The mediating role of perceived value in the relationship between service quality and trust a case study of private general hospital in HCMC

UNIVERSITY OF ECONOMICS HO CHI MINH CITY
International School of Business
------------------------------

LAM HAI NGUYEN

THE MEDIATING ROLE OF PERCEIVED VALUE IN THE
RELATIONSHIP BETWEEN SERVICE QUALITY AND TRUST – A CASE
STUDY OF PRIVATE GENERAL HOSPITAL IN HCMC

MASTER OF BUSINESS (Honours)

Ho Chi Minh City – Year 2012


UNIVERSITY OF ECONOMICS HO CHI MINH CITY
International School of Business
------------------------------

LAM HAI NGUYEN

THE MEDIATING ROLE OF PERCEIVED VALUE IN THE
RELATIONSHIP BETWEEN SERVICE QUALITY AND TRUST – A CASE
STUDY OF PRIVATE GENERAL HOSPITAL IN HCMC

ID: 60340102

MASTER OF BUSINESS (Honours)
SUPERVISOR: DR. PHAM NGOC THUY

Ho Chi Minh City – Year 2012

1

ACKNOWLEDGEMENTS

I would like to express my sincere gratitude to Dr. Pham Ngoc Thuy who has
supported me a lot with the thesis preparation and motivated me throughout the journey
of the thesis. Her professional experiences help me understand research methods as
well as useful knowledge for my research.
I greatly appreciate to all my friends who supported me to do the survey at the hospital
with me.
I would like to thank the board management and Doctors at Van Hanh Hospital to
allow me to do the survey at this hospital and provided necessary information.
Finally, I would like to send my best regards to all of those who kindly supported me
during the data collection phase and the completion of this thesis.

December 9, 2012
Ho Chi Minh City, Viet Nam

Lam Hai Nguyen


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ABSTRACT

Healthcare is a significant part of a country's economy. The delivery of health care
services is very important of health care system, both to patients and hospitals. There
are many factors in treatment influencing to patients. This research aims to identify the

service quality affecting to patient perceived value and the patient perceived value
affecting to patient trust.
A questionnaire has been developed based on the dimension of patient – perceived
Total Quality Service ( TQS) in healthcare scale, Corporate reputation scale, Perceived
value scale, trust scale and then adjusted by results of in-depth interview of doctors,
nurses and patients. The number of respondents is 177 people. The average duration of
the interviews was ten minutes. The respondent is that of individuals over the age of
18, who used the hospitalization services of private general hospitals in 12 months
(from the interview day).
Findings highlight the positive influences of service quality to perceived value and the
strong significant impact of perceived value to trust. Therefore, investor should
improve service quality to gain patient trust.
Because of limited time and resources, the dimension of service quality has 4 factors
while the conceptualization of service quality SERVQUAL features five dimensions:
tangibles, reliability, responsiveness, empathy and assurance (Parasuraman et al.,
1988). Future researches may consider including more factors to understand deeply in
service quality in healthcare.


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TABLE OF CONTENTS
CHAPTER 1: INTRODUCTION .................................................................................... 5
1.1
1.2
1.3
1.4
1.5
1.6

Research background ............................................................................................. 5
Research Problems ................................................................................................ 6
Research questions and objectives ........................................................................ 7
Research scope ...................................................................................................... 7
Research methodology .......................................................................................... 8
Thesis structure ...................................................................................................... 8

CHAPTER 2: LITERATURE REVIEW & THEORETICAL MODEL .................. 10
2.1

Service quality ........................................................................................................ 10

2.1.1 Organization reputation ................................................................................ 10
2.1.2 The Administrative procedures..................................................................... 11
2.1.3 Facilities: ....................................................................................................... 12
2.1.4 Doctor and Nurse care .................................................................................. 12
2.2 Patient perceived value ........................................................................................... 14
2.3

Patient trust ............................................................................................................. 15

2.4

Conceptual model ................................................................................................... 15

2.5

Hypotheses .............................................................................................................. 17
2.5.1

