Evaluating the Influence of Service Quality and Image of the Brand on Patient Experience: A Comprehensive Review
Anisha Biswas
Assistant Professor,
Department of Hospital Management
Brainware University, Kolkata (India)
Dr. Saileswar Ghosh
Professor and HOD,
Department of Management
Brainware University, Kolkata (India)
Dr. Indrajit Ghosal
Associate Professor & Research Coordinator,
Department of Management
Brainware University, Kolkata (India)
Corresponding Author
ghosal.m1981@gmail.com
Abstract
This thorough analysis has examined the complicated relationship in the healthcare industry between patient experience, brand image, and service quality. The inclusion criteria focused on studies addressing SQ (service quality), image of brand, &patient experience published in last eight years. The findings indicate that high service quality enhances patient experiences. Additionally, a strong brand image fosters patient trust and the perceived reliability of healthcare facilities. In order to maximise patient satisfying experiences and loyalty via experience, the debate emphasises the synergistic influence of these aspects and underscores the necessity for healthcare providers to excel in both SQ and image of brand.
Method- A literature search was conducted in July 2024 using databases like Sage Journals, Emerald, Elsevier, Research Gate, and Taylor & Francis. Fifty publications were selected based on relevance to the research goal, including authorship, publication year, study population, instruments, and major findings.
Result- High service quality, including responsiveness, reliability, and empathy, significantly improves patient experiences. A strong brand image boosts trust and perceived reliability, resulting in better patient experiences when combined with these factors.
Discussion -This study highlights the importance of high service quality and a strong Brand Image in enhancing patient gratification and allegiance. It suggests healthcare providers should invest in both areas for a robust patient experience.
Keywords: Service quality, Perceived Service Quality, Brand Image, Patient experience.
Introduction
The need for better medical treatment to enhance lives and the shift in living standards has increased interest in hospital services in recent years. Services differ from things due to their intangibility, diversity, perishability, and segregation (Zeithaml et al., 1985). Since healthcare services are intangible goods, it isn't easy to quantify them. In addition, attributes like simultaneity, heterogeneity, and intangibility make it challenging to gauge the quality of healthcare services (Mosadeghrad 2013; Endeshaw 2020). The concept that services differ from products drives the need for new thinking, methodologies, and strategies in the service industry (Berry and Parasuraman, 1993). However, in both wealthy and developing nations, healthcare is the service that is expanding fastest growing (Dey et al.,2006). This sector's service approach prioritises patient-caregiver interactions (Spath,2009) and any misjudgements or errors by healthcare workers can be deadly for patients. Improving perceived service quality leads to more satisfied clients. Service quality is an approach that prioritises continuous improvement of all processes and functions, including work stages. Quality is defined as understanding customer desires and translating them into specifications that meet their needs (Anil &Satish, 2019). Emphasized by Agyapong and Kwateng (2018) the need of health institutions identifying factors that impact customer satisfaction to raise the standards of services for patients. Research of Subagja and Susanto's (2019) patient’s good experience is influenced by service quality. Also, a patient's loyalty is influenced by variables such as service quality, customer happiness, and business image. Nonetheless, several researchers have expressed concern for SERVQUAL (Teas & Kenneth, 1993, Babakus&Mangold, 1992; Cronin & Taylor, 1992, 1994). Research on the impression of brand image and perceived quality on before-service consumption remains limited (Riezebos, 2003; Cham et al., 2016). The Brand image reflects service features and influences patients' choice decisions (Hyder et al., 2019; AlSaleh, 2019). Service quality alone might not be enough to sustain a longstanding association between patients and the hospital since people are growing increasingly receptive to competitive innovations and knowledgeable about healthcare services (Gaur et al., 2011). Whereas, Brand image is an important notion in Brand creation as it reflects consumers' thoughts and sentiments towards the business and their overall perception (Wu, 2011). According to Qomariah's (2018) research, visitor happiness is influenced by Product features, brand image, and consumer value. Visitor loyalty is influenced by Brand image, product qualities, and satisfaction, rather than consumer value. Firman et al. (2020), effective relationship management with customers generates worth to patients. On the other side, expectations include getting information on pain treatment, returning to regular life, and prognosis/prevention (Turner et al., 1998; Sanchez-Menegay et al., 1994). The purpose of this review paper is to comprehensively evaluate the influence of service excellence and brand image on patient experience, aiming to determine important elements and interactions that influence patient expectations and perception in healthcare settings. Ultimately, the findings will contribute to developing strategies to enhance service quality and strengthen Brand image, fostering a more positive and effective patient experience.
