service quality.pptyyyyyyyyyyyyyyyyyyyyyyy

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1. Service Quality
“Count what is countable,
measure what is measurable and
what is not measurable, make
measurable” Galileo

2. Definitions of Quality
“Qualityisfitnessforuse;theextenttowhich
theproductsuccessfullyservesthepurpose
oftheuserduringusage”(Juran,1974)
“Qualityisconformancetorequirements”
(Crosby,1983)
“Qualityiszerodefects–doingitrightfirst
time”
“Qualityisexceedingwhatcustomersexpect
fromtheservice”

3. Definition of Service Quality
“ameasureofhowwelltheservicelevel
deliveredmatchescustomerexpectations.
Deliveringqualityservicemeansconforming
tocustomerexpectationsonaconsistent
basis.”LewisandBooms
“aformofattitude,relatedbutnotequivalent
tosatisfaction,thatresultsfromthe
comparison of expectationswith
performance.”BoltonandDrew

4. Defining Quality
Althoughwecannotdefinequalityweknowwhatquality
is”Pirsig(1987)
Qualityisnotcreatedspontaneously.Itisdesignedand
manufactured:Ithasitsownsources.Asomewhatelusive
concept,qualityisdifficulttodefineandeasytoperceive.

5. Defining Quality
AccordingtoISO9000:-
Qualityisdefinedas„thedegreetowhichaset
ofinherentcharacteristicsfulfillsrequirements‟.
Itisbothobjectiveandsubjectiveinnature.
AccordingtoWHO:-
Qualityofcareisthelevelofattainmentofhealth
systems’intrinsicgoalsforhealthimprovement
andresponsivenesstolegitimateexpectations
ofthepopulation.

6. Five Approaches to Quality
Transcendent approach (psychology)
Product based approach (economics)
User based approach (marketing and
operational management)
Manufacturing based approach (operational
management)
Value based approach

7. Transcendent Approach
Pirsigs approach –quality cannot
always be defined. We learn to
recognise quality only through
experience -Sports

8. Product based Approach
Thisapproach maintainsthat
differencesinqualityarecausedbythe
quantityoffeaturesorattributesofa
product.Thisapproachviewsquality
asameasurablevariableandtherefore
asanobjectiveandabsoluteterm.

9. User based Approach
In this approach quality is defined by
the customer. Therefore quality is
subjective to a large extent because
every user has different thoughts and
ideas about what quality is. This
approach corresponds with Juran’s
definition: “Quality is fitness for use”

10. Manufacturing based Approach
Inthisapproachqualityisassociatedwith
conformancetorequirements.Everyproduct
mustmeetafixednumberofspecific
requirements.Anydivergenceisconsidered
adecreaseinquality.Aswiththeproduct
basedapproachqualityisviewedasan
objectiveandmeasurabletermsincethe
requirementsaremostlystatedintechnical
terms/specifications.

11. Value based Approach
In this approach quality is considered in
relation to cost and price. The concept
reflects the point that customers seek
value for money. “What do I get for the
sacrifices I make?”

12. Quality Dimensions for
Pharmaceutical Product
A. QUALITY FROM THE PRODUCT VIEWPOINT
1. Performance
2. Secondary features
3. Durability
B. QUALITY FROM THE PATIENT VIEWPOINT
4. Aesthetics
5. Perceived quality
6. Service
C. QUALITY FROM THE PROCESS VIEWPOINT
7. Conformance
8. Reliability

13. Performance
Performance dealswiththebasic
characteristicsofaproductorservice.Fora
medicine,itsselectivetherapeuticactionisa
fundamentalcharacteristicofperformance;
otherperformancecharacteristicsarethe
degreeofcounter-productiveeffectsthe
productpresentsandtheadverseinteractions
inwhichthedrugparticipates.These
characteristicsorperformancecomponents
canbeobjectivelymeasured.

14. Secondary features
Bysecondaryfeatureswemeanaspectsthat
complementbasicfunctionsofaproductor
service.Easinesstoprovidetherequireddrug
amounttothepatient,thedegreeofriskof
alterationsinthedrug,andthepossibilitythat
thedrughastosubstituteothermore
expensivealternativescanallbeconsidered
secondaryfeaturesorfeatures.Secondary
featuresareadynamicconceptthatevolves
withtime.

15. Durability
Thedurabilitydimensionrelatestotheperiod
thatcanelapsebetweenthemomentaproduct
ismanufacturedandthemomentitis
consumed.Thisperiodisinpracticelimitedby
theexpirationdateprintedonthepackage.
Sinceproductssuchasfood,drinksand
medicinesendtheirusefullifeashorttimeafter
consumption,theanalysisofdurabilitydoesnot
presenttechnicaloreconomiccomplexity,asis
thecasewithproductsthatdeterioratepartially
orgradually,orthosethatcanbefixedwhen
broken.