Relationship between service quality and perceived value .......................... 17

2.5.2

Relationship between perceived value and trust........................................... 17

CHAPTER 3: RESEARCH METHODOLOGY ......................................................... 18
3.1

Research process ..................................................................................................... 18

3.2 Qualitative study ......................................................................................................... 19
3.3

Measurement scale .................................................................................................. 19
3.3.1
3.3.2
3.3.3
3.3.4
3.3.5

Construction of measurement scales ............................................................ 19
Measurement scale of the Organization reputation ...................................... 20
Measurement scale of Administrative Procedures ...................................... 20
Measurement scale of the facility ................................................................. 21
Measurement scale of Doctor & Nurse care ................................................. 21


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3.3.6 Measurement scale of Patient perceived value ............................................. 22
3.3.7 Measurement scale of Patient trust ............................................................... 23
3.4 Questionnaire design ............................................................................................... 25
3.5

Main survey ............................................................................................................ 26

3.6

Data collection ........................................................................................................ 26

3.7

Data analysis ........................................................................................................... 27

CHAPTER 4: DATA ANALYSIS AND RESULTS .................................................... 28
4.1

Descriptive data analysis......................................................................................... 28

4.1.1 Data summary ............................................................................................... 28
4.1.2 Characteristics Of Respondents .................................................................... 29
4.1.3 Descriptive data ............................................................................................ 29
4.2 Assessment of measurement scales ........................................................................ 31
4.2.1 Cronbach alpha reliability analysis ............................................................... 31
4.2.2 Exploratory Factor Analysis ......................................................................... 33
4.2.3 The revised conceptual model ...................................................................... 39
4.3 Correlation and Hypotheses testing ........................................................................ 40
4.3.1
4.3.2

Correlation .................................................................................................... 40
Testing assumptions of multiple regression ................................................. 42

CHAPTER 5: CONCLUSION AND IMPLICATION ................................................ 47
5.1

Main finding: .......................................................................................................... 47

5.2

Managerial implications.......................................................................................... 48

5.3

Research limitations and implications for future .................................................... 48


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CHAPTER 1: INTRODUCTION
1.1

Research background

Healthcare industry is a special service industry that is paid much attention because it
has directed relation to citizens. According to the World health organization, the health
systems‟ goal is good health, responsiveness to the expectations of the population, and
fair financial contribution.
Vietnam healthcare system relates to government. The decision-making powers belong

to the central government, which takes inputs from governing authorities of cities and
provinces. Its healthcare market emphasizes „cure‟ rather than „prevention‟. In mid1993, realizing the need for private foreign investment in medicine, the central
government opened the healthcare sector to private local and foreign firms by allowing
them to setup clinics and hospitals. Since then the number of private hospitals has been
growing fast, especially due to the failure of the public sector to meet the country‟s
needs of proper healthcare.
HCMC is invested to become a centralized health care in South region. However, the
facilities of public general hospitals are worst. The top public general hospitals are Cho
Ray hospital, Nhan dan Gia Dinh Hospital…. Some of these are downgrading
significantly.
Health Ministry has some projects to solve this problem such as: upgrading
infrastructure, facilities, training for physician in provinces…. Besides this, HCMC will
build new public general hospitals.


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On the other hand, private general hospitals also improve their ability to server
patients. Anh Thuy & Phi Khanh (2012) reports that HCMC has 33 private general
hospitals in order to solve the over loaded of public general hospitals.
In order to compete with public general hospital as well as themselves, private general
hospitals are invested modern facilities, human resource to bring the value to patients.
Providing quality service is considered an essential strategy for successful and survival
in today competitive environment (Zeithaml, Berry & Parasuraman,1996)
Customer perceived value explores the interaction between the product and service,
while service quality generally focuses on the product or service, i.e what the
organization provided ( Robert, 1996).
1.2

