Riyadh Private Hospitals’ Service Quality

Abstract

Quality in service delivery is an important aspect of healthcare provision. This study was aimed at measuring the quality of services provided by three private hospitals in the city of Riyadh. Existing literature indicates that the SERVQUAL method has been used in measuring the quality of service in the healthcare sector across the globe. This study was vital because the information that was received can be analyzed to get a better understanding of the current strengths and weaknesses of health care institutions in the city of Riyadh and beyond.

The rationale for picking private hospitals was informed by their better organization, patient-centricity service charter, and systematic service delivery approach. Through the primary survey, the sample of the study was composed of 90 randomly-selected male and female patients from three randomly-selected private hospitals. The researcher designed a five-point Likert scale questionnaire within the dimensions of assurance, tangibility, responsiveness, reliability, and empathy.

The independent variables were the five dimensions, while the dependent variable was a measure of service quality. The researcher used SPSS program to analyze the data of this study by generating the mean, standard deviation, percentage response rate, and rank for each study aspect. The findings revealed that the majority of the respondents within the three hospitals were relatively satisfied with the current service quality charter.

However, there were disparities in timely service execution and the general personnel-patient interaction. The disparity was associated with instances of dishonesty on the side of the personnel on honoring promises and offering services in a timely manner. This means that the three case study hospitals should revise the service charter to ensure that the personnel is well motivated to offer quality and timely services to the patients.

Introduction

It is imperative to mention that the role of quality is an interesting topic that is frequently discussed by scholars. The demands of customers are always increasing, and their expectations are set incredibly high most of the time. Furthermore, many companies have recognized that the focus on this aspect is vital and may lead to significant profits. Also, it helps to establish long-term relationships with clients, and this is especially true for the healthcare industry.

This approach is beneficial for both institutions and patients because trained professionals would have a better understanding of the needs and preferences of a particular individual, and valuable time is not lost for the examination of patient history. It is in the interest of a hospital to ensure that customers are retained, and it can be achieved if the quality is viewed as one of the most important factors. Moreover, it is important to understand that activities that are focused on the promotion of quality must be justified from the economic point of view, and it is necessary to find the right balance.

It is important to understand that it may be necessary to hire an external professional team that would perform all the measurements. One of the most important factors that must be discussed is that many firms are focused on the provision of such services, and they have enormous experience in this industry. Also, it is imperative to understand that employees would not have to be distracted and can focus on their tasks.

Such positions and quality analysts and managers should be available in every single private hospital because they will guarantee that the data received is reliable, and no issues with validity are present. Also, it is necessary to understand that various techniques can be used to increase the level of quality in a particular organization. For example, the role of planning and education should not be overlooked (Mosadeghrad, 2014).

A set of goals and outcomes is vital because it can be used to identify if any process has been shown or any issues with scheduling are present. Furthermore, healthcare professionals actively participate in training programs, and a focus on development is also vital because every individual recognizes that high levels of quality cannot be achieved without an understanding of the latest approaches and techniques. The fact that employers have started to pay enormous attention to the competency of workers is also vital because there have been instances when employees are extremely unprofessional in the past, and it has led to numerous complications.

The problem is that a consensus on what measures of quality should be used has not been reached. However, some of the models that are suggested are quite comprehensive and have proven to be efficient most of the time (Yildiz & Demirors, 2014).

Statement of the problem

Despite the importance of health care facilities in KSA, they are still fighting to achieve a high level of quality services in dealing with customers’ needs and their satisfaction. Raheem, Nawaz, Fouzia, Imamuddin (2014) said, “In these days, the hospital needs to enhance the level of satisfaction if they want to remain in the competition with other hospitals.” Thus, there is a need to investigate the level of the quality of services provided in private hospitals.

Significance of the study

It is necessary to note that this topic is incredibly important because many private hospitals in Riyadh city have started to focus on such aspects as the quality of service to meet global standards and expectations of consumers. Moreover, this study is vital because the information that has been received can be analyzed to get a better understanding of current strengths and weaknesses of health care institutions.

Furthermore, it may be important to develop new approaches to ensure that some of the issues that are currently present are promptly addressed. The need to consider the experience of other countries and study the strategies that have proven to be effective also needs to be taken into account. Moreover, the cooperation with international organization and participation in exchange programs may be vital. Also, one of the core issues that are frequently overlooked is that some conditions are much more common in Saudi Arabia than in other countries, and it may be important to develop particular guidelines.

Another issue that needs to be discussed is that health care professionals have to deal with numerous changes, and it may not be an easy task to keep track of all the policies and techniques. The level of experience is a critical factor that affects the overall quality of services. Furthermore, nurses and other specialists should be provided with all the necessary resources that would help them to stay competent and develop as professionals and individuals. It is paramount to mention that this sector was quite problematic not so long time ago, and there have been many instances of misdiagnosis and unequal treatment of patients.

However, the government has recognized that it is a significant issue that needs to be resolved, and many policies have been introduced. The situation has been getting over the years, and it is entirely possible that Saudi Arabia will be one known for its high-quality healthcare in the future. Another aspect that is worth mentioning is that it may not be an easy task for the government to measure quality levels in such institutions, and it is necessary to establish a particular set of standards that should be acknowledged. In conclusion, it is evident that current state of the industry is satisfactory, but several changes can be made to ensure that the quality of services is increased because it is one of the core factors that affect satisfaction levels of customers.

Objective of study

In this study, the major objective is to measure the quality of services provided in private hospitals in Riyadh.

The Question of the Study

• How to measure the quality of services provided in private hospitals in Riyadh?

Delimitations of the Study

The findings of this study are restricted by the following factors:

1. The study was restricted to participants in three private hospitals in Riyadh city in KSA in year 1437 – 2016.
2. The study depended on one instruments to collect the data: questionnaire.
3. The sample included 90 participants.

Literature Review

Introduction

This chapter presents a discussion of the theoretical framework of literature related to the status of quality services. Then it presents Arab and foreign empirical studies on quality services provided in private hospitals.

The Status of quality services provided in private hospitals

In the case of any health problems people usually face two choices, namely attending public or private hospitals. In the vast majority of cases, people chose public sector as it is cheaper than the private one. However, private hospitals provide a competitive advantage. Public hospitals experience an impressive flow of patients, whereas public ones have fewer clients and choose the patient-centered approach.

Caring and attentive employees contribute to the improvement of the quality of service. In addition, attending the private medical establishment, the patient can choose the preferred surgeon. It is impossible to do in public institutions as the client will be taken care with the doctor in the shift. The ability to choose is significant for the positive outcome, and that is, people pay for this option.

Earlier, it was difficult to measure the quality of service; however, it should be pointed out that the SERVQUAL analysis facilitated this process. This approach is also known as the model that describes gaps between expectations and performing. SERVQUAL aims to describe the gap and consequently leads to the better understanding of what type of service is provided by the hospital. The quality of service used to be determined by the following ten aspects, namely “reliability, tangibility, communication, security, credibility, competence, understanding, access, understanding and knowing customers, responsiveness” (Alahmari, Aljasser, & Sasidhar, 2015).

However, nowadays the quality of service is evaluated in accordance with five fundamental factors, namely “reliability, tangible, responsiveness, assurance and empathy” (Alahmari, Aljasser, & Sasidhar, 2015). To get better involved in the issue, the stated above factors should be examined. First of all, the quality of service is measured by empathy. It is significantly important for the clients to get individual attention.

Tangible deals with the hospital itself and what it can offer to the customers. The number of laboratories and equipment impacts the way the patients perceive the quality of service. Assurance describes the level of competence of the staff and the possibility to create the relationships with the clients based on trust and respect. For the patients to be satisfied, the service should be reliable. The clients usually want to be aware of the process of treatment, and it should occur according to the schedule while timing is a significant aspect that influences the quality of the health care. Responsiveness is about the willingness to provide the appropriate help and ease the life of the patients in the hospital.

