The Vision 2030 initiative in Saudi Arabia outlines a goal to improve the private sector’s participation to the gross domestic product (GDP) from 40 to 65% by 2030 [1]. This strategic vision represents a collaborative endeavor between the private and governmental sectors with the aim of fostering the growth of the Saudi economy (Vision) [1]. Among the private sectors anticipated to play a key role in contributing to the GDP is the health sector, which encompasses hospitals and polyclinics specializing in various medical fields. The sustainability and growth of these health-related businesses, coupled with the emergence of new entrants into the market, are crucial factors contributing to the overall market development. An essential metric for determining the success of businesses within this sector is patient satisfaction and their willingness to return to clinics. The feedback and perceptions of patients serve as pivotal indicators for evaluating the success of these enterprises. Notably, dental clinics encounter challenges related to service quality, price sensitivity, and insurance availability. According to the latest updates on Saudi Arabia Dental Care Market Analysis as of October 12, 2023, the current valuation of the dental care market is approximately $287.04 million in 2022 [2]. Projections indicate an anticipated increase to $489.51 million by 2030, tackling a compound annual growth rate of 7.9% over the forecasted time period [2]. Saudi Arabia, driven by initiatives like Vision 2030, has attracted a substantial number of pilgrim tourists, with 6.5 million visitors in 2021 due to Hajj and Umrah. Additionally, there is a notable rise in the expatriate population as part of the diversification efforts to move away from an oil-based economy [2].
Several studies have highlighted that dental health clinics are well-established in Saudi Arabia (Althumairy RI,) [3]. The SERVQUAL model, introduced by Parasuraman et al. [4] in 1988, has been widely adopted by retail organizations to gauge client perceptions of service quality across five dimensions: tangibility, reliability, responsiveness, assurance, and empathy (Parasuraman et al.). These dimensions have proven critical in evaluating the quality of services in various sectors, including healthcare, and have been instrumental in understanding the dynamics of patient satisfaction and service quality in dental services [5].
Research within the health and education sectors in Saudi Arabia, such as the study by Al-Omar BA et al. (1998), has emphasized the impact of quality dimensions on client perception [6]. In the dental private sector located in Riyadh, Khan. N et al. (2007) found a link between dentists’ behaviors and communication and higher rates of patient satisfaction. This underscores the importance of interpersonal skills and effective communication in enhancing patient satisfaction [7].
The application of the SERVQUAL model in the dental sector has provided valuable insights into the specific needs and expectations of patients. For example, the dimension of tangibility, which relates to the physical aspects of the dental facility and equipment, has been shown to influence patient perceptions of professionalism and the quality of care provided. Similarly, reliability, which pertains to the consistency and accuracy of the service, is crucial in building trust between patients and dental practitioners.
Responsiveness, or the promptness and willingness of staff to assist patients, is particularly important in emergency dental situations where timely care can significantly impact patient outcomes and satisfaction. Assurance, which encompasses the knowledge and courtesy of staff and their ability to inspire trust and confidence, is vital in a healthcare setting where patients need to feel confident in the care they are receiving. Lastly, empathy, or the caring and individualized attention provided to patients, is essential in creating a positive patient experience, particularly in a field as personal as dental care.
Further studies have built on these findings, exploring the nuances of patient satisfaction in the dental sector. For example, research has shown that patients’ perceptions of service quality can vary based on factors such as age, gender, and previous dental experiences. Understanding these variations is crucial for dental practitioners and clinics aiming to tailor their services to meet the diverse needs of their patient population.
Moreover, the implementation of the SERVQUAL model in dental clinics has led to the development of targeted strategies to enhance service quality. These strategies include training programs for dental staff to improve communication and interpersonal skills, investments in modern dental equipment and facilities to enhance the tangibility aspect, and the implementation of patient feedback systems to monitor and improve responsiveness and assurance.
