Academic journal article Iranian Journal of Public Health

The Effect of Service Quality on Patient Loyalty: A Study of Private Hospitals in Tehran, Iran

Academic journal article Iranian Journal of Public Health

The Effect of Service Quality on Patient Loyalty: A Study of Private Hospitals in Tehran, Iran

Article excerpt


Background: Service quality is perceived as an important factor for developing patient's loyalty. The aim of this study was to determine the hospital service quality from the patients' viewpoints and the relative importance of quality dimensions in predicting the patient's loyalty.

Methods: A cross-sectional study was conducted in 2010.The study sample was composed of 943 patients selected from eight private general hospitals in Tehran. The survey instrument was a questionnaire included 24 items about the service quality and 3 items about the patient's loyalty. Exploratory factor analysis was employed to extracting the dimensions of service quality. Also, regression analysis was performed to determining the relative importance of the service quality dimensions in predicting the patient's loyalty.

Result: The mean score of service quality and patient's loyalty was 3.99 and 4.16 out of 5, respectively. About 29% of the loyalty variance was explained by the service quality dimensions. Four quality dimensions (Costing, Process Quality, Interaction Quality and Environment Quality) were found to be key determinants of the patient's loyalty in the private hospitals of Tehran.

Conclusion: The patients' experience in relation to the private hospitals' services has strong impact on the outcome variables like willingness to return to the same hospital and reuse its services or recommend them to others. The relationship between the service quality and patient's loyalty proves the strategic importance of improving the service quality for dragging and retaining patients and expanding the market share.

Keywords: Patient's loyalty, Service quality, Private hospitals, SERVPERF, Iran


Healthcare is a dynamic and rapidly growing sector of public services market which is currently facing increasing competition and significant changes (1). Competition is particularly unavoidable for private hospitals in a free market economy system (2). Statistics generated by Iranian Ministry of Health shows that, overall, 54 out of 134 private hospitals (i.e. 40%) with approximately 48 percent of the all country's private beds are located in Tehran, the capital (3); stimulating a severe competition among the hospitals in attracting patients. In the highly competitive market, creating a strong relationship with the customers, which could be consequently followed by their loyalty, is considered to be a key factor for increasing the market share and building a sustainable competitive advantage (4). Loyal customers are argued to be overly crucial for an organization if it is to survive in the market, as attracting new customers is much more expensive than retaining the existing customers (5). As competition grows and given the rising costs of attracting new customers, service providers are increasingly focusing their strategic activities on customer loyalty (6).

Service quality is perceived as an important factor for building customer loyalty. High quality services can attract new customers, retain the current customers, and even entice competitors' customers (4). Zeithaml et al. have suggested that when service quality assessment is positive, it is the customers' desirable behavioral intentions that strengthen their relationship with the service provider. Saying positive things about the service provider to others, recommending provider or service to others and remaining loyal to the provider are desirable behavioral intentions (7).

There is convincing evidence that when patients receive high-quality services in a hospital, they are more likely to return to the same hospital in the future, say positive things about that to others, and recommend it to their friends and relatives (8). Recommendations from friends, relatives and other patients are stated to be an important source of information for choosing a provider (9). Also, healthcare marketing experts have envisaged positive word-of-mouth by satisfied patients as the most effective advertising method for physicians and hospitals' services (10). …

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