16. Aesthetics
Aestheticsisbyetymologyawordrelatedto
perceptionbyhumansenses.Thustasteand
odorofamedicineandthevisual
attractivenessofapackageareaesthetics
componentsofapharmaceuticalproduct.Toa
largeextent,thesecomponentsaresubjective,
althoughthereisusuallyagreatdealofopinion
agreementaboutthem.Hygienicaspectis
anothercomponentoftheaesthetics
dimension.

17. Perceived quality
Perceivedqualityisanindirect
comparativedimension.Giventhe
complexitiesofjudgingthequalityofa
pharmaceuticalproduct,thepublicand,
tosomeextent,themedicalprofession,
basetheirimpressionsonindirect
signals.Drugoriginalityandimmediate
effectofamedicineareaspectsof
perceivedquality,amongothers.

18. Service
Aproductcannotclaimgreatqualityifitis
notavailableatdrugstoresandother
pointsofsale,orifinterestedparties
cannotobtainclear,easytoread
informationontheproductanditseffects.
Thus,productavailabilityatpharmacies
andampledistributionofinformationon
thepartoflaboratoriesconstitutea
dimensionwelabel“service.”

19. Conformance
Conformanceisthedegreeofadherenceofthe
designandmanufactureofaproductto
acceptedindustrialstandards.Inthecaseof
pharmaceuticaltablets,forexample,
conformancemeasuresthepresenceofcracks
andthecorrespondencebetweenthequantity
oftabletsdeclaredinthepackageanditsreal
content.Unlikeaestheticsorperceivedquality,
conformanceisadimensionthatcanbe
objectivelymeasured.

20. Reliability
Reliabilityisthedimensionthatcreates
intheclientthementalstateofsecurity
aboutthepropertiesandeffectsofa
medicine.Theabsenceofadverse
effectsofcomponentsandthe
correspondence between dose
declaredinthepackageanditsreal
contentsfallunderthisdimension.

21. Service Quality
The customer’s judgment of overall
excellence of the service provided in
relation to the quality that was expected.
Process and outcome quality are both
important. (Bitner and Zeithaml)

22. The problems with using a
subjective view of Quality
How should widely divergent individual
wants be linked up to create a workable
concept of quality?
How should a distinction be made
between attributes leading to quality
and attributes leading to higher
customer satisfaction?

23. Impact of the characteristics of
Service
Intangibility
–Difficult to measure and assess
Inseperability
–The role of people in the service transaction has
an influence on quality levels
Heterogeneity
–A service is almost never exactly repeated
Perishability
–May lead to customer dissatisfaction (no tickets)
These result in consumers facing a higher
perceived risk in the consumption of services

24. A Final Definition
“Quality is the extent to which the
service, the service process and the
service organisation can satisfy the
expectations of the user.”
(Kasper et al, 1999)

25. Therefore quality is a subjective issue
as the actual output of the service is
judged by the customer in terms of their
expectations of the outcome or benefit.

26. Developing Service Quality
Reasons
–Organisations with a reputation for
consistently high quality can sustain a
competitive advantage in the service
marketplace
–Quality is “free”
–Better quality services can attract premium
prices

27. Relationship between Customer Satisfaction and
Loyalty in Competitive Industries0%
20%
40%
60%
80%
100%
Very
dissatisfied
DissatisfiedNeither
satisfied nor
dissatisfied
Satisfied Very
satisfied
Satisfaction measure
Loyalty (retention)

28. Service
Encounter
Quality
Service Design
Service
Organisation
and Culture
Service
Productivity

29. Perceived
Service
Expected
Service
CUSTOMER
COMPANY
Customer
Gap
GAP 1
GAP 2
Gaps Model of Service Quality
GAP 3
External
Communications
to CustomersGAP 4
Service Delivery
Customer-Driven Service
Designs and Standards
Company Perceptions of
Consumer Expectations

30. Gaps Model of Service Quality
•Customer Gap:
•difference between expectations and
perceptions
•Provider Gap 1:
•not knowing what customers expect
•Provider Gap 2:
•not having the right service designs and
standards
•Provider Gap 3:
•not delivering to service standards
•Provider Gap 4:
•not matching performance to promises

31. The Customer Gap
Expected
Service
Perceived
Service
GAP

32. Dimensions of Service Quality
Tangibles
Reliability
Responsiveness
Competence
Courtesy
Credibility
Security
Access
Communication
Understanding the
Customer