Research Problems

Big cities as HCM have a large population. Public general hospitals are not only served
for local citizen but also served for other citizens who from provinces to HCMC for
their treatment. Therefore, these hospitals are always overloaded patients.
Overloaded in hospital are defined “many people come to hospitals for their treatment
at the same time that human resource and capability in hospital can not afford and
served

patients

”

(Ministry of Health, 2012). The percentage of overloaded in public general hospitals
such as 115 hospital, Nhan dan Gia Dinh Hospital are 113%, 106%, respectively
(Ministry of Health, 2012).
Because of overloaded, patients are treated without courteousness and attention.
Therefore, the trend of treating at private general hospital is increasing. According to
Health Ministry, the number of private general hospital increased 11.4 % in 2011.


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The investors should understand what patients receive from hospital‟s service attributes
in order to contribute to patient‟s trust.
How do the private general hospitals compete with public general hospitals and with
themselves. Exploring the affecting of service quality on patient‟s trust will help the
owner of private general hospital to improve their business.
1.3

Research questions and objectives

To solve the problem defined above, the research aims at answering the following
questions:
How is the service quality affecting to patient‟s perceived value? By understanding
this, the owners or investors can identify the right direction for their investment.
How does the patient perceived value affect to patient trust? By evaluating the
relationship between patient perceived value and patient trust, private general hospitals
will know how to make the customer‟s comeback.
Based on the above research questions, the objectives of this study are:
1. To identify the impact of Service Quality on Patient Perceived Value
2. To measure the influence of Patient Perceived Value to Patient Trust
1.4

Research scope

The research focuses on private general hospitals in HCMC.
The respondent is that of individuals over the age of 18, who used the hospitalization
services of private general hospitals in 6 months (from the interview day). Children
(under 18 years old) and old people (over 60 years old) will not include in the study.


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The respondents choose the private general hospital without health insurance.
1.5

Research methodology

This research is applied the quantitative method which were reviewed the theoretical
background adaptable to the context. The selection of the sample was random, a

random route in each hospital being established for each of the interviewers. The
number of respondents is 177 people. The average duration of the interviews was ten
minutes. The respondent is that of individuals over the age of 18, who used the
hospitalization services of private general hospitals in 12 months (from the interview
day).
The data collected will be validated by Cronbach Anpha Reliability Analysis and
selected by Exploratory Factor Analysis. Finally, the model will be tested by using
Multiple Regression Analysis by SPSS version 20.0.
1.6

Thesis structure

Chapter 1: Introduction. This chapter includes an overview of research background,
research problems, questions and objectives. The research limitation, method and
structure are also mentioned.
Chapter 2: Literature review and conceptual model. The chapter consists of a
review of previous research on the concepts of Service Quality Dimensions, Patient
Perceived Value and Patient Trust. Basing on previous research, a conceptual model
and hypotheses are presented.
Chapter 3: Research methodology. Research process, measurement and methods of
collecting samples and analyzing data are presented.


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Chapter 4: Data analysis and Result. This chapter comprises assessment of
measurements scales, hypothesis testing. Interpretation and discussion on the results of
quantitative research and statistical analysis are represented.
Chapter 5: Conclusion and implication. Main findings of this study are drawn out as
well as managerial implications for investors in health care industry.

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CHAPTER 2: LITERATURE REVIEW & THEORETICAL MODEL
2.1 Service quality

Service quality is a central issue in services marketing and has been discussed in many
writing. According to Parasuraman et al. (1985) the global quality of a service depends
on the encounter between expectations and performance level perceptions and can be
measured through the five SERVQUAL underlying dimensions: tangible elements
(physical facilities, equipment and appearance of personnel), reliability (ability to
perform the promised service dependably and accurately), responsiveness (willingness
to help customers and provide prompt service), empathy (caring and individualized
attention that the firm provides to its customers) and assurance (including competence,
courtesy, credibility and security). Customer orientation ensures that the content of the
service offering satisfies the customer‟s needs. However, it demands that the manner in
which the service is delivered and the customer‟s relations with the company must also
meet customer expectations.
Raposo (as cited in Donabedian,1980) service quality in health should include an
analysis of the structure to achieve a given level of healthcare quality (the
characteristics of doctors, hospitals and staff); of the process (interaction with the
structure) and of the result (what happens to the patient after the medical act.
2.1.1 Organization reputation
Weigelt and Camerer (1988), a set of attributes ascribed to a firm, inferred from the
firm‟s past actions . Satir (as cited in Fombrun and Van Riel,1997), a corporate
reputation is a collective representation of a firm‟s past actions and results that
describes the firm‟s ability to deliver valued outcomes to multiple stakeholders. It
gauges a firm‟s relative standing both internally with employees and externally with its

