03 April 2018

Questionnaire for Service Quality of Hospitals – Download

Following questionnaire was proposed by Asghar Zarei et al. in 2012 on their study “Service quality of private hospitals: The Iranian Patients’ perspective”. Authors derived the questionnaire from famous SERQUAL Questionnaire of Parasuraman et al.
The questionnaire composed of 2 parts:
The first part includes 8 questions relating to the socio-demographic data of the patient.
The second part includes three dimensions of the service quality as follows:

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Questionnaire for Service Quality of Hospitals

Socio-demographic Variables

Gender:          Male               Female
Age:               ≤ 30                 31-40               41-50               51-60               ≥ 61
Education level:         Illiterate          Primary and secondary school             Academic Degree
Residence:      Urban                         Rural
Hospital ward:           Internal            Surgery            Obstetrics and Gynaecology               Other
Health condition:                   Excellent         Good               Average           Bad

Service Quality Dimensions and items

Service Quality Dimensions and itemsStrongly Disagree
Neither Agree Nor Disagree
Strongly Agree
1. Sincere interest of personnel in solving patients’ problems
2. Carrying out of the services right at the first time
3. Providing services at appointed time
4. Error-free and fast retrieval of documents
5. Telling when services will be performed
6. Prompt performance of medical and non-medical services
7. Willingness of personnel to help patients
8. Attending of personnel whenever called
9. Instilling confidence in patients
10. Feeling safety and security in interaction with personnel
11. Polite and friendly dealing of personnel with patients
12. Knowledgeable personnel to answer patients’ questions
13. Individual attention to patients
14. Availability of 24-hour services
15. Attention to the patient’s beliefs and emotions
16. Having patients’ best interest at heart
17. Understanding specific needs of patients
18. Neat and well-dressed personnel
19. Clean and comfortable environment of the hospital
20. Modern and up-to-date equipment
21. Visually appeal of physical facilities
Zarei, A., Arab, M., Froushani, A. R., Rashidian, A., & Tabatabaei, S. M. G. (2012). Service quality of private hospitals: The Iranian Patients’ perspective. BMC health services research12(1), 31.