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ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025
Page 4989 www.rsisinternational.org
A Systematic Review of Dimensions for Measuring Quality of
Healthcare Facilities Management Services Using Prisma Guidelines
Rubiah Md Zan1, Choong Weng Wai1, Fitriyah Razali1, Oti Amankwah2
1Faculty of Built Environment and Surveying, Universiti Teknologi Malaysia, Malaysia
2Department of Estate Management, Kumasi Technical University, Ghana
DOI: https://dx.doi.org/10.47772/IJRISS.2025.910000410
Received: 12 October 2025; Accepted: 19 October 2025; Published: 13 November 2025
ABSTRACT
Purpose - This paper provides access to the study in measuring the quality of healthcare services, specifically
in healthcare Facilities Management (FM). This paper provides a comprehensive understanding of the service
dimensions that influence the measurement of healthcare quality services.
Methodology/approach - The methodology of this research is qualitative research with the systematic analysis
of literature review using PRISMA Guidelines which was gathered from several research journals from Web of
Science (WOS) and SCOPUS database.
Findings – Data were gathered through electronic database, N=27,600 with specific criteria from 2017 to 2025
research timelines. As a result, 60 peer reviewed papers relevant to the aim and objectives of the research were
utilised. The research findings indicate that original SERVQUAL dimensions: reliability, assurance, tangible,
empathy, and responsiveness (RATER) are still relevant. Until today, SERVQUAL Model with RATER
dimensions are used to measure customer satisfaction in many sectors including healthcare. By measuring
services quality, the gap that is identified would be addressed and improved. This is important to demonstrate
best practice in healthcare quality.
Research limitations/implications – The findings highlight the intricate mechanism by which a systematic
review study using PRISMA guidelines could help strengthen the research methodology in healthcare FM. These
results provide useful insights for a healthcare FM to investigate the quality of service in healthcare FM.
Originality/values - To the best of the authors’ knowledge, a limited number of journals exist to examine the
systematic review that focuses on service quality and customer satisfaction.
Keywords: Systematic Review, Dimensions, Measuring Quality, Healthcare Facilities Management (FM),
Prisma Guidelines.
INTRODUCTION
Healthcare had grown rapidly worldwide with many changes and improvement in the healthcare industry.
Healthcare facilities vary from one to another in term of their services, speciality and resources availability. A
study of healthcare quality services is widely measured and common within customer orientation to measure the
best quality that meet the customer expectation and perception. Healthcare facilities vary from one another in
term of their services, specialty and resources availability. The quality of services in healthcare FM is
predominantly assessed using scales grounded in the customer’s perspective. Consequently, service quality has
been a central theme in numerous literature reviews. Among the most influential works is the research study by
Parasuraman et al. (1988), which conceptualised service quality as the degree and direction of the discrepancy
between customers’ expectations and perceptions. Within the healthcare sector, competition between public and
private institutions is well recognised. In many regions, efforts to deliver high-quality healthcare services have
prompted the development of strategies aimed at meeting evolving market demands.
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The ultimate goals of the strategies are mainly to continuously improve standards and to ensure safe, efficient,
effective and client-centred institution. As quality has become the most important element in services industry,
people are constantly looking for quality product and services. This desire has caused many institutions to
consider quality as a strategic goal to achieve competitive advantage (Amos et al., 2021). There is a strong direct
relationship between service quality and organization performance, where if there is an improvement in service
quality, the productivity is said to increase and thus the performance (Mosadeghrad, 2013). However, it is
difficult to define the word “quality” because of its subjective nature and intangible characteristic. Due to that,
the concept of quality is worth looking at from the customer’s point of view since the ultimate goal of the
provider is to satisfy customer needs and to ensure customer satisfaction. This is evident in most research which
is based on the quality concept as customer needs and expectations form the basis of the research. Providing
high-quality service is the key importance in any management of the organization. Hospital or healthcare in
particular aim to provide excellent clinical care and quality services to their patients.
