■ Hospital experience

Suffering from some acute pain received from a sport practice during a weekend, I decided two days later to go to a hospital casualty service at about 16 hours. The person at the card desk asked for my problem, name, address and age. These were written on a pink card and I was asked to wait.

This was done in a fairly straightforward, quick and routine manner. However, the staff did not reply to my ?bonjour? nor ?merci?, barely looked at me and certainly did not show any empathy. The waiting room was improperly lit and had a lot of seats that were barely comfortable. I was called two to three minutes later and asked to line up in a row inside the casualty for the duty Doctor H to see me.

After ten minutes, Doctor H called me in. I was not formally invited to take a seat, so I was uncomfortable to do so. The examination room was relatively small and my chair was located practically at the entrance with the door left opened. I was asked in a direct manner ?Ki ou gagnye ??

I had no time for ?bonjour?. The room was quite clean and Doctor H looked relatively young and was dressed in the usual white coat. He gave the impression to be moderately responsive and conveyed some degree of assurance. After the examination, I was asked to carry out an X-ray examination and was given a sheet for the X-ray service. On my way out, the duty nurse vaguely indicated to me where to go.

At the X-ray ?window?, I remitted the small white paper with the doctor?s scribble on it to one staff member who again acted very mechanically by just asking to ?atann?. I waited for about five minutes in a dark and windy corridor. Again, I was asked in a straightforward and routine manner to stand and take my breath for the X-ray. The technician was professional in his approach and conveyed assurance of his work. He too did however too not respond to any ?bonjour? and ?merci?.

Back to the casualty, Doctor H informed me ?pena nanye kase? and started to write lengthily on the pink card. He did not explain to me the nature and the cause of the pain. The physician rather informed me that I could come back and suggested an appointment the following day for the ?film? to be examined by another colleague.

I was finally prescribed two drugs on a small white sheet. The medicines were readily obtained at the ?Pharmacy? window after queuing for five minutes. By the time I went to the pharmacy, I was used to the general lack of empathy and I also stopped saying ?bonjour?, ?au-revoir? and ?merci? as nobody was likely to answer.

■ Clinic experience

Three days later, as I was not still feeling any better, I decided to go to the clinic on my way to work. Also I started to have some doubts about the hospital treatment. In particular, Doctor H had not made it clear to me the nature of the pain, its evolution, and the effectiveness (or side effects) of the medicines.

I checked at the clinic at about 10 a.m and was greeted ?bonjour? by the receptionist at the casualty who made relatively good eye contact. I was asked about my problem and asked to wait.

The waiting room was also barely lit but the seats were comfortable. The room had green plants and an aquarium with colourful fish. In terms of perceived ?tangibles?, I felt somehow already better to be in a soothing atmosphere. The receptionist informed me about three to four minutes later to see Doctor C at the consultation section.

There, another polite receptionist wearing a neat uniform asked for my name and informed me that I was third on the waiting list. The consultation waiting room was however quite narrow and I had to give up reading my newspaper. Indeed, I had to continuously fold the pages in order not to invade the space of my fellow-waiting patient.

After about 15 minutes, I was called in and I was asked to close the door. The room was rather large, twice that of the hospital and much cleaner. Doctor C was dressed formally with a necktie and had a welcoming smile that gave me an immediate impression of experience and assurance. I was politely invited to sit down (s?il vous plaît) and Doctor C listened carefully to my ?story? before proceeding to the same examination carried out at the hospital.

On completing the examination, he explained to me in detail his diagnosis, the pain evolution as well as the treatment and possible side effect of the drug prescribed. Before leaving, I settled the amount requested to Doctor C and was issued a receipt. I was nicely greeted ?au-revoir? by both receptionists on leaving although I secretly hoped not to see them again soon.

■ Comparison of service quality attributes

Based on the above descriptions, the reliability and core service for the treatments received at both the hospital and the clinic are comparable. They are definitely of good standard. The time cycles are also of the same orders although the hospital seems to have an advantage, as there is an objective to limit the waiting times. However, the physical tangibles of the two services differ totally.

The clinic tends to be much cleaner with a soothing atmosphere. It is apparent that the hospital tends to concentrate on the treatment process itself and there is no approach (and related expense) for the hospital on improving the general environment with plants and other similar items. The impression developed is that the hospital is aiming at functionality and effectiveness and views the service from a product quality angle.

Concerning customer aspects, the clinic is definitely more customer-focused, responsive and convey greater assurance than the hospital. In particular, the Doctor at the clinic communicates in a much better manner, displaying numerous attributes of empathy and assurance. For instance, it was heard during the conversation ?mo kone komye sa fer mal?, ?monn deza admet kikenn pou sa? and ?me ou ka mwin grav?.

Furthermore, the lack of response to ?bonjour?, ?merci? and ?au-revoir? at the hospital is quite disturbing and influenced very negatively the perceptions of politeness, respect and consideration at the hospital. One would tend to think that the hospital people including Doctor H are badly mannered. However, from our mauritian experience we do know that the same Doctor H will be delivering a service comparable to Doctor C at a clinic or at home when he will be paid ?directly?.

■ Perceived value and satisfaction

Based on the above experiences, it may be concluded that the clinic is better than the hospital in terms of overall service quality and correspondingly my satisfaction could be higher with the former. However, the truth is somewhere in between as one key factor still need to be considered. Namely the perceived value for determining my overall satisfaction. Perceived value is a comparative dimension, that is, the benefits versus the costs equation; that is what you ?get? versus what you ?pay?. ?Get? may be the functional, emotional or social aspects of the service itself, and ?pay? refer to financial and psychological costs.

A fundamental difference between the two services experienced described is that the hospital one is ?free? whilst the clinic one is not.

At a naïve level, we Mauritians tend to believe that we are getting value at the hospital as the ?gets? (viewed mostly as functional treatment here) will always exceed the financial costs namely ?free? for the hospital. In fact, the psychological costs associated with the lack of communication, politeness, and empathy at the hospital can largely offset this advantage. Also, there is nothing really ?free? as tax amount paid must be factored in the equation.

On the other hand, as presented in the l?express article, clinics are often described as being expensive. This too can however be influenced in a much positive manner by the service quality. Indeed, the clinic experience described earlier involved much lesser psychological costs and had much better ?gets? in terms of assurance, responsiveness and empathy enjoyed.

■ Conclusion

Service quality is a complex concept as it is a composite of attributes including physical, sensory, behavioural, temporal and functional amongst others. In this context, whether our hospitals are ?better? than local clinics cannot be answered in a simple and generalised manner. Each case is unique and the outcome lies on a continuum between the two extremes.

Iqbal BHUGUN

Email: [email protected]