33. Servqual criteria
Tangibles –appearance of physical facilities,
equipment and communication materials
Reliability –the ability to perform the
promised service dependably and accurately
Responsiveness –the willingness to help
customers and provide prompt service
Assurance –knowledge and courtesy of
employees and their ability to inspire trust
and confidence
Empathy –caring, individualised attention the
firm provides to its customers

34. Customer Perceptions of Service
Quality and Customer Satisfaction
Service
Quality
Reliability
Responsiveness
Assurance
Empathy
Tangibles
Product
Quality
Price
Personal
Factors
Customer
Satisfaction
Situational
Factors

35. Problems with the Gap model
and Servqual
Expectations should be based on experience
norms –what consumers should expect
given their experience with that specific type
of service organisation.
Satisfaction is a transaction-specific measure
whereas Service Quality is a long-run overall
evaluation
The link between service quality, customer
satisfaction and purchase intentions has
never been empirically tested

36. The Three R’s of Marketing
The establishment and maintenance of
long term customer relationships
The development of programmes that
will lead to the retentionof customers
for extended periods.
The establishment of procedures to
ensure that the company can recover
from mistakes that are made.

37. The Cost of Service Quality (Xerox)
The costs of conformity
–Prevention and appraisal
The costs of non-conformity
–Failure to meet customer requirements
before and after delivery
The costs of lost opportunities

38. Total customer benefits model
Type of
Benefit
Monetary Non-
monetary
AllocatableCurrent sales
Historic Sales
Customer
satisfaction
WOM
revenues
Not allocatableReferrals
Repeat
business
Sales growth
Loyalty
Corporate
image
Positioning

39. Service quality costs model
Type of CostMonetary Non-
monetary
AllocatableDiscounts
Samples
Direct
remuneration
Time spent
with customers
Specific errors
Not allocatableTraining
Recruiting
Time
General errors
Loss of
goodwill

40. Service Quality must be understood
and managed
–Dimensions of Service Quality
Determinants of SQ
–Benefits and costs of SQ
–The limitations and uses of Servqual

41. Quality
Carryingoutinterventionscorrectly
accordingtopre-established
standardsandprocedures,with
anaimofsatisfyingthecustomers
ofthehealthsystemand
maximizing resultswithout
generatinghealthrisksor
unnecessarycosts.
Conformance to specification

42. Definitions
NationalAssociationofQualityAssurance
Professionalsdescribedqualityas“thelevelof
excellenceproducedanddocumentedinthe
processofpatientcare,basedonthebest
knowledgeavailableandachievableataparticular
facility.”
theCommunityHealthAccreditationProgram
definedqualityas“thedegreetowhichconsumers
progresstowardadesiredoutcome”
Fitness for
use

43. Dimensions of Quality
Technical competence
Access to service
Effectiveness
Efficiency
Amenities
Interpersonal relations
Continuity
Safety

44. Quality of Care
Qualityofcareas“thedegreetowhich
healthservicesforindividualsand
populationsincreasethelikehoodof
desiredhealthoutcomesandare
consistentwithcurrentprofessional
knowledge”[IOM,1990]

45. Dimensions of quality of care
Effectiveness of Care
Access to Care
Patient Satisfaction with Care
Quality care problems
Undertreatment
Overtreatment

46. Five elements to measure
Quality of care
1.The purpose of quality measurement
2.The population
3.The timing of measurement
4.The source of patient information
5.The setting in which care is to be measured.
Quality of care measures are often established
through a peer review process by professional
societies and often government agencies.

47. Quality Assurance
Qualityassuranceisformalsetof
activitiesthataimtomeasureand
improvethequalityofhealthcare
servicesprovided,includingmedical,
administrative,andothersupportive
services.

48. QA
Qualityassuranceincludesaninitial
assessmentphaseandfollowupactionsto
remedyanydeficienciesidentifiedthroughthe
assessment.Continuousqualityassurance
(CQA)isadynamicqualityassuranceprocess
basedonthenotionthatqualityofhealthcare
servicescanbeimprovedandthatsuch
improvementiscontinuousandbasedon
monitoringperformanceandidentifying
improvementopportunities.

49. Why Focus on Quality
Evenwherehealthsystemsarewell
developedandresourced,thereisclear
evidencethatqualityremainsaserious
concern,withexpectedoutcomesnot
predictablyachievedandwithwide
variationsinstandardsofhealth-care
deliverywithinandbetweenhealth-care
systems.

50. Why focus on Quality
Wherehealthsystems–particularlyin
developingcountries–needtooptimize
resourceuseandexpandpopulation
coverage,theprocessofimprovement
andscalingupneedstobebasedon
soundlocalstrategiesforqualitysothat
thebestpossibleresultsareachieved
fromnewinvestment.