In general, service quality comprises of two elements which are technical quality; which is based on the result
of the service encounter and also functional quality; which focuses on the internal procedures involves in
providing a service (Teshnizi et al., 2018). Service quality has become prominent in healthcare sector as it values
the relationship between human lives’, quality assurance and promotion. On the part of healthcare management,
an improvement in service quality is known to lead to an increase in profit, cost saving and market share
(Bisschoff & Clapton, 2014).
This research paper aims to provide comprehensive review for measuring dimension of healthcare quality
services with the objectives to study the adaptation of the dimension to healthcare FM services and the significant
relationship between service quality and customer satisfaction in healthcare FM.
LITERATURE REVIEW
Service Quality
In the services industry, quality can be defined as an intangible activity provided by the service provider as a
solution to a customer's problem that does not result in ownership of anything. (Kotler & Armstrong, 2001).
Service quality is therefore essential for service providers aspiring to attract and retain their customers (Butt &
Run, 2009) and it is a services of deeds, processes and performances (Zeithaml, V.A. and Bitner, 1996).
Customers evaluation of service quality is not only their subjective assessment of services meeting the set
standards but also an evaluation of their performance in the process of service delivery. Customers usually have
prior expectations of the service that they are going to receive (Upadhyai et al., 2019). In service quality
literature, the discrepancy or gap between the prior expectation of the customer before receiving the service and
the perception formed by the customer post-services delivery is called perceived service delivery (Gronroos,
1984). Service quality, thus, can be defined as the discrepancy between customers’ perceptions about the firm
offering such services (Bolton & Drew, 1991). This concept was expended, with the formation of five dimension
of service quality that comprises of tangible, reliability, responsiveness, assurance and empathy (Parasuraman
et al., 1988).
In many emerging and developed countries, over the years this servicing industry have played a major role in
the growth of businesses and organizations. Numerous studies have proven that service quality is an important
contributing factors of customers’ satisfaction, which thus, equally affects customer’s loyalty (Fida et al., 2020;
Kuo et al., 2013; Santouridis & Trivellas, 2010). When quality of service surpasses customer satisfaction, this
results in the effect of customer satisfaction and thus loyalty.
Impact of Service Quality on Customer Satisfaction
Customer satisfaction is the act of delivering expected service that meets customers’ satisfactions (Gonzalez,
2019). Satisfaction is an inner feeling of pleasure or displeasure arising from comparison of perceived
performance of service or product in relation to actual performance (Korfiatis et al., 2019). Customer satisfaction
has been of interest to most researchers and organizations. Service quality is said to be very significant issue as
far as customer satisfaction is concerned (Iglesias et al., 2019). A positive correlation is said to exist between
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)
ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025
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superior service quality and enhanced performance of organization (“Enabling a Transformative Service System
by Modelling Quality Dynamics,” 2019; (Iglesias et al., 2019; Roth & Van Der Velde, 1991). The most important
attributes that result in satisfaction include the delivery of goods and personal services, which are recognized by
the customer to be significant. It exerts an impact on customers' recommendations through word-of-mouth to
others(Pakurár et al., 2019; Stauss & Seidel, 2019; Zhang et al., 2019). Further, Porter & Kramer, (2019)stated
that customers develop a more positive perception towards organizations that they believe value and care about
its customers and their feedback.
In the following discussion, we will examine the relevant publications and from there, extract the information
regarding the dimensions of measuring quality of healthcare Facilities Management. The research goals are
formalized in the following questions:
Q1: What is the best way to define healthcare service quality?
Q2: Why measure performance of customer satisfaction in healthcare hospital?
Q3: What is the model of dimension to measure healthcare service quality?
METHODOLOGY
To achieve the research objectives of this paper, a systematic review was conducted. This review focused on the
articles that explicitly describe the dimension applied in measuring quality of healthcare FM services. The
PRISMA (Preferred documenting Items for Systematic Review and Meta-Analyses) guidelines (Moher et al.,
2009) were used as the primary framework for collecting data and documenting the process of review in this
study. A PRISMA reporting guideline instructs writers how to properly report findings of systematic reviews.