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stakeholders, in both its competitive and institutional environment. According to
Firestein (2006), reputation the strongest determinant of any organization‟s
subtainability.
Basing on Bromley, 2002; Sandberg, 2002, reputation is a socially shared
impression, a consensus about how a firm will behave in any given situation.
Gro ¨nroos (1990) realized the role of “image” in the conceptualization of service
quality, and emphasized it as a filter in the perception of service quality in addition to
the technical and functional quality dimensions. Caruana (2002) and Hong and Goo
(2004) found that “corporate image” enjoyed by a service firm influenced its customer
satisfaction. The image a firm enjoys also plays a pivotal role of conveying to a
customer what the firm has to offer in terms of technical and functional qualities. The
image affects the expectations of the customers and hence it is important in making the
customers have realistic expectations. So, even in healthcare services, the reputation of
hospital has to be considered as an element of service quality.

2.1.2 The Administrative procedures
Lewis (1990) stated that a process refers to service delivery systems, the various
physical features associated with an organization and is services, and the role of the
organization‟s employees (both customer contact and backroom staff) in the service
encounter and the delivery of service quality. Zeithaml et al. (1990) described a process
(in the service context) as the actual procedures, mechanisms and flow of activities by
which the service is delivered, i.e. the service
delivery and the operating system.
Service delivery processes should be standardized so that customers could receive a
hassle-free service (Sureshchandar et al., 2002a).

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Curry and Sinclair (2002) stated that patients would feel less inconvenienced by their
treatment if access to the service itself were improved. Administrative processes (AP)
in a hospital set-up include the processes during admission, procedures during stay in
hospital, and the procedures involved in the exit and discharge stage of the patient‟s
stay in hospital.

2.1.3 Facilities:
In other service industries such as hotels, restaurants, retail stores, professional offices,
and banks, it has long been recognized that the physical environment can have an
immediate effect on the attitudes and behaviors of customers and employees (Bitner,
1992). Increasingly, healthcare organizations are acknowledging the important role of
the healthcare facility in improved patient and staff outcomes (Berry & Bendapudi,
2003; Nelson et al., 2005). In an increasingly competitive market, healthcare
consumers have more options care, healthcare organizations must work hard to create
environments that encourage repeat visits and increase patient satisfaction (Fottler,
Ford,Roberts, Ford, & Spears, 2000).
Facility includes the cleanliness, maintenance and availability of services such as
waiting rooms, diagnostic test rooms, operation theatres, wards, food, beds, resident
rooms, ambulance services, technological capability, pharmacy, etc. Several studies
have attempted to study the importance of the physical facilities, or tangibles, in
service delivery.

2.1.4 Doctor and Nurse care


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The medical encounter between a doctor and a patient requires intensive levels of