Background & Context
In today's competitive healthcare climate, knowing the elements that drive patient experience is critical for healthcare providers seeking to increase consumer happiness and loyalty. SQ and BI are two crucial elements that affect patient perceptions and experiences. Service quality includes characteristics such as healthcare personnel's responsiveness, dependability, and empathy, whereas Brand image represents a healthcare institution's entire reputation and perceived worth. Previous research has demonstrated that great service quality leads to higher patient happiness and trust, whilst a powerful brand perception increases patient loyalty with a favourable experience and desire to promote the institution to others. This comprehensive study tries to examine the available research on the link between these parameters and patient experience, giving insights that will aid healthcare providers improve their services and strengthen their Brand positioning in the market.
Motivation of the Study
This investigation was driven by the critical need to enhance patient experience in the healthcare sector, which is increasingly recognized as a vital component of healthcare quality and patient outcomes. Despite extensive research on individual aspects of service quality and Brand image, there is a lack of comprehensive reviews that integrate these elements to understand their combined impact on patient experience. By combining existing information and pointing out gaps in the literature, this study aims to provide healthcare providers with actionable insights that can drive improvements in service delivery and Brand management. Ultimately, the goal is to help healthcare organizations foster stronger patient relationships, improve best experience and achieve better overall health outcomes through a deeper understanding of how brand image and service excellence are interwoven.
The repose of this study is structured as monitors: In Section 2, we examine relevant research with keywords and appropriate citations. In Section 3, we introduce the conceptual model setting. In Section 4, we conduct a detailed methodology towards the study and objectives. In Section 5, we have discussed the discussion with Implications in different ways. Lastly, in Section 6, we conclude this research.
Literature Review
The literature scheduled the consequence of service quality and brand image on patient experience in the healthcare industry is directly connected to our study work.
Service quality related to patient experience
According to Parasuraman et al. (1985, 1988) five characteristics determine the quality of a service. The 5 dimensions of service quality that comprised SERVQUAL were tangibles, assurance, responsiveness, empathy, and reliability. These five characteristics were recognized by the authors. The following table lists the factors that the dimension’s address:
Tangibles: Kansra and Gupta (2016) discovered that the tangibility of services has an impact on the quality of care provided by public hospitals. Al-Daoar and Zubair (2018) discovered, however, that tangible dimensions had no noticeable effect on patient satisfaction.(Bitner, 1992) introduced her theoretical structure for analyzing how physical environments affect both clients and staff. According to Bitner (1990), a customer's degree of satisfaction may be influenced by their outward look. As per the research of Melia (2016), tangibles include things like actual buildings, machinery, and communication channels in addition to supplies utilized by businesses and staff appearance during customer service, all of which can draw in customers and increase their level of happiness. Lau et al. (2013) mentioned, tangibles, or outward appearance, such as actual buildings, furnishings, staff, and channels of contact, improve customer happiness.
Reliability: Patients who receive reliable care are seen when needed and are given the course of therapy they believe is best for their condition. Researchers Kansra and Gupta (2016),Meesala and Paul (2016), and Zaim et al. (2010) discovered that patients' satisfaction and the quality of the hospital services provided by the unit is influenced by the dependability of the services. As per (Kansra& Gupta, 2016) public hospitals place a higher value on reliability than do private hospitals. According to Tharanga et al. (2018) patients expected the dependability aspects the most. The capacity to deliver on commitments of dependable, precise, and dependable services is known as reliability (Lau et al., 2013).
Responsiveness: According to studies by Meesala and Paul (2016) and Al-Daoar and Zubair (2018), responsiveness affects how satisfied patients are satisfied with the grade of care they receive from a healthcare facility. Kansra and Gupta (2016) also noted that private hospitals place a higher value on service responsiveness than do state hospitals. The willingness, ability, or attentiveness of staff members to assist customers and deliver prompt, attentive services is known as responsiveness (Ahmad &Sungip, 2008).
