer complaints and customer referrals. Any change in the

independent variable will bring a change in the dependent variable.

13
1.8 Justification of the study

The reason for this study at Holy Cross Orthodox Hospital is due to the scarce and limited

literature concerning the topic in Uganda since most of the literature is about the developed

countries hence this study enables the hospital know the exact root causes of customers

complaints and ensure improved service delivery in the long run for the benefit of both the

customers and the hospital from the findings of the study (Kotler, 2015; Kotler & Armstrong

2006).

1.9 Significance of the study

The study may provide a clear focus on the importance of service quality on patient

satisfaction that may lead to customer satisfaction which will help in laying strategies

towards supporting service delivery in the hospital.

This study may inform policy makers and managers of organizations in highlighting certain

service quality practices such as tangibility, access, responsiveness, empathy and reliability

that can ensure effective patient satisfaction/client satisfaction. These equality service

practices like reliability, tangible service and responsiveness maybe adopted into the

policies governing.

Besides, this study contributes to the body of knowledge (BoK) by, government, public and

private sector, researchers, and academicians with new knowledge to extend and develops

more knowledge on health quality service and patient satisfaction.

The study may be of great value to Holy Cross Orthodox Mission Hospital because it will

highlight the gaps where patients are dissatisfied with the services provided and in turn this

will help to improve the quality of health care services provided to the patients accessing

services from this institution.

14
1.10 Scope of the study

1.10.1 Content Scope:

The research focused on health quality service dimensions like tangible service, responsive

service. The research targeted different respondents from the both inpatient and outpatient

departments in all departments and patients, different race, gender, year of service through

a structured random sampling. The researcher had interest in finding out how quality

service contributes to patient satisfaction aspects in terms of defined as satisfaction rate,

customer complaints and referrals by customers.

1.10.2 Geographical Scope:

The study was conducted mainly at Holy Cross Orthodox Mission Hospital Namungoona in

Kampala District. HCOH is located in Lubaga Division, 6 Kilometers on Kampala Hoima

Road because it’s the nearest and affordable health service provider.

1.10.3 Time Scope:

This study will cover the time scope of ten years from 2010–2020 to be able to investigate

quality service and patient satisfaction in Holy Cross Orthodox Mission Hospital Uganda

over an extended period for deep analysis. This will help in analyzing how quality service

will help to ensure effective customer satisfaction.

1.11 . Operations Definitions:

Service quality is the specific assessment and consideration made by visitors between

expected service quality and actually given services. Service quality has many dimensions as

prescribed by academicians but we are specifying three which are:-

Tangibles: This dimension measures the physical environment of the hospital in relation to

the outpatient department. The nature of the equipment used at the hospital. (Physical

facilities, equipment, and appearance of personnel).

15
Reliability: Is the ability of the service staff to provide services promptly, accurately, reliably

and satisfactorily.

Responsiveness: Is the ability of the service staff to provide prompt and appropriate services

to patients by responding to patient complaints and resolving complaints of patients and their

families and conveying clear information to patient complaints.

SERVQUAL is a service quality mode or tool which was developed by Zeithaml,

Parasuraman and Berry in the mid-1980s, in order to evaluate quality in the service industry

and developed from the GAP model.

Patient satisfaction is a person's experience of enjoyment as a result of comparing certain

services or products.

16
 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

In this chapter, the researcher delves on what several scholars, authors, international

organizations and researchers have articulated on Health care service quality and patient

satisfaction. This chapter aimed at reviewing what these individuals and institutions have

developed in terms of knowledge on the research topic. Hence, this chapter presents the

historical review, theoretical review and actual literature review objective by objective in

addition to summary of literature review.

2.2 Theoretical review

Underling our understanding of quality of service utilized instrument of SERVQUAL, which

was developed by Parasuraman of the Marketing Science Institute (Alex & Ondiek, 2014;

Parasuraman, Zeithaml, & Berry, 1988) with five measurements of service quality. There

have been several endeavors, which were made by different researchers, to identify variables

that measure service quality, amid which the most used, is SERVQUAL (Ismael et al.

2021).The Service Quality model has been used in different ways in most of the study reports

reviewed. The model identifies the principal dimensions (or Components) of service quality;

proposes a scale for measuring service quality (SERVQUAL) and suggests possible causes

of service quality problems. SERVQUAL instrument comprises of: Reliability, Assurance,

Tangibles, Empathy, Responsiveness, which is used as a measure of consumers’ expectations

(before) and perception (post usage) of a service (Ahrholdt, Gudergan, & Ringle, 2017).

The SERVQUAL tool reside the most entire endeavor to hypothesize and evaluate service

quality. Anwar and Ghafoor (2017) have stated that this model is more applicable while it’s

utilized with other related services quality models. The SERVQUAL scale is a primary tool

in service marketing literature for accessing quality. This tool has been extensively utilized

17
by researchers and industry leaders in order to access guest appreciation of service quality for

a discrepancy of services (Anwar, 2017).

In brief, the SERVQUAL tool is based on GAP theory which has been unfolded by

Parasuraman et al. (1985). GAP refers to the differences between desired levels of

performance and actual levels of performance” (Anwar & Ghafoor, 2017). “In services this is

the difference between the expected and the actual level of service provided” (Juan, et al.,

2017). Gaps are significant in the following aspects; once a gap is distinguished, corrective

actions and process improvement should take place. The process in identifying and

correcting these gaps is called gap analysis. The first GAP is the Knowledge of dissimilarity

between guest’s expectation and perceptions of management of these expectations (Lack of

knowledge of patients’ expectations). In order to truly improve patients service the hospital

has to clearly understand patients’ wants properly identified. So the SERVQUAL instrument

can be used into help in this understanding. Then GAP two is the Standards GAP which is

the dissimilarity among what company’s management perceives and service quality

specifications (Improper standards of service quality) (Anwar & Balcioglu, 2016).

Given this, different countries have totally different cultures and a number of dimensions of

Service quality model may vary from culture to culture. More so this could imply that as

more and more business strive to hit targets and pressure increases as a result of customers

becoming more sophisticated, they become less willing to accept poor quality goods and

services (Sorbero, Paddock & Woodroffe, 2016). Thus employers may fail to recognize the

significance of striving to ensure that their staff perception of services quality corresponds

with the customers they aiming to satisfy. SERVQUAL measurements give a positive

understanding to the health teach where they ought to center to provide better service to the

patients (Aliman & Mohamad, 2016).

18
However, to meet environmental demands, successful organizations use gap- analyzer

models or other related tools to understand customer centered needs. They set their activities

as per customer preferences and use them as service quality standards (Tarabipour et al.

2016) has used the model to assess the hospital service quality. Therefore, this study used the

Service model much as in the service sector it is not a complete model for measuring service

quality, but it is widely accepted. The SERVQUAL questionnaires have been used by

different companies and it is a ready-made approach that is appropriate to be used in various

service situations. SERVQUAL signify service quality as dissimilarity between the expected

services by a patients and guest’s perception of the received services (Abdullah et al. 2017).

Earlier studies have illustrated that all the service dimensions had to a certain degree a

positive connection with patients’ satisfaction, with tangibility, reliability and assurance been

the foremost indicators of patient’s satisfaction and loyalty of the patients to the service

(Setyawan et al., 2019).

2.3 Conceptual Review

Kotler (2019) defines satisfaction as the consumer’s fulfillment response, the degree to which

the level of fulfillment is pleasant or unpleasant. According to this definition, the satisfaction

goals are established by the customers themselves before they set out to make a purchase.

This is also why they start looking for more information at this point reviews, comparisons,

alternatives, among others. Your website, content marketing efforts, and presence on other

review sites make a difference at this point. So do customer stories and testimonials.Once the

customer selects the product or service, they’ll start evaluating the actual experience against

the expected one (Wilson, Zeithaml, Bitner & Gremler, 2018).

Since customer satisfaction has been considered to be based on the customer’s experience on

a particular service encounter (Ehsani & Ehsani, 2015). It is in line with the fact that service

responsiveness is a determinant of customer satisfaction, because service responsiveness

19
comes from outcome of the services from service providers in organizations. Additionally,

Sivadas and Baker-Prewitt (2020) found out that customer satisfaction and service

responsiveness are related. They also dictated that service quality is more abstract because it

may be affected by perceptions of value or by the experiences of others that may not be so

good, than customer satisfaction which reflects the customer’s feelings about many

encounters and experiences with service firm (Su et al., 2020).

It has been proven by Kim and Chung (2022) that an organization that consistently satisfies

its customers enjoy higher retention levels and greater profitability due to increase customer

loyalty; for this reason every organization works hard daily to win the hearts of customers by

satisfying them in order they become loyal customers to their brands as it increases sales and

profits. The quality of service is an indicator of superiority to the competitor which

determines success or failure of a firm.

Singh, Prasher, and Kaur (2020) also define service quality as conformance to requirements.

To achieve that destination we have to measure ourselves, our organizations processes and

the outputs of those processes continuously and then make course corrections where

necessary based on facts to stay on course along the way. It is clear that quality is also related

to the value of an offer, which could evoke satisfaction or dissatisfaction on the user’s part as

heart of doing the right thing, at the right time, in the right way, for the right person and

having the best possible results”

Service Quality the result of the comparison that customers make between their expectations

about a service and their perception of the way the service has been performed. From these

definitions, we conclude that the quality of hospital services is an integrative assessment of

the services offered to the external client, for clients are considered to be independent

individuals with various requirements on the basis of which services are provided based on

20
certain specifications. This requires that hospitals carefully select creative employees with

good/appropriate qualifications and capabilities.

Mulyana and Prayetno (2018) define Consumer satisfaction as the level of one's feelings

after comparing the performance of perceived results compared with expectations".

According to Kotler (2015) "Consumer satisfaction is the feeling of pleasure or

disappointment of someone who emerged after comparing the perception or the impression

to the performance or the outcome of a product and its expectations".

