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ConclusionsSERVQUAL is a powerful tool for assessingquality of health care services. However, it needsto be viewed critically as its strength, i.eparsimony, could be at the same time its weakness.It has been criticized for being too simple toprovide a general theoretical understanding ofconsumer evaluation or to be useful in empiricalprediction.44 The emphasis on general all-inclusivemodels for measuring quality of service coulddisorient management from the philosophy ofputting the customers perspective first. Gro¨nroos45highlighted that such measures reflect anobjective view or a third person perspective ofwhat service quality may mean to a consumerwhereas service quality is a more dynamic phenomenon.Generic measures of service qualitymay be an oversimplification and predefinition ofwhat consumers indeed looking for.46Quality of health care needs to be redefined byencompassing multiple dimensions. Beyond asimple expectations–perceptions gap, people mayhold different understandings of health care thatin turn influence the perception of quality of services.Current research on the quality of healthservices assumes a specific type of patient that is aconscious customer who makes rational decisions.However, different types of understandingsof health care may coexist. For example, patientsmay consider care a passive process where theyare willingly dependent on the professionals forinformation and prescription. On the other hand,patients may be distrustful of health services, andthey just have to rely on them because of theirillness and they monitor or question the processcarefully. Finally, other patients may see theprocess of treatment as a shared experience, andthey consider choice as a key determinant ofcare.46 Taking such perspectives into considerationmay enrich service quality research.
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