In conclusion, the SERVQUAL model has been a valuable tool in assessing and improving service quality in the dental sector in Saudi Arabia. The insights gained from its application have highlighted the importance of various dimensions of service quality, such as interpersonal skills, effective communication, and the physical environment, in enhancing patient satisfaction. As the dental sector continues to evolve, ongoing research and the application of models like SERVQUAL will be essential in ensuring that dental services meet the highest standards of quality and patient care.
Dental care quality has been identified as the primary motivating factor for seeking dental treatment in private dental centers, as highlighted by (Al Johara, A.) [8]. The study underscores the significance of quality in attracting patients to private facilities. Further research by Ahmad I et al. (2011) revealed that patient satisfaction is influenced by various factors, including satisfaction with staff, patient awareness, and satisfaction with management. These findings suggest that the overall experience of patients, encompassing their interactions with staff and their understanding of the treatment process, plays a crucial role in their satisfaction [9].
Al-Refeidi A et al. (2012) pointed out the need to minimize delays before treatment initiation and alleviate patient anxiety during the treatment process. This emphasizes the importance of efficient service delivery and emotional support in ensuring a positive patient experience. Delays and anxiety can significantly impact patient satisfaction, highlighting the need for dental clinics to streamline their processes and provide supportive care [10].
Patel JY (2014) brought attention to challenges faced by patients, including difficulty in comprehending explanations by dental students and extended waiting times, which lead to patient dissatisfaction. This indicates the need for effective communication and education strategies to ensure patients understand their treatment plans [11]. Additionally, the study highlights the impact of waiting times on patient satisfaction, echoing the findings of Alnemer KA et al. (2015). Their research observed that individuals experiencing lengthier waiting times between admission and actual visit exhibited a higher dissatisfaction level, further emphasizing the need for timely service delivery [12].
The findings from these studies underscore the multifaceted nature of patient satisfaction in dental care. Quality of care, efficient service delivery, effective communication, and emotional support are all critical factors that influence patient satisfaction. Dental clinics and practitioners must address these areas to enhance patient experiences and satisfaction levels. Moreover, ongoing research and feedback mechanisms can help identify areas for improvement and implement strategies to address patient concerns, ultimately leading to better patient outcomes and higher satisfaction rates in dental care services.
In the dental clinics of National Guard Health Affairs, Subait AA et al. (2016) conducted a study that revealed a high level of contentment among participants. Interestingly, their satisfaction was found to be unaffected by gender or socio-economic variances but was correlated with the participants’ level of education. This suggests that educated individuals may have different expectations or perceptions of dental care services, which can influence their satisfaction levels [13].
Fernandez R. et al. (2016) delved into the factors influencing the selection of dental care providers. Their findings indicated that the population did not base their choices on factors such as the gender or place of graduation of the dentist. Instead, it was suggested that other factors, such as service quality and reputation, may play a more significant role in provider selection. This highlights the importance of maintaining high standards of service quality and building a strong reputation in the competitive dental care market [14].
Ali DA (2016) conducted a study that revealed overall satisfaction among respondents, with the highest levels of satisfaction reported in the performance of dentists and services provided by dental assistants. However, the study also uncovered dissatisfaction regarding the physical look and feel of the clinic and its accessibility. This underscores the importance of the physical environment in patient satisfaction, emphasizing that aspects such as aesthetics, comfort, and convenience are crucial in creating a positive patient experience [15].
The validity of the SERVQUAL model in assessing service quality and patient satisfaction was confirmed in various studies. The model’s dimensions, which include tangibility, reliability, responsiveness, assurance, and empathy, have been associated with factors such as gender, education, and age. In Western Saudi Arabia, Alraihi KJ et al. (2016) found that outpatient expectations were particularly influenced by empathy. This finding highlights the significance of emotional support and understanding in patient satisfaction, suggesting that the ability of dental care providers to empathize with their patients and provide compassionate care is a key determinant of patient satisfaction [16].
These studies collectively emphasize the multifaceted nature of patient satisfaction in dental care. Factors such as education level, service quality, reputation, the physical environment of the clinic, and the emotional support provided by dental care professionals all play crucial roles in shaping patient experiences and satisfaction levels. Understanding these factors and addressing them effectively can help dental clinics enhance their service quality and patient satisfaction, ultimately leading to better patient outcomes and a stronger reputation in the dental care industry.
