Customer Care Practice and Its Effects in Burundian Private Hospitals ()
1. Introduction
In today’s competitive world, it is really difficult to attract new customers because it requires a lot of effort and resources. To retain customers, it is vital to build a strong relationship and to look over things which matters in building this relationship with customers. It is also important to understand which factors have a lasting effect on the long term relationship. According to Oliver (1980), in any industry, quality improvement is the principal factor that impacts consumer satisfaction (Meesala & Paul, 2018) . The most successful company is the one whose owners provide services and goods of a high quality, through managing policies, programming and application of strategies to satisfy its customers and retain them (Oliver (1980) as cited in (Meesala & Paul, 2018) ). This happens when the customer feels that specifications of services and goods are fixed to his or her expectations. The important aspect to be considered about customer care and customer high satisfaction is the quality of service delivered (Bowen & Chen, 2001) . When the companies and organizations give great customer care service, people may have different views according to their past experience, be good or bad, concerning the way they have been treated as customers on different services delivered to them. Customer care service has become important in many ways for most organizations even though many observers are of the view that organizations don’t take it seriously. Therefore, customer satisfaction has the huge effect on customer engagement, while service quality, perceived value and customer satisfaction affect also indirectly customer loyalty through mediation (Hapsari, Clemes, & Dean, 2017) .
Normally, patients are not customers in a traditional sense of business because customers are generally well-being people who enjoy high status by virtue of their potential to purchase goods or services, while, patients, on the other hand, are (by current definition), not well (Torpie, 2014) . Therefore, healthcare service is not like other businesses and patients are not like other kinds of customers. In healthcare industry, the World Health Organization’s framework for healthcare assessment considers the customer satisfaction as an important evaluation means to determine the quality of services (Murray & Frenk, 1999; as cited in (Khosravi & Anvari, 2013) ).
Literature unveiled that in developing countries, customer satisfaction is the concept that is mostly ignored in the contemporary evaluation of health care systems, especially in public sectors (Khosravi & Anvari, 2013) . Normally, many people visit health care settings when they are in pain looking for healthcare providers to satisfy their health needs. Unfortunately, once one arrives in healthcare setting, some caregivers display a bad attitude towards clients such as neglect, unpleasant and insolent behavior on the part of the nursing staff as well as the attitude of the hospital staff generates a serious problem in the reception of the patient such as, for example, longer hospital stays or even high mortality (Manzoor, Wei, Hussain, Asif, & Shah, 2019) . Henceforth, poor customer service leads organization to lose their customers and profitability, and negatively impacts corporate image (Alrubaiee & Alkaaida, 2011 as cited in ( Leonard, 2017 )). In most developing countries, patients’ satisfaction has been remarkably low although several literature reports how quality care in these countries can be delivered even though that factors that enhance patients care satisfaction are mostly unidentified (Amporfro et al., 2021) . Burundi, as one of developing countries, customer care practice is influenced by customer service or by the attitude of staff. The current study aims to find out if the customer care practice provided in Burundian private hospital has any effect on customer satisfaction and consequently if it leads to customer loyalty.
2. Literature Review
Customers always want the fastest response in all situations, especially with patients in health needs, getting information quickly is what every customer (patients) needs. The ability to respond quickly and adequately is a very important thing as it helps businesses (hospitals) create trust and sympathy from customers (Tien, Diem, Vu, Dung, Bien, Duc, & Van Dat, 2021) .
In the contemporary business, customer occupies a prominent place in the companies as an important partner that needs to be managed well in order to sustain the life of the company. Therefore, customer service is a service for industry process that organizations need to shape and influence customer perceptions of their service experience (Tablan, 2016; as cited in (Leonard, 2017) ). Customer requirements for quality products and healthcare service in the private hospital have come to be the most evident to professionals. Customer satisfaction is the most important factor affecting institution’s survival as it has the most vital impact on customer retention (Kiguli, Ekirapa-Kiracho, Okui, Mutebi, Macgregor, & Pariyo, 2009) .
Traditionally, customer care was viewed as the concept used in business enterprises as a means of increasing profits (Ax-Fultz et al., 2016; as cited in (Orayo, Maina, Wasike, & Ratanya, 2019) ). Additionally, it is also the function that enables customers to have direct contact with the organization to enable them give appropriate feedback on their products and their service (Orayo et al., 2019) . Therefore, in healthcare industry, good customer care service leads to quality management and patient satisfaction services.
