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The Structure of Service Quality Perceptions for Multiple-Encounter Services

Andaleeb, Syed Saad PhD; Kara, Ali PhD

doi: 10.1097/QMH.0000000000000001
Original Articles

Objective: The objective of this study was to examine a complex service environment—hospitals—to suggest how service quality could be reframed and measured for multiple-encounter service situations more effectively.

Subjects: In this cross-sectional study, a sample of 371 patients completed the survey instrument. Service quality measures were guided by the literature but allowed to flow from the respondents at the preliminary stage.

Methods: Confirmatory factor analysis, along with structural equation modeling, was used to test the hypothesized relationships among key actors' performance metrics (KAPMs).

Results: Patient satisfaction is significantly influenced by perceived service quality based on KAPMs. For multiple-encounter services, service quality dimensions and measures ought to be tied to KAPMs.

Conclusions: Primary actors—ie, doctors—need knowledge and skills about patient psychology, negotiation, handling difficult patients, and, importantly, “putting the customer first.” Sensitivity training on such matters should be provided. The secondary actors are the nurses who have more frequent contact with the patients. Nurses need to be perceived as “patient advocates.” Effective advocacy begins with prompt and caring services to build trust. The tertiary actors in their support role also ought to be integrated into becoming vital part of the service provided.

Sam and Irene Black School of Business, The Pennsylvania State University at Erie (Dr Andaleeb); and College of Business Administration, The Pennsylvania State University at York (Dr Kara).

Correspondence: Ali Kara, PhD, College of Business Administration, The Pennsylvania State University at York, 1031 Edgecomba Ave, York, PA 17403 (

No funding was received for this work from NIH, Welcome Trust, HHMI, or any other sources.

The authors declare no conflicts of interest.

© 2013Wolters Kluwer Health | Lippincott Williams & Wilkins