The Effect of Perceived Service Quality and Expectation on Customer Satisfaction
Thi Le Ha Nguyen1* and Paulo Moreira J2s
1Department of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
2International Healthcare Management Research & Development Centre, Shandong Provincial Qianfoshan Hospital, China
Submission:July 07, 2023; Published:July 31, 2023
*Corresponding author:Ha Nguyen, Department of Medicine and Pharmacy, Vietnam National University, Hanoi, Email: [email protected]
How to cite this article:Thi Le Ha Nguyen, Paulo Moreira J. The Effect of Perceived Service Quality and Expectation on Customer Satisfaction. J Tumor Med Prev. 2023; 4(1): 555630. DOI: 10.19080/ JTMP.2023.07.555630
Objective: Customer satisfaction is a useful tool to measure the service quality of the service firm. Service quality was measured by perceived service quality and expectation through the insight of the client. The purpose of this paper examines the relationships between various factors in the integrated model which includes perceived service quality, patient expectation, patient satisfaction, and patient loyalty. Methods: The study was carried out at a tertiary-level hospital in Vietnam. A self-administration questionnaire was delivered to inpatients who were treated in April 2018. The Statistical Package of Social Sciences version 25.0 and Amos 25.0 for structural equation modeling were used to perform the analysis statistic. Findings: The results presented that patient expectation and perceived service quality have a positive influence on patient satisfaction; patient expectation on perceived service quality and patient satisfaction on patient loyalty. Originality: Findings indicated that expectation and perceived quality are factors directly effect to satisfaction. Practice implications: Our research has implications contributed to policymakers when considered expectation and perceived quality that improving customer satisfaction and maintain loyalty.
Keywords: Perceived Service Quality; Expectation; Satisfaction; Loyalty
Nowadays, service quality has been a key factor in the competitive environment of the service industry Jiang et al , Chakravarty . Thus, assessing consumer satisfaction was used to measure and evaluate the service quality of service firms Chen et al , Kim et al. . Our study aims to investigate the influence of perceived service quality and expectations related to customer satisfaction and loyalty. Client satisfaction is a useful metric to measure service quality in a service company Quintana et al. . Studies have demonstrated that customer satisfaction is determined by perceived quality and expectations of service quality Lin et al. ; Naqavi and Baneshi  Perceived quality plays a mediating role between emotional service expectation and user satisfaction Jeong et al. . Furthermore, perceived quality is a mediating factor in expectation and loyalty.
Therefore, perceived quality and expectation of various parts of service quality are the necessary factors in determining customer satisfaction Shahsavar and Sudzina  willingness to re-utilize Jung et al. . The measurement of satisfaction focuses on a gap of relationship between perceived quality and client expectations with aspects of service. Perceived service quality has a direct effect on consumer satisfaction and affects indirectly customer loyalty through satisfaction plays a mediator factor. Client satisfaction is a mediating factor in the relationship between service quality and loyalty. Thus, customer satisfaction was an indispensable factor when measuring service quality of providers.
In our research model include four factors of perceived service quality, patient expectation, patient satisfaction, and patient
loyalty. In which perceived service quality and patient expectation
factors consider tangibility, reliability, and responsiveness. Patient
satisfaction and patient loyalty measure service quality. These
factors were increasing our knowledge when considering factors
related to satisfaction and maintain customer loyalty..
In the literature review part, the author reviews the related
references to the scope of this paper. The purpose of the paper was
to examine perceived service quality and expectations related to
customer satisfaction and loyalty.
Perceived service quality (PSQ)
Service quality of providers was measured by a gap
relationship between perceived quality and customer expectation.
Aspects of service quality were assessed including tangibility
consider the physical facilities, equipment, personnel and
communication materials perceived by the five human senses;
Reliability mention to the firm’s ability to deliver a safe and reliable
service; Responsiveness consist staff’ willingness to cooperate
with and assist the customer; Empathy refers staff’s ability to
understand the customer’s mood and feelings; and Assurance
focuses on to the ability of a firm to instill a sense of competence
and confidence in their customer. A close relationship between
perceived quality and expectation was supported by. Perceived
quality directly influences customer satisfaction. It is a core
element in maintaining customer loyalty and related to indirect to
customer loyalty through customer satisfaction is a mediator role.
Satisfaction is a predictor of repurchase intention.
