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SERVICE QUALITY AT A MILITARY HOSPITAL
BY
PONCE
KOKOU
MINOR DISSERTATION
Submitted in partial fulfilment of the
requirements for the degree
MAGISTER COMMERCII
in
BUSINESS MANAGEMENT
in
the
FACULTY OF MANAGEMENT
at the
UNIVERSITY OF
JOHANNESBURG
Supervisor: Prof Mornay Roberts-Lombard
JANUARY 2014
Co-supervisor: Dr Estelle van Tonder
ii
ABSTRACT
With the raise of competition in the Gabonese health industry
and increased costs, most health service providers in Gabon have become under
pressure to deliver good service quality. This also relates to the military
hospital in Libreville in Gabon striving to provide adequate health services to
its patients. The cost for hospitals to attract patients through several means
such as providing good service quality has become crucial. Patient loyalty and
retention can have an important financial advantage for a hospital, thus it has
become essential for hospitals to create a sustaining relationship with their
patients. The question of assessing service quality presents itself. This study
investigated service quality at a military hospital in Libreville in Gabon. It
was the objective of this study to establish if there is a difference in how
patients rate doctors and nurses on the service quality dimensions.
This research was quantitative and descriptive in nature.
Theory relating to service quality and patient satisfaction was provided. The
population for the study consisted of patients who were at least 18 years old,
males and females, who have experienced medical services and stayed over at the
military hospital for at least one night. A self-administered questionnaire was
designed based on the theoretical literature illustrated in the study. The
questionnaire assessed various elements that were identified through the
literature review. The questionnaire was based on a set of statements linked to
the literature theory, and a 7-point Likert scale which enabled respondents to
choose from seven different alternatives ranging from strongly disagree to
strongly agree. A number of statistical analysis techniques were undertaken to
achieve the objectives of the study, such as factor analysis. The conclusion
and findings of the research assisted in explaining the objectives of the study
and the results of the statistical analysis were found to reject the hypotheses
that there is no significant difference in how patients rate the reliability,
responsiveness, assurance and empathy of doctors and nurses and to reject the
hypothesis that patients do not have a positive perception of the tangible
aspects of a military hospital in Libreville, Gabon.In terms of the doctors'
services, patients felt a need for more privacy in terms of the confidentiality
of their treatment, a need for more individual attention, a need to be heard,
and to trust doctors. Therefore such needs could be addressed through improved
compassion, communication and understanding of doctors during the diagnosis of
the problem. The feeling expressed was that doctors should pay more attention
to patients' problems and share with them
iii
their experience. Doctors at the military hospital should
develop more work ethic where patients' records and cases should never be
discussed with anyone without patients' permission. The military hospital
should employ highly trained and qualified doctors to address the trust issue
with patients. Lastly, consultation time may need to be reviewed to add some
extra time to better address patients' needs during their consultation with
doctors.
In terms of the services delivered by nurses towards patients,
the latter were of the opinion that there was a need for more individual
attention from nurses. Such individual attention could include greater
information sharing when a patient is treated, friendlier communication to
install greater trust and respect. Such needs could be addressed through
improved patience, compassion and understanding by nurses during their dealings
with patients. Nurses should also develop more work ethic regarding patients'
records, and cases should never be discussed with anyone without their
permission. Officials in the hospital should hire highly trained and qualified
nurses to address the issue of trust in patients and consultation time may need
to be reviewed to add some extra time to better address patients' needs during
their dealings with nurses.
iv
DECLARATION
I, the undersigned Ponce Kokou, hereby declare that this
dissertation is my own original work. It has not been presented or submitted
before for any degree at this or at any other university. Any assistance
received in preparing this work has been duly acknowledged in this
dissertation. It is submitted in fulfilment of the requirements for the degree
of Master of Commerce in Business Management at the University of
Johannesburg.
Signature (Day, month, year)
v
ACKNOWLEDGEMENTS
First, I thank the almighty God, Jesus Christ, for giving me his
love, strength, wisdom, courage, determination and inspiration, without which I
would never been able to complete this work.
