The Influence of Quality of Service and Satisfaction on Word of

Mouth

Lino Pereira, Yuni Istanto, and Dyah Sugandini

Universitas Pembangunan Nasional Veteran Yogyakarta

Keywords: Quality of service, satisfaction, and word-of-mouth.

Abstract: This study is a survey study using inpatients in hospitals. Data were collected from 200 respondents using

non-probability sampling techniques. This study aims to analyze word of mouth which is influenced by

service quality and patient satisfaction. The quality of service in this study is divided into three dimensions,

namely responsiveness, assurance and empathy. This study uses inpatient respondents in hospitals in Timor

Leste and Yogyakarta, Indonesia. The results showed that all proposed hypotheses could be accepted.

Quality of service can influence Word of mouth by mediating patient satisfaction.

1 INTRODUCTION

In the last three decades, there has been increased

attention to the quality of health care services

(Rehaman & Husnain, 2018). The organization is

interested in identifying the most critical factors in

the organization which, if managed properly, will

ensure survival and success in the future. Some

hospitals also make efforts to promote their business

abroad in the medical tourism segment. The

euphoria and excitement about the health industry

are worthy of review in the context of service

quality. Especially after competitive issues and

increasingly strict game rules in this sector make

quality very important for the organization's long-

term success (Meesalaa & Paul, 2016).

Changes in lifestyle cause patients to require

quality health services because the standard of living

has also changed towards better medical care. The

quality of medical care accommodation has become

a major concern for patients, so hospitals are

expected to provide better accommodations to

patients (Rehaman & Husnain, 2018). Quality of

service is considered high and is an important factor

for creating customer satisfaction and can identify

services as a competitive advantage of the hospital

(Golmohammadi et al., 2014). Patients need high-

quality services provided by hospital staff. Patient

satisfaction is widely used in the health sector to

determine service quality (Ahmed, Tarique & Arif,

2017). Leiter et al. (1998) executed an empirical

study in the hospitals of Canadian, and the results

showed that nurses, doctors and the information

which received by the patient is influencing the

patient satisfaction.

As service quality increases, the probability of

customer satisfaction will also increase. Increased

customer satisfaction leads to behaviours such as

commitment, customer retention, and the creation of

mutually beneficial relationships with service

providers and users, increased customer tolerance

for service failures and positive word of mouth

advertising about organizations.

Service quality dimensions (SERVQUAL and

SERVPERF) that are widely accepted include:

tangibility, empathy, reliability, empathy, and

guarantees can be used to understand patient

satisfaction, especially in the context of developing

countries, where governments offer subsidies for

health care costs. The purpose of this study was to

analyze the impact on patients in developing

countries and their impact on word of mouth

(WOM). Previous literature has not been much

discussed about the quality of hospital services

associated with the characteristics of developing

countries. Characteristics of health services in

developing countries are the cost of subsidized

health care, low literacy rates, low levels of health

awareness, there is information asymmetry. And the

population is relatively very solid. This has the

potential to make patients dependent on the doctor's

advice which refers to the choice of the service

provider.

Pereira, L., Istanto, Y. and Sugandini, D.

The Inﬂuence of Quality of Service and Satisfaction on Word of Mouth.

DOI: 10.5220/0009964200840088

In Proceedings of the International Conference of Business, Economy, Entrepreneurship and Management (ICBEEM 2019), pages 84-88

ISBN: 978-989-758-471-8

2 LITERATURE REVIEW

2.1 Word-of-Mouth

Word of mouth is part of customer loyalty.

Consumers who return several times to buy services

from the same company are loyal customers. Martin

(2017) argues that patient loyalty can be measured

from three components (1) Using service providers

again (2) Using service providers for different

treatments (3) speaking positively about service

providers and recommending to others (Meesalaa &

Paul, 2016).