Study conducted in South Africa for measuring service quality management in a private hospital in Gauteng, unveiled that the hospital was able to inspire confidence with the services provided as well as provide a service that is consistently courteous with a high level of knowledge, on the other hand, patients were expecting that hospital would not be too busy to help them in the service provided to them which is the most important factor pertaining to service quality (Bisschoff & Clapton, 2014) . Clinic Van Norman (CVN), one of the private hospital in Burundi, would have customer care service as one of its products, and there is no study that have been conducted in Burundi for assessing the customer care service and its effect on customer satisfaction in Burundian private hospital.
3. Methods
A cross-sectional study design was used to find out if the customer care practice provided in Burundian private hospital has any effect on customer satisfaction and consequently if it leads to customer loyalty. This study was carried out at Clinique Van Norm, a free Methodist Church related institution located in the north District of Bujumbura city, in Ngagara-Burundi, among 115 staff of CVN (medical and no-medical staff), within 4 seniors staff and 111 agents. A purposive sampling method was used to select a sample of 55 participants by using Alain Bouchard’s formula through a targeted population of 111 agent staff and 4 senior staff of CVN. The formula is:
N = Population
n = Sampling by determined Universal 96
NC = Sampling Corrected
Our population was heterogeneous and we had to determine the sample for each population.
The first one is for senior staff of Clinic Van Norman. The population was 4
for this category. Using Alain Bouchard formula, the sample was
participants;
The second is for Clinic Van Norman agents staff in which the population was 111 participants for that category. Using Alain Bouchard formula the sample was
participants.
This is to make a sample of 55 participants for this study.
They were included in this study all staff members of CVN who have a contract and agreed to participate in this survey. They were excluded in the study from those who did have not a contract and did not want to participate. The questionnaire was used to collect data on customer care practice and its effects from executives and employees of CVN. To minimize errors and biases in the study, this questionnaire was given to a group of economists and other great people with PhDs’ levels for face validity and approves it before being used in the field. The feedback was of high consistency even if some remarks did not lack. For instance, all questions which were not approved with a quote of excellence were removed on the questionnaire, and the document which was considered is the one that was already approved by competent persons. A self-report method involving questionnaire completion with four components of 17 items addressing demographic data, customer care service for customer satisfaction at CVN, customer care impacts customer loyalty at CVN and the importance of customer care service to CVN was used to collect data. We designed it to assess interrelationships between the demographic variables of participants affect participant’s practice on customer care service for satisfying their clients in reference to published scientifically work papers and authors expertise (Kursunluoglu, 2011; Jahanshahi, Gashti, Mirdamadi, Nawaser, & Khaksar, 2011; Meesala & Paul, 2018) . A Statistical Package for Social Sciences (SPSS 21.0) was used to analyze and interpret data which were presented by tables and graphs. In our study, the dependent variable is qualitative (customer care practice) and the independent variables categorical (Age, experience and customer care satisfaction). In order to reject or not our hypothesis that customer care practice influence customer satisfaction at CVN, a chi-square test was used to find out the relationship between variables.
4. Results
The current study shows that majority of the participants (69.1%) were female and their age ranged between 19 - 51 years (
= 30.89 years). Among the 55 participants, 4 were senior staffs while 51 were agent staffs within 39 medical staffs (70.9%) and 16 non-medical staffs (29.1%) (Table 1).
Effects of customer care service on customer satisfaction at Clinic Van Norman
By assessing customer care practice at CVN, the current study unveiled that only 29.1% of the participant urged to have customer care service at CVN to manage customer satisfaction, 40% erroneously argued that there is no relationship between customer service and customer satisfaction at in their clinic and not to have any matter in customer satisfaction. On other hand, only 14.5% were able to give the main activities done in customer service. Lastly, only 54.5% confirmed that receptionist staffs’ attitude could affect the customer satisfaction in their Clinic (Figure 1).
In this study, participants affirm that the lack of understanding customer needs (85.5%), lack of incentive (89.1%), communication value (92.7%), insufficiency management systems (67.3%) and the workload (60%) were the main obstacles to satisfy their customer (Figure 2).
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Figure 1. Effects of customer care service on customer satisfaction.
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Figure 2. Obstacles to customer satisfaction that can hinder CVN performance.
In the current study, participants affirm that knowing our customers (54.5%), clear communication with the customer (90.9%), identification of the customers’ needs and goals (27.3%), training staff (67.3%), adaptability (49.1%), team working culture within the company (41.8%) and maintaining professionalism in their work (78.2%) could be the best strategies to develop customer care service technique for customer satisfaction (Figure 3).
