An evaluation of SERVQUAL and patient loyalty in an emerging country context Subhash Lonial a , Dennis Menezes a , Mehves Tarim b , Ekrem Tatoglu c* and Selim Zaim d a University of Louisville, Department of Marketing, Louisville, Kentucky, 40292 USA; b Department of Health Care Management, Marmara University, Istanbul, 34900 Turkey; c Department of International Trade and Business, Bahcesehir University, Besiktas, Istanbul, 34349 Turkey; d Department of Management, Fatih University, Buyukcekmece, Istanbul, 34500 Turkey The growth of the service sector in the US spawned a strong interest and growing body of literature related to the measurement of service quality. SERVQUAL, a multi-item scale first proposed by Parasuraman, Zeithaml, and Berry (1985), has been used for measuring customer perceptions of service quality across a wide variety of service environments including healthcare in the US. There is a dearth of research that relates to an evaluation of SERVQUAL across various cultural and economic environments. This empirical study is an attempt to fill this gap by focusing on the healthcare environment in Istanbul, Turkey. In addition to a rigorous evaluation of SERVQUAL using confirmatory factor analysis, measures of internal consistency and discriminant validity, the relationships between the various dimensions of SERVQUAL, an overall measure of service quality and patient loyalty are evaluated using structural equations modelling and path analysis. A number of hypotheses are developed and tested. The results suggest that SERVQUAL and its dimensions of perceived service quality are reliable and valid across cultural and economic environments in the context of healthcare/hospital albeit some need for adaptation. Path analysis indicates that service quality directly affects both overall quality of and feelings toward hospital services. Overall quality affects customer repatronage intentions and feelings towards hospital services. However, no significant relationship was found between service quality and repatronage intention. Keywords: SERVQUAL; patient loyalty; healthcare; Turkey. Introduction The growth and increasing significance of the service sector in developed markets like the US has spawned a sizeable body of related research addressing a variety of issues such as service quality and its dimensions (Parasuraman, Zeithaml, & Berry, 1985; Brown & Swartz, 1989; Dabholkar, Thorpe, & Rentz, 1996; Brady & Cronin, 2001); the measure- ment of service quality (Parasuraman, Zeithaml, & Berry, 1988; Carman, 1990; Cronin & Taylor, 1992; Brady, Cronin, & Brand, 2002); the relationship between service quality and customer satisfaction (Anderson & Sullivan, 1993; Anderson, Fornell, & Lehmann, 1994; Caruana, Ewing, & Ramaseshan, 2000); and, more recently, the influence of customer sat- isfaction on customer loyalty and organisation performance (Rust & Zahorik, 1993; Anderson, Fornell, & Rust, 1997; Bloemer, Ruyter, & Wetzel, 1999). The pioneering ISSN 1478-3363 print/ISSN 1478-3371 online # 2010 Taylor & Francis DOI: 10.1080/14783363.2010.487663 http://www.informaworld.com * Corresponding author. Email: ekremt@bahcesehir.edu.tr Total Quality Management Vol. 21, No. 8, August 2010, 813–827