The peculiarities of the private hospitals stimulate them to work better and to provide the clients with the outstanding service. According to the researchers, the quality of service in the private establishments is higher as the staff aims to find a common language with the clients and to increase the satisfaction of the patients with the service provided.

There are a number of advantages that explain why patients choose private over public service. First of all, private medical establishments do not have the list of the patients who needs to wait. There are some cases when the patients need to wait for the transplantation almost one year.

The difference between public and private hospitals is in financing as the public ones use the governmental money, namely local or federal. In other words, the government paid for the patients, and that is, the hospitals serve everyone, even if the person does not have money. Public hospitals are responsible for providing every client with the health care. The private hospitals can refuse the patient in treatment. However, according to the law, in the case of emergency, the private hospitals should help the person and stabilize the health condition and then take him to the public one.

Private establishments are usually smaller, and that is, believed to be more centered on the needs of the patient. Moreover, the patients are likely to receive more care as the nurses should not be responsible for as many clients as in the public hospital. The relationships between the doctors and patients are based on trust and respect. Private sector aims to keep pace with the technologic development. One of the drawbacks that the private medical establishments have is the high costs that not everyone can afford.

The quality of health care is a multi-faceted issue that can be viewed from different angles. The fundamental aim is to satisfy the clients with the service and to improve the index of positive outcomes that affects the quality. There are three groups that influence the level of quality of the medical service; among them are the following, namely people who provide the service, those who supervise it, and the target group, clients who use the service. Depending on the group, the quality of service can be measured differently. Taking into consideration the significance of the issues, a number of authors address to this problem in the scientific works.

The SERVQUAL method is appropriate when measuring the quality of service, and that is, should be implemented to obtain reliable results. The usage of the SERVQUAL method is common while analyzing the work of the hospital and evaluating the professional attitude of the staff to the clients. According to the SERVQUAL, there is the difference between the expectations of the patient of the kind of service he will get and the service he gets in the reality. From this point, the quality of care can be measured. The methodology provides a relevant analysis that is recognized and documented.

To get a better understanding of the issues, the question regarding the expectations should be considered. It is important to point out that expectations are personal subjective feelings regarding the performance. They are commonly based on personal background, experience, or beliefs. From the one hand, marketing and advertisement influence personal expectations, however, from the other hand, personal experience in dealing with the medical establishments is significant to be taken into account.

The vast majority of people have an experience of dealing with public hospitals. As the matter of fact, not everyone was satisfied with it. The introduction of the private sector increased the level of trust in medicine, and the client-centered approach was beneficial as it contributes to the positive development of the health care segment. Although the quality of service can be influenced by personal experience, it should be stressed that a lot of organization can manipulate and influence the way the client perceive the quality. Management and advertisement are the powerful tools that affect the image of the outstanding quality.

The private sector has the reputation of the best service. Attending private hospitals people usually have too high expectations. However, it should not necessarily be so. The doctors, who work in the private sector are all human beings, and, unfortunately, cannot make a miracle. However, the fact is that the quality of health care is much better in the private segment. If the expectations were too high, there are great chances for the perception to be lower. It should be noted that in this case, the results are not adequate and rather questionable. It is a significant drawback of the SERVQUAL method that should be kept in mind.

The question regarding the evaluation of the quality of service provided in the medical establishments is vital to be taken into account. The primary objective of applying the SERVQUAL analysis is to receive a better understanding of what the clients want to get, what kind of service is desirable, and how they want to be treated. The question is, whether the clients’ expectations are not too high. In the public sector, the patients provided with less care, and that is, the expectations are usually lower than in the private sector. Private hospitals are expensive, and people want to get an outstanding service.

However, the professional who work in the sphere have almost the same skills and knowledge as in the public one. It is impossible to show only positive results. The sphere of medicine faces challenges and deaths every day, and it does not depend on whether the hospital is public or not. Due to the advertisement and reputation of the private sector, the expectations of the clients are believed to the considerably high.

The quality of service provided in the private sector is usually better than in the public one. As most of the patients have a negative experience with the treatment in the public hospitals, they want to get more professional and reliable care for money. The patients pay money and want their expectations to be met. The increasing amount of the public hospitals in the modern world proves that there is greater demand for more professional care.

As the population increases, the number of hospitals should increase as well. Although the opinion of the customer is important, one should keep in mind that the improvement of service should not be the obstacle to the professional skills of doctors to develop and improve as the positive outcome depends not only on the caring staff but the skillful physicians and surgeons.

Although public hospitals are essential and provide help across the globe to any patient, it should be stressed that there are a number of challenges that influence the work of this sector. Recent studies suggest that the large portion of people who attend public hospitals have low income or do not have insurance. The evaluation of quality helps to indicate the problems and drawbacks of the system. In most of the countries, the health care industry received the priority and nowadays develops very fast. Patients and their expectations have stimulated the intense development of the industry. The hospitals provide the clients with the same kind service; however, the quality is different and is measured with the consideration of the patient’s expectations and what they get.

Private hospitals are an integral component in the system of medicine. They can be found in any area and are not as overcrowded with the patients as the public hospitals. Taken into consideration the undeniable fact that the vast majority of private hospitals are expensive consequently, they are acceptable for the wealthy layer of society. There are a number of private hospitals across the world; however the difficulties they face seems to be similar.

The sphere of health care faces a number of issues and problems that significantly affect the quality of the service and care delivery. Medicine is always in progress, and it should catch up with the development of the society. The fundamental difference between private and public hospitals is that the private sector is orientated on the profit. The first problem that should be noted is the budgetary accent that the private hospitals make during the development of the strategies. According to the experts, such attitude has negative implications on the system of health care and influence the morale of employees in an impressive way.

However, it is essential to point out that the main concern of the medical establishment should be the wellbeing of patients and the staff. This objective can be reached by an outstanding and professional work of nurses and doctors, of every team member. The next issue that the private hospitals face is the lack of rewards for the staff. The system of rewards and recognition beneficially affects the motivation of the workers and is likely to increase the effectiveness.

Taking this fact into consideration, the public institutions pay more attention to this fact, whereas the private hospitals are more centered on the budgetary questions and desire to make more profit. It results in the fact, that the majority of nurses feels more respectful and appreciated working in the public hospitals. As the matter of fact, the private hospitals are usually not as big as the public ones; and it is the reason there are can be not so many specialists in the private medical establishment.

Apart from the above stated issues, it should be highlighted that the private sector is powerful and is a strong competitor to the public hospitals. Although the quality of service in private hospitals is usually better, not so many people can afford treatment in this sector. According to the recent researchers, nowadays people suffer more from different diseases; the major reason for it is the environmental pollution and climate changes that were caused by the unlimited human activity. That is the demand for the health care increases. Growing number of private hospitals proves this fact.

Arab and Foreign Empirical Studies on quality services provided in private hospitals

Providing patients with the high-quality health-care service is considered to be a demanding task. Although the sphere of medicine should receive the priority, there is hardly a country in the world that does not face challenges in the sphere of the health delivery service. One of the major issues is that the level of patient’s satisfaction with the care provided is difficult for estimating. The biggest problem is that the concepts of the quality and satisfaction are rather broad and can be understood by people in a different way.

To improve the quality of medicine and provide the patient with the highly professional help, the government of Saudi Arabia spent over 10 billion of dollars on the health care industry which is equal almost 15% of the overall budget. Public and private services are commonly compared.

The health insurance links the quality of care with the patient’s expectations. The experts claim that the high quality of the health care will consequently increase the satisfaction of the clients with the service. As the matter of fact, the newly implemented and changed the system of medicine in Saudi Arabia results in the tense competition on the market between two sectors, namely the private and public hospitals. In regards to competitiveness, the question arises whether the situation on the market will have a positive impact on the patient’s satisfaction.