According to Tse and Wilton (2018) "Satisfaction or consumer dissatisfaction is the

consumer's response to the evaluation of discrepancy or disconfirmation that is felt between

previous expectations (or other performance norms) and the actual performance of the

perceived product after its use". However, there are some disagreements in the transaction-

specific satisfaction.

Parasuraman, Zeithaml and Berry (2005) suggested that perceived service quality was an

antecedent to perceived service quality. In satisfaction surveys, a direct causal relationship is

presupposed between the quality of a certain service delivery and user satisfaction. If service

quality increases, satisfaction is assumed to increase as well. In reality however, research in

experiential marketing, experiential risk, experiential value and satisfaction has witnessed

significant increase post 2000 (Wu et al. 2019).

2.3 Review of related literature

2.3.1 Tangible service and Patient satisfaction

A hospital is a place for treating diseases, there is always a chance of getting contaminated

with diseases. Contamination fears make clients worry during their hospital stay. A clean

hospital assures patients that they are safe. Participants concurred that ensuring patient safety

is an essential factor in the delivery of care (Peter & Batonda, 2022). Clients feel more

comfortable if providers respect their privacy during counseling sessions and examinations.

21
Lack of privacy can make it more difficult for patients to participate actively in their

treatment plan: Patients desired for technically knowledgeable, skillful, and experienced

providers capable of accurate diagnoses and effective treatment. It gives physical

representation of pictures of the services that clients, especially new clients, used to assess

the quality (Rahman & Sitio, 2020). In spite of the fact that tangibles are frequently utilized

by service providers to reinforce their reputation, give congruity, and sign quality to client,

most organizations unite together tangibles with other in order to establish a service quality

technique for the company (Tran & Le, 2020). Thus this study seeks to fill this gap of

knowledge.

Although patients are concerned with the technical aspect of care, they mostly tend to form

their opinions about service quality based on their assessment of non-clinical aspects of care

such as the availability and accessibility of facilities and amenities, security in and around the

facility, clean and comfortable rooms, privacy, tasty meals, comfortable clothes, and a quiet

and attractive environment (Tuncer; Unusan & Cobanoglu, 2021). Healthcare services should

be available to patients any time they need them. Healthcare service availability is a

necessity, but it is not enough. Services should be accessible to clients if they are to be

considered useful. Patients are concerned about having accessible doctors and nurses

(Physical access) and having affordable (Financial access) and acceptable healthcare services

(Conceptual access). Thus this study seeks to fill this gap of knowledge.

The healthcare service environment is acknowledged as an important healthcare quality

component. Clients preferred a clean and homelike environment. The physical cleanliness

and hygiene considerations due to their links to hospital acquired infections were mentioned

by most clients as important quality attributes. The way that the cleaning staff carried out

their work was also scrutinized by clients. Patients expect professionalism from staff and felt

anxious regarding their care if certain standards were not met in terms of follow ups on the

22
side of the healthier care service providers. This helps the customer to know who they are

identifying with. Hospital as an important healthcare institution, need to recognize the

importance of patients’ preferences. Patient satisfaction measures should be used to monitor

the performance of health services especially for hospital. Hospital executives should

recognize patients, who are the customers, as the most important exchange partners. They

visit hospitals expecting appropriate, high-quality medical care, a safe environment, and

reasonably comfortable amenities. Much of the failure in patient relations comes from the

difficulties in managing that trust. Thus this study seeks to fill this gap of knowledge.

2.3.2 Reliability of service and patient satisfaction.

Customer guidance enables an organization to assess how its customers feel about the

interactions they may have with it or the services they receive (McColl-Kennedy &

Schneider, 2020). By carrying out this kind of research, the organization is giving thought to

the customer experience, and shifting the focus of the organization to be more outward

looking. Customer guidance is also a straightforward and accessible starting point for

introducing customer insight in organizations which may be unfamiliar or uncomfortable

with using techniques such as qualitative research as evidence for taking action (Best &

Neuhauser, 2016). According to Levy (2019) customer guidance provides an organization

with overall numerical ‘scores’ for the levels of satisfaction that customers are experiencing

with different areas of service delivery. In the same line Akoi, SAbdulrahman, Muhamed,

Noori, and Anwar (2021) note that effective customer guidance is a crucial step in the

process of ensuring customer satisfaction and it plays an active role in driving service

improvement. Thus this study seeks to fill this gap of knowledge.

According to Levy (2019) customers will always prefer a product or service that gives them

maximum satisfaction. But how will the organization know whether the consumers’

consumption habits have changed, or if they are well served? How will the organization

23
know if competitors’ brands are doing better than theirs, which can trap their customers?

With the increasing number of businesses and growing competitions today, each company

wants to be the customers’ first choice. To achieve this, organizations need to answer the

questions above via continuous research in this area so as to lead the organizations to their

twin objective of satisfying their customers and making profits. Thus this study seeks to fill

this gap of knowledge.

Reliability of services is part of lifetime management. The significant importance lies in

fulfilling promptly the patients’ requests (Anwar & Balcioglu, 2016). It is obtained that the

service quality data does influences the patient satisfaction in having medical treatment at the

health center. This is due to the good quality can increase people’s trust when they want to

have medical treatment in that health institution. The relationship of total quality

management (TQM) is implemented in the hospital with commitment, then performance

indicators of a hospital will gradually direct towards excellence. Excellence being a goal of

every hospital will motivate and help hospitals commit their quality improvement strategies

to provide an opportunity to improve hospital service quality, gaining competitive advantage

and satisfying patient needs and requirements. Thus this study seeks to fill this gap of

knowledge.

According to Hameed and Anwar (2018) reliability “reflects the service provider’s ability to

perform service dependably and accurately”. It includes “doing it right the first time” and as

for the patients it is one of the most significant dimensions. In detail, reliability implies that

the organization conveys on its guarantees - guarantees about conveyance, service supply,

issue determination and pricing policy. However, health care services differ from other

services because of vitality and criticality. The customer (Patient) surrenders his/her

confidentiality and cooperation with the health worker during the encounter to make

treatment successful. Therefore, enquiring about patient’s opinions give clue for improved

24
service quality that may lead to growth of an organization (Islam R et al, 2016). As it is

recorded by the World Health Organization (WHO, 2017) service availability and readiness

assessment provides a standard health facility assessment questionnaire to assess, map and

monitor service availability and readiness designed to support a health facility census with a

focus on the core functional capacities and availability of services thus hospitals are entitled

to have the best for them to stay on top. Thus this study seeks to fill this gap of knowledge.

Peng and Moghavvemi (2015) contend that the most important factors in retaining customers

in the service sector are accuracy in completing orders, maintaining precise records and

quotations, accuracy in billing and fulfilling promised service. Doing what you say you are

going to do when you say you are going to do it is essential to pleasing your customers. They

want to rely on your business to deliver a working product or effective service, to get help

when they need it and for all of this to happen in a timely fashion (Brittany, 2020). The

effects of accurate, dependable and consistent services yields into loyal customers who in

turn share a high category of their spending to the firm and in long run captivates others to

become customers; further still, inefficiencies greatly affect customer’s perception of service

quality. Thus this study seeks to fill this gap of knowledge

2.3.3 Responsiveness and patient satisfaction

A responsive company uses technology to learn more about customer needs and trains its

employees to deliver the highest standards of customer service (Sivadas & Baker-Prewitt,

2020). Since customer satisfaction has been considered to be based on the ability of

employees to listen to customer’s experience and complaints on a particular service

encounter (Cronin & Taylor, 2012), it is in line with the fact that listening to customers is a

determinant of customer satisfaction, because it comes from outcome of the services from

service providers in organizations. Additionally, Sureshchander, Rajendran and Anatharaman

(2021) suggest that listening to customers would be antecedent to customer satisfaction

25
regardless of whether these constructs were cumulative or transaction-specific. Satisfaction

and service quality have certain things in common, but satisfaction generally is a broader

concept, whereas service quality focuses specifically on dimensions of service. Thus this

study seeks to fill this gap of knowledge

Nguyen, Pham, Tran and Pham (2020) noted that harsh words are always indicative of

insight; customer concerns are not always a sign that something is wrong. According to

Tabash, Albugami, Salim and Akhtar (2019), free customers always ask for more free stuff

and future requests often turn into product demands. While helping customers is always

right, haphazardly following their demands is always wrong. In addition, multiple messages

from multiple customers with recurring concern are the beginning of satisfaction

imperfections among customers. It’s important to realize that organizations that are customer

focused acknowledge customer complaints in a positive manner as it promotes customer

satisfaction in a long run (Tse & Wilton, 2018). The effects of accurate, dependable and

consistent services yields into loyal customers who in turn share a high category of their

spending to the firm and in long run captivates others to become customers; further still,

inefficiencies greatly affect customer’s perception of service quality. Thus this study seeks to

fill this gap of knowledge.

The responsiveness dimension of service quality is related to the organization’s willingness

and ability to help customers and to provide quick service with proper timeliness. The

willingness of employees to provide the required service at any time without any

inconvenience will have an impact on customer satisfaction (Selvakumar J.J, et. al., 2016).

This dimension of service quality is perceived through the people aspect of service quality.

However, information technology advancement like emails, webpage and customer service

interface improves the responsiveness of service delivery firm (Kaura, et al., 2012) hence

price becomes a key concern in the attainment of health service quality. Responsiveness is

26
the willingness to help customers and to provide prompt service. Although this dimension

underscores mindfulness and immediacy in managing patients’ appeals, questions,

complaints and other issues (Anwar & Ghafoor, 2017). Thus this study seeks to fill this gap

of knowledge

Responsiveness was defined by the length of time when customers wait for an answer or

solution. In short, responsiveness solves the customer problem as soon as possible by

providing expected information or replacing products (Newsmoor Journal 2019). Lee (2002)

defines the key drivers of customer satisfaction, as the customer basic needs. He argues that

customer satisfaction studies have paid too much attention to service quality attributes

instead of customers’ basic needs. He criticizes the use of SERVQUAL’s five service

dimension of tangibles, reliability, responsiveness, assurance, and empathy saying the model

has become the standard customer satisfaction survey design. He argues that the five

SERVQUAL dimensions are not customers’ basic needs and says that they will not

accurately predict customer satisfaction. Thus this study seeks to fill this gap of knowledge

2.5 Summary of the Literature review

Howell and Shamir (2005) addressed that some general service quality dimensions suggested

and used by several studies to analyze the customer satisfaction. So we will follow this

approach to do our study. We used the same dimensions to measure the service quality and a

different dimension to measure customer satisfaction in the context of Private health care

service providers.