There are other fields where PRISMA can be used for improving the reporting of systematic reviews and meta-
analyses besides medical research (Moher et al., 2009). It has been used by several academics for reporting the
assessment of quality services in healthcare management to increase customer happiness and loyalty (Bakar et
al., 2008; Shabbir et al., 2016; Tan et al., 2019). There were several phases involved in the review process namely
identification of the articles, duplicate screening on articles, eligibility assessment on article, inclusion and
exclusion of articles. This review process has been explained in the following section. However no meta- analysis
was conducted for this research due to diversity of service typologies.
Data Collection
This comprehensive literature review utilized the qualitative approach. The literature was collected and compiled
from various publications and previous research papers prior to the research study area. The literature search
was conducted in 2021 to collect relevant articles where the articles were obtained and included in the review
and analytical review and synthesis had been conducted in order to strengthen the gap of research from the
literature review. The searches utilised relevant electronic database including original qualitative and
quantitative papers. The most acknowledge electronic database used for the searches are WOS (Web of Science),
PubMed, Scopus and Google Scholar. The main keywords used for the searching were service quality in
healthcare management, dimension in measuring healthcare quality services and service quality dimension in
healthcare FM services. Prior to conducting the literature search, inclusion and exclusion criteria were
established to assist the researchers in identifying suitable articles from the huge database for inclusion in this
study.
Screening Process
During the process of screening, PRISMA guidelines were followed where search result of the database was
checked for duplicates using Mendeley Software. At this point, all duplicates were removed. Abstract were read
and full text were thoroughly studied.
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)
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Data Extraction Eligibility Criteria
Standardized excel sheet were developed for data extraction from selected studies. At this stage eligibility criteria
for the research type includes either quantitative or mix method only. Most required articles are with empirical
data either using questionnaire survey or interview survey.
Selection of articles
The data extraction sheet was used to collect basic characteristics of included studies (author and year, country,
study design, respondents, survey administration, and so on). Second, detailed information was obtained on the
determination of service quality dimensions, the development of measurement instruments, and their properties.
These properties were concerned with the domains of respective instruments' item generation and response scale.
The following inclusion criteria (ICs) were met by this paper; hence it was included in the review:
EC1: Pre-2016 publication.
EC2: Composed in a non-English language.
EC3: Concise documents (1-4 pages) such as extended abstracts or research in progress.
IC4: Clearly stated and describe dimension measuring service quality specifically in healthcare FM sector.
IC5: Empirical research that conducted field experiments to explore the dimension in service quality for
healthcare FM.
Papers excluded from the inclusion criteria.
EC1: Published before 2016.
EC2: Written in a language other than English.
EC3: short papers (1-4 pages, i.e. extended abstract or research in progress).
EC4: Mention “dimension for service quality” but not as part of healthcare FM research being conducted.
EC5: Medical or clinical related articles
All the duplicate articles were removed from the database group.
The papers retrieved from the electronic database using the specified search terms underwent multiple rounds of
eligibility assessment according to the PRISMA framework. This process was used to identify the publications
that met the review criteria.
Data Analysis
The outcome of the research study shows that 60 articles appeared to be relevant to the subject under
investigation.
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)
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Figure 1.0 shows the flowchart of the systematic literature review for this paper as follow;
Fig 1.0 Review process based on PRISMA framework
RESULTS AND FINDINGS
Table 1.0 summarizes the 60 eligible articles included in this review. The table outlines key research
characteristics for each study, including respondent type, sample size, data collection instrument, and the
specific service quality dimensions applied. The chronological distribution of these studies is illustrated in
Figure 2.0 (i) and (ii). As shown in the figure, the highest number of publications appeared in 2016 with 19
papers, followed by 2017 and 2018, each contributing seven papers. Between 2020 and 2025, the number
of studies published per year was 6, 2, 2, 2, 5, and 5, papers respect ively, reflecting a steady continuation
of research interest in the field.
The SERVQUAL Model is used in Figure 3.0 to display the frequency of RATER in healthcare dimensions.