SERVQUAL is a widespread tool that is commonly used in the marketing; nevertheless, it can be applied to the sphere of medicine as well. The researchers believe that SERVQUAL “remains the most complete attempt to conceptualize and measure service quality” (Alahmary, 2014). According to the recent findings, in most of the cases, the patients choose private hospitals as their expectations to receive more professional help is higher in comparison to the public ones. The increasing amount of young population is the stimulus of the educational and health-care industry to develop rapidly (Al‐Borie & Damanhouri, 2013).

The private and public sectors show intent to built new medical establishments. To keep pace with the increasing number of people, private hospitals expand and add more beds for the hospital. The investments in the private establishments remain high. With the higher demand for the medical workers, the government of Saudi Arabia takes actions to encourage students to choose health scare industry for future development.

The major factor that contributes to the indication of the quality of the health delivery service is hospitals. It is worth noting that nowadays the vast majority of hospitals are client-orientated as the patients determine whether the hospital has a competitive advantage among the rivals. The medical system in Saudi Arabia experiences changes and reorganization. The changes affect decentralization, the capacity of beds, insurance, and the quality of the provided service.

According to the statistics, the population of Saudi Arabia growth with every year and this is the reason for the increasing demand for the development of the health care industry. The Kingdom of Saudi Arabia has the highest index of the population growth in the GCC.

More than a half of hospitals in Saudi Arabia are owned by the Ministry of Health. The vast majority of the hospitals under the guidance of the Ministry of Health provide the population with the basic level of the health service, however, it worth stating that there are some centers that can be considered as the specialized. Almost six million of expatriates that live in Riyadh have to consult private hospitals in the case they need help as the Ministry of Health made some restrictions for the expatriates to get health care in the public establishments. That is, the private sector gains momentum.

Hospitals in Saudi Arabia are controlled by the Ministry of Health and certain companies that provide the employees with the medical service. Nowadays, hospitals in Saudi Arabia faced some changes that led to some advantages and improvement of the health care service. First and foremost, the hospitals became more accessible and offer the clients highly professional care. According to the recent researchers, starting from 1970 till now, the number of hospitals grew from 75 to almost 500 (Zarei, Arab, Froushani, Rashidian, & Tabatabaei, 2012).

The findings suggest that the amount of beds increased by six times. The government lays an accent on the development and improvement of the medical sphere as it contributes to the well-being of the nation. However, it should be pointed out that Saudi Arabia is not the single country that aims to make hospitals function more professional and increase the quality of service. A number of countries have chosen the same direction, among them are the following ones, namely France, Italy, and Japan.

The World Health Organization investigated the quality of service provided in the hospitals of different countries and came to the conclusion that the medical care in France can be considered as the role-model. The survival rates are impressively high in the country. People can cure of cancer and receive a highly professional help. In the United Stated, however, the system struggles with different factors that are an obstacle on the way to achievement the goal. The most evident problems are the following, high costs, the negative outcome of the clients’ treatment, and high demand for the health care service and lack of the registered nurses.

To get deeper involved in the issue, the definition of the quality of service should be taken into consideration. The experts stress that the quality is the “degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (Al‐Borie & Damanhouri, 2013). Investigating the quality of service, certain indicators should be taken into account, namely “safe, effective, patient-centered, timely, efficient, and equitable” (Al‐Borie & Damanhouri, 2013).

In addition, the medical establishments that provide a high-quality care should be responsible for offering the patients the performance based on the recent scientific findings. The hospital should minimize the negative outcomes and eliminate injuries. Wasting time is unacceptable in most of the cases, and that is, the workers should be ready to provide reliable medical help as soon as possible. The outcomes should be improved as well as the survival rate.

Moreover, the high-quality service should be provided to every person despite differences in nationality or race. Despite the fact that the quality of service has improved in Saudi Arabia, it is worth highlighting that there are still certain barriers that are an obstacle on the way of achievement of the success.

In order to get better acquainted with the quality of health delivery service in private hospitals, it should be examined from certain dimensions. First and foremost, the factor of safety should be observed. As the matter of fact, less than a half of private hospitals have a safety committee which can negatively affect the overall work of the medical establishment. Moreover, less than ten percent have a safety officer (Al‐Borie & Damanhouri, 2013). According to the recent findings in the sphere of private hospitals, not all the hospitals have the list of the products that look-alike sound-alike. Because of this fact, a number of mistakes take place. The presence of the safety committee or officer contributes to eliminating mistakes and reduces the index of negative outcomes.

The second aspect deals with the effectiveness. The most of the patients’ complaints were caused with the lack of the information regarding the health condition. The patients are provided with the discharged information more often in the private hospitals. The vast majority of clients (almost sixty-five percent) stressed that they could not understand the information they were given by the pharmacist.

The patients in Saudi Arabia show better satisfaction point in the case the pharmacist is in the medical team and provides the clients with all the needed information regarding the medications. Moreover, over forty percent of the patients want pharmacists not only to explain the information regarding the medication but to highlight the usage and the reaction of drugs. The half of the clients of the private institutions are satisfied with the work of pharmacists and are sure that they play an important role during the recovery process (Aljuaid, Mannan, Chaudhry, Rawaf, & Majeed, 2016).

For the private sector to improve the index of effectiveness, every member of the team should be responsible for the provided care and take a time to explain the patients the peculiarities of the diagnosis or medical prescriptions. The better awareness of the clients regarding the stated above issues will contribute to the improvement of the service.

According to the recent researches in the field of the satisfaction of the patients with the service in the private hospitals, almost twenty-five percent of the respondents out of three hundred patient stated that the pharmacists did not pay attention to the rights of the clients to be well informed regarding the diagnosis and treatment, despite the fact, that the patients have the right for it. It affects the index of quality of the service significantly, and that is, should be taken into consideration and improved.

As the matter of fact, the area regarding the quality of the health-care provided in the private hospitals is not well researched and demands further investigation. The major concern of the private institution is to provide highly professional service with the accent laid on the safety.

Providing high-quality care to satisfy the expectations of the patients is a demanding task. However, it is even more complicated to measure the satisfaction of the service. It is difficult because the concept of quality and satisfaction is very broad and there is no single meaning. According to the recent studies, the bed capacity in hospitals used to be over 50,000, almost eighty percent were at the disposal of public ones, and twenty percent belonged to the private establishments. However, the government decided that the health care industry should catch up with the growing population, and the bed capacity should be increased. The Saudi Arabia government invested over ten billion of dollars for the improvement of the quality of care and facilitation of the work of the public hospitals.

It is worth highlighting that public, as well as private medical institutions can be compared. The experts, such as Al-Shekh and Alsharqi, claim that the perception and experience of the patients influence the expectations (Al‐Borie & Damanhouri, 2013). The way clients perceive the service should impact the performance. Alsharqi is sure that the tense competition in the health-care industry should beneficially impact the quality of the service provided (Al‐Borie & Damanhouri, 2013).

The recent statistics shows that the total number of people who attend the hospitals in Saudi Arabia is almost three million. The vast majority of people still consult public hospitals; however, almost twenty-five percent of the patients prefer private health care providers. The statistics are understandable as the private hospitals are rather expensive, and the vast majority of people cannot afford it.

The perception of the patients is a crucial factor that determines the quality of care. With the consideration of the above stated peculiarities of the private sector in Saudi Arabia, the question arises whether there are the same issues associated with the problem in different countries. Although the real level of the health care service can be low, the fundamental objective is how the clients view this service and their opinion regarding the staff and efficiency.

The researchers state that there is a correlation between the perception and satisfaction. The satisfaction of the patients seems to be the main aspect that indicates whether the quality of service should be improved and what strategies should be implemented in the sphere of health care in order to reach desirable results. That is, some hospitals lay an accent on the satisfaction of the patients and make it the most prioritized strategy and objective.

