Draft Report - Masters Dissertation

An investigation into customers perception of service quality at New
Radiology department in the Gauteng Province of South Africa
Masters Dissertation
ABSTRACT
The study employed a case study research design to investigate customers
perceptions of service quality at a new Radiology department in the Gauteng
Province of South Africa. The study further theoretically tested the applicability of the
SERVQUAL model as a measure of service quality in the radiology department,
determined the impact of service quality on customer satisfaction and determine
customers perceptions of service quality at a new Radiology department.
The SERVQUAL model was found not to be valid for the study, with only the tangible
construct having all its items falling under the same factor. However, it should be
noted that this conclusion was based on the discriminant validity of SERVQUAL as
reflected in the factor analysis.
The SERVQUAL model provided a satisfactory level of overall reliability, indicating

no problems with the questionnaire. Thus, the SERVQUAL questionnaire was an
appropriate tool of data collection for the designed survey. The gap analysis score
revealed that expectation and perception were almost equal, an indication that
service quality at a new Radiology department was satisfactory. While the study
further confirms the general view in literature that the SERVQUAL model act as a
powerful tool for assessing the quality of health care services, the researcher
strongly feel that the tool needs to be viewed critically regarding its strength.
Regarding the impact of service quality on customer satisfaction at a new radiology

department, the study found that reliability construct had the largest impact on
overall service quality, with the gap analysis showing that customers have higher
perceptions on radiology staff performing services and procedures correctly the first
time, not causing rework. Responsiveness construct was ranked the second with the
gap analysis revealing that customers had higher perceptions on new Radiology staff
trying to help customers. The least ranked construct was tangibility.
Pertaining the relationship between perceptions and service quality at a new

Radiology department, the study found customer perceptions to have positive and
significant influence on three service quality constructs and these were reliability,
responsiveness and empathy.
DECLARATION
2
ACKNOWLEDGMENTS
3
Table of contents
ABSTRACT...................................................................................................................ii
DECLARATION............................................................................................................iii
ACKNOWLEDGMENTS...............................................................................................iv
CHAPTER ONE: INTRODUCTION AND BACKGROUND..........................................1
1.1. Introduction and background...........................................................................1
1.2. Problem Statement..........................................................................................2

4
1.3. Significance of the Study.................................................................................2
1.4. Aim of the Study..............................................................................................3
1.5. Objectives of the Study...................................................................................3
1.6. Research questions.........................................................................................4
1.7. Hypotheses of the study..................................................................................4
1.8. An outline of the Study....................................................................................4
1.9. Summary.........................................................................................................5
CHAPTER TWO: LITERATURE REVIEW....................................................................6
2.1. Introduction......................................................................................................7
2.2. The service concept........................................................................................7
2.3. The quality concept.........................................................................................9
2.4. The service quality concept...........................................................................10
2.5. Customer satisfaction....................................................................................11
2.6. Factors that affect customer satisfaction in the health sector.......................12
2.7. Customers Expectations compared to Perceptions.....................................13
2.8. Relationship between service quality and customer satisfaction..................13
2.9. The Service Quality Models..........................................................................14
2.10. The SERVQUAL model..............................................................................14
2.11. Ways to improve service delivery at Radiology department......................22
2.12. The proposed analytical model of the study..............................................24
2.13. Summary....................................................................................................25
CHAPTER THREE: RESEARCH METHODOLOGY...Error! Bookmark not defined.
3.1. Introduction.....................................................Error! Bookmark not defined.
3.2. Research methodology...................................Error! Bookmark not defined.
3.3. Research design.............................................Error! Bookmark not defined.
3.4. Research population.......................................Error! Bookmark not defined.
3.5. Sampling strategy...........................................Error! Bookmark not defined.

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3.6. Data collection instrument..............................Error! Bookmark not defined.
3.7. Data analysis..................................................Error! Bookmark not defined.
3.8. Pilot study.......................................................Error! Bookmark not defined.
3.9. Validity and Reliability.....................................Error! Bookmark not defined.
3.10. Ethical Consideration...................................Error! Bookmark not defined.
3.11. Summary.....................................................Error! Bookmark not defined.
CHAPTER FOUR.......................................................................................................26
RESULTS AND INTERPRETATION OF FINDINGS..................................................26
4.1. Introduction....................................................................................................26
4.2. Empirical descriptions...................................................................................27
4.3. Demographic information of the respondents...............................................30
4.4. Descriptive analysis.......................................................................................34
4.5. Descriptive statistics for the five constructs..................................................44
4.6. Reliability tests and validity of constructs......................................................45
4.7. Factor analysis for the difference between perceptions and expectations...48
4.8. Gap analysis of expectations and perceptions.............................................51
4.9. Correlation analysis.......................................................................................54
4.10. Summary....................................................................................................58
CHAPTER FIVE..........................................................................................................60
DISCUSSIONS, RECOMMENDATIONS AND CONCLUSIONS...............................60
5.1. Introduction....................................................................................................60
5.2. Discussion of research findings....................................................................60
5.3. Limitations and implications for future research............................................67
5.4. Recommendations........................................................................................67
5.5. Conclusions...................................................................................................68
REFERENCES...........................................................................................................69
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APPENDIX A: Letter of Permission to Conduct the Study..........Error! Bookmark not
defined.
APPENDIX B: Consent Form.......................................Error! Bookmark not defined.
APPENDIX C: Research Questionnaire......................Error! Bookmark not defined.
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CHAPTER ONE: INTRODUCTION AND BACKGROUND
1.1. Introduction and background

It is increasingly becoming widely recognised that in todays globalisation and
increased competition, quality has become important (John, Yatim & Mani, 2010).
However, in the existing literature, there is not clear definition of what constitute
service quality. For example, while Parasuraman, et al. (1988) defines service quality
as the ability of an organization to meet or exceed customer expectations, Zeithaml
et al. (1990) opines that service quality is the difference between customer
expectations of service and perceived service, where perceived service is measured
by customers as they compare their expectations against their perceptions of a
service from the supplier.
Despite the diverging opinions amongst practitioners about what constitute service
quality, the concept of service quality is increasing becoming important. For an
organisation to gain market share, it has to outcompete its rivals by providing high
quality product or service to ensure customer satisfaction (Tsoukatos & Rand, 2006).
Therefore, paying attention to service quality generally enables an organisation to
develop a partnership with its customers to gain competitive edge (Hernon & Nitecki;
2001).
Besides the global view of service quality, the concept is also gaining traction within
the health service context, especially radiology departments. According to Hoe
(2007) nowadays, radiology departments are commercialised and considered
revenue generating centres. These radiology departments are characterised by both
internal and external customers. Often patients may not be their primary customers,
but patients are the customers who has the potential to create the problems if their
demands are not met. Therefore, it is important for radiologists to understand
customer service delivery, service quality and what is required for customer
satisfaction (Hoe, 2007).
1
1.2. Problem Statement
Marketing specialist such as Mpinganjiira (2011) recommended that the most
efficient method for service oriented business is to develop a thorough
understanding of how quality service translate to customer satisfaction in order to
attain and maintain competitive advantage. In the same note, defining and
measuring the quality of service has been a major challenge in the healthcare
industry.
Currently, in the global competitiveness, the quality of service provided play a critical
role in customer satisfaction, regardless of the type of service rendered (HCQA,
2010). Medical practitioners are experimenting new approaches to improve health
care quality, safety and solutions including the use of computerized information
technology to increase care management, payments linked to quality which is pay-
for-performance, expand measurement and electronic reporting among the list
(HCQA, 2010).
Ojo (2010) elaborates that customer satisfaction is directly proportional to service

quality and prompts companies to welcome customers suggestions and to design
programs which can measure service quality and customer satisfaction. The New
Radiology department has understudy fully installed digital equipment and Picture
Archiving Computerised Systems (PACS) to effectively improve the service quality.
However, how this has translated into customer satisfaction remains unknown.
Therefore, this study seeks to investigate customers perceptions of service quality at
New Radiology department in the Gauteng Province of South Africa.
1.3. Significance of the Study

Zhang (2009) states that quality is fast becoming a critical issue for Radiology
departments today. Thus, measuring and improving quality is essential not only to
ensure optimum effectiveness of care and comply with increasing regulatory
requirements. Instead, the increasing competition among radiology departments in
South Africa sparks the need for these institutions to find new ways of achieving a
competitive advantage. Therefore, an understanding of customers opinion on
service quality and applying it in creating efficient service delivery system is a
profound strategy for achieving customer satisfaction (Mpinganjiira, 2011).
2
The purpose of this study was to find the most important service quality dimensions
that affect customer satisfaction in New radiology department. This paper will also
enable the management of New Radiology department to device new strategies to
gain competitive advantage, generate value, and retain customers by building long-
term relations and increasing their market share. The results from the study are
expect to contribute to the existing debate on service quality measurement in the
health service sector. There the management at New Radiology department also
benefits from the findings as it will gives them direction and guidance in terms of the
areas they are doing well and those that need urgent attention to ensure improved
service quality.
1.4. Aim of the Study

The aim of the study was to investigate customers perceptions of service quality at a
new Radiology department in the Gauteng Province of South Africa.
1.5. Objectives of the Study

In line with the problem statement, the study seeks to address the following three
objectives:
To test the applicability of the SERVQUAL model as a measure of service

quality at the New radiology department.
To determine the impact of service quality on customer satisfaction at New
radiology department.
To determine customers perceptions of service quality at New radiology
department.
1.6. Research questions

Against the background of the research objectives stated above, this study will
answer the questions outlined below:
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To what extent is the SERVQUAL model applicable as a measure of service
quality at the New radiology department?
What is the impact of service quality on customer satisfaction at New radiology
department?
What are customers perceptions regarding the dimensions that relate to
service quality at New radiology department?
1.7. Hypotheses of the study

Based on the research objectives and questions stated above, the following
hypotheses were addressed in this particular study:
Ha1: Tangibility has a positive and significant impact on customer

satisfaction at a radiology department.
Ha2: Reliability has a positive and significant impact on customer
Ha3: Responsiveness has a positive and significant impact on customer
Ha4: Assurance has a positive and significant impact on customer
Ha5: Empathy has a positive and significant impact on customer satisfaction
at radiology department.
Hb1: Customers perceptions are positively and significantly related to service

quality
1.8. An outline of the Study

The outline of the research study took form of five chapters which are explained
below:
1.8.1. Chapter One: Introduction

This chapter gives a general overview of the research and discusses the background
of the problem, the problem statement, the aim of the study, the research objectives,
the research questions, the significance of the study, the format of the study and
concludes with the conceptual framework.
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1.8.2. Chapter Two: Literature Review
This chapter gives an overview of the relevant literature regarding customers
perceptions of service quality at New Radiology department in the Gauteng Province
of South Africa. The focus will be on the application of the SERVQUAL scale in the
radiology department in order identify the key quality dimensions, analyse the
importance of these dimensions and their relationship with customer satisfaction and
service quality.
1.8.3. Chapter Three: Research Methodology

This chapter outlines the processes that this research will follow with regard to the
research design and methodology. The focus will also be on the justification of the
method of research, sampling strategy and types of sampling, research instrument,
data collection, questionnaire construction and ethical considerations.
1.8.4. Chapter Four: Results, and Interpretation of Findings

In this chapter, the collected data will be analysed in relation to the research
objectives.
1.8.5. Chapter Five: Discussion, Recommendations and Conclusions

