Quality models emerged in the late 1970s, as a result of
numerous studies proposing concepts, operationalizations
and systematization for quality services. Already the subjectivity
present in the perception of quality is being incorporated
through different approaches and their consequences.
The first essays on the topic of quality in service suggested
starting from comparisons between what users
considered that they should be offered by the provider
and what he actually offered(1). In this direction, quality
service can be considered the ratio of the level of service
effectiveness and expectations of the user. Thus, to promote
quality service means to meet the needs and expectations
of a user in an effective manner(1).
To evaluate a service is more complex than to evaluate
a product, because the product is tangible and its defects
can be detected, its functioning assessed and its durability
compared. Conversely, service is first purchased and then
it is produced and consumed simultaneously, and then
the possible nonconformities are produced and experienced,
characterizing their inseparability(2).
Services are intangible and heterogeneous,
at the same time being judged by
the performance and the experience of
those who use them, with the possibility
of interpretation and different judgments,
according to the provider and the user in
question. Besides the intangibility, services
present three other characteristics that
affect program development: inseparability,
variability and perishability(3).
The intangibility is characterized by the activities
which cannot be seen, felt, heard or proven before
they are acquired. The inseparability translates to the
simultaneity in which services are produced and consumed.
The professionals responsible for providing the
service are part of it and interaction with users is a special
characteristic of services. The variability concerns
to whom, where and when services are provided. The
perishability reinforces that services cannot be stored
in advance, so it is necessary that strategies are established
for the balance between existing demand and
provision of services(3).
The objective of this study was to reflect on the assessment
model of service quality of Parasuraman, Zheitaml
and Berry, and to demonstrate its applicability in the evaluation
of health services, in order to measure the degree
of user satisfaction.
The evaluation of the model of service quality of
Parasuraman, Zheitaml and Berry
In order to understand how users perceived and assessed
the quality of services, a study was developed
in 1985 involving twelve focus groups, three in each of
the four different services investigated - retail banking,
credit cards, securities brokerage, and repairs and
maintenance. Based on common perceptions among
the groups, the authors formally defined service quality
as the degree and type of discrepancy between the
perceptions and expectations of users, suggesting that
they all, in general, employed similar aspects of service
by which quality could be assessed(4).
The results obtained from these focus groups confirmed
that users were influenced by the dimensions
of the process and not only by the results of the evaluation
of service quality. In this study, the pattern of
responses revealed ten evaluative criteria by which
the user can evaluate, regardless of the service investigated,
namely: tangibility: the physical appearance
of the facilities, equipment, framework for employees
and normative materials; reliability: ability to perform
the promised service dependably and accurately; responsiveness:
the ability to help users promptly; competence:
appropriation of the abilities and knowledge
required to perform services; cordiality: politeness,
respect, consideration and friendliness of
the employees; credibility: trust, truth and
honesty; safety: absence of danger, risk
or doubt; accessibility: proximity and empathic
contact; communication: keeping
users informed in appropriate language;
and, comprehension: endeavoring to understand
the user and his needs.
By submitting the results to statistical
analysis to determine the interrelationships
between these dimensions, three of them
remained intact: tangibility, reliability and responsiveness.
The seven remaining dimensions were included
in two others: assurance and empathy(4). The analysis
of these five dimensions demonstrated that users were
using them as criteria for judging the quality of service.
The dimensions are not mutually exclusive, yet provide
an important framework for understanding the expectations
of users, and issues that delineate the service
from the point of view of those who will judge it(1).
After this refinement, the following definitions were
used:
• Tangibility: concerns the physical facilities, equipment,
personnel and materials that can be perceived by
the five human senses;
• Reliability: translated into the ability of the supplier
to execute the service in a safe and efficient manner. It depicts
the consistent performance, free of non-compliance,
in which the user can trust. The supplier must comply with
what was promised, without the need for rework.
• Responsiveness: refers to the availability of the
provider to attend voluntarily to users, providing a