Many of the publications used the RATER dimension in their research papers in accordance with the pioneer
dimensions taken from Valarie A. Zeithaml, A. Parasuraman, Leonard L. Berry, (1990) according to all the
review papers. According to the pie chart, 30 papers used RATER while the remaining 14 used either modified
RATER or other dimensions to fit their research studies.
Table 1.0 List of selected articles with data collection tools and service dimensions.
Researchers Country Respondents Sample
size
Data collection
tools
Service Dimensions Journal
Sumaedi et
al., (2016)
Indonesia Patient 161 Questionnaire Quality of healthcare
delivery, quality of
healthcare personnel, the
adequacy of health
resource and the quality of
administration process,
perceive sacrifice, perceive
value and image
International
Journal of
Productivity and
Performance
Management
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)
ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025
Page 4994 www.rsisinternational.org
Yarmen et al.,
(2016)
Indonesia Patient 100 Questionnnaire Healthcare service
outcome, healthcare
service interaction and
healthcare service
environment
International
Journal of
Productivity and
Performance
Management
Kalaja et al.,
(2016)
Albania Inpatient 200 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
Procedia - Social
and Behavioral
Sciences Journal
Meesala &
Paul, (2016)
India Patient 440 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
Journal of Retailing
and Consumer
Services
Mohebifar et
al., (2016)
Iran Patient 360 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
Osong Public
Health and
Research
Perspectives
journal
Aliman &
Mohamad,
(2016)
Malaysia Outpatient 273 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
Procedia - Social
and Behavioral
Sciences journal
D. Lee,
(2016)
South Korea Patient 368 Questionnaire Empathy, tangible, safety,
efficient,
Service Business by
Springer
Nadi et al.,
(2016)
Iran Patient 600 Questionnaire Empathy, physical
appearance,
responsiveness, assurance
and reliability
Journal of
Academic of
Medical Sciences
of Bosnia and
Herzegovina.
Jandavath &
Byram,
(2016)
India Inpatinet 493 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
International
Journal of
Pharmaceutical and
Healthcare
Marketing
Torabipour et
al., (2016)
Iran Indoor patient 100 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
Jundishapur
Journal of Health
Sciences
Sandhyaduhit
a et al., (2016)
Indonesia patient 297 Questionnaire Responsiveness,
assurance,
professionalism,
reliability, empathy and
tangible
International
Journal of E-Health
and Medical
Communications
Pouragha &
Zarei, (2016)
Tehran Outpatient 500 Questionnaire Acceesibility, appoinment,
perceived waiting time,
admission process,
physical environment,
physician consulation,
infomration to patient,
perceived cost of service
Materia Socio
Medica – Journal of
the Academy of
Medical
Shafii et al.,
(2016)
Yazd, Iran Patient 300 Questionnaire Responsiveness, security,
assurance, tangible, health
communication and patient
orientation
Osong Public
Health and
Research
Perspectives
Fraihi &
Latif, (2016)
Suadi
Arabia
Outpatient 306 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
Saudi Medical
Journal
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Page 4995 www.rsisinternational.org
Amole et al.,
(2016)
Nigeria Patient 326/42
0
Questionnaire Staff communication and
relibility, assurance,
Output quality, hospital
environment
Journal of Varna
University of
economics
Pramanik,
(2016)
India Patient 368 Qestionnaire Reliability, assurance,
tangible, empathy and
responsiveness
Journal of Health
Management
Pooja Kansra
and Abhishek
Kumar Jha,
(2016)
India Patient 50 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
International
Journal Services
and Operations
Management
Dammaj et
al., (2016)
Jordan Patient 100 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
International
Journal
Productivity and
Quality
Management
Ali et al.,
(2016)
India Patient 210 Questionnaire Tangible, assurance,
empathy and
responsiveness
Benchmarking: an
International
Journal
Fan et al.,
(2017)
China Patient 1589 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
Journal
Information- PLOS
ONE
Ahmed et al.,
(2017)
Malaysia Hospital staff 438 Questionnaire Progress of quality
management, medical
service cost, reduce error,
patient waiting time,
reduce waste in process,
patinet compaint,
employee job satisfaction
and patient satisfaction
