Memoire Online - Service quality at a military hospital

Data gathering is the method utilised to gather both primary and secondary data. Primary data was collected and assessed for the study at hand (Munyaradzi, 2010: 214). The measuring element for this research was made through the use of primary data gathered via self-administered survey questionnaires. This implied that self-administered survey questionnaires were distributed to all existing patients of the military hospital in Libreville, Gabon, 18 years or older, males and females, who had experienced services and stayed over at the military hospital for at least one night.

Secondary data refers to data that has been gathered and utilised for previous research (Holder, 2008:72). In this study, the researcher made use of research articles, books, scholar publications, interviews and Internet sources.

4.2.8 Step 8: Data analysis

Quantitative data represents numerical data which can aid in providing responses to research questions. This data can vary from simple calculations such as frequency to more difficult data. To be helpful, the data should be evaluated and interpreted.

Quantitative analysis methods can help in this procedure. These vary from building simple diagrams which describe the frequency of occurrence through creating statistical relationships among variables, to more difficult statistical modelling. It is important to make sure that the data analysis technique matches the research paradigm and design. Analysing data starts once data has been gathered. Through the analysis step, various interrelated processes are undertaken to review and re-organise data. The stages of data analysis involve editing, coding, processing and statistical analysis of the data (Terre Blanche et al., 2006:86). To achieve the objective of this study and to test the hypotheses, SPSS 17.0 for Windows was used to evaluate data. These different constituents of data analysis are reviewed in the following sections.

Editing is undertaken to ensure that data is prepared for coding and moved to data storage. It is a procedure for verifying and correcting the data for omissions, consistency and reliability. Through editing, questionnaires and the raw data are verified for errors made by either the researcher or the respondent. The main purpose of editing is to make sure that the data is correct, consistent with the objective of the questions, uniformly entered, completed and organised to make coding and tabulation easier (Du Plessis, 2010:143).

Coding is the procedure for giving a code or a number to every possible answer to a specific question. The aim of coding is to convert the respondents' responses to survey questions into codes which can be examined and put into a statistical analysis software package. Precoding can be utilised if the researcher is aware of what the answer categories will be before gathering data. In this way, once the questionnaire has been built and the organised answers have been determined, coding develops into a routine procedure (Du Plessis, 2010:143).

Various techniques can be used to analyse and interpret quantitative data. Quantitative data relates to numeric data that the researcher can use to address the research question. However, a proper selection of the quantitative technique is a prerequisite to ensure that data analyses techniques correctly address the research question (Du Plessis, 2010:141). Once data has been gathered, and is ready to be analysed, the researcher has to perform some basic statistical analyses in order to prepare data such as data editing, coding and the statistically adjustment of data (Aaker, 2006:432-434).

? Data editing: The purpose of editing data is to spot any errors that appeared in the answers. Such errors may have been caused by the researcher's own error, lack of clarity, contradictions and ineligible respondents. The researcher may usually return to the study field, address the missing values or remove unsatisfactory respondents as a way to address these errors.

? Coding: When all the answers are entered into a computer file, statistical software will be used to analyse information. However, before this process occurs, the data has to be verified in terms of any errors which may have occurred during the process of entering the data. Once the data is verified, statistical adjustments to the data can be performed.

? Statistical adjustments: Various adjustments to the data are performed to make them ready for data analysis. Such improvement may be perceived as weighting, dummy variables, scale transformation and re-specification (Van Vuuren, 2011:110-111).

The following exact statistical procedures were selected for their suitability to test the research hypotheses of the study. These procedures include descriptive statistics such as frequency Tables and measurement of the mean, as well as measures of dispersion including the standard deviation. Finally, the paired sample t-test was used to accept or reject the stated hypotheses. The Statistical Consultation Service of the University of Johannesburg (STATKON) conducted the analyses. All calculations were done by means of SPSS.

Surveys provide fast, cheap and efficient ways of collecting information about the population. However, when making use of surveys, the researcher should reduce the frequent errors found in surveys via defining the population properly, making sure that the sample corresponds to the population, and choosing respondents who are available and able to collaborate in the study. The respondents should also understand the questions and the researcher should properly understand and fill in the respondents' responses (Du Plessis, 2010:144). The manner in which the researcher dealt with frequent errors is reviewed next:

A sample error arises every time the results of the sample diverge from the values of the population. The phenomenon arises at the time the investigator shows no concern when the sample is drawn (Du Plessis, 2010:144). In this research, a sample of 200 respondents chosen from all patients 18 years or older, males and females who had experienced services and stayed over at the military hospital in Libreville, Gabon for at least one night, was used to reduce sampling error.

This type of errors arises at the time respondents lie or do not lie intentionally. These errors also happen when the researcher influences the answers from respondents by highlighting some fact, or when the researcher makes errors by ticking the incorrect response (Terre Blanche et al., 2006:152-153). Response errors were reduced by building Likert-type statements on the questionnaire from related theory and pre-testing the questionnaire to respondents in the population.

Non-response errors arise at the time the results of the respondents in the research differ from what the outcomes would have been if all the respondents initially chosen, had contributed in the research. Respondents may not be willing to take part in the research for lack of time or for lack of interest (Du Plessis, 2010:144).

The chosen sample for this research was ideal to ensure representativeness, and the use of self-administered questionnaires increased the answer rate as respondents were more willing to take part in the study. Respondents who refused to cooperate were simply replaced by contacting other adult patients having experienced medical services at the military hospital in Libreville, Gabon for at least one night to ensure that a total of 200 respondents were interviewed.

Research methodology was the concern of this chapter. The chapter dealt with the scope of the survey, the sampling technique, and the way the survey was organised. The chapter focused on the method of collecting data, the reasons for choosing the self-administered questionnaire and the value of a covering letter. Editing, coding, data analysis, the statistical evaluation of data and the reliability of the results were also addressed in this chapter. The chapter highlighted the errors that could influence the validity of the results and the methods that were employed to reduce them. The next chapter will analyse the research findings and will focus on the answers of the respondents to the statements in the questionnaire.