interaction where the encounter has been shown to have a significant impact on patient
satisfaction (O‟Connor et al., 1994). These interactions typically involve complex
communication patterns and customer problems (Bitner,1990). There is often a formal,
long-term relationship between doctor and patient, with the doctor having a significant
discretion in meeting customer needs, and evaluation is largely based on credence
attributes (Bitner et al., 1990). Georgette & Robert (1997) found three of five factors
affecting service quality perception of hospitals were related to the interactions with
doctors or other staff. These factors included professional expertise, validation of
patient beliefs, interactive communication, image and antithetical performance
(Georgette & Robert,1997).Ongoing doctor-patient relationships place more emphasis
on feelings and emotions rather than cognitive elements, as would be the case in an
analysis of a discrete exchange. Carman (2000) stated that acute hospital services
provide a salient setting to study the dichotomy between the affective attributes of the
service experience (functional) and the technical attributes of outcomes of physician
care.
Nursing service is one of the most important components of hospital services. Many
researchers have made discoveries about the relationship between nursing and patient
outcomes. Carman (1990) used a regression model in which the quality of a set of
attribute dimensions are rated and regressed on a rating of overall quality, and reported
that Personal Quality Nursing Care was the most important attribute of acute hospital
care. In another study by Carman (2000), Personal Quality Nursing Care, as the core
service of a hospital, was consistently rated as the most important. In addition, several
studies have examined the importance of communication in the service interaction.
Frohna (2001) stated that regardless of whether a patient is cured, the outcome of the
physician-patient

encounter

depends

on

communication.

Through

effective


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communication, physicians are more likely to positively influence health outcomes for
their patients.

2.2 Patient perceived value

Customer evaluates the quality of the purchased product and updates his or her
expectations about the quality of future purchases. For customers, the perceived price,
which includes time, effort, and search costs, is more meaningful than the actual
monetary price of an item or service. The customer usually judges price and service
quality based on the concept of “equity” and generates his or her satisfaction or
dissatisfaction level based on that concept (Oliver, 1997).
According to Chen & Hu (as cited in Rust ,2000), customer choice is influenced by the
perception of functional value. Which are formed primarily by perceptions of quality,
price and convenience.
Customer perceived value is also important because it can lead to brand loyalty.
Consistency between product attributes and customer values (i.e., positive perceived
value) reduces uncertainty and helps the customer build trust in the form of reliable
expectations of the provider in ongoing exchanges (Carver & Scheier, 1990). Perceived
price may be monetary or non-monetary such as time costs, search costs and

psychology costs ( Zeithaml, 1988).
This study, the author explores perceived price fairness, in terms of monetary and nonmonetary costs to the consumer.


15

2.3 Patient trust

The majority of definitions for trust describe it as the belief by one firm that a partner
will perform actions producing positive results for the former (Alrubaiee, & Feras
Alkaa'ida as cited in Schurr and Ozanne, 1985; Dwyer, Schurr and Oh, 1987; Anderson
and Narus, 1990; Moorman, Deshpande and Zaltman, 1993; Morgan and Hunt, 1994;
Sanzo et al., 2003).
As Alrubaiee, & Feras Alkaa'ida (as cited in Sirdeshmukh et al.,2002) stated, trust is
the expectations held by the consumer that the service provider s“can be relied on to
deliver on its promises”. Alrubaiee, & Feras Alkaa'ida (as cited in Anderson and
Weitz,1989) defined trust as one party‟s belief that its needs will be fulfilled in the
future by actions undertaken by the other party. Alrubaiee, & Feras Alkaa'ida (as cited
in Morgan and Hunt,1994) stated, trust exists when one party has confidence in an
exchange partner‟s reliability and integrity.
Alrubaiee, & Feras Alkaa'ida (as cited in Mishra et al.,2008) posited that there are four
dimensions of trust (i.e., reliability, openness, competence, and concern)
Patient safety concerns may lead customers to stop using a particular hospital‟s
services owing to negative word-of-mouth. According to Alrubaiee, & Feras Alkaa'ida
(as cited in Entwistle and Quick‟s 2006), trusting patients are vigilant, i.e. trust is not
simply a vague hope or thinking optimistically; health service providers must keep
patients alert to errors in the course of their care.
2.4 Conceptual model

Many researchers have made service quality affecting to satisfaction. Patient

satisfaction is regarded as an outcome of care, and it is one of the major
contributors clinical or hospital outcomes.


