ArticleMeasuring Functional Service Quality Using SERVQUAL in a High-Dependence Health Service RelationshipClark, W. Randy PhD; Clark, Leigh Anne PhDAuthor Information Author Affiliations: Management and Marketing Department, Jennings A. Jones College of Business, Middle Tennessee State University, Murfreesboro, Tennessee. Corresponding author: W. Randy Clark, PhD, Management and Marketing Department, Jennings A. Jones College of Business, Middle Tennessee State University, PO Box 443, Murfreesboro, TN 37129 ([email protected]). The Health Care Manager: October 2007 - Volume 26 - Issue 4 - p 306-317 doi: 10.1097/01.HCM.0000299248.53441.e9 Buy Metrics Abstract Although there is a growing concern about health care quality, little research has focused on how to measure quality in long-term care settings. In this article, we make the following observations: (1) most users of the SERVQUAL instrument reassess customers' expectations each time they measure quality perceptions; (2) long-term care relationships are likely to be ongoing, dependent relationships; (3) because of this dependence, customers in the long-term care setting are likely to reduce their expectations when faced with poor service quality; (4) by using this "settled" expectations level, service providers may make biased conclusions of quality improvements. We recommend various methods for overcoming or minimizing this "settling" effect and propose modifications to the SERVQUAL gap 5 measure to assess quality in a long-term care setting. © 2007 Lippincott Williams & Wilkins, Inc.