Importance of customer care service to CVN performance improvement
The current study unveiled that only 10.9% knows staffs who work in customer service, while 89.1% did not know anyone working in this service (Figure 4).
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Figure 3. Strategies for developing customer service techniques to satisfy customers.
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Figure 4. Availability of staff working in customer service.
A significant number of participant (49.1%) said that rewards and recognition of the customer value was used to build customer loyalty, while 30.9% were offering really interesting benefits and 20% were trying to personalize their relationship with customer (Figure 5).
Importance of customer care service to the Clinic Van Norman
A significant number of participant in this study affirm that customer service was important in achieving improvement in customer care performance (96.4%), while improving customer service could also influence the performance (92.7%). Additionally, they affirm that good customer service could translate into the credibility, recognition and performance of customer satisfaction at CVN (Figure 6).
Considering the chi-square tests results, the current study unveiled that the participants’ age (p = 0.004) could impacts significantly the customer care service offer to patients. Moreover, a number of practices of CVN staffs (such as
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Figure 5. Strategies applied to build customer loyalty in CVN.
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Figure 6. Importance of customer care service to the Clinic Van Norman.
lack of understanding customer, lack of incentive, communication value, insufficient management and workload) have seen to significantly impact customer care practice (p < 0.05) (Table 2).
5. Discussion
It is known that, not merely in healthcare setting, customer satisfaction is an important evaluation means to determine the quality of services offered to customers. The current study sought to find out if the customer care practice provided in Burundian private hospital has any effect on customer satisfaction and consequently if it leads to customer loyalty.
The current study shows that majority of the participants (69.1%) were female and their age ranged between 19 - 51 years (
= 30.89 years). Among the 55 participants, 4 were senior staffs while 51 were agent staffs within 39 medical staffs (70.9%) and 16 non-medical staffs (29.1%) (Table 1).
By assessing customer care practice at CVN, the current study unveiled that customer care practice at CVN was not sufficient as 29.1% of the participant erroneously urge that they have customer care service at CVN to manage customer satisfaction (Figure 1). Normally, we found out that there was no customer service
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Table 2. Assessing relationship between customer care service and some of independent variables.
at CVN which could impact customer care practice. For those who accept it, it might be explained by the fact that throughout our professional training, we urged to respect our client and be responsible to the service we offer to customers. Customer service is a vital predictor to the institution customer satisfaction and loyalty, as we can’t separate it from the quality of service that we provide our customers (Juanamasta et al., 2019) . Moreover, 40% erroneously argued that there is no relationship between customer service and customer satisfaction at in their clinic and not to have any matter in customer satisfaction. This could explained by the above reason of lack of customer service and its management. As we see that in the contemporary world where customers are more educated, they want a good service and are willing to pay for it; that is why we found that, especially in healthcare, people prefer private service than public service. Thus, in the contemporary business, company’s success or failure is critically related to the quality of customer service delivered (Mouawad & Kleiner, 1996) . Instating customer service at CVN and in-service training or any continuing professional development program is highly recommended to improve staffs knowledge and practice on customer care service and management, hence could improve customer satisfaction. According to Oliver, customer satisfaction is generally the reaction of customer in the context of fulfilling his needs and evaluating the customer to the state of his needs being met (Chang & Wang, 2011; cited in (Sitio & Ali, 2019) ).
Even though that their practice was not sufficient regarding customer care service, a significant number of participants (54.5%) affirm that receptionist staffs’ attitude could affect the customer satisfaction in their Clinic (Figure 1). Therefore, the recommended installation of customer service at CVN would help to manager staffs’ behavior on regarding to customer care practice which could improve customer satisfaction at CVN. The concept of personnel behavior elicit well how the good manner and polite relationship of the personnel with customers’ satisfaction are inter related.
In this study, participants affirm that the lack of understanding customer needs (85.5%), lack of incentive (89.1%), communication value (92.7%), insufficiency management systems (67.3%) and the workload (60%) were the main obstacles to satisfy their customer (Figure 2). This could be explained by the above reason of lack of customer service and its management within CVN. As we recommended instating customer care service within CVN, we hope it could improve the staffs’ knowledge and practice regarding customer care service offered at CVN. Moreover, this could improve internal communication and decision making in regards to customer satisfaction. According to Mathies and Buford’s (2011), good customer service consists of listening to the customer or making the customer happy (Leonard, 2017) . Study conducted in Tehran for investigating and comparing factors affecting customer satisfaction in public and private sector hospitals, results unveiled that good behavior with patients, qualified services, accountability of personnel and the patients’ attitudes were the most effects of some customer-related factors on customers’ satisfaction (Khosravi & Anvari, 2013).