Word of Mouth is a conversation between

consumers and other consumers about their

consumption experience (Wetzer et al. 2007). The

concept of WOM is important in the health care

sector (Goyette et al. 2010; Trigg 2011). Patients

increasingly want to be involved in their decision

making processes regarding their health care and

medical care (Niehues et al. 2012), and also for the

selection of hospital Martin’s(2017).

2.2 Service Quality

This study uses the SERVPERF model

As a measurement of service quality to make it

easier to understand the quality of services provided

by a hospital. SERVPERF is a service-based

performance measure (Cronin and Taylor, 1992;

1994). The SERVQUAL model, which compares

customer expectations before and after service

delivery (Parasuraman et al., 1988). Parasuraman et

al. (1985) argue that "the position of consumers'

perceptions of service quality on a continuum

depends on the nature of the difference between

expected services and perceived services". Cronin

and Taylor (1992) offer the first theoretical

justification for removing expectations of the

SERVQUAL portion and adding it to performance

measures. Cronin and Taylor (1992)

Develop performance-based measurement

instruments namely, SERVPERF (Service

Performance) which only focus on perceived service

quality. The SERVPERF model represents

performance or service quality measurements that

only focus on organizational performance felt by

consumers rather than focusing on the difference

between perceptions of performance versus their

expectations of service quality. Also, service quality

is measured only through the dimension of customer

perception rather than their expectations. Cronin &

Taylor (1994) develop the quality dimension into

five. (1) Reliability measured by indicators

maintains error-free records, sincere interest in

solving problems, delivering services as promised.

(2) Responsiveness is measured by responding

quickly, willing to help patients, offering fast

services to patients. (3) Assurance, including the

ability to instil confidence in patients, knows to

answer patient questions, the ability to deal with

patient problems. (4) Empathy, including giving

individual attention, comfortable consultation hours,

understanding the specific needs of patients. (5)

Tangibles, including the appearance of neat

employees, attractive visual facilities, neat

appearance of polyclinic services, professional

employee appearance, and modern equipment.

2.3 Customer Satisfaction

Meesalaa & Paul defines customer satisfaction as a

consumer response to an evaluation of perceived

differences between prior expectations and performs

the actual product or service after consumption.

Assessment of patient satisfaction has changed not

only from recovering from an illness during

hospitalisation, but patients have assessed

satisfaction is comprehensively starting from the

quality of services provided by doctors, nurses and

administration (Sreenivas & Babu, 2012).

Patient satisfaction can be described as the

attitude passed by the patient receiving the service to

whether or not the service is met. Hussain, Asif,

Jameel & Hwang (2019). The objectives of

analyzing patient satisfaction in the health service

sector are: (1) The organization must decide how the

level of satisfaction affects patients who seek

service, treatment and sustainably use services. (2).

Satisfaction is used as an indicator of the quality of

service delivery as well as to help doctors and health

care institutions to build a better understanding of

patient feedback. (3) Patient satisfaction with health

care services is a multi-aspect concept with aspects

that are connected to the main attributes of services

and providers. (4). Patient satisfaction becomes very

important in relation to quality improvement

programs from the patient context, total quality

management, and anticipated service outcomes (5)

Satisfied patients will continue to use health

services, maintain their relationships with certain

health service providers and comply with care

requests (Aldebasi & Ahmed, 2011; Hussain et al.,

2019).

The Inﬂuence of Quality of Service and Satisfaction on Word of Mouth

2.4 Hypothesis

H1: Responsiveness influences WOM with the

mediation of satisfaction

H2: Assurance influences WOM with the

mediation of satisfaction

H3: Empathy influences WOM with the

mediation of satisfaction

H4: Satisfaction influences WOM

3 RESEARCH METHOD

This study uses respondent patients who have been

hospitalized. Data were obtained from patients in

Timor-Leste and the Special Region of Yogyakarta,

Indonesia. This study uses a questionnaire with a

five-point Likert scale. The sampling technique is

convenience sampling. The number of samples

obtained was 200, consisting of 100 samples from

respondents from Timor-Leste, and 100 samples

from respondents from Yogyakarta Indonesia. Data

analysis techniques using Partial Least Square.