Studies on service quality have focused on the banking industry (Khan &Fasih 2014; Kaura,

et al., 2012), airline industry (Lubbe, Douglas, &Zambellis, 2011), hotel industry (Marković,

&RasporJanković, 2013), educational industry (Naidoo, 2011, 2014; Jayasundara, et al.,

2009) with little focus on governmental organizations (Tambi, Ghazali & Rahim, 2008 and

27
Chen &Gant, 2001) with limited focus on the hospital settings hence a gap identified for the

study to fill.

Several literatures reviewed explained how service quality affects and is related to customer

satisfaction in the banking industry. However, there are some gaps and unanswered

questions, for instance the gaps stressed by Parasuraman et al (1996) like the consumer

expectations and management perception gap. Organizations may have inaccurate

perceptions of what consumers actually want and expect. This requires appropriate

management processes, market analysis, tools and attitude. In this case however, much as

management tries, as long as they don’t know exactly what the customer wants, then even

excellent service may be irrelevant to the customers. Another gap is the service delivery gap.

Guidelines for service delivery do not guarantee high quality service delivery or

performance. Reason being that there may be lack of sufficient support for frontline staff,

process problems, contact staff performance variability.

The literature shows that in today’s highly competitive environment, the key to sustainable

competitive advantage lies in delivering quality service (Shemwell et al, 1998). However,

delivering quality service alone is not enough. For example, in the banking industry, there are

other factors other than service quality, like capital base, without which customers cannot be

satisfied. However, the literature reviewed did not directly address service quality

perspectives and customer satisfaction in hospital environment in Uganda.

28
 CHAPTER THREE

METHODOLOGY

3.1 Introduction

This chapter presents and describes the approaches and techniques the researcher used to

collect data and investigate the research problem. This includes research design, study

population, sample size and selection, sampling techniques and procedure, data collection

method, data collection instruments, data quality control (validity and reliability), procedure

of data collection, data analysis and measurement of variables and ethical considerations.

3.2 Research Design

A research design is the strategy, plan and structure of a research project (Sileyew, 2020).

The study used convergent parallel design of mixed methods whereby gathering of both

quantitative and quantitative data. This is done concurrently then analysis of the two data sets

done individually and eventually combines the findings during the interpretation phase of the

analysis. The convergent parallel design facilitated both data types to be collected within one

visit to the field and due to the nature of study; the researcher believed both data types would

have an impact on the understanding problem. The study integrated both quantitative and

qualitative data collection and analysis (Žukauskas et al., 2018).This methodology is known

as the “mixed methods” which involved validating results using qualitative and quantitative

data sources, using qualitative data to explore quantitative findings, and using qualitative

data to reinforce a quantitative outcomes study.

3.3 Study Population

Target population refers to a universal set of all members of real or hypothetical set of

people, events or subjects from which an investigator wishes to generate his result (Mugenda

and Mugenda, 2003). The target population consists of 100 who include 05 top managers of

Holy Cross Orthodox Mission Hospital, 05 heads of departments, 06 finance and

29
administration staff, 20 doctors, 25 Nurses and 40 patients of Holy Cross Orthodox Hospital.

The study population consisted of male and female respondents. This population enabled the

researcher to obtain the necessary data for the research.

3.4 Sample Size

This refers to the number of items being selected from the universe to constitute a sample

(Kothari, 2019). The sample size of the population in this study was obtained using the

formula illustrated below:

Sample size (n) = N

2
1 +N (e)
Where n- Sample size
N - Population size
e- Is the confidence level of (95%)
Therefore,
Sample size (n) =100
2
1+100(0.05)
n= 80

Table 3.1: Sample size and sampling techniques

Population category Sample size Sampling techniques

Top managers 02 Purposive
Heads of departments 05 Purposive
Finance and administration. 06 Purposive
Doctors 15 Simple Random
Nurses 20 Simple Random
Patients 32 Simple Random
Total 80
Source: HR manual of Holy Cross Orthodox Hospital in Uganda (2018-2020)

3.5 Sampling Techniques

3.5.1 Simple Random Sampling

Simple random sampling is a sampling technique where each participant can be chosen at

any one time to provide information concerning the study to eliminate bias in data collection.

30
The study used simple random sampling to select respondents from the employees and

patients in Holy Cross Orthodox Mission Hospital in Uganda. According to Thomas (2020)

simple random sampling ensures that every member has an equal chance of being recruited

into the sample.

3.5.2 Purposive Sampling

Purposive sampling technique is a non- probability sampling technique that was used to

select all the respondents who are believed to be in a better position to respond to the

research questions. A purposive technique according to Thomas (2020) enabled the

researcher to acquire an in-depth understanding of the problem and to gain richer, useful and

focused information.

3.6 Data Collection Methods

The study utilized both quantitative and qualitative methods of data collection. The methods

used to collect data are presented below.

3.6.1. Questionnaire Survey

According to Muhammad and Kabir (2018), a questionnaire is a method of survey data

collection in which information is gathered through oral or written questionnaires.
Questionnaires enabled the researcher to collect a large sample of information in a short time
and at a reasonably low cost and give similar or standardized questions to the subjects
making it easier for comparison and generalization. In this case questionnaires (with close
ended questions) were administered with aid of research assistants. The questionnaires were
adopted because the response option for a close ended question is exhaustive and mutually
exclusive. The questionnaires were self-administered to Patients Nurses and Doctors of Holy
Cross Orthodox Hospital in Uganda. Questionnaires have advantages over some other types
of surveys in that they are cheap, do not require as much effort from the questioner as verbal
or telephone surveys, and often have standardized answers that make it simple to compile
data (HR Manual, 2018-2020).

31
3.6.2 Interviews

Interview is a conversation between two or more people where questions are asked by

interviewer to elicit facts or statements from the interviewee. It’s a person-to-person verbal

communication in which one person or a group of persons is interviewed at a time (Seidman,

2013). Interviews were conducted because they have the advantage of ensuring probing for

more information, clarification and capturing non-verbal expressions of the interviewees.

Interviewing is most effective when the goal of the research is to gain insight in to “deeper

understanding of those around us (Seidman, 2013). It gives the researcher time to revisit

some of the issues that have been an oversight in other instruments and yet is deemed vital

for the study. Personal interviews were conducted with 02 top managers, 05 heads of

department, 06 finance and administration staff of Holy Cross Orthodox Mission Hospital in

Uganda. The interviews capture questions on the independent and dependent variable and in

the course of interviewing, probing was applied so as to elicit a good response rate.

3.6.3 Document Review

Abawi (2013) defines document review as the analysis of a list of all materials in form of

reports, pamphlets, websites, and any written material which has information regarding the

objectives of the study. Analyzing documents incorporates coding content into themes

similar to how focus group or interview transcripts are analyzed. The researcher reviewed all

the published and unpublished documents that have been kept for record purposes both hard

copies like quality service plans, stock cards, customer complaint management records,

quality control sheets and soft copies kept within the computers on Electronic forms to

capture the information concerning effects of health service quality and patient satisfaction

at Holy Cross Orthodox Hospital in Uganda was reviewed (HR Manual, 2018-2020)

32
3.6.4 Document Review Checklist

The researcher reviewed all the published and unpublished documents which include among

others the stores records, journals, like quality service plans, stock cards, customer complaint

management records, quality control sheets on health quality service and patient satisfaction

were reviewed (HR Manual, 2018-2020)

3.7. Data Collection Instruments

Questionnaires, interview guide and documentary review checklist were used as the major

tools for this study.

3.7.1 Self-Administered Questionnaire

A questionnaire was used to gain first-hand information and more experience over a short

period of time (Muhammad & Kabir, 2018). A questionnaire was used because it increases

the degree of reliability due to the many items in it and enhances the chances of getting valid

data using close ended questions. A self-administered was given to top managers, heads of

departments, doctor, nurses and patients of Holy Cross Orthodox Hospital in Uganda.

3.7.2 Interview Guide

This enabled the researcher to conduct coherent interviews and also the interviewers to

obtain relevant in-depth narratives by formatting content and flow of the conversations with

interviewees. Interviews were done on a personal interview basis for to top managers, heads

of departments, doctor, nurses and patients of Holy Cross Orthodox Mission Hospital in

Uganda (HR manual HCOH, 2018-2020)

3.8 Quality Control of data

Data quality techniques ensure that data collected is valid and reliable; the instrument were

first be tested to ensure validity and reliability.

3.8.1 Validity of instruments

Validity basically means “measure what is intended to be measured” ((Bannigan & Watson,

2018). In this study, validity was measured empirically. Conceptual empirical confirmation
33
of validity, also called pragmatic validity shall be done to compare information obtained on

study themes using evidenced facts and outcomes found in reality from the primary data that

is gathered. Primary data sources were triangulated as indicated by combining respondent’s

categories (top managers, Heads of Department, doctors, nurses, and patients of Holy Cross

Orthodox Mission Hospital in Uganda to improve content validity.

However, since social variables have no obvious facts or outcomes, the primary data

gathered was subjected to further conceptual or constructs confirmation of validity.

Conceptual confirmation of validity is conferred from the conceptual evidence the extent to

which the variables relationship is consistent with the deductions in the theoretical review of

literature (document review) (Bannigan & Watson, 2018). Quantitatively, to establish

validity the researcher will conduct the content validity index (CVI) test to check the validity

of the questionnaire contents. The CVI is computed using the following formula.