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In previous researches, patient satisfaction considered as one of the most important
quality dimensions and key success indicators in health care. Despite seemingly alike,
perceived service quality and consumer satisfaction. However, Customer perceived
value is also important because it can lead to brand loyalty. Consistency between
product attributes and customer values (i.e., positive perceived value) reduces
uncertainty and helps the customer build trust in the form of reliable expectations of
the provider in ongoing exchanges (Carver & Scheier, 1990).
Based on the models in the Literature review, the conceptual model was built. The
author justifies the mediating role of perceived value in the relationship between
service quality and
trust.
SERVICE
QUALITY

Organization
Reputation

Administrati
ve
Procedures
Facilities

H
1

H
2
H
3

Patient
perceived
value

H
5

Patient trust

H
4
Doctor &
Nurse care

Figure 2.4: The conceptual model of the mediating role of perceived value in the
relationship between service quality and trust


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2.5 Hypotheses

2.5.1 Relationship between service quality and perceived value
Ladhari and Morale (as cited in Bolton and Drew,1991), reported that service quality is
the most important determinant of perceived value. Ladhari and Morale (as cited in

Hartline and Jones, 1996) also mention that in the hospitality service field, service
quality has a positive effect on perceived value. Ladhari and Morale (as cited in
Sweeney et al, 1999) identified a close correlation between service quality and
perceived service value.
In this research, I propose key factors of service quality that affect to perceived value in
health care industry:
Hypothesis H1: Organization reputation of a hospital has a significant impact on the
patient perceived value
Hypothesis H2: Administrative Procedures of a hospital has a significant impact on the
patient perceived value
Hypothesis H3:
perceived value

Facilities of a hospital has a significant impact on the patient

Hypothesis H4: Doctor and Nurse care of a hospital has a significant impact on the
patient perceived value
2.5.2 Relationship between perceived value and trust
Previous research supports the association between perceived value and trust
(Sirdeshmukh et al., 2002; Anderson & Srinivasan, 2003).
Perceived value has direct impact on trust and an indirect impact on commitment (Kim
& Zhao, 2008).
Hypothesis H5: The Patient perceived value has a positive impact on patient trust


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CHAPTER 3: RESEARCH METHODOLOGY
3.1 Research process
After the research problem was identified, the research objectives and research scope

were defined. The literature was conducted to review all relevant theories.

Literature Review
Conceptual model

Qualitative study
(In-depth interview, n=15)

Measurement scale

Quantitative study
(Main survey, n= 177 )

Assessment of measurement
Cronbach alpha, EFA

Testing of hypothesis
Multiple regression

Figure 3.1 : Research process


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3.2 Qualitative study
The qualitative study was conducted by in-depth interview in order to discover, adjust
and supplement the variables to measure the researched items. The qualitative study
was conducted by in-depth interview with ten people who are doctors, nurses, admin
staffs in hospitals and patients in Ho Chi Minh City. This focus group raised the service
quality, perceived value that may affect patient trust including: the reputation of

hospital, the process of admission, the clean of waiting room, the waiting time, the
attention of doctors and nurses.
The result of qualitative study had the same items that author figured out in the
hypotheses.
3.3 Measurement scale
3.3.1 Construction of measurement scales
Based on the proposed hypotheses, the measurement scales adopted from previous
studies and the result of qualitative study conducted. The five-point Likert scale was
used to measure the constructs as follows:
1: Strongly disagree
2: Disagree
3: Neutral
4: Agree
5: Strongly Agree


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3.3.2 Measurement scale of Organization reputation
This scale was developed by adapting items of corporate reputation scale used by
Sabrina Helm (2007):
 I choose X hospital because of its success
 The value for money of treatment is worthy
 I think this hospital is Customer orientation
 I think many people know this hospital reputation
3.3.3 Measurement scale of Administrative Procedures
One of the important dimensions of administrative processes is the delay at different
stages of the patient‟s hospital stay. This scale was developed by adapting items of
perceived value scales used by Mayuri Duggirala, Chandrasekharan Rajendran, R.N.
Anantharaman, (2008):