The tendency towards the increasing number of private hospitals is typical not only for Saudi Arabia but other countries as well. As the matter of fact, the amount of private health care providers has also increased in Turkey. The number of private establishment increased by five times since 1980. The major reason for such progress in the private sector is considered to be the liberalization of the country. The negative experience of the Turkish clients with the public hospitals was the stimulus for the private segment to develop rapidly. The service of the health care providers was numerously analyzed applying the SERVQUAL analysis.

The service should be viewed from certain dimensions, namely “tangibility, assurance, responsiveness, reliability, and empathy” (Bakan, Buyukbese, & Ersahan, 2013). The findings suggest that people in Turkey prefer private over public hospitals because they are sure that the quality of service will be better, and they will get professional help. However, it does not necessarily mean that the quality of service differs dramatically. There are some cases when the clients complain regarding the care they received in private medical establishments. The dissatisfaction was based on the time of treatment, waiting, and consultations.

The lack of staff is the reason for problems with time. Nevertheless, it should be pointed out that the demand for the private hospitals has increased, and this tendency can be traced not only in Saudi Arabia and Turkey. While the quality of service is indicated by the satisfaction of the patients, private sector focuses on the improvement of the service as there is a tense competition on the market and they do not want to lose clients. People have a lot of alternatives, and it influences the attitude towards them, making the service better and more reliable. To succeed and prosper, hospitals should take into consideration the opinion of the clients if they do not want to lose clients.

The SERVQUAL analysis offers six dimensions that can identify the success of the hospital and the level of the service provided. Clients have expectations, but the service they get usually does not reflect these expectations on a hundred percent. The gap between these two concepts indicates the quality of service. According to recent studies, there are some common factors that patients want to see in the private hospital.

First of all, tangibility should be discussed. Clients think that the medical establishment should be fully equipped with modern technologies, bathrooms and rooms should be clean and in a good condition, the food should be healthy and attractive. In addition, nurses should respect the patients and do not interfere into their personal space and parking should be comfortable for usage. The private hospitals meet these requirements and strive to make the hospital more comfortable for the patients.

The second aspect of the SERVQUAL analysis is considered to be assurance. The patients want to be aware of the time and get the service in accordance with the agreement. The main objective is to follow the instructions and procedure in a strict manner. This criterion is usually performed outstandingly in the private establishments.

For the service to meet the expectations of the patients, it should be responsive. People want to know when they will be consulted. Moreover, the want to get a reliable help not only from nurses but other staff as well. Patients aim to get an explanation regarding medicaments and treatment. With the consideration of the discussed above information, it should be stressed that not all the hospitals provide the patients with detailed information regarding the treatment, and it is the drawback of the system. To improve the quality of service, the staff should explain the diagnosis and peculiarities of treatment to the patient and relatives if any.

It is understandable that when the patient has some problems with health he wants to choose a reliable place with the professional and caring staff. For the treatment to be positive and to eliminate any nervous situations, the patient should trust not only staff but billing as well. The client wants to feel safe and to be confident in the quality of service he gets. It seems to be significantly important to highlight the fact that nurses should ensure the patient that there is no need to worry regarding the treatment and consultations as it affects the overall health condition in an impressive way. In reality, private hospitals usually meet these expectations as they want to attract patients. However, clients have a different perception. It may be enough for one client to explain the diagnosis briefly but another customer wants to be informed in details.

The next factor that influences the quality of service is courtesy. The workers of the private hospitals should be polite and follow the procedure. For the process of treatment to be more positive, one should keep in mind that nurses should be cheerful for the patients to have more confidence in the positive outcome of the treatment. Moreover, visitors and relatives should be treated well. Although the staff of the hospital understands the importance of being polite, sometimes the situations are urgent, and there can be not enough time to follow the procedure precisely. However, the worker of the private institutions usually aims to improve the quality of service and dedicate more time to the patients.

The last aspect that the SERVQUAL analysis is empathy. It is worth noting that the patients want the workers of the private hospitals to predict their wishes. Patients want to get desirable attention. As the matter of fact, in most of the cases, the private hospitals offer a high-quality care in order not to lose patients and improve the index of positive outcomes.

It is worth stating that one of the most significant accents the system of medicine in Saudi Arabia makes is the safety of the process of treatment. This concept receives the priority as the level of medical errors should be reduced. The number of medical mistakes on the base of medications increases, according to the expert’s point of view; it is caused because of the lack of safety officers in the medical establishments.

The role of the medication safety officer should not be undervalued. Despite the fact that the responsibility of the officers is limited, it still can contribute to the improvement of the quality and delivery of service. However, it should be stressed that the medical errors are typical not only for Saudi Arabia but other countries across the globe as well. Private hospitals aim to reduce the level of mistakes by hiring more staff and following the procedure.

Medical mistakes can be explained by a variety of factors. First and foremost, the errors occur because of the human factor. The human being tends to make mistakes, and they cannot be eliminated, however, a lot of effort should be put to reduce its quantity (Zamil, Areiqat, & Tailakh, 2012). The implementation of the accreditation process will positively impact the quality of service and will consequently reduce the amount of mistakes made by doctors and nurses as well. According to the recent findings, the accreditation process will improve the medication safety.

Although the patient’s expectations are usually believed to be higher than the quality of service they receive, it is worth noting that the recent findings suggest that there is positive tendency regarding the client’s satisfaction. The relationships and respectful attitude towards the patients have a positive impact on the recovery of patients. Empathy influences the overall satisfaction of the client and the positive outcome. The quality of care and empathy contribute to the improvement of the survival rate and beneficially influences the expectations of the patients.

The researchers prove that the satisfaction of the patients of the private hospitals can be affected by numerous factors. The clients of the private sector usually expect the outstanding quality of the health care. Modern patients want to be active participants of the process of treatment and decision making. They want to be aware of the alternatives of the treatment and possible outcomes. As the matter of fact, the private hospitals dedicate more time to the patients and want to keep the clients and their relatives informative.

Every team member of the private hospital can influence the quality of service; however, it should be stressed that the nursing staff is essential and play a significant role in the improvement of the health service. Being aware of this fact, private hospitals aim to hire as much nurses as needed to provide all the patients with the needed amount of attention and care. Working on the improvement of the patients’ satisfaction, the staff of the private hospitals should take time for educating the relatives of the client regarding the diagnosis or the process of treatment.

Nevertheless, it is worth pointing out that the satisfaction of the patients should not become the single objective as the satisfaction of the staff seems to be an important issue. The patients and the staff are the stakeholders, and their interest should also be taken into consideration. The improvement of the health care service should be made on every stage of the treatment process. The progress and advance should be made from the first second the client enters the private hospital until the time he will be cured. When the hospitals fail to provide appropriate care, they receive poor outcomes and dissatisfaction of the patients.

The implementation of the SERVQUAL analysis is beneficial to take into consideration as it complements the quality of service and may evaluate the drawbacks of the sphere of medicine (Zamil, Areiqat, & Tailakh, 2012). It is worth stating that the further investigations regarding the quality of service provided in the private hospitals and ways for the improvement should be discussed and developed for the health delivery service to make progress.

Conclusions

In conclusion, it should be pointed out that the private sector in the sphere of the health care gains momentum and develops rapidly not only in the Saudi Arabia but the world in general. It is worth pointing out the fact that the public hospitals are overcrowded, do not use the client-centered approach and have other peculiarities that should be taken into consideration while choosing private or public sector.

The expectations of the clients are commonly connected with his experience, background, or the influence of management and advertisement. It is no doubt that the expectations regarding the level of service of the private sector are much higher in those patients who consult private establishments. First and foremost, private hospitals are expensive, have more workers and less patients, which allows dedicating more time to every client.