CVI = No. of items rated relevant

Total no. of items

Table 3.2: Results of Content Validity for research tools

Dimensions No of Items Relevant CVI

Tangibles 06 05 0.83

Responsiveness 06 05 0.83

Service reliability 05 04 0.8

Patient satisfaction 15 14 0.93

Source: Primary Data (2022)

Table 3.2 presents averages of 0.870 and (0.83, 0.83, 0.8 & 0.93 respectively) on all four

variables had a CVIs that were above 0.7, imply that the tool was validity since it was

appropriately answering / measuring the objectives and conceptualization of the study.

According to Mugenda & Mugenda (2003), the tool can be considered valid where the CVI

value is 0.7 and above as is the case for all the four variables provided above.
34
3.8.2 Reliability of instruments

Reliability refers to the likelihood of getting the same results over and over again if a

measure was repeated in the same circumstances. Reliability ensures that measures are free

from error so that they gave same results when repeated measurements were made under

constant conditions. In line with this, the researcher used a heterogeneous population and

participants drawn from across-section of stakeholders who were involved in the

management of Holy Cross Orthodox Mission Hospital in Uganda (HCOH). The instruments

were pre-tested by selection of a few staff members who reviewed and improved it, to ensure

reliability before it was really applied in the study (Yusoff, 2019). The researcher personally

administered the questionnaires to the participants and was available for consultations and

explanations while the participants fill in the data. The researcher checked the questionnaires

to ensure that all the questions were answered appropriately. The pre-test contributed to the

credibility, dependability and trustworthiness of the questionnaires. The findings from the

test were coded in the SPSS, a computer package to test for reliability at the Cronbach’s

alpha coefficient so as to assess the internal consistency above 0.70.

Table 3.3: Results of Reliability Test

Items Cronbach-Alpha reliability test value

Tangibility 0.877

Service reliability 0.829

Responsiveness 0.861

Patient satisfaction 0.819

The above Cronbach alphas result was equal to or greater than 0.70 hence depicted that, the

items were internally consistent and reliably measures value of the study variables.

35
3.9 Data Collection Procedure

Data in the field was collected by getting an introduction letter from the head of department

management and science of Uganda Management Institute (UMI) to introduce the research to

the relevant management staff of Holy Cross Orthodox Mission Hospital in Uganda

(HCOH). When granted permission by the organization, the researcher will make

appointments with the respondents and interact with them at their most convenient time.

3.10. Data Analysis Technique

Data was analyzed both quantitatively and qualitatively.

3.10.1 Quantitative data analysis

The quantitative data obtained using questionnaires were computed into frequency tables and

percentages. Data was analyzed using descriptive statistics to determine mean and standard

deviation of inventory manage and that of organizational performance, then inferential

statistics to undertake correlation and regression analysis for inventory manage and

organizational performance with the help of Statistical Packages for Social Scientists (SPSS).

3.10.2 Qualitative data analysis

To analyze qualitative data, the researcher will analyze, compile and data coding where data

was got from the interviews and open-ended questions in the questionnaire which is arranged

into themes according to the stated objectives by exposing the data to content analysis and

then presented in a narrative form. Through analyzing, data compilation and recording the

researcher will record reflective notes about what he learnt from the data. According to

Borgstede and Scholz, 2021) qualitative data enables one to read his transcribed data line by

line and divide the data into meaningful analytical units.

3.11 Measurement of Variables

Sekaran and Bougie, (2016) supports the use of nominal, ordinal and Likert type of rating

scales during questionnaire design and measure of variables. The nominal scale was used to

measure variables such as gender, department among others. The ordinal scale was employed
36
to measure variables such as age, level of education, years of experience among others. The

five-point Likert scale (SA-strongly Agreed, A-Agree, NS-Not sure, D-disagree and SD-

strongly disagreed) was used to measure the independent variable (Vendor Managed

Inventory) and the dependent variable (Medicine Availability). According to Mugenda &

Mugenda (2003) and Amin (2005), the Likert scale is able to measure perceptions, attitudes,

values and behaviors of individuals towards a given problem. The choice of this scale of

measurement is that each point on the scale carries a numerical score which was used to

measure the respondent’s attitude and its most frequently used summated scaled in the study.

3.12 Ethical Considerations

According to Fleming (2018), ethical issues refer to the integrity in the production of

knowledge, as well as the dignity welfare of the researched.

Confidentiality and privacy: It refers to the obligation of an individual or organization to

safeguard entrusted information. The research participant’s privacy was assured by the

researcher, who kept all the information safely locked up during the research process.

Anonymity: means that either the project does not collect identifying information of

individual subjects (e.g., name, address, Email address, etc.), or the project cannot link

individual responses with participants' identities.

Plagiarism: is presenting someone else's work or ideas as your own, with or without their

consent, by incorporating it into your work without full acknowledgement. All published and

unpublished material, whether in manuscript, printed or electronic form, is covered under this

definition. This was minimized by paraphrasing, citing, quoting, citing quotes, citing own

material, and referencing.

Voluntary participation: The research participants were informed that their participation in

the study was not to be rewarded in anyway; it was entirely on voluntary basis. All the

research participants were informed of their rights to refuse to be interviewed, or to withdraw

at any point for any reason, without any prejudice or explanation.

37
 CHAPTER FOUR

DATA PRESENTATION, ANALYSIS AND INTERPRETATION

4.1 Introduction

This chapter presents the analysis and interpretation of study findings in line with the study

objectives. The study investigated the effects service quality dimensions and patient

satisfaction in Holy Cross Orthodox Mission Hospital in Uganda.

4.2 Response Rate

The response rate findings are presented in table 4.4 below

Table 4.4: Response rate for the study

Instruments Target population Actual Response rate

Questionnaires 64 64 100%

Interviews 14 14 100%

Total 80 80 100%

Source: (Field data, 2022)

From Table 4.4 above, out of the 64 distributed all were returned correctly filled representing

79%. Out of the 14 respondents that were targeted for interviews, all the 14 were interviewed

implying a response rate of 100%. The overall response rate, therefore Was 100%. This

response rate was deemed well enough since it was over and above the 50% recommended

by Amin (2005).

4.3 Background Characteristics

This section presents results on the demographic characteristic of respondents. These include

gender, age, education, experience and responsibility at Holy Cross Orthodox Hospital

(HCOH). This was sought through questionnaires.

4.3.1 Gender of respondents

The study looked at the distribution of the respondents by gender using frequency

distribution. The results obtained on the item are presented in the table below.
38
Table 4.5: Gender of respondents

Gender of respondents Frequency Percentage

Male 25 42

Female 35 58

Total 64 100

Source: Primary Data (2022)

From the findings in table 4.5 above, indicate that majority 58% of the respondents were

females and 42% were male respondents who constituted the study. Therefore, the majority

58% were females hence the study was gender inclusive, and eliminated the issue of gender

bias in the collection of data for the study. The implication of this finding was that no matter

the disparity in percentage of males and females who attended the study, at least views of

both males and females were captured.

4.3.2 Age of respondents

The study looked at the distribution of the respondents by age using frequency distribution.

The results obtained on the item are presented in Figure 4.2 below.

50
45
40
35
30
25
20 Percentage
15
10
5
0
Below 20 21-30 31-40 41-50
Years Years Years Years

Source: Primary Data (2022)

Figure 4.2: Age of respondents

39
In regards to the findings in Figure 4.2 above, majority of respondents 47.5% revealed, they

were of the age group from 31-40 years, while 20% were of the age group below 20 years,

17.5% were of the age range from 21-30 and 15% were of the age group 41-50 years.

Therefore, the majority 47.5% were of the age group 31-40 who were the most productivity

age and had the vital information which was relevant to the study findings. This indicated

that all categories of respondents in reference to different age groups were represented in this

study. This implies that all categories of respondents in reference to different age groups

were represented in this study.

4.3.3 Education of respondents

By examining the highest educational qualifications of the study respondents, the researcher

wished to ascertain whether there were substantial differences in the responses as indicated in

the Figure 4.3 below.

Post graduate Qualification

13%

Certificate
23%

Diploma
Degree 20%
45%

Source: Primary Data (2022)

Figure 4.3: Education of respondents

As from the findings in the table 4.3, majority 45% had obtained bachelor’s degrees in the

various field of study, while 22.5% had obtained certificates, 20% had obtained diplomas and

12.5% had attained post graduate qualification. Therefore, majority 45% had attained a

bachelor’s degree. This implies that the respondents had good academic qualifications and

40
the right skills and knowledge to deliver. Besides, the respondents were able to understand,

read, interpret the questionnaire and gave relevant responses.

4.3.4 Experience of respondents

By examining the Experience of respondents, the researcher wished to ascertain whether

there were substantial differences in the responses as indicated in the Figure 4.4 below;

70

60

50

40
Percentage
30

20

10

0
2-3 years 3-5 years 5-7 years Above 7 years

Source: Primary Data (2022)

Figure 4.4: Working experience of respondents

As indicated in the Figure 4.5 above, majority 65% revealed they had spent 3-5 years of

working experience in the hospital, where as both 12.5% had spent 2-3 years and above 7

years of work experience in the same hospital and 10% had spent 5-7 years. Therefore, the

majority 65% had worked for 3-5 years in the same organization. This implies that, they had

enough information which was relevant for the study findings since they had for long in the

organization and therefore were capable to provide a detailed informed view of the study

since they were part of the management team in the delivery of service in the hospital and

were more reliably informed.

41
4.3.5 Responsibility of respondents

By examining the responsibility e of respondents, the researcher wished to ascertain whether

there were substantial differences in the responses as indicated in the Figure 4.5 below;

Procurement Stores
3% 3% Accounts/
Finance
11%

Patients
51%
Administration
30%

Quality control
3%

Source: Primary Data (2022)

Figure 4.6: responsibility of respondents

As revealed in table 4.5 above, majority 51% were patients, while 30% were in the

administration department, 11% were in working in the accounts and finance department and

both 2.5% were in the procurement, stores and quality control departments. Therefore,

majority 51% were patients. This implies that, they were informed of the service levels of the

hospital hence preferred to come to the hospital facility to get treatment since they were

satisfied of the service levels hence they provided a more detailed and comprehensive

detailed information pertaining the study since they were knowledgeable.