Patient Expectation (PE)
Measurement and evaluation of service quality are based on
assessing customer expectations and perceived quality of aspects
of service. Expectations are related to satisfaction Mattos et al. .
The fulfillment of consumer expectations increased satisfaction
Kumar et al. . Moreover, perceived quality is closely related
to client expectations. Therefore, improving perceived quality
increased customer satisfaction and word-of-mouth Alrwashdeh
et al. . Customer expectation and perceived service quality are
predictor factors of loyalty. Expectation has a positive influence on
healthcare outcomes Haanstra et al. , and indirectly to loyalty
through perceived quality is a mediator factor.
Patient Satisfaction (PS)
Evaluating customer satisfaction is a tool to measure the
service quality of the provider. Service quality has positively
influenced user satisfaction Ho et al. . Therefore, improving
the service quality is to increase customer satisfaction and loyalty.
Measures of service quality were based on the assessment of a
gap relationship between expectation and perceived quality of
parts of service quality. s-quality service is key to a competitive
environment. Measurement of service quality focuses on
customer satisfaction. Customer satisfaction is a mediator factor
of perceived quality and word-of-mouth. It is a predictor element
of loyalty. Customer satisfaction improved by meeting fulfillment
users’ expectations of service quality. Thus, customer satisfaction
is an indispensable element when evaluating service quality of
service firm Rizvi et al. .
Patient loyalty (PL)
Service quality directly influences satisfaction and customer
loyalty Jameel et al. . Increasing perceived quality related
to willingness re-buy of the service organization. Customer
satisfaction and happiness can lead to a sense of loyalty Zhong
and Moon . Expectation and perceived quality related to
satisfaction and loyalty. Perceived quality is a mediator role of
expectation and loyalty. The fulfillment of customer demands on
service quality that contributes to customer satisfaction. Perceive
service quality has a positive influence on satisfaction and wordof-
mouth Lee et al. .
Emotional service expectations related to perceived quality
and loyalty. Measurement service quality based on perceived
quality and expectation of aspects of service Aghamolaei et al. .
A relationship between perceived quality and expectations was
supported by Chakravarty (2011). Customer expectations were
higher than PSQ. Meeting expectations increases satisfaction. The
patient’s expectation has a positive influence on care outcome.
Perceived quality is a mediator role of expectation and loyalty.
Based on these discussions, the study gives hypothesis: H1:
Patient expectation (PE) has a positive effect on Perceived service
Customer expectations have a close relationship to
satisfaction. Expectations impact on perceived service quality
and perceived quality directly affect on loyalty Measurement and
evaluation of service quality based on a gap in the relationship
between customer expectations and PSQ. The key predictors
of satisfaction and perceived quality of healthcare quality were
overall satisfaction and meeting expectations Abidova et al. .
Satisfaction is a mediator factor of perceived quality and word
of mouth. Moreover, the meeting of consumers’ satisfaction and
expectations has a significant influence on service outcomes. Thus,
the hypothesis of the study is proposed: H2: Patient expectation
(PE) has a significant influence on patient satisfaction (PS).
The perceived service quality remarkable affects customer
satisfaction. There is a close relationship identified between
perceived quality and expectation that expectation is higher
than perceived quality. Therefore, improving perceived quality
increased satisfaction. Consumer satisfaction is a mediating
role of perceived quality and loyalty Zhou et al. . Moreover,
the relationship between perceived quality and expectations
was considered to assess service quality and customer loyalty.
Measurement and evaluation of service quality by insights into
the gap between perceived quality and expectations. Thus,
expectations and perceived quality related to satisfaction.
Satisfaction is a necessary tool when evaluating the service quality
of service providers. Considering these findings, we propose the
following hypothesis: H3: Perceived service quality (PSQ) has a
significant effect on patient satisfaction (PS).
In the service industry, the service organization focuses
on customer satisfaction and loyalty are regarded as the key
factor of the competition environment. Customer satisfaction
has met the needs and expectations and or even exceeded the
expectations of users and such delight propels them to the
product Mkpojiogu and Hashim . Thus, customer satisfaction
serves as a tool that measures and evaluates the service quality
of providers by measuring a gap relationship between perceived
quality and expectation with parts of the service. Improved
perceived quality and expectations related to satisfaction and
loyalty. Therefore, service quality has a remarkable influence on
consumer satisfaction and loyalty Jameel et al. . Improving the
quality of care to develop customer satisfaction Yakob and Ncama
. Based on these observations, the following hypothesis is
proposed: H4: Patient satisfaction (PS) has a moderate influence
on patient loyalty (PL).
