The current issue and full text archive of this journal is available at

www.emeraldinsight.com/0952-6862.htm

IJHCQA
26,1 Patients’ satisfaction of service
quality in Saudi hospitals:
a SERVQUAL analysis
20
Hussein M. Al-Borie
The Research and Consultancy Institute, Jeddah, Saudi Arabia and
Received 25 August 2010
Revised 24 April 2011 Department of Health Services and Hospital Administration,
Accepted 15 May 2011 King Abdulaziz University, Jeddah, Saudi Arabia, and
Amal M. Sheikh Damanhouri
Department of Business Administration, King Abdulaziz University,
Jeddah, Saudi Arabia

Abstract
Purpose – Saudi Arabian hospital performance, vis-à-vis patient satisfaction with service provision,
has emerged as a key policy and planning concern. Keeping in view public and private hospital service
quality, this article seeks to provide guidelines to the on-going Saudi Arabian health service
reorganization, which emphasizes decentralization, bed-capacity expansion, research-based
policymaking and initiatives in the health insurance sector.
Design/methodology/approach – The article outlines an empirical study that compares patient
satisfaction with service quality in Saudi Arabian public and private sector hospitals. The authors
employ a stratified random sample (1,000 inpatients) from five Saudi Arabian public and five private
hospitals. Data were collected through questionnaire using the SERVQUAL scale. For reducing the
language bias the questionnaire was translated into Arabic. The response rate was 74.9 percent. Data
were analyzed using SPSS and appropriate descriptive and inferential statistical techniques.
Findings – Cronbach’s alpha for five service-quality dimensions (tangibles, reliability,
responsiveness, safety and empathy) were high and the SERVQUAL instrument proved to be
reliable, valid and appropriate. The results showed that sex, education, income and occupation were
statistically significant in influencing inpatients’ satisfaction, and all the null hypotheses were
rejected. Only inpatient age was not significant.
Practical implications – The study highlights service quality influence in the design of broader
healthcare strategies for Saudi Arabian public and private hospitals. It demands that management
researchers and analysts must identify regional service quality consistencies and related inpatient
demographic indicators.
Originality/value – The study offers some insights into, and guidance for, hospital quality
assurance in Saudi Arabia in general and the urban hospital setting in the Middle-East in particular.
Keywords Patient perception, Patient satisfaction, Service quality, SERVQUAL, Saudi Arabia,
Hospitals, Organizational performance
Paper type Research paper

International Journal of Health Care Introduction

Quality Assurance Providing high quality public or the private hospital services is quite demanding.
Vol. 26 No. 1, 2013
pp. 20-30 Measuring patient satisfaction has been an even more challenging task for qualitative
q Emerald Group Publishing Limited and quantitative researchers, government policymakers and planners, mainstream
0952-6862
DOI 10.1108/09526861311288613 hospital managers and medical professionals. This challenge is derived from the
concepts of satisfaction and quality that are virtually open-ended. Hence, the questions: Patients’
what must satisfy a patient, and what brings quality in hospital care, are determined satisfaction in
by patients’ deep-seated psyches and philosophical contestations on the one end to
human needs theories and open-market economics on the other. We examine Saudi Saudi hospitals
Arabian hospital service quality and outline several inpatient satisfaction and quality
determinants. We focus on variability in satisfaction and quality with a view to the
contextual variations in public and private hospitals and their implications for hospital 21
planning and management.