Chapter four dealt with the research process and the approach which was developed for the empirical study. The population, data gathering, sampling and the questionnaire design were also discussed.

This chapter focuses on analysing and interpreting the results gathered from the empirical findings. The raw data gathered from the survey questionnaire must go through preliminary assessment before it can be analysed. The quality of the results deduced from the statistical techniques and their subsequent interpretation relies merely on how well the data is prepared and transformed into a form suitable for analysis (Kumar, Petersen, & Leone, 2007: 437). Data analysis refers to analysing the gathered data and translating it into results. When data analysis and interpretation are not well conducted, the research fails to attain what it is intended to measure (Du Plessis, 2010:146).

Descriptive statistics encompassing Tables and more advanced statistics were utilised to analyse the data which successfully portrays the relations and trends which were apparent in the study. STATKON helped with the coding and processing of data which was gathered through the use of questionnaires.

The primary objective of the study as identified in section 1.5.1 of Chapter 1 is to establish how patients rate doctors and nurses on the service quality dimensions. Olusoji (2009:7) noted that investigating service delivery by doctors and nurses and customer satisfaction is vital, as these variables can influence the loyalty which patients have towards a hospital. He also argued that a strong correlation exists between services provided by doctors and nurses, patient loyalty and profitability for hospitals. It is perceived from this declaration that a good understanding of the services provided by doctors and nurses that influence patient loyalty, is required to enhance services and profitability at the military hospital in Libreville in Gabon. To give effect to the study at

hand, the following secondary objectives were deduced (refer to section 1.5.2 in Chapter 1):

The following hypotheses as seen in Chapter 1 section 1.5.3 were compiled to assist in meeting the secondary objectives of the study. These hypotheses will be tested for both expected and experience of services provided by doctors and nurses:

The study was conducted at the military hospital in Libreville in Gabon in March 2013 for a period of three weeks. Table 5.1 illustrates a summary of the number of respondents approached, as well as the response rate which was obtained.

A number of 200 respondents were included in the study. This was done via using the sampling frame criteria that depicted that only patients who were at least 18 years of age, males and females, who had experienced medical services and stayed over at the military hospital for at least one night, qualified to participate in the study. As indicated Table 5.1, the 200 people who were asked to participate in the study matched the sampling frame. This gave a response rate of 100%. A total of 200 self-administered questionnaires were received from the four units of the Department of Internal Medicine of the military hospital which include; 50 questionnaires received from the unit that treats malaria and yellow fever, 50 questionnaires received from the heart diseases unit, 50 questionnaires received from the unit that monitors patients' health, and 50 questionnaires received from the VIP unit.

The core of this section is to analyse and interpret the data that was gathered from respondents who visited the military hospital in Libreville in Gabon for three weeks during the period of March 2013, and met the criteria of being part of the study. Results are presented form section A to E where each section will be presented and discussed. As a result, the discussion of the findings will be based upon meeting the primary and secondary research objectives of this current study.

The purpose of this section is to provide the demographic profile of the respondents in the study (refer to section A of the questionnaire). Gender, age, education level, marital status, employment level, residential area, the patient's first visit to the hospital and the

question based on knowing if the patient had been required to stay at the military hospital in Libreville in Gabon, will be discussed under the demographic section.

Table 5.2 illustrates the frequencies of the demographic information that was assessed in the study.

	Gender
Variable	Frequency	Percentage
Male	147	74
Female	53	26
Total	200	100
	Age
Variable	Frequency	Percentage
18 - 28 29 - 38 39 - 49 50 - 60 70 and above Total	34 26 76 40 24 200	17 13 38 20 12 100
	Highest education level
Variable	Frequency	Percentage
No formal education Primary education Secondary education Tertiary education Total Missing system Total	24 6 59 109 198 2 200	12 3 30 55 99 1 100
	Marital status
Variable	Frequency	Percentage
Single Married Divorced Widowed Cohabitant Total Missing system Total	30 127 19 20 1 197 3 200	15 64 10 10 1 99 1 100
	Employment level
Variable	Frequency	Percentage

From Table 5.2, the results indicated that 147 (74%) of the respondents were males and 53 (26%) were females. The higher presence of males in the hospital may be due to the fact since it is a military hospital, males may have felt more attracted to this hospital compared to females. Over one third (38%) of the patients were aged between 39 and 49 years old. This large frequency of patients aged between 39 and 49 years old may be explained by the fact that there are probably more people in this age category living around the military hospital area than any other age group. With regard to the level of education, the majority of respondents (55%) indicated that they have a tertiary education. This high frequency of tertiary educated people attending the hospital may be due to the fact that more educated people may have more knowledge and concerns about their health issues. As a result, this may have caused them to increasingly visit the hospitals compared to the less educated patients. With regard to employment level, more than half (63%) of the patients indicated that they were employed full-time, this could be due to the fact that the hospital is located in the capital city which has the highest concentration of economic activities. As a result, most patients attending the hospital and living in the capital would be likely to be employed. Among the respondents in the study, almost two-thirds (64%) who visited the hospital, indicated living in Libreville. This could be explained by the proximity of the hospital to their place of residence.

Main finding 1 (MF1) - There were more male respondents in the study than females.

Main finding 2 (MF2) - Over one third (38 %) of the respondents were aged between 39 and 50 years.

Main finding 3 (MF3) - A larger number of respondents in the study (54.5%) have a tertiary education.

Main finding 4 (MF4) -The majority of respondents (63%) were employed full-time

Main finding 5 (MF5) - The majority of the respondents in the study (64%) lived in Libreville.