The study recruited members who assist in collecting data.
They were trained for one day on the purpose of the study before
collecting data. The study participants have signed a research
agreement under the supervision of research assistance members.
The research assistants confirm that completed as required after
participants have completed the questionnaire. A sample size of at
least 500 respondents based on the work of Wolf et al.  for the
suit of the structural equation modeling. The study was carried
out of the National Cancer hospital in Ha Noi, Viet Nam. A total
of 550 questionnaires were distributed to participants who were
randomly selected from inpatient lists of 39 clinical departments
treating around 2,500 inpatients per day of the research hospital.
After screening the responded questionnaires, those completed by
516 respondents were used for analysis in this study.
The instrument of study was a constructed questionnaire
of 40 questions consisting of two main parts. Firstly, the sociodemographic
characteristics mention six questions related to
age, sex, marital status, educational level, occupation, and method
of paying hospital fees. Secondly, 34 questions concentrate on
factors of Perceive service quality (PSQ), Patient expectation
(PE), Patient satisfaction (PS), and Patient loyalty (PL). Fourteen
questions concerned PSQ factors, including five questions
concerning tangibility (PSQ1–PSQ5), five questions related to
reliability (PSQ6-PSQ10), and four questions about relationship
responsiveness (PSQ11-PSQ14). These questions were based
on previous research that modified for compatibility with the
research hospital context. Similarly, the relationship of the PE
factor was referred to like fourteen questions comprising five
refers tangibility (PE15-PE19), five concerning reliabilities
(PE20–PE24), and four related to responsiveness (PE25-PE28).
Followed by the PS factor was mentioned by three questions
(PS29–PS31). Finally, the PL factor included three questions
(PL32-PL34). Questions were measured by using a Likert scale
ranging from one to five. The data set was analyzed using the SPSS
(version 25.0) statistical software. Next, the confirmatory factor
analysis was used to identify the interactions and correlation
among the latent variables of the model. Finally, the structural
equation modeling (SEM) tests the validity of the proposed model
by using the Amos 25.0 SEM program.
A Likert scale was used to assess questions in this study,
ranging from ‘very strongly agree’ (5) to ‘very strongly disagree’
(1). The SPSS 25.0 program was analyzed for this scale. Cronbach’s
alpha coefficient was used to evaluate the construct reliability and
validity of the scale which considering the extent to which a set
of indicators consistently and stably reflects a given construct.
Findings supported in (Table 1). As (Table 1), the Cronbach’s
alpha value of the Perceived service quality was between 0.845
and 0.873, the Patient expectation factor was around 0.939 and
0.955, Patient satisfaction was 0.792, and that of patient loyalty
was 0.800. It showed that Cronbach’s alpha values were over
0.70 for all latent variables. This proved that the scales were
adequately internally consistent. Moreover, there are 2 items
in the reliability of patient expectation factor rejected to ensure
sufficient reliability of the scales.
The confirmatory factor analysis (CFA)
Our study used the CFA to examine structural equation
modeling (SEM) which assesses the construct and the correct
assignment of variables. The research model has assessed by
standardized regression weights, the composite reliability (CR),
and the average variance extracted (AVE), presenting in (Table 2).
In Table 2, the standardized coefficient of items was between 0.62
and 0.93 [cut- off=0.5]. The AVE values were from 0.51 and 0.67
[cut- off= 0.5], indicating high discriminant validity. The CR values
were around 0.80 to 0.97 for all latent variables [cut- off= 0.7],
showing adequate internal consistency. The findings indicated
that our model was supported.
Model Goodness-of-fit was supported by the ratio of χ2 to the
degrees of freedom of 2.783 (P = 0.000) and the fit indices include
good fit to the data such as [GFI]= 0.875 [cut-off = 0.80]; normalized
fit index [NFI] = 0.918 [requirement = value of 0–1]; root mean
squared error of approximation [RMSEA] = 0.059 [requirement
= value from 0.05–0.08]; comparative fit index [CFI] = 0.946;
Adjusted goodness of fit index [AGFI] = 0.849 [cut-off=0.80]; and
Tucker-Lewis index [TLI] = 0.938 [cut-off = 0.9] (Table 2). The
results indicated that our research model was supported met the
reliability and validity requirements of the scales.