The final chapter discusses the research findings, presents recommendation and the
conclusions.
1.9. Summary
This chapter provided an introduction to the study, problem statement, rationale of
the study, aims and objectives of the study as well as the research questions. The
chapter concluded by giving an outline of the entire study. The next chapter reviews
the relevant literature with regard to the study and will be followed by study on
different models of measuring service quality but focusing mostly on SERVQUAL
approach, which is the most common method for measuring service quality.
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CHAPTER TWO: LITERATURE REVIEW
2.1. Introduction
The aim of the study was to investigate customers perceptions of service quality at
New Radiology department in the Gauteng Province of South Africa. The study also
seeks to theoretically test of the applicability of the SERVQUAL model as a measure
of service quality in radiology departments, determining the impact of service quality
6
on customer satisfaction and determine customers perceptions of service quality at
New Radiology department. Thus, the chapter deliberate on the theoretical models
applied and the review of the existing literature on the subject matter. Furthermore,
the analytical model that forms the basis of this study shall be proposed.
2.2. The service concept

According to Ovretveit (2000), customer satisfaction and service quality is of special
interest to medical service providers because dissatisfaction with service provider
can result in switching of providers. Amjeriya and Malviya (2012) alluded that
customer satisfaction is the key factor determining how successful the organisation
will be in customer relationship, therefore it is important to measure it.
The gap model as depicted in Figure 1 below maintains that satisfaction is related to
the size and direction of disconfirmation of a persons experience visa-vis his/her
initial expectations (Parasuraman et al.1985). Parasuraman et al., (1985,1988,1991)
further stated that As a gap or difference between customer Expectations and
Perceptions, service quality is viewed as lying along a continuum ranging from
ideal quality to totally unacceptable quality and in this gap or difference, some
points along the continuum are representing satisfactory quality. Parasuraman et al.
(1985) measures service quality as a difference between consumer expectations of
What they want and their perceptions of What they get.
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Figure 1: Service Quality Measured
Source: Parasuraman, Zeithaml & Berry (1985)
Pui-Mua (2004) mentioned that most researchers recognized that service has
inherent characteristics that make its performance difficult to evaluate and these
characteristics are intangibility, inseparability, heterogeneity and perishability. As
services are intangible, they cannot be subjected to precise specifications for uniform
quality and measurement of performance, there is also an immediate effect of the
service provided, the customer feels the impact of the service immediately when it is
produced (Dotchin & Oakland, 1994a; Parasuraman et al.; 1985). The
inseparability and heterogeneity of service mean that there is less managerial control
over quality, since the service cannot be tested and assured before delivery and
standardized during the delivery and the final characteristic of perishability implies
that service organisations need to retain excess capacity to meet the fluctuating
demand of customers (Pui-Mua, 2004:96-103). Pui-Mua further concluded by saying
having good service quality is a source of competitive advantage while poor service
quality can become a cost burden to the organisation and also alienates customers
(Pui-Mua, 2004:96-103).
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2.3. The quality concept
Quality is increasingly becoming a strategic tool for achieving efficiency and
business performance (Chakravarty, 2011). Today, quality plays a significant role in
customer satisfaction (John, Yatim & Mani, 2010). In this line of argument, customer
retention is directly influenced by customers satisfaction (Gopalkrishnan et al.
(2011). To this end, customer loyalty can be achieved by providing high
product/service value, which in turn improves the satisfaction level of customers
(Yang et al., 2004 and Tu et al., 2012). As a result, companies ought to focus on
factors that make a profitable long term relationship with customers and to improve
the brand image in the market. To achieve this, critical attention should be given to
customer satisfaction and service quality (Akbar & Parvez et al., 2009).
John et al, (2010) maintains that there are two forms of quality that are relevant to
any service providing organization and these are technical quality and functional
quality. According to John et al, (2010), technical quality is concerned about the
technical accuracy of the diagnoses and procedures, especially within the health
services context. On the other hand, functional quality is about the manner in which
the health care service is delivered to the patient, which could be the basis of
patients quality perception.
However, there has been diverging views about what constitute quality. Thus, unlike
John et al, (2010) who postulate that there are two forms of quality, Donabedian
(1980) argues that there are three forms of quality. According to Donabedian (1980),
in addition to technical quality, there is interpersonal quality and amenities. Thus,
Donabedian (1980) states that while technical quality is concerned about the
effectiveness of care in producing achievable health gain, interpersonal is concerned
about the extent of accommodation of patient needs and preferences. On the other
hand, amenities is about features such as comfort of physical surroundings and
attributes of the organisation that is rendering services.
Based on the ongoing discussion, it can be concluded that quality has a direct
impact on the satisfaction level of a customer. Therefore, the higher the quality, the
higher the probability of customer retention and attainment of a competitive
advantage. Despite the differing views about what constitute quality both assertions
are important for this particular study. As study, the researcher combines both views
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and maintains that quality has four components, which are technical quality,
functional quality interpersonal quality and amenities. Thus, within the health service
context, technical quality comprises of accuracy of the diagnoses and procedures
which are aimed at providing benefits to the receiver of the service.
2.4. The service quality concept

The literature is congested with different definitions of service quality (Shahin, 2004).
For instance, while Parasuraman et al. (1988) defines service quality as the ability of
an organization to meet or exceed customer expectations, Zeithaml et al. (1990)
opines that service quality is the difference between customer expectations of
service and perceived service, where perceived service is measured by customers
as they compare their expectations against their perceptions of a service from the
supplier. Daniel and Berinyuy (2010) further defines service quality as the difference
between customers expectation for service performance prior to the service
encounter and their perception of the service received. Kotler and Keller (2006)
defines service quality as the kind of performance that is offered by one party to
another and in corporeality is a must part of it.
From the above definitions of the service quality, it can be safely concluded that the
service quality concept is concerned about the difference between customers
expectation and customers perception of the services being consumed. This
difference will then forms the basis of performance by the service provider.
It has been recognised that consumers have become more quality conscious and
consequently quality improvement should play a centre stage in any business
environment (Lee, 2005). Thus, quality should be used as yard stick in the
organisations marketing activities. However, care must be taken when marketing
services so that customers expectations are not raised too high as failure to meet
them will automatically result in unsatisfied customers (Kotler & Keller, 2009).
Therefore, service quality factors have a direct influence on the competitiveness of

an organization (Siddiqi, 2011). As far as the determinants of service quality is
concerned, Parasuraman et al. (1985) provided that there are ten factors that have a
bearing on quality service and these were: access, communication, competence,
courtesy, credibility, reliability, responsiveness, security, understanding and tangibles.
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Given the above discussion, it then presents that service quality must be measured.
Measuring service quality allows for comparison for service delivery before and
after, it aids the identification of quality related problems and the determination of
clear standards for service delivery within an organisation (Shahin, 2004).
According to Daniel and Berinyuy (2010), the concept of service quality is important
as it brings with it various ways and models of measuring it. Furthermore Buttle
(1996) attests that service quality is important because it brings to together
relationships between costs, profitability, customer satisfaction, customer retention
and positive word of mouth which are considered as a drivers of corporate marketing
and financial performance.
2.5. Customer satisfaction

Cronin and Taylor (1992) postulates that customer satisfaction is based on the
customers experience on a particular service encounter. Within the health care
context, customer satisfaction is based on the expectation of the cure to be
administered (Conway & Willcocks, 1997). Thus, customer satisfaction can be
viewed as the desired outcome of healthcare (Turner & Pol, 1995). According to
Linder-Pelz, (1982), customer satisfaction can be defined within the confines of
diverse healthcare dimensions. Thus, customer satisfaction is affected by perception
variables such as expectations, entitlement, occurrences and international
comparisons, as well as the attitude variable, which is value. In order to evaluate
customers satisfaction, variables of interest should be those factors relating to
caring, empathy, reliability and responsiveness. Customer satisfaction is considered
as a reflection of organisational success as it contributes to customer loyalty (Siddiqi,
2011).
2.6. Factors that affect customer satisfaction in the health sector

An assessment of the factors that have a bearing on customer satisfaction is
important because it allows the identification of service quality elements that have
been neglected (Williams & Calnan, 1991). Donabedian (1980) asserts that the
concept of customer satisfaction within the health care sector is a multi-dimensional
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concept that is subjective and complex. Within the healthcare environment, patient
satisfaction is complex because it is affected by many variables (Naidu, 2008). As a
result, various propositions have been made regarding the factors that affect
customer satisfaction in the health sector.
The focus of factors that affect customer satisfaction in the health sector is fast
gaining momentum in the literature (Nketiah-Amponsah & Hiemenz, 2009). Thus,
according to Saeed, Ghafoor, Sarwar and Lodhi (2013), the factors that directly
affect customer satisfaction in Pakistan were quality of service, access mechanism,
skills and physicians behaviour. Allahham (2013) found price and the perceived
value to have a positive effect on consumer satisfaction. Similarly, Efuteba (2013)
and Derose et al. (2001) stressed that the quality of the service rendered is an
important determinant of the customer satisfaction.
Therefore, shaping the health care quality are the elements such as timely,
accessible, appropriate health interventions, continuous and effective health services
as postulated by Cambell et al. (2000). A review of previous studies reveals that
more emphasis has been put on quality rather than customer satisfaction. This
notion emanates from the evidence that exist in literature that shows that there is a
positive relationship between quality and satisfaction (Loveman, 1998). In this line of
argument, Cronin and Taylor (1992) further reasoned that service quality and
customer satisfaction are synonymous because they are both outcomes from a
service rendered.
2.7. Customers Expectations compared to Perceptions

According to Zeithaml, Bitner, and Gremler (2006), customer expectations are
beliefs about a service delivery that serve as standard against which performance is
done. Nabi (2012) simply defined customer expectations as what the customers
wish to receive from the services. Thus customers expectation is affected by a
number of factors, which include prior exposure to the service, word of mouth, expert
opinion, publicity, and communication controlled by the company (Zeithaml, Berry &
Parasuraman, 1993).
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On the other hand, Parasuraman et al., (1985) states that customer perceptions are
based on the comparison of their expectations based on what they feel service
providers should offer, with their perceptions of the performance of the service
provider. Daniel and Berinyuy (2010) asserts that perceptions can be viewed in
terms of how customers predict about what is going to happen after the transaction
or what they feel or desire the service provider should offer.
Therefore, in this particular study, the researcher adopts the view that expectations
are the desires of what they want the service to be and perceptions are based what
customers have experienced after receiving the service.
2.8. Relationship between service quality and customer satisfaction

Pertaining the relationship between service quality and customer satisfaction, Tucker
and Adams (2001) postulates that existing literature is inconclusive about the
direction of causality, especially from the patients perspective. For instance, while
Naidu (2008) opines that quality is positively correlated with satisfaction, the author
stated that the direction and the strength of this relationship is not clear. Some in
literature states that this relationship is difficult to assess because quality is
judgemental and hence difficult to measure (Turner & Pol, 1995). In this line of
rgument, Agbor (2011) examined the relationship between customer satisfaction and
service quality in service sectors with respect to the service quality dimensions. The
author found that while no positive relationship existed in one organisation, a positive
and significant relationship between customer satisfaction and service quality existed
in other two organisations.
Similarly, Oliver (1993) opines that service quality is a precursor to customer

satisfaction. In this regard, Agbor (2011) identified a number of studies that shared
the same sentiments based on the outcomes of their research and these included
Anderson and Sullivan (1993), Fornell, et al. (1996) and Spreng and Macky (1996).
These studies concluded that customer satisfaction emanates from the service
quality.
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While proponents of the relationship between service quality and customer
satisfaction unanimously agree that these concepts share the same characteristics,
they also allude that satisfaction is generally broader (Agbor, 2011) compared to
service quality which is more confined to the service rendered (Wilson et al., 2008).
In other words, customer satisfaction encompasses other elements such as price.
Despite the differences and the similarities between service quality and customer
satisfaction, this particular study takes the view that service quality is a precursor to
customer satisfaction. Thus, the study takes the notion that customer satisfaction is
directly affected by service quality.
2.9. The Service Quality Models