Saudi Arabian hospital service concerns

The Saudi Arabian hospital bed capacity in 2007 was 53,519; most – 31,420
(58.7 percent) under the Ministry of Health (MoH) control; 10,828 (20.2 percent) spread
over the other government departments; and 11,271 (21.0 percent) in the private
hospitals (MoH, 2007; Oxford Business Group, 2009). Saudi Arabia allocated 52.3 billion
SAR ($14 Billion) to develop its healthcare industry, which is about 11 percent of its
2009 budget. Hence, future healthcare planning in Saudi Arabia must comply with the
service quality demands (Mufti, 2000; Al-Shekh, 2003; Al-Doghaither et al., 2003;
Al-Doghaither, 2004; Alsharqi, 2006; Oxford Business Group, 2009).
If public and private hospital services are compared then generalizations are
apparent. For instance, the health insurance expansion will link public and the private
sectors hospital service quality to patient satisfaction. Al-Shekh (2003) compares the
factors that influence Riyadh patients’ hospital experiences and perceptions. He
suggests that perceptions must influence service marketing; i.e. enumerating patient
satisfaction vis-à-vis their demographic data. Alsharqi (2006, p. 285) considers
open-market competition to be inevitable under the new Saudi health system as
privatization is expected to induce competition and healthcare service quality is
expected to improve with a fair competition between the two sectors. He also raises
some concerns: Will patient satisfaction with the healthcare facilities improve? What
quality improvements will take place and what will be their effect on patient
satisfaction and will patient satisfaction with their health status improve?

Comparing public and private hospitals using SERVQUAL

As an operational method, SERVQUAL takes up the challenge to comprehend and
quantify several factors that determine patient satisfaction with hospital service
quality. SERVQUAL is praised as a widely cited research instrument’ primarily in the
marketing literature (Parasuraman et al, 1985), some theoretical and operational
concerns and criticism were also raised (Buttle, 1996). However, a decade after
SERVQUAL’s introduction, it was concluded that it “remains the most complete
attempt to conceptualize and measure service quality” (Nyeck et al., 2002, p. 101). We
refer to some country-specific studies that examine inpatient service quality in Arabian
and the Eastern Mediterranean public and private hospitals, with a view that these
serve useful contexts for our analysis. These cover Saudi Arabia (Al-Shekh, 2003;
Al-Doghaither, 2004); Egypt (Mostafa, 2005); United Arab Emirates (Naceur and
Chaker, 2003); Bahrain (Luke, 2008); Turkey (Taner and Antony, 2006) and Yemen
(Anbori et al., 2010). We outline the broader conclusions these studies draw out:
.
Private hospital inpatient care was more satisfactory than public hospitals.
Results suggest that compared to public hospitals, private hospital inpatients
IJHCQA were more satisfied with physicians, nurses and support staff. Satisfaction with
26,1 doctors and a reasonable service-cost were among the major determinants in
public hospitals (Taner and Antony, 2006).
.
Qualitative data should be used to interpret patient perception and satisfaction
trends, in particular, why public hospitals had relatively higher patient
dissatisfaction rates.
22 .
Patients usually prefer private hospitals hoping for a higher service quality. In
comparison, public hospital staff are pressurized by the government and general
public to improve service quality for competing with the private sector.
.
Sometimes the major question is how well public and private sector healthcare
providers understand the patients’ profile.
.
Public and private hospitals must organize training programs on the significance
of service quality and the role that inpatient satisfaction plays in the healthcare
industry.
. Quantitative methods are valuable for establishing relationships between
variables but weak in identifying the reasons for such relationships. Patients
may have complex beliefs that cannot be easily confined in a questionnaire.
Therefore, mix-methods can enhance research study findings (Mostafa, 2005;
Alsharqi, 2006).
.
A service quality “process” model that caters for continuous monitoring and
subsequent improvement in hospitals could prove to be effective (Luke, 2008).

Methodology and scope

We considered a mixed-method approach to be suitable for our study. It followed
descriptive and analytical methods for collection and analysis of the data. We targeted
all inpatients of Arab nationalities in Saudi Arabian government hospitals. The large
number of respondents and limited fieldwork resources forced us to use a stratified
random sample. Saudi Arabia was divided into five geographical areas and one
province was selected from each: Riyadh, Jeddah, Eastern Region, Tabuk and Najran.
Finally, one government and one private hospital were selected from each province.