The equipment in the private hospitals is commonly more modern and advanced. In addition, the patients have the personal right to choose the doctor or surgeon, which is a crucial factor, especially in the cases when the patients have serious illnesses that demand attention and highly-professional skills. However, the stated above reasons are not the only ones that influence the choice of people and their perception of quality of the health care.

Public medical establishments usually have long waiting lists, and it may cause patients some problems. It is worth highlighting that private sector is not financed by the government, it uses the investments of the businessmen. Having more freedom and not depending on the governmental investments, the private hospitals have a competitive advantage. The fact that there are not some many patients, as not everyone can afford to go to the private hospital increases the level of quality of the health care.

As the matter of fact, the quality of service can be analyzed with the consideration of the following aspects, namely safety, effectiveness, time, client-centered approach, and efficiency. The attention to these factors is essential to be taken into account as they influence the quality of service significantly. It is worth stating that the improvement of the stated and discussed above aspect will beneficially affect the reality of the health care service.

The expectations of the clients should be reflected in the quality of care they get. Despite the fact that in most of the cases, the expectations are too high, the staff of the private and public establishments should strive to make progress and advance in the performing. The accent should be laid not only on the improvement of the index of positive outcomes but the service as well.

The big percentage of the patients does not understand the medications and aim to get appropriate help. The pharmacists should pay more attention to the clients and explain the peculiarities of the drugs and highlight the usage. Taken into account the discussed information, the following conclusion can be drawn; the private sector offers more client-orientated approach, however, still should be improved as there is a gap between the patients’ expectations and the reality of service.

The global tendency proves that there is the increasing number of private hospitals. It can be explained by different reasons. First and foremost, people usually have bad experience while dealing with the public hospitals.

Quality of service estimated by the SERVQUAL analysis takes into account the following aspects, namely tangibility, assurance, responsiveness, courtesy, access, security, and credibility. As the matter of fact, the private medical establishments aim to meet customer’s expectations because there a lot of options that the clients may choose. The SERVQUAL analysis is beneficial for the implementation as it provides the deeper understanding of the issue. The number of private hospitals is growing, and they want to compete with public ones in the market. In order to meet this objective, private hospitals should improve the quality of service as the customers’ expectations influence the perception significantly.

The quality of the service in the private hospitals can be estimated by the evaluation of five primary factors, namely “reliability, tangible, responsiveness, assurance, and empathy” (Mosadeghrad, 2014). It should be stressed that the appropriate analysis of the expectations of the patients and the service they get will contribute to the improvement and progress in the sphere of medicine. I do not profess to be an expert regarding the subject, but I am strongly convinced that the issues and challenges the private sector is facing right now are a great stimulus for the health care industry to advance and deliver an outstanding service that will satisfy even the most demanding client.

Despite the fact that the system of medicine is experiencing the rapid development in Saudi Arabia, it should be stated that the Ministry of Health provides almost seventy-five percent of the population with a public health-care service. Nevertheless, there are still certain problems associated with the sphere of medicine in Saudi Arabia. Among the most widespread challenges are the amount of medical mistakes, safety of medications, waiting lists, and quality of care.

The government does not address these issues, and it consequently leads to the decrease of the quality of the health-care service. It is essential to highlight that the private sector aims to eliminate these problems and works for the improvement of the health delivery. Moreover, the government should take into account that because the population increases and demands of the patients become more advanced, the expectations of the clients regarding the service increase as well.

The only way to eliminate the problems is to be flexible and adjust to different conditions. The increasing amount of the private hospitals will stimulate the governmental establishments to compete and make progress. To master the results regarding the quality of service provided in the health care institutions, the international experience should be taken into consideration. Despite the fact that countries have different cultural peculiarities, the problems the modern system of medicine face are common.

The globalization process brings the countries together and makes them closer. Cooperation and collaboration can impact the development of the health-care service in a positive way. To achieve this aim, different surveys should be implemented into the working process. The information is a great tool that helps to achieve progress.

The segment of private hospitals is represented in every country in the world. Although the quality of service is considered to be better in the private sector, it should be highlighted that the vast majority of private hospitals face the same issues that demand attention. Climate changes and poor condition of the environment lead to the spread of different diseases that should be treated. The rapid development of the private sector is possible because there is an increasing demand for the health care service.

The sphere of medicine requires improvement and advances. There is hardly a person in the world that had no experience with attending of the health care institutions. As the matter of fact, it should be pointed out that the number of private health care providers increases significantly because the public sector does not provide the patients with the appropriate service. To compete on the market, the private hospitals dedicate most of the attention to satisfy the needs of the clients. Striving to reflect the expectations of the clients will contribute to the improvement of service.

Methodology

Introduction

Chapter three shows the methodology which has been followed in this study. It also presents the population and the sample of the study in addition to the instruments used. Besides, this chapter shows the statistical analysis utilized in this research.

Population and Sample of the Study

The population of the study consisted of male and female patients in three private hospitals in Riyadh city in KSA in 1437 –2016. The average age of the participants was 25-45 years. In addition, the sample of the study was composed of 90 randomly-selected male and female patients from three randomly-selected private hospitals.

Research Instrument

The researcher adopted the quantitative approach for data collection which was a questionnaire. The researcher designed a five-point Likert scale questionnaire (see appendix 1) to collect the data of the study. The questionnaire was divided into five dimensions of SERVQUAL model in private hospitals. The first dimension was about the assurance. The second dimension was about the tangibility. The third one was about the reliability. The fourth was about the responsiveness. The final dimension was about the empathy.

Statistical Analysis

The researcher used SPSS program to analyze the data of this study. Moreover, frequencies, percentages, means, and standard deviations were adopted to analyze the data of the study.

Findings of the Study

Introduction

Chapter four presents the findings of the current study which attempted to measure the Quality of Services Provided in Private Hospitals in the Riyadh City. The question of this study was as follow:

• How to measure the quality of services provided in private hospitals in Riyadh city?

Data analysis

A Quantitative questionnaire instrument was used to collect the statistical data of the study. The SPSS program was used to analyze the collected data. To achieve this goal, means (M) and standard deviations (SD) were calculated for the patients’ responses.

Results of the Study

The researcher used descriptive statistics to analysis the patients’ responses by using the SPSS program to find the means and standard deviations for each item of the questionnaire. This was carried out to answer the question of this study.

Table (1) shows the means, the standard deviations and the ranking of each item compared with the rest of items in the first dimension which is the assurance. Table (2) shows the means, the standard deviations and the ranking of the second dimension which is the tangibility. Table (3) shows the means, the standard deviations and the ranking of the third dimension which is the Reliability. Table (4) shows the means, the standard deviations and the ranking of the fourth dimension which is the Responsiveness. Table (5) shows the means, the standard deviations and the ranking of the fifth dimension which is the Empathy.

Summary of the Results

The findings in terms of assurance, tangibility, reliability, responsiveness, and empathy statements indicated that the respondents had definite views on the quality of services within the three private hospitals under study. The five scale measure captured different views, perceptions, and weight assigned to each service quality matrix by the respondents. The summary of results will be highlighted for each scale of measurement in order to relate the quality and reliability of each quality matrix as discussed below.

Scale 1: Assurance Statement

Within the assurance scale, the findings indicated that majority of the respondents were positive, in terms of level of satisfaction as indicated by percentage score of more than 60% for all the items answered. The responses within the first scale, which was testing assurance as a quality indicator as highlighted in table 1, revealed that patient safety, personnel knowledge, personnel behavior, and personnel consistency highly influenced clients perception on the quality of services within the three private hospital.

Patient safety was ranked first at 73.20% with a mean of 3.66. This means that patients viewed their safety as a key instrument for quality health services in the three private hospitals. However, the high standard deviation of 1.007 was an indication that respondents had high disparity in terms of the level of consistency in patient safety assurance in the three private hospitals. The response to question on personnel consistently in being courteous to patients was ranked at number two with a percentage of 72.00% and an average score of 3.60.