42
4.4 Empirical findings

4.4.1 Tangibility of services and patient satisfaction.

The first objective in the study was to examine the effect of tangibility of services on patient

satisfaction. To observe the influence, 6 question items were administered to respondents to

establish the extent to which they agreed with them.

Table 4.6: Descriptive statistics on tangibility

Tangibility D SD
SA (5) A (4) NS (3) Mean Std
(2) (1)
Hospital facilities are attractive 17 45 2
- - 3.83 .595
(27%) (70%) (3%)
Staffs are dressed appropriately 50 14
- - - 3.85 .359
(78%) (22%)
Written materials can easily be 18 47
- - - 3.83 .487
understood (28%) (73%)
They use updated technology to 12 52 -
- - 4.05 .593
serve customers (19%) (81%)
He staff are courteous 24 38 2
- - 3.53 .503
(38%) (59%) (3%)
The waiting room for treatment of 16 46 2
- - 3.85 .530
patients is smart and conducive (25%) (72%) (3%)
Source: Primary Data (2022)
From the findings in table 4.6 above, majority 45(70%) agreed that, hospital facilities are

attractive with a mean value 3.83 and standard deviation 0.595, while 17(27%) strongly

agreed and 2(3%) were not sure. Therefore, majority 52(65%) revealed the hospital facilities

were attractive hence conforming to tangibility. The implication was that, it attracted more

customers to come and visit the hospital for treatment and other medical service due to

tangibility.
43
On the same note, one key informant stated;

The hospital facilities are so brightly colored that it just catches your sight and at

once you feel relieved of stress hence builds a positive imagination and brings back

the lost hope. Indeed, it’s beautiful KI001/24th/5/2022

As indicated in the table above, 50(78%) strongly agreed that, staffs are dressed

appropriately with a mean value of 3.85 and standard deviation of 0.595, and 14(22%) agreed

with staff dressing being appropriate. Therefore, majority 68(85%) of the staffs dressed

appropriately hence the implication was that, they were smart and acted professionally which

has attracted customers to come for treatment in the health facility since they are decent and

command respect.

On the same note, one key informant stated;

Very impressive, the staff of the hospital are so smart and appropriately dressed up in

their medical attires, with tags and names for easy identification which makes them,

admirable. Courteous and precious. This has left a smile on my face and I feel good.

KI002/24th/5/2022

In regards to table above, 47(73%) agreed with written materials were easily understood by

the clients or patients when accessing services in the hospital with a mean value of 3.83 and

standard deviation of 0.593, and 18(28%) indicated they, strongly agreed . therefore, the

majority 47(73%) agreed with written materials could easily be understood by the patients

thus provide adequate information and directions to the different service departments, this

also led to information on authorization and authorized movement to restricted areas due to

the written information.

As revealed in table 4 above, majority 52(81%) agreed with the hospital using updated

technology to serve customers, with a mean value of 4.05 and standard deviation of

0.593.while 12(19%) strongly agreed. Therefore, majority 52(81%) agreed that, the hospital

44
facility uses updated technology to serve customers hence this improved on its service levels

hence ensuring easy exchange of information and maintenance of patient information for

follow ups. Use of computers to print sales and payment receipts ensured accuracy in

customer service.

In regards to the findings in the table above, 38(59%) agreed and indicated, the staff are

courteous with a mean value of 3.83 and standard deviation 0.503, while 24(38%) strongly

agreed and 2(3%) were not sure. Therefore, majority 38(59%) agreed with staff being

courteous since they served customers with care, a sense of humor with clarity and honesty

hence this continued to attract patients since they were more kind in their acts and treated

customers with love.

As indicated in the findings above, 46(72%) agreed with the fact that, the waiting rooms for

treatment of patients was smart and conducive with a mean value of 3.83 and standard

deviation of 0.530, while 16(25%) strongly agreed and 2(3%) were not sure. Therefore,

majority 46(72%) agreed that, the waiting room for treatment of patients was smart and

conducive hence motivated and restored patient hope of getting better even before the service

was offered to them. This has been responsible in increasing the confidence levels of getting

well due to the clean serenity of the rooms. On the same note, one key informant stated;

The hospital facilities had decent waiting rooms, they pleasant, clean and nice with

good smell due to the perfume sprayed flower pots surrounding each seat. They are

always cleaned from time to time to ensure the floor is clean with disinfectants.

KI001/28th/5/2022

4.4.1.1: Simple linear regression analysis for tangibility of services and patient

satisfaction.

Simple linear regression analysis was carried out to establish the effect of tangibility of

services on patient satisfaction. In testing hypothesis one, a composite index was computed

45
from data collected from the respondents on indicators of tangibility of services which was

regressed with data collected from patient satisfaction. The purpose was to determine the

percentage variation in the patient satisfaction explained by tangibility of services as shown

below

Table 4.7: Regression Model Summary

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

1 .524 a .275 .271 .28059
a. Predictors: (Constant), Tangibility of services
Source: Primary data (2022)

Table 4.7 reveals R Square of .275 indicating that only 27.5% of the total variation of patient

satisfaction is explained by Tangibility of services. The model was therefore taken fit to

explain the relationship between the two variables. The inference is that a strengthened

Tangibility of services contributes to patient satisfaction.

4.4.2 Responsiveness and patient satisfaction

The second objective in the study was to examine the effect of responsiveness of services on

patient satisfaction. To observe the influence, 7 question items were administered to

respondents to establish the extent to which they agreed with them.

Table 4.8: Descriptive results of responsiveness

Responsiveness SA A NS D SD
Mean Std
(5) (4) (3) (2) (1)
When there is a problem the
52 8 2
hospital staff respond to it quickly - - 4.38 0.537
(81%) (13%) (3%)
with maximum attention
Staff are willing to answer clients
18 44 2
questions when they arise - - 3.83 0.444
(28%) (69%) (3%)
There specific times allocated for 7 57
- - - 3.58 0.414
accomplishment of tasks (11%) (59%)
Customers are served with respect 12 50 2
- - 4.00 0.513
and at most care (19%) (78%) (3%)
Clients are served on a timely basis 20 40 - 8 - 3.90 0.628
(31%) (63%) (13

46
 %)
Clients treatment is carefully 52 6 2 4
- 4.38 0.769
administered following schedules (81%) (9%) (3%) (6%)
Source: Primary Data (2022)

From table 4.8, above, majority 52(81%) strongly agreed, when there is a problem the

hospital staff respond to it quickly with maximum attention with a mean value 4.38 and

standard deviation 0.537. While 8(13%) agreed and 2(3%) were not sure. Therefore majority

52(81%) strongly agreed that when a problem arises, the hospital staff are very quick to

respond due to agility and this means that responsiveness.

Findings from table 4.8 above, revealed that 44(69%) agreed, that staff are willing to answer

clients questions when they arise, 18(28%) strongly agreed and 3% were not sure. The mean

value of 3.83 and standard deviation of 0.444. Therefore, the majority 44(69%) revealed staff

are willing to answer clients question hence offering clients with responsive answers which

ensures confidence building and provides customer satisfaction.

Findings in table 4.8 above also shows that 57(59%) strongly agreed, that there specific times

allocated for accomplishments of tasks and 7(11%) agreed. The mean value of 3.58 and

standard deviation of 0.414. Therefore, the majority 62(77.5%) revealed there specific times

allocated for accomplishments of tasks which leads to efficient and effective ways of task

being completed in a timely manner which leads to responsiveness in service acquisition.

In regards to the table above, majority 50(78%) revealed customers are served with respect

and at most care with a mean of 4.00 and 0.513 standard deviation. While 12(19%) strongly

agreed and 2(3%) were not sure. Hence the implication is that, when customers are timely

served the needs are adequately met hence leads to patient satisfaction and achieving

maximum satisfaction beyond the service levels.

As indicated in table 6 above, majority 40(63%) revealed that, clients are served on a timely

basis and a mean value of 3.90 and standard deviation of 0.628, whereas 20(31%) strongly
47
agreed and 4(5%) disagreed. The implication was, that timely services offered to clients

improves on the service times since it reduces on delays and facilitates faster service

delivery.

In respect to the table above, majority 52(81%) strongly agreed that client treatment is

carefully administered following schedules with a mean value of 1.38 and standard deviation

of 0.769 whereas 6(9%) agreed, 4(6%) disagreed and 2(3%) were not sure. The implication is

that, client’s services lines and engagement schedules are strictly adhered to which leads to

effective service delivery hence results into maximum customer satisfaction.

4.4.2.1 Simple linear regression analysis for responsiveness and patient satisfaction

The study applied simple linear regression analysis to further investigate the effect of

responsiveness and patient satisfaction. In testing hypothesis two further, a composite index

was computed from data collected from respondents on indicators of responsiveness which

was regressed with data collected from patient satisfaction. The purpose was to determine the

percentage variation in the patient satisfaction explained by responsiveness as shown in

Table 4.9 below.

Table 4.9: Regression Model Summary

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

1 .448 a .501 .198 .183596

a. Predictors: (Constant), Responsiveness

Source: Primary data (2022)

Table 4.9 discloses R Square value of .501 indicating that only 50.1% of the total variation of

patient satisfaction is explained by responsiveness with the rest being explained by other

factors. The model was therefore taken suitable to explain the relationship between the two

48
variables. The implication is that a strengthened responsiveness contributes to patient

satisfaction.

4.4.3: Service reliability and patient satisfaction

The third objective in the study was to examine the effect of service reliability on patient

satisfaction. To observe the influence, 7 question items were administered to respondents to

establish the extent to which they agreed with them.