Table 5.3 Frequency of the number of visits to the hospital and duration of the visit

From Table 5.3, the results indicated that 81, 9% of patients attending the military hospital claimed that it was their first visit to this hospital. Furthermore, all patients attending the hospital were required to stay over for at least one night, since the study included only patients visiting the military hospital and who stayed over for at least one night.

Main finding 6 (MF6) - 81 % of the respondents claimed that it was their first time to visit the military hospital in Libreville, Gabon.

Main finding 7 (MF7) - 100 % of the respondents claimed that they were required to stay at the military hospital in Libreville in Gabon for at least one night.

This section (referring to section B in the questionnaire) aims at providing the patients' perception of the services provided by doctors and nurses respectively at the military hospital in Libreville, Gabon. Their perception of services provided by doctors and nurses was based on four dimensions of service quality, namely reliability, responsiveness, assurance and empathy. The purpose of the analysis in this section is to assist in addressing research objectives 1-4. Tables only reflect response options where actual responses were recorded.

The following discussion below is based on the statements in section B of the questionnaire, which aim to provide more clarity on the opinion of patients regarding the service delivery of doctors and nurses based on the dimensions reliability, responsiveness, assurance and empathy.

«To determine how patients rate the reliability of doctors and nurses.» ? Doctors' reliability

Table 5.4 indicates the patients' perception of services provided by doctors with regard to the doctors' reliability.

Doctors	Disagree	Disagree somewhat	Neutral	Agree somewhat	Agree	Strongly agree	Total	Mean	Standard deviation
Had the ability to examine me properly		1	0.	16.5	52.5	29.5	100	6.09	0.751
			5
Were always honest with me	0.5		1	24.5	50	24	100	5.96	0.778
Acted in my best interests		0.5	1.	22.5	60	15.5	100	5.89	0.689
			5
Acted in a way that caused me to trust	0.5	1.	0.	33.5	53	11.5	100	5.72	0.751
them			5

Table 5.4 illustrates that the majority of respondents, in terms of answering statements B1 - B4, agreed that they were satisfied with their interactions with doctors with regard to the doctors' reliability. The responses have been arranged from most important to least important in terms of the mean of each response, with reference to the patient's experience of the services provided by doctors. The mean is defined as the sum of a set of values divided by their numbers. It is an approximate measure of central location for metric data (interval and ratio data) only. The process is summarised in the following formula (Tustin, Ligthelm, Martins & Van Wyk, 2005: 638):

improvement in these two aspects of the reliability of doctors. Such room for improvement could be through improved compassion and understanding during the diagnoses of the problem.

Table 5.5 indicates the patients' perception of services provided by nurses with regard to the nurses' reliability.

Nurses	Agree somewhat	Agree	Strongly agree	Total	Mean	Standard deviation
Were always honest with me	12	64.5	23.5	100	6.12	0.586
Had the ability to examine me properly	19	66.5	14.5	100	5.96	0.578
Acted in my best interests	19	69.5	11.5	100	5.93	0.549
Acted in a way that caused me to trust them	22	71	7	100	5.85	0.519

Table 5.5 indicates that the majority of respondents, in terms of answering statements B1 - B4, agreed that they were satisfied with their interactions with nurses in terms of the reliability of nurses. The responses have been arranged from most important to least important in terms of the mean of each response, with reference to the patients' experience of services provided by nurses.

Table 5.6 indicates the patients' perception of services provided by doctors with regard to the doctors' responsiveness.

Doctors	Neutral	Agree somewhat	Agree	Strongly agree	Total	Mean	Standard deviation
Communicated the prescription of medications for my treatment with me in a manner that I could understand	0. 5	23	38	38	100	6.14	0.783
Always responded to my queries		18	56	26	100	6.08	0.660
Informed me of my state of health during consultation	0.5	24	59	16	100	5.91	0.643
Always listened to what I had to say	1	30	53	16	100	5.84	0.690

Table 5.6 indicates that the majority of respondents, in terms of answering statements B5 - B8, agreed that they were satisfied with their interactions with doctors regarding the responsiveness of the latter towards patients. The responses have been arranged from most important to least important in terms of the mean of each response, with reference to the patients' experience of services provided by doctors.

MF12: The mean response for statements B6 (6.14) (Communicated the prescription of medications for my treatment with me in a manner that I could understand) and B7 (6.08) (Always responded to my queries) has the highest means which indicates that patients were most satisfied with these aspects of the responsiveness of doctors. The doctors communicated the prescription of medications for their treatment in a manner they could understand. In addition, respondents indicated that doctors always responded to their queries and informed them of their state of health during consultation.

MF13: The mean response for statements B5 (5.89) (Informed me of my state of health during consultation and) and B8 (5.72) (Always listened to what I had to say) rated the lowest mean. Despite the two statements having the lower means, patients were still of the opinion that doctors do listen to their opinions. However, patients indicated that there was room for improvement in these two aspects of the responsiveness of doctors. Such room for improvement could be through improved communication during the diagnoses of the problem. The feeling was that doctors had to develop more patience and understanding with patients whilst diagnosing the patient.

Table 5.7 indicates the patients' perception of services provided by nurses with regards to the nurses' responsiveness.

Nurses	Neutral	Agree somewhat	Agree	Strongly agree	Total	Mean	Standard deviation
Always listened to what I had to say		15.	60	24.	100	6.0	0.628
	5		5		9		Communicated the prescription of medications for my
	13	64.	22.	100	6.1	0.590	treatment with me in a manner that I could understand
		5	5				Always responded to my queries
	16	68.	15.	100	6	0.563
		5	5				Informed me of my state of health during consultation
1	16.	70.	12	100	5.9	0.568
		5	5			4

Table 5.7 indicates that the majority of respondents, in terms of answering statements B5 - B8, agreed that they were satisfied with their interactions with nurses in terms of their responsiveness. The responses have been arranged from most important to least important in terms of the mean of each response, with reference to the patients' experience of services provided by nurses.