Assurance: Gray and Boshoff (2004) , Zaim et al. (2010) &Al-Daoar and Zubair (2018), discovered that the assurance component had no discernible impact on patient satisfaction. Biswas and Verma (2022) and Kansra and Gupta (2016) found that service assurance is a determining factor in how satisfied patients in private hospitals are satisfied with the level of care they receive.Competency, civility, trustworthiness, and security are replaced with assurance in the initial ten criteria for assessing service quality which was stated by (Zeithaml, et al, 1988). The primary components of assurance are employee behaviours such consistently being polite, which in stills trust and knowledge (Parasuraman et al., 1991).
Empathy - According to Gray and Boshoff (2004), one of the most important SERVQUAL model components that affects service standard is the company's ability to show empathy—the ability to care for and individually attend to consumers. Al-Daoar and Zubair (2018) discovered, however, that empathy dimensions had no discernible impact on patient satisfaction. How to enter the other person's private perception realm and fully settle in is defined empathy Rogers (1975, p. 4). Empathic accuracy, or how closely emotions resemble another person's thoughts and feelings will depend on your ability to appropriately discern their precise content.(Ickes, 2011, p.57).Customers are satisfied when the perceived performance meets their expectations for the services. They are not happy if it doesn't (Oliver, 1997; Zeithaml and Bitner, 2000).In negotiations on the patient involvement, it is usual and prominent to focus on the patient's perspective or perception of the medical care they get (Oben, 2020).
Expected service quality
Meeting customer requirements is referred to as providing quality service. Ensuring the quality of the service guarantees that it fulfils these requirements (Kotler, 2012). Another point of dispute in the model is the incorporation of expectations, which has drawn criticism for both its applicability and usefulness (Vinagre&Neves, 2008). To match consumer expectations, the idea of service quality and its metrics need to be updated regularly (Seth et al., 2005;Prasad &Ghosal, 2022).Singh and Choudhury (2017); Zeithaml, Bitner, and Glemler (2009) have calculated the customer's perception by dividing the expected service scores on a certain dimension by the perceived service scores on that same dimension. As Prudencio and Mamede (2018) showed, expectations are derived from subjective perceptions of the type and caliber of the desired service. Customer expectations and service quality are directly correlated with satisfaction. The patient happiness, observed service quality, and demands, good word-of-mouth (WOM) communication, and loyalty all show substantial connections to loyalty (Pevec and Pisnik, 2018 and Gu et al., 2018; Karki et al., 2022). According to some research, there is a clear correlation between discontent and unmet expectations as well as vice versa. These studies employed the idea of met expectations as a reliable measure of satisfaction with the service supplied (Zebiene et al., 2004).Patient expectation refers to the features of the hospital that potential patients look forward to, irrespective of their preferences or what could be deemed ideal (O'Malley et al., 2004).
Perceived service quality
The difference between the anticipated and actual services received is what popular researchers engaged in service quality and services marketing generally understood as SQ (Parasuraman et al., 1985). In general, construct highlights the general state of cleanliness, decor, and purchasing experience at the facility; however, additionally, it records the patient's evaluation of the service's complexity in relation to service timeliness and appropriate communication between the consumer and the provider of the service (Chase & Zhang, 1998).Regarded aid as Consumer interactions with companies, word-of-mouth (WOM), evaluations of the products' capacity to live up to expectations, the Marketing mix, and compared with rivals' offerings all influence how customers see quality (Lewis, 1989). Increased customer loyalty is a result of keeping current consumers and drawing in new ones through perceived service excellence (Agyapong et al., 2018). The degree to which a patient feels that the hospital provided them with high-quality medical treatment and the degree to which the patient is aware of the calibre of such services (Shaikh&Rabbani, 2005). Pai and Chary (2014) call attention to how healthscape affects the standard of care. Therefore, healthcare providers need to know which parts of the healthscape affect service quality in order to build a healthscape that can fulfil customers' expectations for comfort, convenience, safety, security, privacy, and support. Similarly, several investigations have shown a favourable correlation between patients' perceived quality of care and their degree of satisfaction with the health care practitioner, including Swain (2019), Fatima et al. (2018), Mitropoulos et al. (2018), Trivedi and Jagani (2018), Rahman (2019).