Table 4.10: Descriptive results of service reliability

Reliability SA (5) A (4) NS D (2) SD Mea Std
(3) (1) n
Patients specifications are 20 35 - 9 - 3.56 0.675
exactly followed (31%) (54) - (14%)
Promised response are 7 40 3 14 - 3.50 0.858
strictly adhered to on a (11%) (63% (5 %) (22%)
timely basis as scheduled )
Service is performed right 15 45 2 2 - 3.83 0.591
the first time (23%) (70% (3%) (3%)
)
Service levels for all staff 4 36 - 14 10 3.50 1.212
members are always the (6%) (56% (22%) (16%
same at all times and all ) )
days
Medical reports and 10 34 12 2 4 3.50 0.765
statements are free of (16%) (53% (19% (3%) (6%)
errors ) )
Source: Primary Data (2022)
From table 4.10 above, majority 35(54%) agreed and indicated that, patients specifications

are exactly followed with a mean value 3.56 and standard deviation 0.675. While 20(31%)

strongly agreed and 9(14%) disagreed. This means that, patients are reliably handled and
49
treatment is administered in line with the diagnosis details of the patients, hence creates

certainty and awareness of what the treatment steps needed to be followed for wellness hence

contributes to customer satisfaction . On the same note, one key informant stated;

The hospital medical personnel take keen interest in noting and getting the history of

every patient who visits the hospital. The blood samples are collected and run often

more than three times to ensure they treat the real sickness and symptoms. This has

ensured quick follow up in case the drug does not rime with the treatment

prescription. Hence, the medicine or treatment is expeditiously changed and hence

led to cure of major illnesses and complications. KI003/22th/5/2022

Findings from the table 8 above, revealed that 40(63%) agreed, that Promised response are

strictly adhered to on a timely basis as scheduled with a mean of 3.50 and standard deviation

0.858, 7(11%) strongly agreed, 14(22%) disagreed and 3(5%) were not sure. Therefore, the

implication was that, the promises were handled based on the promise and were easily

followed up for appointments to scheduled hence a basis for customer satisfaction.

Findings in table above also shows that 45(70%) agreed, that service is performed right the

first time, 15(23%) strongly agreed and both 3% were not sure and disagrees. The mean

value of 1.83 and standard deviation of 0.591. Therefore, the majority 45(70%) revealed the

service is performed right the first time which leads to minimization of errors and offers

quality adherence to the quality set standards for service controls hence offers a first

impression and long life customer experience hence contributes patient satisfaction.

In regards to the table above, majority 36(56%) agreed and revealed Service levels for all

staff members are always the same at all times and all days with a mean of 3.50 and 1.212

standard deviation. While 14(22%) disagreed, 10(16%) strongly disagree and 4(5%) strongly

agreed. Hence the implication is that, timeliness in service levels improves effective handling

of customers which leads to customer satisfaction.

50
As indicated in table above, majority 34(53%) revealed that, Medical reports and statements

are free of errors and a mean value of 3.50 and standard deviation of 0.765, whereas 12(19%)

were not sure, 10(16%) strongly agreed and both 2(3%) disagreed and strongly disagreed.

The implication was that, errors were avoided due to continuous improvements and quality

controls that help to detect errors and ensure standardized operating procedures.

4.4.3.1 Simple linear regression analysis for service reliability and patient satisfaction

The study applied simple linear regression analysis to further investigate the effect of service

reliability and patient satisfaction. In testing hypothesis two further, a composite index was

computed from data collected from respondents on indicators of service reliability which was

regressed with data collected from patient satisfaction. The purpose was to determine the

percentage variation in the patient satisfaction explained by service reliability as shown in

Table 4.11 below.

Table 4.11: Regression Model Summary

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

1 .448 a .601 .198 .183596

a. Predictors: (Constant), Non-monetary rewards

Source: Primary data (2022)

Table 4.11 discloses R Square value of .601 indicating that only 60.1% of the total variation

of patient satisfaction is explained by service reliability with the rest being explained by

other factors. The model was therefore taken suitable to explain the relationship between the

two variables. The implication is that strengthened service reliability contributes to patient

satisfaction.

51
4.4.5: Patient Satisfaction in Holy Cross Orthodox Mission Hospital

This was the dependent variable of the study. The researcher was interested in identifying the

patient satisfaction of HCOH. Data collected is presented in table 10 below;

Table 4.12: Descriptive statistics on patient satisfaction in Holy Cross Orthodox

Mission Hospital

SA A NS D SD Mean Std
We provide services as 40 18 6 - - 3.28 .503
planned/promised (62%) (28%) (9%)
We keep our clients updated on 22 38 4 - - 3.88 .618
our products and service (34%) (59%) (6%)
performance
We get feedback from our clients 7 47 6 - - 3.90 .493
(11%) (73%) (9%)
We understand the need of the 56 8 - - - 3.33 .522
people we serve (87%) (13%)
We ensure total quality 26 38 - - - 3.83 .671
management (41%) (59%)
We offer services that meet 26 36 2 - - 3.70 .513
customer satisfaction (41%) (56%) (3%)
Patients complaints are timely 14 52 12 2 - 3.03 .656
handled and addressed (17.5%) (65%) (15%) (2.5
%)
Customer’s complaints are 36 20 6 - - 3.60 .587
recorded (56%) (30%) (9%)
Reduced customer complaints 12 44 8 - 2.05 .634

52
 (15%) (67.5% - (13%
) )
Work plans routinely managed 10 48 4 2 - 3.13 .753
(16%) (75%) (3%) (3%)
Services are delivered to the 16 48 8 4 - 3.10 .866
public on time as required (25%) (75%) (12.5%) (5%)
Accessing our services is always 16 60 2 2 1.88 .560
fast (20%) (75%) (2.5%) (2.5
%)
Our suppliers deliver what we 52 6 10 - - 4.48 .811
need on time (81%) (7.5%) (16%)
Customer referral is through 2 62 - - - 4.98 .157
word of mouth (3%) (97%)
Increased customer loyalty 30 32 2 - - 3.50 .693
(47) (48%) (3%
Source: Primary Data (2022)

From table 4.12 above, majority 75% strongly agreed, 22.5% agreed that HCOH provide

services as planned/promised to meet its obligations effectively, with a mean of 1.28 and

standard deviation of 0.503 and therefore manage its day to day operations smoothly due to

its service standards to ensure customer satisfaction.

In regards to findings from the table above, majority 60% strongly agreed, 27.5% agreed that

HCOH keeps their clients updated on their products and service which has consistently

grown, with a mean of 1.88 and standard deviation of 0.618 whereas only 12.5% were not

sure regarding this matter. Hence client’s updates are an indicator of patient satisfaction.

In respect to findings in table 10 above, it is revealed that, the majority 75% agreed, 17.5

strongly agreed and 7.5% were not sure that, we get feedback from our clients hence able to

get timely responses that help us improve on our deliveries and service levels hence ensure

patient satisfaction through meeting their demands with a mean of 1.90 and standard

53
deviation of 0.493. The implication was the tailoring of customer services for the various

range of customers.

Findings in table 10 above further revealed that, 70% strongly agreed, 27.5 agreed and 2.5%

were not sure that, HCOH understands the need of the people we serve to meet its customer

obligations effectively, with a mean of 1.33 and standard deviation of 0.522. From the

majority stand point, the hospital creates and delivers value to its esteemed clients hence able

to generate high returns and profits.

Table 10 shows that, 52.5% agreed, 32.5% strongly agreed and 15% were not sure that,

HCOH ensures total quality management in safe guarding the continuity of quality standards

with a mean of 1.83 and standard deviation of 0.671. It can be noted that, total commitment

to quality is a first priority in defining the quality of health care and ensuring continuous

quality improvements to ensure client/patient satisfaction.

From the data findings in table 10, the majority 65% agreed and 32.5% strongly agreed while

2.5% were not sure that, HCOH offers services that meet customer satisfaction with a mean

of 1.70 and standard deviation of 0.513. This has impacted on the operations of the hospital

since customer service and satisfaction is the major priority for growth and rapid timely

expansion.

In regards to the findings in table 10 above, the majority 65% agreed, 17.5% strongly agreed,

15% were not sure and 2.5% disagreed that, Patients complaints are timely handled and

addressed with a mean of 2.03 and standard deviation of 0.656. Taking the stand of the

majority, complaints regarding to patients are adequately handled and given ample time to

resolve the issues with in the shortest period of time hence creates a strong relationship

between the clients and the hospital staff thus mutual friendship.

From the findings in table 10 above, the majority 50% agreed, 45% strongly agreed and 5%

were not sure that, Customer’s complaints are recorded with a mean of 2.13 and standard
54
deviation of 0.753. Taking on the majority stand, customer complaints are recorded to ensure

the same mistakes don’t recur in future and ensure appropriate measures are taken for

expressive decision making as some creates a learning process hence ensure patient

satisfaction.

As indicated in the findings from table 10 above, majority 67.5% agreed, whereas both 15%

strongly agreed and were not sure, 2.5% disagreed that, there was reduced customer

complaints, with a mean of 2.05 and standard deviation of 0.634. Taking the majority stand,

reduced customer complaints was exhibited due to the timely handling and resolving

customer complaints in a professional and timely manner hence generated and won the hearts

of most clients hence contributed to customer satisfaction.

From table 10 above, 72.5% agreed, 12.5% strongly agreed, 10% disagreed and 5% were not

sure that, work plans routinely managed, with a mean of 2.13 and standard deviation of

0.753. Therefore, the majority indicated work plans were routinely managed to ensure

service levels were all fully engaged at peak hours to reduce congestion within the health

facility.

As indicated in table 10 above, the findings revealed that, majority 62.5% agreed, 20%

strongly agreed, 12.5% were not sure and 2.5% disagreed that, Services are delivered to the

public on time as required with a mean of 2.10 and standard deviation of 0.886. Therefore,

based the majority, services were delivered to the public on a timely basis to ensure the

turnaround time was achieved to provide maximum customer satisfaction.

