Service quality evaluation in internal healthcare service chains

Measurement of quality is an important area within the services sector. To date, most attempts at measurement have focussed on how external clients perceive the quality of services provided by organisations. Although recognising that relationships between providers within a service environment are important, little research has been conducted into the identification and measurement of internal service quality. This research focuses on the measurement of internal service quality dimensions in the complex service environment of an internal healthcare service chain. The concept of quality in healthcare continues to develop as various provider, patient and client, governmental, and insurance groups maintain an interest in how to 'improve' the quality of healthcare service management and delivery. This research is based in healthcare as a major area within the service sector. The service environment in a large hospital is complex, with multiple interactions occurring internally; health is a significant field of study from both technical and organisational perspectives providing specific prior research that may be used as a basis for, and extension into service quality; and the implications of not getting service delivery right in healthcare in terms of costs to patients, families, community, and the government are significant. There has been considerable debate into the nature, dimensionality, and measurement of service quality. The five dimensions of SERVQUAL (tangibles, assurance, reliability, responsiveness, and empathy) have become a standard for evaluations of service quality in external service encounters, although these have been challenged in the literature. As interest in internal service quality has grown, a number of researchers have suggested that external service quality dimensions apply to internal service quality value chains irrespective of industry. However, this transferability has not been proven empirically. This research examines the nature of service quality dimensions in an internal healthcare service network, how these dimensions differ from those used in external service quality evaluations, and how different groups within the internal service network evaluate service quality, using both qualitative and quantitative research. Two studies were undertaken. In the first of these, interviews with staff from four groups within an internal service chain were conducted. Using dimensions established through qualitative analysis of this data, Study Two then tested these dimensions through data collected in a survey of staff in a major hospital. This research confirms the hierarchical, multidirectional, and multidimensional nature of internal service quality. The direct transferability of external quality dimensions to internal service quality evaluations is only partially supported. Although dimension labels are similar to those used in external studies of service quality, the cross-dimensional nature of a number of these attributes and their interrelationships needs to be considered before adopting external dimensions to measure internal service quality. Unlike in previous studies, equity has also been identified as an important factor in internal service quality evaluations. Differences in service expectations between groups in the internal service chain, and differentiation of perceptions of dimensions used to evaluate others from those perceived used in evaluations by others were found. This has implications on formulation of future internal service quality instruments. For example, the expectations model of service quality is currently the dominant approach to conceptualising and developing service quality instruments. This study identifies a number of problems in developing instruments that consider differences in expectations between internal groups. Difficulty in evaluating the technical quality of services provided in internal service chains is also confirmed. The triadic nature of internal service quality evaluations in internal healthcare service chains and the problems associated with transferring the traditional dyadic measures of service quality are identified. The relationships amongst internal service workers and patients form these triads, with patient outcomes a significant factor in determining overall internal service quality, independent of technical quality. This thesis assists in supporting the development of measurement tools more suited to internal service chains, and will provide a stronger and clearer focus on overall determinants of internal service quality, with resultant managerial implications for managerial effectiveness.