Study population
The yearly average of inpatients in all hospitals across Saudi Arabia is 2,792,106 (MoH,
2007). Out of these, almost 59 percent are in the MoH hospitals, 18 percent in the
hospital affiliated to other government departments, and 23 percent in private
hospitals. Of five hospitals representing each category, 1,000 patients were randomly
selected (100 per hospital) who were given questionnaires. We included patients
admitted to hospitals from 16 May to 15 June, 2009. Efforts were made to represent the
population:
.
A rapport was established with hospitals managers and quality assurance
department staff for them to distribute and collect questionnaires.
.
Owing to the absence of other health service providers in Najran and Tabuk, one
public and one private hospital each were selected in these areas as an exception.
In the other regions; i.e. Jeddah, Riyadh and Eastern Province, one government
and one private hospital were selected randomly.
 .
Since MoH hospitals constitute most public hospitals, these were considered to Patients’
represent all public hospitals. satisfaction in
Instruments Saudi hospitals
Steps were taken to ensure our questionnaire’s suitability for meeting the study
objectives and testing our hypotheses. SERVQUAL was employed to measure the gap
between patient expectation and realization. This scale considers five service quality 23
dimensions: tangibles; reliability; responsiveness; safety and empathy. Dimensions
were scored using 27 statements. The questionnaire was translated into Arabic and
was read by six Economics and Administration faculty members at the King
Abdulaziz University; and modifications were made. The revised questionnaire had
two sections: questions on hospital type, name and location; inpatient demographic
profile, why he/she visited a particular hospital; visit frequency; and inpatient
services-quality expectations prior to his/her visit; and actual service ratings during
their stay. The difference between the two ratings was considered to be a quality
indicator.

Data collection and analysis

Locating 100 inpatients in each hospital was facilitated by the physicians. The
researchers distributed and collected the completed questionnaires with the
physician’s help. Data were entered and analyzed using SPSS v.17. The five quality
dimensions (op cit) became independent variables.

Reliability
The 27 statements making up the five dimensions were:
(1) tangibles (7);
(2) reliability (4);
(3) responsiveness (4);
(4) safety (4); and
(5) empathy (8).

These statements measured the gaps between service quality expectations and
realizations. The scale’s reliability was tested using Cronbach’s Alpha (Table I).

Variants Realizations Expectations

Statements Alpha Statements Alpha

Tangibles 7 0.906 7 0.906

Reliability 4 0.842 4 0.84
Responsiveness 4 0.908 4 0.923
Safety 4 0.919 4 0.929 Table I.
Empathy 8 0.942 8 0.93 Reliability dimensions –
Total statements 27 0.968 27 0.969 Cronbach’s alpha
IJHCQA Results and discussion
26,1 From 1,000 questionnaires distributed, 749 complete documents were analyzed
(response rate ¼ 74.9 percent). Of the respondents, 61 percent were males and
33 percent (all respondents) were 30-39 years (Table II).

Service quality by hospital type

24 Table III shows that general expectations towards service quality using the gap scale
indicated negative results for all public (2 0.37) and private (2 0.23) hospitals, except
the Riyadh private hospitals (þ 0.16).
There was significant difference ( p , 0.05) in service quality according to hospital
type. Private hospital service quality was higher than public hospital levels. The
difference was minimal, the statistical significance and all actual performance
averages in private hospitals were higher than public hospitals” (Table IV).
Service quality rankings differed between public and private hospitals (Table V),
the best three dimensions in public hospitals were tangibles, empathy and safety. In

Gender
Male Female Total
Age group n % n % n %

15-19 years 21 47.7 23 52.3 44 5.9

20-29 years 78 43.8 100 56.2 178 23.8
30-39 years 165 66.8 82 33.2 247 33
40-49 years 133 73.1 49 26.9 182 23.3
Table II. 50-59 years 36 57.1 27 42.9 63 8.3
Sample gender and age 60 years and above 23 68.6 11 31.4 35 4.7
distribution Total 457 61 292 39 749 100

Gaps between
expectations
Expectations Realizations and realizations
Hospital City n Mean SD Mean SD Mean SD