In regards to table above, majority 75% agreed, 20% strongly agreed and both 2.5% were not

sure and disagreed that, accessing our services is always fast with a mean of 1.88 and

standard deviation of 0.560. Based on the majority, our services are so fast and quick to meet

the ever increasing customer needs and wants through easy of accessibility both physical and

online or a phone call, due to the presence of an emergency rescue response team.
55
In respect to the table, majority 72.5% strongly agreed, 20% were not sure and 16% agreed

that, our suppliers deliver what we need on time with a mean of 1.48 and standard deviation

of 0.811. This has ensured that the medicines and drugs are administered to the right patients

and hence avoid the issues of stock and ensure availability of essential medicines to support

our patients.

As per the findings in table 10 above, majority 97.5% agreed and 2.5% strongly agreed that,

Customer referral is through word of mouth with a mean of 4.98 and standard deviation of

0.157. Therefore the majority agreed that, Customer referral is through word of mouth from

the satisfied customers who have promoted the health facility due to the service levels and

expectation that they have achieved beyond the minimum required expectation hence

resulted into customer satisfaction.

Lastly, table 10 above, 47.5% agreed, 37.5 strongly agreed and 15% were not sure that, there

was increased customer loyalty with a mean of 1.78 and standard deviation of 0.693. The

findings shows that despite of the few errors, the hospital facility has performing quite well

due to the increased customer loyalty arising from the services patients consume from the

health facility hence expanded the market for our services, this has been greatly experienced

with the inflow of patients seeking specialized medical attention and the testimony reports of

services offered at an affordable cost hence ensure high patient satisfaction.

56
 CHAPTER FIVE

SUMMARY, DISCUSSION, CONCLUSION AND RECOMMENDATIONS

5.1 Introduction

The study examined the effect of service quality dimensions and patient satisfaction in Holy

Cross Orthodox Mission Hospital in Uganda. This chapter provides summaries of the

findings from the study, discusses the empirical results in view of the research objectives, and

draws conclusions and finally recommendations.

5.2 Summary of findings

5.2.1 Tangibles and patient satisfaction

Findings revealed that, majority of the respondents strongly agreed with Staffs being dressed

appropriately and having written materials can easily be understood that, can used to identify

easily and also agreed that, they used updated technology to serve customers and staff are

courteous. Table 4.7 reveals R Square of .275 indicating that only 27.5% of the total

variation of patient satisfaction is explained by Tangibility of services. The model was

therefore taken fit to explain the relationship between the two variables. The inference is that

a strengthened Tangibility of services contributes to patient satisfaction.

5.2.2 Responsiveness on patient satisfaction

Findings revealed that, majority of the respondents strongly agreed, that whenever, there was

a problem the hospital staff respond to it quickly with maximum attention. Other respondents

agreed that, Staffs are willing to answer clients questions when they arise, there was specific

times allocated for accomplishment of tasks and Customers were served with respect and at

most care on a timely basis. Table 4.9 discloses R Square value of .501 indicating that only

50.1% of the total variation of patient satisfaction is explained by responsiveness with the

rest being explained by other factors. The model was therefore taken suitable to explain the

relationship between the two variables. The implication is that a strengthened responsiveness

contributes to patient satisfaction.

57
5.2.3 Service reliability and patient satisfaction

Findings revealed that, majority of the respondents strongly agreed that, Patients

specifications were exactly followed, Promised response are strictly adhered to on a timely

basis as scheduled, Service was performed right the first time and Medical reports and

statements are free of errors. Table 4.11 discloses R Square value of .601 indicating that

only 60.1% of the total variation of patient satisfaction is explained by service reliability with

the rest being explained by other factors. The model was therefore taken suitable to explain

the relationship between the two variables. The implication is that strengthened service

reliability contributes to patient satisfaction.

5.3 Discussion

A discussion of the findings was carried out objective by objectives.

5.3.1 Tangibility Service Quality Dimension and Patient Satisfaction

According to this study findings, there was a positive and significant effect between Tangible

service quality and patient satisfaction, with majority of respondents strongly agreed with

Staffs being dressed appropriately and having written materials can easily be understood that,

can used to identify easily and also agreed that, they used updated technology to serve

customers and staff are courteous.

The study finding are supported by Peter and Batonda, (2022) who revealed that a hospital is

a place for treating diseases, there is always a chance of getting contaminated with diseases.

Contamination fears make clients worry during their hospital stay. A clean hospital assures

patients that they are safe. Participants concurred that ensuring patient safety is an essential

factor in the delivery of care. Clients feel more comfortable if providers respect their privacy

during counseling sessions and examinations. Lack of privacy can make it more difficult for

patients to participate actively in their treatment plan: Patients desired for technically

58
knowledgeable, skillful, and experienced providers capable of accurate diagnoses and

effective treatment.

Tuncer; Unusan & Cobanoglu (2021) also indicated that although patients are concerned

with the technical aspect of care, they mostly tend to form their opinions about service

quality based on their assessment of non-clinical aspects of care such as the availability and

accessibility of facilities and amenities, security in and around the facility, clean and

comfortable rooms, privacy, tasty meals, comfortable clothes, and a quiet and attractive

environment. Healthcare services should be available to patients any time they need them.

Healthcare service availability is a necessity, but it is not enough. Services should be

accessible to clients if they are to be considered useful.

5.3.2 Reliability Service Quality Dimension and patient satisfaction

According to this study findings, revealed a positive and significant effect between service

reliability and patient satisfaction. The majority of the respondents strongly agreed, that

whenever, there was a problem the hospital staff respond to it quickly with maximum

attention. Other respondents agreed that, staffs are willing to answer clients questions when

they arise, there was specific times allocated for accomplishment of tasks and Customers

were served with respect and at most care on a timely basis. The Reliability dimension

positively influences patient satisfaction at Holy Cross Orthodox.

The study findings are supported by Akoi, SAbdulrahman, Muhamed, Noori, and Anwar

(2021) who indicated that customer guidance enables an organization to assess how its

customers feel about the interactions they may have with it or the services they receive.

Customer guidance is also a straightforward and accessible starting point for introducing

customer insight in organizations which may be unfamiliar or uncomfortable with using

techniques such as qualitative research as evidence for taking action. Levy (2019) also

asserts that customer guidance provides an organization with overall numerical ‘scores’ for

59
the levels of satisfaction that customers are experiencing with different areas of service

delivery.

The findings are supported by Anwar & Balcioglu (2016) who revealed that reliability of

services is part of lifetime management. The significant importance lies in fulfilling promptly

the patients’ requests. It is obtained that the service quality data does influences the patient

satisfaction in having medical treatment at the health center. This is due to the good quality

can increase people’s trust when they want to have medical treatment in that health

institution. The relationship of total quality management (TQM) is implemented in the

hospital with commitment, then performance indicators of a hospital will gradually direct

towards excellence.

Findings are consistent with Hameed and Anwar (2018) reliability “reflects the service

provider’s ability to perform service dependably and accurately”. It includes “doing it right

the first time” and as for the patients it is one of the most significant dimensions. In detail,

reliability implies that the organization conveys on its guarantees about conveyance, service

supply, issue determination and pricing policy. However, health care services differ from

other services because of vitality and criticality. The customer (Patient) surrenders his/her

confidentiality and cooperation with the health worker during the encounter to make

treatment successful.

5.3.3 Responsiveness Service Quality Dimension and Patient Satisfaction

According to these study findings, there was a positive and significant effect between

Tangible service quality and patient satisfaction. Majority of the respondents strongly agreed

that, Patients specifications were exactly followed, Promised response are strictly adhered to

on a timely basis as scheduled, Service was performed right the first time and Medical

reports and statements are free of errors.

60
The findings are supported by Sivadas and Baker-Prewitt (2020) who revealed that a

responsive company uses technology to learn more about customer needs and train its

employees to deliver the highest standards of customer service. Since customer satisfaction

has been considered to be based on the ability of employees to listen to customer’s

experience and complaints on a particular service encounter, it is in line with the fact that

listening to customers is a determinant of customer satisfaction, because it comes from

outcome of the services from service providers in organizations. Additionally,

Sureshchander, Rajendran and Anatharaman (2021) suggest that listening to customers

would be antecedent to customer satisfaction regardless of whether these constructs were

cumulative or transaction-specific. Satisfaction and service quality have certain things in

common, but satisfaction generally is a broader concept, whereas service quality focuses

specifically on dimensions of service. Thus this study seeks to fill this gap of knowledge

The findings are in agreement with Nguyen, Pham, Tran and Pham (2020) who noted that

harsh words are always indicative of insight; customer concerns are not always a sign that

something is wrong. Customers always ask for more free stuff and future requests often turn

into product demands. While helping customers is always right, haphazardly following their

demands is always wrong. In addition, multiple messages from multiple customers with

recurring concern are the beginning of satisfaction imperfections among customers. It’s

important to realize that organizations that are customer focused acknowledge customer.

The findings are agreement with Anwar & Ghafoor (2017) who revealed that responsiveness

of service quality is related to the organization’s willingness and ability to help customers

and to provide quick service with proper timeliness. The willingness of employees to provide

the required service at any time without any inconvenience will have an impact on customer

satisfaction. This dimension of service quality is perceived through the people aspect of

service quality.

61
5.4 Conclusion

5.4.1 Tangibility Service quality and Patient Satisfaction.

Tangibility was an effective dimension on patient satisfaction at Holy Cross Orthodox

Mission Hospital. Patients care about the facilities and neatness of both the facilities and its

employees and the way communication is provided especially when getting the first hand

information. Tangibility was used to convey the image and reflects the company’s quality.

Patients such for modern facilities that entail physical and modern looking amenities. The

clean and convenient layout is what patients look at. Therefore Holy Cross Orthodox Mission

Hospital needs to improve on assuring patients through improved service quality as it will

build patient satisfaction.