A plethora of models have been developed in an attempt to measure service quality
(Daniel & Berinyuy, 2010). These models include the SERVPERF model (Cronin &
Taylor, 1992), the Evaluated Performance model (Teas, 1993) and the SERVQUAL
model (Parasuraman et al. 1985). However, of interest in this particular study is the
SERVQUAL model, which is discussed in detail the next section.
2.10. The SERVQUAL model

Framing this study is the service quality model (The SERVQUAL model). The
concept of service quality has its roots in the work of Parasuraman et al (1985).
Based on the findings of their study, the authors developed a Service Quality model.
The model was built based on the information gathered from both executives and
customers. According to Figure 2 below, the lower portion represents the gaps as
revealed by the executive interviews (the marketer side) and the upper portion
represents the gaps as revealed by the customer interviews (customer side). Thus,
the marketer side is represented from Gap 1 through to Gap 4 while the customer
side is represented by Gap 5.
Figure 2: Service Quality model
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Source: Parasuraman et al (1985)
In a further study, Parasuraman et al (1988) revealed an instrument for measuring
consumers perception of service quality, which has become known as SERVQUAL.
The developed instrument contained five dimensions which are shown in Table 1
below:
Table 1: Five dimensions of SERVQUAL
Dimension Description
Tangibles Physical facilities, appearance of personnel and equipment
Reliability Ability to perform the promised service dependably and
accurately
Responsiveness Willingness to help customers and provide prompt service
Assurance A combination of items designed originally to assess
Competence, Courtesy, Credibility, and Security) ability of the
organizations employees to inspire trust and confidence in the
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Dimension Description
organization through their knowledge and courtesy.
Empathy A combination of items designed originally to assess (Access,
Communication, and Understanding the customer)
personalized attention given to customer.
Source: Parasuraman et al (1985)
Thus, the SERVQUAL instrument comprises of 22 statements that seeks to assess

consumer perceptions and expectations regarding the quality of a service
(Ramseook-Munhurrun, Lukea-Bhiwajee & Naidoo, 2010).
According to Parasuraman et al. (1988) customer expectations represents what

customers think a service should offer as compared to what might be on offer. A gap
is created when customer perceptions of the delivered service is not in line with their
expectations (Ramseook-Munhurrun, Lukea-Bhiwajee & Naidoo, 2010). Thus, the
gap score is calculated by the perception statements being deducted from the
expectation statements (Ramseook-Munhurrun, Lukea-Bhiwajee & Naidoo, 2010). A
positive gap score represents that expectations are actually exceed. In essence, the
SERVQUAL instrument helps to identify where gaps in service exist and to what
extent and these gaps are illustrated in Table 2 below. Thus, the table presents the
five SERVQUAL gaps as generally defined by Seth and Deshmaukh (2005).
Table 2: Definition of the SERVQUAL Gaps
Gap Gaps aspect Definition

Gap 1 Customer This gap addresses the difference between
expectation- consumers expectation and managements
management gap perception of service quality.
Gap 2 Management This gap addresses the difference between
perception- management perceptions of customers expectation
delivery gap and service quality specification that is improper
service-quality standards.
Gap 3 Service quality The gap addresses the difference between service
specification- specification and service actually delivered, that is
service delivery the service performance gap.
gap
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Gap Gaps aspect Definition
Gap 4 Service delivery- The gap addresses the difference between service
external delivery and communication to customers about
communication service delivery that is whether promise matches
gap delivery.
Gap 5 Expected service- The gap addresses difference between customers
perceived service expectation and perceived service. This gap
gap addresses the difference between customers
expectation and perceived service
Source: Seth and Deshmaukh (2005)
While the lower mean score indicate that there is a larger the gap in service quality,
the higher mean score indicates that there is a smaller the gap in service quality.
Gaps 1 to 4 are within the control of an organization and they can be assessed to
identify the causes and changes that needs to be implemented in order to reduce or
even eliminate Gap 5. Thus, Gap 5 reflects the difference between customers
perceptions and expectations of the level of service provided.
2.7.1. Criticisms of the SERVQUAL model

The SERVQUAL model as means of measuring service quality has been subject to
scrutiny and has received a much of criticisms. Cronin and Taylor (1992) criticised
the SERVQUAL model based on the models emphasis on administering
expectations. Thus, the authors argue that instead of putting much emphasis on
expectations, service quality can be measured by focusing on performance as
reflected by customer perceptions.
2.7.2. Empirical validation of the SERVQUAL model in general

Despite the criticism levelled against SERVQUAL model, the model has been used
to measure service quality in a number of contexts (Ramseook-Munhurrun, Lukea-
Bhiwajee & Naidoo, 2010). For instance, Ramseook-Munhurrun, Lukea-Bhiwajee
and Naidoo (2010) examined the extent to which service quality is delivered within
the Mauritian public service. The authors utilised empirical data collected from front-
line employees (FLE) and customers. Thus, using the SERVQUAL model they
assessed how closely customer expectations of service and FLE perceptions of
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customer expectations match. The study found that while customer expectations
were not met, FLE were aware what those expectations were.
Shahin (2004) adopted the SERVQUAL instrument in order to ascertain the

existence of any actual or perceived gaps between customer expectations and
perceptions of the service offered. The author further assessed the extent to which
the management of services can result in improvement of the prioritized service
quality dimensions and the resultant effect on the service quality gaps. The study
found that the organizations can at least assess five dimensions of service
quality to ascertain the level of services provided, and to determine which
dimensions need improvement, confirming the applicability of the SERVQUAL
model.
However, Daniel and Berinyuy (2010) theoretically tested the applicability of the
SERVQUAL model in the grocery stores context and empirically determined how
students (consumers) perceive service quality they received and if they were
satisfied with services offered by these stores in Umea. The authors found out that
the SERVQUAL model was not applicable in measuring service quality. The authors
argued that from the factor analysis they observed that there were items under
certain dimensions that were overlapping and regrouping under different dimensions.
The authors further realised that some items were associated to more than one
component. Despite the non-applicability of the SERVQUAL model in the grocery
stores context, the study found that overall service quality perceived by consumers
was not satisfactory. This suggests that expectations exceeded perceptions with all
the dimensions depicting higher expectations than perceptions of services received.
2.7.3. Empirical validation of the SERVQUAL model in public hospitals

Zarei, Arab, Froushani, Rashidian and Tabatabaei (2012) investigated the various
dimensions of the service quality in the private hospitals of Iran. The study found the
total mean score of patients expectation to be 4.91 compared to the perception
score of 4.02. The authors concluded that the SERVQUAL model was a valid,
reliable, and flexible instrument to monitor and measure the quality of the services in
private hospitals of Iran.
18
Similarly, Pakdil and Harwood (2005) employed the SERVQUAL model to measure
the level of patient satisfaction. The authors found that the mostly ranked expectation
was adequate information about their anesthesia and surgery, and the second one
is adequate friendliness, courtesy. They further confirmed the validity of the
SERVQUAL model in revealing differences between patients preferences and their
actual experience.
In addition, Irfan, Ijaz and Shahbaz (2011) adopted the SERVQUAL model to
evaluate the service quality delivered by the private hospitals in Pakistan based on
patient perception. The results from the study indicated that the SERVQUAL model
has managed to provide an insight that service quality of the private hospitals meets
patient satisfaction.
Also, Rizwan and Hina (2011) explored the dimensions of the SERVQUAL model to
determine the significant determinants of service quality, in terms of patients
satisfaction in the selected hospitals of Karachi. The study found that the model has
the predictors that provide a measure the patients satisfaction for each hospital.
However, instead of applying the SERVQUAL model in its entirety, De Jager, and Du
Plooy (2007) only focused on the tangibility and assurance dimensions as
determinants of service quality for public health care in South Africa. While the study
found that patients experience a sense of dissatisfaction with regards to the services
rendered, it actually confirmed the applicability of the model in a hospital set up.
Mthethwa and Chabikull (2016) utilised the SERVQUAL model to examine the
satisfaction of patients based on their experience at Medunsa Hospital in South
Africa. The authors found that, overall, two thirds of the patients were satisfied. While
the differences in satisfaction rates for all service quality dimensions were found to
be statistically insignificant, access, empathy and tangible were found to have a
significant influence.
19
In another study, Gholami, Kavosi and khojastefar (2016) employed the SERVQUAL
model. The authors concluded that SERVQUAL provides a powerful tool for
assessing the quality of health care services. Thus, the results from the study further
confirms that the SERVQUAL model is a valid, reliable and flexible tool to monitor
and measure service quality in emergency unit.
In conclusion, the extensive application of the SERVQUAL instrument and a

measure of service instils confidence in its use as a technique for measuring service
quality in in the health service context. Thus, the main advantage of the SERVQUAL
instrument is that it is a tried and tested instrument that can be used in comparative
benchmark studies (Brysland & Curry, 2001). Furthermore, the instrument is
statistically valid emanating from the fact that it been subjected to extensive field
testing and refinement Shahin (2004). This further gives the researcher confidence in
employing the SERVQUAL instrument to fulfil the objectives of the study. The next
section deals with the empirical validation of the instrument specifically in the
radiology departments.
2.7.4. Empirical validation of the SERVQUAL model in radiology departments

Almeida, at al. (2012) applied the SERVPERF scale, a modified version of
SERVQUAL model to identify the key quality dimensions and analyse the importance
of these dimensions and their relationship with customer satisfaction. However, the
results obtained did not confirm the original dimensions of the SERVPERF scale.
The authors did not dismiss the applicability of the SERVPERF scale in its entirety.
Instead, they recommended that the scale can be used according to the type of the
service in question. Similar conclusion about the non-applicability of the SERVPERF
scale were arrived at by De Man (2002) and Ramsar-Fowdar (2005), who stated that
SERVPERF scale did not cover all quality dimensions of the Radiology department
that are important to patients. These findings however did not discount the
applicability of the SERVQUAL model in radiology departments.
Wong (2002) adopted the SERVQUAL instrument to evaluate the quality of the
service provided for ambulatory clients at the Bone Densitometry Unit in the Royal
Brisbane Hospital. The study found that of the five dimensions, responsiveness,
20
assurance and empathy factors were more important predictors of overall service
satisfaction. Of importance however is the fact that this study is one of those that
have confirmed the applicability of the SERVQUAL instrument in a radiology set up.
Moreover, Mukhtar, Saeed and Ata (2013) attempted to test the reliability and
applicability of this methodology to measure the service quality in deferent contexts.
The study utilised the data collected from patients who visited the dental hospital in
specific categories of outdoors, indoors and radiology departments. The study
concluded that although the instruments face and construct validity could not be
established, the SERVQUAL Model remains an efficient and effective instrument to
measure the quality of a variety of service.
Similarly, Sirohi and Singh (2016) focused on the applicability of the SERVQUAL
model in various hospital departments including the radiology and pathology services
departments. The authors found that within the radiology department, most of the
respondents perceived that the hospital had modern equipment and physical
facilities were visually appealing. Furthermore, the results indicated that the ward
staff on duty received quick reports of all the pathological investigations which in the
due course facilitated the timely treatment of the patients.
Therefore, in addition to the fact that the SERVQUAL model was found to be
applicable in other contexts, a review of the above few studies further confirms that
the model is also valid when applied in radiology departments. This further instils
confidence in the research to go ahead with the use of the model for this particular
study.
2.11. Ways to improve service delivery at Radiology department

