Customers’ Loyalty through Healthcare Quality; Mediating Role of Customers’ Commitment: A Comparative Study of Public and Private Hospitals


  • Sajjad Ahmad Afridi Hazara University Mansehra
  • Maqsood Haider Department of Management Sciences, FATA University
  • Asad Shahjehan Hazara University, Mansehra


The core ambition of present work is to gage Customers’ opinion of healthcare quality, Customers’ loyalty and commitment in the hospitals of Peshawar. Data were collected from the hospitalized customers and from customers recently availed the health services of various public and private hospitals. The reliability and validity of the data were confirmed through Cronbach’s alpha and confirmatory factor analysis respectively. Hypotheses of the study were tested through path analysis via AMOS. Finding discovered that healthcare quality has a substantial influence on Customers’ loyalty. The mediating effect of Customers’ commitment was also tested between the association of service quality and Customers’ loyalty. Findings disclosed that customer’s commitment completely intervenes the link of healthcare quality and Customers’ loyalty. Furthermore, independent sample t-test was performed to investigate the variance in the perception of Customers’ regarding public and private healthcare quality, Customers’ commitment and loyalty. Finding clarified that Customers’ perception of healthcare quality, Customers’ loyalty and commitment is higher in private than public hospitals of Peshawar. The outcomes of the present research may be useful to the management of the health care, that it provides the importance of service quality in enhancing Customers’ commitment and loyalty.

Author Biographies

Sajjad Ahmad Afridi, Hazara University Mansehra

Assistant Professor, Department of Management Sciences

Maqsood Haider, Department of Management Sciences, FATA University

Assistant Professor, Department of Management Sciences

Asad Shahjehan, Hazara University, Mansehra

Assistant Professor, Department of Management Sciences


Afridi, S. A., & Khattak, M. A. (2015). Impact of trust on customer Advocacy: A study regarding health sector of Peshawar.

Afthinos, Y., Theodorakis, N. D., & Nassis, P. (2005). Customers’ expectations of service in Greek fitness centers: Gender, age, type of sport center, and motivation differences. Managing Service Quality: An International Journal, 15(3), 245-258.

Aghamolaei, T., Eftekhaari, T. E., Rafati, S., Kahnouji, K., Ahangari, S., Shahrzad, M. E., . . . Hoseini, S. H. (2014). Service quality assessment of a referral hospital in Southern Iran with SERVQUAL technique: patients’ perspective. BMC health services research, 14(1), 322.

Al-Hawari, M. A. (2011). Automated service quality as a predictor of customers' commitment: a practical study within the UAE retail banking context. Asia Pacific Journal of Marketing and Logistics, 23(3), 346-366.

Babakus, E., & Mangold, W. G. (1992). Adapting the SERVQUAL scale to hospital services: an empirical investigation. Health services research, 26(6), 767.

Beer, M. (2003). Why total quality management programs do not persist: the role of management quality and implications for leading a TQM transformation. Decision Sciences, 34(4), 623-642.

Bettencourt, L. A. (1997). Customer voluntary performance: customers as partners in service delivery. Journal of retailing, 73(3), 383-406.

Bowen, J. T., & Shoemaker, S. (2003). Loyalty: A strategic commitment. The Cornell Hotel and Restaurant Administration Quarterly, 44(5-6), 31-46.

Caruana, A. (2002). Service loyalty: The effects of service quality and the mediating role of customer satisfaction. European Journal of marketing, 36(7/8), 811-828.

Cheng Lim, P., & Tang, N. K. (2000). The development of a model for total quality healthcare. Managing Service Quality: An International Journal, 10(2), 103-111.

Choi, K.-S., Lee, H., Kim, C., & Lee, S. (2005). The service quality dimensions and patient satisfaction relationships in South Korea: comparisons across gender, age and types of service. Journal of Services Marketing, 19(3), 140-149.

Curtis, T. (2009). Customer Satisfaction, Loyalty, and Repurchase: Meta-Analytical Review, and Theoretical and Empirical Evidence of Loyalty and Repurchase Differences.

Fogli, L. (2006). Customer service delivery (Vol. 4): San Francisco: Jossey-Bass.

Foster, B. D., & Cadogan, J. W. (2000). Relationship selling and customer loyalty: an empirical investigation. Marketing Intelligence & Planning, 18(4), 185-199.

Gong, T., & Yi, Y. (2018). The effect of service quality on customer satisfaction, loyalty, and happiness in five Asian countries. Psychology & Marketing, 35(6), 427-442.

Grönroos, C. (1984). A service quality model and its marketing implications. European Journal of marketing, 18(4), 36-44.

Grönroos, C. (2000). Creating a relationship dialogue: communication, interaction and value. The marketing review, 1(1), 5-14.

Hessels, A., Flynn, L., Cimiotti, J. P., Bakken, S., & Gershon, R. (2015). Impact of heath information technology on the quality of patient care. On-line journal of nursing informatics, 19.

Hofstede, G. (2009). Geert Hofstede cultural dimensions.

Jacoby, J., & Chestnut, R. W. (1978). Brand loyalty: Measurement and management: John Wiley & Sons Incorporated.

Kotler, P., & Armstrong, G. (2010). Principles of marketing: Pearson education.

Kotler, P., & Keller, K. (2005). MARKETING MANAGEMENT, United States Edition: Pearson Education.

Kumar, V. (2013). Profitable customer engagement: Concept, metrics and strategies: SAGE Publications India.