The standard division was 0.992, indicating that the respondents were perceived the level of personnel consistently in being courteous to patients was fair. The response to the question on the behavior of personnel as instilling confidence in patients was ranked at the third position at 71.20% and an average score of 3.56. However, the high standard deviation of 1.040 indicated that the personnel were not very consistent in showing behavior that can instill confidence in patients. The last question under the assurance scale on the personnel knowledge in answering patients’ questions was ranked at number four as significant in determining the quality of services as perceived by the respondents.

The response indicated a score of 68.80% with a mean of 3.19. The lowest level of disparity was recorded for this question as reflected in the low SD of 0.898. This is an indication that the patients acknowledged consistency among the personnel in terms of their technical knowledge to address concerns raised by customers. From the assurance scale, it is apparent that patient safety, personnel consistency, personnel behavior, and personnel knowledge influenced the degree of quality in service delivery in that order as perceived by the respondents. However, the respondents were concerned by the high disparity in perceived patient safety and personnel behavior as indicated by the high SD for the two aspects.

Scale 2: Tangibility Statement

Within the tangibility scale, the findings indicated that majority of the respondents were positive, in terms of level of satisfaction as indicated by percentage score of more than 60% for all the items answered. Modern equipment was rated by the respondents as the first determinant of quality services with a score of 82.00% and a mean of 4.10. Besides, this aspect had the lowest SD of 0.808 (low disparity), indicating that all the three private hospitals had very modern hospital equipment.

Appearance of personnel, in terms of neatness, was ranked by the respondents as the second most significant determinant of quality services in the three private hospitals. The aspect of personnel appearance had a score of 80.40 and a mean of 4.02. The low SD for personnel appearance at 0.807 is an indication that three private hospitals are consistent on the aspect of personal grooming and neatness of the employees service the patients.

The response to question on how the materials associated with the service are visually appealing was ranked at the third position with a mean score of 4.00, as influencing the perceived level of quality services in the three private hospitals. Specifically, the lowest SD of 0.793 in response to this question is an indication that the respondents are fully satisfied with the visual nature of the materials associated with service at the three private hospitals.

Response to the question on the physical facilities as visually appealing was ranked at number four with a mean score of 3.86 at 77.20%. The highest SD recorded at 0.943 is an indication that there is disparity in the visual appearance of the physical facilities across different sections in the three private hospitals. The slight disparity could be attributed to different design of the room and other facilities, which might not be appealing to the respondents.

Scale 3: Reliability Statement

Within the reliability scale, the findings indicated that majority of the respondents were positive, in terms of level of satisfaction as indicated by percentage score of more than 60% for all the items answered. The findings for the fourth scale, which was testing reliability as a determinant of service quality in the three private hospitals, indicated that getting things right at the first time was ranked at number one by the respondents with a percentage score of 68.40 and a mean of 3.42. This means that 68.40% of the respondents indicated that getting things right in the first attempt would translate into quality service delivery. The standard deviation from the first question was calculated as 0.912.

The low value indicate that respondents agreed that the three private hospitals were consistent in getting things right in at the first time. The response to question on insisting on error-free records was ranked at number two with a percentage score of 66.20 and a mean of 3.31. This is an indication that 66.20% of the respondents agreed that the three hospitals have error-free records. The low SD value of 0.932 is an indication that the level of disparity in having error-free records in the three private hospitals was relatively low.

The response to question touching on sincerity of the three private hospitals to solve problems highlighted by a patient was ranked at position three with a mean of 3.31. Specifically, 66.20% of the respondents agreed that the three private hospitals display sincere interest in solving patient problem. The low SD score of 0.907 is an indication that the respondents were of the opinion that the three hospitals are relatively consistent in showing interest to address their problems.

The question testing on how the three private hospitals keep their promise in a timely manner was ranked at number four with a mean of 3.20. Apparently, 64.00% of the respondents were convinced that the three case study hospitals were always acting on their promises in a timely manner. However, the highest SD score of 1.134 within the tangibility scale is an indication of a wide disparity from one hospital to another in honoring promises to patients in a timely manner.

The question touching on the ability of the three private hospitals to provide their services at the time they promise to do was ranked at number five with a mean score of 3.1. 63.80% of the respondents agreed that three case study hospitals were providing their services at the time they promise to do. However, the high SD score of 1.048 is an indication of a relatively wide disparity in timely service delivery from one private hospital to the other.

Scale 4: Responsiveness Statement

Within the responsiveness scale, the findings indicated that majority of the respondents were positive, in terms of level of satisfaction as indicated by percentage score of more than 60% for all the items answered. In response to question testing on the personnel wiliness to help patients, 71.80% of the respondents agreed that the three private hospitals were on the right track with an average score of 3.59.

This response rate was ranked at the first position with a standard deviation of 0.970, indicting existence of relatively low disparity in willingness of personnel across the three hospitals to help patients. The response to question testing on the ability of the personnel to give prompt services to patients was ranked at number two within a percentage response rate of 66.20% and a mean of 3.31.

The relatively large SD of 0.956 is an indication of existing disparity in prompt service delivery to patients from one private hospital to the other. The question on personnel never too busy to respond to patients’ requests was ranked at number three with an average mean score of 3.26. Specifically, 65.20% of the respondents agreed that the three private hospitals have personnel who are not too busy to respond to patients’ requests. The relatively low SD of 0.931 is an indication that the private hospitals were relatively consisted in ensuring that the personnel are never too busy to respond to patient request.

The response to question on personnel telling patients exactly when services will be performed was ranked at position four within a mean score of 3.23. 64.60% of the respondents agreed that the three private hospitals had strategies put in place to ensure that personnel tell patients exactly when services will be performed. However, the high SD at 1.082 is an indication of existing large disparity in the effectiveness of these strategies from one private hospital to the other.

Scale 5: Empathy Statement

Within the empathy scale, the findings indicated that majority of the respondents were positive, in terms of level of satisfaction as indicated by percentage score of more than 60% for all the items answered. The question touching on the three private hospitals having operating hours that are convenient to all their customers was ranked at position one with a mean score of 3.84 in response rate. Specifically, 76.80% of the respondents agreed that the three private hospitals have operating hours that are convenient to all their clients. However, the relatively high SD of 0.911 is an indication of disparity in operating hours from one private hospital to another under the study.

The question dwelling on the three private hospitals having staffs who give personal attention to patients was ranked at position 2 with a mean score of 3.68. Specifically, 73.60% of the respondents agreed that three hospitals under study have staffs who give personal attention to patients. The relatively low SD at 0.897 is an indication of a fairly large disparity in giving personal attention to patients among the three private hospitals.

The question on personnel understanding the specific needs of their patients was ranked at position three with a mean score of 3.52 and a SD of 0.951. 70.40% of the respondents agreed that the three private hospitals have personnel who understand the specific needs of their patients. However, high disparity, as indicated by the high standard deviation, exists among the three hospitals, especially in terms of how the personnel understand the specific needs of their patients. The question on the three hospitals having the patients’ best interest rates was ranked at number four indicating that many patients were currently not satisfied with prevailing rates when compared to other components of the empathy scale. Specifically, 69.60% of the respondents agreed that three private hospitals have the patient’s best interests at rates.

However, the high SD at 1.008 in an indication of widening disparity in having the patient’s best interests at rates among the three hospitals. In testing the empathy scale, the question on the three hospitals giving patients individual attention was ranked at position 5 with mean score of 3.37 and standard deviation at 0.977. Specifically, 67.40% of the respondents agreed that the three private hospitals under case study give patients individual attention. The high SD at 0.977 is an indication of widening disparity in the ability to give patients individual attention from one hospital to another.