In the current study, participants affirm that knowing our customers (54.5%), clear communication with the customer (90.9%), identification of the customers’ needs and goals (27.3%), training staff (67.3%), adaptability (49.1%), team working culture within the company (41.8%) and maintaining professionalism in their work (78.2%) could be the best strategies to develop customer care service technique for customer satisfaction (Figure 3). Study conducted in Vietnam to assess customer care and customer relationship maintenance at Gamuda Land, state that for maintaining a loyal customer base and attract more potential customers, a bunch of strategies were created, such as sending a thank you letter to customers after buying an apartment, organizing community activities, delivering promotion information about new products or services, offer incentives to the loyal customer and building a complaint reception department in each residential area (Tien et al., 2021) . On the other hand, participants said that rewards and recognition of the customer value (49.1%), offering really interesting benefits (30.9%) and personalize their relationship with customer (20%) were strategies applied to build customer loyalty at CVN (Figure 5). Regardless the absence of customer care service management at CVN, this study unveiled that staffs try implement some of the strategies for improving customer care satisfaction. According to Yesilada & Direktör (2010) who compared public and private hospitals based on the quality of services, they concluded that reliability-confidence, empathy and tangible factors were the main determinants of customer satisfaction (Yesilada & Direktör, 2010; as cited in (Khosravi & Anvari, 2013) ). This simply means as CVN is one of the private clinic in Bujumbura, regardless a formal management, employees at CVN try to do their best by implementing customer care practice for improving customer satisfaction. The Bureau of health in Tigray (2004) as cited in (Srinivasan & Saravanan, 2015) shows that most of the Ethiopian government health institutions showed low client satisfaction because of long waiting time and unavailability of basic drugs, under staffed and less equipped, problems relating to accommodating in patients and out patients for treatments coming from rural areas (Srinivasan & Saravanan, 2015) . For increasing patient satisfaction at CVN, customer service management department should implement quality service culture by providing a comfortable waiting room for services, punctuality and availability of medical staffs and resources, while all staff should serve politely, as well as being patient in providing services.
The current study unveiled that only 10.9% erroneously know staffs who work in customer service, while 89.1% did not know anyone working in this service (Figure 4). This is to confirm the previous assumption on Figure 1, where 70.9% affirm that they don’t have customer care service at CVN to manage customer satisfaction. Customer service is a service for industry process that institutions need to shape and influence customer perceptions of their service experience (Leonard, 2017) . CVN need to install customer care service, recruits expert in customer care management for the purpose of improving customer care practice as well as the customer satisfaction. This have been supported by participants in this study as a significant number of them affirm that customer service was important in achieving improvement in customer care performance (96.4%), while improving customer service could also influence the performance (92.7%) and good customer service could translate into the credibility, recognition and performance of customer satisfaction at CVN (Figure 6).
Lastly, the current study unveiled that the participants’ age (p = 0.004) could impacts significantly the customer care service offer to patients while a number of practices of CVN staffs (such as lack of understanding customer, lack of incentive, communication value, insufficient management and workload) have seen to significantly impact customer care practice (p < 0.05) (Table 2). This could be explained by the fact that younger employees, mostly freshly graduate still implement the customer care management principles contrary to the old ones who have their own empirical habits of treating customer the way they want. Customer care service could help to manage their staffs’ attitude towards customer services offered to their clients, whilst in service training and workshop on customer care is needed to attain full compliance.
6. Recommendation
The following are the recommendations that originated from the study:
The CVN should establish customer service department and in-service training for improving their staffs knowledge and practice on customer care service hence could improve customer satisfaction.
Further study could be conducted on customer care practice on both public and private hospital, by using different method of data collection with different group of population such as customer in order to arrive at the results that this work has not been able to achieve.
7. Conclusion
This study unveiled that customer care practice at CVN was not sufficient as the clinic did not have the customer service unit. Participants’ age (p = 0.004) had impact significantly the customer care service offered to patients. Lack of understanding customer, lack of incentive, communication value, insufficient management and workload were the most practice for participants that have seen to significantly impact customer care practice (p < 0.05). In-service training and customer service department instating were highly recommended for improving participants’ knowledge and practice on customer care service and management, hence could improve customer satisfaction.
Limitation
In our study, the limitations were that it was conducted in one private institution while the city of Bujumbura has many institutions running private hospital, whilst; authors did not test the questionnaire’s reliability.