Aldosari MA et al. (2017) conducted a study that linked enhanced patient satisfaction to the amiability and understanding exhibited by Primary Health Care (PHC) staff. This finding underscores the significance of interpersonal skills and the ability of healthcare providers to connect with patients on a personal level, contributing to a more positive healthcare experience [17].
Fan LH et al. (2017) emphasized the importance of continuous quality improvement in hospitals based on patient feedback. By utilizing the dimensions of the SERVQUAL model, they highlighted how healthcare institutions can systematically address areas of improvement and enhance service quality, ultimately leading to higher levels of patient satisfaction. This approach underscores the value of patient feedback as a critical tool for quality improvement in healthcare settings [18].
In Pakistan, Shafiq M et al. (2017) conducted a study that analyzed service quality utilizing the SERVQUAL dimensions. Their research indicated the model’s applicability beyond Saudi Arabia, demonstrating its versatility and effectiveness in assessing service quality in different cultural and geographical contexts. This suggests that the SERVQUAL model can be a valuable tool for healthcare providers worldwide in their efforts to improve service quality and patient satisfaction [19].
Rocha J et al. (2017) applied the SERVQUAL model in dental settings, focusing on promoting increased engagement and communication between doctors and patients. Their study further underscored the model’s relevance in dental care, highlighting the importance of effective communication and patient engagement in enhancing the quality of dental services. By addressing these aspects, dental care providers can create a more patient-centered environment, leading to better patient experiences and satisfaction [20].
These studies collectively highlight the critical role of service quality, patient feedback, and effective communication in enhancing patient satisfaction in healthcare settings. By adopting the SERVQUAL model and focusing on continuous quality improvement, healthcare providers can identify key areas for enhancement and implement strategies that cater to the needs and expectations of their patients. This approach not only leads to improved patient satisfaction but also contributes to the overall success and reputation of healthcare institutions.
Balhaddad AA et al. (2018) conducted a study that demonstrated a significant correlation between client satisfaction and demographic factors such as age and education in dental services. This suggests that different age groups and educational backgrounds may have varying expectations and perceptions of service quality, highlighting the need for dental service providers to tailor their approaches to meet the diverse needs of their clientele [21].
Mendes IAC et al. (2018) explored the applicability of the SERVQUAL questionnaire in Brazil, revealing significant agreement between patients and physicians regarding the assessment of service quality. This finding indicates the model’s cross-cultural applicability and underscores its usefulness as a tool for measuring service quality in different healthcare settings and cultural contexts [22].
Teshnizi SH et al. (2018) reported negative results across all SERVQUAL dimensions in their study, indicating unsatisfactory health service quality that requires improvement. This highlights the importance of continuous monitoring and evaluation of service quality in healthcare settings to identify areas for enhancement and implement necessary interventions to improve patient satisfaction and overall service quality [23].
The integration of Primary Health Care Centers (PHCCs) with hospitals was found to be an effective strategy by Alsayali MM et al. (2019). This approach enhances operational efficiency and has a positive impact on patient satisfaction, suggesting that a more integrated healthcare delivery system can lead to better patient outcomes and experiences [24].
The Patient Experience Measurement Program, highlighted in 2020 by the Saudi Ministry of Health (MOH), aims to enable patients and their families to actively evaluate the services they receive. This initiative encompasses services provided by health facilities, healthcare centers, or virtual services and underscores the importance of patient feedback in service quality assessment and improvement. By involving patients and their families in the evaluation process, healthcare providers can gain valuable insights into the patient experience, identify areas for improvement, and make informed decisions to enhance service quality and patient satisfaction.
Overall, these studies and initiatives emphasize the significance of understanding and addressing the diverse needs and perceptions of patients, the applicability of the SERVQUAL model in different cultural settings, and the importance of patient feedback and integrated healthcare systems in improving service quality and patient satisfaction in healthcare services [25].