From the above findings, it is apparent that the respondents were categorical on factors that define the magnitude of quality in service delivery within the three private hospitals under study. The main service quality determents highlighted by the respondents are critical in the health care delivery environment include patient safety, service quality in terms of equipment, timely service delivery, and operating within convenient timeline.

Besides, the respondents indicated that personnel knowledge and positive behavior would go along ways in guaranteeing high quality services within the three private hospitals. However, the highest disparities were recorded in terms of consistency of guaranteeing patient safety, personnel behavior that can instill confidence in patients, timely delivery of services, and having the patient’s best interest at rates charged. These inconsistencies might derail the current high standards of quality service delivery if not addressed in a timely manner.

These inconsistencies were identified by the high SD of double digits. Irrespective of these disparities, the respondents were general satisfied with many service quality charters adopted by the three private hospitals as indicated by the high percentage scores for each of the five scales tested. From the above results, it is apparent that most of the respondents had clear knowledge of the factors determining the level of service quality in the three private hospitals. Specifically, an average score of 65% was obtained for different questions that aimed to identify the quality of services as influenced by assurance, tangibility, reliability, responsiveness, and empathy factors.

Discussion, Conclusion, and Recommendations

Introduction

Chapter five includes discussion of the results of the studying light of the previous studies.

Besides, it also presents conclusions and recommendations for future research.

Discussion of the Results of the Study

From the findings, five areas were noted as critical in the successful creating of a sustainable and quality healthcare environment for private hospitals. These areas are provision of high quality general healthcare service. This means that quality healthcare services are provided in the most professional manner and in the friendliest environment to address the needs of each patient in the three private hospitals under study.

The services operate within customer centricity model to create the ideal healthcare service environment. For instance, in testing the assurance parameter, as a determinant of quality healthcare services, it was established that the three hospitals provide customized health services to patients across the region of operations and beyond. The primary focus of the three private hospitals is provision of quality healthcare services to residents.

Therefore, creation of structures to deliver quality health services has not only ensured that the operations at the hospital are sustainable but also accessible since majority of the respondents graded the personnel and facility of the healthcare centers as above average (Escrig-Tena, Bou-Llusar, & Roca-Puig, 2011). The key to sustainable healthcare services depend on the ability to create customized healthcare services to address the needs of each targeted client.

In the three hospitals, the patient centricity approach in service quality charter encompass proactive communication channel building to ensure that the process of encoding and decoding information when interacting with each patient promote confidentiality and friendly interaction. Basically, this objective operates on the pillar of equality in handling the concerns of all patients such as first-come-first-serve policy, follow-up on previous treatment, and provision of accurate information to all patients (Hall, 2012).

As indicated in the reliability parameter, the hospitals have systems that guarantee timely services to clients in a professional manner as reflected by the average score of 65% in positive response rate. These health institutions are aware of the significance of the patient in the healthcare provision environment. Therefore, there primary role has been to ensure that the patients are made to feel as comfortable as possible to make the patient-personnel interaction healthy (Soumendu, 2011). The hospitals have overseen long term services focused on improving the scheme for managing patient records and other health information systems as indicated in the score of 66.20% for reliability parameter.

It is also apparent the three private hospitals have been active in creating strategies that ensure personnel motivation, to guarantee quality services received by clients. The hospitals have endeavored to create an ideal work environment that promotes employee development and growth, which translates into better services as observed by the participants. In the health sector, the performance and conduct of the employees are very important since they have an impact on the patient’s health and lives (Weiss, 2010).

In addition, the principal challenge in the health care sector is the implementation of the processes that ensures that conflicts are managed in a fair and just manner (Escrig-Tena, Bou-Llusar, & Roca-Puig, 2011). As institutions that aim to be the regional leaders in patient satisfaction, the three hospitals have laid down strategies to ensure that the employees are motivated and well trained as graded by the respondents who rated personnel knowledge and positive attitude beyond the 70% mark. The team’s level of motivation and general satisfaction within the three hospitals determine every level of success of since they are the implementers of every quality performance policies (Fielding & Briss, 2013).

These policies provide a proactive and steady response, encourage open communication, and support all-inclusive problem solving as a means of ensuring optimal employee performance (Hall, 2012). When the system functions within accepted parameters, as is the case within the three case study hospitals, the personnel have eventually developed a self consciousness to deliver quality services as noted by the respondents.

Total quality management is critical in monitoring the efficiency and proactive organizational culture in line with the objective, goals, and mission of an organization. Quality improvement facilitates sustainable and optimal use of resources in service delivery. Organizations function best when the intra and inter performance systems are perfect. Therefore, successful organizations manage information continuously (Fielding & Briss, 2013).

The practice of proactive management involves the science of processing information to facilitate informed decision making among the personnel (Escrig-Tena, Bou-Llusar, & Roca-Puig, 2011). In the case of the three private case study hospitals, the performance tracking system have been implemented to guarantee organization effectiveness since the parameters of assurance, tangibility, reliability, responsiveness, and empathy have performed above average as indicated by the research results.

Performance management system is a process of fostering developing within the organizational set ups through the adoption of a cycle of well planned intervention approaches aimed at enhancing the general efficiency of an organization, and at the same time bettering the positions of a majority of its members (Fielding & Briss, 2013). Specifically, a good working environment should be flexible, relevant, and comfortable within set measurement standards that support intrinsic and extrinsic relationship between an organization and different performance systems. There are laid down structures at the three private hospitals formulated to keep staff in healthy and stable mind in their duty of serving the interests of the patients (Escrig-Tena, Bou-Llusar, & Roca-Puig, 2011).

Implementation of the expertise service strategy is a systematic measure that is instituted by an organization in order to maintain efficient and effective operation matrix. The three private hospitals have effective service delivery standards for controls to ensure efficiency. Apparently, the benchmarking initiative for expertise service delivery involves streamlining service charter to ensure efficiency via a proactive quality mitigation channel, which reports progress of the intended quality improvement system (Fielding & Briss, 2013).

In relations to the case study hospitals, there are laid down strategies aspiring to achieve efficiency in the chain of command between output and customer satisfaction (Escrig-Tena, Bou-Llusar, & Roca-Puig, 2011). Since scope of quality is universal across different sizes of businesses, implementation of total quality management at the three hospitals has been modified to fit within different services that are demanded by the clients. One of the value strategies that the three organizations have utilized is to make sure that they attribute the health services to convenience and quality (MacKay & McKiernan, 2011).

These hospitals have a strong commitment to customers and professionals who depend on their services. Among the notable service quality charter confirmed by the respondents are greatly responsible for high quality in service in the three hospitals are highlighted in the order of ranking below.

1. Quality and reliable health care services.
2. Proper service charter through expertise service approach.
3. Continuous personnel-patient consultation and support in health care delivery.
4. Creation of sustainable and reliable patient-medical personnel relationships.
5. Provision of relatively affordable health care services.
6. Creation of ideal and friendly service delivery environment.
7. Implementation of best employee motivation strategies for optimal performance.
8. Upholding integrity and openness in service delivery to clients.

Despite the sterling performance by the three private hospitals, in terms of quality in service delivery, the respondents were particularity concerted by the high rate charged and reliability of the personnel on acting on their promises and timely service delivery (MacKay & McKiernan, 2011). As a strategy for efficiency reassurance within these hospitals, it is important to further improve on efficiency and create a functional and dynamic personnel training plan since the field of healthcare support is very dynamic (Fielding & Briss, 2013). The constant and periodic trainings will further equip the personnel with the latest knowledge in health management and minimize instances of poor patient feedback.

The three main health care delivery system concerns include the aspects of fairness, objectivity, and transparency. Objectivity minimizes biasness and prejudice when drawing the health care policy (Weiss, 2010). On the other hand, fairness involves collective consultation with stakeholders and adopting consultative decisions. Transparency involves the aspects of proactive reviews that are consistent with the performance evaluation and monitoring system.