All hypotheses of our study presented in (Table 3) show the
path of impact on factors, standardized coefficients, and significant
(sig.) at value less 0.05. Hypothesis H1: PE has a positive effect on
PSQ by the path coefficient (PE---> PSQ) was statistically significant
at 0.441 (p = 0.001), showing that this hypothesis was supported.
This proves PE is related to PSQ. Similarly, prior studies have
supported a noticeable relationship between perceived quality
and expectations on aspects of service quality (Chakravarty,
2011; Naqavi and Baneshi, 2014). Perceived quality is a mediating
factor of expectation and consumer satisfaction Jeong et al. 
and loyalty Lin et al. . Thus, service providers should consider
expectation and perceived quality are the key factors of increased
satisfaction and maintain customer loyalty. Hypothesis H2: Patient
expectation (PE) on patient satisfaction (PS) supported by the path
coefficient (PE--->PS) for H2 was statistically significant at 0.132
(p = 0.002), indicating that this hypothesis was accepted, which
PE has a remarkable effect to PS. This hypothesis was supported.
Also, the work of Haanstra et al.  supported that customer
expectation have a close relationship to satisfaction. Customer
expectation related to satisfaction through perceived quality plays
as a mediator role (Jeong et al., 2019). Moreover, measurement
and evaluation of client satisfaction based on parts of service
quality assess by a gap of perceived quality and expectation.
Hypothesis H3: Perceived service quality (PSQ) on patient
satisfaction (PS) was shown by the coefficient of the path (PSQ--->
PS) at 0.759 statistical significance (p = 0.001), indicating PSQ has
a positive effect on PS. Finding consistent with previous research
of supported that satisfaction is a mediating factor of perceived
quality and word of mouth. Perceived quality has directly related
to customer satisfaction, and loyalty or indirectly related to
loyalty through client satisfaction plays a mediator role. Our study
contributed to policymakers when strategy plan considering
improving perceived quality to increase customer satisfaction and
Hypothesis H4: Patient satisfaction (PS) on patient loyalty
(PL) was supported by the coefficient of the path (PS--->PL) with
a statistical significance of 0.700 (p = 0.001), suggested that the
hypothesis was supported that PS related to PL. Similarly with
prior research, satisfaction related to word-of-mouth and the
repurchase intention or customer satisfaction is a mediator role
between the relationship between service quality and loyalty.
Implications for practice Our study has implications for the service
providers, managers, and policymakers when considering factors
that direct influence on customer satisfaction including perceived
quality and expectation. These factors contribute to developing
the strategic plan in improving service quality, increasing
satisfaction, and maintaining client loyalty, creating profitability,
and the sustainability value of the firm.
This paper investigates the influence of perceived service
quality (PSQ), the patient expectation (PE) on patient satisfaction
(PS), and patient loyalty (PL). A self-administration questionnaire
was distributed inpatient who treated at a tertiary-level hospital
in Vietnam in April 2018. A total of 516 documents were used to
analyze this study. The data analysis was used by SPSS version
25.0 software and Amos 25.0 program. The confirmatory factor
analysis (CFA) was used to confirm the dimensionality and
convergent and discriminant validity of the model and used
structural equation modeling (SEM) to test the validity of the
proposed hypotheses model. Findings presented that PE and
PSQ have a positive influence on PS; PE on PSQ; and PS on PL.
Moreover, the results showed that PE and PSQ are factors that
directly influence satisfaction.
Therefore, service organizations should concentrate on PE
and PSQ to increase satisfaction and maintain loyalty. PSQ and
PE factor and in relation to various aspects of service quality,
including tangibility, reliability, and responsiveness to ensure
user satisfaction. Policymakers maybe consider these factors
in their strategic planning with the aim of improving consumer
satisfaction and loyalty. Furthermore, the study also enhances our
understanding of how the various aspects of service quality relate
to consumer satisfaction.
This study has limited only focused on inpatients. Thus, the
views of outpatients were not measured. For further research to
holistically measure of service quality by both outpatients and
inpatients. Moreover, our study was carried out at the public
hospital. Further research should consider both private hospitals
and public hospitals for an overall view.
Jeong JY, Park J, Hyun H (2019) The role of emotional service expectation toward perceived quality and satisfaction: moderating effects of deep acting and surface acting. Frontiers in Psychology 10(321): 1-11.