International
Journal of Quality
and Service
Sciences
Shafiq et al.,
(2017)
Pakistan Inpatient and
outpatient
340 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
The Journal of
Health Care
Organization,
provision and
Financing
Singh &
Prasher,
(2017)
India patient 650 Questionnaire Relibility, assurance,
tangible, empathy,
responsiveness and
Trustworthiness
Journal of Total
Qualtiy,
Management and
Business Excellent
Samal et al.,
(2017)
India Patient 120 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
Research Journal
Pharmacy and
Technology
Pekkaya et al.,
(2017)
Turkey Outpatient 1029 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
International
Journal of
Healthcare
Management
Owusu
Kwateng et
al., (2017)
Ghana patient 400 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
International
Journal Of
Healthcare
Management
Al-Neyadi et
al., (2018)
UAE Patient 127 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
International
Journal of
Healthcare
Management
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Page 4996 www.rsisinternational.org
Gichangi &
Mwanda,
(2018)
Kenya patient 2217 Questionnaire Consultation time,
communication by the
healthcare workers,
availibility of staff, privacy
in wards,availibility of
drug
Journal of
Environmental and
Public Health
Dar, (2018) India Outpatient 100 Questionnaire Doctor’s empathy,
assurance, responsiveness,
tangibility and efficiency
International
Journal Healthcare
Technology and
Management
Skordoulis &
Chalikias,
(2018)
Greece Patient 630 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
International
Journal
Productivity and
Quality
Management
Dullie et al.,
(2018)
Malawi Patient 440 Questionnaire First contact access,
communication continuity,
relationsl continuity,
service available, service
provided, communication
orientation
BMC Healthcare
Services Research
Tripathi et al.,
(2018)
India Patient 338 Questionnnaire Reliability, assurance,
tangible, empathy and
responsiveness
International
Journal of
Healthcare
Management
Madhura
Prabhu &
Iyer, (2018)
India Patient 100 Questionnnaire Reliability, assurance,
tangible, empathy and
responsiveness
Journal of Health
Management
Akdere et al.,
(2018)
Turkey Inpatient 972 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
Total Quality
Management &
Business
Excellence
Amankwah,
Choong, et
al., (2019)
Ghana Patient 660 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
Evironmental
Health Insight
Sood et al.,
(2019)
India Helathcare
provider
incuding
clinicians, staff
nurses, lab &
Imaging
technologists,
pharmacists and
hospital
management
staff
362 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
Indian Journal of
Public Health
Research and
Development
Javed et al.,
(2019)
Pakistan Patient 550 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
International
Journal Health
Planning
Management
Umoke et al.,
(2020)
Nigeria Patient 400 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
SAGE Open
Medicine
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Zun et al.,
(2020)
Malaysia Patient 386 Questionnaire Reliability,
responsiveness, assurance,
empathy and tangible.
Malaysian Journal
of Medicine and
Health Sciences
Barrios-
ipenza &
Calvo-mora,
(2020)
Peru Patient 250 Questionnaire Healthcare personnel, non-
healthcare personnel,
facilities, equipment and
tangible,
International
Journal of
Environmental
Research and
Public Health
Mohammad
et al., (2020)
Bangladesh Post-stroke
outpatient
331 Questionnaire Modified RATER
Reliability, assurance,
tangible, empathy,
responsiveness. Cost and
availability
Iranian
Rehabilitation
Journal
Kot &
Syaharuddin,
(2020)
Indonesia Patient 360 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
International
Journal Of
Economics And
Finance Studies
Došen et al.,
(2020)
Crotia Patient 564 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
Acta Clinica
Croatica
Perera &
Dabney,
(2020)
United
States
America
(USA)
Inpatient 125 Questionnaire Tangible and Non-tangible
(Reliability, assurance,
empathy and
responsiveness)
Journal of Health
Organization and
Management
Agyei et al.,
(2020)
Ghana Patient 540 Questionnaire Reliability, assurance,
tangible, empathy and
responsiveness
British Journal of
Health Care
Management
Kipo-
sunyehzi,
(2021)
Ghana Hospital
implementer
and
benefeciaries
107 Questionnaire Referral, effectiveness in
monitoring, timeliness,
efficiency, reimbursement,
compliance with standard
guidelines of GHS and
accreditation process.