Also, I would like to thank the following people for their
involvement to this dissertation:
? My mother and father, Adèle and Paul Kokou in Gabon
for their continued love, support and encouragement, during this tough journey.
I pray to the Lord Jesus Christ to continue blessing you and to give you many
more years and reward you in abundance. Your presence in my life is all I ever
wanted. Merci Papa Paul et Madre pour tout le soutien, l'amour, la
tendresse, l'affection et la confiance dont vous m'aviez toujours
apporté. Je ne pourrai jamais vous remercier assez. Que le Seigneur
Jésus Christ, Dieu tout puissant vous accorde protection, santé,
paix, et très longue vie. Sans vous, je n'aurai jamais achevé ce
diplôme, vous êtes ma vie, mon coeur, vous représentez tout
pour moi.
? My brothers and sisters Nicaise, Ghislaine, Alain, Wilfried,
Maryse, Marina, Nancy, nieces and nephews Fatoumata, Bertrand, Nanou, Celia,
Ruby, Sarah for their continued support, prayers, love and guidance during this
difficult journey. I pray to the Lord Jesus Christ to continue blessing you and
giving you many more years. Thank you for believing in me.
? My supervisors Prof Mornay Roberts-Lombard and Dr Estelle
Van Tonder as well as Richard Devey from STATKON for their continued advice,
guidance and patience. Thank you for assisting me in overcoming the challenges
experienced during this long journey. The road was tough, but you drove me
through it. May God almighty bless and reward you abundantly.
vi
DEDICATION
To the Lord Jesus Christ, to the much-loved family in the
world, Mr and Ms Kokou, my brothers, sisters, nephews and nieces.
vii
TABLE OF CONTENTS
ABSTRACT ii
DECLARATION iv
ACKNOWLEDGEMENTS v
DEDICATION vi
TABLE OF CONTENTS vii
LIST OF TABLES xii
LIST OF FIGURES xiv
CHAPTER 1 : CONTEXTUALISATION OF THE STUDY
1
1.1 INTRODUCTION 1
1.2 BACKGROUND 2
1.3 PROBLEM STATEMENT 4
1.4 PURPOSE OF THE STUDY 4
1.5 OBJECTIVES 5
1.5.1 Primary objective 5
1.5.2 Secondary objectives 5
1.5.3 Hypotheses 5
1.6 SIGNIFICANCE OF THE STUDY 6
1.7 LITERATURE REVIEW 6
1.7.1 Overview of the service sector 6
1.7.2 Service marketing in health care organisations
7
1.7.3 Service quality 8
1.7.4 Service quality and patient satisfaction
8
1.7.5 Measuring service quality using the SERVQUAL
instrument 9
1.8 RESEARCH METHODOLOGY 11
1.9 ETHICAL CONSIDERATIONS 13
1.10 LIMITATIONS OF THE STUDY 13
1.11 DIVISION OF THE STUDY 14
1.12 TERMINOLOGY 15
1.13 CONCLUSION 17
VIII
CHAPTER TWO: THE HEALTH CARE INDUSTRY IN AFRICA AND
GABON
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19
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2.1
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INTRODUCTION
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19
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2.2
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HEALTH CARE STATUS IN AFRICA
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19
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2.3
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HEALTH DEVELOPMENT INITIATIVES IN CENTRAL AFRICA
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21
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2.4
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HEALTH SERVICE QUALITY IN GABON
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23
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2.4.1
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Public health development initiatives in Gabon
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23
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2.4.2
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Private sector development initiatives in Gabon
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24
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2.5
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IMPLICATIONS OF HEALTH SERVICE QUALITY IN GABON
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27
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2.6
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HEALTH DEVELOPMENT INITIATIVES IN GABON
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27
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2.7
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THE MILITARY HOSPITAL IN GABON
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30
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2.6
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CONCLUSION
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36
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CHAPTER THREE: SERVICES MARKETING, SERVICE QUALITY AND
CUSTOMER
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SATISFACTION
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38
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3.1
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INTRODUCTION
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38
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3.2.