4 RESULTS

4.1 Characteristics of Respondents

Based on the results of research conducted on 200

respondents, it can be identified regarding the

characteristics of respondents as follows:

Table 1. The Characteristic of Respondents

A respondent from

Timor Leste

A respondent from

Yogyakarta, Indonesia

Gender: Male 39%

Female 61%

41%

59%

Age (years).

21-30 17.5% 3 %

31-40 30.0% 13 %

41-50 26.7% 56 %

> 50 25.8% 39 %

Education

Elementary School 8.3% 42 %

Junior High School

20.8%

37 %

High School

36.7%

12.5 %

Diploma

20.0%

3 %

> Bachelor

14.2%

5.5 %

Work

Students / Students 5% 25 %

Civil Servants

18.3%

19.5 %

Soldiers / Police

11.7%

15 %

Private Employees

17.5%

9 %

Entrepreneurs

25%

12.5 %

Other

22.5%

19 %

The income

less than $ 50.00

13.3%

25 %

$ 50.00- $ 100.00

15.8%

29.5 %

$ 100.00- $ 200.00

11.7%

15 %

$ 200.00- $ 500.00

44.2%

12.5 %

> $ 500.00

15.0%

12.5 %

4.2 Results of Data Processing

Based on the results of data analysis, that has been

obtained p-value values that determine the

significance of the proposed hypothesis. The p-value

test results can be seen in table 2.

Table. 2. P-value

Original

Sample (O)

P Values

Assurance  Satisfaction 0.533 0,000

Empathy  Satisfaction 0.208 0,001

Responsiveness

Satisfaction

0.166 0,038

Satisfaction  WOM 0.777 0,000

From the PLS 3.2.8, the output obtained the

value of the indirect effect of each variable as

follows (see table 3).

Table 3. Specific Indirect Effects

Specific Indirect Effects

Assurance  Satisfaction

 WOM

0.414

Empathy  Satisfaction 

WOM

0.162

Responsiveness 

Satisfaction  WOM

0.129

The appearance of the WOM model in hospital

patients can be seen in Figure 1.

ICBEEM 2019 - International Conference on Business, Economy, Entrepreneurship and Management

Figure1. Model WOM

4.3 Discussion

The results of the PLS analysis show that there is a

positive and significant influence on the quality of

service to Word of Mouth. These results can be

interpreted that the quality of service plays an

important role in shaping the Word of Mouth at the

Health Clinic. This means that the better the quality

of service, the higher the Word of Mouth at the

Health Clinic.

The results show that there is a positive influence

on service quality on satisfaction. These results can

be interpreted that the quality of service plays an

important role in shaping patient satisfaction at the

Health Clinic. The influence of service quality on

patient satisfaction shows that the better the quality

of service, the higher the patient satisfaction. The

results show a positive effect on patient satisfaction

with Word of Mouth. This means that the higher the

patient's satisfaction, the patient's Word of Mouth

will increase. Patient satisfaction is a patient's

perception of a type of service experience they

experience.

The results also found that satisfaction was

proven as a variable mediating the relationship

between service quality to Word of Mouth. This

means that the better the quality of service, the

higher the patient satisfaction so that the higher the

patient's desire to do Word of Mouth.

5 CONCLUSIONS

Based on the results of the study as described in the

previous chapter, several conclusions can be drawn.

There is the effect of Responsiveness (16.6%) on

WOM with mediation satisfaction (p-value of 0.038)

so that the first hypothesis is supported. There is an

effect of Assurance (53.3%) on WOM with

satisfaction mediation (p-value of 0.00) so that the

second hypothesis is supported. There was an

influence of Empathy (20.8%) on WOM with

satisfaction mediation (p-value of 0.001), so that the

third hypothesis was supported. There is an effect of

Satisfaction (77.7%) on WOM (p-value of 0,000), so

the fourth hypothesis is supported.

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