Brand Image related to patient experience
Being a powerful marketing instrument and key differentiator for companies, image of brand is important (Park & Park, 2019). Padmi and Suparna (2021) assert that brand equity—which refers to the overall sentiments and views of customers about a brand and its consequences for consumer behaviour—is significantly influenced by the image of brand. Purchasing decisions are influenced by image of brand, which serves as a mediator in determining a consumer's choice of brand (Pratiwi et al., 2022). Through customer engagement, customer loyalty is likely to rise with a strong brand image. (Kusumaningrum&Wajdi, 2021). According to Keller (1993), a buyer's view of a brand is revealed by the brand connections they are able to recall. A brand's image offers value in several ways, such as making it easier to digest information, differentiating the business, evoking favourable feelings, and providing a platform for future advancements (Aaker, 2023).The image of brand of a company is defined as opinion, attitude, and emotion towards a brand, which reflects the cognitive or psychological elements of the brand (Gardner & Levy,1955). A person's subjective assessment of a product or company's worth, derived from their overall interactions with it, shapes their feelings and choices in the marketplace. This is known as a brand (Kaplan, K. 2016).Kotler and Clarke proposed that a patient's thoughts, ideas, and perceptions about a certain hospital can be combined to form the hospital's image of brand, in the context of health care. Patients' own experiences with previous medical examinations and treatments typically shape their perception of a hospital (Kim et al., 2008).
Patient experience based on service quality
Global recognition has been extended to the patient experience as an autonomous component of healthcare quality, alongside clinical efficacy and patient safety (Doyle et al., 2013Quality plays a big role in these developments in the business, as does the emphasis on patient engagement, changes in healthcare legislation that relate hospital and physician revenue to patient experience metrics, and the emergence of the consumer mind set (Wolf et al., 2014). The Beryl Institute made a significant contribution by providing a definition that highlights both the complexity of the framing assignment and the integrated and multifaceted element of the patient experience (The Beryl Institute, 2020). The patient experience will benefit the hospital industry and civilization in general in a number of ways, such as establishing tailored and individualised clinical bedside care, providing exact guidance for future research, promoting consistent and long-lasting improvements in the standard of medical care, and influencing health-care policy (Oben, 2020). Experience of the patient is multifaceted, and quality in other dimensions need not be reflected in a single metric, nor does it have to (Anhang Price et al., 2013).Clinical efficacy and patient safety are two other quality objectives that are consistently and favorably correlated with the patient experience (Ahmed et al., 2014; Prasad &Ghosal, 2020).
Conceptual Model
Methods
Criteria for review
Peer-reviewed articles were considered for inclusion in this review based on several specific criteria to ensure the relevance and quality of the selected studies. Firstly, articles needed to primarily focus on service quality, including the various dimensions of expectations and perceptions related to healthcare services. This emphasis on service quality was crucial to understanding how different aspects of service delivery impact patient experience and satisfaction. Secondly, the articles had to address the topics of brand image and patient expectations. This criterion ensured that the selected studies provided insights into how a healthcare facility's brand perception influences patient trust, satisfaction, and overall experience. Thirdly, the methodology employed in the articles was a key consideration. Only studies that utilized observational or interventional methodologies were included, as these approaches provide empirical data and direct observations about the phenomena under investigation. Fourthly, to facilitate accessibility and comprehension, only articles with full texts available in English were considered. Finally, the articles had to be distributed in peer-reviewed periodicals. This criterion was set to ensure that the studies included in the review had undergone rigorous evaluation by experts in the field, thereby maintaining a high standard of scientific quality and reliability.
The way to select literature and articles
A literature search was conducted in July 2024 using databases from Sage Journals, Emerald, Elsevier, Research Gate, and Taylor & Francis, accessed via Google Scholar. The search utilized free-text synonyms and controlled vocabulary for terms such as “Service quality,” “patient experience,” “Brand image,” and “healthcare.” To refine the results, a search filter was applied to include only English-language studies published within the last eight years. Duplicate citations were removed using bibliographic software, and interrater reliability was confirmed through a random sample of citations. Each citation was independently reviewed by two screeners, and any discrepancies were resolved through discussion.