Journal of Public
Administration and
Policy
Sanıl &
Eminer,
(2021)
North
Cyprus
Patient 388 Questionnaire Modified RATER
Affordability,
accessibility, acceptability
and perceived value
BMC Public
Health-Scimago
Journal
Yarmak,
(2022)
Russia Patient 120 Questionaire Reliability, assurance,
tangibility, empathy,
responsiveness
ArtyKuty
Jonkisz et al.,
(2022)
Poland Review - Review Reliability, assurance,
tangibility, empathy,
responsiveness
MDPI IJERPH
Alrwashdh &
Alishaq,
(2023)
Jordan Patient 420 Questionnaire Reliability, assurance,
tangibility, empathy,
responsiveness
IJQHC
Communications
Değer &
İşsever,
(2024)
Turkey Patient 310 Questionnaire Reliability, assurance,
tangibility, empathy,
responsiveness; Physical
characteristics
MDPI Healthcare
Hosseinzadeh
et al., (2024)
Iran Patient 280 Questionnaire Reliability, assurance,
tangibility, empathy,
responsiveness
JJCDC
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Rahman &
Islam, (2024)
Bangladesh Patient 275 Survey Modified RATER
Reliability, assurance,
tangibility, empathy,
responsiveness; Safety;
Communication
Discover Public
Health
Wulandari et
al., (2024)
Indonesia Patient 380 Survey Reliability, assurance,
tangibility, empathy,
responsiveness
Open Access
Journal
Hijazi et al.,
(2024)
Jordan Patient 959 Questionnaire Reliability, assurance,
tangibility, empathy,
responsiveness
PubMed
Alfatafta et
al., (2025)
Jordan Patient 390 Questionnaire Reliability, assurance,
tangibility, empathy,
responsiveness
BMC Health
Services Research
Al-Balas et
al., (2025)
Jordan Patient 415 Survey Reliability, assurance,
tangibility, empathy,
responsiveness
Int. J. Healthcare
Management
Alizadeh et
al., (2025)
Iran Patient 8021 Quesnionnaire Reliability, assurance,
tangibility, empathy,
responsiveness
Wiley
Beheshtinia et
al., (2025)
Iran Mixed 386 Mixed Alternative model: QFD /
SERVQUAL House of
Quality for healthcare
improvement
MDPI
Kristianti &
Sriwijaya,
(2025)
Indonesia Patient 300 Quentionai Reliability, assurance,
tangibility, empathy,
responsiveness
Open Access
Journal
Fig 2.0 Timeline of review papers
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Fig 3.0 Timeline of review papers
Fig 4.0 Frequency of Healthcare Dimensions Using SERVQUAL Model
DISCUSSION
Q1: What is healthcare service quality?