MF14: The mean response for statements B8 (6.09) (Always listened to what I had to say), B6 (6.1) (Communicated the prescription of medications for my treatment with me in a manner that I could understand) has the highest means which

indicates that patients were most satisfied with these aspects regarding the responsiveness of nurses. Respondents indicated that nurses always listened to what patients had to say and communicated the prescription of medications for their treatment in a manner that they could understand.

MF15: The mean response for statements B7 (6.0) (Always responded to my queries) and B5 (5.94) (Informed me of my state of health during consultation) was the lowest. Despite the two statements having the lowest means, patients were still of the opinion that nurses informed them of their state of health during consultation and always responded to their queries. However, this aspect of responsiveness could have been improved.

«To determine how patients rate the assurance of doctors and nurses.» ? Doctors' assurance

Table 5.8 indicates the patients' perception of services provided by doctors with regards to the doctors' assurance.

Doctors	Disagree somewhat	Neutral	Agree somewhat	Agree	Strongly agree	Total	Mean	Standard deviation
Were well trained and qualified	0.5	5.5	12.5	70	11.5	100	5.87	0.699
Showed respect and dignity towards me		1.5	19.5	70	8.5	100	5.86	0.567
Carried out their tasks competently		2	20.5	69	8.5	100	5.84	0.588
Respected the confidentiality of my treatment		4.5	30	49	16.5	100	5.78	0.773

Table 5.8 indicates that the majority of respondents, in terms of answering statements B9 - B12, agreed that they were satisfied with their interactions with doctors with regard to the assurance that doctors provided to patients. The responses have been arranged

from most important to least important in terms of the mean of each response, with reference to the patients' experience of services provided by doctors.

Table 5.9 indicates the patients' perception of services provided by nurses with regard to the nurses' assurance.

Nurses	Neutral	Agree somewhat	Agree	Strongly agree	Total	Mean	Standard deviation
Respected the confidentiality of my treatment	1.5	10.6	33.3	54.5	100	6.41	0.74
Carried out their tasks competently	1.5	10.6	39.9	48	100	6.34	0.729
Were well trained and qualified	2	8.1	49	40.9	100	6.29	0.7
Showed respect and dignity towards me		12.1	58.6	29.3	100	6.17	0.622

Table 5.9 indicates that the majority of respondents, in terms of answering statements B9 - B12, agreed that they were satisfied with their interactions with nurses in terms of their assurance. The responses have been arranged from most important to least important in terms of the mean of each response, with reference to the patients' experience of services provided by nurses.

«To determine how patients rate the empathy of doctors and nurses.» ? Doctors' empathy

Table 5.10 indicates the patients' perception of services provided by doctors with regards to the doctors' empathy.

Doctors	Neutral	Agree somewhat	Agree	Strongly agree	Total	Mean	Standard deviation
Were concerned about my well- being	2	15.5	57.5	25	100	6.06	0.696
Cared about me	2	12	74	12	100	5.96	0.566
Provided me with individual attention	1	17	72.5	9.5	100	5.91	0.545
Understood my specific needs	2	25	53.5	19	100	5.90	0.719

Table 5.10 indicates that the majority of respondents, in terms of answering statements B13 - B16, agreed that they were satisfied with their interactions with doctors in terms of the empathy that doctors had towards them. The responses have been arranged from most important to least important in terms of the mean of each response, with reference to the patients' experience of services provided by doctors.

Table 5.11 indicates the patients' perception of services provided by nurses with regard to the nurses' empathy.

Nurses	Neutral	Agree somewhat	Agree	Strongly agree	Total	Mean	Standard deviation
Were concerned about my well-being		2	18	80	100	6.78	0.461
Understood my specific needs	0.5	2	24.5	73	100	6.7	0.530
Cared about me		2	28.5	69.5	100	6.68	0.511
Provided me with individual attention		4	34.5	61.5	100	6.58	0.571

Table 5.11 indicates that the majority of respondents, in terms of answering statements B13 - B16, agreed that they were satisfied with their interactions with nurses in terms of their empathy. The responses have been arranged from most important to least important in terms of the mean of each response, with reference to the patients' experience of services provided by nurses.

5.4.2.2 Comparing patient perception of services delivered by doctors and nurses

The following discussion is based on the statements in section B of the questionnaire. The aim of the discussion is to provide more clarity on the differences of opinion of patients regarding the service delivery by doctors and nurses based on the four

dimensions of service quality (reliability, responsiveness, assurance and empathy). It will furthermore aim to address objective 5, namely:

«To establish if there is a difference in how patients rate doctors and nurses on the
service quality dimensions»

The paired sample t-test was used to establish whether significant differences exist in how patients rate the service delivery of doctors and nurses based on the four dimensions of service quality.

Table 5.12: Overall mean scores, standard deviations and p-value for the reliability of doctors and nurses

MF26: Patients were of the opinion that nurses were overall more successful in achieving reliability compared to doctors as recorded by the higher mean scores obtained for the reliability statements relating to nurses (refer to Table 5.12). The research at hand relies on a 95% level of confidence, therefore a p-value equal or less than 0.05 implies that the results are not subject to change according to the paired sample t-test. Hence a value smaller than 0.05 indicates a significant difference between how patients perceive the reliability of doctors and nurses. Therefore, considering a p-value of 0.238, patients do not perceive the reliability of doctors and nurses significantly differently.

Table 5.13: Overall mean scores, standard deviations and p-value for the responsiveness of doctors and nurses

paired sample t-test. Hence, a value smaller than 0.05 indicates a significant difference between how patients perceive the assurance of doctors and nurses. Therefore, considering a p-value of 0.000, patients do perceive the assurance provided by doctors and nurses as significantly different.