According to Hoe (2007), services within the radiology department can be improved
by carefully identifying the customers that access the radiology department,
understand how they access the radiology services, identify their needs and assess
their satisfaction. Each of these steps is discussed in detail in the following sections.
21
2.6.1. Identifying the customers for the department
Customers needs need to be determined and processes put in place to satisfy them.
Knowing who the primary and secondary customers are in the department is very
essential. External customers are patients (inpatients, outpatients, their family
members and relatives), specialists, referring physicians, other departments and
their staff, payers (medical insurance companies). Internal customers are the
radiology staff. Thus, because customers are different, they require different services
at all times. For an example patients want short waiting times, medical staff want
fast and reliable reports, the hospital want reliability and safety, the Ministry of health
want lower cost and medical insurance expects accuracy and relevance.
2.6.2. Understanding how customer assess radiology services

According to the SERVQUAL model as developed by Parasuraman et al., (1988,
1991), a combination of five attributes defines an organisations service quality.
According to Hoe (2007), within the context of a radiology department, the following
are SERVQUAL variables:
2.6.2.1. Responsiveness
Willingness and ability to help customers promptly in radiology. This means being
able to get appointments for patients quickly as well as sending films and report soon
after the examination to the referring doctors.
2.6.2.2. Assurance
The customer must feel comfortable with the competence of the service provider.
Many radiologists do not bother to interact or talk to patients but the need for
interaction is growing.
2.6.2.3. Empathy
Radiology staff need to show some degree of caring and attention to customers. This
highlights the importance of interpersonal skills, which starts from font desk reception
staff to the radiologist.
22
2.6.2.4. Tangibility
Physical appearance of the department and facilities, and the quality of the
equipment. In radiology, because of high capital cost of equipment, it is not always
possible to have the best equipment but it is always important that the available
equipment is used correctly and the quality of work produced is of high quality (Hoe,
2007).
2.6.3. Identifying customers need and assess their satisfaction

This is about making an effort to understand the customer which involves learning
about specific requirements, providing individualized attention and recognizing also
the regular customer. Amjeriya and Malviya, (2012) stated that customer satisfaction
is a reflection of the organisation performance. As such, Grnroos (2007) suggested
that in order to increase long term quality, the customers expectations should be
focused, revealed and calibrated. Furthermore, Grnroos (2007) developed the
dynamic model of expectation that describes that the quality of professional services
develops in a customer relationship over time. The assessment of service quality is
associated with continuous improvement. Accordingly, De Jager and Gbadamosi
(2010) are of the idea that continuous assessment enables an organisation to
understand its position and devise various ways to continuously improve its
customers satisfaction levels.
2.12. The proposed analytical model of the study

To understand how service quality dimensions influence satisfaction of customers
within the New Radiology department, the following conceptual framework presented
in Figure 4, developed mainly from the SERVQUAL model, becomes useful.
23
Figure 3: Proposed theoretical model for the study
As shown in Figure 4, the model illustrated above shows how the use of service
quality can lead to overall satisfaction of customers. According to the model, there
are five dimensions; reliability, responsiveness, assurance, empathy, tangibility and
patients satisfaction (Parasuraman et al, 1985, 1988, 1991). This model was used to
assess customers perception of service quality and investigating how SERVQUAL
attributes influence satisfaction. Thus, a similar analytical model was used by Qin
and Prybutok (2009), and Gholami, Kavosi and khojastefar (2016), which validates
the use of the same for this particular study.
2.13. Summary
New radiology department in the Gauteng Province of South Africa. This section
focused on the existing literature that informs the study. Further discussed in this
chapter was the applicability of the SERVQUAL model as a measure of service
quality in radiology departments, determining the impact of service quality on
customer satisfaction and determine customers perceptions of service quality at
24
New radiology department. Thus, the chapter deliberated on the theoretical models
applied and the review of the literature which was available on the subject matter.
Finally, the theoretical framework that forms the basis of this study was proposed.
25
CHAPTER FOUR
RESULTS AND INTERPRETATION OF FINDINGS
4.1. Introduction
The previous chapter discussed the research methodology adopted for the study.
This chapter gives a presentation of the research results. Thus, this chapter
analyses, presents and interprets the results of the data obtained from the
questionnaires completed. The chapter begins by providing empirical descriptions,
followed by a demographic overview of the respondents, which helps to provide a
context for the results. This will be followed by a presentation of the findings
stemming from the survey. The ultimate goal of this chapter is no make an alignment
between research objectives and questions of study and the methodological choices
discussed earlier in the study.
4.2. Empirical descriptions
4.2.1. Measurement
The SERVQUAL model proposed by Parasuraman et al., (1988), was used as the
main guide for the questionnaire structure. The questionnaire was administered to
accurately collect data on the customers expectations and perceptions of service
quality with the New Radiology department. The questionnaire was designed to test
the applicability of the SERVQUAL model in the radiology context and also to know
26
how clients perceive service quality in the public health sector and identify the factors
that bring client satisfaction.
Expectations and perceptions were both assessed on a measurement scale of 5-

point Likert scale ranging from 1-strongly disagree to 5-strongly agree. A lower score
represents the level of disagreement while the higher score represents the level of
agreement on each expectation or perception variable. Thus, Daniel and Berinyuy
(2010) postulates that perceptions are based on the actual service clients have
received while expectations are based on past experiences and information received
about radiology departments. The service quality score is made up of the difference
between the perception (P) and expectation (E) scores (P-E). The service quality
score range from -6 to +6, with a score of -6 representing very dissatisfied and +6
representing very satisfied. In essence, the quality score measures the degree to
which expectations (E) exceed perceptions (P) or service gap. Thus, the higher the
positive score the higher and the level of service quality, which leads to client
satisfaction. However, service quality can be considered satisfactory when
expectation and perception are equal (Daniel & Berinyuy, 2010).
4.2.2. Coding
The SERVQUAL dimensions were main constructs used in this particular study and
they were coded in order for ease of analysis.
Tangibility (TA)
TA1: Radiologys equipment is preserved, modern and of high quality
TA2: Radiology has proper X-Ray equipment that is visually appealing and pleasant
TA3: Radiology staff are well dressed and neat
TA4: Reports and other documents delivered to the customer are easily understood
and professional
Reliability (RL)
RL1: Radiology conducts procedures on time
27
RL2: You are prioritized, helped as a customer and your problems are resolved
immediately/ as soon as possible.
RL3: Radiology staff performs services and procedures correctly the first time, not
causing rework
RL4: Radiology services provided meet your overall expectation and are within the
implementation time promised
RL5: Submitted reports, images and information about the customer are of good
quality and without errors
Responsiveness (RN)
RN1: Radiology staff informs customers exactly when services will be executed
RN2: Radiology staff promptly meets the customers needs
RN3: Radiology staff tries to help customers
RN4: Radiology staff is available to respond to customers requests
Assurance (AS)
AS1: Radiologys staff is trustworthy.
AS2: Customers feel secure in using radiology services.
AS3: Radiology staff is polite and courteous to the customers.
AS4: Radiology staff has adequate knowledge to answer questions from customers.
Empathy (EM)
EM1: Radiologys team gives individual attention to each customer
EM2: Radiology operates at times suitable/convenient to all customers
EM3: Radiology has a team to give personalized attention to customers
EM4: Radiology prioritizes the interests of customers
EM5: Radiology team understands the specific needs of the customer

28
Demographics (DM)
DM1: Age group (1=20 29 years, 2=30 39 years, 3=40 49 years, 4=50+)
DM2: Gender (0=male, 1=female)
DM3: Marital status (1=Single, 2=Married/Co-Habiting, 3=Divorced/Separated,

4=Widowed)
MD4: Employment status (1=Employed, 2=Self-Employed, 3=Unemployed,

4=Student, 5=Pensioner)
DM5: Residence (1=GP, 2=NW, 3=KZN, 4=FS, 5=NC, 6=WC, 7=LP, 8=MP, 9=EC,
10=Other)
DM6: Customer category (1=Physician, 2=Specialist, 3=Patient, 4=Family Member,

5=Staff Member)
DM7: Type of procedure (1=sonar, 2=general X-rays, 3=bone mineral density, 4=all
studies, 5=BA studies)
4.2.3. Variable computing

TA- Average gap score for tangible items = (TA1+TA2+TA3+TA4)/4
RL- Average gap score for reliability items = (RL1+RL2+RL3+RL4+RL5)/5
RN- Average gap score for responsiveness items = (RN1+RN2+RN3+RN4)/4
AS- Average gap score for assurance items = (AS1+AS2+AS3+AS4)/4
EM- Average gap score for empathy items = (EM1+EM2+EM3+EM4+EM5)/5
OSQ- Overall service quality = (TA+RL+RN+AS+EM)/5
4.3. Demographic information of the respondents
In carrying out the study, 210 responses were received from the questionnaires that
were administered to the participants. The basic questions asked pertaining the
demographic and background variable statistic focused on gender, age, marital
29
status, employment status, residency, customer category and type of procedures or
referrals. Each of these variables is presented below.
4.3.1. Respondents age group
The age of the respondents were recorded in to four age groups: 20-29 years, 30-39
years, 40-49 years and 50 years and above.
Thus, Figure 5 below shows that the majority of the participants (44.6%) involved in
the study fell under the age group of 50+ years, followed by 33.3% of the
respondents between 40 49 years. Furthermore, 13.2% of the respondents
belonged to 30 39 years and above age group. However, very few respondents
(6.9%) fell under the age group of 20 29 years.
Figure 4: Age group of respondents
Age Gr oup
44.60%
35.30%
13.20%
6.90%
20 29 ye a rs 30 39 ye a rs 40 49 ye a rs 50 +
4.3.2. Gender of the respondents

The other demographic factor selected for the study was gender and illustrations of
the result are given in Figure 6 below. The figure highlights the gender distribution of
the study with female being highest and comprising of 92.6%. The remainder were
male respondents, representing only 7.4%.
30
Figure 5: Gender of the respondents
Ge n d e r
92.6%
7.4%
Fe ma l e Ma l e
4.3.3. Marital status of the respondents

The other demographic factor selected was the marital status of the respondents and
illustration of the results is shown below.
Figure 6: Marital status of the respondents
ma rita l s ta tu s
69.4%
12.1% 10.7%
7.8%
Single Ma r r i e d / C o - H a b i t i n g D iv orc ed/ Separat ed W i d o we d
Figure 7 above shows that majority of the respondents (69.4%) were married or co-
habiting, followed by 12.1% of the respondents who were single. Taking the third
31
position was 10.5% of the respondents who were divorced or separated and a small
proportion of the respondents (7.6%) were widowed.
4.3.4. Residence of the respondents

Another demographic factor considered in the study was the residence of the
respondents. Thus, the majority of the respondents (90.6%) resided in Gauteng
Province, followed by a 3.4% who were from Mpumalanga Province, 2.0% who were
from Limpopo Province and 1.5% were from the Northwest Province. Participants
living in Kwa-Zulu Natal, Free State and Western Cape Provinces represented 0.5%,
respectively. The remaining 1.0% of the respondents were from other places.
Figure 7: Place of residence of the respondents
p la c e o f re s id e n c e
90.6%
1.5% 0.5% 0.5% 0.5% 2.0% 3.4% 1.0%

GP NW KZN FS WC LP MP Oth e r
4.3.5. Customer category

Figure 9 below shows that the majority (88.8%) of the respondents were patients,
followed by 5.6% who were specialists, 3.6% were family members and 1.0% were
physicians and staff members, respectively.
32
Figure 8: Customer categories
c u s to me r c a te g o ry
88.8%
5.6% 3.6% 1.0% 1.0%

Pat ie n t Sp e cialis t Fa m i l y M e m b e r Ph ys ician St af f M e m b e r
4.3.6. Type of procedures/ Referrals