Managing and evaluating service quality is an intricate procedure. This is because in order to improve the quality
of the services, it is important to understand the characteristic of the services which are considered important by
the customer. For the organization which are responsible to the facilitates management service provision must
evaluate the level of satisfaction of the customer with the services provided (Lepkova & Žūkaitė-Jefimovienė,
2013). Previously, service quality was described in terms of functional and technical quality, whereas latter
known as five dimensions of service quality: tangibles (physical facilities, equipment, and personnel
appearance); reliability refers to (the capacity to consistently and precisely deliver the promised services);
responsiveness (willingness to assist customers and provide prompt service); assurance (employees’ knowledge,
politeness and their capacity to instil trust and confidence) and empathy (caring, individualised attention the
organisation provides its customers) (Parasuraman et al., 1988). Generally, as the healthcare service is part of
services, it might seem similar to other types of services around the market; however, healthcare is said to be
inherently different from other industries in the service sector. Healthcare is a credence service where the
evaluation of clinical quality is often difficult for patient to judge even after post-treatment (Berry, 2007). As
67%
33%
Frequency of Study Dimension
RATER NON-RATER
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defined by WHO healthcare services should be safe, prevent injuries, and be effective as well as providing
evidence- based healthcare services to people who need them, while being people- focused; responding to
individual preferences, needs, and values in a timely manner; and reducing waiting times and delay that could
be harmful. It is also said that healthcare service quality is critical to healthcare business due to the different
stakeholders including patients, health professionals and hospital management. Due to that, it is important to
sustain and constantly develop service quality for both parties as the hospital service encompasses the welfare
of humans (Bautista & Tangsoc, 2016). As this paper focusing on healthcare FM service quality and to avoid
confusion, frankly there is a close relationship between the study of healthcare service quality and healthcare
FM service quality as agreed by (Amankwah et al., 2019). The quality of healthcare FM services should be
evaluated using service quality concept with SERVQUAL as the measuring tools as suggested by (Parasuraman
et al., 1988). As the healthcare services quality is advocated with healthcare FM, it should be tailored towards
patients’ needs (Pheng & Rui, 2016). Therefore, for the purpose of this study, the term “quality” in healthcare
FM refers to excellence in healthcare facilities resource management to ensure the best of healthcare standards
through monitoring and evaluation of standards of available healthcare resources to ensure patient’s safety thus
achieve patients’ satisfaction.
Q2: Why Measure performance of customer satisfaction in healthcare hospital?
Hronec (1993) defines performance measurement as a quantification of how well the activities within the process
or the output of the process achieve a specific goal in an organization. Mainly the performance measurement has
become accepted as a management strategy as it is deemed to provide a standard by which the main business of
an organization can be measured to ensure success. Some benefit that can be achieved through performance
measurement are client focus, value for money and high standard of service delivery. FM has been involved in
the performance measurement revolution. Through that, key performance indicators for measuring facilities in
healthcare has been introduced and grouped into four main categories such as development, organization and
management, performance and efficiency (Shohet, 2006). Most often, quantitative dimensions are used in FM
performance measurement while performance metrics are used in performance evaluation process as it has
significant indicators to evaluate performance of the facility. In healthcare sector as the industry facing rapid
changes in practice, the role that patient plays to justify quality has become the competitive concern. Focusing
on mortality and morbidity rate is just a part of the way in reviewing the competency of the hospital, but asking
the patient about their satisfaction of the services provided is becoming the essential and valuable tools for the
optimum evaluation of the healthcare providers (Hafiz et al., 2011). Due to that, performance measurement
system (PMS) tools have become necessary to determine and measure the performance of the services in
hospitals. Investigation on patient satisfaction survey aid healthcare provider in finding areas in which their
service might be improved and enable policy makers to understand patients need and therefore create strategic
plans for more effective and high- quality services (Rahim et al., 2021).
Q3: What is the model of dimension to measure healthcare service quality?
Parasuraman et al., (1985) discovered ten dimensions of service excellence across five distinct sectors, one of
the sectors is healthcare. Later the following year, the dimensions had been reduced to five dimensions namely
responsiveness, assurance, tangible, empathy and reliability (RATER). The dimensions are recognized and
widely applied worldwide in many sectors to measure service quality. The dimensions of healthcare service
quality can be categorized into medical care and non-medical components. The medical aspect encompasses
technical and interpersonal dimensions. The technical dimension refers to the knowledge, skills, professional
judgment, and competence of medical treatment in an effective and efficient patient-centered services. The
interpersonal dimension focuses on the quality of interaction between healthcare providers and patients,
including effective communication, friendliness, attentiveness, empathy, and understanding (Donabedian, 1988).
Meanwhile, the non-medical aspect of care includes three dimension which are servicescapes, accessibility; and
responsiveness. Servicescape includes the basic amenities and physical environment which the service delivers.