51. •deliveringhealthcarethatisadherenttoan
evidencebaseandresultsinimprovedhealth
outcomesforindividualsandcommunities,
basedonneed
Effectiveness
•deliveringhealthcareinamannerwhich
maximizesresourceuseandavoidswaste
Efficiency
•deliveringhealthcarethatistimely,geographicallyreasonable,
andprovidedinasettingwhereskillsandresourcesare
appropriatetomedicalneed.
Accessibility
•deliveringhealthcarewhichtakesintoaccountthe
preferencesandaspirationsofindividualserviceusersandthe
culturesoftheircommunities
Patientcentered
•deliveringhealthcarewhichminimizesrisksandharmto
serviceusersSafety
•deliveringhealthcarewhichdoesnotvaryin
qualitybecauseofpersonalcharacteristicssuch
asgender,race,ethnicity,geographicallocation,
orsocioeconomicstatus
Equity
Health care domain

52. Roles and responsibilities in
quality Improvement
Policy and strategy development
Health service providers role
Communities and service users

53. Decision-makerscannothopetodevelopandimplement
newstrategiesforqualitywithoutproperlyengaging
health-serviceproviders,communities,andserviceusers.
Health-serviceprovidersneedtooperatewithinan
appropriatepolicyenvironmentforquality,andwitha
properunderstandingoftheneedsandexpectationsof
thosetheyserve,inordertodeliverthebestresults.
Communitiesandserviceusersneedtoinfluenceboth
qualitypolicyandthewayinwhichhealthservicesare
providedtothem,iftheyaretoimprovetheirownhealth
outcomes

54. Roles and responsibilities in
quality improvement

55. Process for building the
strategy

56. Six domain of quality
intervention

58. APPROACHES OF QUALITY
Quality Control (QC)
Total Quality Management (TQM)
Quality Assurance (QA)
Continuous Quality Improvement (CQI)

59. Quality Control
Quality control in health care organization
refers to activities that evaluate, monitor or
regulate services rendered to consumers.
Observe
•The process
Identify
•Variable characteristics
Track
•Variables through statistical methods

60. Quality Control Process
It is an eight-step process for monitoring and evaluating
performance. It must include the following steps:
Establish control criteria.
Identify the information relevant to the criteria.
Determine ways to collect the information.
Collect and analyze the information.
Compare collected information with the established
criteria.
Make a judgment about quality.
Provide information and if necessary, take corrective
action regarding finding to appropriate source.
Determine when there is a need for re-evaluation.

61. Total Quality Management (TQM)
A way to continuously improve performance at
every level of operation in every functional area
of on organization using all available human and
capital resources.
Aim to reduce the waste and cost of poor quality.
The main elements of TQM are three:
-the customer, whose needs are paramount to the
determination of quality,
-the teamwork as a mean of achieving quality,
-the scientific approach to decision-making based on data
collection and analysis.

62. Quality Assurance
All of the activities that make it possible to
define standards, to measure and
improve
the performance of services and health
providers so that care is as effective as
possible

63. Quality Assurance
defined as “the process for objectively and
systematically monitoring and evaluating the
quality and appropriateness of patient care, for
pursuing opportunities to improve patient care for
resolving identified problem”.
The focus of quality assurance is the discovery
and correction of errors. These activities are
carried out by, quality assurance personnel or
department personnel.

64. Quality Assurance
Standards, norms,
guidelines)
One cannot measure that
which one has not defined
Define
Quality
•The variation in standards
One cannot improve that
which one has not
measured
Measure
Quality
•Comply with norms
Improve
Quality

65. Continuous Quality Improvement
(CQI)
CQI is a cyclical process.
It involves identifying an area where there is
an opportunity for improvement then outline
the sequence of activities that should occur in
order to solve that problem, and
implementing them.
Once the cycle is completed it has to be
determined whether the problem has been
solved.
If the problem continues, the cycle should be
repeated.

68. Continuous Quality Improvement
Cycle (CQIC)
There are seven steps involved in implementing
CQI cycle:
Step 1identify an areawhere opportunities for
improvement exists.
Step 2define a problemwithin that area, and
outline the sequence of activities(the process)
that should occur in that problem area.
Step 3establish the desired outcomesof the
process and the requirementsneeded to achieve
them.

69. Continuous Quality Improvement
Cycle (CQIC) cont.
Step 4select specific stepsin the process,
and for each step list the factors that prevent
the achievement of desired outcome.
Step 5collect and analyze data about the
factors that are preventing the achievement
of the desired outcomes of the desired steps.
Step 6take corrective actionto improve the
process.
Step 7monitorthe results of the action
taken