 The admission processes are handled promptly and properly.
 In emergency case, I am easy of getting the desired bed on admission
 It is easy to get appointments to specialists (doctors) in the X hospital.
 It is easy to get appointments to specialists (doctors) in the X hospital.
 I am easy to get appointments and the required help, advice or information over
the phone and at the reception counter.
 The waiting time for me to see doctors is kept minimum in the Out-Patient
Department.
 The time spent waiting for diagnostic tests and treatment, at the pharmacy, scan
centers, blood banks and laboratories was reasonable


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3.3.4 Measurement scale of Facilities
This dimension assesses the patient‟s perception of quality with regard to the physical
facilities in the hospital. This includes the cleanliness, maintenance and availability of
services such as waiting rooms, diagnostic test rooms, beds, resident rooms,
ambulance services, technological capability, pharmacy, etc.
This scale was developed by adapting items of perceived value scales used by Mayuri
Duggirala, Chandrasekharan Rajendran, R.N. Anantharaman, (2008):
 The waiting rooms, clinical and diagnostic test rooms, pre-operative and postoperative (or patient/resident ward) rooms are adequately quiet, comfortable and
clean.
 X hospital has availability of adequate and up-to-date technological capability in
the hospital
(e.g. diagnostic facilities like CT scans, MRI scans, X-rays and ultrasound) to
serve patients effectively.
 The pharmacy in X hospital has availability of required drugs in when patients
want to buy drugs.

3.3.5 Measurement scale of Doctor & Nurse care
This dimension addresses the patient‟s experience with regard to the kind of care given
by the doctors, nurses, paramedical and support staff, and administrative staff in the
hospital. Gronroos (1990) provided an integrated list of six criteria of good perceived
service quality: professionalism and skills, attitudes and behavior, accessibility and
flexibility, reliability and trustworthiness, recovery, and reputation and credibility.


22

This scale was developed by adapting items of perceived value scales used by Mayuri
Duggirala, Chandrasekharan Rajendran, R.N. Anantharaman, (2008):
 I feel doctors are courteous, patient and attentive to my needs and well being.
 Doctors answer my questions and clearly explain the diagnosis and treatment
outcome to me, in a way that I could understand.
 I realize doctors are competent and skilful in their jobs.
 The nursing staffs are courteous.
 The nursing staffs give me prompt and timely attention.
 I realize nurses are competent and skilful in their jobs.
3.3.6 Measurement scale of Patient perceived value
This scale was developed by adapting items of perceived value scales used by Walfried
Lassar Banwari Mittal and Arun Sharma (1995):
 The expense of treatment is well priced
 Considering what i would pay for the treatment, i will get much more than my
money's worth
 I think my request in treatment at X hospital is qualified
 Considering what i would pay for the treatment, I got a good experience during
my treatment
 Considering what i would pay for the treatment, I feel safe, comfortable with X
hospital

 I think the quality of treatment at X hospital is worth with my money and my
time.


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3.3.7 Measurement scale of Patient trust
This scale was developed by adapting items of trust scale used by Alrubaiee & Alnazer
(2010); Zanzo et al.,( 2003); Sirdeshmukh et al. (2002); Liu et al. (2008); Gaurav
(2008); Eisingerich & bell (2007); Garbarino & Johnson (1999); Doney & Cannon
(1997) on the patient‟s trust in hospital and staff during hospitalization, taking into
account a series of hospital service characteristics.
This scale was developed by adapting items of perceived value scales used by Laith
Alrubaiee (2011):
 X hospital provides high quality service
 Patients treated with equality
 X hospital can be trusted
 I feel physician /staff looking out for my satisfaction.
 Doctors at X hospital are always reliable to patients
Summary Variables and coding:

Organization
Reputation

Variable

Coding

Indicators

ORGRE1

I choose X hospital because of its success

ORGRE2

The value for money of treatment is worthy

ORGRE3

I think this hospital is Customer orientation

ORGRE4

I think many people know this hospital reputation