The list includes accommodation, building appearance, landscaping, staff uniform, signage, cleanliness and
others (Gronroos, 1984). In terms of accessibility, the facility's location, the time required to get there, and the
cost-effectiveness of the service were considered. These factors represented how simple admission, billing,
discharge, and other non-health-related activities were. Furthermore, responsiveness refers to the realistic
expectations that a person has for care, which include respect for the patient's autonomy and dignity, the
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confidentiality of care, prompt service, availability of social support networks while receiving care, and the
quality of basic facilities (Silva, 2000). Additionally, latest update by Rahim et al., (2021) stated that physical
facility environment such as parking, cleanliness and waiting room directly contributed to the high rating of
customer satisfaction. When talking about measurement, patient expectation and perception are valuable insight
in healthcare FM service quality. For further improvement on the healthcare service quality dimensions,
Parasuraman et al., (1988) suggested that for future application of the dimensions measurement, the earlier
suggested basic dimensions which is “RATER”, are allowed to be modified to suit peculiar situations
(Amankwah, Choong, et al., 2019). Even though SERVQUAL is the most applied measurement in the market,
it is still being challenged by other modified measurement such as SERFPERF, PRIVHEALTHQUAL,
PubHosQual and HEALTHQUAL. Thus, for comparison, the SERVPERF scale can be used because of its
psychometric validity and instrument economy if all that is desired is to evaluate a company's overall service
quality or to compare service quality across service industries. However, because of its greater diagnostic
capability, the SERVQUAL scale should be preferred when pinpointing the areas of a firm's service quality
shortcomings for managerial adjustments (Jain & Gupta, 2004). PRIVHEALTHQUAL happened to be the
SERVQUAL modified dimensions which was developed in Mauritius by adding extra 2 dimensions from the
original RATER which are equitable treatment, reliability or fairness, image or tangibility, core medical services
or skill, responsiveness, empathy or assurance apparatus and record, dissemination of information
(Hammanjoda, 2022). For PubHosQual it was first developed in India where the model measured patients’
perspective in healthcare service quality. The dimensions used for the measurement model are admission,
medicals service, overall service, discharged and social responsibility. It is said to be grounded on the Indian
public hospital context and did not incorporate with technical aspect of healthcare services (Endeshaw, 2021;
Kilbourne et al., 2004). HEALTHQUAL is an adaptation of SERVQUAL. During the development of the model,
only one hospital in Malta, was used as a case study to test the HEALTHQUAL Model. In its early application,
it is not often welcomed. In addition, the model had identified six key dimensions that can be use: admission
processes, medical staff (doctors) attitudes, nursing officer attitudes, ward/hospital environment, patients'
amenities/facilities, and discharge planning and coordination. The work of (Donabedian, 1988), Camilleri &
Callaghan, (1998) work provided valuable insight into what was required for hospital service standards
(Endeshaw, 2021). However, the model's dimensions are uncertain because they can change depending on the
process of care services and the outcome of treatment. (D. H. Lee, 2016).
CONCLUSION
This paper seeks to address the existing gap in the literature on service quality dimensions by conducting a
systematic review guided by the PRISMA framework. A comprehensive body of academic studies was
examined, revealing that the work by Parasuraman remains a pioneering and highly cited reference on service
quality dimensions, particularly within the context of healthcare services. Through a rigorous screening and
selection process, a total of 60 relevant studies were identified and analysed to inform this review.
Healthcare quality is found to be multidimensional with many different sub-dimensions based on their contextual
need. Evidence synthesized from this review also concludes that SERVQUAL still the most used model for
healthcare service quality measurement along with limited use of other models. There are possibilities to measure
the services using the original dimensions which are reliability, assurance, tangible, empathy and responsiveness
(RATER) while in some cases, modified dimensions might also be applicable depending on the scope of the
research study. Until today, RATER dimensions are used to measure customer expectation which customer
always consider when using services. In measuring services quality, the gap that is identified within the
healthcare services industry have to be addressed and improved. This is important to meet customer expectation.
Furthermore, SERVQUAL model mostly used in accessing hospital service quality especially in developing
countries such as Malaysia, India, Iran, Ghana, Indonesia and other countries and the applicable of the model
along with the RATER dimension is still relevant until today.
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