In the dental clinics of Majmaah University, a study by Almutair A et al. (2021) found that making appointments was straightforward, leading to patient satisfaction with both the reception and healthcare providers. This underscores the significance of administrative efficiency and the quality of interpersonal interactions in ensuring patient satisfaction. The ease of scheduling appointments and the positive interactions with staff contribute to a seamless and pleasant patient experience, which is crucial in building patient trust and loyalty [26].
Othman BM (2022) conducted research highlighting that patients in Saudi Arabia were more satisfied with the treatment quality, reliability, accountability, and assurance provided by dentists. However, the study also revealed a notable impact of empathy on patients’ satisfaction perception and their willingness to seek services from dentists in Saudi Arabia. This finding underscores the importance of emotional support in the patient-dentist relationship, suggesting that empathy is a key factor in patient satisfaction and loyalty [27].
Feedback from dental students, as reported by Othman BM and Alharbi MA (2022), emphasized the perceived reliability, accountability, and quality of education provided by Saudi dental faculty. The assurance dimension significantly influenced students’ willingness to attend future lectures, while empathy played a considerable role in their satisfaction and willingness to attend future lectures. This suggests that the quality of education and the emotional support provided by faculty can have a profound impact on students’ engagement and satisfaction, which is essential for their academic success and professional development [28].
Aldossary MS et al. (2023) reported considerable satisfaction among patients in Saudi Arabia with dental treatments offered at MOH facilities. This indicates a positive perception of the quality of dental care provided in public health facilities, reflecting the efforts made to maintain high standards of care and patient satisfaction in these institutions [29].
El Dalatony MM et al. (2023) emphasized the pivotal role of physicians and dentists in enhancing patient satisfaction and fostering trust. The study underlined the potential for a strong connection between patients and dentists to elevate satisfaction and foster long-term loyalty. This highlights the importance of building trust and strong relationships in achieving patient satisfaction and loyalty in dental care, which is crucial for the success and reputation of dental practices [30]. The role of empathy in improving healthcare outcomes is significant, identifying various modifiable factors that influence empathetic behavior. While individual training programs have been shown to effectively enhance empathy, comprehensive organizational strategies for systematic improvement remain underdeveloped [31].
Patients’ perceptions of physician empathy significantly shape their evaluation of the physician-patient relationship. This influence occurs both directly and indirectly through the trust patients place in the physician’s benevolence. These findings emphasize the critical role of perceived empathy and benevolence in fostering trustful and cooperative relationships between physicians and their patients [32].
In summary, the literature review reveals that the SERVQUAL model has been widely used to assess service quality in dental services in Saudi Arabia. Key factors influencing patient satisfaction include the quality of treatment, reliability, assurance, and empathy. Administrative efficiency, the physical environment of the clinic, and the quality of interpersonal interactions also play high levels of satisfaction. Understanding and addressing the diverse needs and expectations of patients is essential for delivering high-quality dental care. By fostering positive patient-dentist relationships, ensuring effective communication, and providing empathetic and reliable care, dental service providers can enhance patient satisfaction and build a loyal patient base.
Furthermore, the integration of feedback mechanisms, such as the Patient Experience Measurement Program, allows for the continuous monitoring and improvement of service quality. By actively involving patients and their families in the evaluation process, dental clinics can gain valuable insights into the patient experience and identify areas for improvement.
The emphasis on the quality of education and the support provided by dental faculty also highlights the importance of professional development in the dental field. Ensuring that dental students receive a high-quality education and adequate emotional support can lead to better prepared and more empathetic dental professionals, ultimately benefiting patient care.
Overall, the literature review underscores the multifaceted nature of patient satisfaction in dental care and the importance of a holistic approach to service quality improvement. By prioritizing key factors such as treatment quality, reliability, assurance, empathy, and administrative efficiency, dental service providers in Saudi Arabia can continue to enhance the patient experience and maintain high standards of dental care.