Public Tabuk 61 2.96 0.68 2.77 0.63 20.19 0.53

Najran 50 3.34 0.78 2.58 0.73 20.75 0.62
Riyadh 101 3.93 0.65 3.91 0.79 20.02 0.55
Jeddah 96 3.78 0.77 3.70 1.01 20.08 0.65
Dammam 92 3.97 0.59 2.98 1.03 20.99 1.05
Total 400 3.68 0.77 3.31 1.02 20.38 0.63
Private Tabuk 34 3.61 0.64 3.26 0.74 20.34 0.42
Najran 69 4.68 0.38 3.70 0.30 20.98 0.45
Riyadh 81 3.80 0.70 3.96 0.75 þ0.16 0.65
Jeddah 87 4.09 0.75 4.03 0.77 20.06 0.51
Dammam 78 3.66 0.59 3.57 0.81 20.09 0.70
Table III. Total 349 4.00 0.73 3.77 0.75 20.23 0.70
Expectation and
realization Total 749 3.83 0.77 3.52 0.93 0.31 0.77
private hospitals they were safety, empathy and tangibles. Table V indicates that Patients’
private hospital realization averages were higher than public hospitals. Moreover, the satisfaction in
differences between expectations and realizations for all 27 statements were
statistically significant. Saudi hospitals
The better dimensions of service quality in public hospital services were the
tangibles. This dimension included staff appearance, followed by convenient and
accessible location, modern equipment and technology. The better private hospital 25
services were: convenient and easily accessible; and medical staff
cordiality/friendliness. Employee humanitarian attitude, courtesy and
communication skills when dealing with patients ranked last. The worst
public-hospital services were medical specialization; dealing with hospitals; and
employee cooperation with patients. The worst private services depended on
individual interests of the inpatients. Hospital corridors, convenient elevators and a
clean and comfortable dormitory followed next. On the whole, patients’ evaluations
differed across the regions that the hospitals under study were located.

Hypotheses testing
There were statistically significant differences between realizations and expectations
for all five dimensions (Table VI):
(1) There were (negative) differences between realizations and expectations
average for all seven statements in the first dimension; i.e. tangibles. Therefore,
we rejected our first null hypothesis: there is no significant statistical difference
between patient expectations and actual service level they get on the tangibles
dimension.
(2) There were (negative) differences between realizations and expectations
average for four statements in the second dimension; i.e. “reliability”. Therefore,
we rejected our second null hypothesis: there are no statistically significant
difference between the patient expectations and realizations on the reliability
dimension.
(3) There were (negative) differences between realizations and expectations
average for eight statements in the third dimension; i.e. “responsiveness”.
Therefore, we rejected our third null hypothesis: there is no significant
statistical difference between patient expectations and realizations on the
“responsiveness” dimension.
(4) There were (negative) differences between realizations and expectations
average for four statements in the fourth dimension; i.e. “safety”. We therefore
rejected our fourth null hypothesis: there is no significant statistical difference
between the patient expectations and realizations on the safety dimension.