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SERVICES MARKETING
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40
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3.2.1
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Definition of services marketing
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40
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3.2.2
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Generic elements of the definition of services marketing
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42
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3.2.3
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The importance of services marketing
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44
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3.3
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MANAGING ORGANISATIONS IN A SERVICE ENVIRONMENT
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47
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3.3.1
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Different dimensions when managing an organisation in a
service
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environment
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47
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3.3.2
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The services marketing mix
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49
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3.4
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THE THREE LEGS OF SERVICES MARKETING
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52
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3.4.1
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The services marketing triangle
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52
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3.5
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SERVICE QUALITY
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54
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3.5.1
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Defining service quality
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55
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3.5.2
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Generic elements of service quality
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56
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3.5.3
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The importance of service quality
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57
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3.5.4
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The different elements of service quality
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58
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3.5.5
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Failure gaps in service quality
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59
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3.6
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CUSTOMER SATISFACTION
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62
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3.6.1
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Defining customer satisfaction
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62
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3.6.2
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Satisfaction with care between doctors and nurses
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63
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3.6.3
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The generic elements to customer satisfaction
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64
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3.6.4
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Types of customer expectations and the zone of tolerance
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65
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3.6.5
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Factors influencing service expectations
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66
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3.6.5.1 Desired and predicted service 66
3.6.5.2 Adequate service 67
3.6.6 The link between expectations, customer
satisfaction and service
quality 68
3.7 CONCLUSION 69
CHAPTER FOUR: RESEARCH METHODOLOGY 71
4.1 INTRODUCTION 71
4.2 THE RESEARCH PROCESS 71
4.2.1 Step 1: Identify and formulate the problem or
opportunity 72
4.2.2 Step 2: Determine the research objectives
73
4.2.3 Step 3: Research design 73
4.2.3.1 Quantitative research 74
4.2.3.2 Descriptive research 74
4.2.4 Step 4: Conduct secondary research
75
4.2.5 Step 5: Select a primary research method
75
4.2.5.1 Data gathering technique 75
4.2.5.2 Self-administered questionnaires
76
4.2.5.3 Covering letter 77
4.2.5.4 Questionnaire 77
4.2.5.5 Questionnaire design 78
4.2.5.6 Pretesting of the questionnaire 83
4.2.5.7 Reliability and validity of the questionnaire
84
4.2.6 Step 6: Determine the research frame
86
4.2.6.1 The survey area 86
4.2.6.2 The study unit 86
4.2.6.3 Population 86
4.2.6.4 Sampling method 87
4.2.6.5 Probability sampling method 88
4.2.6.6 Sample technique 88
4.2.6.7 Sample size 90
4.2.7 Step 7: Data gathering 92
4.2.8 Step 8: Data analysis 92
4.2.8.1 Editing of data 93
4.2.8.2 Coding of data 93
4.2.8.3 Processing and statistical analysis of data
94
4.3 RALIABILITY OF THE RESULTS 95
4.3.1 Sampling errors 95
X
4.3.2 Response errors 95
4.3.3 Non-response errors 95
4.4 CONCLUSION 96
CHAPTER FIVE: DATA ANALYSIS AND INTERPRETATION
97
5.1 INTRODUCTION 97
5.2 MEASUREMENT OF OBJECTIVES AND HYPOTHESES
97
5.3 RESEARCH INSTRUMENT AND RESPONSE STATISTICS
98
5.4 DISCUSSION OF THE RESEARCH FINDINGS 99
5.4.1 Section A - Demographics 99
5.4.2 Section B: Perception of services provided by doctors
and nurses ... 103
5.4.2.1 Patient perception of services provided by
doctors and nurses 103
5.4.2.2 Comparing patient perception of services
delivered by doctors and
nurses 112
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