Evidence in both the manufacturing and services industries indicates that quality is a key determinant of market share and return on investment as well as cost reduction (Anderson and Zeithaml 1984; Parasuraman, Zeithaml, and Berry 1985). Two forms of quality are relevant to service-providing organizations: technical quality and functional quality (Gronroos 1984). Technical quality in the health care environment, also referred to as quality in fact, is defined primarily on the basis of the technical accuracy of the diagnoses and procedures. Various techniques for measuring technical quality have been proposed and are currently in use in health care organizations (Joint Commission for Accreditation of Health Care Organizations 1987). Because this information is not generally available to the consuming public, knowledge of the technical quality of health care services remains within the purview of health care professionals and administrators (Bopp 1990).
Functional quality refers to the manner in which the health care service is delivered to the patient. Since patients are often unable to accurately assess the technical quality of a health care service, functional quality is usually the primary determinant of patients' quality perceptions (Donabedian 1980, 1982; Kovner and Smits 1978). There is growing evidence to suggest that this perceived quality is the single most important variable influencing consumers' value perceptions. These value perceptions, in turn, affect consumers' intentions to purchase products or services (Bolton and Drew 1988; Zeithaml 1988).
Research suggests that service organizations share various commonalities in the service delivery process both within and across industries (Zeithaml, Berry, and Parasuraman 1988). For example, the intangible nature of services dictates that, unlike products, most services are produced and consumed at the same time. This characteristic increases the importance of the provide-consumer relationship as well as the potential for variation in service quality.
Consequently, identifying techniques that enhance service quality perceptions in one industry may enable researchers to develop generalizations applicable to other industries as well (Parasuraman, Zeithaml, and Berry 1985, 1986). The development and scientific examination of such generalizations, however, requires the use of standard measurement instruments that are applicable across the service industries studied (Heise 1974; Price and Mueller 1986). Parasuraman, Zeithaml, and Berry (1988) recently developed such a measurement tool, SERVQUAL, to be used in a variety of service industries. While SERVQUAL has been tested in a number of service settings, its applicability to the hospital environment has not yet been assessed.
Therefore. the purpose of this article is to report the results of a study that examined the usefulness of the SERVQUAL scale for assessing patients' perceptions of service quality in the hospital environment. At the practical level, the representativeness of the SERVQUAL items as they relate to hospital services was assessed. In addition to content appropriateness, the length of the scale was a major consideration for the population under study, in this case former patients of a hospital. The scale was subjected to extensive reliability and validity assessment. The potential usefulness of the study results were enhanced by the fact that health care practitioners were...