Table 5.15: Overall mean scores, standard deviations and p-values for the empathy of doctors and nurses

MF29: Patients were of the opinion that nurses were overall more successful in achieving empathy compared to doctors as recorded by the higher mean scores obtained for the assurance statements relating to nurses (refer to Tables 5.15). The research at hand relies on a 95% level of confidence, therefore a p-value equal or less than 0.05 implies that the results are not subject to change according to the paired sample t-test. Hence, a value smaller than 0.05 indicates a significant difference between how patients perceive the empathy of doctors and nurses. Therefore, considering a p-value of 0.000, patients do perceive the empathy provided by doctors and nurses as significantly different.

5.4.3 Section C: Perceptions of patients towards the tangibility dimension of the hospital

This section (referring to section C in the questionnaire)aims at providing the patients' perception regarding the tangible aspects of a military hospital in Gabon. Five statements were used to measure patient opinion on the tangibility dimension of service quality. The results of this section will assist in addressing research objective 6, namely:

«To establish the perception of patients regarding the tangible aspects of a military hospital in Gabon»

Please note that Table 5.16 only reflect response options where actual responses were recorded.

Tangibility	Neutral	Agree somewhat	Agree	Strongly agree	Total	Mean	Standard deviation
The toilet facilities in the hospital were clean	0.5	2	69.5	28	100	6.25	.509
The colour scheme at the hospital was attractive	0.5	3	71	25.5	100	6.22	.510
The hospital had a pleasant atmosphere	0.5	12.5	59.5	27.5	100	6.14	.634
The interior decoration at the hospital was aesthetically appealing	0.5	18	60	21	100	6.01	.675
The furniture at the hospital such as beds and chairs was comfortable	11.5	7.5	65	16	100	5.86	.823

Table 5.16 indicates that the majority of respondents agreed that they were satisfied with the tangible aspects of the military hospital. The responses have been arranged from most important to least important in terms of the mean of each response, with reference to the patients' perceptions of the tangible aspects.

MF 30: The mean response for statements C1 (6.25), (6.22), C3 (6.14) has the highest means which indicates that patients were most satisfied with these aspects of the tangible aspects. Respondents indicated that the toilet facilities in the hospital were clean; the colour scheme at the hospital was attractive, and the military hospital had a pleasant atmosphere

MF 31: The mean response for statements C4 (6.01) and C5 (5.86) rated the lowest mean. Despite the two statements having the lowest means, patients were still of the opinion that the interior decoration at the hospital was aesthetically appealing and the furniture at the hospital such as beds and chairs was comfortable. However, patients indicated that there was room for improvement in these two aspects of the tangible aspects. Such room for improvement could be through changing the furniture and the interior decoration at the hospital on a regular basis.

Table 5.17: Overall mean scores and standard deviations for the tangibility dimension of service quality as rated by the respondents

MF32: Patients were overall satisfied with the tangible aspects of the hospital in Libreville, Gabon as recorded by the high mean scores obtained for the tangibility statements relating to the hospital (refer to Table 5.17).

This section (referring to section D in the questionnaire)aims at providing the patients' overall perception of services provided at a military hospital in Gabon. Five statements were used to measure patients' overall perception of services. The results are discussed in Table 5.18. Tables only reflect response options where actual responses were recorded.

The overall service provided by the military hospital was of a high standard		18	46.5	35	100	6.18	0.712
I felt good about coming to this military hospital for my treatment		15	57	28	100	6.13	0.644
The overall quality of the administration service at the military hospital was excellent	0.5	17	62	20.5	100	6.03	0.630
The overall service I received at the military hospital met my expectations	10.5	7.5	54.0	28	100	6	0.883

Table 5.18 indicates that the majority of respondents agreed that they were satisfied with the overall services provided at the military hospital. The responses have been arranged from most important to least important in terms of the mean of each response, with reference to the patients' overall perceptions of services provided at the military hospital.

Table 5.19: Overall means score and standard deviation for the overall perception of service delivery as rated by the respondents

MF32: Patients were overall satisfied with the tangible aspects of the hospital in Libreville, Gabon as recorded by the high mean score obtained for the tangibility statements relating to the hospital (refer to Table 5.19).

5.4.5 Section E: Factors that could influence the choice for the military hospital

This section (referring to section E in the questionnaire) aims at providing a list of factors that could influence patients' choice for the military hospital in Gabon. Sixteen statements were used to determine the influential factors for selecting the military hospital. The results are discussed in Table 5.20.

Factors		Not at all important		Low importance		Neutral		Moderately important		Extremely important		Total		Mean		Standard deviation
Availability of medicines				0.5		0.5		11.5		87.5		100		4.86		0.402
Specialised physicians						1.5		12		86.5		100		4.85		0.398
Availability of modern medical equipment						1.5		13.5		85		100		4.84		0.411
Hospital cleanliness				0.5		2		12		85.5		100		4.83		0.464
Employees are friendly towards patients							18		82		100		4.82		0.385
Hospital is well organised					1.5		21.5		77		100		4.76		0.465
Quality of nurses					1		22		77		100		4.76		0.451
Other							25		75		100		4.75		0.500
Ease of getting to hospital location			0.5		2.5		18.5		78.5		100		4.75		0.519
Competent staff			11.5		2.5		14		72		100		4.47		0.997
Good reputation in media	2		7.5		13.5		23		54		100		4.2		1.060
Care cost			6.5		13		37.5		43		100		4.17		0.892
Patients' past experience	1.5		10.1		22.2		35.9		30.3		100		3.83		1.021
Hospital near residence	1		10.5		23.5		37.5		27.5		100		3.8		0.992
Know people who went to the hospital	1.5		11.5		30.5		29		27.5		100		3.7		1.043
Relatives living in the hospital area	2.5		18.5		7		56.5		15.5		100		3.64		1.032

Table 5.20 indicates that the majority of respondents agreed that their choice for the military hospital was influenced by a number of factors. The responses have been arranged from most important to least important in terms of mean of each response, with reference to a list of factors that could influence patients' choice for the military hospital in Gabon.