Statement of the problem
Gauging patient satisfaction and their inclination to revisit dental clinics is crucial. The feedback and perceptions of patients play a pivotal role in evaluating business success. This success is integral for the sustained viability of these enterprises and for facilitating the entry of new participants into the market, thereby enhancing market development, and contributing to the growth of the domestic market. Therefore, there is a need to study patient perception toward satisfaction and willingness to revisit dental clinics based on service quality which will contribute to better understanding and enhancement in dental clinics service quality, driving patient satisfaction and loyalty within dental industry.
Research objectives
This research aims to tackle the influence of service quality dimensions including tangibility, reliability, responsiveness, assurance, empathy on patient satisfaction from Dental clinics. The research will answer the question of Which service quality dimension has the strongest correlation with patient satisfaction and willingness to revisit dental clinics?
Significance of the study
The significance of this study lies in its potential to contribute to the understanding and enhancement of service quality in dental clinics, which is crucial for driving patient satisfaction and loyalty within the dental industry. As Saudi Arabia strives to diversify its economy away from oil dependency, sectors like healthcare, including dental services, are expected to play a pivotal role in achieving the goals of Vision 2030. The research aims to tackle the influence of service quality dimensions such as tangibility, reliability, responsiveness, assurance, and empathy on patient satisfaction and their willingness to revisit dental clinics. Understanding which service quality dimensions most impact patient satisfaction and willingness to revisit is essential for the sustained viability of these enterprises and for facilitating the entry of new participants into the market, thereby enhancing market development. This, in turn, contributes to the growth of the domestic market and Aligns with the broader economic goals of the country. By focusing on patient perceptions towards satisfaction and their willingness to revisit based on service quality, the study addresses a critical aspect of business success in the health sector, which is integral to the overall market development and the achievement of Vision 2030 objectives.
Terminologies
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Observational Quantitative Cross-sectional Study:
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A study design where data is gathered from a sample at a specific moment, aiming to comprehend the relationships between variables.
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Random Sample:
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A sample selected without bias from the entire population, ensuring each member has an equal chance of inclusion.
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Exclusion Criteria:
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Specific conditions that render individual’s ineligible for participation in the study, such as insufficient information, incomplete responses, or no previous visits to private dental clinics.
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Electronic Questionnaire:
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A survey tool presented digitally, typically distributed via email, smartphones, or social media.
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SERVQUAL Model:
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A framework employed to evaluate service quality, encompassing dimensions like tangibility, reliability, responsiveness, assurance, empathy, satisfaction, and patient willingness to revisit.
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0 to 5 Scale:
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A measurement scale ranging from 0 (indicating minimal agreement) to 5 (reflecting maximal agreement) used to quantify responses in the questionnaire.
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Tangibility:
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A facet in the SERVQUAL model associated with the physical look and feel of facilities, equipment, people, and communication materials.
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Reliability:
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A dimension in the SERVQUAL model focusing on the ability to consistently provide accurate and dependable services.
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Responsiveness:
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A SERVQUAL dimension reflecting the willingness and ability to promptly assist patients.
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Assurance:
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A SERVQUAL dimension related to the competence, courtesy, and credibility exhibited by personnel.
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Empathy:
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A SERVQUAL dimension centered on the care, individualized attention, and understanding demonstrated toward patients.
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Satisfaction:
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A SERVQUAL dimension assessing the overall contentment of patients with the services provided.
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Patient Willingness to Revisit:
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An aspect in the SERVQUAL model gauging the likelihood of patients returning to the same dental clinic.
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Sociodemographic Data:
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Information concerning social and demographic features, including education, gender, age.
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Data Analysis:
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The process of scrutinizing, cleansing, transforming, and modeling data to derive valuable information.
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Statistical Package for Social Sciences (SPSS):
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Software to analyze and process the data statistically.
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Variable Characteristics:
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Attributes or features of the different variables under consideration in the research study.
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Frequency Distribution:
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A summarized report depicting the distribution of values in a dataset, showcasing how frequently each value occurs.
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Associations:
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Connections or relationships between variables.
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Chi-square Test:
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A statistical method to explore associations between categorical variables.
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P Value:
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The probability value utilized to analyze results statistical significance, with a value less than 0.05 subjected to be significant.
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