Assessing service quality and customer behavioral responses in hospital outpatient services: a formative measurement approach

Purpose – In contrast to the reflective approach of service quality measurement, this paper proposes and validates a parsimonious multidimensional second-order formatively measured model of service quality for primary healthcare services provided by hospital outpatient departments. The index’s empirical validity is examined by investigating the strength of its relationship with certain behavioral responses such as patient satisfaction and behavioral intentions. Design/methodology/approach - Data were collected through a stratified random sampling from eight hospital outpatient departments in Greece. Covariance-based structural equation modelling techniques were used to validate the proposed service quality index and further investigate its effect on patient satisfaction and behavioral intention. Findings - The data analysis indicated that the proposed formative index is fully functional with medical care being the factor mostly contributes to service quality perception, followed by administrative service and staff performance, facilities condition and nursing care. It, further, confirmed the partial mediating role of satisfaction as it enhances the high impact of service quality on behavioral intentions. Research limitations – The relationships among hospital outpatient departments service quality, patient satisfaction and behavioral intentions were validated with data from one country and a healthcare system which is state driven and funded. Practical implications - An understanding of hospital primary healthcare service quality formation is important to healthcare decision makers because it offers them the opportunity to consider patients’ needs and wants and take the appropriate actions for improving the relevant underling procedures in a more efficient manner in order to achieve favorable behavioral responses. Originality/value - The paper manages to propose and empirically evaluate a formatively measured approach of service quality and investigate the effects of the proposed index on patient satisfaction and behavioral intention, especially in the hospital outpatient services context in Greece.