Ethnographic Observation of a Sub-Culture - Research Paper Example

Ethnographic Observation of a Sub-Culture Introduction Intense service quality management is absolutely essential to the success of an organization. Quality relates to conforming to the requirements of customers and their expectations, and customer satisfaction occurs only when these expectations are met. Evidently, stronger methods or approaches of managing service quality result in improved customer focus, greater retention and loyalty. Rust and Subramanian (1992) also link customer satisfaction to quality and argue that quality service has a direct effect on market share and customer retention. In addition, Athanassopoulos (2000) explains satisfaction as a predetermining condition or antecedent of customer retention. This paper explains the concept of functional quality and how it applies to a hospital. Functional Quality Gronroos (1985) mentions two types of qualities that are important for service-providing industries. These are functional quality and technical quality. These are also the standpoints from which the quality of a service of a company can be evaluated. In the hospital context, functional quality can be defined as the manner in which services are delivered to the patient in the healthcare organization. This quality evaluation standpoint is more subjective in that it mainly focuses on how technical quality is being delivered to the customers. This concept is therefore unquantifiable. On the contrary, technical quality focuses on what is being done; the standard of the output and thus it is relatively quantifiable. In a hospital environment for example, it is defined by the technical accuracy of the procedures and diagnoses. It can also be explained as the extent to which the physically measurable attributes of medical procedures in a hospital meet the professionally acceptable standards. Application of the Concept of Functional Quality to a hospital A focus on functional quality in a hospital simply implies an evaluation of the patient interaction with the healthcare system in terms of their experience right from reception, diagnosis, treatment and even hospitalization. Although it has been a challenge, the definition and measurement of service quality is of great importance to health care organizations. This is because service quality is more critical to service providing industries as compared to manufacturing and other types of industries. The functional quality of a hospital can be measured using a service quality measurement scale (SERVQUAL). This scale was developed from a marketing perspective and its purpose is to provide a tool for measuring service quality in organizations that would apply it across a large range of services. The developers of the scale agree that although each service industry has some aspects that are unique to it, there are five identifiable dimensions of service quality that are generally applicable to all service-providing organizations. These dimensions are tangibles, reliability, responsiveness, assurance and empathy (Parasuraman, Zeithaml, and Berry 1988). Tangibles refer to equipment, physical facilities and the appearance of personnel. A hospital can, therefore, be said to have a high functional quality if it has these components both in sufficiency and in terms of high quality. For example, enough high quality machines, enough and clean wards, and employees who are neat and clean all the time are part of high functional quality. Reliability is key in determining patient perceptions and a hospital can be rated as being reliable if it has the ability to deliver the promised services accurately and independently. Patients do not like it when they receive constant referrals because it is costly and shifting time could risk their lives. High reliability, therefore, increases customer satisfaction and as Ovenden (1995) explains, keeping customers happy fades away competition. This is equally achieved through responsiveness. The responsiveness of a hospital can be defined as the willingness to help patients and provide prompt service. Spreng et al. (1995) explain that reliability directly influences patient willingness to come back to the hospital another time. Assurance in a hospital setting refers to the knowledge and courtesy of the employees of a hospital and their ability to inspire confidence and trust among patients. If this assurance lacks in a hospital, patients lose trust and confidence in it. According to Lehtinen and Lehtine (1982), how a hospital handles patients is equally important to how it treats them. Empathy is, therefore, an important aspect of quality service in hospitals. This requires that its staff should be caring and provide individualized attention to the patients. Hansemark and Albinsson (2004) conducted a study on how the employees of an organization experience the concepts of customer retention and satisfaction. From the study, seven ways to recognize and/or enhance customer satisfaction were discovered. These were included relationship, confidence, dialogue, service, feeling and complaints. These indicate that strategies for boosting satisfaction and retention were the same. Based on these results, a hospital can be said to have a high functional quality if the hospital and its staff normally build good relationships with the patients. According Zeithaml, Berry, and Parasuraman (1988), the intangible nature of services requires that most of them are produced and consumed simultaneously and this characteristic increases the importance of the consumer-provider relationship. Building a good rapport with the patients is important for winning their trust, confidence and cooperation. A hospital should, therefore, make constant review of its relationship with customers. The hospital should also encourage its staff to maintain good dialogue with the patients so as to encourage them to open up to facilitate diagnosis and treatment. The hospital should also be in a position to demonstrate a quick response to the complaints of patients, for example on visiting hours, consultation procedures, room lighting among others. The Relevance of Functional Quality to the Hospital Technical quality is the chief determinant of quality of healthcare organizations and the Joint Commission for Accreditation of Health Care Organizations (1987) has proposed various techniques for evaluating technical quality in healthcare organizations. However, this information is generally