Figure 10 below shows that the majority of the procedures were mammograms,
which makes up 65.7% of the procedures. This was followed by sonar, with a
proportion of 20.8%, general X-rays (6.8%), bone mineral density (3.4%), all studies
(1.9%) and BA studies for screening (1.4%).
33
Figure 9: Type of procedures/referral for
Typ e o f p ro c e d u re
65.7%
20.8%
6.8%
3.4% 1.4% 1.9%
4.4. Descriptive analysis

This section presents a descriptive analysis of the results based on the survey
conducted.
4.4.1. Tangibility (TA)

This section present a descriptive analysis of the results based on the survey
conducted pertaining to tangibility.
4.3.1.1. Expectation
The respondents were asked to rank statements pertaining to tangibility of services
in relation to expectation. Thus, the following were the findings as shown in Table 4
below:
91.7% of the respondents indicated that the radiologys equipment is

preserved, modern and of high quality.
92.2% of the respondents were in agreement that radiology has proper X-Ray
equipment that is visually appealing and pleasant.
34
97.1% of the respondents were in agreement that radiology staff are well
dressed and neat.
94.1% of the respondents were in agreement that reports and other
documents delivered to the customer are easily understood and professional.
Table 3: Tangibility-Expectation
Strongly
Disagree
Neutral
Agree
Agree
Construct Variable : Expectation
Radiologys equipment is preserved, modern and of high 0.5% 7.8% 26.2% 65.5%
quality
Radiology has proper X-Ray equipment that is visually 7.8% 26.2% 66.0%
appealing and pleasant
Radiology staff are well dressed and neat 2.9% 26.7% 70.4%
Reports and other documents delivered to the customer are 5.9% 27.9% 66.2%
easily understood and professional
4.3.1.2. Perception
in relation to perception. Thus, the following were the findings as shown in Table 5
below.
96.0% of the respondents were of the perception that the radiologys

equipment is preserved, modern and of high quality.
97.0% of the respondents were of the perception that the Radiology has
proper X-Ray equipment that is visually appealing and pleasant.
98.5% of the respondents were of the perception that the radiology staff are
well dressed and neat.
96.9% of the respondents were of the perception that the reports and other
documents delivered to the customer were easily understood and
professional.
35
Table 4: Tangibility-Perception
DisagreeStrongly
AgreeStrongly
Agree
Neutral
Disagree
Construct Variable: Perception
Radiologys equipment is preserved, modern and of 0.5% 3.5% 12.0% 84.0%

high quality
Radiology has proper X-Ray equipment that is visually 0.5% 0.5% 2.0% 14.0% 83.0%
appealing and pleasant
Radiology staff are well dressed and neat 0.5% 1.0% 15.0% 83.5%
Reports and other documents delivered to the customer 3.1% 15.0% 81.9%
are easily understood and professional
4.4.2. Reliability (RL)

conducted pertaining to reliability.
The respondents were asked to rank statements pertaining to reliability of services in
relation to expectation. Thus, the following were the findings as shown in Table 6
below.
90.3% of the respondents were in agreement that the radiology conducts

procedures on time.
90.8% of the respondents were in agreement that they were prioritized,
helped as a customer and your problems are resolved immediately/ as soon
as possible.
92.7% of the respondents were in agreement that the radiology staff performs
services and procedures correctly the first time, not causing rework.
93.7% of the respondents were in agreement that radiology services provided
meet their overall expectation and are within the implementation time
promised.
91.7% of the respondents were in agreement that the submitted reports,
images and information about the customer are of good quality and without
errors.
36
Table 5: Reliability-Expectation
Strongly
Neutral
Disagree
Agree
Agree
Radiology conducts procedures on time 1.0% 8.8% 28.8 61.5%
%
You are prioritized, helped as a customer and your problems 1.5% 7.8% 29.3 61.5%
are resolved immediately/ as soon as possible. %
Radiology staff performs services and procedures correctly the 7.3% 22.0 70.7%
first time, not causing rework %
Radiology services provided meet your overall expectation and 1.0% 5.4% 29.8 63.9%
are within the implementation time promised %
Submitted reports, images and information about the customer 8.4% 23.2 68.5%
are of good quality and without errors %
4.3.2.2. Perception
The respondents were asked to rank statements pertaining to reliability of services in
relation to perception. Thus, the following were the findings as shown in Table &
below.
87.4% of the respondents were of the perception that the radiology

department conducts procedures on time.
90.5% of the respondents were of the perception that they were prioritised,
helped as a customer and your problems are resolved immediately/ as soon
as possible.
97.5% of the respondents were of the perception that the radiology staff
performs services and procedures correctly the first time, not causing rework.
90.5% of the respondents were of the perception that the radiology services
provided meet your overall expectation and are within the implementation time
promised.
95.3% of the respondents were of the perception that the submitted reports,
images and information about the customer are of good quality and without
errors.
37
Table 6: Reliability-Perception
DisagreeStrongly
AgreeStrongly
Neutral
Disagree
Agree
Construct Variable : Perception
Radiology conducts procedures on time 0.5% 2.5% 9.6% 16.2 71.2

% %
You are prioritised, helped as a customer and your 1.5% 8.0% 15.6 74.9
problems are resolved immediately/ as soon as % %
possible.
Radiology staff performs services and procedures 2.5% 14.1 83.4

correctly the first time, not causing rework % %
Radiology services provided meet your overall 0.5% 3.0% 6.0% 16.1 74.4
expectation and are within the implementation time % %
promised
Submitted reports, images and information about the 1.1% 3.7% 12.2 83.1
customer are of good quality and without errors % %
4.4.3. Responsiveness (RN)

conducted pertaining to responsiveness.
The respondents were asked to rank statements pertaining to responsiveness of
services in relation to expectation. Thus, the following were the findings as shown in
Table 8 below.
92.6% of the respondents were in agreement that the radiology staff informs
customers exactly when services will be executed.
94.5% of the respondents were in agreement that the radiology staff promptly
meets the customers needs.
95.6% of the respondents were in agreement that the radiology staff tries to
help customers.
94.6% of the respondents were in agreement that the radiology staff is
available to respond to customers requests.
38
Table 7: Responsiveness-Expectation
AgreeStrongly
Neutral
Disagree
Agree
Radiology staff informs customers exactly when services will be 0.5% 6.9% 28.1% 64.5%
executed
Radiology staff promptly meets the customers needs. 5.3% 30.0% 64.5%
Radiology staff tries to help customers 4.2% 29.1% 66.5%
Radiology staff is available to respond to customers requests. 5.5% 28.9% 65.7%
4.3.3.2. Perception
The respondents were asked to rank statements pertaining to responsiveness of
services in relation to perception. Thus, the following were the findings as shown in
Table 9 below.
informs customers exactly when services will be executed.
promptly meets the customers needs.
94.4% of the respondents were of the perception that the radiology staff tries
to help customers.
93.9% of the respondents were of the perception that the radiology staff is
available to respond to customers requests.
Table 8: Responsiveness-Perception
Neutral
Disagree
Agree
Disagree
Strongly
AgreeStrongly
Radiology staff informs customers exactly when 2.6% 9.2% 17.3% 70.9%
services will be executed
Radiology staff promptly meets the customers 0.5% 2.0% 4.6% 17.3% 75.5%
needs.
Radiology staff tries to help customers 1.0% 4.6% 16.3% 78.1%
Radiology staff is available to respond to 1.5% 4.6% 19.0% 74.9%

customers requests.
39
4.4.4. Assurance (AS)
This section presents a descriptive analysis of the results based on the survey
conducted pertaining to assurance.
The respondents were asked to rank statements pertaining to assurance of services
in relation to expectation. Thus, the following were the findings as shown in Table 10
below.
95.1% of the respondents were in agreement that the radiologys staff is

trustworthy.
94.6% of the respondents indicated that they feel secure in using radiology
services.
95.6% of the respondents were in agreement that the radiology staff is polite
and courteous to the customers.
94.5% of the respondents were in agreement that the radiology staff has
adequate knowledge to answer questions from customers.
Table 9: Assurance-Expectation
AgreeStrongly
Neutral
Agree
Disagree
Radiologys staff is trustworthy. 0.5% 4.4% 28.6% 66.5%
Customers feel secure in using radiology services. 5.4% 24.6% 70.0%
Radiology staff is polite and courteous to the customers. 4.4% 27.0% 68.6%
Radiology staff has adequate knowledge to answer questions 5.4% 28.7% 65.8%
from customers.
4.3.4.2. Perception
in relation to perception. Thus, the following were the findings as shown in Table 11
below.
40
93.8% of the respondents were of the perception that the radiologys staff is
trustworthy.
98.5% of the respondents were of the perception that customers feel secure
in using radiology services.
94.9% of the respondents were of the perception that the radiology staff is
polite and courteous to the customers.
97.9% of the respondents were of the perception that the radiology staff has
Table 10: Assurance-Perception
AgreeStrongly
Neutral
Disagree
Agree
Radiologys staff is trustworthy. 6.2% 16.9% 76.9%
Customers feel secure in using radiology services. 1.5% 18.5% 80.0%
Radiology staff is polite and courteous to the customers. 0.5% 4.6% 14.8% 80.1%
Radiology staff has adequate knowledge to answer questions from 2.1% 14.9% 83.0%
customers.
4.4.5. Empathy (EM)

conducted pertaining to assurance.
The respondents were asked to rank statements pertaining to empathy in delivery of
services in relation to expectation. Thus, the following were the findings as shown in
Table 12 below.
94.1% of the respondents were in agreement that the radiologys team gives
individual attention to each customer.
90.6% of the respondents were in agreement that the radiology operates at
times suitable/convenient to all customers.
93.1% of the respondents were in agreement that the radiology has a team to
give personalized attention to customers.
41
91.1% were in agreement that the radiology prioritizes the interests of
customers.
93.1% of the respondents were in agreement that the radiology team
understands the specific needs of the customer.
Table 11: Empathy-Expectation
Strongly
Neutral
Agree
Agree
Radiologys team gives individual attention to each customer. 5.9% 26.5% 67.6%
Radiology operates at times suitable/convenient to all customers. 9.4% 27.1% 63.5%
Radiology has a team to give personalized attention to customers. 6.9% 29.1% 64.0%
Radiology prioritizes the interests of customers. 8.9% 27.6% 63.5%
Radiology team understands the specific needs of the customer. 7.0% 27.4% 65.7%
4.3.5.2. Perception
The respondents were asked to rank statements pertaining to empathy in the
provision of services in relation to perception. Thus, the following were the findings
as shown in Table 13 below.
95.4% of the respondents were of the perception that the radiologys team
gives individual attention to each customer.
82.7% of the respondents were of the perception that the radiology operates
at times suitable/convenient to all customers.
92.4% of the respondents were of the perception that the radiology has a
team to give personalized attention to customers.
89.4% of the respondents were of the perception that the radiology prioritizes
the interests of customers.
90.7% of the respondents were of the perception that the radiology team
understands the specific needs of the customer.
42
Table 12: Empathy-Perception
DisagreeStrongly
AgreeStrongly
Disagree
Neutral
Agree
Radiologys team gives individual attention to each 4.6% 14.7% 80.7%

customer.
Radiology operates at times suitable/convenient to all 2.0% 7.1% 8.1% 14.2% 68.5%
customers.
Radiology has a team to give personalized attention 7.6% 17.3% 75.1%

to customers.
Radiology prioritizes the interests of customers. 10.7% 17.8% 71.6%
Radiology team understands the specific needs of 9.2% 16.9% 73.8%

the customer.
4.5. Descriptive statistics for the five constructs

Table 14 below shows that the standard deviation scores are not consistent for all
five constructs, suggesting a wide range of opinion on service quality among the
respondents surveyed. Each construct is explained in more detail below.
Table 13: Descriptive statistics for the five constructs
TA RL RN AS EM
Mean Statistic 0.1918 0.0590 -0.0729 0.0794 0.0622
Std. Deviation Statistic 0.59525 0.99097 1.46509 1.07561 0.69901
Skewness Statistic 0.561 -5.176 -6.413 -8.311 -0.095
Std. Error 0.174 0.174 0.175 0.175 0.175
Kurtosis Statistic 2.835 54.484 53.207 98.586 1.891
Std. Error 0.346 0.346 0.349 0.349 0.348
4.8.1. Tangibility (TA)