The hypotheses developed in Chapter 1 will now be dealt with (refer to section 1.5.3).

H01: There is no significant difference in how patients rate the reliability of doctors and nurses.

HA1: There is a significant difference in how patients rate the reliability of doctors and nurses.

H02: There is no significant difference in how patients rate the responsiveness of doctors and nurses.

HA2: There is a significant difference in how patients rate the responsiveness of doctors and nurses

H03: There is no significant difference in how patients rate the assurance of doctors and nurses.

HA3: There is a significant difference in how patients rate the assurance of doctors and nurses.

H04: There is no significant difference in how patients rate the empathy of doctors and nurses.

HA4: There is a significant difference in how patients rate the empathy of doctors and nurses.

H05: Patients do not have a positive perception of the tangible aspects of a military hospital in Libreville, Gabon.

HA5: Patients do have a positive perception of the tangible aspects of a military hospital in Libreville, Gabon.

The following hypotheses: H01, which states that there is no significant difference in how patients rate the reliability of doctors and nurses, H02, which states that there is no significant difference in how patients rate the responsiveness of doctors and nurses, and the following alternative hypotheses HA3, which states that there is a significant difference in how patients rate the assurance of doctors and nurses, HA4, which states that there is a significant difference in how patients rate the empathy of doctors and nurses, HA5, which states that patients do have a positive perception of the tangible aspects of a military hospital in Libreville, Gabon are therefore accepted.

The following alternative hypothesis: HA1, which states that there is a significant difference in how patients rate the reliability of doctors and nurses, HA2, which states that there is a significant difference in how patients rate the responsiveness of doctors and nurses, and the following null hypotheses H03, which states that there is not a significant difference in how patients rate the assurance of doctors and nurses, H04, which states that there is not a significant difference in how patients rate the empathy of doctors and nurses, and the H05, which states that patients do not have a positive perception of the tangible aspects of the military hospital in Libreville, Gabon are therefore rejected.

The purpose of this research was to assess the service quality of doctors and nurses at the military hospital in Libreville (refer to section 1.4). The objectives of the study were

assessed empirically via a survey questionnaire. Section A of the questionnaire collected the demographic details of respondents. Section B gathered information on patients' experience of services of doctors and nurses based on the four dimensions of service quality namely reliability, responsiveness, assurance and empathy. Section C gathered information on patients' perceptions of the tangibility aspects and overall service quality. Section D tested the overall perception of patients regarding the service delivery at the military hospital in Libreville, Gabon. Section E gathered information on factors that could influence patients' decision to select the military hospital in Libreville, Gabon. The objectives of this study were assessed by concentrating on the following aspects:

The objective of this research was to establish if there is a difference in how patients rate doctors and nurses on the service quality dimensions. Chapter five covered the analysis and interpretation of the results of the data gathered from the survey questionnaires that were completed by the respondents in the study. The major findings in the research were that there is no significant difference in how patients rate the reliability and responsiveness of doctors and nurses, there is a significant difference in how patients rate the assurance and empathy of doctors and nurses and patients do have a positive perception of the tangible aspects of the military hospital. Therefore,

H01, H02, HA3, HA4 and HA5 were accepted. The next chapter will focus on the conclusions related to this research.

Chapter five dealt with the research results which were gathered from the empirical exploration, as well as the major findings. The goal of Chapter Six is to make a number of conclusions, implications and recommendations from Chapter Five and the entire study.

The primary objective of this research as seen in Chapter 1 (refer to 1.5.1), was to establish how patients rate doctors and nurses on the service quality dimensions at a military hospital in Libreville, Gabon.

Secondary objectives were also made in Chapter 1 (refer to 1.5.2) in order to complement the primary objective. The secondary objectives will again be introduced in section 6.2 and will deal with the relevant major findings from this research. Each secondary objective will be discussed followed by a discussion on the implications and recommendations. Chapter Six will end with a discussion on the limitations and recommendations for more research to be undertaken.

In this research, one major aspect was investigated which was to establish how patients rate doctors and nurses on the service quality dimensions. This aspect constituted the core within in which the secondary objectives as illustrated in Chapter 1.5.2 were established. This chapter will be based on a discussion of the main conclusions, implications and recommendations of the findings of each secondary objective.

6.2.1 Perceptions of patients regarding the four service quality dimensions investigated in this study

The secondary objectives of this study related to perceptions of patients regarding the four service quality dimensions, were determined as follows:

? To determine how patients rate the reliability of doctors and nurses. ? To establish how patients rate the responsiveness of doctors and nurses. ? To determine how patients rate the assurance of doctors and nurses. ? To establish how patients rate the empathy of doctors and nurses.

The major findings in terms of patients' perceptions regarding the reliability, responsiveness, assurance and empathy of doctors and nurses were as follows:

- There is no significant difference in how patients rate the reliability of doctors and nurses.

- There is no significant difference in how patients rate the responsiveness of doctors and nurses.

- There is a significant difference in how patients rate the assurance of doctors and

- There is a significant difference in how patients rate the empathy of doctors and nurses.

The major findings derived from the empirical research phase in terms of patients perceptions of service delivery of doctors relating to the four dimensions of service quality are indicated next:

In terms of reliability, it is clear from the results obtained that the majority of respondents were satisfied with their interactions with doctors with regard to the doctors' reliability. Patients indicated that they were most satisfied with the doctors' ability to examine them properly and to be honest with them in terms of their medical assessment. Patients were however of the opinion that there was room for improvement in the way doctors acted in their best interests, and in the way that caused them to trust them. Such room for improvement could be through improved compassion and understanding during the diagnoses of the problem. Such an improvement could enhance their satisfaction level with the reliability of doctors.