5.4.2 Reliability Service quality dimension and Patient Satisfaction.

The study concluded that Holy Cross Orthodox Mission hospital could still improve on its

service reliability by focusing on enhanced accuracy, consistence, and dependability of the

service and to enhance customer loyalty.

The discoveries on the influence of service reliability on customer loyalty showed that, there

is some level of service reliability at Holy Cross Orthodox Mission hospital , predisposed by

ability of staff to taking on extra tasks by staff to ensure quality service provision,

convenience in handling of customer service problems, increased readiness to respond to

customers' requests, provision of on time and in time services to customers, and neatness and

professional delivery of services to customers.

5.4.3 Responsiveness Service quality dimension and Patient Satisfaction.

The study on the influence of responsiveness on customer loyalty found that, customer

loyalty is significantly influenced by provision of relevant care and help to customers, quick

response to customers' requests, implementation of service quality policies at the airport, and

informing customers about when services were performed.

62
The study concluded that Holy Cross Orthodox Mission hospital could still improve on its

service responsiveness by focusing on enhanced readiness, flexibility, willingness of the

service and to enhance customer loyalty and retention.

5.5. Recommendations

The following are the recommendation that Holy Cross orthodox mission hospital should

embrace in order to ensure effective patient satisfaction and among others include;

5.5.1 Tangibility Service quality dimension and Patient Satisfaction.

The hospital administration is recommended to provide attendants and patients with

appropriate waiting facilities and restrooms and the hospital management is recommended to

develop the employees’ communication skills in respect of dealing with patient and the level

of response to their needs, giving them empathy and safety.

5.5.2 Reliability Service quality dimension and Patient Satisfaction.

The study recommends that, Hospital Management should continue their commitment to

provide medical services to patients in a timely manner with recruitment of highly skilled

healthcare personnel must do their utmost to provide the patients with person-centered care.

The study recommends that, the hospital Management should actively and rigorously

develop an advanced appointment system to solve the problems of overcrowded clinics and

long working hours and regularly assess patient perceptions and satisfactions through

surveys, which could then be used to improve the quality of health care and overall patient

satisfaction.

5.5.3 Responsiveness Service quality dimension and Patient Satisfaction.

63
The study recommends that, the Hospital administration should give and ensure more

attention to patients’ problems, have a better response to patients’ complaints, and pay

special attention to their care.

The study recommends that, the tools used for measuring perceived healthcare quality and

patient satisfaction is reliable and valid. The researcher suggests that Holy Cross Orthodox

Mission hospital can adapt this tool to enhance its quality improvement efforts. And also

Management should train employees in decision making programs to enable them make

rapid decisions but not slow decision makers while focusing on commitment which yields

long term benefits other than short term in order to build a long term relationship with the

people they serve.

5.6 Limitations of the Study

The contribution of this research should be viewed in the light of some limitations.

First, this study was limited to Holy Cross Orthodox Mission hospital as a case study, which

limited the generalization of the findings. Hence future research should include more

hospitals to allow generalization.

Second, this research conceptualized service quality from the patient satisfaction. The

researcher suggests other researches perceive healthcare quality from the perspective of

other stakeholders.

Third constraint is that, in the study of service quality dimensions was reflected through

tangibles, Reliability and Responsiveness service quality dimensions. Besides these

dimensions there are other service quality dimensions that can influence patient satisfaction,

which were not being considered in this study.

The fourth limitations of the study were the timeframe and location of data collection and

consequently the generalizability and applicability of the results. Service processes change

64
over time, so the quality and features of the service can be better understood through long-

term data collection and analysis.

5.7 Areas for Further Study

This study has given some insights into the service quality dimensions and patient

satisfaction in private medical facility (Holy Cross Orthodox Mission Hospital) in Uganda.

Hence it would be beneficial for future research to consider the following suggestions:

 Service quality dimensions in the public health care sector with focus on Referral

hospitals.

 Responsiveness in delivery of ART in Government hospital and quality service in

combating the spread of malaria in developing countries.

 Reliability of service and medical service delivery in rural areas.

65
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 APPENDIXI: QUESTIONNAIRE FOR THERESPONDENTS

Uganda Management Institute

P. O. Box 20131

Kampala

May 2021.

Dear respondent,
I am currently undertaking research on the topic “Service Quality Dimensions and Patient
Satisfaction in Uganda: A Case of Holy Cross Orthodox Hospital” in partial fulfillment for the
award of a master’s degree in business administration of Uganda Management Institute.” The
information sought is required only for academic purposes. Participation is entirely out of your
volition and necessary for the success of this work. I request you to respond with truthfulness and
honesty for the success of the research. Information provided was treated with maximum
confidentiality.
Yours Sincerely
..............................
Nandugga Prossy

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Instructions to the respondents (Please tick where applicable)

Section A: Background Information

A1. Your Sex
Male Female

A.2 Your age group:

Below 20 years 21-30years 31-40years 41-50 years Above 50 years

A.3 Your level of education:

Certificate Diploma Bachelor’s degree Post Graduate Qualifications

A.4 How long have you worked for Holy Cross Orthodox Hospital?
Less than 1 year 2-3 years 3-5years 5-7 years Above 7 years

A.5 What responsibility do you hold in Holy Cross Orthodox Hospital?

Procurement Stores Accounts Administration Quality control

/Finance

Section B: Service Quality Dimensions (IV)

The section divided into three parts, namely, Tangibility, Responsiveness and Reliability
please indicate/tick (√) against the corresponding box to show your level of agreement with the
statement regarding patient satisfaction at Holy Cross Orthodox Hospital. Use the following
scale: Strongly Disagree (1); Disagree (2); Neither Agree nor Disagree (3); Agree (4); strongly
agree (5)

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B1 TANGIBILITY SA A NS D SD
1 2 3 4 5
B 1.1 Hospital facilities are attractive
B 1.2 Staffs are dressed appropriately
B 1.3 Written materials can easily be understood
B 1.4 They use updated technology to serve customers
B 1.5 The staff are courteous
B 1.6 The waiting room for treatment of patients is smart and
conducive
B 2. Responsiveness
B 2.1 When there is a problem the hospital staff respond to it
quickly with maximum attention
B 2.2 Staff are willing answer clients’ questions when they arise
B 2.3 There specific times allocated for accomplishment of tasks
B 2.4 Customers are served with respect and at most care
B 2.5 Clients are served on a timely basis
B 2.6 Clients’ treatment is carefully administered following
schedules
B3 Reliability
B 3.1 Patient’s specifications are exactly followed
B 3.2 Promised response are strictly adhered to on a timely basis
as scheduled.
B 3.3 Services is performed right the first time
B 3.4 Service levels for all staff members are always the same at
all times and all days
B 3.5 Medical reports and statements are free of errors

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SECTION C: Patient satisfaction under this section, please indicate/tick (√) against the
corresponding box to show your level of agreement with the statement regarding client
satisfaction at Holy Cross Orthodox Hospital. Use the following scale: Strongly Disagree (1);
Disagree (2); Neither Agree nor Disagree (3); Agree (4); strongly agree (5)

S/N Patient satisfaction S A N D SD

A S
C1 Satisfaction rate
C 1.1 We provide services as planned/promised.
C 1.2 We keep our clients updated on our products and service
performance,
C 1.3 We get feedback from our clients
C 1.4 We understand the need of the people we serve
C 1.5 We ensure total quality management
C 1.6 We offer services that meet Customer satisfaction
C2 Patient complaints
C 2.1 Patient’s complaints are timely handled and addressed
C 2.2 Customer’s complaints are recorded
C 2.3 Reduced customer complaints
C 2.4 Work plans routinely managed
C3 Customer referrals.
C 3.1 Services are delivered to the public on time as required

C 3.2 Accessing our services is always fast

C 3.3 Our suppliers deliver what we need on time
C 3.4 Customer referral is through word of mouth

C 3.5 Increased customer loyalty

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 Appendix II: Interview Guide

Tangibility

1. How attractive are the Hospital facilities?

2. Are staffs are dressed appropriately with labels for easy identification?

3. Are written materials easily understood by both clients and staff?

4. Do they use updated technology to serve customers?

5. Are the staffs courteous?
6. Are the waiting rooms for treatment of patients smart and conducive?
Responsiveness
7. When there is a problem do the hospital, staff respond to it quickly with maximum
attention? If NO explain and if Yes, Please, state the reason?

8. Are the staff willing answer clients’ questions when they arise?

9. Are there specific times allocated for accomplishment of tasks?

10. Are Customers served with respect and at most care?

11. Are Clients are served on a timely basis based on appointment? If not please clarify?

12. Is Clients’ treatment carefully administered following schedules?

Reliability

13. Are Patient’s specifications exactly followed? If yes, please explain?

14. Are promised response strictly adhered to on a timely basis as scheduled.

15. Is Services performed right the first time?

16. Are always Service levels for all staff members always the same and all days?
Yes/No
17. If No, please explain?
18. Are Medical reports and statements free of errors?

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Satisfaction rate

19. Does Holy Cross Orthodox Hospital provide services as planned/promised?

20. Does Holy Cross Orthodox Hospital update clients on our products and service
performance,

21. Does Holy Cross Orthodox Hospital get feedback from our clients?

22. Does Holy Cross Orthodox Hospital understand the need of the people we serve?

23. Does Holy Cross Orthodox Hospital ensure total quality management?

24. Does offer services that meet Customer satisfaction?

Patient complaints

25. Are Patient’s complaints timely handled and addressed?

26. Are Customer’s complaints recorded?

27. How does Holy Cross Orthodox Hospital reduce customer complaints?

28. Are work plans routinely managed?

Customer referrals.

29. Are Services are delivered to the public on time as required?

30. Is accessing our services always fast?

31. How is Customer referral done through word of mouth?

32. How has Holy Cross Orthodox Hospital Increased customer loyalty?

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Appendix III: Document review checklist
The following documents were reviewed for the secondary data
i. Stores records,
ii. Quality service plans,
iii. Stock cards,
iv. Customer complaint management records,
v. Quality control sheets on health quality service and patient satisfaction

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