Type of hospital n Mean SD SE t-value p-value

Table IV.
Public 400 20.38 0.83 0.041 2.622 0.009 T-test for service quality
Private 349 20.23 0.70 0.037 and hospital type
IJHCQA
Public Private
26,1 hospitals hospitals
n Statements Mean SE Mean SE p-value
1 Tangibles: hospital departments design makes it 3.23 1.325 3.77 1.048 0.001
easier for the patients to access services
2 Internal organization helps achieve a rapid response 3.37 1.308 3.67 1.022 0.008
26 to patient requests
3 Hospital facility, lounges, corridors and elevators are 3.35 1.298 3.63 1.087 0.010
adequate and appropriate to the services
4 Hospital is equipped with the latest devices, 3.49 1.176 3.74 1.087 0.003
technologies and medical equipment
5 Hospital staff are well 2 groomed and have a good 3.70 1.081 3.95 0.977 0.001
appearance
6 Hospital’s location is convenient and easily 3.60 1.195 4.04 0.982 0.001
accessible
7 Hospital rooms are clean, comfortable and attractive 3.33 1.245 3.63 1.231 0.001
Average 3.44 3.78
8 Reliability: hospital staff are committed to providing 3.42 1.213 3.68 1.111 0.003
services at specified times
9 Hospital staff were keen to resolve patient problems 3.33 1.261 3.75 1.066 0.001
and answer their questions
10 Hospital services are correct from the outset 3.05 1.365 3.73 1.086 0.001
11 All the necessary medical specialties are available in 3.24 1.354 3.70 1.086 0.001
the hospital
Average 3.26 3.72
12 Empathy: I can put my full confidence in all hospital 3.04 1.341 3.68 1.119 0.001
staff.
13 Hospital staff respond immediately to patient 3.18 1.363 3.72 1.107 0.001
inquiries and complaints
14 Hospital staff respond promptly to all patient needs 3.10 1.372 3.65 1.176 0.001
regardless of the degree of concern
15 The hospital medical files and records are accurate 3.31 1.303 3.67 1.093 0.001
and error 2 free.
Average 3.16 3.68
16 Safety: I feel safe when dealing with hospital staff 3.31 1.337 3.92 1.028 0.001
17 The medical staff have sufficient knowledge to 3.38 1.302 4.00 1.007 0.001
answer patient questions
18 Hospital staff are always ready to cooperate with me 3.34 1.274 3.85 1.009 0.001
19 Patients told about the time limit for delivering and 3.29 1.346 3.70 1.070 0.001
completing the service
Average 3.33 3.87
20 Responsiveness: hospital staff are characterized by 3.32 1.350 3.82 1.043 0.001
humanity, decency and civility
21 Hospital staff follow up sick cases constantly 3.39 1.309 4.01 0.879 0.001
22 Staff handle hospital information confidentially 3.60 1.224 3.92 0.942 0.002
23 Hospital workers are helpful and sympathize with 3.40 1.294 3.93 0.932 0.001
the patients
24 Inpatients’ interests are always at the forefront 3.34 1.319 3.61 1.139 0.013
25 The medical team is friendly and is fun 3.25 1.430 3.74 1.111 0.001
26 Work and time allotted for hospital are suitable for 3.25 1.291 3.77 0.972 0.001
patients
Table V. 27 Hospital staff are familiar with and aware of patients 3.25 1.325 3.73 0.977 0.001
Public vs private needs
hospitals Average 3.35 3.82
 (5) There were (negative) differences between realizations and expectations Patients’
average for four statements in the fifth dimension; i.e. “empathy”. Therefore, we satisfaction in
rejected the fifth null hypothesis: there is no significant statistical difference
between the patient expectations and realizations on “empathy” dimension. Saudi hospitals
Demographic impact factors and gaps between realizations and perceptions
The satisfaction levels had statistically significant differences by sex. Males were more 27
satisfied than female patients. However, there were no significant statistical differences
between age groups. The educational level had a significant impact on satisfaction,
while there were statistically significant differences among patient occupations; the
patients who were private sector employees and businessmen had higher
satisfaction-levels compared to students and government employees.

Hospital type’s impact on service quality

There were statistically significant differences between service quality according to
hospital type (public/private). Service quality provided by private was higher than
public hospitals. Patients’ quality rankings varied between public and private
hospitals. In the public hospitals the best three dimensions were tangibles, empathy
and safety; whilst in the private hospitals these were safety, empathy and tangibles.

Area impact on service quality

Tables VII and VIII show large statistically significant differences in service quality
across different regions in public hospitals (0.02 in Riyadh to 0.99 in Dammam) and
across private hospitals (0.16 in Riyadh to 0.98 in Najran). Service quality was highest
in Riyadh public and private hospitals, followed by Jeddah, Tabuk, Najran, and
Dammam for public hospitals; and Jeddah, Dammam, Tabuk and Najran, respectively
in the private hospitals.
Jeddah hospitals were considered to be the best in Saudi Arabia for tangibility and
reliability while Riyadh hospitals were viewed as best for responsiveness, safety and
empathy. Tabuk hospitals were considered to be the worst for all five quality
dimensions.