Tangibility had an average score of 0.1918 and a standard deviation of 0.59525
indicating the spread of gaps away from the mean. The distribution is negatively
skewed with a skewness of 0.561 which indicates that the figures are deviated more
43
to the left. The kurtosis value is 2.835 which means that there is clustering
somewhere away from the mean.
4.8.2. Reliability (RL)

The mean for reliability construct is 0.0590 which means that customers are not
satisfied with the quality of services as depicted by the reliability dimension. The
standard deviation is 0.99097 which means that the gaps are spread away from the
mean. The distribution is positively skewed with a value of -5.176 indicating the gaps
are deviated to the left of the mean and the gaps are clustered away from the mean
with a kurtosis value of 54.484.
4.8.3. Responsiveness (RN)

The mean for responsiveness was -0.0729, with the standard deviation of 1.46509.
The deviation is to the left with a positive skewness of -6.413. The gaps are also
clustered at a point different from the mean of the distribution because the kurtosis
value is 53.207.
4.8.4. Assurance (AS)

The mean for the assurance construct was 0.0794, with a standard deviation of
1.07561, showing little deviation from the mean which is spread towards the left as
the distribution is negatively skewed with a value of -8.311 and the gaps cluster at
some point away from the mean with a kurtosis value of 98.586.
4.8.5. Empathy (EM)

The mean for empathy was 0.0622, with a standard deviation of 0.69901 which
means that the gaps are deviated from the mean but not very much. They are
deviated to the right because the distribution is positively skewed with a value of
-0.095 and clustered at a value away from the mean with a kurtosis value of 1.891.
4.8.6. Overall service quality

Table 15 below shows that this dimension has the mean gap of 0.0629, with a
standard deviation of 0.72045. The deviation is to the right because the distribution is
positively skewed with a value of -1.340 and clustered around a value other than the
mean. The kurtosis value is 9.659.
44
Table 14: Descriptive statistics for Overall service quality
N Mean Std. Skewness Kurtosis

Deviation
Statistic Statistic Statistic Statistic Std. Statistic Std.
Error Error
OSQ 196 0.0629 0.72045 -1.340 .174 9.659 .346
4.6. Reliability tests and validity of constructs

This section discussed the reliability of the data collection instrument used for the
study as well as the validity of the constructs contained in the questionnaire.
4.5.1. Reliability tests

Cronbachs alpha, which is the most common measure of scale reliability, was used
to measure the internal consistency of the questionnaire in terms of how closely
related the set of data is as a group (Gliem & Gliem, 2003). Based on the collected
data from the study, a Cronbach alpha () of 0.763 was obtained. This indicates that
there were no problems with the questionnaire and it was an appropriate tool of data
collection for the designed survey. Although slightly below the Cronbach alpha () of
0.92 achieved in the Parasuraman et al. (1988) study, this value is above the 0.70,
which is considered the minimum acceptable level. Furthermore, the obtained
reliability value for the study was considered substantial given the fact that the
highest reliability that can be obtained is 1.0 and this is an indication that the items of
the five constructs of SERVQUAL model are accepted for analysis.
Thus, Figure 11 below shows the reliability test results obtained from SPSS.
Figure 10: Reliability test
Reliability Statistics
Cronbach's Alpha N of Items
0.763 5
4.5.2. Validity of constructs

Table 16 below shows the correlation between the constructs. The higher
correlations between these constructs suggest that they are actually measuring the
45
same thing. However, RN has a lower correlation with other constructs, except with
RL, which could possibly mean that this item is not measuring the same contracts as
others. Therefore, it could make sense to remove this item. Before removing it from
the analysis, it is important to assess the implication of this on the overall Cronbachs
alpha. In order to do this, Item-Total Statistics are carried out.
Table 15: Validity of constructs-correlation analysis
Inter-Item Correlation Matrix

TA RL RN AS EM
TA 1.000 0.485 0.361 0.419 0.718
RL 0.485 1.000 0.732 0.297 0.531
RN 0.361 0.732 1.000 0.235 0.442
AS 0.419 0.297 0.235 1.000 0.365
EM 0.718 0.531 0.442 0.365 1.000
The reliability scale of 0.763 was obtained based on all five dimensions. Thus, Table
12 below shows the value of the Cronbachs alpha after that particular construct is
deleted so as to see if the deleted item is genuine or not. In the event that the
cronbachs alpha for a particular construct increases when an item is deleted, it then
indicates that the item is not genuine in that construct. Therefore, according to the
table, one could see that the removal of all constructs, would result in a lower
Cronbachs alpha, suggesting that the chosen constructs are best suitable for the
study.
Figure 11: Validity of constructs
Item-Total Statistics
Scale Mean if Item Scale Variance if Corrected Item- Cronbach's Alpha

Deleted Item Deleted Total Correlation if Item Deleted
46
TA 0.1299 10.515 0.607 0.726
RL 0.2661 8.134 0.721 0.652
RN 0.3999 6.663 0.585 0.732
AS 0.2476 9.608 0.370 0.779
EM 0.2645 9.938 0.635 0.708
4.7. Factor analysis for the difference between perceptions and expectations
In this particular study, the researcher already knew the number of constructs and as
such, a confirmatory factor analysis was adopted. The KMOs test lies between 0
and 1 with a value of 0 indicating that the sum of partial correlations is large relative
to the sum of correlations. In this case, factor analysis is likely to be irrelevant. On
the other hand, a value close to 1 indicate that the patterns of correlations are
relatively compact and factor analysis yield distinct and reliable factors (Field, 2005).
Table 17 below shows that the KMO value is 0.929, which is statistically significant.
This an indication that factor analysis is relevant for the study.
Table 16: KMO and Bartlett's Test
KMO and Bartlett's Test

Kaiser-Meyer-Olkin Measure of Sampling Adequacy. 0.929
Bartlett's Test of Sphericity Approx. Chi-Square 3797.173
df 231
Sig. 0.000
Table 17 below shows the factor loadings for each item in relation to the various
factors. These values shows the weight and correlation of each item has to a factor
or component. As suggested by Daniel and Berinyuy (2010), all values that were
below 0.45 were taken off from this table as they were not significant for analysis.
According to the table, items from different dimensions are regrouped under the
same factor. However, some items from one dimension are found to fall in more than
factor like RL3, AS4, EM1 and EM3.
This factor analysis proves that SERVQUAL model is not a good measure of service
quality in radiology departments because we expect to see similar items fall under
47
the same factor as an indication that they measure the same thing. In this case, only
items under TA were found to be falling under the same factor.
Table 17: Factor Analysis (Rotated Component Matrix)
Rotated Component Matrixa
Component
1 2 3 4
TA1 0.731
TA2 0.837
TA3 0.784
TA4 0.756
RL1 0.734
RL2 0.717
RL3 0.479 0.626
RL4 0.915
RL5 0.633
RN1 0.848
RN2 0.919
RN3 0.784
RN4 0.821
AS1 0.718
AS2 0.922
AS3 0.770
AS4 0.492 0.635
EM1 0.644 0.528
EM2 0.853
EM3 0.734 0.468
EM4 0.830
EM5 0.807
48
Rotated Component Matrixa
Component
1 2 3 4
Extraction Method: Principal Component Analysis.
Rotation Method: Varimax with Kaiser Normalization.
a. Rotation converged in 5 iterations.
Table 19 below shows that much of the total data fit into the four factors and this is
carried using variance. The total variance percentage accumulated in the four factors
was 79.940% and the factor 1 carries 56.950% of data indicating that most of the
data fits into that factor. The other five factors carry below 10% each and show
relatively low fit of data in the factors.
Table 18: Total Variance Explained

Component
Initial Eigenvalues Extraction Sums of Squared Loadings Total
Total % of Cumulative Total % of Cumulative

Variance % Variance %
1 12.529 56.950 56.950 12.529 56.950 56.950 8.304
2 1.639 7.452 64.402 1.639 7.452 64.402 5.448
3 1.411 6.412 70.815 1.411 6.412 70.815 1.752
4 1.036 4.711 75.525 1.036 4.711 75.525 1.110
5 0.876 3.982 79.508
6 0.684 3.111 82.619
7 0.534 2.427 85.045
8 0.433 1.968 87.014
9 0.360 1.634 88.648
10 0.348 1.583 90.231
49
Component
Initial Eigenvalues Extraction Sums of Squared Loadings Total
Total % of Cumulative Total % of Cumulative

Variance % Variance %
11 0.295 1.340 91.571
12 0.271 1.231 92.802
13 0.260 1.180 93.983
14 0.239 1.085 95.068
15 0.216 0.983 96.051
16 .198 0.899 96.951
17 0.170 0.773 97.724
18 0.135 0.611 98.335
19 0.124 0.561 98.897
20 0.110 0.502 99.398
21 0.073 0.332 99.730
22 0.059 0.270 100.000
Extraction Method: Principal Component Analysis.
4.8. Gap analysis of expectations and perceptions

As highlighted above, expectations and perceptions were both assessed on a
measurement scale of 5-point Likert scale, ranging from 1-strongly disagree to 5-
strongly agree. According to Daniel and Berinyuy (2010), it is generally expected that
customer expectations are exceeded by the perceived level of service as reflected
by the perception scores. When this happens, this will result in a negative gap score
(Perception Expectation). However, it is also common that customers expectations
exceed the actual service perceived and this is an indication that there is always
need for improvement Parasuraman et al. (1988).
50
Table 20 below shows that the highest expectation scores were obtained for
radiology staff promptly meets the customers needs (5.1034), customers feel secure
in using radiology services (4.8916), radiology staff tries to help customers (4.8768)
and radiology services provided meet your overall expectation and are within the
implementation time promised (4.8244). However, the table shows that these scores
are not significantly different from scores of other items, which is an indication that
generally, customers have higher expectations from the New Radiology department.
Furthermore, items rated highest for actual service perceived were: radiology staff
tries to help customers (4.9847), radiology staff are well dressed and neat (4.8100),
radiology staff has adequate knowledge to answer questions from customers
(4.8093), radiology staff performs services and procedures correctly the first time,
not causing rework (4.8090) and radiologys equipment is preserved, modern and of
high quality (4.7950). Just like with expectation, there is no significant difference
between the scores of perceptions. However, the perception scores were generally
lower than expectation scores.
The gap scores are the difference between the perception and expectation scores
with values ranging from -6 to +6. These gap scores measure service quality and
hence customer satisfaction. Therefore, the more perceptions are close to
expectations, the higher the perceived level of quality (Daniel & Berinyuy, 2010). The
table below shows that the highest gap scores were obtained for radiology staff
promptly meets the customers needs (-0.4503), radiologys equipment is preserved,
modern and of high quality (0.2270), radiology services provided meet your overall
expectation and are within the implementation time promised (-0.2164), radiology
staff has adequate knowledge to answer questions from customers (0.2053), and
radiology has proper X-Ray equipment that is visually appealing and pleasant
(0.2025).
51
Table 19: Summary of means of customer's expectations, perceptions and gap scores
Construct Statement Expectation Perception Gap