In terms of responsiveness, the results indicated that the majority of respondents were satisfied with their experience of doctors' responsiveness. Respondents indicated that they were most satisfied with the way doctors communicated the prescription of medications for their treatment in a manner they could understand and the fact that they always responded to their queries. Patients were however of the opinion that doctors could listen to them more, and inform them of their state of health during consultation. Such room for improvement could be through improved communication during the diagnoses of the problem. The feeling was that doctors had to develop more patience and understanding with patients whilst diagnosing the patient.

In terms of assurance, it was evident that the majority of respondents were satisfied with the dealings they had had with doctors with regard to the doctors' assurance. Respondents indicated that they were most satisfied with the doctors' trainings and qualifications, the way they carried out tasks competently and the respect and dignity they as patients received from doctors. Respondents were however of the opinion that doctors could show more respect in terms of the confidentiality of treatment. Such an improvement could be through improved work ethic in the hospital, where patients' records and cases should never be discussed with anyone without the patients'

permission. Patients also indicated that doctors were less successful in achieving assurance than achieving reliability and responsiveness as recorded by the lower mean scores in the assurance dimension, compared to the mean scores in the reliability and responsiveness dimension of doctors' services.

In terms of empathy, the results indicated that the majority of patients were satisfied with the dealings they had had with doctors with regard to the doctors' empathy. Patients indicated that that they were most satisfied with the doctors' concerns about their well-being and the way they cared for them. Patients were however of the opinion that doctors could understand their specific needs better and provide them with more individual attention. Such an improvement could be made through improved communication during the dealings with patients. The feeling experienced and expressed was that doctors have to pay more attention to patients' problems and share with them their experience. Patients also illustrated that doctors were successful in achieving reliability, responsiveness, assurance and empathy. Especially considering that the mean results for all four dimensions were all high.

The major findings derived from the empirical research phase in terms of patients' experience of service delivery of nurses relating to the four dimensions of service quality, are subsequently indicated.

In terms of reliability, it is clear from the results obtained that the majority of respondents were satisfied with their interactions with nurses with regard to their reliability. Patients indicated that they were most satisfied with the honesty of nurses and their ability to examine them properly. Patients were however of the opinion that there was room for improvement in the way nurses acted in their best interests, and how such action resulted in a trust patients have towards nurses. Such improvements could be through improved compassion and understanding during the diagnoses of the problem. Such an improvement could also enhance their satisfaction level with the reliability of nurses.

In terms of responsiveness, the results indicated that the majority of respondents were satisfied with their experience of nurses' responsiveness. Respondents indicated that they were most satisfied with the fact that nurses always listened to what they had to say and communicated the prescription of medications for their treatment in a manner that they could understand. Patients were however of the opinion that nurses could inform them more about their state of health during consultation and respond more to

their queries. Such room for improvement could be through improved communication during the diagnoses of the problem. The feeling was that nurses had to develop more patience and understanding with patients whilst diagnosing the patient.

In terms of assurance, it was evident that the majority of respondents were satisfied with the dealings they had had with nurses with regard to the nurses' assurance. Respondents indicated that they were most satisfied with the fact that nurses respected the confidentiality of their treatment, the fact that they carried out their tasks competently, and were well trained and qualified. Respondents were however of the opinion that nurses could show more respect and dignity towards them. Such an improvement could be through improved work ethic in the hospital where patients could be treated with more respect.

In terms of empathy, the results indicated that the majority of patients were satisfied with the dealings they had had with nurses with regard to the nurses' empathy. Patients indicated that that they were most satisfied with the nurses' concerns about their wellbeing, the way they cared for them, and the fact that they understood their specific needs. Patients were however of the opinion that nurses could provide them with more individual attention. Such an improvement could be made through improved communication during the dealings with patients. The opinion of patients was that nurses have to pay more attention to patients' problems and share with them their experience.

? The majority of patients were satisfied with their interactions with doctors regarding their reliability, responsiveness, assurance and empathy.

? The majority of patients were satisfied with their interactions with nurses regarding their reliability, responsiveness, assurance and empathy.

? Nurses were overall more successful in achieving reliability, responsiveness, assurance and empathy compared to doctors.

? In terms of perceptions of the actual service delivery of doctors on the service dimension, patients indicated that doctors were more successful in achieving responsiveness and empathy compared to reliability and assurance.

? In terms of perceptions of the actual service delivery of nurses on the service dimension, patients indicated that nurses were more successful in achieving empathy and assurance compared to responsiveness and reliability.

? In terms of the comparison between perceptions of actual service delivery of doctors and nurses on the service dimension, patients indicated that nurses were overall more successful in achieving empathy, assurance, responsiveness and reliability compared to doctors.

Executives at the military hospital need to implement service quality programmes to educate medical personnel about the importance of service quality in health care for patient retention and loyalty.

Patient satisfaction is perceived as a vital aspect for the military hospital. Not only to satisfy patient needs, but to increase patient loyalty. Patient loyalty is an essential aspect in terms of increasing market share and profitability. The recommendations for this section are based on the results of the empirical findings in terms of patients' rating of doctors and nurses on the service quality dimensions.

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 diagnoses of the problem. The feeling was expressed that doctors should pay more attention to patients' problems and share with them 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 in 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 nurses' services, patients felt a need for more trust towards nurses, a need for more information, for more respect and for more individual attention. Such needs could be addressed through improved patience, compassion, communication and understanding of nurses during their dealings with patients. Nurses should develop more work ethic where 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. Other hospitals could enhance the reliability, responsiveness, assurance and empathy of their doctors and nurses based on the above recommendations.