Interpretations
Employing the SERVQUAL scale was useful for measuring Saudi inpatient
satisfaction. It was considered to be a reliable instrument in our study because the
Cronbach’s alpha for five quality dimensions was strong. Cronbach’s alpha for each
dimension scale was strong too. The empathy dimension had the highest value in
comparison with other dimensions. Similarly, Cronbach’s alpha for the safety
dimension was strong. The third one was the responsiveness dimension for which the

Quality dimensions Average difference SD SE t-values p-value

Tangibles 20.242 0.08 0.03 8.259 0.001

Reliability 20.301 0.84 0.03 9.741 0.001 Table VI.
Responsiveness 20.343 1.04 0.04 9.033 0.001 Realizations and
Safety 20.316 1.06 0.04 8.166 0.001 expectations for each
Empathy 20.328 0.91 0.03 9.902 0.001 quality dimension
IJHCQA Cronbach’s alpha was 0.908 for expectations and 0.923 for the realizations, and the
26,1 fourth was tangible dimension (0.906 each for both expectations and realizations. For
the last; i.e. the reliability dimension, Cronbach’s alpha was 0.842 for expectations and
0.84 for realizations.
There were significant differences in the service quality according to hospital type
(public or private). Private hospitals service quality was higher than public and these
28 differences were statistically significant. Service quality dimension rankings from the
patients’ opinions differed among public and private hospitals. The best three
dimensions in the public hospitals were tangibles, empathy and security, respectively;
whilst in private hospitals the best three dimensions were security, empathy and
tangibles. The reliability dimension was fourth, followed by responsiveness in all
public and private hospitals.
The best service quality dimension in public hospitals was tangibles. This
dimension included hospital staff appearance, convenient and easily accessible
locations, followed by modern equipment and technology. The best service quality in
private hospitals was convenient and easily accessible locations followed by medical
staff cordiality and friendliness when dealing with patients. Employee humanitarian
attitude, courtesy and communication skills dealing with the patients ranked last. The
lowest service quality level in public hospitals was medical specialization. Safety came
next, followed by employee cooperation dealing with patients. The lowest service
quality in private hospitals depended on patients’ individual interest. Hospital
corridors, convenient elevators, clean and comfortable patient dormitory were next.
The patients’ perception of the five dimensions of quality differed across the regions
under study.

Recommendations
We recommend macro-health planning and policymaking changes for Saudi Arabia’s
hospitals. On the broader policymaking level, our findings could help to set and revisit

City n Average SD SE F-test p-value

Tabuk 61 2 0.19 0.53 0.07 31.250 0.001

Najran 50 2 0.75 0.62 0.09
Riyadh 101 2 0.02 0.55 0.05
Table VII. Jeddah 96 2 0.08 0.65 0.07
Health service quality in Dammam 92 2 0.99 1.05 0.09
public hospitals Total 400 2 0.38 0.63 0.04

City n Average SD SE F-value p-value

Tabuk 34 2 0.34 0.42 0.07 31.738 0.001

Najran 69 2 0.98 0.45 0.05
Riyadh 81 þ 0.16 0.65 0.07
Table VIII. Jeddah 87 2 0.06 0.51 0.05
Private hospital service Dammam 78 2 0.09 0.70 0.07
quality Total 349 2 0.23 0.70 0.04
the priorities for improving Saudi Arabian health services using key quality indicators. Patients’
Our data clearly hints at misappropriated health-services resources in the regions. We satisfaction in
recommend policymakers initiate evidence-based healthcare budgeting for different
regions. Our findings also invite future researchers in health economics and policy Saudi hospitals
analysis to project this misappropriation in its broader details. For instance, even when
the government policies were in favor, private sector healthcare managers grossly
neglect rural areas, which have a higher population, such as Tabuk and Dammam. 29
This situation places the 1999 national health insurance plan at risk, which had been
issued by Royal Order.
At the institutional level, periodically evaluating and continuously monitoring
service quality dimensions must be incorporated in all Saudi Arabian hospitals. This
approach could improve public and private hospital services. Also, our quality
dimension ranking scale could be used to design hospital services: from initial
purposes and objectives to operational planning, mainstream strategic management
and competitive marketing. Expectations and realizations gaps that we highlighted
mean that private hospital managers are required to standardize and upgrade services
they offer. We consider these dimensions to be influential and recommend that are
taken up in future research studies.

Limitations
The study was constrained by geographical feasibility, time and other resources.
Ideally, all 20 regions (as defined by the MoH) should have been included but we were
confined to five Saudi Arabia regions. Also, owing to resource limitations, the study
did not include other key variables that are related to service quality, like leadership
and organizational design. The survey difficulties were aggravated by a lack of
cooperation from private hospital managers, notably their reluctance to distribute the
questionnaires to inpatients.