Score Score Score
Tangibility (TA) TA1 4.5680 4.7950 0.2270
TA2 4.5825 4.7850 0.2025
TA3 4.6748 4.8100 0.1352
TA4 4.6029 4.7876 0.1847
Reliability (RL) RL1 4.5073 4.5505 0.0432
RL2 4.5073 4.6382 0.1309
RL3 4.6341 4.8090 0.1749
RL4 4.8244 4.6080 -0.2164
RL5 4.6010 4.7725 0.1715
Responsiveness (RN) RN1 4.5665 4.5663 -0.0002
RN2 5.1034 4.6531 -0.4503
RN3 4.8768 4.9847 0.1079
RN4 4.6020 4.6718 0.0698
Assurance (AS) AS1 4.6108 4.7077 0.0969
AS2 4.8916 4.7846 -0.1070
AS3 4.6422 4.7449 0.1027
AS4 4.6040 4.8093 0.2053
Empathy (EM) EM1 4.6176 4.7614 0.1438
EM2 4.5419 4.4010 -0.1409
EM3 4.5714 4.6751 0.1037
EM4 4.5468 4.6091 0.0623
EM5 4.5871 4.6462 0.0591
Overall average gap score for all 5 constructs = 0.0594
52
4.9. Correlation analysis
In order to test the hypotheses posed in this study a correlation statistical method
was used to assess possible linear relationships between variables. Wright (1922)
defined correlation as a direct method of assessing a general association between
two variables. Correlation coefficient (r) is the statistic used to measure correlation
between variables. It represents the strength of the assumed linear association
between the variables in question and it takes any dimensionless value between -1
and +1.
Therefore, a correlation coefficient of zero indicates that there is no linear

relationship existing between the two variables. A correlation coefficient of 1 or +1
indicates a perfect linear relationship. A positive coefficient represents that the
variables are positively related. This suggests that as one variable increases, the
other variable also increases. On the other hand, a negative coefficient represents
that the variables are inversely related. This suggests that as one variable increases,
the other variable decreases. The strength of the relationship between variables is
measured between -1 or +1. The closer the value is to -1 or +1, the stronger the
association is between the variables.
A precondition for the use of Pearsons product moment coefficient is that both
variables being studied are normally distributed. However, since the majority of the
variables are not normally distributed, a Spearman rank correlation was used for the
study.
4.9.1. The impact of service quality on customer satisfaction

The correlation analysis was carried to test the following hypotheses:
Ha1: Tangibility has a positive and significant impact on customer

Ha2: Reliability has a positive and significant impact on customer
Ha3: Responsiveness has a positive and significant impact on customer
53
Ha4: Assurance has a positive and significant impact on customer
Ha5: Empathy has a positive and significant impact on customer satisfaction
at radiology department.
Table 20: Correlation analysis
Correlation Sig. Positive &

Hypotheses coefficient (2- significant
(Spearman's tailed) relationshi
rho) p
Tangibility and overall service quality 0.785** 0.00 Yes
Reliability and overall service quality 0.891** 0.00 Yes
Responsiveness and overall service quality 0.840** 0.00 Yes
Assurance and overall service quality 0.796** 0.00 Yes
Empathy and overall service quality 0.832** 0.00 Yes
**. Correlation is significant at the 0.01 level (2-tailed).
The results in Table 21 above revealed that tangibility construct ( = 0.785, p<0.01),
reliability ( = 0.891, p<0.01), responsiveness ( = 0.840, p<0.01), assurance ( =
0.796, p<0.01) and empathy ( = 0.832, p<0.01), had positive effects on overall
service quality and hence customer satisfaction. Thus, the results show that
reliability had the most significant influence on overall service quality followed by
responsiveness.
4.9.2. Customers perceptions of service quality

The correlation analysis in this section was carried out to test the following
hypothesis:
Hb1: customers perceptions are positively and significantly related to service

quality
In this regard, the table below shows that the most customer perceptions that have
positive and significant bearing on service quality were:
RL1 Radiology conducts procedures on time ( = 0.526, p<0.01)
54
RL4 Radiology services provided meet your overall expectation and are within
the implementation time promised ( = 0.465, p<0.01)
RL2 You are prioritised, helped as a customer and your problems are resolved
immediately/ as soon as possible ( = 0.457, p<0.01)
EM2 Radiology operates at times suitable/convenient to all customers ( =
0.448, p<0.01)
RN2 Radiology staff promptly meets the customers needs ( = 0.406, p<0.01)
RN1 Radiology staff informs customers exactly when services will be
executed ( = 0.395, p<0.01)
EM3 Radiology has a team to give personalized attention to customers ( =
0.385, p<0.01).
RN3 Radiology staff tries to help customers ( = 0.378, p<0.01).
Table 21: Correlation analysis
Correlation Sig. (2- Positive &

Hypotheses coefficient tailed) significant
(Spearman's relationship
rho)
TA1 Radiologys equipment is preserved, 0.372** 0.00 Yes
modern and of high quality
TA2 Radiology has proper X-Ray equipment that 0.333** 0.00 Yes
is visually appealing and pleasant
TA3 Radiology staff are well dressed and neat 0.241** 0.01 Yes
TA4 Reports and other documents delivered to 0.240** 0.01 Yes

the customer are easily understood and
professional
RL1 Radiology conducts procedures on time 0.526** 0.00 Yes
RL2 You are prioritised, helped as a customer 0.457** 0.00 Yes

and your problems are resolved immediately/ as
soon as possible.
RL3 Radiology staff performs services and 0.347** 0.00 Yes

procedures correctly the first time, not causing
rework
RL4 Radiology services provided meet your 0.465** 0.00 Yes

overall expectation and are within the
implementation time promised
RL5 Submitted reports, images and information 0.210** 0.004 Yes

about the customer are of good quality and
without errors
55
Correlation Sig. (2- Positive &
Hypotheses coefficient tailed) significant
(Spearman's relationship
rho)
RN1 Radiology staff informs customers exactly 0.395** 0.00 Yes
when services will be executed
RN2 Radiology staff promptly meets the 0.406** 0.00 Yes

customers needs.
RN3 Radiology staff tries to help customers. 0.378** 0.00 Yes
RN4 Radiology staff is available to respond to 0.347** 0.00 Yes

customers requests.
AS1 Radiologys staff is trustworthy. 0.220** 0.002 Yes
AS2 Customers feel secure in using radiology 0.250** 0.000 Yes

services.
AS3 Radiology staff is polite and courteous to 0.340** 0.000 Yes

the customers.
AS4 Radiology staff has adequate knowledge to 0.302** 0.000 Yes

answer questions from customers.
EM1 Radiologys team gives individual attention 0.268** 0.000 Yes

to each customer.
EM2 Radiology operates at times 0.448** 0.000 Yes

suitable/convenient to all customers.
EM3 Radiology has a team to give personalized 0.385** 0.000 Yes

attention to customers.
EM4 Radiology prioritizes the interests of 0.372** 0.000 Yes

customers.
EM5 Radiology team understands the specific 0.359** 0.000 Yes

needs of the customer.
Although a positive and significant association was found between customers

perceptions and service quality, the association was found to be weak for all
variables, except RL1 Radiology conducts procedures on time that had a correlation
coefficient of 0.526. Furthermore, customers perceptions that falls under the
reliability construct were found to have the most influence on service quality, followed
by those that falls under responsiveness and then empathy.
56
Table 22: Overall correlation analysis
Correlation Sig. Positive &

Hypotheses coefficient (2- significant
(Spearman's tailed) relationshi
rho) p
Reliability construct 0.853** 0.00 Yes
Responsiveness construct 0.822** 0.00 Yes
Empathy construct 0.784** 0.00 Yes
4.10. Summary
This chapter provided a presentation of the research results. The chapter analysed,
presented and interpreted the results of the data obtained from the questionnaires
completed. Various statistical methods were employed in order to test different
assumptions and hypothesis posed for the study. Statistical methods applied for the
study include basic descriptive analysis, reliability tests and factors analysis.
57
CHAPTER FIVE
DISCUSSIONS, RECOMMENDATIONS AND CONCLUSIONS
5.1. Introduction
New radiology department in the Gauteng Province of South Africa. Further
purposes of this study were theoretically test of the applicability of the SERVQUAL
model as a measure of service quality, determining the impact of service quality on
customer satisfaction and determine customers perceptions of service quality at
New radiology department. The pervious chapter provided a presentation of the
research results. Therefore, this chapter presents a discussion of the results,
recommendations and conclusions of the study. For easy reading and flow, each
section is guided by the research questions for which the study sort to answer and
these are provided in the next section.
5.2. Discussion of research findings

In Chapter One, the research objectives and questions guiding this research were
presented and these are illustrated in Table 23 below.
58
Table 23: Research objectives and research questions
Research objective (OBJ) Research question (RQ)
OBJ1: To test the applicability of the RQ1: To what extent is the SERVQUAL
SERVQUAL model as a measure of model applicable as a measure of service
service quality at the New radiology quality at the New radiology department?
department.
OBJ2: To determine the impact of RQ2: What is the impact of service

service quality on customer satisfaction quality on customer satisfaction at New
at New radiology department. radiology department?
OBJ3: To determine customers RQ3: What are customers perceptions

perceptions of service quality at New regarding the dimensions that relate to
radiology department. service quality at New radiology
department?
5.2.1. RQ1: To what extent is the SERVQUAL model applicable as a measure

of service quality in the New radiology department?
Factor analysis was carried out to test the modified SERVQUAL model based on the
data collected from the New radiology department. The results revealed that some
items from different constructs load into one single factor and some split into two
separate factors meaning that the SERVQUAL model was not valid for the study.
However, one the tangible construct had all its items falling under the same factor.
Similar to this were the findings by Daniel and Berinyuy (2010), the SERVQUALs
discriminant validity for the study differed from the original study carried out by
Parasuraman et al., (1988). Thus, the study shows lack of support for the
discriminant validity of SERVQUAL as reflected in the factor analysis.
However, the SERVQUAL model provided a satisfactory level of overall reliability of

0.763, indicating that there were no problems with the questionnaire and it was an
appropriate tool of data collection for the designed survey. The obtained overall
reliability score although low, was almost close to the one obtained in Parasurman et
al., (1988) study on SERVQUAL. The validity of the constructs were also tested for
59
which the removal of all constructs would result in a lower Cronbachs alpha,
suggesting that the chosen constructs were best suitable for the study.
The gap score analysis carried out shows that the overall average gap score of
0.0594 all the five constructs. Thus, this score shows that expectation and
perception are almost equal, an indication that service quality at the concerned
radiology department is satisfactory. Although the difference is not that wide,
customers expectations are exceed by what they actually receive from the radiology
department. The observed gap shows that somehow, customers are satisfied with
the quality of serviced they receive from the radiology department.
Much of the satisfaction is derived from the fact that radiologys equipment is
preserved, modern and of high quality; radiology staff has adequate knowledge to
answer questions from customers; and radiology has proper X-Ray equipment that is
visually appealing and pleasant. These variables had a positive gap scores, which
were generally low. However, the sources of dissatisfaction were because the
radiology staff fails to promptly meet the customers needs and the fact that the
radiology services provided does not meet customers overall expectation and are not
within the implementation time as promised. Thus, the gap scores measure service
quality were negative and wider for these variables.
5.2.2. RQ2: What is the impact of service quality on customer satisfaction at

New radiology department?
As indicated above, one of the objectives of the study was to determine the impact of
service quality on customer satisfaction at a New radiology department. This section
presents the empirical findings from the study and the on-going discussion makes
reference to Figure 13 below.
60
Figure 12: The impact of various constructs on customer satisfaction
5.2.2.1. Ha1: Tangibility has a positive and significant impact on customer