Reflectively, this policy contains all these aspects within its scope (Escrig-Tena, Bou-Llusar, & Roca-Puig, 2011). In order to make change in the three spheres of influence at the three private hospitals, it is important to draw a policy on healthcare that focuses on timely service delivery and personnel commitment to address the current concerns raised by the respondents, especially on reliability of the personnel in honoring service delivery charter (MacKay & McKiernan, 2011).

Irrespective of the size of the three private hospitals, the underlying goal is business sustainability through employee integration and motivation into the operations model to guarantee service quality (Fielding & Briss, 2013). The existing literature revealed that quality in healthcare services is significant towards integrating employee motivation and positive business environment, which guarantee sustainable operations and eventual patient satisfaction (Escrig-Tena, Bou-Llusar, & Roca-Puig, 2011). Besides, quality in service delivery is necessary towards ensuring that employee perform at optimal level to ensure that different patient service delivery strategies are sustainable in the three private hospitals under study.

Although respondents highlighted the need for quality in service delivery within the three private hospitals under study, it was apparent that their perception on different aspects of actual personnel function in delivery was the same. The respondents, who double up as patients in the three hospitals were categorical about the need to increase patient-personnel communication and exclusivity in service delivery to create a holistic healthcare environment (MacKay & McKiernan, 2011).

This means that transformational leadership on the side of the management is critical in providing an environment where the subordinates can be easily motivated to perform at optimal level by delivering quality healthcare services to the patients. When transformational leadership is adopted in the work environment as a management strategy, “it is easy to convince the personnel to be flexible to change and perform at their level best” (Fielding & Briss, 2013, p. 29). Among the key characteristics of transformational leadership strategy include empowerment, commitment, critical problem solving, and adaptability of the work force. When these factors are internalized in the three case study hospitals and other hospitals within and without Riyadh, it will be easy to reinforce a culture of quality service delivery.

Conclusion

Conclusively, the critical elements of an effective service quality implementation strategy include personnel commitment, employee involvement, workplace analysis, efficiency in managing the healthcare environment, and operation. An effective quality service implementation strategy system must therefore include the evaluation procedure to help gauge its effectiveness and guide in the creation of the measures to correct flaws in the system.

The study showed how factors like corporate leadership practices, planning systems, social responsiveness, management control, and the organization performance have impact on the level of patient quality service delivery. These factors have a significant effect on how customers perceive the aspect of quality in service delivery, within the private healthcare sector. As indicated by in the findings on quality of services provided by the three private hospitals in Riyadh City, it is apparent that healthcare organization structure, operations management, and efficiency of the work force determine sustainability and quality of services delivered to patients.

Besides, the ability to customize products and offer competitive but high quality services determine success in short and long-run. Skills required in supporting business strategy plan are found in operation management models, which functions as an implementer and driver of business decisions. The findings in terms of assurance, tangibility, reliability, responsiveness, and empathy statements indicated that the respondents were generally satisfied by the on the quality of services offered by the three private hospitals. The quality charters for the three private hospitals incorporate planning, development, implementation, and discovery as indicated by the high general patient views.

The quality charter has remained efficient due to variety of high quality services, proactive personnel, and fair health provision environment. Since quality improvement and control refers to business activities which are focused to fulfill satisfying expectation of consumers, there is need for the three hospitals to develop a proactive service delivery charter to facilitate achievement of complete interaction module between clients and employees through use of personnel management, which adopts specialized insight in business experience and professionalism.

Such strategies are adopted need to instill positive impacts in the current organizational service delivery. As a result, the three private hospitals will not only be able to sustain the current quality service delivery charter but also improve on the aspect of personnel-patient engagement.

Recommendations for Future Research

The focus of this research was based on measuring the quality of services provided in three private hospitals in the city of Riyadh. The research was entirely based on determinant of satisfaction level as perceived by patients as determined by quality healthcare services. Thus, little is mentioned on the hospital management and level of personnel skills as also responsible for quality in service delivery in the sensitive healthcare service delivery, within a private healthcare institution setting.

Hence, further study should be carried out on the need to incorporate the management and level of personnel skills rationale before making an inclusive conclusion on the level and determinants of quality service delivery in the private healthcare provision sector. This will ensure that the results of the study can represent the holistic nature of service quality delivery within private healthcare institutions within the city of Riyadh, since the management and level of personnel skills will be reviewed.

Appendix 1: The Questionnaire of the Study (English Version)

Appendix 2: The Questionnaire of the Study (Arabic Version)

References

Alahmari, M., Aljasser, I., & Sasidhar, B. (2015). Patient Satisfaction and Perception of Quality of Care in Outpatient Clinic in an Eye Specialist Hospital in Saudi Arabia. British Journal of Economics, Management & Trade BJEMT, 10(4), 1-8.

Alahmary, K. (2014). Quality of primary care from the patient perspective in Saudi Arabia: A multi-level study. Saudi Medical Journal, 35(8), 1285-1289.

Al‐Borie, H., & Damanhouri, A. (2013). Patients’ satisfaction of service quality in Saudi hospitals: A SERVQUAL analysis. International Journal of Health Care Quality Assurance International J Health Care QA, 26(1), 20-30.

Aljuaid, M., Mannan, F., Chaudhry, Z., Rawaf, S., & Majeed, A. (2016). Quality of care in university hospitals in Saudi Arabia: A systematic review. Saudi Medical Journal, 6(2), 704-711.

Bakan, I., Buyukbese, T., & Ersahan, B. (2013). The impact of total quality service (TQS) on healthcare and patient satisfaction: An empirical study of Turkish private and public hospitals. The International Journal of Health Planning and Management, 29(3), 292-315.

Escrig-Tena, A., Bou-Llusar, C., & Roca-Puig, V. (2011). Modeling the implications of quality management elements on strategic flexibility. Advances in Decision Sciences, 2(1), 1-27.

Fielding, J., & Briss, P. (2013). Promoting evidence-based public health policy: Can we have better evidence and more action? Health affairs, 25(4), 969-978.

Hall, L. M. (2012). Quality work environments for nurse and patient safety. Toronto, Canada: Jones and Bartlett Publishers.

MacKay, B., & McKiernan, P. (2011). The role of hindsight in foresight: refining strategic reasoning. Futures, 36(3), 161-179.

Mosadeghrad, A. M. (2014). Factors influencing healthcare service quality. International Journal of Health Policy and Management, 3(2), 77-89.

Raheem, A. R., Nawaz, A., Fouzia, N., & Imamuddin, K. (2014). Patients’ Satisfaction and Quality Health Services: An Investigation from Private Hospitals of Karachi, Pakistan. Patients’ Satisfaction and Quality Health Services: An Investigation from Private Hospitals of Karachi, Pakistan, 3(7), 34-38.

Soumendu, B. (2011). Commitment, involvement, and satisfaction as predictors of employee performance. South Asian Journal of Management, 18(2), 92-107.

Weiss, W. (2010). Building morale, motivating, and empowering employees. Supervision Journal, 72(9), 23-26.

Yildiz, O., & Demirors, O. (2014). Healthcare quality indicators – a systematic review. International Journal of Health Care Quality Assurance, 27(3), 209-222.

Zamil, A., Areiqat, A., & Tailakh, W. (2012). The Impact of Health Service Quality on Patients’ Satisfaction over Private and Public Hospitals in Jordan: A Comparative Study. International Journal of Marketing Studies, 4(1).

Zarei, A., Arab, M., Froushani, A., Rashidian, A., & Tabatabaei, S. (2012). Service quality of private hospitals: The Iranian Patients’ perspective. BMC Health Services Research BMC Health Serv Res, 12(1), 31.