Conclusions
This study identifies some important dimensions of healthcare service quality in Saudi
Arabian hospitals and points to directions and questions for future researchers. It also
provides some guidance to healthcare quality assurance policy and practice.

References
Al-Doghaither, A.H. (2004), “Inpatient satisfaction with physician services at King Khalid
University Hospital, Riyadh, Saudi Arabia”, Eastern Mediterranean Health Journal, Vol. 10
No. 3, pp. 358-64.
Al-Doghaither, A.H., Abdelrehman, B.M., Saeed, A.A.W. and Magzoub, M.E.M.A. (2003),
“Factors influencing patient choice of hospitals in Riyadh, Saudi Arabia”, Perspectives in
Public Health: The Journal of the Royal Society for the Promotion of Health, Vol. 123 No. 2,
pp. 105-9.
Alsharqi, O. (2006), “An analysis of access to and the quality of the new health system in Saudi
Arabia: mixed methodology study”, PhD thesis, Monash University, Melbourne.
Al-Shekh, A.A. (2003), Perceptions of Hospital Experiences in Riyadh City, Saudi Arabia:
A Comparison of Service Quality in Public and Private Hospitals, University of Wales,
Swansea.
IJHCQA Anbori, A., Ghani, S.N., Yadav, H., Daher, A.M. and Su, T.T. (2010), “Patient satisfaction and
loyalty to the private hospitals in Sana’a, Yemen”, International Journal for Quality in
26,1 Health Care, published online, 12 June.
Buttle, F. (1996), “SERVQUAL: review, critique, research agenda”, European Journal of
Marketing, Vol. 30 No. 1, pp. 8-24.
Luke, G.J. (2008), “An assessment of the service quality expectations and perceptions of the
30 patients of Awali Hospital in the Kingdom of Bahrain”, Master’s thesis, Rhodes
University, Grahamstown.
MoH (2007), Health Statistical Yearbook, MoH, Riyadh, pp. 133-4.
Mostafa, M.M. (2005), “An empirical study of patients’ expectations and satisfactions in
Egyptian hospitals’”, International Journal of Healthcare Quality Assurance, Vol. 18 No. 7,
pp. 516-32.
Mufti, M.H. (2000), Healthcare Development Strategies in Saudi Arabia, Kluwer
Academic/Plenum, New York, NY.
Naceur, J. and Chaker, M. (2003), “Comparing the quality of private and public hospitals”,
Managing Service Quality, Vol. 13 No. 4, pp. 290-9.
Nyeck, S., Morales, M., Ladhari, R. and Pons, F. (2002), “10 years of service quality measurement:
reviewing the use of the SERVQUAL instrument”, Cuadernos de Diffusion, Vol. 7 No. 13,
pp. 101-7.
Oxford Business Group (2009), The Report: Saudi Arabia 2009, London, pp. 223-4.
Parasuraman, A., Berry, L.L. and Zeithaml, V.A. (1985), “A conceptual model of service quality
and its implications for future research”, Journal of Marketing, Vol. 49 No. 4, pp. 41-50.
Taner, T. and Antony, J. (2006), “Comparing public and private hospital care service quality in
Turkey”, Leadership in Health Services, Vol. 19 No. 2-10.

Further reading
Asubonteng, P., McCleary, K.J. and Swan, J. (1996), “SERVQUAL revisited: a critical review of
service quality”, Journal of Services Marketing, Vol. 10 No. 6, pp. 62-81.

About the authors

Dr Hussein M. Al-Borie is the Vice Dean of Scientific Chairs, The Research and Consultancy
Institute; and an Assistant Professor in the Department of Health Services and Hospital
Administration, Faculty of Economics and Administration, King Abdulaziz University. Hussein
M. Al-Borie is the corresponding author and can be contacted at: [email protected]
Dr Amal M. Sheikh Damanhouri is an Assistant Professor in the Department of Business
Administration, Faculty of Economics and Administration, King Abdulaziz University.

To purchase reprints of this article please e-mail: [email protected]

Or visit our web site for further details: www.emeraldinsight.com/reprints