Tangibility was the least impactful construct as shown by a correlation coefficient of
0.79. However, the most attributing elements were that the radiology staff are well
dressed and neat and that the radiology department has proper X-Ray equipment
that is visually appealing and pleasant, as perceived by the majority of the
respondents.
Furthermore, the results revealed that New radiology staff are well dressed and neat
and radiologys equipment is preserved, modern and of high quality, with mean
values of 4.8100 and 4.7950, respectively.
5.2.2.2. Ha2: Reliability has a positive and significant impact on customer

The reliability construct had the largest impact on overall service quality as reflected
by the highest correlation coefficient of 0.89. The findings indicated that the two most
important reliability characteristics were that radiology services provided meet
61
customers overall expectation and are within the implementation time promised; and
the radiology staff performs services and procedures correctly the first time, not
causing rework.
The service gap analysis showed that customers have higher perceptions on
radiology staff performing services and procedures correctly the first time, not
causing rework (4.8090) and that submitted reports, images and information about
the customer are of good quality and without errors (4.6010).
Given the above observed perceptions, the results shows that the highest service
quality within the New radiology department was achieved because the radiology
staff performs services and procedures correctly the first time, not causing rework,
with a service quality gap of 0.1749 and the fact that submitted reports, images and
information about the customer are of good quality and without errors, with a service
quality gap of 0.1715. These observed narrow gaps suggest that while the
customers expectations are exceed on these aspects, there service quality is still
lower than expected.
5.2.2.3. Ha3: Responsiveness has a positive and significant impact on

customer satisfaction at a radiology department
The results revealed that responsiveness construct was ranked the second in terms
of its impact on customer satisfaction as reflected by a correlation coefficient of 0.84.
Thus, the two most important perception variables that had a bearing on customer
satisfaction as reflected by the respondents were that the radiology staff tries to help
customers and that the radiology staff is available to respond to customers requests.
The service gap analysis indicated that customers had higher perceptions on New
radiology staff trying to help customers and radiology staff being available to respond
to customers requests, with mean values of 4.9847 and 4.6718, respectively.
5.2.2.4. Ha4: Assurance has a positive and significant impact on customer

satisfaction at a radiology department
Assurance ranked the fourth in terms of its impact on overall service quality as
reflected by a coefficient of 0.80. The most contributory elements were that
62
customers feel secure in using radiology services and that the radiology staff has
The results further shows that the most impactful elements were that the New
radiology staff has adequate knowledge to answer questions from customers and
customers feeling secure in using radiology services, with mean values of 4.8093
and 4.7846, respectively.
5.2.2.5. Ha5: Empathy has a positive and significant impact on customer

satisfaction at radiology department.
Empathy was ranked the third in terms of its impact on overall service quality as
reflected by a coefficient of 0.83. To this end, the two most important contributory
aspects were that the radiologys team gives individual attention to each customer
and that the radiology has a team to give personalized attention to customers.
A similar pattern was also observed through the descriptive analysis which shows
that customers have higher perceptions on radiologys team gives individual
attention to each customer and radiology has a team to give personalized attention
to customers, with mean values of 4.7614 and 4.6751, respectively.
5.2.3. RQ3: What are customers perceptions regarding the dimensions that
relate to service quality at New Radiology department?
The section present the results regarding customers perceptions that relate to
service quality at New Radiology department as guided by the following hypothesis:
Hb1: Customers perceptions are positively and significantly related to service quality
The undergoing discussion will be guided by Figure 14 below:
63
Figure 13: Customers perceptions that relate to service quality
According to the figure above, customer perceptions that have positive and
significant relationship with service were found under three constructs and these
were reliability, responsiveness and empathy. On the whole, reliability was found to
have the strongest relationship with overall service quality as reflected by a high
coefficient value of 0.85. Thus, specific customer perceptions under the reliability
construct were radiology conducts procedures on time (0.53), radiology services
provided meet your overall expectation and are within the implementation time
promised (0.47) and you are prioritized, helped as a customer and your problems are
resolved immediately/ as soon as possible (0.46).
Responsiveness was the second important construct that was found to have a
bearing on overall service quality at New radiology department as shown by a
coefficient of 0.82. Thus, the customer perceptions that fall under this construct were
radiology staff promptly meets the customers needs (0.41), radiology staff informs
customers exactly when services will be executed (0.40) and radiology staff tries to
help customers.
Lastly, the second set of customers perceptions was identified under the empathy
construct, which have correlation coefficient of 0.78. To this end, the perceptions that
64
attributed to this relationship were radiology operates at times suitable/convenient to
all customers (0.45) and radiology has a team to give personalized attention to
customers (0.40).
5.3. Limitations and implications for future research

Care and attention was applied when designing and collecting data so as to maintain
objectivity and accuracy. However, the study was faced by various but few
challenges. Some respondents were not fully cooperating in providing clear answers
and some reluctant to completing in the questionnaire. Despite having explained the
purpose of the study the respondents felt to some extent that the study is an
unnecessary distraction from their responsibilities of the day. In addition, there was a
widespread misconception among the respondents about the whole exercise. Thus,
the respondents thought providing certain information will have negative implication
to them as patients or compromise their jobs as employees at the radiological
department issues were going to implicate them.
Furthermore, this study did not include samples from different or separate
geographical setup/contexts. As such, patients from other locations may have
different perceptions towards customer services offered by radiology departments
due to the different culture, level of education and some other demographic factors.
Despite the fact that the study management to investigate customers perceptions of
service quality using primary data collected from New radiology department in the
Gauteng Province of South Africa, the results cannot be generalised. Therefore,
future research should consider doing a multi-case study covering a number of
geographical locations.
5.4. Recommendations
Based on the research findings, the following recommendations were made:
There were areas of dissatisfaction identified in this study. Therefore, efforts

should be made to ensure that the radiology promptly meet the customers
65
needs and the fact that the radiology services provided meet customers
overall expectation and are within the implementation time as promised.
The observed narrow gaps on the reliability construct suggest that while the
customers expectations are exceed on the aspects, there service quality is
still lower than expected. There the management at New Radiology
department should focus on ensuring that its staff improves on its reliability.
Responsiveness can be improved by focusing on ensuring that the radiology
staff help customers and are available to respond to customers requests.
To improve the level of customer satisfaction and quality of services the
healthcare managers should focus more on the dimensions of Empathy,
Assurance and Tangibility. Empathy can be improved through giving individual
and personalised attention to each customer. Assurance can be enhanced by
further training the New Radiology staff to ensure that they have adequate
knowledge to answer questions from customers.
Customer satisfaction surveys at New Radiology department should be
conducted periodically to timely discover and overcome possible gaps in the
process of providing quality services to the patients.
5.5. Conclusions
New radiology department in the Gauteng Province of South Africa. Further purpose
of this study to theoretically test of the applicability of the SERVQUAL model as a
measure of service quality in radiology departments, determining the impact of
service quality on customer satisfaction at new radiology department and determine
customers perceptions of service quality at New radiology department.
The SERVQUAL model was found not to be valid for the study, with only the tangible
construct having all its items falling under the same factor. However, it should be
noted that this conclusion was based on the discriminant validity of SERVQUAL as
reflected in the factor analysis. The SERVQUAL model provided a satisfactory level
of overall reliability, indicating no problems with the questionnaire. Thus, the
SERVQUAL questionnaire was an appropriate tool of data collection for the designed
survey. The gap analysis score revealed that expectation and perception were
almost equal, an indication that service quality at the concerned radiology
66
department was satisfactory. While the study further confirms the general view in
literature that the SERVQUAL model act as a powerful tool for assessing the quality
of health care services, the researcher strongly feel that the tool needs to be viewed
critically regarding its strength.
Regarding the impact of service quality on customer satisfaction at a New radiology

department, the study found that reliability construct had the largest impact on
overall service quality, with the gap analysis showing that customers have higher
perceptions on radiology staff performing services and procedures correctly the first
time, not causing rework. Responsiveness construct was ranked the second with the
gap analysis revealing that customers had higher perceptions on New radiology staff
tries to help customers. The least ranked construct was tangibility.
Pertaining the relationship between perceptions and service quality at New

Radiology department, the study found customer perceptions to have positive and
significant influence on three service quality constructs and these were reliability,
responsiveness and empathy. The study concluded by providing a number of
recommendations in order to improve the level of customer satisfaction at New
Radiology department.
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An investigation into customers perception of service quality at New

Radiology department in the Gauteng Province of South Africa

The SERVQUAL model provided a satisfactory level of overall reliability, indicating

Regarding the impact of service quality on customer satisfaction at a new radiology

Pertaining the relationship between perceptions and service quality at a new

CHAPTER ONE: INTRODUCTION AND BACKGROUND..........................................1

1.1. Introduction and background...........................................................................1

1.2. Problem Statement..........................................................................................2

1.4. Aim of the Study..............................................................................................3

1.5. Objectives of the Study...................................................................................3

1.6. Research questions.........................................................................................4

1.7. Hypotheses of the study..................................................................................4

1.8. An outline of the Study....................................................................................4

CHAPTER TWO: LITERATURE REVIEW....................................................................6

2.2. The service concept........................................................................................7

2.3. The quality concept.........................................................................................9

2.4. The service quality concept...........................................................................10

2.5. Customer satisfaction....................................................................................11

2.6. Factors that affect customer satisfaction in the health sector.......................12

2.7. Customers Expectations compared to Perceptions.....................................13

2.8. Relationship between service quality and customer satisfaction..................13

2.9. The Service Quality Models..........................................................................14

2.10. The SERVQUAL model..............................................................................14

2.11. Ways to improve service delivery at Radiology department......................22

2.12. The proposed analytical model of the study..............................................24

CHAPTER THREE: RESEARCH METHODOLOGY...Error! Bookmark not defined.

3.1. Introduction.....................................................Error! Bookmark not defined.

3.2. Research methodology...................................Error! Bookmark not defined.

3.3. Research design.............................................Error! Bookmark not defined.

3.4. Research population.......................................Error! Bookmark not defined.

3.5. Sampling strategy...........................................Error! Bookmark not defined.

3.7. Data analysis..................................................Error! Bookmark not defined.

3.8. Pilot study.......................................................Error! Bookmark not defined.

3.9. Validity and Reliability.....................................Error! Bookmark not defined.

3.10. Ethical Consideration...................................Error! Bookmark not defined.

3.11. Summary.....................................................Error! Bookmark not defined.

RESULTS AND INTERPRETATION OF FINDINGS..................................................26

4.2. Empirical descriptions...................................................................................27

4.3. Demographic information of the respondents...............................................30

4.4. Descriptive analysis.......................................................................................34

4.5. Descriptive statistics for the five constructs..................................................44

4.6. Reliability tests and validity of constructs......................................................45

4.8. Gap analysis of expectations and perceptions.............................................51

4.9. Correlation analysis.......................................................................................54

DISCUSSIONS, RECOMMENDATIONS AND CONCLUSIONS...............................60

5.2. Discussion of research findings....................................................................60

5.3. Limitations and implications for future research............................................67

APPENDIX B: Consent Form.......................................Error! Bookmark not defined.

APPENDIX C: Research Questionnaire......................Error! Bookmark not defined.

1.1. Introduction and background

Ojo (2010) elaborates that customer satisfaction is directly proportional to service

1.3. Significance of the Study

1.4. Aim of the Study

1.5. Objectives of the Study

To test the applicability of the SERVQUAL model as a measure of service

1.6. Research questions

1.7. Hypotheses of the study

Ha1: Tangibility has a positive and significant impact on customer

Hb1: Customers perceptions are positively and significantly related to service

1.8. An outline of the Study

1.8.1. Chapter One: Introduction

1.8.3. Chapter Three: Research Methodology

1.8.4. Chapter Four: Results, and Interpretation of Findings