Extraction of Data
This study's primary objective was to determine how patient experience is impacted by brand image and service quality. After identifying the articles, it was determined to note any patterns, directions, parallels, or discrepancies. After examination, 50 publications were selected with consideration for the study's research goal. After carefully choosing the papers, data were extracted using a format that contained the name of the author, the year of publication, the population under study, the instruments employed, and the major findings.
Findings:
Discussion
The review suggests that high service quality and a strong image of brand are more influential than their individual effects, suggesting healthcare providers should excel in both areas to maximize patient satisfaction and loyalty.
(Fatima et al., 2018), highlights The endeavours of private hospitals to deliver superior healthcare services, emphasising the favourable effects of promptness, correspondence, and the physical surroundings on patient contentment and allegiance. It recommends that further variables affecting patient perceptions and service quality be investigated in future studies.
Tripathi&Siddiqui, (2020), suggests that the lack of reliability, responsiveness, and empathy in healthcare services, leading to dissatisfaction and potential patient churn. To address these gaps, healthcare managers should foster trust through consistent service delivery and transparency in billing practices.
Hosseini&Behboudi (2017),The study shows that while brand trust has no effect on healthcare service utilisation, brand image and customer happiness do. It recommends that in order to cultivate favourable impressions, healthcare management should improve their brand image, offer high-quality services, and continue to communicate effectively.
Odoom, Narteh, &Odoom (2021) the study shows the significance of healthcare branding in influencing customer repeat patronage intentions. Factors like medical personnel quality, service lines, and tangibles significantly impact hospital brand image. To increase patient loyalty, healthcare marketers should concentrate on upholding a favourable brand image.Lee (2019),the likelihood of people being incredibly happy with the care they receive is higher. when they are thrilled with their encounter with a healthcare provider and their expectations are fulfilled. Providing the patient with a memorable and fulfilling experience will improve the provider's competitive edge. The patient's experiences are specifically linked to loyalty, simplicity of acquisition, and inclination to return.
Managerial Implications
Healthcare managers should prioritize continuous training and development programs for their staff. Focusing on soft skills such as empathy, communication, and patient engagement is crucial. Well-trained staff can significantly enhance the perceived quality of care, leading to improved patient satisfaction.
Developing and maintaining a strong, positive brand image is vital. Healthcare managers should ensure that their brand conveys trust, reliability, and excellence. This can be achieved through consistent and clear communication, marketing efforts that highlight positive patient outcomes, and showcasing testimonials and success stories.
This study emphasises the necessity of more empirical investigation into the complex interrelationships among patient experience, brand image, and service quality.. Academics should focus on longitudinal studies to assess the long-term impacts and incorporate diverse healthcare settings to generalize findings across different contexts. Developing robust theoretical frameworks that integrate concepts from service quality, brand management, and patient experience. Academics should aim to refine existing models and propose new ones that better capture the complexities of healthcare service delivery.
Conclusion
This comprehensive review has explored the intricate relationship between service quality, image of brand, and patient experience in the healthcare sector. The findings consistently highlight that high service quality and a strong, positive image of brand significantly enhance patient satisfaction and overall experience. High-quality service delivery, characterized by timely, effective, and empathetic care, directly impacts patient perceptions and their subsequent loyalty to healthcare providers. Concurrently, a well-established brand image, which conveys trust, reliability, and excellence, plays an important role in shaping patient predictions and experiences. The Synergy between service quality and brand image creates a robust framework for healthcare providers aiming to improve patient outcomes. Moreover, the review reveals that patient experience is a multifaceted construct influenced by various factors, including personal interactions with medical staff, the efficiency of administrative processes, and the overall environment of healthcare facilities.
Future prospects
Future studies should examine how quality of service and image of brand in the healthcare industry are affected by cutting-edge technology such as Blockchain, Machine Learning, and Artificial Intelligence. These emerging technologies having the potential to revolutionize patient experience by enhancing efficiency, accuracy, and transparency in service delivery. The influence of social media and online reviews on healthcare brand image and patient experience is an emerging area of interest. Future studies can explore how online reputation management and patient feedback on digital platforms impact healthcare providers. Encouraging interdisciplinary research that combines insights from healthcare management, marketing, psychology, and information technology can provide a holistic understanding of how to improve patient experience. Collaborative efforts can lead to innovative solutions that address multiple facets of healthcare delivery.
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