6.3 PATIENTS' PERCEPTIONS REGARDING THE TANGIBLE ASPECTS AT A SPECIFIC MILITARY HOSPITAL

The secondary objective related to patients' perceptions regarding the tangible aspects at a military hospital was illustrated as followed:

? To establish the perception of patients regarding the tangible aspects of a military hospital in Gabon.

The following hypothesis below resulted from the above-mentioned secondary objective:

H05: Patients do not have a positive perception of the tangible aspects of a military hospital in Gabon.

The major findings in terms of patients' perceptions regarding the tangible aspects were as follows:

Patients have a positive perception of the tangible aspects of a military hospital.

The tangible aspect of service quality is crucial in the delivery of services in hospitals as it can reduce the gap between patients' expectations and the actual delivery of service. It provides a picture of what is inside a hospital and can influence patients' choice when selecting a health service provider. Tangible aspects of service are viewed to significantly influence patients' satisfaction level with services provided.

In addition to the main findings from the literature review, the findings from the empirical study indicated that patients had a positive perception of the tangible aspects of a military hospital. The empirical results confirmed that the tangible aspect significantly influenced patient satisfaction.

The majority of patients indicated that they had a positive perception of the tangible aspects of a military hospital.

The military hospital needs to maintain or improve the tangible aspects of services provided, in order to create a higher level of patient retention and loyalty.

It was concluded from the literature review that the tangible aspect of services needs to be maintained and improved in order to ensure patient satisfaction. The empirical results indicated some aspects that can be improved, and this will form the basis for the recommendations. Patients indicated that the interior decoration at the hospital and the furniture at the hospital such as beds and chairs needed to be improved. Such improvement could be through changing the furniture and the interior decoration at the hospital on a regular basis. Other hospitals could enhance the tangible aspects of their service through changing their equipment on a regular basis.

6.4 OVERALL PERCEPTION OF SERVICES AND FACTORS THAT COULD INFLUENCE THE CHOICE OF A MILITARY HOSPITAL

Both the overall perception of the military hospital and the factors that could influence the choice of a military hospital will guide the management of the hospital in terms of areas of continued focus and improvement. The patients indicated that they were content with the overall service provided by the hospital and that they felt good about coming to the hospital. Patients furthermore indicated that the quality of the doctors and nurses working at the hospital, as well as the availability of modern medical equipment, influenced their decision to visit the hospital.

The majority of patients indicated that overall, the service offering of the military hospital was superior to the one offered by government hospitals.

The military hospital would need to maintain or improve its current levels of service delivery to patients in order to create a higher level of patient retention and loyalty.

It will be to the benefit of the military hospital if management enhanced the quality of service delivery by the administrative staff of the hospital. A strategy to enhance such service delivery is to invest more capital in the training of administrative staff in areas such as people skills (towards patients specifically), service delivery through the use of technology, telephone communication skills, friendliness towards patients (i,e. customer care), as well as knowledge regarding the administrative processes and systems of the hospital. Furthermore, more robust recruitment practices must be put in place to ensure that the most skilled and qualified individuals are recruited for administrative positions, specifically. This will enhance the service delivery levels of the administrative staff at the hospital, and the satisfaction levels of patients, since they are interacting with more knowledgeable and competent employees in administration, but also experience and communicate the overall image and reputation of the hospital in the community.

This study was exposed to various limitations like any other research. However, future investigations on this type of research will be able to generate new thoughts and provide a deeper understanding of service quality in hospitals. The limitations in this study are outlined.

The literature review in this study indicated the major constituents of service quality such as reliability, responsiveness, assurance, empathy and tangibility and an understanding of the relationships between service quality, customer satisfaction, loyalty and profitability. However, new literatures may be necessary to provide deeper assessments of services delivered by doctors and nurses respectively on each of their service quality dimension.

The research was done on service quality at the military hospital in Libreville in Gabon and is specific to the hospital in question. Thus the study is limited to that particular hospital and it cannot be applied to the entire industry as the population chosen for the study was limited to the said hospital only.

? Sampling is a problem, as there is no sample which can allow the researcher to make forecasts of the entire population. In this current study, a total of 200 respondents completed the survey questionnaires.

? The sample only included patients who were at least 18 years, males and females, who had experienced medical services and stayed over at the military hospital for at least one night. Thus the study did not involve all patients and it is not possible to make forecasts for all patients of the military hospital in Libreville in Gabon.

The current study only assessed service quality at the military hospital in Libreville in Gabon, thus it cannot be utilised for the entire health care industry. A future study may be done to investigate service quality for the entire industry and include multiple healthcare practices.

Both the primary and secondary objectives formulated for this study were addressed based on the conclusions, implications and recommendations in this research. It is therefore concluded that the findings of this research help to understand service quality in a military hospital setting.

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Comparing service quality of doctors and nurses at a military hospital Dear respondent,

This questionnaire is built to obtain answers from you regarding your perceptions and expectations of the quality of services offered by doctors and nurses at the military hospital. This research will be used as part of my studies with the University of Johannesburg.

This survey will remain confidential and anonymous and request your honest answers.

Please feel free to answer at your own choice with an X (cross) in the appropriate box where applicable.

This survey will take no longer than 10 minutes to complete. Thank you for your time in completing this questionnaire.

Comparer la qualité des services offerts par les médecins et le personnel infirmier dans un hôpital militaire

Ce questionnaire est conçu pour obtenir des réponses auprès de vous au sujet de vos perceptions et attentes de la qualité des services offerts par les médecins et le personnel infirmier à l'hôpital militaire.

Cette recherche sera utilisée dans le cadre de mes études à l'Université de Johannesburg.

Veuillez indiquer par un X dans le cadre réservé à votre réponse. Ce formulaire ne vous prendra pas plus de 10 minutes à compléter

Service quality at a military hospital

4.2.7 Step 7: Data gathering

4.2.8 Step 8: Data analysis