inaccessible or not available to the consuming public. Bopp (1990) explains that knowledge of the technical quality of services offered by healthcare organizations remains within the purview of healthcare administrators and professionals. This means that patients are often not able to accurately assess a hospital’s technical quality and this makes functional quality the primary determinant of the perceptions of patients regarding the quality of the organization (Donabedian 1980, 1982; Kovner and Smits 1978). According to Bolton and Drew (1988) and Zeithaml (1988), there is also growing evidence indicating that this perceived quality among patients is the single most critical variable influencing the perceptions of consumers on healthcare value. Saxena (2008) explains that in manufacturing industries, the manufacturing and engineering processes can be tailored consistently to make sure the quality of products produced is high. However, services are intangible. They are normally delivered and consumed throughout the process of production. Customers, therefore, have a variety of dimensions through which they can evaluate service quality. This is unlike service providing organizations, like hospitals. A hospital is a series of interlinked processes whose end result is one or more outputs. In this industry, service is the direct output and quality represents the subjective evaluation of an individual patient regarding an output/service given and their personal interactions that occurred as the output was being delivered to them. Quality in a hospital is therefore rooted on the individual patient expectations which are determined by the individual's needs and past experiences. This means they not only make consideration of the hospital’s technical quality but also its functional quality. For example, was the hospital environment clean? Were the nurses informative and caring? Were services delivered quickly, with caution, cheerfully and with an understanding of the needs and preferences of individual patient? (Brent and James, 1989). Ideas to Improve the Relevance of Functional Quality The delivery of healthcare is a complex process and research has shown that systems and human beings are imperfect information processors. This means that regardless of human attention or intention, mistakes are prone to occur as complexity increases. A hospital should, therefore, ensure that it continuously monitors its healthcare processes in order to detect any errors and correct them on timely basis before damage occurs. It is obvious that inappropriate diagnosis can lead to unnecessary treatment and hospitalization. The hospital should, therefore, ensure a high standard of diagnosis procedures to avoid inappropriate interventions which could damage patients. A hospital should ensure that it always maintains high standards of service all the times, both to new and regular customers. The most important question for this is whether the hospital is certain of doing the right thing in the right way for each patient for the first time and at all times. The hospital should also be more careful on selecting the manner of treatment. Different procedure can lead to the same result. The hospital should therefore focus on these which are less expensive to minimize customer complaints on the use of expensive procedures, especially when patients know of cheaper but effective alternatives. Concussion This paper clearly indicates that it is only through the alignment of its activities to the expectations of the customers that an organization can claim to be on its track towards achieving its vision. Vision in this respect relates to customer value and customer focus - a vision that energizes the organization and its people to accomplish extraordinary things. It is, therefore, very important that various organizations get to know the expectations of their customers and strive to meet them. At the same time, organizations should not over focus on any concept of managing quality service at the expense of the other, for example, functional quality over technical quality. This is because quality is a sum of technical quality, functional quality and customer expectations. Organizations must, therefore, strive to ensure a balanced focus on the two dimensions of quality. References Athanassopoulos, A. (2000), "Customer satisfaction cues to support market segmentation and explain switching behavior", Journal of Business Research, 47(3), 191-207. Bolton, R. and Drew, J. (1988). A Model of Perceived Service Value. Technical Note 88-420.1. Waltham, MA. GTE Laboratories. Bopp, K. (1990). How Patients Evaluate the Quality of Ambulatory Medical Encounters: A Marketing Perspective. Journal of Health Care Marketing, 10(1), 6-15. Brent, C. and James, M. (1989). QUALITY MANAGEMENT FOR HEALTH CARE DELIVERY. Chicago, Illinois. The Hospital Research and Educational Trust. Retrieved from http://intermountainhealthcare.org/qualityandresearch/institute/Documents/articles_qmmp.pdf. Donabedian, A. (1980). Explorations in Quality Assessment and Monitoring: The Definition of Quality and Approaches to Its Assessment. Ann Arbor, MI. Health Administration Press. Gronroos, C. (1984). A Service Quality Model and Its Marketing Implications. European Journal of Marketing, 18 (4), 36-44. Hansemark, O. and Albinsson, M. (2004). Customer satisfaction and retention: the experiences of individual employees. Managing Service Quality, 14(1) pp. 40-57. Joint Commission for Accreditation of Healthcare Organizations. (1987). Agenda for Change (Update).Newsletter, 1 (1), 1-4. Kovner, A. and Smits, H. (1978): Point of View: Consumer Expectations ofAmbulatory Care. Health Care Management Review, 3 (1), 69-75. Lehtinen, J. and Lehtinen, 0. (1982). Service Quality: A Study of Quality Dimensions. Helsinki. Service Management Institute. Ovenden, A. (1995). Keep your customers happy and your competition will slowly fade away. The TQM Magazine, 7 (1), 46-49. Rust, R. and Subramanian, B. (1992). Making complaints a management tool. Marketing Management, 1 (3), 41-45. Saxena, S (2008). Determining Components of Service Quality. Retrieved from http://www.conexl.com/docs/101/QOSOFFSHORE.pdf Spreng, R. Harrell, G. and Mackoy, R. (1995). Service recovery: impact on satisfaction and intentions. Journal of Services Marketing. 9 (1), 15-23. Zeithaml, V. (1988). Consumer Perceptions of Price, Quality, and Value: A Means-End Model and Synthesis of Evidence. Journal of Marketing, 52(July), 2-22. Read More