Ladhari, R. (2009). A review of twenty years of SERVQUAL research. International journal of quality and service sciences, 1(2), 172-198.

Lam, S. Y., Shankar, V., Erramilli, M. K., & Murthy, B. (2004). Customer value, satisfaction, loyalty, and switching costs: an illustration from a business-to-business service context. Journal of the academy of Marketing Science, 32(3), 293-311.

Lassar, W. M., Manolis, C., & Winsor, R. D. (2000). Service quality perspectives and satisfaction in private banking. Journal of Services Marketing, 14(3), 244-271.

Lee, J.-H., Kim, H.-D., Ko, Y. J., & Sagas, M. (2011). The influence of service quality on satisfaction and intention: A gender segmentation strategy. Sport Management Review, 14(1), 54-63.

Li, X., & Peng, P. (2015). The impact of customer experience on customer commitment and behavioral intention in theme park. The Journal of the Korea Contents Association, 15(6), 499-508.

Mayer, R. C., & Schoorman, F. D. (1998). Differentiating antecedents of organizational commitment: A test of March and Simon's model. Journal of Organizational Behavior: The International Journal of Industrial, Occupational and Organizational Psychology and Behavior, 19(1), 15-28.

Meesala, A., & Paul, J. (2018). Service quality, consumer satisfaction and loyalty in hospitals: Thinking for the future. Journal of Retailing and Consumer Services, 40, 261-269.

Mohammad, A. A. S., & Alhamadani, S. Y. M. (2011). Service quality perspectives and customer satisfaction in commercial banks working in Jordan. Middle Eastern Finance and Economics, 14(1), 60-72.

Morgan, & Hunt. (1994). The commitment-trust theory of relationship marketing. The journal of marketing, 20-38.

Morgan, R. M., & Hunt, S. D. (1994). The commitment-trust theory of relationship marketing. Journal of marketing, 58(3), 20-38.

Mudie, P., & Pirrie, A. (2006). Services marketing management. 3. painos: Elsevier Ltd. Great Britain.

Mudie, P., & Pirrie, A. (2012). Services marketing management: Routledge.


Nishtar, S. (2006). The gateway paper: health systems in Pakistan, a way forward.

Parasuraman, Zeithaml, V. A., & Berry, L. L. (1994). Reassessment of expectations as a comparison standard in measuring service quality: implications for further research. Journal of marketing, 58(1), 111-124.

Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1988). Servqual. Journal of retailing, 64(1), 12-40.

Patawayati, D. Z., Setiawan, M., & Rahayu, M. (2013). Patient satisfaction, trust and commitment: Mediator of service quality and its impact on loyalty (an empirical study in Southeast Sulawesi Public hospitals). IOSR Journal of Business and Management, 7(6), 1-14.

Peprah, A. A., & Atarah, B. A. (2014). Assessing patient’s satisfaction using servqual model: A case of sunyani regional hospital, Ghana. International Journal of Business and Social Research, 4(2), 133-143.

Raie, M., Khadivi, A., & Khdaie, R. (2014). The Effect of Employees' Customer Orientation, Customer's Satisfaction and Commitment on Customer's Sustainability. Oman Chapter of Arabian Journal of Business and Management Review, 34(2361), 1-13.

Raposo, M. L., Alves, H. M., & Duarte, P. A. (2009). Dimensions of service quality and satisfaction in healthcare: a patient’s satisfaction index. Service Business, 3(1), 85-100.

Reichheld, F., & Detrick, C. (2003). Loyalty: A prescription for cutting costs. Marketing Management, 12(5), 24-24.

Roustasekehravani, A., Hamid, A. B. A., & Hamid, A. A. (2015). The Effect of Brand Personality and Brand Satisfaction on Brand Loyalty: A Conceptual Paper. Journal of management Research, 7(2), 10.

Selvakumar, J. J. (2016). Impact of service quality on customer satisfaction in public sector and private sector banks. Purushartha: A Journal of Management Ethics and Spirituality, 8(1).

Sinha, P. K., Mishra, H. G., & Kaul, S. (2014). Dominance of Affective over Cognitive Customer Satisfaction in Satisfaction-Loyalty Relationship in Service Encounters.

Snipes, R. L., Thomson, N. F., & Oswald, S. L. (2006). Gender bias in customer evaluations of service quality: an empirical investigation. Journal of Services Marketing, 20(4), 274-284.

Sower, V., Duffy, J., Kilbourne, W., Kohers, G., & Jones, P. (2001). The dimensions of service quality for hospitals: development and use of the KQCAH scale. Health care management review, 26(2), 47-59.

Spathis, C., Petridou, E., & Glaveli, N. (2004). Managing service quality in banks: customers’ gender effects. Managing Service Quality: An International Journal, 14(1), 90-102.

Woodruff, R. B., & Gardial, S. (1996). Know your customer: New approaches to understanding customer value and satisfaction: Wiley.

Zineldin, M. (2006). The quality of health care and patient satisfaction: an exploratory investigation of the 5Qs model at some Egyptian and Jordanian medical clinics. International journal of health care quality assurance, 19(1), 60-92.




How to Cite

Afridi, S. A., Haider, M., & Shahjehan, A. (2020). Customers’ Loyalty through Healthcare Quality; Mediating Role of Customers’ Commitment: A Comparative Study of Public and Private Hospitals. CITY UNIVERSITY RESEARCH JOURNAL, 10(1). Retrieved from